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Meaningful Use Stage-2 User Guide

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Table of Contents Page

Introduction .................................................................................................................................................. 4

Core 1a: CPOE for medication orders .............................................................................................................. 4 What is the criterion to record the Denominator and Numerator Values? ....................................................................................... 4 How can I increase Denominator in InSync? ...................................................................................................................................... 4 How can I increase Numerator in InSync? .......................................................................................................................................... 5

Core 1b: CPOE for radiology orders ................................................................................................................ 7 What is the criterion to record the Denominator and Numerator Values? ....................................................................................... 7 How can I increase Denominator in InSync? ...................................................................................................................................... 7 How can I increase Numerator in InSync? .......................................................................................................................................... 8

Core 1c: CPOE for lab orders ........................................................................................................................... 9 What is the criterion to record the Denominator and Numerator Values? ....................................................................................... 9 How can I increase Denominator in InSync? ...................................................................................................................................... 9 How can I increase Numerator in InSync? ........................................................................................................................................ 10

Core 2: E-Prescribing (eRx) ........................................................................................................................... 11 What is the criterion to record the Denominator and Numerator Values? ..................................................................................... 11 How can I increase Denominator in InSync? .................................................................................................................................... 11 How can I increase Numerator in InSync? ........................................................................................................................................ 12

Core 3: Record Demographics ...................................................................................................................... 13 What is the criterion to record the Denominator and Numerator Values? ..................................................................................... 13 How can I increase Denominator in InSync? .................................................................................................................................... 13 How can I increase Numerator in InSync? ........................................................................................................................................ 13

Core 4: Record and chart changes in vital signs ............................................................................................ 14 What is the criterion to record the Denominator and Numerator Values? ..................................................................................... 14 How can I increase Denominator in InSync? .................................................................................................................................... 14 How can I increase Numerator in InSync? ........................................................................................................................................ 14

Core 5: Record smoking status for patients 13 years or older ........................................................................ 16 What is the criterion to record the Denominator and Numerator Values? ..................................................................................... 16 How can I increase Denominator in InSync? .................................................................................................................................... 16 How can I increase Numerator in InSync? ........................................................................................................................................ 16

Core 6: Use clinical decision support to improve performance on high-priority health conditions .................. 18 This Core has Yes/No Attestation. .................................................................................................................................................... 18

Core 7a: Patient electronic access - Patient Portal access.............................................................................. 19 What is the criterion to record the Denominator and Numerator Values? ..................................................................................... 19 How can I increase Denominator in InSync? .................................................................................................................................... 19 How can I increase Numerator in InSync? ........................................................................................................................................ 19

Core 7b: Patient electronic access - view, download, or transmit .................................................................. 21 What is the criterion to record the Denominator and Numerator Values? ..................................................................................... 21 How can I increase Denominator in InSync? .................................................................................................................................... 21 How can I increase Numerator in InSync? ........................................................................................................................................ 21

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Core 8: Provide clinical summaries for patients for each office visit .............................................................. 23 What is the criterion to record the Denominator and Numerator Values? ..................................................................................... 23 How can I increase Denominator in InSync? .................................................................................................................................... 23 How can I increase Numerator in InSync? ........................................................................................................................................ 23

Core 9: Protect Electronic Health info ........................................................................................................... 25 This Core has Yes/No Attestation. .................................................................................................................................................... 25

Core 10: Incorporate clinical lab test results as a structured data ................................................................. 26 What is the criterion to record the Denominator and Numerator Values? ..................................................................................... 26 How can I increase Denominator in InSync? .................................................................................................................................... 26 How can I increase Numerator in InSync? ........................................................................................................................................ 27

Core 11: Generate lists of patients by specific conditions to use for quality improvement, reduction of disparities, research, or outreach .................................................................................................................... 28

This Core has Yes/No Attestation. .................................................................................................................................................... 28

Core 12: Use clinically relevant information to identify patients who should receive reminders for preventive/follow-up care and send these patients the reminders, per patient preference .............................. 29

What is the criterion to record the Denominator and Numerator Values? ..................................................................................... 29 How can I increase Denominator in InSync? .................................................................................................................................... 29 How can I increase Numerator in InSync? ........................................................................................................................................ 29

Core 13: Use clinically relevant information from Certified EHR Technology to identify patient-specific education resources and provide those resources to the patient ...................................................................... 31

What is the criterion to record the Denominator and Numerator Values? ..................................................................................... 31 How can I increase Denominator in InSync? .................................................................................................................................... 31 How can I increase Numerator in InSync? ........................................................................................................................................ 31

Core 14: Medication Reconciliation .............................................................................................................. 32 What is the criterion to record the Denominator and Numerator Values? ..................................................................................... 32 How can I increase Denominator in InSync? .................................................................................................................................... 32 How can I increase Numerator in InSync? ........................................................................................................................................ 32

Core 15a: Provide summary of care record to patient for each transitions of care and referrals .................... 34 What is the criterion to record the Denominator and Numerator Values? ..................................................................................... 34 How can I increase Denominator in InSync? .................................................................................................................................... 34 How can I increase Numerator in InSync? ........................................................................................................................................ 34

Core 15b: Transmit summary of care record for each transitions of care and referrals .................................. 36 What is the criterion to record the Denominator and Numerator Values? ..................................................................................... 36 How can I increase Denominator in InSync? .................................................................................................................................... 36 How can I increase Numerator in InSync? ........................................................................................................................................ 36

Core 16: Immunization Registries Data Submission ...................................................................................... 38 This Core has Yes/No Attestation. .................................................................................................................................................... 38

Core 17: Use Secure Electronic Messaging .................................................................................................... 39 What is the criterion to record the Denominator and Numerator Values? ..................................................................................... 39 How can I increase Denominator in InSync? .................................................................................................................................... 39 How can I increase Numerator in InSync? ........................................................................................................................................ 39

Menu Set 1: Syndromic Surveillance data submission ................................................................................... 40 This Menu Set has Yes/No Attestation. ............................................................................................................................................ 40




Menu Set 2: Record electronic notes in patient records ................................................................................. 41 What is the criterion to record the Denominator and Numerator Values? ..................................................................................... 41 How can I increase Denominator in InSync? .................................................................................................................................... 41 How can I increase Numerator in InSync? ........................................................................................................................................ 41

Menu Set 3: Imaging Results ........................................................................................................................ 42 What is the criterion to record the Denominator and Numerator Values? ..................................................................................... 42 How can I increase Denominator in InSync? .................................................................................................................................... 42 How can I increase Numerator in InSync? ........................................................................................................................................ 43

Menu Set 4: Record Family health history .................................................................................................... 44 What is the criterion to record the Denominator and Numerator Values? ..................................................................................... 44 How can I increase Denominator in InSync? .................................................................................................................................... 44 How can I increase Numerator in InSync? ........................................................................................................................................ 44

Menu Set 5: Report Cancer Case................................................................................................................... 46 This Menu Set has Yes/No Attestation. ............................................................................................................................................ 46

Menu Set 6: Report Specific Case ................................................................................................................. 47 This Menu Set has Yes/No Attestation. ............................................................................................................................................ 47




INTRODUCTION This document depicts the step-by-step process for increasing denominator and numerator in InSync for Meaningful Use Stage-2 Core and Menu Set Measures.

CORE 1A: CPOE FOR MEDICATION ORDERS Objective: Use computerized provider order entry (CPOE) for medication orders. Measure: More than 60 percent of medication orders created by the EP during the EHR reporting period

are recorded using CPOE. Exclusion: Any EP who writes fewer than 100 medication, radiology, or laboratory orders during the EHR

reporting period.

WHAT IS THE CRITERION TO RECORD THE DENOMINATOR AND NUMERATOR VALUES?

Criteria to record Denominator value

An encounter should have been started within reporting period for an active patient.

Medication should have been prescribed/managed/renewed during reporting period (with or without CPOE). * Note: Number of denominator increase will depend on the number of medications ordered during reporting period, for example, if 3 medications are ordered (2 with CPOE and 1 without CPOE), the number of denominator increase will be 3.

Criteria to record Numerator value

Only the medications that are prescribed/managed/renewed during reporting period will be considered for numerator increase. * Note: Number of numerator increase will depend on the number of medications prescribed/managed/renewed during reporting period, for example, if 3 medications are prescribed (2 with CPOE and 1 without CPOE), the number of numerator increase will be 2.

HOW CAN I INCREASE DENOMINATOR IN INSYNC?

Ensure that an encounter is started and the medication is prescribed/managed/renewed (with or without CPOE) within reporting period. To start an encounter:

From the top menu bar, click Patient Search.

Click Facesheet adjacent to the patient name.

Click the Start Encounter button. To prescribe/manage/renew a medication (with CPOE):






Expand the Medications panel. Do the following: o To prescribe a medication, click the Prescribed Medications button. o To manage a medication, click the Manage Medications List button. o To renew a medication, click the Prescribed Medications button.

On the NewCrop page, search a drug and select the sig details.

Click Save Rx.

Click the “Take Complete Rx to Review Page” button.

Click the “Finish/Add to Current Meds” button. * Note: Instead of above step, it is recommended to perform the following steps in order to qualify for Core 2 E-Prescribing (eRX) Measure in addition. o Click the “Take Complete Rx to Review Page” button. o Click the “Transmit Rx” button. o Select a pharmacy from the list. o Click the “Transmit Rx/Add to Record” button.

Click Close. * Note: You can also prescribe/manage/renew medication from the encounter.

To order a medication (without CPOE):



Expand the Medications panel.

Click the Prescribed Medications button.

On the NewCrop page, click the Orders link from top left corner.

Type the medication name.

Click Save.

Click Close. * Note: You can also order a medication from the encounter.

HOW CAN I INCREASE NUMERATOR IN INSYNC?

Ensure that the medication is prescribed/managed/renewed (with CPOE only). To prescribe/manage/renew a medication (with CPOE):




Click the Prescribed Medications button. Do the following: o To prescribe a medication, click the Prescribed Medications button. o To manage a medication, click the Manage Medications List button. o To renew a medication, click the Prescribed Medications button.


Click Save Rx.





Click the “Finish/Add to Current Meds” button. * Note: Instead of above step, it is recommended to perform the following steps in order to qualify for Core 2 E-Prescribing (eRX) Measure in addition. o Click the “Take Complete Rx to Review Page” button. o Click the “Transmit Rx” button. o Select a pharmacy from the list. o Click the “Transmit Rx/Add to Record” button.

Click Close. * Note: You can also prescribe a medication from the encounter.




CORE 1B: CPOE FOR RADIOLOGY ORDERS Objective: Use computerized provider order entry (CPOE) for radiology orders. Measure: More than 30 percent of radiology orders created by the EP during the EHR reporting period


reporting period.




Radiology order should have been placed during reporting period (manual or electronic). * Note: Number of denominator increase will depend on the number of radiology orders placed, for example, if 3 radiology orders are placed (2 electronically and 1 manually), the number of denominator increase will be 3.


A criterion to record numerator value is covered in the Denominator itself. Whenever you place a radiology order (manually or electronically), the numerator value will be increased along with the denominator.


Ensure that an encounter is started and the radiology order is placed (electronically or manually) within reporting period. To start an encounter:



Click the Start Encounter button. To place a radiology order (electronically):



Expand the Pending Services panel.

Click the Order Radiology button.

Select mandatory details.

Start typing test name in the Order field; select an appropriate radiology order from the list.

Click Place Order. * Note: You can also place a radiology order from the encounter.

To place a radiology order (manually):






Start a new encounter or edit an in-progress encounter.

From the links shown on the top, click Treatment Plan.

Click the Radiology link.

Select appropriate check boxes to place a radiology order.


There are no additional steps required to increase the numerator value. If you have placed radiology order, manually or electronically (which is one of the criteria to increase denominator), the numerator value will automatically increase.




CORE 1C: CPOE FOR LAB ORDERS Objective: Use computerized provider order entry (CPOE) for laboratory orders. Measure: More than 30 percent of laboratory orders created by the EP during the EHR reporting period


reporting period.




Laboratory order (manual or electronic) should have been placed during reporting period. * Note: Number of denominator increase will depend on the number of laboratory orders placed, for example, if 3 laboratory orders are placed (2 electronically and 1 manually), the number of denominator increase will be 3.


A criterion to record numerator value is covered in the Denominator itself. Whenever you place a lab order (manually or electronically), the numerator value will be increased along with the denominator.


Ensure that an encounter is started and the laboratory order is placed (electronically or manually) within reporting period. To start an encounter:



Click the Start Encounter button. To place a laboratory order (electronically):




Click the Order Laboratory button.


Start typing test name in the Order field; select an appropriate Laboratory order from the list.


To place a laboratory order (manually):






Edit the in-progress encounter.


Click the Labs link.

Select the Manual Lab Order radio button.

Select appropriate check boxes to place a laboratory order.


There are no additional steps required to increase the numerator value. If you have placed lab order, manually or electronically (which is one of the criteria to increase denominator), the numerator value will automatically increase.




CORE 2: E-PRESCRIBING (ERX) Objective: Generate and transmit permissible prescriptions electronically (eRx). Measure: More than 50 percent of all permissible prescriptions, or all prescriptions, written by the EP are

queried for a drug formulary and transmitted electronically using CEHRT. Exclusion: Any EP who:

(1) Writes fewer than 100 permissible prescriptions during the EHR reporting period. (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/her EHR reporting period.




Medication should have been prescribed during reporting period. * Note: Number of denominator increase will depend on the number of medications prescribed during reporting period, for example, if 3 medications are prescribed, the number of denominator increase will be 3.


Drug formulary check should have been performed for all the medications prescribed during the reporting period.

Prescribed medication should have been electronically transmitted to pharmacy.


Ensure that an encounter is started and the medication is prescribed within reporting period. To start an encounter:



Click the Start Encounter button. To prescribe a medication:






Click Save Rx.


Click the “Finish/Add to Current Meds” button.




Click Close. * Note: Above steps are sufficient to increase the denominator however it is advisable to transmit a medication as mentioned in following section (i.e. How Can I increase Numerator in InSync) which would increase denominator and numerator at once. * Note: You can also prescribe a medication from the encounter.


Ensure that,

The drug formulary check is performed for all the medications prescribed during the reporting period.

Prescribed medication is electronically transmitted to pharmacy. To perform drug formulary check:

Please contact the InSync EMR Support team to enable this option in NewCrop. To transmit the medication to pharmacy:






Click Save Rx.


Click the “Transmit Rx” button.

Select a pharmacy from the list.

Click the “Transmit Rx/Add to Record” button.

Click Close. * Note: You can also transmit a medication from the encounter.




CORE 3: RECORD DEMOGRAPHICS Objective: Record the following demographics: preferred language, sex, race, ethnicity, date of birth. Measure: More than 80 percent of all unique patients seen by the EP have demographics recorded as

structured data. Exclusion: No exclusion.





Patient’s demographic details such as DOB, sex, race, ethnicity, and preferred language should have been recorded.


Ensure that an encounter is started within reporting period. To start an encounter:



Click the Start Encounter button.


Ensure that patient’s demographic details such as DOB, sex, race, ethnicity, and preferred language are recorded, or else an option is selected in case if patient has declined to provide these details. To record patient’s demographic details:

From the left menu options, select Patients > Add Patient.

Enter Date of Birth (DOB), Sex, Race, Ethnicity, and Preferred Language OR

Select the “Patient declined / unable to provide Race, Ethnicity and /or Preferred Language” check box.




CORE 4: RECORD AND CHART CHANGES IN VITAL SIGNS Objective: Record and chart changes in the following vital signs: height/length and weight (no age limit);

blood pressure (ages 3 and over); calculate and display body mass index (BMI); and plot and display growth charts for patients 0-20 years, including BMI.

Measure: More than 80 percent of all unique patients seen by the EP have blood pressure (for patients age 3 and over only) and/or height and weight (for all ages) recorded as structured data.

Exclusion: Any EP who: (1) Sees no patients 3 years or older is excluded from recording blood pressure. (2) Believes that all 3 vital signs of height/length, weight, and blood pressure have no

relevance to their scope of practice is excluded from recording them. (3) Believes that height/length and weight are relevant to their scope of practice, but blood

pressure is not, is excluded from recording blood pressure. (4) Believes that blood pressure is relevant to their scope of practice, but height/length and

weight are not, is excluded from recording height/length and weight.





Patient’s following vital information should have been recorded: o Height/length (all ages) and Weight (all ages) o Blood Pressure (only patients aged 3 and over)

* Note: If any of the above details are not applicable to your practice, you can choose an option to exclude them while generating report.







Ensure that you have recorded following vital details; Height/length (all ages), Weight (all ages), and Blood Pressure (only patients aged 3 and over), or have chosen an option to exclude the items depending on nature of your practice. To record vital details:







From the links shown on the top, click Vitals. o In the BP Systolic and Diastolic fields, enter blood pressure details. o In the Height field, record patient’s height/length. o In the Weight field, record patient’s weight in kgs, lbs, or, lbs-oz.

Click Save. * Note: If the Blood Pressure or Height & Weight is not applicable to your practice, select “Exclude Blood Pressure” or “Exclude Height & Weight” check box prior to generating the report.




CORE 5: RECORD SMOKING STATUS FOR PATIENTS 13 YEARS OR OLDER Objective: Record smoking status for patients 13 years old or older. Measure: More than 80 percent of all unique patients 13 years old or older seen by the EP have smoking

status recorded as structured data. Exclusion: Any EP that neither sees nor admits any patients 13 years old or older.



Patient’s age should have been 13 years or more.

At least one encounter should have been started within reporting period for an active patient.


Smoking status should have been recorded within or outside encounter.


Ensure that the patient’s age is 13 years or more and at least one encounter is created for that patient within the reporting period. To ensure patient’s age:

On top menu bar, click Patient Search.

Locate the DOB column next to the patient’s name.

Ensure that the different between current date and the DOB is more than or equal to 13 years. To start an encounter:





Ensure that at least one smoking status has been recorded. Smoking status can be recorded either from the Patient History tab or from the Charting section. To record smoking status from the patient history tab:


Edit the patient record.

From the top panel, select the History tab.

From the left pane, select the Social History option.

Do the following: o Record smoking status.

OR




o Select “Patient is non-smoker” check box. * Note: You can also record smoking status from the encounter.




CORE 6: USE CLINICAL DECISION SUPPORT TO IMPROVE PERFORMANCE

ON HIGH-PRIORITY HEALTH CONDITIONS Objective: Use clinical decision support to improve performance on high-priority health conditions. Measure: Measure 1:

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

Measure 2:

(2) The EP has enabled and implemented the functionality for drug-drug and drug-allergy interaction checks for the entire EHR reporting period.

Exclusion: For the second measure, any EP who writes fewer than 100 medication orders during the EHR reporting period.

THIS CORE HAS YES/NO ATTESTATION.




CORE 7A: PATIENT ELECTRONIC ACCESS - PATIENT PORTAL ACCESS. Objective: 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. Measure: More than 50 percent of all unique patients seen by the EP during the EHR reporting period are

provided timely (available to the patient within 4 business days after the information is available to the EP) online access to their health information.

Exclusion: Any EP who: (1) Neither orders nor creates any of the information listed for inclusion as part of both

measures (Core 7A and 7B), except for "Patient name" and "Provider's name and office contact information, may exclude both measures.

(2) 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 may exclude only the second measure (Core 7B).





Encounter should have been ended within 4 business days from visit date.

The patient should have an access on the patient portal (InTouch) application.







Ensure that an encounter has been ended within 4 business days from visit date and the patient has an access on the patient portal (InTouch) application. To end encounter within 4 business days of visit date:



Expand the Show Encounter(s) panel.

Edit an in-progress encounter.




From the top right corner, click the End Encounter icon. (Make sure that the current date has not crossed the 4 business days from visit date).

To provide an access to the patient on patient portal (InTouch) application:



In the Patient Information tab, do the following: o In the Email field, type patient’s e-mail address. o Select the Allow Login check box.

Click Save.




CORE 7B: PATIENT ELECTRONIC ACCESS - VIEW, DOWNLOAD, OR

TRANSMIT Objective: 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. Measure: More than 5 percent of all unique patients seen by the EP during the EHR reporting period (or

their authorized representatives) view, download, or transmit to a third party their health information. Exclusion: Any EP who:

(1) Neither orders nor creates any of the information listed for inclusion as part of both measures (Core 7A and 7B), except for "Patient name" and "Provider's name and office contact information, may exclude both measures.

(2) 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 may exclude only the second measure (Core 7B).





Patient portal user should have accessed or transmitted the clinical summary by clicking any of the following buttons: View, Download, or Transmit, within or outside reporting period. * Note: The View, Download, and Transmit buttons will be visible to the patient portal user only when the encounter is ended.





Click the Start Encounter button. * Note: Make sure the encounter is closed in order for the patient portal user to access View, Download, and Transmit buttons.


Ensure that the patient portal user has accessed or transmitted the clinical summary for the ended encounter. To access or transmit the clinical summary: (To be done by patient portal user)




(Patient portal user to) login to InTouch application.

In the Clinical Summary section, click View, Download, or Transmit button.




CORE 8: PROVIDE CLINICAL SUMMARIES FOR PATIENTS FOR EACH OFFICE

VISIT Objective: Provide clinical summaries for patients for each office visit. Measure: Clinical summaries provided to patients or patient-authorized representatives within one

business day for more than 50 percent of office visits. Exclusion: Any EP who has no office visits during the EHR reporting period.





Clinical Summary should have been provided to the patient within 1 business day.


Ensure that an encounter is created within reporting period. To start an encounter:





Ensure that the clinical summary is provided to the patient within 1 business day. To provide clinical summary (within 1 business day):




End the in-progress encounter. (Make sure that the current date has not crossed the 1 business day from the visit date). The clinical summary option will be automatically checked upon ending an encounter.

OR




Click the More link.

In the “Stage-1 (Core 13) & Stage-2 (Core 8) - Provide Clinical Summaries to Patient” section, do the following:




o Select the Clinical Summary provided to the patient check box. o In the Medium field, select either “Print” or “Declined” option. By default “Print” option is

selected. o Select the Clinical Summary Provided/Offered Date. (Make sure that the current date has not

crossed the 1 business day from the visit date).

Click Update.




CORE 9: PROTECT ELECTRONIC HEALTH INFO Objective: Protect electronic health information created or maintained by the certified EHR technology

(CEHRT) through the implementation of appropriate technical capabilities.

Measure: Conduct or review a security risk analysis in accordance with the requirements under 45 CFR 164.308(a) (1), including addressing the encryption/security of data stored in CEHRT in accordance with requirements under 45 CFR 164.312 (a)(2)(iv) and 45 CFR 164.306(d)(3), and implement security updates as necessary and correct identified security deficiencies as part of the provider's risk management process for EPs.

Exclusion: No exclusion.





CORE 10: INCORPORATE CLINICAL LAB TEST RESULTS AS A STRUCTURED

DATA Objective: Incorporate clinical lab-test results into Certified EHR Technology (CEHRT) as structured data Measure: More than 55 percent of all clinical lab tests results ordered by the EP during the EHR reporting

period whose results are either in a positive/negative or numerical format are incorporated in Certified EHR Technology as structured data

Exclusion: Any EP who orders no lab tests where results are either in a positive/negative affirmation or numeric format during the EHR reporting period.




Laboratory order (manual or electronic) should have been placed during reporting period. * Note: Number of denominator increase will depend on the number of laboratory orders placed, for example, if 3 laboratory orders are placed (2 electronically and 1 manually), the number of denominator increase will be 3.


Number of results received (electronically or manually) for the laboratory orders that are placed during reporting period will increase the Numerator value. * Note: Number of numerator increase will depend on the total number of test results received during reporting period, for example, if number of test results received is 3 (2 electronically and 1 manually), the number of numerator increase will be 3.


Ensure that an encounter is created and the laboratory order is placed (electronically or manually). To start an encounter:



Click the Start Encounter button. To place a laboratory order (electronically):




Click the Order Laboratory button.


Start typing test name in the Order field; select an appropriate Laboratory order from the list.





To place a laboratory order (manually):





Click the Laboratory link.

Select appropriate check boxes to place a laboratory order.


Ensure that the test result for the placed laboratory order is received during reporting period. To receive the lab test result (electronically):



Expand the Result(s) panel.

Click the Get Result(s) button. OR



Expand the Show Encounters panel.


From the links shown on the top, click Results/Order Queue.

Select the Results tab.

Click the Get Result(s) button. To add the lab test result (manually):






In the Pending Orders tab, click the Add Result link.

Record the result details.

Click Add.




CORE 11: GENERATE LISTS OF PATIENTS BY SPECIFIC CONDITIONS TO USE

FOR QUALITY IMPROVEMENT, REDUCTION OF DISPARITIES, RESEARCH, OR

OUTREACH Objective: Generate lists of patients by specific conditions to use for quality improvement, reduction of

disparities, research, or outreach.

Measure: Generate at least one report listing patients of the EP with a specific condition. Exclusion: No exclusion.





CORE 12: USE CLINICALLY RELEVANT INFORMATION TO IDENTIFY

PATIENTS WHO SHOULD RECEIVE REMINDERS FOR PREVENTIVE/FOLLOW-UP CARE AND SEND THESE PATIENTS THE REMINDERS, PER PATIENT

PREFERENCE Objective: Use clinically relevant information to identify patients who should receive reminders for

preventive/follow-up care and send these patients the reminders, per patient preference. Measure: More than 10 percent of all unique patients who have had 2 or more office visits with the EP

within the 24 months before the beginning of the EHR reporting period were sent a reminder, per patient preference when available.

Exclusion: Any EP who has had no office visits in the 24 months before the EHR reporting period.



At least 2 encounters should have been started prior to 24 months from reporting period for an active patient. * Note: For example, if the reporting period starts from 01/01/2014, then the 2 encounters should have been recorded between 01/01/2012 and 12/31/2013.


At least 1 reminder should have been sent to the patient within the reporting period.


Ensure that at least 2 encounters are started prior to 24 months from the reporting period for an active patient. To start an encounter:




Record at least one of these charting items: Vitals, Problem List, History, Diagnosis, Allergy, Medication, Lab Tests, and Lab Results. * Note: Make sure that the encounter date falls within the past 24 months from the date when the report is being generated.


Ensure that at least 1 reminder is sent to the patient within the reporting period. To send the patient reminder:




From the left menu items, select Reports > Custom Clinical Report.

Select the visit period in which one of the above 2 encounters are recorded.

Select a section which is recorded in one of these 2 encounters, for example, Vitals.

Click the Patient Reminder button.

On the “Patient Reminders for Clinical Findings” screen, select the method of communication from the drop-down list.

Select the check box from the extreme right end.

Click the “Save Sent Reminders & Send Reminders via Portal” button.




CORE 13: USE CLINICALLY RELEVANT INFORMATION FROM CERTIFIED

EHR TECHNOLOGY TO IDENTIFY PATIENT-SPECIFIC EDUCATION

RESOURCES AND PROVIDE THOSE RESOURCES TO THE PATIENT Objective: Use clinically relevant information from Certified EHR Technology to identify patient-specific

education resources and provide those resources to the patient. Measure: Patient-specific education resources identified by Certified EHR Technology are provided to

patients for more than 10 percent of all unique patients with office visits seen by the EP during the EHR reporting period.

Exclusion: Any EP who has no office visits during the EHR reporting period.



Encounter should have been started with POS Code as “Office”.


Education material should have been provided to the patient.


Ensure that an encounter is started with “Office” visit code. To start an encounter:




In the POS Code field, select “11-Office” from drop-down list.



Ensure that education material is provided to the patient. * Note: In order to provide education material, make sure that at least one item is recorded from the following: Problem List, Diagnosis, Medications, Lab Order. To provide an education material:




In the Education column, select the check box. Similarly, you can also provide education material in other sections.




* Note: You can also provide an education material from the encounter.

CORE 14: MEDICATION RECONCILIATION Objective: The EP who receives a patient from another setting of care or provider of care or believes an

encounter is relevant should perform medication reconciliation. Measure: The EP who performs medication reconciliation for more than 50 percent of transitions of care

in which the patient is transitioned into the care of the EP. Exclusion: Any EP who was not the recipient of any transitions of care during the EHR reporting period.



At least one encounter should have been started that has either “New Patient” option selected or else both “Existing Patient” and “Provision of Summary…” check box selected. * Note: Number of denominator increase will depend on the number of encounters started (with above selections), for example, if 5 encounters started for the same patient during reporting period (1 encounter has “New Patient” option selected and 4 encounters have “Existing Patient” and “Provision of Summary…” check box selected), the number of denominator increase will be 5.


Either medication reconciliation should have been actually performed or an option should have been opted as an indication that the medication reconciliation is performed.


When starting an encounter, ensure that either you have opted “New Patient” option or have opted both “Existing Patient” option and “Provision of Summary…” check box.

To increase the denominator:




Start a new encounter or click the More link for the existing encounter.

Do either of the following: o Select “New Patient” option, or o Select “Existing Patient” option and “Provision of Summary of Care Record to provider from

external source” check box.


Ensure that the medication reconciliation has been actually performed or an option is opted as an indication that the medication reconciliation is performed.




To reconcile the medication:




From the links shown on the top, click Medications/Allergies.

Click the Reconcile Medications & Allergies button.

On the Medication and Allergies Reconciliation screen, 2 sections appear: Allergies List and Medications List.

Perform the following steps to reconcile the medications: o The left pane indicates the existing medications you have prescribed for the patient, if any. o The right pane allows you to browse and upload the xml file that you have imported from an

external provider. o Click the Browse button; select the xml file that you received from an external provider, and click

Upload.

o Once the xml file is uploaded, you can add it to the preview list by clicking the icon. o Review the medications that you have imported and click Confirm. The imported medications will

be merged with the prescribed medications in the system. OR




From the links shown on the top, click Medications/Allergies.

Select the Medication Reconciled check box.




CORE 15A: PROVIDE SUMMARY OF CARE RECORD TO PATIENT FOR EACH

TRANSITIONS OF CARE AND REFERRALS Objective: The EP who transitions their patient to another setting of care or provider of care or refers

their patient to another provider of care should provide summary care record for each transition of care or referral.

Measure: The EP who transitions or refers their patient to another setting of care or provider of care provides a summary of care record for more than 50 percent of transitions of care and referrals.

Exclusion: Any EP who transfers a patient to another setting or refers a patient to another provider less than 100 times during the EHR reporting period is excluded from all three measures.



Referrals should have been recorded in the system. * Note: Number of denominator increase will depend on the number of referrals recorded, for example, if 4 referrals are recorded (either in single encounter or in multiple encounters), the number of denominator increase will be 4.


Clinical information should have been provided along with the referral summary.


Ensure that referral summary is recorded in the encounter. To record referral summary:






Click the Referral / Follow Up link.

In the Referral section, add a referral record.

Click Save.


Ensure that the clinical information is provided along with the referral summary. To provide clinical information along with the referral summary:










In the Referral section, edit the referral record.

Select the “Provided Clinical Information” check box.

Click Update.




CORE 15B: TRANSMIT SUMMARY OF CARE RECORD FOR EACH

TRANSITIONS OF CARE AND REFERRALS Objective: The EP who transitions their patient to another setting of care or provider of care or refers

their patient to another provider of care should provide summary care record for each transition of care or referral.

Measure: The EP who transitions or refers their patient to another setting of care or provider of care provides a summary of care record for more than 10 percent of such transitions and referrals either (a) electronically transmitted using CEHRT to a recipient or (b) where the recipient receives the summary of care record via exchange facilitated by an organization that is a NwHIN Exchange participant or in a manner that is consistent with the governance mechanism ONC establishes for the NwHIN.

Exclusion: Any EP who transfers a patient to another setting or refers a patient to another provider less than 100 times during the EHR reporting period is excluded from all three measures.



Referrals should have been recorded in the system. * Note: Number of denominator increase will depend on the number of referrals recorded, for example, if 4 referrals are recorded (either in single encounter or in multiple encounters), the number of denominator increase will be 4.


Clinical information should have been electronically transmitted along with the referral summary.


Ensure that referral summary is recorded in the encounter. To record referral summary:







In the Referral section, add a referral record.

Click Save.


Ensure that the clinical information is electronically transmitted along with the referral summary.




To electronically transmit the clinical information along with the referral summary:







In the Referral section, edit the referral record.

Click Update.

Edit the referral record again.

Click the Transmit icon from the grid.

On the Transmit C-CDA file screen, select the recipient and click Send.




CORE 16: IMMUNIZATION REGISTRIES DATA SUBMISSION Objective: Capability to submit electronic data to immunization registries or immunization information

systems except where prohibited, and in accordance with applicable law and practice. Measure: Successful ongoing submission of electronic immunization data from CEHRT to an immunization

registry or immunization information system for the entire EHR reporting period. Exclusion: Any EP that meets one or more of the following criteria may be excluded from this objective:

(1) the EP does not administer any of the immunizations to any of the populations for which data is collected by their jurisdiction's immunization registry or immunization information system during the EHR reporting period;

(2) the EP operates in a jurisdiction for which no immunization registry or immunization information system is capable of accepting the specific standards required for CEHRT at the start of their EHR reporting period;

(3) the EP operates in a jurisdiction where no immunization registry or immunization information system provides information timely on capability to receive immunization data; or

(4) the EP operates in a jurisdiction for which no immunization registry or immunization information system that is capable of accepting the specific standards required by CEHRT at the start of their EHR reporting period can enroll additional EPs.





CORE 17: USE SECURE ELECTRONIC MESSAGING Objective: Use secure electronic messaging to communicate with patients on relevant health information. Measure: A secure message was sent using the electronic messaging function of CEHRT by more than 5

percent of unique patients (or their authorized representatives) seen by the EP during the EHR reporting period.

Exclusion: Any EP who has no office visits during the EHR reporting period, or any EP 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.





Provider should have received a message from the patient portal user within reporting period.


Ensure that an encounter is started for the patient within reporting period. To start an encounter:





Ensure that the patient portal user has sent a message to the provider within reporting period. (Patient portal user) to send message to the provider:

(Patient portal user) to login to the InTouch application.

From the top menu bar, click My Messages.

Click Compose New Message.

Select the provider.

Enter the Subject.

Click Send.




MENU SET 1: SYNDROMIC SURVEILLANCE DATA SUBMISSION Objective: Capability to submit electronic syndromic surveillance data to public health agencies except

where prohibited, and in accordance with applicable law and practice. Measure: Successful ongoing submission of electronic syndromic surveillance data from CEHRT to a public

health agency for the entire EHR reporting period. Exclusion: Any EP that meets one or more of the following criteria may be excluded from this objective:

(1) the EP is not in a category of providers that collect ambulatory syndromic surveillance information on their patients during the EHR reporting period;

(2) the EP operates in a jurisdiction for which no public health agency is capable of receiving electronic syndromic surveillance data in the specific standards required by CEHRT at the start of their EHR reporting period;

(3) the EP operates in a jurisdiction where no public health agency provides information timely on capability to receive syndromic surveillance data; or

(4) the EP operates in a jurisdiction for which no public health agency that is capable of accepting the specific standards required by CEHRT at the start of their EHR reporting period can enroll additional EPs.

THIS MENU SET HAS YES/NO ATTESTATION.




MENU SET 2: RECORD ELECTRONIC NOTES IN PATIENT RECORDS Objective: Record electronic notes in patient records. Measure: Enter at least one electronic progress note created, edited and signed by an EP for more than

30 percent of unique patients with at least one office visit during the EHR reporting period. The text of the electronic note must be text searchable and may contain drawings and other content

Exclusion: No exclusion.



An encounter should have been started within reporting period.


At least one charting element should have been recorded within reporting period.







Ensure that at least one charting element is recorded within reporting period. To record a charting element:





Record details in at least one charting element (for example, CC/HPI, Vitals, Treatment Plan, etc.).




MENU SET 3: IMAGING RESULTS Objective: Imaging results consisting of the image itself and any explanation or other accompanying

information are accessible through CEHRT. Measure: More than 10 percent of all tests whose result is one or more images ordered by the EP during

the EHR reporting period are accessible through CEHRT. Exclusion: Any EP who orders less than 100 tests whose result is an image during the EHR reporting

period; or any EP who has no access to electronic imaging results at the start of the EHR reporting period.




Radiology order should have been placed during reporting period (manual or electronic). * Note: Number of denominator increase will depend on the number of radiology orders placed, for example, if 3 radiology orders are placed (2 electronically and 1 manually), the number of denominator increase will be 3.


The radiology result should have been received electronically, manually, or as a part of imaging result. * Note: Number of numerator increase will depend on the number of radiology results received, electronically, manually, or as a part of imaging result, for example, if 3 radiology result are received (1 electronically, 1 manually, and 1 as a diagnostic image), the number of numerator increase will be 3.


Ensure that an encounter is started and the radiology order is placed (electronically or manually) within reporting period. To start an encounter:



Click the Start Encounter button. To place a radiology order (electronically):




Click the Order Radiology button.


Start typing test name in the Order field; select an appropriate radiology order from the list.





To place a radiology order (manually):





Click the Radiology link.

Select appropriate check boxes to place a radiology order.


Ensure that the radiology result is received in one of the either way: electronically, manually, or as a diagnostic image. To receive the radiology result manually:





In the Category field, select Radiology from the drop-down list.

Click the Add Result link.

Enter the result details.

Click Add.

To receive the radiology result electronically:





Select the Results tab.

Click the Get Result(s) button. To receive the radiology result as a diagnostic image:





In the Category field, select Radiology from the drop-down list.

Expand the test name by clicking the + icon.

Once the diagnostic result is attached, select the “Diagnostic Result Image” check box.

Click Save.

Click the Attach link to browse for the diagnostic image.




MENU SET 4: RECORD FAMILY HEALTH HISTORY Objective: Record patient family health history as structured data. Measure: More than 20 percent of all unique patients seen by the EP during the EHR reporting period

have a structured data entry for one or more first-degree relatives. Exclusion: Any EP who has no office visits during the EHR reporting period.



An encounter should have been started within reporting period.


Patient's family history for any of these family members "father, mother, child, brother, sister" should have been recorded with illness from IMO search (within or outside reporting period).







Ensure that at least one family member’s history is recorded within or outside reporting period. To record patient’s family member’s history:





From the links shown on the top, click History.

From the left pane, click Family History.

In the Family Member drop-down, select any of the following: father, mother, child, brother, sister.

Select the illness from the list.

Click the Add Record icon. OR



Click the History tab.




From the left pane, click Family History.

In the Family Member drop-down, select any of the following: father, mother, child, brother, sister.

Select the illness from the list.

Click the Add Record icon.




MENU SET 5: REPORT CANCER CASE Objective: Capability to identify and report cancer cases to a public health central cancer registry, except

where prohibited, and in accordance with applicable law and practice. Measure: Successful ongoing submission of cancer case information from CEHRT to a public health central

cancer registry for the entire EHR reporting period. Exclusion: Any EP that meets at least 1 of the following criteria may be excluded from this objective:

(1) The EP does not diagnose or directly treat cancer; (2) The EP operates in a jurisdiction for which no public health agency is capable of receiving

electronic cancer case information in the specific standards required for CEHRT at the beginning of their EHR reporting period;

(3) The EP operates in a jurisdiction where no PHA provides information timely on capability to receive electronic cancer case information; or

(4) The EP operates in a jurisdiction for which no public health agency that is capable of receiving electronic cancer case information in the specific standards required for CEHRT at the beginning of their EHR reporting period can enroll additional EPs.





MENU SET 6: REPORT SPECIFIC CASE Objective: Capability to identify and report specific cases to a specialized registry (other than a cancer

registry), except where prohibited, and in accordance with applicable law and practice. Measure: Successful ongoing submission of specific case information from CEHRT to a specialized registry

for the entire EHR reporting period. Exclusion: Any EP that meets at least 1 of the following criteria may be excluded from this objective:

(1) The EP does not diagnose or directly treat any disease associated with a specialized registry sponsored by a national specialty society for which the EP is eligible, or the public health agencies in their jurisdiction;

(2) The EP operates in a jurisdiction for which no specialized registry sponsored by a public health agency or by a national specialty society for which the EP is eligible is capable of receiving electronic specific case information in the specific standards required by CEHRT at the beginning of their EHR reporting period;

(3) The EP operates in a jurisdiction where no public health agency or national specialty society for which the EP is eligible provides information timely on capability to receive information into their specialized registries; or

(4) The EP operates in a jurisdiction for which no specialized registry sponsored by a public health agency or by a national specialty society for which the EP is eligible that is capable of receiving electronic specific case information in the specific standards required by CEHRT at the beginning of their EHR reporting period can enroll additional EPs.



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