Electronic Health Records (EHR)

he South Florida Regional Extension Center (SFREC) was created and funded by the Office of the National Coordinator of Health Information Technology (ONC) to help local physicians and health care providers select, successfully implement and meaningfully use certified electronic health records (EHR) to improve the efficiency, quality and value of health care.

There are different rules and requirements for Medicare and Medicaid providers, hospitals and critical access hospitals (CAH). For example, eligible providers may not be hospital-based, and those who do not see Medicare or Medicaid patients are not eligible for funding.

In addition, Medicaid Eligible Professionals (EP) must meet one of three patient volume thresholds over any continuous
90-day period within the most recent calendar year:

  • Minimum of 30 percent patient volume
  • Pediatricians only: have a minimum of 20 percent Medicaid patient volume
  • Practicing predominantly (more than 50 percent of encounters over six months)
    in a FQHC or RHC; only have a minimum of 30 percent “needy individual” patient volume

The Centers for Medicare and Medicaid Services (CMS) is making up to $27 billion in EHR incentive payments,
or as much as $44,000 (through Medicare) or $63,750 (through Medicaid) per EP.

The chart above gives a snapshot of the two incentive programs. The rows refer to the calendar payments made to providers
each year when they continue to meet requirements for meaningful use, up to the maximum given for the incentive period.

  • For the Medicare program, the incentive payments vary depending on what year the provider successfully demonstrates meaningful use. In 2013 and in each subsequent year the provider is eligible for up to $39,000 in Medicare incentives, while an eligible professional who first demonstrates in 2011 is eligible for the maximum amount of $44,000. The last year to begin participation is 2014.
  • Medicaid payments do not vary depending on the year the eligible professional first participates in the Medicaid EHR Incentive Program. The last year to begin the program is 2016.

    NOTE: Pediatricians who participate in the Medicaid EHR Incentive Program at the 20-29 percent patient volume receive two-thirds of the full EHR incentive amount.

Stage I: Meaningful Use (MU) Requirements
Core Measures

(Must meet all 13 in 2014.) 

  • Computerized provider order entry (CPOE) for more than 30 percent of all patients by a licensed health care professional.
  • Implement drug-drug and drug-allergy checks.
  • Maintain an up-to-date problem list of current and active diagnoses for more than 80 percent of patients.
  • eRX for more than 40 percent of permissible drug scripts.
  • Maintain Active Medication List for more than 80 percent of all patients.
  • Maintain Active Medication Allergy List for more than 80 percent of all patients.
  • Record patient demographics for more than 50 percent of all patients.
  • Record and chart changes in vital signs for more than 50 percent of patients 2 years and older.
  • Record smoking status for more than 50 percent of patients 13 years and older.
  • Provide more than 50% of all patients with the ability to view online,download,and transmit health information
  • Implement one clinical decision support rule.
  • Provide patients with clinical summaries for more than 50 percent of visits within three business days.
  • Protect electronic health information.

Clinical Quality Measures

The distinction between core and alternate CQMs has been eliminated. Nine CQMs are recommended for EP’S who work with adults and nine CQMs are recommended for EP’S who work with a pediatric population.

EP’s who elect not to report from either set of the recommended CQMs can select from a menu of 64 approved CQMs, which must cover at least 3 of 6 domains

Menu Set Measures

(Select any five of the 9; must include one public health measure.) 

  • Implement drug formulary checks.
  • Incorporate clinical lab test results into EHR for more than 40 percent of all lab results ordered.
  • Generate list of patients by specific conditions.
  • Send patient reminders for more than 20 percent of all patients 65 years or older or 5 years or younger.
  • Provide patient-specific education resources to more than 10 percent of all patients.
  • Perform medication reconciliation for more than 50 percent of patients received through transitions of care.
  • Provide summary care report for more than 50 percent of patients referred or transitioned for care.
  • Capability to submit electronic data to immunization registries.
  • Capability to submit electronic syndromic surveillance data to public health agencies

Beginning in 2014, a provider cannot select a menu objective and claim an exclusion for it if there are other menu objectives they can meet.

Public Health Measures

  • Capability to submit electronic data to immunization registries
  • Capability to submit electronic syndromic surveillance data to public health agencies

Disclaimer: Educational tool only — subject to change by the federal government 03/31/14.

Stage II: Meaningful Use (MU) Requirements
EP Core Onjectives

(EPs must meet all 17 objectives)

  • Use computerized provider order entry (CPOE) for medication, laboratory and radiology orders directly entered by any licensed healthcare professional who can enter orders into the medical record per state, local and professional guidelines.
  • Generate and transmit permissible prescriptions electronically (eRx).
  • Record the following demographics: preferred language, sex, race, ethnicity, date of birth.
  • Record and chart changes in the following vital signs: height/length and weight (no age limit); blood pressure (ages 3 and over); calculate and display body mass index (BMI); and plot and display growth charts for patients 0-20 years, including BMI.
  • Record smoking status for patients 13 years old or older.
  • Use clinical decision support to improve performance on high-priority health conditions
  • Provide patients the ability to view online, download and transmit their health information within four business days of the information being available to the EP.
  • Provide clinical summaries for patients for each office visit.
  • Protect electronic health information created or maintained by the Certified EHR Technology through the implementation of appropriate technical capabilities.
  • Incorporate clinical lab-test results into Certified EHR Technology as structured data.
  • Generate lists of patients by specific conditions to use for quality improvement, reduction of disparities, research or outreach.
  • Use clinically relevant information to identify patients who should receive reminders for preventive/follow-up care and send these patients the reminders, per patient preference.
  • Use clinically relevant information from Certified EHR Technology to identify patient-specific education resources and provide those resources to the patient.
  • The EP who receives a patient from another setting of care or provider of care or believes an encounter is relevant should perform medication reconciliation.
  • The EP who transitions their patient to another setting of care or provider of care or refers their patient to another provider of care should provide a summary care record for each transition of care or referral.
  • Capability to submit electronic data to immunization registries or immunization information systems, except where prohibited, and in accordance with applicable law and practice.
  • Use secure electronic messaging to communicate with patients on relevant health information.

EP Menu Objectives

(EPs must meet three of six objectives)

  • Capability to submit electronic syndromic surveillance data to public health agencies, except where prohibited, and in accordance with applicable law and practice.
  • Record electronic notes in patient records.
  • Imaging results consisting of the image itself and any explanation or other accompanying information are accessible through Certified EHR Technology.
  • Record patient family health history as structured data.
  • Capability to identify and report cancer cases to a public health central cancer registry, except where prohibited, and in accordance with applicable law and practice.
  • Capability to identify and report specific cases to a specialized registry (other than a cancer registry), except where prohibited, and in accordance with applicable law and practice.

How South Florida Regional Extension Center Can Help

  • A team of experienced local health IT professionals with intimate knowledge of the South Florida medical community
  • A trusted partner working side by side with providers through the process
  • A nonprofit organization with direct and reliable access to a pipeline of key information on health IT and meaningful EHR use

Important Next Steps
Register

If you are not already registered for the Medicare and Medicaid EHR Incentive Program, the SFREC will assist you in the process. The sooner you register, the earlier you will receive funding. You will need your tax identifier number and your national provider identifier number and can register online at www.ehrincentives.cms.gov.

Readiness Assessment

Call our toll-free number (1-866-628-9193) and schedule a readiness assessment for your office. We will review your practice workflow, infrastructure and hardware needs. If you already have an EHR system, we will guide you on meaningful use attestation.

Review EHR Selection

The SFREC will assist you in your EHR selection process by reviewing product tutorials, demos and software specifications, and available group discounts.

Move Toward Meaningful Use

The SFREC is your trusted advisor and will guide you through each step of the meaningful use process and assist you with the Medicare/Medicaid Incentive Program.