On Friday, CMS released the long awaited Meaningful Use / MIPS stage 3 draft rule.   In this blog post, we summarize key elements of the 300-page long draft rule and highlight areas of major change. The document substantially reorganizes  the Meaningful Use / MIPS standards into 8 program areas. These standards are focused on promoting more data interchange between providers, and in general to meet the goal of “interoperability” between different patient record systems. Overall, they represent substantially higher goals than in the past.

This post focuses on the stage 3 measures that providers will need to consider when making strategic decisions that may be impacted by the Meaningful Use / MIPS program’s future direction.

As succinctly as I could manage (considering the size of the document!), following are the proposed standards, and how they would change the Meaningful Use / MIPS future for providers if finalized as written.  I have italicized major potential impacts.

THE PROPOSED STANDARDS

1. Protect electronic protected health information (ePHI) would remain essentially unchanged in its requirement that providers conduct or review a security risk analysis annually.  The standard specifies that such an analysis would also have to be done upon  installation of new systems and upon upgrades to new certified editions.

2. ePrescribing.  This standard would require more than 25 percent of hospital discharge medication orders for permissible prescriptions (for new and changed prescriptions) to be queried for a drug formulary, and transmitted electronically using CEHRT.  While this is the same functionality currently required in a menu item for stage 2, it significantly raises the volume threshold from 10% to 25%.

3. The requirement that providers implement clinical decision support (CDS) interventions remains essentially unchanged. It focuses on improving performance on high-priority health conditions, and using drug-drug interaction and drug-allergy checking on medication orders.

4. The stage 3 requirements for computerized provider order entry (CPOE) for medication, laboratory, and diagnostic imaging orders would increase thresholds  with the medication standard at 80%, and laboratory and diagnostic imaging at 60%. Also of note is that the previous definition of radiology has been expanded to comprise the complete array of diagnostic imaging modalities, including ultrasound, MRI, and CT.

5. The requirement for patient electronic access to health information would still be measured by the number of patients who have their information available online, but the threshold would be increased to 80% from the current 50%,  and the time window shortened to within 24 hours of the patient visit.

Under this goal, a second measure is that the provider would have to use clinically relevant information from CEHRT to identify patient-specific educational resources, and provide electronic access to this material to more than 35 percent of unique patients. This is an increase from the current 10 per cent threshold. Further, the electronic access requirement to these documents is new.

In either case, the patient access can be provided directly via the CEHRT (certified EHR technology) through a patient portal module or via access to an application-program interface (API). APIs are used to provide patients access to their health information through third-party applications and devices. In many cases, the API option would provide providers and their patients with more flexibility than currently available in many patient portals.

6. To enable coordination of care through patient engagement, CMS has identiied 3 measures, but providers would only need to meet the threshold for two:

• Providers would be required to use communications functions of certified EHR technology to enable 25% of their patients (or their authorized representatives) to interact with the EHR via view, download and transmit functionality, or via API. This is a substantial increase from the previous 5% standard, and may represent a real challenge for many providers, particularly those with poor computer literacy in their patient population.

• A new requirement is that providers would have to use the secure messaging function of CEHRT to the patient, to communicate with 35% of unique patients. The secure messages sent must contain relevant health information specific to the patient.   Provider initiated communications and responses to patient communications both would count.   While this functionality exists in current 2014 edition software, usage hasn’t been required up to now.  This measure is likely to cause significant pushback from the provider community as it introduces a new communication channel that must be managed.

• Patient-generated health data or data from a non-clinical setting must be incorporated into the CEHRT for more than 15 percent of all unique patients. This might include health and care-related data from care providers such as physical therapists and home health care providers as well as data obtained from patients themselves from self-monitoring of their health (such as recording vital signs, activity and exercise, medication intake, and nutrition). This functionality is new, and this measure is likely to create significant pushback because it requires participation from patients and other providers not in control of the eligible provider/hospital.

7. The program goal for Health Information Exchange (HIE) is related to the old electronic summary of care requirements, but also includes new requirements for the recipient of a summary of care. Specifically, the new rule would require incorporation and reconciliation of received data.   The provider would have to meet two of the following three measures:

• The provider that transitions or refers their patient to another care setting or care provider of care would have to create and electronically exchange a summary of care record on more than 50 percent of transitions/referrals. This is a significant expansion of the old electronic summary of care goal (10 percent).

• The provider would have to incorporate into the patient’s EHR an electronic summary of care document from a source other than the provider’s EHR system for more than 40 percent of transitions or referrals received,  and for new patient encounters  (i.e. the provider has never before encountered the patient). If the 50% standard noted above is barely met by other providers, this requirement may be particularly challenging to reach.   This problem may be alleviated somewhat through proposed language that, when a provider requests a transition of care document but fails to receive it and has checked at least one HIE for the data, the patient may be marked as unavailable and excluded from the denominator.

• The provider would have to perform clinical information reconciliation for more than 80 percent of transitions or referrals received, and for encounters with new patients. This clinical information reconciliation could be performed for medication, medication allergies, and the current problem list. Although the 80 percent threshold is significantly higher than the previous threshold for medication reconciliation alone, adding the other two options should help considerably, in #8.

 8. The final program goal, Public Health and Clinical Data Registry Reporting identifies six exchanges that qualify for this measure (5 for physicians) and would require that the provider be actively engaged (this includes being in the testing phase) with four (3 for physicians).   The six options:

• The provider is in active engagement with a public health agency to submit immunization data and receive immunization forecasts and histories from the public health immunization registry/immunization information system (IIS).
• The provider is in active engagement with a public health agency to submit syndromic surveillance data from a non-urgent care ambulatory setting for EPs, or an emergency or urgent care department for eligible hospitals and CAHs.
• The provider is in active engagement with a public health agency to submit case reporting of reportable conditions.
• The provider is in active engagement to submit data to a public health registry. Public health registries are administered by, or on behalf of, other public health agency entities. Submissions to multiple registries would be counted toward the required number of exchanges.
• The provider is in active engagement to submit data to a clinical data registry. Clinical data registries record information about the health status of patients and the healthcare they receive over varying periods of time. Clinical data registries are administered by, or on behalf of, other non-public health agency entities.Submissions to multiple registries would be counted toward the required number of exchanges.
• The eligible hospital or CAH is in active engagement with a public health agency to submit electronic reportable laboratory results.

Watch for future posts in a series on the future of Meaningful Use / MIPS. We will discuss details regarding other proposed changes in the new rule, and lessons extracted from the certification standards for vendors.

Phoenix consultants know Meaningful Use / MIPS.

Contact us to see for yourself.