meaningful use stage 1, 2014 edition webinar stage 1 2011

Meaningful Use – Stage 1, 2014 edition Webinar

For additional information regarding PrognoCIS, please visit our Client Resource Center ( ).

Stage 3 After 2016

(improved outcomes)

4010 Moorpark Avenue, Suite 222 San Jose, CA 95117

www.prognocis.com [email protected] Copyright 2014 – Bizmatics, Inc.

Stage 1 2011 – 2013

(data capture/sharing)

Stage 2 2014 – 2015

(adv. clinical processes)

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Meaningful Use – Stage 1 http://www.cms.gov/Regulations-and-Guidance/Legislation/EHRIncentivePrograms/Meaningful_Use.html

Determine your eligibility Choose a program (Medicare or Medicaid)

See Downloads EHR EP Decision Tool.Zip

Register with CMS Each EP must register per individual clinical credentials even if part of a Group

Implement required measures Have MU settings enabled within PrognoCIS Gather data for specified reporting period

File attestation with CMS Meaningful Use consists of 3 stages EP must participate for 2 years under Stage 1

User-related Guides and FYI

http://cms.gov/apps/ehealth-eligibility/ehealth-eligibility-assessment-tool.aspx

Eligibility

Per Provider Type, Medicare or Medicaid

Fully-credentialed

Mid-level

Registration & Attestation with CMS https://ehrincentives.cms/gov/hitech/login.action

Bookmark this page

http://www.cms.gov/Regulations-and-Guidance/Legislation/EHRIncentivePrograms/Downloads/EHR

MedicareEP_RegistrationUserGuide.pdf

EHR Certification: #A014E01MAG3ZEAV • EP must register under individual credentials • This number effective January 1, 2014

Medicare Meaningful Use - 2014

Available only to credentialed providers (MD, DO); mid-level (PA, ARNP) not eligible

Medicare EPs must select a 3-month period based upon year of participation, i.e.:

1st year attesters can choose any 90 days but must begin by July 1 & attest by Oct. 1, 2014 to

avoid 2015 payment adjustment; 2016 payment adjustment only applies after Feb. 28, 2015.*

Users beyond their 1st year must choose a period that corresponds to calendar-year quarter.

January 1 – March 31, 2014

April 1 – June 30, 2014

July 1 – September 30, 2014

October 1 – December 31, 2014

*Attestation Deadline: Feb 28, 2015.

*https://www.cms.gov/apps/files/statecontacts.pdf

Medicaid Meaningful Use - 2014

Available to credentialed providers (MD, DO) as well as mid-level (PA, ARNP)

Medicaid EPs can select any 90-day period within calendar year 2014

EP census from previous calendar year must = 20% Pediatrics/30% Adult or Mixed patients who are

Medicaid-eligible

Verify with your state*

http://www.cms.gov/Regulations-and-Guidance/Legislation/EHRIncentivePrograms/Participation-Timeline.html

Stage 1 Payment/Penalty Adjustment • Medicare EPs who do not successfully meet requirements by 2014 are subject to payment adjustments:

• 2015 payment adjustment is based on failing to successfully attest in 2013 (or by Oct 1, 2014*) • 2016 payment adjustment is based on failing to successfully attest in 2014

• Incentive payments are independent of payment adjustments; hence an incentive can be earned and yet provider still be penalized (i.e.: by failing to comply with deadlines or qualify for hardship exemption)

• Incentives will no longer be available for any EP who does not demonstrate MU by 2014

*Oct. 1, 2014 deadline as per

Hardship Exemption (see next slide)

Payment Adjustment Hardship Exemption http://www.cms.gov/Regulations-and-Guidance/Legislation/EHRIncentivePrograms/Downloads/PaymentAdj_HardshipExcepTipSheetforEP.pdf

Revised deadline to apply for 2015 hardship must

submit their application by Nov 30, 2014.

http://www.cms.gov/Regulations-and-Guidance/Legislation/EHRIncentivePrograms/Downloads/HardshipExtension_Application.pdf

EHR Incentive Rule Revisions - October 2014 https://www.federalregister.gov/articles/2014/09/04/2014-21021/medicare-and-medicaid-programs-

modifications-to-the-medicare-and-medicaid-electronic-health-record

Important Notes:

PrognoCIS is fully certified for 2014 Meaningful Use; hence EHR

Flexibility Rules do not apply to our providers. Some exceptions

will be made available per individual measures, however.

Email inquiries to: [email protected]

Educational Resources Page at CMS http://www.cms.gov/Regulations-and-Guidance/Legislation/EHRIncentivePrograms/EducationalMaterials.html

1. Use CPOE for entering medication orders 2. Drug/Drug and Drug/Allergy interaction checking 3. Maintain up-to-date Problem List of current/active diagnoses 4. Generate and transmit permissible prescriptions electronically (eRx) 5. Maintain active medications list 6. Maintain active medication allergies list 7. Record specific demographics (Language, Gender, Race, Ethnicity, DOB) 8. Record and chart changes in specific vital signs (Height, Weight, BP, BMI) 9. Record smoking status for patients 13 years old or older 10. Implement 1 clinical decision support rule relevant to specialty 11. Provide patients ability to view online, download, or transmit PHI within

four business days 12. Provide clinical summaries for patients for each office visit 13. Protect electronic health information via CEHRT through technical

capabilities

Core Set Measures http://www.cms.gov/Regulations-and-Guidance/Legislation/EHRIncentivePrograms/Downloads/EP-MU-TOC.pdf*

EP must be able to physically demonstrate compliance per audit requirements.

Some measures modified in 2014

http://www.cms.gov/Regulations-and-Guidance/Legislation/EHRIncentivePrograms/Downloads/Stage1ChangesTipsheet.pdf

For 2nd year attesters, 2014 measures are modified from 2011

edition.

• Denominator = total number of orders created by the EP during the reporting period • Numerator = total number of medications entered into the CEHRT structured data (CPOE),

(status must be either A or O), which must exceed 30%.

CPOE for Medication Orders Core Set 1 30%

Note: • For 2014 certification, PrognoCIS has selected the alternate option of counting the

number of medications ordered for the Denominator instead of the number of unique patients seen as in Meaningful Use 2011 edition.

Exclusion: Any EP who writes fewer than 100 prescriptions during the 90-day reporting period.

PrognoCIS chose this

option.

CPOE for Medication Orders (cont’d)

Encounter TOC a Prescription CPOE a Refill / Rx

Encounter TOC Prescription CPOE Refills • Status must = A (Approved) or O (Ordered) to be counted in the Numerator • Method of transmission is not a factor (can be printed, eRx, or Fax)

Face Sheet Current Medications • Source = Ext Rx (new feature to v3*)

• *External Rx must be part of Denominator only • Rx Date must reflect the actual date when the

medication was ordered; not data-entry date.

The EP must implement* drug-drug and drug-allergy interaction checking for the entire reporting period.

Drug Interaction Validation Core Set 2

Yes/No

• Attestation = Attest Yes that you have implemented/enabled Drug/Drug and Drug/Allergy Interaction validation checks within the CEHRT.

Notes: • The measure does not require that indications actually exist. • If MU is enabled for the clinic, this feature is automatically enabled regardless of system

properties rx.check.drugdruginteraction/rx.check.dispensabledrugs.allergy. • Property rx.drugdruginteraction.severitylevel still determines the level of severity that will

be applied for the interaction checking.

*See Appendix E – MU Settings – Setup Required tab

Prescription a Update /Save a Alert pop-up

Drug Interaction Checks

Severity Level Interaction allergy.druginteraction.severitylevel rx.drugdruginteraction.severitylevel

• 1 – Most severe • 2 – Moderately severe • 3 – Least severe

Rx-Hub automatically

enabled for EP.

Maintain Problem List Core Set 3

80%

• Denominator = all unique patients seen by the EP* during the reporting period • Numerator = total number of patients in denominator who have at least one entry in the

structured data (that is an ICD Code) or an indication that there are no known problems for the patient, and this must exceed 80%

Notes: • The problem list must consist of current and active as well as past diagnoses relevant

to the care of the patient. If there are no known diagnoses, an indication to that status must be documented (i.e.: select No Known Medical History check box).

• “Up-to-date” means the most recent diagnosis known by the EP; the knowledge of which can be ascertained from previous records or CCD received during transition of care from another provider.

• ONC Certification requires ICD-9 or SNOMED-CT be used to identify the problem.

*See Appendix C – Encounter Type Setup

Maintain Problem List (cont’d)

Face Sheet a Past Medical History

Workflow Adjustment:

Conversion Alert! If you use Patient Forms from the Portal for patients

to complete their history information, you may have to modify the PMH section to provide a

ICD Master Search rather than a text field.

User Navigation

Alert

Per ICSA certification, only problems identified by ICD-9 or SNOMED codes are

considered in the numerator for compliance. Ailments or Symptoms are n/a.

• Denominator = total number of all permissible prescriptions written for drugs requiring a prescription by EP during the reporting period excluding Controlled Substances, In-house, Sample, OTC, & Custom drugs.

• Numerator = total number of permissible drugs* within the denominator that are electronically transmitted, which must exceed 40%.

e-Prescribing (eRx) Core Set 4 40%

Notes: • *The concept of “permissible prescriptions” refers to the current restrictions established by

DOJ , RE: EPCS (http://www.deadiversion.usdoj.gov/schedules/orangebook/e_cs_sched.pdf). • Instances where patient specifically requests a paper prescription may not be excluded

Exclusion: (a) Any EP who writes fewer than 100 prescriptions

during the 90-day reporting period; OR, (b) if there is no in-house pharmacy nor an eRx pharmacy

within 10 miles of the practice location.

E-Prescription Encounter TOC Prescription eRx • Denominator looks at the drug Type column • Numerator depends upon a pharmacy being assigned w/eRx symbol

eRx sends Rx directly to pharmacy

Prescription a eRx icon

Denominator • Drug Types eRx, blank

• EPCS (Signed, Not Signed) n/a for Stage 1 Numerator • Pharmacy must be eRx enabled

In this example, the Denominator = 2, Numerator = 1

Active Medication List Core Set 5

80%


structured data or an indication that there are no known medications for the patient, and this must exceed 80%

Notes: • If there are no known medications, an indication to that status must be documented

(i.e.: select No Known Current Medication check box). • Providers are not required to update this list on every encounter.


Medication List (cont’d)

Face Sheet a Current Medication

Do not leave blank.

To learn about

Transition of Care, see v3 Upgrade webinar!

User Navigation

Alert

Medication Allergy List Core Set 6

80%


structured data or an indication that there are no known drug allergies for the patient, and this must exceed 80%

Notes: • If there are no known drug allergies, an indication to that status must be documented

(i.e.: select No Known Drug Allergies check box). • Providers are not required to update this list on every encounter.


Medication Allergy List (cont’d)

Face Sheet a Allergy

Do not leave blank as to

DRUG allergies.

Counts as Drug Allergy: • Allergens • Allergy Ingredient • Dispensable Drug • Generic Drug

Not Count as Drug Allergy: • Food • Environmental

User Navigation

Alert

Record Demographics

• Denominator = all unique patients seen by the EP* during the reporting period • Numerator = patients who have all five required elements recorded in Patient Register

(unless prohibited by law as supported by proper notation), and must exceed 50%; e.g.:

• Date of Birth • Gender • *Preferred Language • *Race • *Ethnic Group

Core Set 7 50%


Conversion Alert! Only ACTIVE values will be counted for MU.

Converted & HL7 interface values must match exactly, or they will be flagged as (Inactive) & excluded unless the user modifies these

after the conversion occurs. http://www.loc.gov/standards/iso639-2/php/English_list.php

http://www.cdc.gov/phin/tools/PHINvads/index.html http://www.cdc.gov/phin/activities/vocabulary.html

Patient Register • auto-complete, pre-defined lists per MU standards (non-customizable) • Race support up to 5 maximum values; selecting new values will overwrite existing values. • Only permissible scenario to skip these values is where prohibited by law to obtain such data

Patient Register a Other Info

Record Vital Signs Core Set 8 50%

• Denominator = all unique patients seen by EP* during the reporting period • Numerator = patients who have at least 1 entry of the respective vital signs (per pre-defined

conditions*) and must exceed 50%; e.g.: • Height/Length and weight (required for all ages; must be numerically recorded) • Blood pressure (applicable only for age 3 and above; must be numerically recorded)

*See Appendix E – MU Settings – Provider & Clinic tabs


Note: • If you are not currently recording values as separate, numerical fields, you will have to

modify your templates accordingly.

Encounter TOC Vitals

Encounter TOC a Vitals

BMI is required; however, is not necessary for attestation.

User Navigation

Alert

Exclusions (see Appendix E): 1 – Any EP who believes all 3 vitals are not relevant to scope of practice are excluded 2 – Any EP who sees no patients 3 & over are excluded from BP 3 – Any EP who believes Ht/Wt is relevant but BP is not are excluded from recording BP 4 – Any EP who believes BP is relevant but Ht/Wt is not are excluded from recording height/length & weight

Vital Signs Template • Weight, Height, and BP are data-entry fields by clinician • Blood Pressure must be entered as two separate, numeric fields *

Note: A single, fraction text field entry is no longer acceptable. • Attestation does not require Growth Chart nor BMI to be reported.

Record Smoking Status Core Set 9 50%

Exclusion: Any EP who does not see nor admit

any patient 13 y/o or above.


• Denominator = all unique patients over age of 13 seen by EP* during the reporting period • Numerator = patients who record smoking status as structured data, which must exceed

50%.

Notes: • You must specify 1 out of 8 standard responses, each of which is mapped to an applicable

SNOMED-CT code. Yes/No is not an acceptable response. • Users must be trained to use the new element that is added during conversion and stop

using the older question, which is no longer valid. • ICSA certification requirement; not necessarily CMS.

Social History

Face Sheet a Social History a Smoking Status

Social History Template Smoking Status • Each valid answer will be linked to its appropriate SNOMED-CT-CT Code • Applicable properties/templates will be updated during conversion to reflect new data

User Navigation

Alert

Note: A new element will be added to all

existing SH templates – you must remember to

answer it and not previous ones.

Conversion Alert! If you use Patient Forms from the Portal for patients

to complete their history information, you may have to modify the this question (when new Elements are added to library, forms must be

recompiled to reflect them.)

Clinical Decision Support Rule Core Set 10

Yes/No

• Attestation = EPs must attest Yes to having implemented at least 1 rule of clinical relevance in their specialty for the duration of the reporting period.

Notes: • CMS does not issue guidance; leaving it to the discretion of the EP to base such rules on

their workflow, patient population, and quality improvement efforts within the practice. • Drug-Drug/Drug-Allergy Interaction Checking does not count towards this measure. • During v3 upgrade, 9 NQF-related expressions will be automatically added to your URL. • NQF-related Expressions are required for Stage 2; hence they are automatically available

for Stage 1 use or you can create your own per local preference.

Encounter a Specified Trigger a Expression pop-up (Based upon defined triggers + Roles defined in login.expression.applicable)

2011-13 CS-11

Creating Expressions

Trigger

Expression Type • EMR – locally-defined expressions*; Source of information is required and must be entered by user • Medline Plus – automated expressions; Source is automatically provided via Web Service app

Expression Type

Action (optional)

Conditions may be as basic or as specific as

needed.

Settings a Configuration a Workflow a Expressions (Based upon defined triggers + Roles defined in login.expression.applicable).

The Rule

User Type

• During v3 upgrade, 9 CDS will be imported based upon certified NQFs. • EP may elect to use 5 of these 9 or create local rules per specialty

Patient Electronic Access Core Set 11 50%

• Denominator = all unique patients seen by EP* during the reporting period • Numerator = patients who are provided timely (within 4 days after visit) online access to

their health information to view, download, and transmit to a 3rd party, which must exceed 50%.

2011-13 CS-12 &

MS-5

Exclusion: Any EP who neither orders nor creates information that would otherwise be contained within the online record as per CMS

Definition (except for patient & provider details).

^See Appendix D – Patient Portal Login User ID


Notes: • CS-11 replaces former CS-12 and MS-5 under the 2011-edition of Stage 1 Meaningful Use

Patient Portal – Access to PHI

• Patient Portal must be enabled for the practice (see MU Settings Clinic tab)

• Patient must have a User ID/Password in order to access it; either auto-generated or manually assigned from Patient Register Login Details*.

*Cannot Auto-generate when no

email address

MU Settings Setup Required tab

displays Portal indicator

See Appendix D – Patient Portal Login User ID

Clinical Summaries Core Set 12 50%


2011-13 CS-13

• Denominator = total number of Office Visits* by the EP during the reporting period • Numerator = total number of office visits within the for which the patient is provided a

Clinical Summary within 3 business days (at no charge to patient), which must exceed 50%.

Notes: • Clinical Summary format is hard-coded to CCD format and cannot be customized;

however, EP can choose to suppress certain data before distributing it to the patient. • Patient may refuse to accept the clinical summary and still be counted in the numerator • E&M CPT Code is no longer required to be counted in denominator.

Clinical Summaries (cont’d)

Encounter TOC a Encounter Close Patient Portal a Past Visits a Clinical Summary icon

Exclusion: Any EP who has no office visits

during the reporting period.

Office Visit* (per CMS definition) • Billable encounters that result from E&M services provided to the patient, including: • Concurrent care or transfer of care visits, Consultant visits, or prolonged physician service w/o

direct face-to-face contact (e.g.: Tele-Health)

*Encounter Type driven measure. See

Appendix C.

Patient may decline to receive the summary and it will still count in the Numerator.

Clinical Summary (cont’d)

• Recreate – recompiles the system default as to data (i.e.: removes any edits you may have previously done)

• Edit – enables you to hide specific sections of the summary before distributing it to the patient or PA

• Portal – activates the summary on the portal for the patient to access via Logon User ID/Password provided

• Print – sends hard copy to printer in the office • Download – prompts for a password then saves the file to

your pc’s Download directory or path otherwise specified if local IE Browser/Settings allow. File is saved as a self-extracting .EXE file to give to the patient via external media (USB drive/CD-ROM).

Patient Preference dictates method of delivery

User must select an Action in order to receive Numerator credit.

Simply viewing this screen does not comply in itself.

Clinical Summary - Edit

Note: Even if all elements of a section are suppressed, the title of the section will still be present per MU requirements. It will just be blank on the printed summary the patient receives. Edits can be reversed via recreate button.

Provider Preference dictates level of editing

Suppress individual values within a section

Suppress all elements within a

section

Clinical Summary - Portal

You must click portal button (in EMR) in order for the icon to appear on Past Visits page

of Portal.

You must click portal button (in EMR) in order for the icon to appear on Past Visits page

of Portal.

See Appendix D for instructions for creating Portal Logins

Clinical Summary - Download

Provider Preference dictates level of editing

• Encrypt – assign a password (alpha-numeric) of choice to encrypt the PHI file

• Save As – save the file to desired path Note: Most browsers auto-save to a Downloads directory.

• Distribute – the *.exe file can be copied to a USB-drive or burned to a CD-ROM to be given to the patient

Exact process for file download may vary per

browser.

Core Set 13 Yes/No

Home Page a Resource Center

Protect Electronic Health Info

• Attestation = EPs must attest Yes to having conducted or reviewed a security risk analysis and implemented security updates as necessary and corrected identified security deficiencies prior to or during the reporting period.

Notes: • CEHRT technology is automatically compliant; however, user action is required on the

ARRA Dashboard (EP Action hyperlink) to indicate the human activity was also executed. • The security risk analysis must occur at least once prior to the end of the reporting period • EP must maintain physical proof (i.e.: a Journal/Operations Log) of compliance with these

requirements • In order to attest as to compliance, the EP will have to explicitly indicate via the ARRA

Dashboard Action hyperlink that he/she has generated such lists.

2011-13 CS-15

2 components – i.e.: Human + EHR

http://www.hhs.gov/ocr/privacy/hipaa/administrative/securityrule/

Protect Electronic Health Info

At least once prior to end of each reporting period: Conduct a Security Risk Analysis*

Implement applicable security updates Implement an Employee Sanction Policy to ensure PHI compliance amongst all staff Perform a periodic system activity review

Technical organization/infrastructure Physical safeguards as to workflow, document storage, etc.

Download Security Risk Analysis

Checklist from Client Resource

Center.

Menu Set Measures

1. Drug Formulary Checks 2. Clinical Lab Test Results 3. Patient Lists by Conditions 4. Patient Reminders 5. Patient-specific Education Resources 6. Medication Reconciliation for patients transitioned from other care setting 7. Summary of Care Record to other providers of care for referrals 8. *Submit electronic data to state immunization registries 9. *Submit electronic syndromic surveillance data to public health agencies

Notes: • EP must attest to 5 of the 9; 1 of which must be one of the

PHA measures (MS-8 or MS-9) • The selected PHA measure may be excluded if applicable* as

long as both can be excluded; if one can be met, it must be chosen over the one that can be excluded

• The other 4 measures must be selected from the remaining 7 • None of these non-PHA measures may be excluded • If an exclusion applies, EP must select a different measure that

cannot be excluded so he/she is attesting to a total of 5 without exclusion overall

EP must be able to physically demonstrate compliance per audit requirements.

http://www.cms.gov/Regulations-and-Guidance/Legislation/EHRIncentivePrograms/Downloads/EP-MU-TOC.pdf*

http://www.cms.gov/Regulations-and-Guidance/Legislation/EHRIncentivePrograms/Downloads/Stage1ChangesTipsheet.pdf

Drug Formulary Checks Menu Set 1 Yes/No

Exclusion: Any EP who writes fewer than 100

prescriptions during the reporting period.

• Attestation = EPs must attest Yes to having enabled this functionality and having had access to at least one internal or external formulary for the entire reporting period.

Notes: • At least one formulary needs to be available to the EP when prescribing medications

during the reporting period. • Rx-Hub is automatically enabled for all EPs once Meaningful Use is enabled for your

practice

Prescription Formulary Prescription Formulary Info • Each drug ordered is automatically queried for formulary as it is entered by the user • Validates per patient’s pharmacy coverage at Pharmacy Benefits Manager • Status of prescription must be A (Approved) or O (Ordered) to count in the numerator


enabled for EP.

Alternate Drugs per formulary

will auto-display

Prescription a Formulary Info icon


enabled for EP.

Clinical Lab Test Results Menu Set 2

40%

Exclusion: An EP who orders no lab tests whose results

are either in a positive/negative or numeric format during the EHR reporting period.

• Denominator = total number of lab tests ordered by the EP within the reporting period which results are expressed either as a positive or negative affirmation or as a number.

• Numerator = total number of results that are positive or negative or a numeric value entered into structured data for applicable tests, which must exceed 40%.

Notes: • Structured data results do not have to be electronically exchanged (HL7). • Faxed results (even if attached as a Lab Result) do not count in numerator. • Status of the Lab Order must = O, R, or C. (Status E or A are not compliant). • Property cpoe.labresults.forapproved should not be set to Y if MU is enabled.

Encounter TOC a Lab Result

Clinical Lab Test Results (cont’d) • Lab test ordered through EMR (manually or via HL7 bi-directional interface) must have status = O

(Ordered), R (Results Received), or C (Completed) • Results must be entered to a test(s) ordered within the reporting period. When results are

received electronically, the LOINC Code is required. (HL7 interfaces comply with this requirement.)

Patient Lists by Conditions Menu Set 3

Yes/No

• Attestation = EPs must attest Yes to have generated certain lists based on specific patient conditions. (The measure does not dictate which reports should be generated; that is at the EP’s discretion.)

Notes: • During v3 upgrade, multiple reports used for certification will be provided automatically. • Additional custom reports can be added upon request per local needs. • A new EP Action status applies on ARRA Dashboard to indicate the human activity was also

executed before the green thumb-up can display.

Report a Meaningful Use a Patient Lists

Meaningful Use Reports – Patient Lists • User must generate at least one report classified as Patient-Lists • PrognoCIS Audit Trail will capture activity; should be generated under EP User ID

Patient-Lists

Patient Reminders Menu Set 4

20%

• Denominator = total number of unique patients 65 years or older or 5 years or younger prior to the beginning of the reporting period

• Numerator = total number of reminders sent via phone or email during the reporting period, which must exceed 20%.

Notes: • Preventive Care includes F/Up requested by Provider, HM, or Vaccinations. • Custom Reminders may also be defined by the practice.

Exclusion: An EP who has no patients 65 years or

older or 5 years or younger prior to the beginning of the reporting period.

Patient Reminders • Health Maintenance, Vaccination, Follow-up or locally-defined per need • No appointment currently scheduled but the service is due per Face Sheet calculation

• MU-specific reminders • Follow-up, Health Maintenance, Vaccination • Services due per Face Sheet or Encounter

History but patient has not yet scheduled • Specify stage (Stage 1 or Stage 2) • Specify reporting period date range

• Click GO button

Home Page a Patient Reminders

To learn how to create custom reminders, see v3 Upgrade webinar!

Menu Set 5 10% Patient-specific Education Resources


2011-13 MS-6

• Denominator = total number of unique patients seen by the EP* within the reporting period • Numerator = total number of patients in the denominator who receive the CEHRT-identified

education during or outside of the reporting period, which must exceed 10%.

Notes: • Individual check box for distribution method must be selected & click the OK button. • Medline Plus education associated to PHI does count and will auto-flow to Patient

Education from the respective screens if chosen. However, it must be printed or emailed from the resident screen first in order to apply in the numerator.

• Education manually added through the + button on Encounter does not count.

Encounter TOC Education

Encounter TOC a Education a OK

Internal Education – user must select check box & click

OK

Prognocis education must be generated by the user clicking OK button to populate the numerator as per defined Type:

Print sends the attached PDF handout to the default printer Brochure indicates pre-printed material was given to patient URL indicates that you have referred the patient to a web site

New triggers enable you to define education per Rx Norm, LOINC, or SNOMED Codes if applicable

Medline - printed or emailed from the individual pop-up on the appropriate screen via the Edu icon ( ):

Current Medications via RxNorm code PMH via SNOMED-CT or ICD code Assessment ICD via SNOMED-CT or ICD code Lab Order/Result via LOINC code

Medline Education is selected from

icon & flows here FYI

Medline Plus Education

RxNorm code

SNOMED-CT

code

ICD code

Medline Plus Education ( )

LOINC code (Labs)

See next slide for sample of the Medline Plus education link

• Built-in education based upon clinical codes (RxNorm, SNOMED, LOINC, ICD, etc.)

Medline Plus Education (cont’d)

Flows to Encounter for MU credit

Notes: • User can preview the education before deciding to print or email to patient. • Requires no local configuration & is automatically included with v3 upgrade. • There is no data entry in the PrognoCIS Education Master. • Email templates can be customized under Settings Configuration Email Patient Education Material for sending the information to the patient.

Embedded Web Service

• Link within the Education pop-up launches the source link on Medline Plus web page • Education is not stored within PrognoCIS; authored by CDC, NLM, etc.

Settings a Configuration a Clinic a Education

Education Master – Internal

Problem SNOMED Code - invokes a search screen to select desired ICD or SNOMED Code

Drug – invokes a drug name search to select a specific Drug

Lab Test Result- invokes a search screen to select desired lab test

New Triggers

• Triggers now include 3 new categories (Drug, Lab Test Result, SNOMED) • Applicable for File, Brochure, and URL education Types

Medication Reconciliation Menu Set 6

50% 2011-13

MS-7

• Denominator = total number of unique Transitions of Care encounters seen by the EP* within the reporting period. (A TOC Status must be selected per the encounter.)

• Numerator = total number of transitions of care within the reporting period for which the EP reconciled medications, which must exceed 50%.

Notes: • *Transition of Care – the movement of a patient from one clinical setting to another (e.g.:

inpatient, outpatient, physician office, home health, rehab, etc.). At a minimum, this includes all New Patients and all Patients w/Summary of Care either paper or electronic.

• Medication Reconciliation – the process of identifying the most accurate list of all medications that the patient is taking; including name, dosage, frequency, and route.

Exclusion: An EP who was not the recipient of any transitions of care during the reporting period.


Face Sheet a Current Medication

Medication Reconciliation (cont’d)

Click Add Drug to manually select drugs (no CCD) When a CCD is applicable (i.e.: Source = C-CCA)

• it must be imported before the encounter is started • user must select appropriate Reconcile indicator

Add to Current Meds above Remove from TOC & thus not add to your list

• No Transition – defaults for existing patients when no CCD • New Patient – defaults for patient’s 1st encounter • With SOC – defaults when CCD imported on last encounter • Without SOC – must be manually selected if applicable

Summary of Care

Exclusion: Any EP who does not transfer/refer a patient to another

setting of care or provider during the reporting period.

Menu Set 7 50%

Note: • Transition of Care – the movement of a patient from one setting of care (hospital, ambu-

latory primary or specialty care, long-term health, home health) to another • The EP can send the summary of care (CCD) via electronic or paper copy directly to the

receiving provider or give it to the patient to deliver to the next provider if applicable.

2011-13 MS-8

• Denominator = number of transitions of care/referrals during the reporting period for which the EP was the transferring/referring provider. (Letters Out flagged as a TOC.)

• Numerator = # of TOC Letters that are actually in a Sent status with a Summary of Care attached, which must exceed 50%

• Select TOC indicator to identify the Letter Out as a transition or referral • Attach the Summary of Care Export (created from the previous step) • Select to Print, Email, Download, or N2N to recipient (CCD cannot be faxed)

Patient a Letters Out

New Continuity of Care Document (CCD) is auto-generated for all patients when N2N is enabled. It will compile all

applicable PHI at the point when the TOC Letter is actually generated and sent via secure N2N messaging.

Numerator 15 a

Summary of Care for TOC/Referral

Print, Email, N2N, or Download

Immunization Registries Data Submission

Menu Set 8 Yes/No

• Attestation = Answer Yes if you comply in one of the following areas: 1. Submission previously established remains enabled through entire reporting period 2. Submission of a test file to the state registry if applicable 3. Registration w/PHA with intent of starting ongoing submission:

a. 60 days prior to start of the reporting period & achieved such prior to the end of the reporting period

b. and EP is currently in testing/validation stage with the registry c. and EP is awaiting invitation from the agency to begin testing.

2011-13 MS-9

Either of these PHA measures (Immunization Registry or Syndromic Surveillance) must be chosen. If one can be met it must supersede one that can be excluded.

Immunization Registry by State (October 2014)

Live/In Production

Arizona

California

Florida

Illinois

Maryland

Texas

*See Appendix E – MU Settings – Setup Required tab

Exclusions: 1 – EPs who do not administer immunizations 2 – No existing immunization registry available in your state 3 – Prohibited by law

WIP/Finalizing

Alabama

Michigan

Missouri

New Mexico

New York

Pennsylvania

• If your state has a Registry, then a test file should be provided ASAP (before you start your reporting period) in order to attest Yes for this measure.

• If your state has a Registry but is not listed above and you are interested in attesting for this measure, please send us an email at: [email protected].

Syndromic Surveillance Data Submission Menu Set 9 Yes/No

• Attestation = Yes/No that you comply in one of the following areas: 1. Submission previously established remains enabled through entire reporting period 2. Registration w/PHA with intent of starting ongoing submission:

a. 60 days prior to start of the reporting period & achieved such prior to the end of the reporting period

b. and EP is currently in testing/validation stage with the registry c. And EP is awaiting invitation from the agency to begin testing

2011-13 MS-10

Either of these PHA measures (Immunization Registry or Syndromic Surveillance) must be chosen. If one can be met it must supersede one that can be excluded.

Unknown Status

Kentucky

New Mexico

Pennsylvania

Rhode Island

South Carolina

South Dakota

Texas

No Registry Available

Alabama

Alaska

Arizona

California

Connecticut

Florida

Iowa

Kansas

Minnesota

Mississippi

Montana

Syndromic Surveillance Registry by State

Exclusions: 1 – EP does not collect syndromic surveillance data during the reporting period 2 – No existing PHA available 3 – Prohibited by law

Nevada

New Hampshire

New York

North Carolina

Oklahoma

Oregon

Tennessee

Vermont

West Virginia

Wyoming

Registry Available

Arkansas

Colorado

Delaware

Georgia

Hawaii

Idaho

Illinois

Indiana

Louisiana

Maine

Maryland

e

Massachusetts

Michigan

Missouri

Nebraska

New Jersey

North Dakota

Ohio

Utah

Virginia

Washington

Wisconsin

If applicable per state, you must

submit a Test File to Registry.

Download complete list of all 64 QMs, effective

2014*

http://www.cms.gov/Regulations-and-Guidance/Legislation/EHRIncentivePrograms/Recommended_Core_Set.html

http://www.cms.gov/Regulations-and-Guidance/Legislation/EHRIncentivePrograms/2014_ClinicalQualityMeasures.html

Appendix A - Clinical Quality Measures

Former CS-10 has been removed; however, CQM

is still required.

Certified NQF Measures for Reporting CQM

NQF-0002 – Appropriate testing for children with Pharyngitis

NQF-0018 – Controlling high blood pressure

NQF-0022 – Use of high-risk medications in the elderly

NQF-0024 – Weight assessment/counseling for nutrition & physical activity for children/adolescents

NQF-0028 – Preventive care/screening: Tobacco use screening and cessation intervention

NQF-0036 – Use of appropriate medications for Asthma

NQF-0052 – Use of imaging studies for Low Back Pain

NQF-0069 – Appropriate treatment for children with Upper Respiratory Infections (URI)

NQF-0421 – Preventive care/screening: Body Mass Index (BMI) screening and follow-up

Clinical Quality Measures (NQF) http://www.cms.gov/Regulations-and-

Guidance/Legislation/EHRIncentivePrograms/Downloads/EP_MeasuresTable_Posting_CQMs.pdf

Note: Other NQF measures may be available on request; however, individual certification

may take more than 90-days. It is suggested to use these standard NQF if at all possible to ensure you are able to comply within reporting period.

Report a Meaningful Use a Clinic a Enc Types

If a measure does not apply to your specialty, it

is ok to report 0 for it.

NQF Validation Table (Clinical Quality Measures)

NQF button opens the dashboard of all active

CQM & statuses

Notes icon launches the NQF specifications and

requirements, which are labeled as Formulas

NQF Validation Table (cont’d)

Lists the requirements to guide you through your

visit documentation Zoom icon lets you select applicable codes and add them to your assessment

NQF Validation Table (cont’d)

CPT/SNOMED search includes only those

valid per the NQF specifications

If the code is selected from this search, it will

add to the Assessment screen

If CPT already present on Assessment, status

of NQF will = Pass

ICD search includes only those valid per the

NQF specifications

If ICD is selected from this search, it will

add to the Assessment screen

If ICD already added to Assessment, status

of NQF will = Pass

Appendix B – Dashboards & Reports Meaningful Use Dashboards

Encounter Dashboard

System Dashboard

Pass

Fail

EP / Action

Meaningful Use Reports

2014-MU – system-level reports that reflect all applicable measures for the EP based on settings

Eligibility – provides data per EP based upon Medicaid payer to determine eligibility

Patient-Lists – provides lists of patients per defined conditions as per Core Set Measure 11

QRDA – Quality Reporting Data Analysis – the new term for Clinical Quality Measures (MU-2011)

which reflects individual and/or cumulative results of the specific NQF measure(s) specified

All EPs should monitor your numbers regularly.

Encounter-level Validation

Encounter TOC a Encounter Close a

• “Healthy fear” of the red Sometimes red will be valid Sometimes user action is required

• Exempt measures will display grayed-out • Defined under MU Settings Provider, OR • Defined individually per Age parameters

• System-level measures reflect overall status

• Automatically invokes when closing an encounter, or user can manually launch it via the icon • Advises the user of measures that are passing, failing, or are not applicable for that encounter

System-level Validation – Core Measures

• indicates the measure is compliant Note: Qualified exclusions count as compliant

although they will actually display with .

• Exempt measures will display grayed-out • Defined under MU Settings by number

• indicates that the EP must take explicit action and indicate it is completed before a green thumb-up will display as compliant

Home Page a ARRA Dashboard a Core Measures

EP must comply with all 13 Core Set Measures

System-level Validation – Menu Measures

Home Page a ARRA Dashboard a Menu Set

• indicates the measure is compliant

• indicates that the measure is failing • Grayed-out measures are N/A as per the MU

Settings defined for EP/Clinic • Exclusions at the measure level do not count

towards the 3 required measures

EP must comply with 5 out of 9

measures

ARRA Dashboard – EP Action Required

Home Page a ARRA Dashboard

At Least Once Status

EP – indicates that the EP must take an explicit action

that corresponds with the measure to indicate

compliance with a system functionality or CMS

requirement

Action – invokes the Details pop-up which instructs the

EP what action is required and provides a check box

which can be selected to indicate the affirmative

- indicates that the EP has completed the action

New Feature

Dashboard Blank (MU Settings not Defined)

Indicates the Provider has not been defined

under MU Settings

*See Appendix E – MU Settings

Report a Meaningful Use

Meaningful Use Reports Report Definition • Classification – categorizes the function within Meaningful Use of the specific report • Option Name – defines the nature of the report as to its content • Code – identifies the report by the type of structured data it is reporting

• Stage-specific details for all measures combined

• Details for NQF measures

Report Equivalent of the Dashboard It is strongly recommended that you monitor your progress by using the MU Reports or the ARRA Dashboard. All reports are driven by provider and date range based upon MU settings.

Reports a Meaningful Use a Meaningful Use Stage 1*

Things to Remember:

MU Settings apply (only defined measures will be reflected in output) Run report for each individual EP and reporting period CS = Core Set, all 17 mandatory MS = Menu Set, report 3 out of 6 Percentage must exceed Min. Reqd. Pending/.00 may be valid for exclusions

• Stage-specific details for all measures combined*

• Details for NQF measures

http://www.cms.gov/Regulations-and-Guidance/Legislation/EHRIncentivePrograms/Downloads/Guide_QRDA_2014eCQM.pdf

QRDA Overview

Introduced in conjunction with Meaningful Use Stage 2 in 2014; requirement of certification

HL7 format for electronically exchanging Clinical Quality Measures

http://cms.gov/Regulations-and-Guidance/Legislation/EHRIncentivePrograms/eCQM_Library.html

QRDA-1 represents individual patient-level reporting of CQM

Raw, applicable patient data (e.g.: DOS, clinical condition, etc.)

Uses standardized coded data (e.g.: ICD-9-CM, SNOMED-CT CT, etc.)

QRDA-3 represents aggregate (combined-level) reporting of CQM

Aggregated summary quality data for one provider for one or more eCQMs

Cumulative pool of data gathered at the QRDA-1 level

This is the 2014 equivalent of the former tabular Clinical Quality Measures report in MU-1, 2011-edition

QRDA = new term that apples to reporting

Clinical Quality Measures

QRDA Reports (Quality Reporting Data Architecture)

Appendix C – Encounter Type Setup • Exempt from MU Reporting - exclude from MU altogether (e.g.: surgery, hospital, etc.) • It may be necessary to create some new (additional) Encounter Types (e.g.: nurse visits/procedures

or Office Visit – Education only vs Office Visit – E&M, etc.) • Every encounter type needs to have an appropriate SNOMED Code assigned to it

Settings a Configuration a Clinic a Enc Types (*former property arra.exempt.enctypes is now obsolete)

Mandatory!

Seen by EP = All cases where the EP and the patient have an actual physical encounter in which they render any service to the patient should be included in the denominator as Seen by the EP. Also a patient seen through telemedicine would still count as a patient "seen by the EP." However, in cases where the EP and the patient do not have an actual physical or telemedicine encounter, but the EP renders a minimal consultative service for the patient (like reading an EKG), the EP may choose whether to include the patient in the denominator as "seen by the EP" provided the choice is consistent for the entire EHR reporting period.

Office Visit = defined as any billable visit that includes: (1) concurrent care or transfer of care visits; (2) consultant visits; or (3) pro-longed physician service without direct, face-to-face patient contact (e.g.: tele-health). A consultant visit occurs when a provider is asked to render an expert opinion/service for a specific condition or problem by a referring provider. The visit does not have to be individually billable in instances where multiple visits occur under one global fee.”

Appendix D - Patient Portal Login User ID • CS-11 - Patient or Authorized User Electronic Access to PHI • CS-12 - Clinical Summary within 3 business days of Office Visit

Patient Register a

User ID & PW are required

• All new patients with an email entered under Patient Register will automatically receive a User ID/Password to the portal

• For existing patients w/o an email entered, 1st time an email address is entered, a User ID/Password will be automatically generated from the Register

• If an existing email address is modified, an email will not be automatically generated to the user.

• Portal access is governed by certain Admin Properties per client preference

• login.types property must include PT, AU

Appendix E – Meaningful Use Settings

Settings a Configuration a MU Settings

Notes: • In addition to some properties and configuration, user-level customization may apply. • Provider-level and Clinic-level MU Settings can be modified as needed per workflow and

local preference. • User Role security permissions are required.

MU Settings - Provider

Vital Details: • None – EP must report all vitals as required • Indicate exclusion as applicable per specialty

ePrescription: • N/A for stage 1 (grayed-out)

Reporting Details: • Required for statistics & dashboard tracking • Attestation Date applies as applicable to track

“outside of reporting period” numerators

Public Health Agency Data Submissions: • Select to exclude If EP does not administer

• Vaccinations • Syndromic Surveillance Data • Cancer Registry Data • Other Specialized Registry Data

• See Clinic tab when EP performs the task and must attest accordingly

Settings a Configuration a MU Settings a Provider

Mandatory!

Measures: • Specify all measures the EP is not excluding

(missing #s will display gray on dashboard) • Displays the 9 Clinical Quality Measures

Stage, Reporting Period, & Attest Date are

critical to assign per EP

Settings a Configuration a MU Settings a Clinic

Dashboard: • MU module enabled for this URL • MU system dashboard displayed • Encounter-level dashboard displayed

Mandatory! MU Settings - Clinic

Public Health Agency Data Submissions: • When attesting Yes, select status of the clinic’s

interface with the PHA, e.g.: • Registered within deadline • Engaged in testing/validation with PHA • Waiting to start testing/validation w/PHA • Currently in production w/interface to PHA • Submitted a Test File to the PHA

• When attesting No, indicate reason, e.g.: • No PHA w/capability to accept HL7

Note: This is when the EP actually does administer vaccines/gathers syndromic data & has not excluded it on Provider tab.

• Request a Test File be sent on your behalf

Miscellaneous: • Specify the Test Codes used on input templates

as applicable to Vitals & Social History Note: These elements must be answered during the encounter in order to count.

• Displays Encounter Type designations for MU

BP must be 2 separate numeric fields; Smoking Status element must be

used by end-user.

Settings a Configuration a MU Settings a Clinic

MU Settings – Setup Required

Interface Details: • Enter your email address when requesting that

any interactive function be enabled, and MU Team will respond w/status of your request.

Setup Status Table: • To request an item be enabled, select the check

box & click the send email button above • Requested column will reflect the date your request is

received by MU Team • Remarks will vary depending upon the interface (i.e.:

will show Lab Vendor, Immunization Registry state) • Final Status will indicate if the module is enabled or not

for your practice

Important Certification Reminders

Outside of Reporting Period Numerators (Stage 1) • In some cases, the Numerator may extend beyond end of reporting period up until Attestation

• CS-3, CS-5, CS-6, CS-7, CS-8, CS-9, CS-11 • MS-2, MS-5, MS-6

• MU Dashboard/Reports can still be generated using the Reporting Period date range • It is imperative that you enter the Attestation Date under MU Settings Provider* tab • PrognoCIS Audit Trail will capture the applicable numerator data in-between the two dates

Clinical Quality Measures • NQFs may be reported with 0 value and there is no penalty to the EP • SNOMED Code must be associated to all encounter types for NQF compliance per certification

requirements

CMS EHR Incentive Program Certification 2014 • PrognoCIS achieved full certification for 2014 Meaningful Use in January 2014 • EHR Flexibility Rules amendment published in October 2014 does not apply to PrognoCIS users

Ready…Set…Go! Determine your eligibility and program Register with CMS and obtain IAM User ID/Password for each EP individually Determine desired reporting period based on year of participation Define applicable MU Settings for EP & Clinic + Encounter Type MU qualifiers Educate appropriate staff and implement necessary workflow/processes Monitor MU Dashboard/Reports regularly Complete your attestation with CMS when applicable (following end of 90-days)

Current deadline is Feb. 28, 2015

Collect your reimbursement! Let’s Review… 13 core measures are mandatory 5 out of 9 menu measures are required Comply with Risk Assessment Analysis 9 NQF clinical quality measures required

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