Meaningful Use Stage 2 Questions and Answers

Ask Joy:  This Week on Meaningful Use Stage 2

This week, we’ll be answering questions about some of the specifics of Meaningful Use Stage 2. In last week’s Learning Lunch, I covered some of the major items to be mindful of as we transition to Meaningful Use Stage 2. Attendees sent in some great questions, and the answers will certainly be helpful to the community at large.

Q: Does medication reconciliation include medication dosages?  

A: CMS defines medication reconciliation as the process of identifying the most accurate list of all medications that the patient is taking, including name, dosage, frequency, and route, by comparing the medical record to a list of medications obtained from a patient, hospital, or other provider.

Q: Who can enter medication, lab and radiology orders for computerized physician order entry (CPOE)?

A: Great question. Though the acronym implies that a physician must enter the order, the truth is that any licensed healthcare professional who is operating under state, local and professional guidelines can place an order into the medical record. The CPOE objective expands on the definition by stating that the order must be entered by someone who could exercise clinical judgment in the case that the entry generates any alerts about possible interactions or other clinical decision support aides. This means that CPOE must occur when the order first becomes part of the patient’s medical record and before any action can be taken on the order. Each provider will have to evaluate on a case-by-case basis whether a given situation is entered according to state, local, and professional guidelines, allows for clinical judgment before the medication is given, and is the first time the order becomes part of the patient’s medical record.

Q: We have providers in different stages. How will that be handled with the group reporting option in Meaningful Use Stage 2?

A: Medicare EPs within a single group practice may report core and menu objective meaningful use data through a “batch” file process in lieu of individual Medicare EP attestation through the CMS Attestation website. The batch process includes defining the stage of meaningful use the individual EP is in, numerator, denominator, exclusion, and yes/no information for each core and menu objective. CMS outlines all of this and indicates on page 123 of the Final Rule that the batch reporting process will be established no later than January 1, 2014. CMS defines a Medicare EHR Incentive Group as two or more EPs, each identified with a unique National Provider Identifier (NPI) associated with a group practice identified under one tax identification number (TIN) through the Provider Enrollment, Chain, and Ownership System (PECOS).

Q: Can you explain the reporting function for patient reminders? 

A: Sure. First, let’s define the details of this measure:

Denominator: the number of unique patients who have had two or more office visits with the EP in the 24 months prior to the beginning of the EHR reporting period.

Numerator: the number of patients in the denominator who were sent a reminder per patient preference when available during the EHR reporting period.

Threshold: The resulting percentage must be more than 10 percent in order for an EP to meet this measure.

One way to succeed with this measure is to run a report at the beginning of your EHR reporting period, singling out patients who have been in for a visit twice in the past two years. For every 100 patients on that report, send out at least 10 reminders. Reminders sent before the reporting period will not count toward meaningful use.

Q: Do you have any recommendations for physicians to meet the 5% patient engagement threshold, especially those in low income areas where patients have limited access to the internet?  

A: I read recently that asking medical records to engage patients is like asking a dictionary to tell a story. Getting patients engaged in their health takes creativity and long-term thinking. To start, it may be worth investing in a kiosk that connects to your patient portal for your reception area. Especially in low income areas where patients may not have access to the internet at home or at work, patients could still have a chance to look at their health record either before or after their visit. A good portal will give patients a chance to update any of their demographic, medication, or family history information, as well as see if they are due for any vaccinations or schedule future appointments. Their engagement through the portal could result in bettering their health, but it could also help providers meet their targets for meaningful use. As for promoting a patient portal, studies show that patients are more likely to enroll in a portal at check-out rather than at check-in. Posting signs about the portal where patients will seem them is a great way to communicate.

Q: What qualifies as transfer of care for the medication reconciliation objective?

A: For medication reconciliations, CMS defines transitions of care as the movement of a patient from one clinical setting (inpatient, outpatient, physician office, home health, rehab, long-term care facility, etc.) to another or from one EP to another. At a minimum, transitions of care include first encounters with a new patient and encounters with existing patients where a summary of care record (of any type) is provided to the receiving provider. The summary of care record can be provided either by the patient or by the referring/transiting provider or institution.

Q: If a provider moves to a new practice during the reporting period, how can we get complete, accurate numbers for attestation?  

A: Since the reporting period is increasing to a full calendar year (except in 2014), any provider who transfers to another practice mid-year will need to bring his or her Meaningful Use Dashboard report along. Most all certified EHR systems have a Meaningful Use Dashboard or reporting function to track an individual provider’s progress in meeting the criteria to participate in the EHR Incentive Program. This report will include their individual Meaningful Use metrics for both Stage 1 and Stage 2 and will help you to compile accurate numbers when it’s time to attest.

Q: Where can I find state immunization & surveillance registries? If my state’s registry is not able to receive information electronically, can I be excluded from the public health measure?

A: A list of the statewide immunization registries can be found on the CDC website. The syndromic surveillance information needs to be submitted to your state public health agency. If your state’s public health agency does not have the capacity to receive the information electronically, the provider can be excluded. However, keep in mind that you must report on at least one public health measure. You cannot claim an exclusion to both.