Stage 3 Meaningful Use

Program Year 2019

All Providers in the Promoting Interoperability Program (formerly the Medicaid EHR Incentive Program) are considered to be Stage 3 Meaningful Use participants.

The following requirements are for the 2019 Program Year:

All EHR software must be certified at the 2015 certification level.  This allows for capturing and reporting Stage 3 Meaningful Use Objectives and Measures.  Please see the CMS requirement page for additional information

Please download the full list of Stage 3 Meaningful Use Objectives.

 

There are Eight Stage 3 Meaningful Use Objectives

Objective OneProtecting Patient Health Information

Conduct or review a Security Risk Analysis yearly (one for each program year)  Must be completed between January 1 and December 31, 2019.  There is not an allowable exclusion for this MU Objective.


Objective TwoElectronic Prescription

Generate and transmit permissible prescriptions electronically.

Measure 1 –  More than 60 percent of all permissible prescriptions written by the eligible professional (EP) are queried for a drug formulary and transmitted electronically using certified electronic health record technology (CEHRT).

Exclusions –  An EP may take an exclusion if any of the following apply: (1) Writes fewer than 100 permissible prescriptions during the Promoting Interoperability (PI) reporting period; or (2) Does not have a pharmacy within their organization and there are no pharmacies that accept electronic prescriptions within 10 miles of the EP’s practice location at the start of his or her EHR reporting period.


Objective Three – Clinical Decision Support

Implement clinical decision support (CDS) interventions focused on improving performance on high-priority health conditions.

Measure 1 – Implement five CDS interventions related to four or more clinical quality measures (CQMs) at a relevant point in patient care for the entire EHR reporting period. Absent four CQMs related to an EPs scope of practice or patient population, the CDS interventions must be related to high-priority health conditions.

Measure 2 – Enable and implement the functionality for drug-drug and drug-allergy interaction checks for the entire EHR reporting period.

Exclusions –  Measure 2: An EP who writes fewer than 100 medication orders during the EHR reporting period may take an exclusion.


Objective Four – Computerized Order Entry (C.P.O.E.)

Use CPOE for medication, laboratory, and diagnostic imaging orders directly entered by any licensed healthcare professional, credentialed medical assistant, or a medical staff member credentialed to and performing the equivalent duties of a credentialed medical assistant, who can enter orders into the medical record per state, local, and professional guidelines.  An EP must satisfy all three measures for this objective through a combination of meeting the thresholds and exclusions.

Measure 1 – More than 60 percent of medication orders created by the EP during the EHR reporting period are recorded using computerized provider order entry.

Measure 2 – More than 60 percent of laboratory orders created by the EP during the EHR reporting period are recorded using computerized provider order entry.

Measure 3 – More than 60 percent of diagnostic imaging orders created by the EP during the EHR reporting period are recorded using computerized provider order entry.

Exclusions – Measures 1, 2, and 3 – Any EP that writes fewer than 100 medication, lab, or diagnostic image orders during the EHR reporting period.


Objective Five – Patient Electronic Access to Health Information

The eligible professional (EP) provides patients (or patient-authorized representative) with timely electronic access to their health information and patient-specific education.  An EP must satisfy both measures for this objective through a combination of meeting the thresholds and exclusions:

Measure 1 – For more than 80 percent of all unique patients seen by the EP: (1) The patient (or the patient-authorized representative) is provided timely access to view online, download, and transmit his or her health information; and (2) The provider ensures the patient’s health information is available for the patient (or patient-authorized representative) to access using any application of their choice that is configured to meet the technical specifications of the Application Programming Interface (API) in the provider’s certified electronic health record technology (CEHRT).

This could mean that a secure email was sent, information was given out, instructions to set up portal account were given to the patient.

Measure 2 – The EP must use clinically relevant information from CEHRT to identify patient-specific educational resources and provide electronic access to those materials to more than 35 percent of unique patients seen by the EP during the EHR reporting.

Exclusions –  Measures 1 and 2: An EP may take an exclusion for either measure, or both, if either of the following apply: (i) He or she has no office visits during the EHR reporting period (this exclusion only applies to providers that offer supporting services – Radiologists, Cardiologists, Pathologists, etc…. – non-face-to-face encounters).

(ii) He or she conducts 50 percent or more of his or her patient encounters in a county that does not have 50 percent or more of its housing units with 4Mbps broadband availability according to the latest information available from the Federal Communications Commission (FCC) on the first day of the EHR reporting period (this exclusion does not apply to any Mississippi Providers).

Note:  These actions can occur before, during or after the 90-day EHR reporting period.


Objective Six – Coordination of Care Through Patient Engagement

Use certified electronic health record technology (CEHRT) to engage with patients or their authorized representatives about the patient’s care.   EPs must attest to all three measures and must meet the thresholds for at least two measures to meet the objective:

Measure 1 –  More than 5 percent of all unique patients (or their authorized representatives) seen by the eligible professional (EP) actively engage with the EHR made accessible by the EP and either— (1) View, download, or transmit to a third party their health information; or (2) Access their health information through the use of an Application Programming Interface (API) that can be used by applications chosen by the patient and configured to the API in the EP’s CEHRT; or (3) A combination of (1) and (2).

Measure 2 –  For more than 5 percent of all unique patients seen by the EP during the EHR reporting period, a secure message was sent using the electronic messaging function of CEHRT to the patient (or the patient-authorized representative), or in response to a secure message sent by the patient or their authorized representative.

(new 2019) Measure 3 –  Patient generated health data or data from a non-clinical setting is incorporated into the CEHRT for more than 5 percent of all unique patients seen by the EP during the EHR reporting period.

Exclusions –  Measures 1, 2, and 3 : An EP may take an exclusion for either measure, or both, if either of the following apply: (i) He or she has no office visits during the EHR reporting period (this exclusion only applies to providers that offer supporting services – Radiologists, Cardiologists, Pathologists, etc…. – non-face-to-face encounters).

(ii) He or she conducts 50 percent or more of his or her patient encounters in a county that does not have 50 percent or more of its housing units with 4Mbps broadband availability according to the latest information available from the Federal Communications Commission (FCC) on the first day of the EHR reporting period (this exclusion does not apply to any Mississippi Providers).

Note:  These actions can occur before, during or after the 90-day EHR reporting period.


Objective Seven –  Information Exchange

The eligible professional (EP) provides a summary of care record when transitioning or referring their patient to another setting of care, receives or retrieves a summary of care record upon the receipt of a transition or referral or upon the first patient encounter with a new patient, and incorporates summary of care information from other providers into their electronic health record (EHR) using the functions of certified EHR technology (CEHRT).  EPs must attest to all three measures and must meet the threshold for at least two measures to meet the objective:

Measure 1 –  For more than 50 percent of transitions of care and referrals, the EP that transitions or refers their patient to another setting of care or provider of care: (1)Creates a summary of care record using CEHRT; and(2)Electronically exchanges the summary of care record (this can be easily done through the Secure Messaging functionality of the EHR)

Measure 2 –  For more than 40 percent of transitions or referrals received and patient encounters in which the EP has never before encountered the patient, he/she incorporates into the patient’s EHR an electronic summary of care document.

Measure 3 –  For more than 80 percent of transitions or referrals received and patient encounters in which the EP has never before encountered the patient, he/she performs a clinical information reconciliation. The EP must implement clinical information reconciliation for the following three clinical information sets: (1)Medication. Review of the patient’s medication, including the name, dosage, frequency, and route of each medication.  (2)Medication allergy. Review of the patient’s known medication allergies. (3)Current Problem list. Review of the patient’s current and active diagnoses.

Exclusions – Measures 1 and 2  Fewer than 100 patients are referred to another point of care.  Fewer than 100 patients are received/transferred from another point of care.

He or she conducts 50 percent or more of his or her patient encounters in a county that does not have 50 percent or more of its housing units with 4Mbps broadband availability according to the latest information available from the Federal Communications Commission (FCC) on the first day of the EHR reporting period (this exclusion does not apply to any Mississippi Providers).


Objective Eight  – Public Health Reporting

The eligible professional (EP) is in active engagement (*see note below) with a public health agency (PHA) or clinical data registry (CDR) to submit electronic public health data in a meaningful way using certified electronic health record technology (CEHRT), except where prohibited, and in accordance with applicable law and practice.  An EP must satisfy two measures for this objective. If the EP cannot satisfy at least two measures, they may take exclusions from all measures they cannot meet.

Measure 1  –   Immunization Registry Reporting: The EP is in active engagement with a PHA to submit immunization data and receive immunization forecasts and histories from the public health immunization registry/immunization information system (IIS).

Measure 2  –  Syndromic Surveillance Reporting: The EP is in active engagement with a PHA to submit syndromic surveillance data.

Measure 3  –  Electronic Case Reporting: The EP is in active engagement with a PHA to submit case reporting of reportable conditions.

Measure 4  –  Public Health Registry Reporting: The EP is in active engagement with a PHA to submit data to public health registries.

Measure 5  –  CDR Reporting: The EP is in active engagement to submit data to a CDR.

Exclusions: 

Measure 1:   An EP may take an exclusion if – He or she does not administer immunizations to any of the populations served.  This could include providers that do not administer any immunizations as part of their normal scope of practice.

Measure 2:   Any of the following Exclusions are applicable and allowable in Mississippi  (1) does not capture syndromic surveillance data,  (2) operates in a jurisdictions for which no PHA is capable of receiving electronic syndromic surveillance data,  (3) He or she practices in a jurisdiction where no PHA has declared readiness to receive syndromic surveillance data from EPs as of six months prior to the start of the EHR reporting period.   Note: Mississippi will accept Syndromic Surveillance data reporting under the following conditions:  The clinic is part of a large health enterprise system (sharing the same EHR) and this system is already onboarded with the Syndromic Surveillance Registry.

Measures 3, 4, and 5:     An EP may take an exclusion if any of the following apply:   (1)He or she does not diagnose or directly treat any reportable diseases for which data is collected by their jurisdiction’s reportable disease system during the EHR reporting period;   (2)He or she practices in a jurisdiction for which no PHA is capable of receiving electronic case reporting data in the specific standards required to meet the CEHRT definition at the start of the EHR reporting period; or  (3)He or she practices in a jurisdiction where no PHA has declared readiness to receive electronic case reporting data as of six months prior to the start of the EHR reporting period.

There are three levels of Active Engagement:

(1)  RegistrationCompleted registration process  within 60 days after the start of 90-day EHR Reporting Period.  Registrations from previous years would be acceptable.  However, this status may be lost if the clinic does not appropriately respond to the registry when notified to move into the next level of Active Engagement.  A letter of Acknowledgement will be required during attestation of the EHR for Meaningful Use in Mississippi.

If an Exclusion is taken, the EP must upload a brief statement (on clinic letterhead) such as:  I am taking an exclusion for Measure 1 (Immunization Registry Reporting).  I do not administer any immunizations because this is outside of my normal scope of practice.

(2) Testing and Validation –  The EP is in the process of testing and validation of the electronic submission of data. EPs must respond to requests from the PHA or, where applicable, the CDR within 30 days; failure to respond twice within an EHR reporting period would result in that EP not meeting the measure.

(3) Production – The EP has completed testing and validation of the electronic submission and is electronically submitting production data to the PHA or CDR.

Please read the entire CMS Specification Sheet for MU Obj 8 – Public Health Reporting for a full understanding of reporting requirements.

Please contact our office if you have additional questions.        Email: ms-ehr@medicaid.ms.gov


 

 

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