Quality Payment Program – EHR certification measures

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CRMMICROSOFT

SOCIALCRMDESIGN

EXPERIENCE

CLOUDJAVA RWD

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QPP – Through providers’ lensDisparate programs such as EHR incentive program, PQRS and VBM tied together to yield ONE score

Advanced APMs MIPS

ACI Quality IA Cost

EHR incentive program PQRS Value-ModifierNEW

2018 Report using a 2015 edition CEHRT

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What needs to be done?Capabilities that EHRs need to have for 2015 Edition

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Problem list and Family health history

Demographics

Patient Information

• Support newer baseline version of SNOMED CT (Sept 2015 or higher)

GAP Measures

CPOE – Meds, Labs, Diagnostic

imaging Medication List

Medication allergy list

Formulary and preferred drug list

checks Smoking status

• Conform to standards for Sexual Orientation and Gender Identity, CDC-OMB mapping for race and ethnicity

• Optionally record data for Social, Psychological and Behavioral Data through questionnaire

• Record UDIs for implantable devices; obtain and associate GUDID attributes

Implantable devices

Patient Health Information Capture

Import documents shared by patient through reference or links

Label, record and access the documents; support external site

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Common Clinical Data Set

Interoperability

Support updated C-CDA Release 2.1 across document templates

Implement bilateral asynchronous cutover, display clinical relevance information

Optionally add a New Care Plan represents synthesis of multiple plans of care/treatment

Support Edge protocol for DIRECT

Apply and recognize security labels, support DS4P IG

Export data using configurable storage location, time period, user privilege access to export summaries

Receipt of C-CDA for both versions; support both passive and active communication

Validation of accurate reconciliation

Clinical Information Reconciliation & Incorporation

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Application Access

Data Access

Receive request, return ID/token for subsequent retrieval of patient related information through APIs (ONC recommends FHIR)

Technical impact includes implementing OAuth 2.0 through trusted connection

Document the accessibility of API

Respond to individual data elements under CCDS, within specific date range

Third party should be able to receive patient data, common clinical data set using discrete data and get document

Audit interactions between systems

Real-time access of data to patient through APIs; Support new C-CDA version

View, Download and transmit to 3rd party

Adopt updated Info button standard (Release 2) and associated updated IGs (SOA-based IG and URL-based IG)

Request using preferred language(optional)

Patient-specific education

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Privacy & Security

Audit reports, Auditable events and tamper resistance

• Audit changes in user privileges

• SHA-2 or higher;

Integrity

GAP Measures

Authentication, access control, and

authorization

Amendments

Automatic access time-out

Emergency access

End-user device encryption

• Counterparts Application Access to common clinical data set measure

Trusted Connection

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Public Health Agencies

Immunization Registry (Bi-directional)

• Receive history and forecast; updated IG (v1.5)

• NDC code support for administered vaccines; CVX for historical

Syndromic Surveillance (Optional)

• No updates for Ambulatory; Updated IG for Inpatient

Cancer Registry (Optional)

• TNM Clinical Stage observation separated into a nested series

of smaller templates

Antimicrobial Use & Resistance reporting (Optional)

• Generate CDA based on HAI Antimicrobial Use and

Resistance, summary report for denominator and numerator

Healthcare Surveys (Optional)

• Include data elements in survey document; aligns with CCDA

Electronic case reporting

• Implement trigger codes, match patient list, send a constrained ToC

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eRx

Care Coordination via Patient Engagement

Patient Electronic Access

HIE

Reporting – Automated Measures

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170.315(b) (1) - Transitions of Care

(2) - Clinical information réconciliation and incorporation

170.315(b)(3) - Electronic Prescribing

(a)(10) - Drug- Formulary and Preferred Drug List Checks

170.315(g)(7) - Application access – patient selection

(g)(8) - Application access – data category request

(g)(9) - Application access – all data request

(a)(13) - Patient-Specific Education Resources

170.315(e) (1) - View, Download, and Transmit to 3rd party

(2) - Secure Messaging

(3) - Patient Health Information Capture

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Record, Export and Report

Clinical Quality Measures

Support updated IG for QRDA Cat I (Release 3) which aligns with C-CDA 2.1 and QRDA Cat III

Import CQM data formatted to QRDA standard for one or multiple patients

Only support implementation of QRDA Cat I (Release 3)

Filter CQM results at patient and aggregate levels; create data file and display results

Import & Calculate *

Filter *

Choose at least 1 HIGH PRIORITY measure or 1 OUTCOME based measure

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Improvement Activities under ACI

Expanded Practice Access Provide 24/7 access to eligible clinicians or groups who have real-time access to patient's medical record

Has EHR impactHigh weightage Medium weightage

Care Coordination

• Implementation of use of specialist reports back to referring clinician or group to close referral loop

• Implementation of documentation improvements for practice/process improvements

• Implementation of use of specialist reports back to referring clinician or group to close referral loop

• Practice improvements for bilateral exchange of patient information

Population Management

• Anticoagulant management improvements

• Glycemic management services

• Chronic care and preventative care management for empaneled patients

• Implementation of episodic care management practice improvements

• Implementation of medication management practice improvements

• Implementation of methodologies for improvements in longitudinal care management for high risk patients

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Improvement Activities under ACI

Beneficiary Engagement• Use of CEHRT to capture patient reported outcomes

• Engagement of patients through implementation of improvements in patient portal

• Engagement of patients, family and caregivers in developing a plan of care

Has EHR impactHigh weightage Medium weightage

Behavioral and Mental Health• Implementation of integrated PCBH model

• Electronic Health Record Enhancements for BH data capture

Patient safety and practice assessment • Use of decision support and standardized treatment protocols

Achieving Health Equity • Leveraging a QCDR to standardize processes for screening

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27%

15%

4%

36%

18%

Split of effort across various areas in MU3

CCDA FHIR PHA Rest MU Quality

HighlightsCQMs

API access

• Structural changes and New

templates (expect this in future too)

• Need to support backward

compatibility

• Future-proof yourself, through an

extensible and flexible design

• Over 271 distinct criteria under

‘Quality’

• Offer choice for providers to report

on those with the best scores

• Eliminate programming changes

annually

• Open your EHR data to authorized

third-parties

• Respond to requests for partial or

complete data

• FHIR recommended

• Minimize design changes in future

CCDA

28 man-months

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The next 11 months

ACI development Certification

Quality measures

Provider training

(6-7 months) (1 month)

(3 months)*

(1 month)

* Assuming an EHR caters to multiple specialties and needs to cover multiple criteria

** Assuming these changes turn out to be simple enough.

Note: The timelines mentioned above are indicative and may vary across solution providers

Aug2017

Upgrade

(1 month)

IA

(2 months)**

Oct2017

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For more information, contact amit.m@Nalashaa.com

Nalashaa Solutions llc.555, US Highway One South, Ste 170, Iselin, NJ 08830 +1-732-602-2560 Ext: 200

Thank You