Series 1: “Meaningful Use” for Behavioral Health Providers

PowerPoint Presentation

Series 1: Meaningful Use for Behavioral Health Providers9/2013From the CIHS Video Series Ten Minutes at a Time

Module 3: Core Objectives/Measures for Behavioral Health Providers

Part 2 - Objectives 8 through 15

Welcome to the SAMHSA-HRSA Center for Integrated Health Solutions video series Ten Minutes at a Time. This information on how to meet the standards for Meaningful Use and how to select and successfully implement an electronic health record system is organized into brief, convenient modules targeted to Behavioral Health providers. This is Series 1: Meaningful Use for Behavioral Health Providers Module 3, Meaningful Use Core Objectives and Measures in Behavioral Health, Part 2 Objectives 8 through 15. The goal of this module is to provide a high level overview of Core Objectives and Measures from the perspective of the Behavioral Health provider. It is divided into two parts to ensure that each of the 15 Objectives receives an appropriate level of consideration. 1Module 3, Part 2 OverviewReview of key terms and concepts from Part 1Core Objectives and Measures 8 through 15 from the perspective of the Behavioral Health provider

We will begin by reviewing the key terms and concepts introduced in Part 1, then examine Core Objectives and Measures 8 through 15 from the perspective of the Behavioral Health provider.2Key Terms/Concepts

Unique patientPatient seen one or more times, only counted once during the EHR reporting periodUsed for arriving at the denominator in many of the measures

Attestation Some measures require that the EP confirm that certain EHR functionality has been enabled and is in use

Exclusion RuleNot all measures can be met by every EP, due to different types of practices and patients. These types of measures have an exclusion rule that excludes the EP from having to meet that particular Objective. Each application of the exclusion rule reduces the total number of Core Objectives that must be met.

Here are some key terms and concepts. A unique patient is any patient that has been seen at least once by the Eligible Professional (EP). The patient may visit several times during a year, but they are still counted as only one patient. A patient who is reported as a unique patient in Year 1 is recounted as a unique patient in Year 2, as long as they have been seen by the EP at least once at any point during Year 2. The number of unique patients seen by the EP is used as the denominator for calculating many of the Measures. We will be reviewing some Objectives that only require the EPs attestation-that is, their confirmation that the necessary EHR functionality is enabled and in use. Some Objectives have an Exclusion Rule. It is not possible for all types of EPs to attain all of the Objectives. For example, dentists do not give immunizations. In these cases, the EP can claim that the Exclusion Rule applies to their practice. Each of the Objectives presented here identify the Exclusion Rule when there is one. When the Exclusion Rule is applied, it reduces the overall number of Core Objectives that must be attained. 3

More about this Objective, in Generalhttp://www.healthit.gov/providers-professionals/achieve-meaningful-use/core-measures/record-vital-signs More about collecting vital signs in the Behavioral Health settinghttp://www.muforbh.com/vital-signs-are-vital

Objective 8 may be one of the most challenging for some Behavioral Health providers to meet if they are not already in the practice of collecting vital signs. Although the Objective has an Exclusion Rule, it would be difficult to effectively argue that height, weight and blood pressure are not relevant to the Behavioral Health providers practice. For example, psychiatric medications may cause significant weight gain, and therefore susceptibility to the related chronic health conditions. Some providers have tried to collect vital signs data in the past. Barriers include the fact that it is not a reimbursable behavioral health service, the practice is too busy to collect the information consistently, and/or staff lack the expertise. This Objective underscores the fact that it is sometimes necessary to introduce new workflows to meet the Objectives.

http://www.healthit.gov/providers-professionals/achieve-meaningful-use/core-measures/record-vital-signs

http://www.muforbh.com/vital-signs-are-vital

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More about this Objectivehttp://www.healthit.gov/providers-professionals/achieve-meaningful-use/core-measures/record-smoking-status More about tobacco cessation and intervention in behavioral healthhttp://www.integration.samhsa.gov/resource/tobacco-cessation-for-persons-with-mental-illnesses-a-toolkit-for-mental-health-providers

Thanks to national tobacco control efforts, tobacco use in the general population has decreased dramatically since it reached a peak in the 1960s. Yet those with serious mental illness and/or substance use disorders continue to use tobacco at that peak rate, and experience the related health problems at a much higher percent than the general population.

Sometimes even the suggestion of acknowledging tobacco dependence as a significant mental health care issue can raise resistance, because tobacco use is often an accepted part of the treatment setting culture. Providers might be surprised to discover that many of their patients are interested in quitting; that treatment outcomes actually improve when tobacco intervention and cessation are part of the treatment plan; and there are evidence-based practices that can help patients with serious mental illness and/or substance use disorders achieve the goal of freedom from tobacco.

Tobacco intervention and cessation activities also appear in the core set of Clinical Quality Measures (Objective 10, discussed in the next slide).

http://www.healthit.gov/providers-professionals/achieve-meaningful-use/core-measures/record-smoking-status

http://www.integration.samhsa.gov/resource/tobacco-cessation-for-persons-with-mental-illnesses-a-toolkit-for-mental-health-providers

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More about this Objectivehttp://www.healthit.gov/providers-professionals/achieve-meaningful-use/core-measures/clinical-quality-measures

Module 5 in this series goes into detail about Core Objective 10, Report Ambulatory Clinical Quality Measures (or CQMs) to CMS. In Stage 1, Behavioral Health and other providers who are following the Medicaid track will report this data to the State Medicaid Office, and attest to this activity. It is important to note that there are no exclusion rules related to reporting CQMs. However, the denominator for a CQM may be reported as 0. See Module 5 for more information on this.

Click this link for more information about this Objective: http://www.healthit.gov/providers-professionals/achieve-meaningful-use/core-measures/clinical-quality-measures

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More about this Objectivehttp://www.healthit.gov/providers-professionals/achieve-meaningful-use/core-measures/clinical-decision-support-rule

Besides the drug-drug and drug-allergy alerts in Core Objective 2, the EHR must allow the EP to implement an additional Clinical Decision Support rule. The provider should consider Clinical Decision Support (or CDS) tools that do not interfere with the professionals workflow or increase the cognitive burden. Consider the selection of CDS interventions that are not alerts, including disease specific order sets or documentation forms and templates, that remind the provider to capture essential historical or physical exam findings for a patient with a certain diagnosis.

Click this link for more information about this Objective: http://www.healthit.gov/providers-professionals/achieve-meaningful-use/core-measures/clinical-decision-support-rule

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More about this Objectivehttp://www.healthit.gov/providers-professionals/achieve-meaningful-use/core-measures/electronic-copy-of-health-information http://www.gpo.gov/fdsys/pkg/FR-2010-07-28/pdf/2010-17210.pdf More the Electronic Specifications for Certification

When responding to patient requests for information, the Behavioral Health provider should continue to follow the HIPAA Privacy Rule as specified at 45 CFR 164.524 which addresses access of individuals to protected health information. It outlines the requirements that providers must follow for providing patients with electronic copies of their health information. Note that while HIPAA allowed the provider 30 days for this process, the Meaningful Use Objective only allows 3 business days. Treatment plans and progress notes may be considered for inclusion, but that would be according to the HIPAA rules concerning this. Psychotherapy notes are not part of the patient record and are not included. An electronic copy of health information may include access via an online patient portal.

http://www.healthit.gov/providers-professionals/achieve-meaningful-use/core-measures/electronic-copy-of-health-information

http://www.gpo.gov/fdsys/pkg/FR-2010-07-28/pdf/2010-17210.pdf

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More about this Objectivehttp://www.healthit.gov/providers-professionals/achieve-meaningful-use/core-measures/clinical-summaries More about Behavioral Health and Sharing Patient Informationhttp://www.healthit.gov/sites/default/files/bh-roundtable-findings-report_0.pdf

When we visit the doctors office, we are accustomed to receiving a clinical summary of the visit this includes any special directions from the provider to the patient, medications prescribed, referrals made, results of diagnostic tests if they are available, and so on. Clinical summaries are an important component of Meaningful Use since they can be used for making patient referrals, closing the referral loop and communicating critical information to the patient and their caregivers. Objectives 13 and 14 are both concerned with ensuring that the patient information follows the patient throughout the health care system, and they are explored in depth in Module 8.

http://www.healthit.gov/providers-professionals/achieve-meaningful-use/core-measures/clinical-summaries

http://www.healthit.gov/sites/default/files/bh-roundtable-findings-report_0.pdf

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More about this Objectivehttp://www.healthit.gov/providers-professionals/achieve-meaningful-use/core-measures/electronic-exchange-of-clinical-information More about the EHR Certification Criteriahttp://www.gpo.gov/fdsys/pkg/FR-2010-07-28/pdf/2010-17210.pdf

The phrase key clinical information references a minimum patient data standard that is part of federal statute and is in use throughout the country. It is summarized in the Objective. This Objective is discussed in detail in Module 8. At this time there are basically two ways to exchange this data set through the State or Regional Health Information Exchange, and through the point-to-point transmission of information using Nationwide Health Information Network (NwHIN) Direct. Direct is essentially a very secure email system that allows providers to exchange patient data electronically while adhering to all applicable requirements, thereby meeting the standard for Meaningful Use. Please see Modules 8 and 10 for more information on how Behavioral Health providers can participate in this type of patient information exchange.

http://www.healthit.gov/providers-professionals/achieve-meaningful-use/core-measures/electronic-exchange-of-clinical-information

http://www.gpo.gov/fdsys/pkg/FR-2010-07-28/pdf/2010-17210.pdf

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More about this Objectivehttp://www.healthit.gov/providers-professionals/achieve-meaningful-use/core-measures/protect-electronic-health-information More about HIPAA Privacy and Securityhttp://www.hhs.gov/ocr/privacy/hipaa/understanding/special/healthit/

HIPAA Privacy and Security Rules and compliance with 42 CFR Part 2 are discussed in detail in Module 10 of this series. Keep in mind that rules and regulations are not intended to prevent the flow of patient information. They are intended to provide the guidance necessary to ensure that patient information is shared appropriately in the course of patient care. Although these protections sometimes represent challenges in the exchange of patient information, it is still possible for Behavioral Health providers to participate in exchange and adhere to all applicable federal statutes. 11SummaryEach Objective has its own Measure Determine Objective was attained Calculate the number of unique patients seen by the EP during the reporting period (denominator), and; Calculate the number of unique patients who received the service (numerator)Expressed as a percentCompared to the Measure requirementSome Objectives have an exclusion rule and some only require that the EP attest that the functionality is in use

So, here are some important things to keep in mind. There are 15 Core Objectives, and each Objective has its own Measure. To confirm that the Objective has been attained, the certified complete EHR must be able to calculate the number of unique patients seen by the EP that meet the measure requirements, and then calculate how many of those received the identified treatment. This is expressed as a percent of patients and compared to the Meaningful Use measure. Some Objectives have an exclusion rule and some only require that the EP attest that the functionality is in use.

12We Have Solutions for Integrating Primary and Behavioral Healthcare

Contact CIHS for all types of primary and behavioral health care integration technical assistance and training needs

1701 K Street NW, Ste 400 Washington DC 20006

Web: www.integration.samhsa.govEmail:[email protected]:202-684-7457

Prepared and presented by Colleen ODonnell, MSW, PMP, CHTS-IM for the Center for Integrated Health Solutions

Our thanks go to SAMHSA and to HRSA for providing support to the Center for Integrated Health Solutions (CIHS) for this and many other forms of training and technical assistance related to the integration of primary and behavioral health care. Please visit our web site at www.integration.samhsa.gov, email us at [email protected], or just pick up the phone and give us a call at 202-684-7457.

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