Patient Engagement Jason Felts, HIT Practice Advisor Oklahoma Foundation for Medical Quality

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Mission of OFMQHIT

To advance the implementation and use of vital health information technology to improve healthcare

quality, efficiency and safety by assisting physician practices and hospitals in achieving meaningful use of

electronic health records.

OFMQHIT Service Lines • Security & Privacy Analysis • Security & Privacy Validation • Meaningful Use Gap Analysis • Meaningful Use Gap Audit • Meaningful Use Attestation • HIPAA Security Preparedness • HIPAA Privacy Preparedness • Staff IT Security Training

Jason Felts, MS Jason Felts has more than six years of experience in healthcare and currently works as a Health Information Technology (HIT) Practice Advisor for the Oklahoma Foundation for Medical Quality. He currently works with multiple physician practices and hospitals throughout the state of Oklahoma and serves as a consultant for meaningful use, workflow redesign, privacy and security of health information systems, and many other Health IT related issues.

Jason serves as the meaningful use coordinator for the Regional Extension Center. He is a member of the Meaningful Use Burning Issues Group. This elite group of individuals fields questions nationally about meaningful use from healthcare providers and other Regional Extension Centers.

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What is Meaningful Use? • Meaningful Use is using certified electronic

health record technology to: – Improve quality, safety, efficiency and reduce

health disparities – Engage patients and family – Improve care coordination, and population and

public health – Maintain privacy and security of patient health

information

What is patient engagement? • Encouraging patients and their family to take a more

active role in their healthcare • Connects the provider and the patient on different

platforms: patient portal, PHR, social media, mHealth • Ongoing communication • Streamlined health information

Which MU objectives deal with patient engagement?

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Stage 2 EP Core Objectives • CPOE (Computerized Physician

Order Entry) • eRx • Record demographics • Record vital signs • Record smoking status • Implement 5 Clinical Decision

Support (CDS) rules • Structured lab results • Generate lists of patients by

condition • Reminders for

preventative/follow-up care

• Provide online access to health info

• Provide clinical visit summaries • Provide patient education

resources • Secure messaging with patients • Medication reconciliation • Provide summary of care

document • Submit electronic data to

immunization registry • Protect electronic health info

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Core Objectives o Patient Electronic Access o Objective: Provide patients with the ability to view online,

download, and transmit (VDT) their health information within 4 business days of the info being available to the EP

o Measure 1: More than 50% of unique patients seen by the EP during the reporting period are provided timely online access to their health info with the ability to VDT

o Measure 2: More than 5% of all unique patients seen by the EP during the reporting period view, download, or transmit their health info to a 3rd party

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Patient Electronic Access o Measure 1

o Threshold – 50% o What does this mean? o Patients have access to their health info o Patients do not have to actually login to meet this measure o Data must be available if patients chooses to log in, this

includes: o Patient name, provider’s name and office contact info, current and past

problem list, procedures, laboratory test results, current med list and med history, current med allergy list and history, vitals, smoking status, demographic info, care plan field(s), care team.

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Patient Electronic Access

o Measure 2 o Threshold – 5% o What does this mean? o Patients have to login and view,

download OR transmit their health info to a 3rd party

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Patient Electronic Access o How do I get patients to login???

o Education o Talk to patients about methods of communication o Discuss conveniences of online access o Let patients know what options are available through a portal

o Marketing o Flash drives, magnets, key chains, lanyards o Include website/portal info

o Kiosk/Tablet in waiting room o Convenience o Accessibility

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Patient Electronic Access o Exclusions o Any EP who:

o 1) Neither orders nor creates any of the information listed for inclusion as part of both measures, except for “Patient name” and “Provider’s name and office contact information,” may exclude both measures.

o 2) Conducts 50% or more of his or her patient encounters in a county that does not have 50% or more of its housing units with 3 Mbps broadband availability according to the latest information available from the FCC on the first day of the EHR reporting period may exclude only the 2nd measure

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Core Objectives o Secure Electronic Messaging o Objective: Use secure electronic messaging to

communicate with patients on relevant health information

o Measure: A secure message was sent using the electronic messaging function of CEHRT by more than 5% of unique patients seen by the EP during the reporting period

o Exclusion: EP who has no office visits, or 50% of encounters with patients the have insufficient broadband availability

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Secure Electronic Messaging o Secure Message – Any electronic communication

between a provider and patient that ensures only those parties can access the communication

o Electronic message can be: o Email or the electronic messaging function of a PHR or patient

portal, or any other electronic means (e.g. mHealth – mobile health)

o Email must be encrypted if it contains PHI

o The message must come from the patient (or authorized representative)

o No expectation that the EP personally responds to electronic messages to the patient

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Core Objectives o Reminders for Preventative Care o Objective: Use clinically relevant info to identify patients

who should receive reminders for preventative/follow-up care and send these patients the reminders, per patient preference.

o Measure: 10% of patients who have had 2 or more office visits within 24 months of the beginning of the reporting period

o Patient preference – the method of communication that patients prefer to receive their reminders (i.e. mail, phone, secure messaging)

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Patient Reminders o What classifies as a patient reminder?

o Reminders for preventative/follow-up care that the patient is not already scheduled to receive

o Reminders for referrals o Reminders to engage in certain activities

o Why do we have to determine “patient preference”? o Accommodating known reasonable requests in accordance with

the HIPAA Privacy Rule o 45 CFR 164.522(b) – guidance established for accommodating

patient requests o Provider option if patient declines to provide preferred

communication medium

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Core Objectives o Patient-Specific Education Resources o Objective: Use clinically relevant info from CEHRT to

identify patient-specific education resources and provide those resources to the patient

o Threshold: 10% of all unique patients

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Patient Education o Patient-specific education resources identified by

CEHRT- Resources or a topic area of resources identified through logic built into CEHRT which evaluates information about the patient and suggests education resources that would be of value to the patient

o These resources DO NOT have to be stored within or generated by the CEHRT.

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Core Objectives o Summary of Care o Objective: 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 summary of care for each TOC or referral.

o How is this patient engagement… o EP can send an electronic or paper copy of the SOC

directly to the next provider…can provide it to the patient to deliver to the next provider, if the patient can reasonably be expected to do so

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Common Denominator o What do all of these things have in common (besides

they are all MU objectives of course)? o View, Download, Transmit o Secure electronic messaging o Patient Reminders o Patient-specific education resources o Summary of Care document

o They can all be done through a patient portal!

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FAQs o Q - Do I have to have a patient portal for Meaningful Use?

o Yes, beginning in 2014 the view, download, transmit objective will be required for all EPs and EHs participating in the EHR incentive program, regardless of MU stage

o Q - When does the portal have to be up and running? o You will need a portal in place and meet the required

thresholds for a 90-day reporting period in 2014. Medicare EPs– data must be fixed to a quarter (i.e. April – June); Medicaid EPs can use any 90-days

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FAQs o Q – What happens if I don’t get a portal?

o You will not achieve Meaningful Use, which means you will be subject to Medicare payment adjustments (1% adjustment per year, and cumulative for every year the EP is not a meaningful user; applied to Medicare physician fee schedule).

o Q – Do messages that the medical staff send through the portal count as secure messages? o Secure messaging must come from the patient to

count towards your MU measure (5%).

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Goals o Patient Engagement

o Empower patients to take an active-role

o Improve communication

o Provide educational materials and tools

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NPRM o New proposed rule surrounding the EHR incentive

program o Rule was published May 23, 2014 o Mandatory 60-day comment period o May change some timelines and requirements for the MU

program

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What do we do about the NPRM? o Important – This is only a proposed rule, NOT final o Recommendations – proceed forward as normal; continue

to move forward with Health-IT and Meaningful Use o Stay in contact with OFMQ – we will ensure that you get up-to-

date information on new regulations and policies

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NPRM o The document can be found at:

o www.regulations.gov/ o Search “Meaningful Use” or “EHR Incentive Program” o Read the rule and comment online

Hardship Exceptions

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EP Hardship Exception • EPs & EHs may apply for hardship exceptions to avoid

the Medicare payment adjustments. • Applications need to be submitted no later than July

1 of the year before the payment adjustment year • http://www.cms.gov/Regulations-and-

Guidance/Legislation/EHRIncentivePrograms/PaymentAdj_Hardship.html

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What is the Hardship Exception?

Eligible professionals may apply for hardship exceptions to avoid the payment adjustments previously described. Hardship exceptions will be granted only under specific circumstances and only if CMS determines that providers have demonstrated that those circumstances pose a significant barrier to their achieving meaningful use.

Hardship Exception Categories 1. Infrastructure: Eligible professionals must demonstrate that

they are in an area without sufficient internet access or face insurmountable barriers to obtaining infrastructure (e.g., lack of broadband).

2. New Eligible Professionals: Newly practicing eligible professionals who would not have had time to become meaningful users can apply for a 2-year limited exception to payment adjustments. Thus eligible professionals who begin practice in calendar year 2015 would receive an exception to the penalties in 2015 and 2016, but would have to begin demonstrating meaningful use in calendar year 2016 to avoid payment adjustments in 2017.

3. Unforeseen Circumstances: Examples may include a natural disaster or other unforeseeable barrier.

Hardship Exception Categories (Continued)

4. Patient Interaction: • Lack of face-to-face or telemedicine interaction with patient • Lack of follow-up need with patients

5. Practice at Multiple Locations: Lack of control over availability of CEHRT for more than 50% of patient encounters

6. 2014 EHR Vendor Issues: The eligible professional’s EHR vendor was unable to obtain 2014 certification or the eligible professional was unable to implement meaningful use due to 2014 EHR certification delays.

Hardship Exception • Applications are due by midnight EDT on July 1, 2014. • Submitting the form doesn't guarantee a waiver from

the payment penalties set to begin Jan.1, 2015. • Eligible professionals who do not achieve Meaningful

Use by Oct. 31, 2014 and who do not apply for the Hardship Exception will be subject to penalties beginning in 2015

OFMQ-HIT Expertise • ARRA Incentive and Eligibility Review

• Meaningful Use Assessment and Gap Analysis

• Practice & Workflow Assessment and Design

• EHR Vendor Selection & Optimization

• Project Planning & Vendor Oversight

• HIPAA Security and Privacy Preparedness

• Post Go-Live Practice Assessment & EHR Optimization

• IT Security and Privacy Review & Assessment

Questions?

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We Are Here To Help!

Email: OFMQHIT@OFMQ.com

Call: (877) 963-6744 Visit: www.ofmqhit.com

If you’re interested in improving your practice and office efficiency through EHR software use or our

service lines, contact us!

Upcoming Events

Our Next WebEx Seminar Wed, July 16 | 12:15pm (Central Time)

“Clinical Quality Measures”

Rural HIT Workshop Tues, July 22 | 8am-12pm

High Plains Technology Center | Woodward, OK Register at www.ofmq.com/rural-hit-workshops

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