TMG Meaningful Use

7/25/2012

Hello. My name is Kevin Toppenberg, MD. I am a primary care physician in Greeneville, TN. I have been active in the VistA community for at least 7 years, and have used VistA in my office during this time. I have decided to pursue meaningful use certification with VistA. This page will document my progress towards this, and record notes that I make to myself along the way. I hope this is helpful to others.

In CMS terminology, I am an "Eligible Provider" (EP), not a hospital. Also, I am going after Medicare (not Medicaid) certification. So my discussion below will be targeted accordingly.

Q: Where can I find the certification status of WorldVistA?

• Go to CMS Certified Health IT Products
• Search for "WorldVistA" -- NOTE: the search engine on this page is flaky. I found that when I clicked the search button, it would return a list of ALL technology. But when I then simply clicked search AGAIN (with WorldVistA still in the search term box), then it would find it.

Q: There seems to be so many steps to be ready to attest meaningful use. It's overwhelming. Any overview sites?

• When I looked into this a year or so ago, reading the ~80 pages of densely packed legal terms, I gave up. It seemed too daunting. But now that I am revisiting this, it seems to not be too bad at all. I found that I am already doing most of the requirements.
• I recommend starting with this overview: CMS EHR Meaningful Use Overview. The information I am posting here is from this site.
• Alternatively, here are the slides from a CMS webinar presentation.
• Here is another CMS document (2010) document with similar detail.

Q: What's the bottom line? What do I have to do to be ready to attest meaningful use?

1. Meet 20 of 25 "Meaningful Use Objectives" source
   • Must meet 15 "core" measures
   • Must also meet 5 of 10 possible "menu" set measures
2. Meet 6 of 41 "Clinical Quality Measures (CQM's)" source
   • Must meet 3 required core quality measures
   • must also meet 3 of 38 possible additional quality measures

Q: Can you tell me more about the 15 "core" meaningful use measures? (all are required)

They are as follows:

1. CPOE -- Provider directly enters in orders source
2. Implement drug-drug and drug-allergy interaction checks source
3. Maintain and up-to-date problem list of current and active diagnoses source
4. Generate and transmit permissible prescriptions electronically (eRx) source
5. Maintain active medication list source
6. Maintain active medication allergy list source
7. Record required demographics source
8. Record required vital signs source
9. Record smoking status for patients aged 13 yrs and up source
10. Report clinical quality measures to CMS source
11. Implement 1 clinical decision support rule source
12. Provide patients with an electronic copy of their health information source
13. Provide clinical summaries for patients for each office visit (at least 50% of patients, within 3 days) source
14. Perform at least 1 test of exchanging key clinical information with another entity electronically source
15. Protect electronic health information source

Q: What about the 5 "menu" set of meaningful use objectives? (5 of 10 possible are required)

1. Implement drug formulary checks source
2. Incorporate lab results into EHR as structured data source
3. Generate list of patients by specific conditions for quality improvement source
4. Send patient reminders per patient preference source
5. Provide patients with timely electronic access to their health information source
6. Provide patient-specific education resources source
7. Perform medication reconcilliation source
8. Send summary care record to other providers source
9. Submit data to immunization registries source
10. Submit syndromic surveillance data source

Q: What about the required Clinical Quality Measures (CQM)?

• As above, providers must report 3 core CQM's
  1. Hypertension: Blood Pressure Measurement -- NQF0013: "Percentage of patient visits for patients aged 18 years and older with a diagnosis of hypertension who has been seen for at least 2 office visits, with blood pressure (BP) recorded." details details2
  2. Preventive Care Screening Measure Pair: details
     • Tobacco Use Assessment
     • Tobacco Cessation Intervention
  3. Adult Weight Screening and Follow-up details
  • OR, 3 alternate core CQM's can be reported. These are to be used if unable to use 3 CQM
  1. NQF 0024 -- BMI for age 2-18 details
  2. NQF 0041 -- Influenza vaccination details
  3. NQF 0038 -- Childhood immunization status details
• An additional 3 from a list of 38 CQM's must be reported. source
  1. Diabetes: Hemoglobin A1c Poor Control details
  2. Diabetes: Low Density Lipoprotein (LDL) Management and Control -- details
  3. Diabetes: Blood Pressure Management details
  4. Heart Failure (HF): Angiotensin-Converting Enzyme (ACE) Inhibitor or Angiotensin Receptor Blocker (ARB) Therapy for Left Ventricular Systolic Dysfunction (LVSD) details
  5. Coronary Artery Disease (CAD): Beta-Blocker Therapy for CAD Patients with Prior Myocardial Infarction (MI) details
  6. Pneumonia Vaccination Status for Older Adults details
  7. Breast Cancer Screening details
  8. Colorectal Cancer Screening details
  9. Coronary Artery Disease (CAD): Oral Antiplatelet Therapy Prescribed for Patients with CAD details
  10. Heart Failure (HF): Beta-Blocker Therapy for Left Ventricular Systolic Dysfunction (LVSD) details
  11. Anti-depressant medication management: (a) Effective Acute Phase Treatment, (b)Effective Continuation Phase Treatment details
  12. Primary Open Angle Glaucoma (POAG): Optic Nerve Evaluation details
  13. Diabetic Retinopathy: Documentation of Presence or Absence of Macular Edema and Level of Severity of Retinopathy details
  14. Diabetic Retinopathy: Communication with the Physician Managing Ongoing Diabetes Care details
  15. Asthma Pharmacologic Therapy details
  16. Asthma Assessment details
  17. Appropriate Testing for Children with Pharyngitis details
  18. Oncology Breast Cancer: Hormonal Therapy for Stage IC-IIIC Estrogen Receptor/Progesterone Receptor (ER/PR) Positive Breast Cancer details
  19. Oncology Colon Cancer: Chemotherapy for Stage III Colon Cancer Patients details
  20. Prostate Cancer: Avoidance of Overuse of Bone Scan for Staging Low Risk Prostate Cancer Patients details
  21. Smoking and Tobacco Use Cessation, Medical Assistance: a) Advising Smokers and Tobacco Users to Quit, b) Discussing Smoking and Tobacco Use Cessation Medications, c) Discussing Smoking and Tobacco # Use Cessation Strategies details
  22. Diabetes: Eye Exam details
  23. Diabetes: Urine Screening details
  24. Diabetes: Foot Exam details
  25. Coronary Artery Disease (CAD): Drug Therapy for Lowering LDL-Cholesterol details
  26. Heart Failure (HF): Warfarin Therapy Patients with Atrial Fibrillation -- NQF 0084
  27. Ischemic Vascular Disease (IVD): Blood Pressure Management details
  28. Ischemic Vascular Disease (IVD): Use of Aspirin or Another Antithrombotic details
  29. Initiation and Engagement of Alcohol and Other Drug Dependence Treatment: a) Initiation, b) Engagement details
  30. Prenatal Care: Screening for Human Immunodeficiency Virus (HIV) -- NQF 0012
  31. Prenatal Care: Anti-D Immune Globulin -- NQF 0014
  32. Controlling High Blood Pressure details
  33. Cervical Cancer Screening details
  34. Chlamydia Screening for Women details
  35. Use of Appropriate Medications for Asthma details
  36. Low Back Pain: Use of Imaging Studies details
  37. Ischemic Vascular Disease (IVD): Complete Lipid Panel and LDL Control details
  38. Diabetes: Hemoglobin A1c Control (<8.0%) details