Revision as of 21:31, 27 January 2010

NOTE: The page below is an older version of governmental requirements. Please see updated page: Meaningful Use (WG6)

There is a meaningful use matrix published on the Health & Human Services (HHS) website at http://healthit.hhs.gov/portal/server.pt/gateway/PTARGS_0_11113_872719_0_0_18/Meaningful%20Use%20Matrix.pdf

This web page is a beginning of addressing the issue of whether VistA based systems support all of the requirements listed there, and tries to explain exactly how these are supported.

Health Outcomes Policy Priorities

• Improve quality, safety, efficiency, and reduce health disparities
• Engage patients and families
• Improve care coordination
• Improve population and public health
• Ensure adequate privacy and security protections for personal health information

Care Goals of Health Outcomes Policy Priorities (HOPP)

Care Goals of HOPP 1: Improve quality, safety, efficiency, and reduce health disparities

• Provide access to comprehensive patient health data for patient’s health care team
• Use evidence-based order sets and CPOE
• Apply clinical decision support at the point of care
• Generate lists of patients who need care and use them to reach out to patients (e.g., reminders, care instructions, etc)
• Report to patient registries for quality improvement, public reporting, etc

Care Goal of HOPP 2: Engage patients and families

• Provide patients and families with access to data, knowledge, and tools to make informed decisions and to manage their health

Care Goals of HOPP 3: Improve care coordination

• Exchange meaningful clinical information among professional health care team

Care Goals of HOPP 4: Improve population and public health

• Communicate with public health agencies

Care Goals of HOPP 5: Ensure adequate privacy and security protections for personal health information

• Ensure privacy and security protections for confidential information through operating policies, procedures, and technologies and compliance with applicable law
• Provide transparency of data sharing to patient

2011 Objectives & Measures

• Objectives Goal is to electronically capture in coded format and to report health information and to use that information to track key clinical conditions

2011 Objectives (HOPP 1): CPOE

Use CPOE for all order types including medications OP, IP

VistA

Computerized Provider Order Entry (CPOE) is provided through CPRS

2011 Objectives (HOPP 1): Drug Checks

Implement drug-drug, drug-allergy, drug-formulary checks OP, IP

VistA

2011 Objectives (HOPP 1): Problem List

Maintain an up-to-date problem list OP, IP

VistA

2011 Objectives (HOPP 1): E-Prescriptions

Generate and transmit permissible prescriptions electronically (eRx) OP

VistA

2011 Objectives (HOPP 1): Active Meds

Maintain active medication list OP, IP

VistA

2011 Objectives (HOPP 1): Med Allergies

Maintain active medication allergy list OP, IP

VistA

2011 Objectives (HOPP 1): Demographic records

Record primary language, insurance type, gender, race, ethnicity OP, IP

VistA

2011 Objectives (HOPP 1): Vital Signs

Record vital signs including height, weight, blood pressure OP, IP

VistA

2011 Objectives (HOPP 1): EHR Lab Test Results

Incorporate lab-test results into EHR OP, IP

VistA

2011 Objectives (HOPP 1): Condition Specific Patient Lists

Generate lists of patients by specific condition to use for quality improvement, reduction of disparities, and outreach OP

VistA

2011 Objectives (HOPP 1): Reminders to Patients

Send reminders to patients per patient preference for preventive /follow up care OP, IP

VistA

2011 Objectives (HOPP 1): Encounter Progress Notes

Document a progress note for each encounter OP

VistA

2011 Objectives (HOPP 2): Patient Electronic Health Record

Provide patients with electronic copy of- or electronic access to- clinical information (including lab results, problem list, medication lists, allergies) per patient preference (e.g., through PHR) OP, IP

VistA

2011 Objectives (HOPP 2): Patient Education

Provide access to patient-specific educational resources OP, IP

VistA

2011 Objectives (HOPP 2): Patient Encounter Clinical Summary

Provide clinical summaries for patients for each encounter OP, IP

VistA

2011 Objectives (HOPP 3): Share Clinical Information

Exchange key clinical information among providers of care (e.g., problems, medications, allergies, test results) OP, IP

VistA

2011 Objectives (HOPP 3): Medical Reconciliation

Perform medication reconciliation at relevant encounters OP, IP

VistA

2011 Objectives (HOPP 4): Immunization Registry

Submit electronic data to immunization registries where required and accepted OP, IP

VistA

2011 Objectives (HOPP 4): Reportable Lab Results

Provide electronic submissions of reportable lab results to public health agencies IP

VistA

2011 Objectives (HOPP 4): Syndrome Surveillance

Provide electronic syndrome surveillance data to public health agencies according to applicable law and practice IP

VistA

2011 Objectives (HOPP 5): HIPAA

Compliance with HIPAA Privacy and Security Rules and state laws

VistA

2011 Objectives (HOPP 5): Fair Data Sharing

Compliance with fair data sharing practices set forth in the Nationwide Privacy and Security Framework (released by The Department of Health and Human Services in December 2008. It is anticipated that further revisions may be made to this document during the calendar year 2010.)

VistA

2011 Quality Measures Reporting (HOPP 1): Diabetes/A1c

- % diabetics with A1c under control OP

VistA

HEMOGLOBIN A1C is a common LABORATORY TEST tracked in VistA

2011 Quality Measures Reporting (HOPP 1): Hypertension

- % hypertensive patients with BP under control OP

VistA

2011 Quality Measures Reporting (HOPP 1): LDL

- % of patients with LDL under control OP

VistA

Low Density Lipid results are stored in the LAB DATA File.

2011 Quality Measures Reporting (HOPP 1): smoking

- % of smokers offered smoking cessation counseling OP, IP

VistA

Smoking cessation is commonly tracked in Clinical Reminders

2011 Quality Measures Reporting (HOPP 1): BMI

-  % of patients with recorded BMI OP

VistA

2011 Quality Measures Reporting (HOPP 1): VTE

- % eligible surgical patients who received VTE prophylaxis IP

VistA

2011 Quality Measures Reporting (HOPP 1): % of CPOE

- % of orders entered directly by physicians through CPOE

VistA

2011 Quality Measures Reporting (HOPP 1): elderly high risk meds

- Use of high-risk medications in the elderly OP, IP

VistA

2011 Quality Measures Reporting (HOPP 1): colorectal screening

- % of patients over 50 with annual colorectal cancer screenings OP

VistA

2011 Quality Measures Reporting (HOPP 1): mammogram

- % of females over 50 receiving annual mammogram OP

VistA

Mammograms are one of the RAD/NUC MED PROCEDURES, that are part of the Radiology package

2011 Quality Measures Reporting (HOPP 1): aspirin

- % patients at high-risk for cardiac events on aspirin prophylaxis OP

VistA

Medication history and diagnosis for patients is tracked in VistA.

2011 Quality Measures Reporting (HOPP 1): pneumovax

% of patients with current pneumovax OP

VistA

PNEUMOVAX is one of the Immunizations tracked in the V IMMUNIZATION File. This also includes other necessary fields to track details of the immunization, and reports for tracking.

2011 Quality Measures Reporting (HOPP 1): flu vaccine

% eligible patients who received flu vaccine OP

VistA

INFLUENZA is one of the Immunizations tracked in the V IMMUNIZATION File. This also includes other necessary fields to track details of the immunization, and reports for tracking.

2011 Quality Measures Reporting (HOPP 1): coded lab results

% lab results incorporated into EHR in coded format OP,IP

VistA

All Lab results entered into VistA are in coded format. All Lab Results from HL7 feeds are in coded format. Scanned images of lab reports or faxes will not be in coded format.

2011 Quality Measures Reporting (HOPP 1): demographics reports

Stratify reports by gender, insurance type, primary language, race, ethnicity OP, IP

VistA

Pharmacy Package tracks PMI LANGUAGE PREFERENCE for Patient Medical Information Sheets

2011 Quality Measures Reporting (HOPP 2): ePHR access

% of all patients with access to personal health information electronically OP, IP

VistA

Release of Medical Information is a part of VistA. The extent of information released and implementation depends on local policy and practice.

2011 Quality Measures Reporting (HOPP 2): Patient Education

% of all patients with access to patient-specific educational resources OP, IP

VistA

Tracking Patient Education is part of Clinical Reminders (in CPRS)

2011 Quality Measures Reporting (HOPP 2): encounter clinical summaries

% of encounters for which clinical summaries were provided OP, IP

VistA

Progress notes for encounters are part of CPRS. This report is part of tracking compliance with documentation of encounters.

2011 Quality Measures Reporting (HOPP 3): 30 day readmission

Report 30-day readmission rate IP

VistA

The Menu Option "DVBA RE-ADMISSION REPORT" (^DVBARADM) has been available since 1991. It or a variant can be used for this report.

2011 Quality Measures Reporting (HOPP 3): med reconciliation

% of encounters where med reconciliation was performed OP, IP

VistA

Medical Reconciliation Tools (PSO*7*294 and TUI*1*238) were released in June of 2008

2011 Quality Measures Reporting (HOPP 3): external exchange ability

Implemented ability to exchange health information with external clinical entity (specifically labs, care summary and medication lists) OP, IP

VistA

HL7 messaging in VistA is extensive, CPRS provides many kinds of Health Information, Continuity of Care information also overlaps with this data

2011 Quality Measures Reporting (HOPP 3): sharing summaries

% of transitions in care for which summary care record is shared (e.g., electronic, paper, eFax) OP, IP

VistA

Multiple methods exist to provide health summaries, including the Continuity of Care information.

2011 Quality Measures Reporting (HOPP 4): Immunization

Report up-to-date status for childhood immunizations OP

VistA

Pediatric care support in VistA is light, however the V IMMUNIZATION FileMan File from the IHS (RPMS) is supported as are the PXTT* menu options supporting the Immunization Record

2011 Quality Measures Reporting (HOPP 4): Reportable Lab Results

% reportable lab results submitted electronically IP

VistA

EHR has recognition of which lab results are reportable, VistA Menu Option: "LR HEALTH DEPT" i.e. "Health Department report" exists and presents a report for a range of days of all isolates (with patient name, address, etc.) for all organisms (fungus, AFB, parasite, etc.) that are reportable to the State Health Department. This must be checked against regulations of a particular state.

2011 Quality Measures Reporting (HOPP 5): Comply with HIPAA

Full compliance with HIPAA Privacy and Security Rules

VistA

Security in VistA is extensive, and allows access to be limited to just what is needed to accomplish a task.

2011 Quality Measures Reporting (HOPP 5): No ongoing investigations

An entity under investigation for a HIPAA privacy or security violation cannot achieve meaningful use until the entity is cleared by the investigating authority

VistA

does VistA need to track accusations of privacy and security violations?

2011 Quality Measures Reporting (HOPP 5): Security Risk Assessment

Conduct or update a security risk assessment and implement security updates as necessary

VistA

need clear definition of what is needed for a security risk assessment

2013 Objectives & Measures (not recorded on this page yet)

• Goal is to guide and support care processes and care coordination