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.

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)"
   • 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. NQF0013 – Hypertension: Blood Pressure Measurement
  2. NQF0028 – Preventive Care Screening Measure Pair:
     • Tobacco Use Assessment
     • Tobacco Cessation Intervention
  3. NQF0421 – Adult Weight Screening and Follow-up
  • OR, 3 alternate core CQM's can be reported. These are to be used of unable to use 3 CQM
  1. NQF 0024 -- BMI for age 2-18
  2. NQF 0041 -- Influenza vaccination
  3. NQF 0038 -- Childhood immunization status
• An additional 3 from a list of 38 CQM's must be reported.