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Indian Health Service The Federal Health Program for American Indians and Alaska Natives

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Performance Measures, 2014-15

Many differences exist among Stage 1, 2013; Stage 1, 2014; and Stage 2, 2014. Some measures have moved from menu to core; some have higher thresholds; some have new requirements; and some have a combination of these changes. Stage 2 also includes several completely new measures. Let's start with the new core measures.

  • Electronic Medication Administration Record (eMar):
    • Measure (EHs only): Automatically track medications from order to administration using assistive technologies in conjunction with an electronic medication administration record (eMAR).
    • Exclusion: Any eligible hospital or CAH with an average daily inpatient census of fewer than 10 patients is excluded from meeting this measure.
  • Secure Electronic Messaging:
    • Measure (EPs only): Use secure electronic messaging to communicate with patients on relevant health information.
    • Exclusion: Any EP who has no office visits during the EHR reporting period or who 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 3Mbps broadband availability according to the latest information available from the FCC on the first day of the EHR reporting period is excluded from the measure. See the National Broadband Map Exit Disclaimer: You Are Leaving www.ihs.gov website for broadband availability.

Stage 2 criteria emphasize patient engagement.

  • Patient Electronic Access:
    • Measure (EPs only): Provide patients the ability to view online, download, and transmit their health information within four business days of the information being available to the EP. (This measure is a combination of three Stage 1, 2013 measures.)
    • Measure (EHs only): Provide patients the ability to view online, download, and transmit their health information within 36 hours after discharge from the hospital.
    • Measure: More than five percent of patients who are seen by the EP or who are discharged from the inpatient or emergency department of an EH must view, download or transmit their information.
      • Any EP or EH who conducts 50 percent or more encounters in a county that does not have 50 percent or more of its housing units with 3Mbps broadband availability according to the latest information available from the FCC on the first day of the EHR reporting period is excluded from this measure (but not from the other two patient access measures listed above). See the National Broadband Map Exit Disclaimer: You Are Leaving www.ihs.gov website for broadband availability.

Stage 2 criteria also focus heavily on the quality of information exchange among providers as a means of improving care coordination for patients.

  • Summary of Care:
    • Measure: EPs and EHs who transition or refer a patient to another setting of care or provider of care to are required to provide a summary of care record for more than 50% of those transitions of care and referrals.
    • Measure: For more than 10% of those transitions and referrals, EPs and EHs that transition or refer their patient to another setting of care or provider of care must provide a summary of care record electronically.
    • Measure: EPs and EHs that transition or refer their patient to another setting of care or provider of care must either a) conduct one or more successful electronic exchanges of a summary of care record with a recipient using technology that was designed by a different EHR developer than the sender's, or b) conduct one or more successful tests with the CMS-designated test EHR during the EHR reporting period.

Several existing measures have also changed.

  • CPOE:
    • Threshold for medication orders has increased to more than 60 percent.
    • (New) 30 percent of laboratory orders must be recorded using CPOE.
    • (New) 30 percent of radiology orders must be recorded using CPOE.
  • Vital Signs:
    • Threshold has increased to more than 80 percent.
    • Patient age has increased from two years and older to three years and older.
    • The number of exclusions has expanded from one to four.
  • Clinical Decision Support:
    • New: The number of CDS interventions has increased to five.
    • Moved from core to menu: The EP/EH has enabled and implemented the functionality for drug-drug and drug-allergy interaction checks.
  • Clinical Summaries (EPs only): The time allowed for providing clinical summaries to patients for more than 50 percent of all office visits has decreased from three days to one day.
  • Patient Reminders (EPs only): Moved from menu to core. Thresholds have increased to 10 percent of unique patients who have had two or more office visits with their EP within 24 months before the beginning of the EHR reporting period.
  • Patient Lists: Moved from menu to core.
  • Patient Education: Moved from menu to core.
  • Medication Reconciliation: Moved from menu to core.
  • Immunization Registries: Moved from menu to core. Changed from one-time to ongoing submission.
  • Electronic Reportable Laboratory Results (EHs only): Moved from menu to core. Changed from one-time submission to ongoing submission.
  • Syndromic Surveillance (Core for EHs; Menu for EPs): Changed from one-time to ongoing submission.
  • Record Demographics: Threshold increased to more than 80 percent.
  • Smoking Status: Threshold increased to more than 80 percent.
  • Clinical Lab Test Results (moved from menu to core): Threshold increased to more than 55 percent.
  • E-Rx (moved from menu to core, EPs only): Threshold increased to more than 50 percent.

Listed below are the new Stage 2 menu measures.

  • Record electronic notes in patient records.
  • Imaging results accessible through CEHRT.
  • Record patient family health history.
  • (EPs only) Identify and report specific cases to a specialized registry (other than a cancer registry).
  • (EHs only) Generate and transmit permissible discharge prescriptions electronically (eRx).
  • Identify and report cancer cases to a state cancer registry (EPs only).*
  • Provide structured electronic lab results to ambulatory providers (for EHs only).*

* The 2014 certified RPMS EHR will not support the measures for cancer registry and electronic lab results to ambulatory providers.

Helpful Resources

Listed below are links that may prove useful in achieving Stage 1 and Stage 2 MU.