meaningful use - stage 3 roadmap eligible hospitals ...166.78.170.144/sites/default/files/final mu...

Revision Date: 10/02/2017 1

Meaningful Use - Stage 3 Roadmap Eligible Hospitals / Critical Access Hospitals

Evident is dedicated to making your attestation for Meaningful Use as seamless as possible. To assist our customers with implementation of the software required to meet Stage 3 requirements, Evident has created the guideline below. Each hospital should contact their Evident Sales Account Manager to purchase the Meaningful Use Stage 3 Bundle. Below is a list of items that will need to be implemented prior to the start of your attestation period:

Load Version 20

Thrive UX enabled for necessary users

Updated Patient Portal installed Once the Meaningful Use Stage 3 Bundle has been purchased, you will be receiving a process document with an education date that will kick off the education process. The process document will outline what will need to be done prior to the education date in order for you and your facility to prepare for and execute a smooth education process. An Evident representative will review all setup that is required as well as answer any questions regarding the objectives. All education material is also available on www.evident.com in the User Area under Meaningful Use. ***In this Roadmap, you will see two major sections: one section specifically for hospitals that are attesting for Medicare or are dual-eligible; and one section with the additional objectives for hospitals that are attesting for Medicaid through their state’s Medicaid website. Please note the differences in required thresholds when reading through this Roadmap.

Statistics Reporting

The Stage 3 statistics report will be utilized for hospitals that are attesting for Stage 3. This report contains all information that is required on percentage-based objectives. It can be found through the following path: Path within Thrive UX: Report Dashboard > MU Statistics Reporting > 2017 > from the dropdown menu, select what type of reporting for which you are eligible (EH Medicare Dual Eligible OR EH Medicaid > make sure that Stage 3 button is selected > select each statistic and apply the appropriate filters and date range > Calculate > PDF to save

Note that checking the Show Demographics button will show patients’ health information as well as additional data that is pertinent to the objective that is being run

Note that checking the Exclude Numerator button removes all visits/profiles in which an action increased the numerator. This was added so you can see all visits/profiles that are missing an action to update the numerator. When selecting the Exclude Numerator button, then Calculate, the numerator should always show as zero.

For your records, a hard copy of the MU Stage 3 Statistics Reports should be retained. These will need to be printed at the conclusion of your reporting period to keep on hand in case of an audit. The PDF can also be stored electronically in a safe place. If further information is needed, please visit www.cms.gov.

http://www.evident.com/

http://www.cms.gov/



Statistics Virtual Handouts are available on the user area of the Evident website. These include:

Clinical Reconciliation via Apps

Clinical Reconciliation via HIR

Secure Messaging

Patient Electronic Access

Patient Generated Health Information

Patient Education

Transition of Care – Send

Transition of Care – Receive and Incorporate

View, Download, Transmit

E-Prescribe

GUIDELINES FOR IMPLEMENTATION Clinical Quality Measures (CQMs): Continuing in Stage 3, there is no longer a separate objective for reporting Quality Measures as a part of Meaningful Use. It is important to note, however that EHs/CAHs will still be required to report on clinical quality measures in order to achieve Meaningful Use, no matter if they are attesting for Medicare, Medicaid, or are dual-eligible. Please see Quality Measures Roadmap and Tip Sheets (available in the User Area of the Evident website) for additional information on Quality Measures.

Medicare OR Dual-Eligible Hospitals

The following objectives will be required if you are attesting to Medicare or are Dual-Eligible (submitting to both Medicare and Medicaid): Protect Patient Health Information Objective: Protect electronic protected health information (ePHI) created or maintained by the CEHRT through the implementation of appropriate technical, administrative, and physical safeguards. Measure: Security Risk Analysis: Conduct or review a security risk analysis in accordance with the requirements under 45 CFR 164.308(a)(1), including addressing the security (including encryption) of data created or maintained by CEHRT in accordance with requirements under 45 CFR 164.312(a)(2)(iv) and 45 CFR 164.306(d)(3), implement security updates as necessary, and correct identified security deficiencies as part of the provider’s risk management process.

Must attest YES to conducting or reviewing a security risk analysis and implementing security updates as necessary and correcting identified security deficiencies to meet this Measure.

Must conduct or review a security risk analysis of CEHRT including addressing encryption/security of data, and implement updates as necessary at least once each calendar year and attest to conducting the analysis or review.



An analysis must be done upon installation or upgrade to a new system and a review must be conducted covering each EHR reporting period. Any security updates and deficiencies that are identified should be included in the provider's risk management process and implemented or corrected as dictated by that process.

It is acceptable for the security risk analysis to be conducted outside the EHR reporting period; however, the analysis must be unique for each EHR reporting period, the scope must include the full EHR reporting period and must be conducted within the calendar year of the EHR reporting period

Applicable Presentations: Security Objective for EHR Incentive Programs Electronic Prescribing (eRX) Generate and transmit permissible prescriptions electronically (eRX). Applications needed to meet Objective: Escribe, EPCS (if using controlled substances) Set-Up for Objective: Escribe and, if applicable, EPCS, need to be enabled in the Prescription Entry Control Table

Path: Thrive UX > Tables > Clinical > Prescription Entry Control Table All physicians using Escribe must be setup with an SPI number and the appropriate service level. How to meet Objective: This objective will be met when electronically prescribing prescriptions after discharge medication reconciliation has been performed. When creating new prescriptions, the prescription must be marked as either 'Dispense as Written' or 'Generic Substitution Permitted', and the Delivery Method on the prescription must be marked as Electronic and then processed.

All new prescriptions created are queried for a drug formulary. Please note: Evident has drug formulary automatically enabled for drug formulary and eligibility through Electronic Prescription (E-scribe) software.

All changes and refills increment the numerator as well. Pathway from within the patient’s chart: Prescription Entry > New Rx > Search for and select medication > Continue through Formulary or select an alternate medication > Fill out prescription information (Rx must have a Prescribing Method of “Dispense as Written” or “Generic Substitution Permitted” > Select Electronic as the delivery method > Select pharmacy > Process Denominator: Number of new or changed permissible prescriptions written for drugs requiring a prescription in order to be dispensed for patients discharged during the EHR Reporting Period.

New, Changed or refilled prescriptions that were written during the reporting period.

Controlled Substances can be included where feasible and allowable by state and local law. Controlled Substances may be excluded from the Escribe statistics report by checking ‘Exclude Controlled Substances’ prior to running the report.



Numerator: The number of prescriptions in the Denominator generated, queried for a drug formulary and transmitted electronically.

Number of prescriptions in the Denominator that were generated through electronic prescription application (and queried for a drug formulary- automatically) and transmitted electronically.

Medicaid Threshold: More than 25% of hospital discharge medication orders for permissible prescriptions (for new, changed, and refilled prescriptions) are queried for a drug formulary and transmitted electronically using certified EHR technology. Medicare/Dual Eligible Threshold: More than 25% of hospital discharge medication orders for permissible prescriptions (for new, changed, and refilled prescriptions) are queried for a drug formulary and transmitted electronically using certified EHR technology. Applicable presentations:

Drug Formulary

Escribe Setup

Electronic Prescribing: Cancelled Prescription Approved by Pharmacy

Electronic Prescribing: Cancelled Prescription Denied by Pharmacy

Electronic Prescribing: Change Request for Generic Substitution

Electronic Prescribing: Change Request for Prior Authorization

Electronic Prescribing: Change Request for Therapeutic Alternative

Electronic Prescribing: Unmatched Change Request

Electronic Prescribing: Associating Problems to a Prescription

Electronic Prescribing: Refill Request

Electronic Prescribing: Oral Liquid Prescriptions Default to mL

Electronic Prescribing: Medication History Patient Electronic Access to Health Information (2 measures) Measure 1 - Provide Timely Access Provide patients the ability to view online, download or transmit their health information within 36 hours of hospital discharge. Applications needed to meet Objective: Release of Information, Patient Portal, API Access Set-Up for Objective:

Set up Release of Information tables via Medical Records.

Create requestor Code for Patient request.

Create Purpose Code for Patient Possesses Info to Access Portal.

Pathway to add ROI code to an education document: Thrive UX > Tables > Clinical > Patient Education Maintenance: Document Maintenance > Search for and double-click on document > Add Code > Enter ROI code for "Patient Possesses Info to Access Portal" in the ROI field (type exactly as it appears in the ROI Control Table) > Save.

Update ROI Control Table with Requestor Type and Purpose Code in the appropriate fields.

The Release of Information Control Record needs to be setup prior to the beginning of the attestation period. In addition, the Control Record should not be changed during the attestation period as this could affect statistics for this measure.



How to meet Measure 1: (Objective can be met through various ways)

1. This objective can be met by having a valid email address on the patient’s registration visit screen (or their authorized provider) in the Census Application. Once the patient is discharged, they will be sent an introductory email to create a login name and user password and their patient/clinical summary (or CCD) will then be available on the patient portal for them to view.

The patient portal address will be the following: http://www.thrivepatientportal.com. The authorized representative entered in the census visit screen will also have access to the patient portal, giving the authorized representative access to the clinical information for the patient (visit they were the authorized representative on). The authorized representative should be verified each time a visit is created.

2. This objective can also be met by placing the “patient portal launch” onto the Point of Care Virtual

Chart. The facility can follow this link and assist the patient in logging into the patient portal. Please note: This will only update the numerator of this objective if the launch is chosen prior to 36 hours after discharge (to meet Measure 1 of this objective). However this launch will stay on the virtual chart for the patient indefinitely so that the facility can instruct the patients how to log into their portal to also meet measure 2 of this objective.

3. This objective can also be met by giving the patient information regarding how to log onto the portal or education classes that will be conducted on how to log into the portal etc. Once this is done, Release of Information can be manually updated with “PIA” which is the code for Patient Possesses Information regarding portal that was created above.

4. A custom patient education document can be created and tied to the Release of Information Code (Usually PIA is used) that is found in the Patient Possesses Info to Access Portal field in the Release of Information Control Table. Once that patient education document is given, this ROI entry will be created to update statistics.

Pathway: Thrive UX > Charts > Select Patient/Visit > Patient Education Documents > New Document > Select Custom from the Search options > Search for and select document set up for Portal Education > Add to Pending > Update Pending > Select Document > View or Print

In order for patients/authorized representatives to access health information via the API access, the Thrive patient portal login is needed. Therefore, the same methods listed above to access portal are the same for API access. API access needs to be enabled, even if there are no APIs being utilized. NOTE: If “Exclude from Portal” or 'Exclude from API' is checked on a patient’s account, the account will not display on the portal. That account will only count in the denominator. Denominator: Number of unique patients discharged from an eligible hospital or CAH's inpatient or emergency department during the EHR reporting period.

Unique patients discharged during the reporting period. Numerator: Number of patients in the denominator (or patient authorized representative) who are provided timely access to health information to view online, download, and transmit to a third party and to access using an application of their choice that is configured to meet the technical specifications of the API in the provider’s CEHRT.

Unique patients who have been provided access within 36 hours of discharge via the following:

Provided email address (patient or authorized provider) or

Launch Portal from Virtual Chart or

Provided education material and updated Release of Information

http://www.thrivepatientportal.com/



Patient in Room **Numerator Change with Reporting Year 2017: Starting with reporting year 2017, ALL patient encounters during the reporting period must have health information available within 36 hours in order for the patient to count in the numerator. Medicaid Threshold: For more than 80 percent of all unique patients discharged from the eligible hospital or CAH inpatient or emergency department (POS 21 or 23):

The patient (or the patient authorized representative) is provided timely access to view online, download, and transmit his or her health information; and

The provider ensures the patient’s health information is available for the patient (or patient authorized representative) to access using any application of their choice that is configured

Medicare Threshold: For more than 50 percent of all unique patients discharged from the eligible hospital or CAH inpatient or emergency department (POS 21 or 23):

The patient (or the patient authorized representative) is provided timely access to view online, download, and transmit his or her health information; and

The provider ensures the patient’s health information is available for the patient (or patient authorized representative) to access using any application of their choice that is configured

It is Evident’s interpretation that Measure 1 can be met once the patient possesses all information necessary to log into the portal as well as be able to access health information from API. Access is defined as the following: When a patient possesses all of the necessary information needed to view, download, or transmit their information. This could include providing patients with instructions on how to access their health information, the website address they must visit for online access, a unique and registered username or password, instructions on how to create a login, or any other instructions, tools, or materials that patients need in order to view, download, or transmit their information. Measure 2 - Patient-Specific Education The eligible hospital or CAH must use clinically relevant information from CEHRT to identify patient-specific educational resources and provide electronic access to those materials to unique patients discharged from the eligible hospital or CAH inpatient or emergency department (POS 21 or 23) during the EHR reporting period. Applications needed to meet Objective: Patient Education Documents, InfoButton, Patient Portal Set-Up for Measure: InfoButton needs to be an active application. How to meet Measure 2: This objective will be met through the use of the Clinical Knowledge/InfoButton. When an education document is given and saved using the Clinical Knowledge option, this will be recorded onto the patient’s account. The document will then be available on the portal for patients/authorized representatives to access.



For patients to have access to the patient education documents from portal, they will need the same requirements listed for Measure 1 (Provide Timely Access):

Provided email address (patient or authorized representative) or

Launch Portal from Virtual Chart or

Provided education material and updated Release of Information

Patient in Room The main difference is that there is no 36 hour time constraint for this objective. The information has to be available by end of calendar year. Pathway: Thrive UX > Charts > Select Patient/Visit > Patient Education Documents > Clinical Knowledge > Select Infobutton (blue button with “i”) for the desired category (patient’s problems, medications) > Double-click desired document > Double-click desired language > Print/Save or Save Denominator: The number of unique patients discharged from an eligible hospital’s or CAH’s inpatient or emergency department (POS 21 or 23) during the EHR reporting period. Number of unique patients admitted during the reporting period. Numerator: The number of patients in the denominator who were provided electronic access to patient-specific educational resources using clinically relevant information identified from CEHRT during the EHR reporting period. For patients to have access to the patient education documents from portal, they will need the same requirements listed for Measure 1 (Provide Timely Access) Numerator Action: Can take place within the Calendar Year (Not limited to reporting period) Medicaid Threshold: The eligible hospital or CAH must use clinically relevant information from CEHRT to identify patient-specific educational resources and provide electronic access to those materials to more than 35 percent of unique patients seen by the EP or discharged from the eligible hospital or CAH inpatient or emergency department (POS 21 or 23) during the EHR reporting period. Medicare Threshold: The eligible hospital or CAH must use clinically relevant information from CEHRT to identify patient-specific educational resources and provide electronic access to those materials to more than 10 percent of unique patients seen by the EP or discharged from the eligible hospital or CAH inpatient or emergency department (POS 21 or 23) during the EHR reporting period. Applicable Presentations: Patient-Specific Education Resources (Eligible Hospital) Important to Note: Failure to provide the patient with electronic access to their health information results in a failure to provide them with electronic access to their patient education documents. Therefore, in order to meet measure 2 of Patient Electronic Access, measure 1 must be met on the patient as well.



Coordination of Care through Patient Engagement (3 measures) Must attest to all three measures and must meet the thresholds for at least two measures in order to meet the objective. Measure 1: View, Download, and Transmit Unique patients (or their authorized representatives) discharged from the eligible hospital or CAH inpatient or emergency department (POS 21 or 23) actively engage with the electronic health record made accessible by the provider and either: 1. View, download or transmit to a third party their health information; or

2. Access their health information through the use of an API that can be used by applications chosen by

the patient and configured to the API in the provider's CEHRT; or

3. A combination of (1) and (2) Applications needed to meet Objective: Patient Portal, API Access Set-Up for Measure:

Patient and/or patient’s authorized representative must have a Patient Portal login setup.

Facilities will need to have Patient Portal and API Access set to Active How to meet Measure 1:

Patients/Authorized representatives will need to set up a patient portal login. That login will be used for both Thrive Patient Portal as well as any API access via a third party application. Patients can login to the portal via the POC Virtual Chart or from www.thrivepatientportal.com.

They can choose a visit and either view, download or transmit their patient/clinical summary (or CCD).

Patients can also access their information via API Access (third party vendor). Denominator: Number of unique patients discharged from an eligible hospital's or CAH's inpatient or emergency department) during the EHR reporting period.

Unique patients discharged during reporting period. Numerator: The number of unique patients (or their authorized representatives) in the denominator who have viewed online, downloaded, or transmitted to a third party the patient’s health information during the EHR reporting period and the number of unique patients (or their authorized representatives) in the denominator who have accessed their health information through the use of an API during the EHR reporting period.

Unique patients in denominator who have done one of the following with Discharge Information (CCD) provided by the hospital:

Viewed Online

Downloaded

Transmitted CCD-Patient Summary to a 3rd Party




Accessed information from a third party application via API Numerator Action: Can take place within the Calendar Year (Not limited to reporting period) Medicaid 2017 Threshold: More than 5% of all unique patients (or their authorized representatives) discharged from the eligible hospital or CAH inpatient or emergency department (POS 21 or 23) actively engage with the electronic health record made accessible by the provider and either:

1. View, download or transmit to a third party their health information; or



3. A combination of (1) and (2) Medicaid 2018 Threshold: More than 10% of all unique patients (or their authorized representatives) discharged from the eligible hospital or CAH inpatient or emergency department (POS 21 or 23) actively engage with the electronic health record made accessible by the provider and either:

1. View, download or transmit to a third party their health information; or



3. A combination of (1) and (2) Medicare/Dual Eligible 2017/2018 Threshold: At least 1 patient (or patient-authorized representative) discharged from the eligible hospital or CAH inpatient or emergency department (POS 21 or 23) actively engages with the electronic health record made accessible by the provider and either:

1. Views, downloads or transmits to a third party their health information; or

2. Accesses his/her health information through the use of an API that can be used by applications

chosen by the patient and configured to the API in the provider's CEHRT; or

3. A combination of (1) and (2) Measure 2 - Secure Electronic Messaging For all Unique patients discharged from the eligible hospital or CAH inpatient or emergency department (POS 21 or 23) during the EHR reporting period, a secure message was sent using the electronic messaging function of CEHRT to the patient (or the patient-authorized representative), or in response to a secure message sent by the patient (or the patient-authorized representative). Applications needed to meet Objective: Secure Messaging and Patient Portal with Secure Messaging Set-Up for Measure:

Patient must have a Patient Portal login setup.

Each provider number can only be attached to one UBL.



Provider may set up a folder on their Home Screen for Secure Messages.

Pathway: Home Screen > New > Enter a Name and Description (example: Secure Messaging) > Under Select Options, select the green icon next to Task Type > Under Configure Items, Select Task Type > Secure Patient Message > Insert > OK > Select the back arrow to return to the Home Screen.

How to meet Measure 2:

Provider must send a new secure electronic message to the patient (or patient’s authorized representative) or respond to a secure message sent by the patient (or patient’s authorized representative).

Pathway for Provider to send a secure message to the patient: Thrive UX > Charts > Select Patient > Select Communication > Secure Messaging > Select Patient or Patient’s Authorized Representative > Continue > Enter Subject and Message > Send.

Pathway for patient to send a secure message to the provider: Internet Explorer > Type address www.thrivepatientportal.com > Log in with username and password > Message Center > Select the pencil in the upper right hand corner > Enter Subject and Message > Send. *In order to count in the numerator, the provider must respond to the secure message sent by the patient/authorized representative.

NOTE: Message must be clinically relevant, and marked as such, to count in the numerator. Denominator: Number of unique patients discharged from an eligible hospital or CAH inpatient or emergency department (POS 21 or 23) during the EHR reporting period.

Number of unique patients with a visit that is admitted and discharged during the reporting period. Numerator: The number of patients in the denominator for whom a secure electronic message is sent to the patient (or patient-authorized representative) or in response to a secure message sent by the patient (or patient-authorized representative), during the EHR reporting period. Medicaid 2017 Threshold: For more than 5 percent of all unique patients discharged from the eligible hospital or CAH inpatient or emergency department (POS 21 or 23) during the EHR reporting period, a secure message was sent using the electronic messaging function of CEHRT to the patient (or the patient-authorized representative), or in response to a secure message sent by the patient (or the patient-authorized representative). Medicaid 2018 Threshold: For more than 10 percent of all unique patients discharged from the eligible hospital or CAH inpatient or emergency department (POS 21 or 23) during the EHR reporting period, a secure message was sent using the electronic messaging function of CEHRT to the patient (or the patient-authorized representative), or in response to a secure message sent by the patient (or the patient-authorized representative). Medicare 2017 and 2018 Threshold: For more than 5 percent of all unique patients discharged from the eligible hospital or CAH inpatient or emergency department (POS 21 or 23) during the EHR reporting period, a secure message was sent using the electronic messaging function of CEHRT to the patient (or the patient-authorized representative), or in response to a secure message sent by the patient (or the patient-authorized representative).




Measure 3 - Patient Generated Health Information Capture Patient generated health data or data from a nonclinical setting is incorporated into the CEHRT for unique patients discharged from the eligible hospital or CAH inpatient or emergency department (POS 21 or 23) during the EHR reporting period. Applications needed to meet Objective: Patient Portal, Electronic File Management, Information Submission Set-Up for Measure:

If adding documents from the portal, the patient/authorized rep will need a patient portal login.

Image Titles will need to be set up:

Path: Thrive UX > Tables > Business Office > Titles (Under Images Heading) > Select Image Title > Select 'Health Information' field on the Image Title

How to meet Measure 3: Patients can upload Health Information documents from the Patient Portal. The documents can then be imported by the facility from the Patient's Profile

Path: Thrive UX > System Menu > Select Facility > Patient Profile > Select Patient > Information Submissions > Select Document > Select Import > Assign an account number and Image Title

If the patient gives the health information directly to the provider/health care team, the user can upload the data via Electronic File Management

Path: Thrive UX > System Menu > Select Facility > Select Visit > Electronic File Management > Add File > Select Location > Select Image Title > Check Patient Information Submissions Box > Save File

Denominator: Number of unique patients discharged from an eligible hospital or CAH inpatient or emergency department (POS 21 or 23) during the EHR reporting period. Numerator: The number of patients in the denominator for whom data from non-clinical settings, which may include patient-generated health data, is captured through the CEHRT into the patient record during the EHR reporting period. Numerator Action: Action has to take place within the reporting period. Medicaid Threshold: Patient generated health data or data from a nonclinical setting is incorporated into the CEHRT for more than 5 percent of all unique patients discharged from the eligible hospital or CAH inpatient or emergency department (POS 21 or 23) during the EHR reporting period. Medicare/Dual Eligible Threshold: Patient generated health data or data from a nonclinical setting is incorporated into the CEHRT for more than 5 percent of all unique patients discharged from the eligible hospital or CAH inpatient or emergency department (POS 21 or 23) during the EHR reporting period. Applicable Presentations:

Patient Portal: View, Download, and Transmit (Eligible Hospital)

Patient Access: Patient Portal - API (Eligible Hospital)

Secure Messaging: Patient Sending a Secure Message from the Patient Portal



Secure Messaging: Viewing Secure Messages from the Communication Application -

Secure Messaging: Viewing Secure Messages from the Home Screen

Secure Messaging: Provider Sending a Secure Message to a Patient

Secure Messaging: Patient Viewing and Replying to Secure Messages

Patient Health Information Capture - Uploading a Document to the Portal

Patient Health Information Capture - Importing a Document from the Portal

Patient Health Information Capture - EHR Upload

Patient Health Information Capture - Image Title Setup Health Information Exchange: Must attest to all three measures and must meet the thresholds for at least two measures in order to meet the objective. Measure 1 – Summary of Care - Send The eligible hospital or CAH who transitions their patient to another setting of care or provider of care or refers their patient to another provider of care provides a summary care record for each transition of care or referral. A transition of care for electronic exchange is one where the referring entity is under a different billing identity within the Medicare and Medicaid Incentive Program than that of the receiving provider and where the providers do not share access to the same EHR. In cases where the providers do share access to the same EHR, a transition or referral may still count toward the measure if the referring provider creates the document via CEHRT and sends the document electronically. Applications needed to meet Objective: Point of Care, Lab, Radiology, Physician Documentation, Clinical Vocabulary, Direct Messaging with Inpriva (3rd party HISP), Pharmacy, Prescription Entry, Clinical Monitoring and Electronic File Management. Set-Up for Measure:

The patient must be discharged.

The patient must have a referral-outbound or transition-outbound entered in their patient chart

Path to enter referral/transition: Thrive UX > Charts > Select Patient > Health History > New > Referral/Transition of Care

Set up the following in Release of Information System via Medical Records:

Purpose code has to be entered in Release of Information Control Table: “Purpose Cd for Complete Patient Summary Sent for Transfer/Referral field”.

Purpose code (created above) has to be entered in Release of Information Control Table: “Purpose Cd for Incomplete Summary Sent for Transfer/Referral field”.

The Release of Information Control Record needs to be setup prior to the beginning of the attestation period. In addition, the Control Record should not be changed during the attestation period as this could affect statistics for this measure.

Each facility will have to go through onboarding for Direct Messaging. In order to receive a Direct Messaging Address, an order must be placed with Evident and your system configured. Once this is done by Evident, your facility will receive an email to explain the onboarding process with Inpriva (our 3rd Party HISP).



NOTE: Inpriva is a fully accredited DirectTrust HISP. As such, the exchange of Direct Messages must be to/from other DTAAP accredited HISPs.

Inpriva will assign your facility a Direct Messaging Address. Once that address is received, it should be placed in the following location:

Pathway: Thrive UX > Tables > Business Office Tables > Under Insurance select Clinic Table > Select a Clinic > Direct Address.

The accepting provider that will be receiving the referral or summary of care can be pre-defined and set up in the following table:

Thrive UX > Tables > Business Office Tables > Referring Physician. How to meet Measure 1: To meet the measure, the summary of care document, specifically the referral/transitions summary (referral/transition of care summary) must be sent electronically via the above mentioned “Submit to Provider” option through Direct Messaging. It is suggested the referral/transitions summary be set up in the virtual chart.

When a patient is transferred to another facility, Problems, Medications, Medication Allergies must be entered on the patient’s account in order to meet the objective.

Referral/Transition of Care widget is accessed and recorded for your patient to be in the denominator.

When ‘Submit to Provider’ is chosen, it creates a Release of Information (ROI) entry for the patient in the Release of Information Application.

NOTE: The provider to whom the referral is made or to whom the patient is transitioned must have either a different National Provider Identifier (NPI) OR hospital CMS Certification Number (CCN) AND must be sent a summary of care document to count in the numerator. Denominator: Number of transitions of care and referrals during the EHR reporting period in which an eligible hospital or CAH’s inpatient or emergency department was the transferring or referring provider. This is calculated from the number of discharges where the transfer/referral outbound widget was addressed or number of discharges where the follow up care question was addressed. Numerator: Number of transitions of care and referrals in the Denominator where a summary of care record was provided and exchanged electronically. Problems, Medications and Medication Allergies were also documented (or no known). Once your CCD-Transfer Summary/Referral is successfully sent, there is an indication of Success in the CCDA transmission log. The path to this log is found via the following path:

Thrive UX > Report Dashboard > CCDA Transmission Log Numerator Action: Can take place within the Calendar Year (Not limited to reporting period) Medicaid Threshold: The eligible hospital or CAH that transitions or refers their patient to another setting of care or provider of care must 1- use CEHRT to create a summary of care record; and 2- electronically transmit such summary to a receiving provider for more than 50% of transitions of care and referrals. Medicare/Dual Eligible Threshold: The eligible hospital or CAH that transitions or refers their patient to another setting of care or provider of care must 1- use CEHRT to create a summary of care record; and 2- electronically transmit such summary to a receiving provider for more than 10% of transitions of care and referrals.



Measure 2 – Summary of Care - Receive/Incorporate For transitions or referrals received and patient encounters in which the provider has never before encountered the patient, the eligible hospital or CAH incorporates into the patient’s EHR an electronic summary of care document. Applications needed to meet Objective: Direct Messaging with Inpriva (3rd party HISP), Electronic File Management Optional: HIE or Commonwell Set up for the Measure: Facilities will need to set the HIE query fields on the 999999 physician table Path: Thrive UX > Table Maintenance > Control > Physicians > Select 999999 physician > MU Tab How to meet the Measure 2: Pathway: Thrive UX > Charts > Select Patient/Visit > Health Information Resource > Import from Inbox > The user will see documents that match that specific patient (if the user does not see a document based on the automatic patient matching, the user can select the View Document Queue-All button to view all document in the inbox for that Direct Address) > Double-click on the CCDA in the Document List to view the CCDA > Select Import

The patient matching is based on the patient’s first name, middle name, last name, suffix, previous name, date of birth, address, phone numbers and birth sex.

CCDA documents can be received via Direct Messaging or from an HIE query. The four following documents will update the numerator once imported:

CCDA 1.1

CCDA 2.1

Referral Note

Discharge Summary Denominator: Number of patients admitted to the eligible hospital or CAH during the EHR reporting period for which an electronic summary of care record is available. ***Unavailable definition: For the purposes of defining the cases in the denominator for measure 2, we stated that what constitutes ‘‘unavailable’’ and, therefore, may be excluded from the denominator, will be that a provider:

Requested an electronic summary of care record to be sent and did not receive an electronic summary of care document; and

The provider either:

Queried at least one external source via HIE functionality and did not locate a summary of care for the patient, or the provider does not have access to HIE functionality to support such a query, or

Confirmed that HIE functionality supporting query for summary of care documents was not operational in the provider’s geographic region and not available within the provider’s EHR network as of the start of the EHR reporting period



To exclude the patient from the denominator:

1. Fill out a transfer/referral - inbound widget in the Health History application and notate that a document was requested and not received.

2. Query an HIE to see if a document is available. If the facility is not a part of an HIE and does not have an HIE to query, the HIE query field on the 999999 physician needs to be set to No. If there is an HIE to query, but the hospital is not part of the HIE, the date that the HIE became active needs to be stated in the 999999 physician table.

If both of the above actions are performed and the HIE does not return a document, the patient will be excluded from the denominator. Numerator: Number of patient encounters in the denominator where an electronic summary of care record received is incorporated by the provider into the certified EHR technology. Numerator Action: Can take place within the Calendar Year (Not limited to reporting period) Medicaid Threshold: For more than 40 percent of transitions or referrals received and patient encounters in which the provider has never before encountered the patient, the eligible hospital or CAH incorporates into the patient’s EHR an electronic summary of care document. Medicare/Dual Eligible Threshold: For more than 10 percent of transitions or referrals received and patient encounters in which the provider has never before encountered the patient, the eligible hospital or CAH incorporates into the patient’s EHR an electronic summary of care document. Measure 3 - Clinical Reconciliation For all patient encounters and transitions or referrals received (all admissions), the eligible hospital or CAH performs a clinical information reconciliation. The provider must implement clinical information reconciliation for the following three clinical information sets: 1) Medication. Review of the patient’s medication, including the name, dosage, frequency, and route of each medication. 2) Medication allergy. Review of the patient’s known medication allergies. 3) Current Problem list. Review of the patient’s current and active diagnoses. Applications needed to meet Objective:

ChartLink

Clinical Information

Clinical Reconciliation

Medication Reconciliation

Problem List Set-Up for Measure: Medication and Pharmacy information will need to be set up. User will need to have access to Health Information Resource in order to import the CCDA document.



How to meet Measure 3: Clinical Reconciliation allows users to reconcile allergies, medications and problems that were either imported from a Transition of Care Summary/Referral Summary CCDA or manually reconciled. Imported data can be merged and duplicates can be consolidated. Users can import new, keep an existing or remove records. Once data is imported to the pending queue, users can access the appropriate application(s) to reconcile the information.

Pathway to reconcile Allergies from an imported CCDA: Thrive UX > Charts > Select Patient/Visit > Allergies > Imported allergies will be listed under the Imported Medication Allergies column and existing allergies will be listed under the Current Medication Allergies column > Select Associate Like Items to automatically associate an import and current allergy based on the RxNorm code (users can also manually associate and remove associations) > either Import New, Keep Existing or Remove all allergies > Review > Reconcile

Pathway to reconcile Medications from an imported CCDA: Thrive UX > Charts > Select Patient/Visit > Medication Reconciliation or Prescription Entry > Imported medications will be listed under the Imported Home Medication column and existing medications will be listed under the Current Home Medication column > Select Associate Like Items to automatically associate an import and current medications based on the RxNorm code (users can also manually associate and remove associations) > either Import New, Keep Existing or Remove medications listed > Review > Reconcile

Pathway to reconcile Problems from an imported CCDA: Thrive UX > Charts > Select Patient/Visit > Problem List > Imported problems will be listed under the Imported Problems column and existing problems will be listed under the Current Problems column > Select Associate Like Items to automatically associate an import and current problem (users can also manually associate and remove associations) > either Import New, Keep Existing or Remove problems listed > Review > Reconcile

Import New: This option will mark the selected item with a pending action of Import New which will add that item to the patient’s allergy/medication/problem list upon reconciling.

Keep Existing: This option will mark the selected current item with a pending action of Keep Existing which will retain that item on the patient’s allergy/medication/problem list upon reconciling.

Remove: This option will mark either an import or current item with a pending action of Remove. If an imported item has Remove selected, that allergy will be deleted upon reconciling (and not become a part of the patient’s allergy list). If a current item has Remove selected, that item will be removed from the patient’s allergy/medication/problem list upon reconciling.

Users can also perform Clinical Reconciliation from within Health Information Resource once a CCDA has been imported.

Pathway: Thrive UX > Charts > Select Patient/Visit > Health Information Resource > Clinical Reconcile > If there are imported records that have not yet been reconciled, there will be a “Yes” under the Imported Records button for Allergies, Home Medications or Problems > Select All or select each item individually > Process to perform the reconciliation.

If an electronic CCDA document is not available for import, users can manually update clinical reconciliation with information directly from the patient.

Pathway: Thrive UX > Charts > Select Patient/Visit > Health Information Resource > Clinical Reconcile > Select All or select each item individually > Process to perform the reconciliation.



NOTE: Problems, Medications, and Allergies need to be entered in prior to performing clinical reconciliation. If no data is present the user will get a notification stating “Unable to perform clinical reconciliation if no imported or existing data is present.” Denominator: Number of patients admitted to the eligible hospital or CAH (POS 21 or 23) during the EHR reporting period. Numerator: The number of transitions of care or referrals in the denominator where the following three clinical information reconciliations were performed: Medication list, medication allergy list, and current problem list. ***All 3 reconciliations have to be performed in order for the patient to count in the numerator. Numerator Action: Can take place within the Calendar Year (Not limited to reporting period) Medicaid Threshold: For more than 80 percent of transitions or referrals received and patient encounters in which the provider has never before encountered the patient, the eligible hospital or CAH performs a clinical information reconciliation. Medicare/Dual Eligible Threshold: For more than 50 percent of transitions or referrals received and patient encounters in which the provider has never before encountered the patient, the eligible hospital or CAH performs a clinical information reconciliation. Applicable Presentations:

CCDA Viewer (Eligible Hospital)

Summary of Care - Send (Eligible Hospital)

Summary of Care - Receive and Incorporate (Eligible Hospital)

Clinical Information Reconciliation - Import from Inbox (Eligible Hospital)

Clinical Information Reconciliation - Clinical Reconcile (Eligible Hospital) Public Health and Clinical Data Registry Reporting Objective: The eligible hospital or CAH is in active engagement with a public health agency or clinical data registry to submit electronic public health data in a meaningful way using certified EHR technology, except where prohibited, and in accordance with applicable law and practice. CMS states that “active engagement” may be demonstrated by any of the following options:

Completed registration to submit data – The EH/CAH has registered to submit data with the PHA or, where applicable, the CDR to which the information is being submitted; registration was completed within 60 days after the start of the reporting period and not on the first day of the reporting period; and the EH/CAH is awaiting an invitation from the PHA or CDR to begin testing and validation.

Testing and validation – The EH/CAH is in the process of testing and validation of the electronic submission of data. Providers must respond to requests from the PHA or CDR within 30 days; failure to respond twice within an EHR reporting period would result in that provider not meeting the measure.

Production – The EH/CAH has completed testing and validation of the electronic submission and is electronically submitting production data to the PHA or CDA.



Medicare/Dually Eligible: must attest YES to three of the following 5 measures Medicaid: Must attest YES to four of the following 5 measures Measures:

1. Immunization Registry Reporting: The eligible hospital or CAH is in active engagement with a

public health agency to submit immunization data and receive immunization forecasts and histories from the public health immunization registry/immunization information system (IIS).

2. Syndromic Surveillance Reporting: The eligible hospital or CAH is in active engagement with a public health agency to submit syndromic surveillance data from an urgent care setting.

3. Electronic Case Reporting*: The eligible hospital or CAH is in active engagement with a public health agency to submit case reporting of reportable conditions.

NOTE: Electronic Case Reporting is not required until 2018. 4. Public Health Registry Reporting*: The eligible hospital or CAH is in active engagement with a

public health agency to submit data to public health registries.

5. Clinical Data Registry Reporting*: The eligible hospital or CAH is in active engagement to submit data to a clinical data registry.

6. Electronic Reportable Laboratory Result Reporting: The eligible hospital or CAH is in active engagement with a public health agency to submit electronic reportable laboratory results.

*NOTE: Evident is currently in the process of certifying these registries. Exclusions: Immunization Registry Reporting: Any eligible hospital or CAH meeting one or more of the following criteria may be excluded from the immunization registry reporting measure if the eligible hospital or CAH:

Does not administer any 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;

Operates in a jurisdiction for which no immunization registry or immunization information system is capable of accepting the specific standards required to meet the CEHRT definition at the start of the EHR reporting period; or

Operates in a jurisdiction where no immunization registry or immunization information system has declared readiness to receive immunization data as of 6 months prior to the start of the EHR reporting period.



Syndromic Surveillance Reporting: Any eligible hospital or CAH meeting one or more of the following criteria may be excluded from the syndromic surveillance reporting measure if the eligible hospital or CAH:

Does not have an emergency or urgent care department;

Operates in a jurisdiction for which no public health agency is capable of receiving electronic syndromic surveillance data from eligible hospitals or CAHs in the specific standards required to meet the CEHRT definition at the start of the EHR reporting period; or

Operates in a jurisdiction where no public health agency has declared readiness to receive syndromic surveillance data from eligible hospitals or CAHs as of 6 months prior to the start of the EHR reporting period.

Electronic Case Reporting: Any eligible hospital or CAH meeting one or more of the following criteria may be excluded from the case reporting measure if the eligible hospital or CAH:

Does not treat or diagnose any reportable diseases for which data is collected by their jurisdiction’s reportable disease system during the EHR reporting period;

Operates in a jurisdiction for which no public health agency is capable of receiving electronic case reporting data in the specific standards required to meet the CEHRT definition at the start of the EHR reporting period; or

Operates in a jurisdiction where no public health agency has declared readiness to receive electronic case reporting data as of 6 months prior to the start of the EHR reporting period.

Public Health Registry Reporting: Any eligible hospital or CAH meeting at least one of the following criteria may be excluded from the public health registry reporting measure if the eligible hospital or CAH:

Does not diagnose or directly treat any disease or condition associated with a public health registry in their jurisdiction during the EHR reporting period;

Operates in a jurisdiction for which no public health agency is capable of accepting electronic registry transactions in the specific standards required to meet the CEHRT definition at the start of the EHR reporting period; or

Operates in a jurisdiction where no public health registry for which the eligible hospital or CAH is eligible has declared readiness to receive electronic registry transactions as of 6 months prior to the start of the EHR reporting period.

Clinical Data Registry Reporting: Any eligible hospital or CAH meeting at least one of the following criteria may be excluded from the clinical data registry reporting measure if the eligible hospital or CAH:

Does not diagnose or directly treat any disease or condition associated with a clinical data registry in their jurisdiction during the EHR reporting period;

Operates in a jurisdiction for which no clinical data registry is capable of accepting electronic registry transactions in the specific standards required to meet the CEHRT definition at the start of the EHR reporting period; or

Operates in a jurisdiction where no clinical data registry for which the eligible hospital or CAH is eligible has declared readiness to receive electronic registry transactions as of 6 months prior to the start of the EHR reporting period.



Electronic Reportable Laboratory Result Reporting: Any eligible hospital or CAH meeting one or more of the following criteria may be excluded from the electronic reportable laboratory result reporting measure if the eligible hospital or CAH:

Does not perform or order laboratory tests that are reportable in their jurisdiction during the EHR reporting period;

Operates in a jurisdiction for which no public health agency is capable of accepting the specific ELR standards required to meet the CEHRT definition at the start of the EHR reporting period; or

Operates in a jurisdiction where no public health agency has declared readiness to receive electronic reportable laboratory results from an eligible hospital or CAH as of 6 months prior to the start of the EHR reporting period.

How to meet this measure: Active engagement - means that the provider is in the process of moving towards sending "production data" to a public health agency or clinical data registry, or is sending production data to a public health agency or clinical data registry. Applicable Presentations:

Syndromic Surveillance

Reportable Labs: Specimen Information Setup

Reportable Labs: Item Master Setup

Reportable Labs: Order Entry Information Setup

Reportable Labs: Reference Range Setup

Reportable Labs: Entering Specimen Information

Reportable Labs: Associating a Problem

Reportable Labs: Reporting a Lab Result

Immunization Setup: Attaching a CPT Code

Immunization Setup: Associating CPT and CVX Codes

Immunization Setup: Vaccine Manufacturer

Immunization Setup: VFC Status Codes

Immunization Setup: HL7 and NCIT Codes for Routes

Immunization Setup: HL7 Codes for Site Options

Immunization Setup: UCUM Codes for Units

Immunization Setup: Omit Reasons

Immunization Setup: Protect Immunization Data

Immunizations: Documenting Immunization Publicity Code

Immunizations: Documenting Multiple Birth and Order

Immunization Forecasting

Immunization Administration - Hospital



Medicaid - Hospitals

The following two objectives will also be required, in addition to the above measures, if you are attesting to Medicaid on your state’s Medicaid website: Clinical Decision Support: Objective: Implement clinical decision support (CDS) interventions focused on improving performance on high-priority health conditions. Measure: must attest YES to both of the following:

1. Implement five clinical decision support interventions related to four or more CQMs at a relevant point

in patient care for the entire EHR reporting period. Absent four CQMs related to an eligible hospital or CAH's scope of practice or patient population, the clinical decision support interventions must be related to high-priority health conditions.

2. The eligible hospital or CAH has enabled and implemented the functionality for drug-drug and drug-allergy interaction checks for the entire EHR reporting period.

How to achieve Objective: Measure 1: This objective is met with real time alerting of the system based on CDS alerts and configurations. The system will track when each CDS alert was activated/ deactivated. This can be found by choosing the specific alert in CDS alert configuration (Table Maintenance) and choosing Status History. Measure 2: The EHR must also have the ability to offer diagnostic or therapeutic reference information based on Problems, Medications, Medication Allergies, Laboratory tests/values, and Vital Signs and a combination option. This will be achieved with the use of the InfoButton. Override Reasons report and Clinical Monitoring reports are available to assist with tracking compliance. Setup for objective: Measure 1: Clinical Decision and the rules must be activated from the following path. NOTE: To be able to configure and enable CDS Alerts, you must be set up in the System Administrator Group. Path: Thrive UX > Tables > Clinical > CDS Alert Configuration > Highlight desired alert > Select Edit > Check the Alert Status Checkbox > Save NOTE: Once an alert has been activated, it cannot be deactivated. Path: Pathway: Table Maintenance > Clinical > CDS Alert Configuration > Choose Alert > Status History > Screen shot > Back arrow > Double-click on alert > Screen shot Measure 2: Drug-Drug, Drug-Allergy Clinical Monitoring options must be set up via Nursing, Pharmacy, and/or ChartLink®. The following are clinical monitoring options that must also be used:

Allergy Checking

Drug Interaction Checking NOTE: The site will be responsible for deciding whether or not Overrides will be required by the facility.



Applicable Presentations: Clinical Decision Support Computerized Provider Order Entry (CPOE) Objective: Use computerized provider order entry (CPOE) for medication, laboratory, and diagnostic imaging orders directly entered by any licensed healthcare professional, credentialed medical assistant, or a medical staff member credentialed to and performing the equivalent duties of a credentialed medical assistant, who can enter orders into the medical record per state, local, and professional guidelines. Measure: Must meet the thresholds for all three measures: 1. More than 60% of medication orders created by the authorized providers of the eligible hospital or

CAH inpatient or emergency department (POS 21 or 23) during the EHR reporting period are recorded using computerized provider order entry.

2. More than 60% of laboratory orders created by the authorized providers of the eligible hospital or CAH inpatient or emergency department (POS 21 or 23) during the EHR reporting period are recorded using computerized provider order entry.

3. More than 60% of diagnostic imaging orders created by the authorized providers of the eligible hospital or CAH inpatient or emergency department (POS 21 or 23) during the EHR reporting period are recorded using computerized provider order entry.

CPOE Medication Orders: Denominator: Number of medication orders created by the authorized providers in the eligible hospital's or CAH's inpatient or emergency department (POS 21 or 23) during the EHR reporting period. Numerator: The number of orders in the denominator recorded using CPOE. CPOE Laboratory Orders: Denominator: Number of laboratory orders created by the authorized providers in the eligible hospital's or CAH's inpatient or emergency department (POS 21 or 23) during the EHR reporting period. Numerator: The number of orders in the denominator recorded using CPOE. CPOE Radiology Orders: Denominator: Number of diagnostic imaging orders created by the authorized providers in the eligible hospital's or CAH's inpatient or emergency department (POS 21 or 23) during the EHR reporting period. Numerator: The number of orders in the denominator recorded using CPOE. How to achieve Objective: This objective is met by placing orders through Computerized Physician Order Entry. CPOE entails the provider’s use of computer assistance to directly enter orders from a computer or mobile device. The order is also documented or captured in a digital, structured, and computable format for use in improving safety and organization. Telephone and verbal orders count for this objective, but should be used sparingly and only when absolutely necessary. Best Practice would be having the provider put in the CPOE orders every time. Electronic prescriptions also count toward this measure.



Setup for objective:

1. Setup for Prescription Entry

Tables Path: Thrive UX > Tables > Clinical > Prescription Entry Control Table

All physicians using Escribe must be setup with an SPI number and the appropriate service level

2. Setup of pharmacy items orderable via CPOE

Path: Thrive UX > Tables > Control > Item Master > search and select item > Pharmacy Info > Page 1 > Chart cart Selectable must be unchecked.

3. Setup to make lab or radiology items orderable via CPOE is found via the

Thrive UX > Tables > Control > Item Master > search and select item > Order Entry Info > Page 3 tab > Ancillary Procedure must be checked.

Applicable Presentations:

CPOE - Order Entry

CPOE - Prescription Writer Additional Certification Presentations to View for Meaningful Use Stage 3 https://userareas.cpsi.com/userareas/presentations/dp_mu3.htm

Amendments - Image Title Creation

Amendments - Entering an Amendment Request

Amendments - Accepting or Denying an Amendment Request

Record Demographics - Race and Ethnicity Table Setup

Record Demographics - Birth Date, Sex, Race, Ethnicity, Preferred Language

Record Demographics - Date and Preliminary Cause of Death

Record Demographics - Sexual Orientation and Gender Identity

Record Smoking Status - Person Profile

Record Smoking Status - Eforms

Record Smoking Status - Census

Record Smoking Status – Flowcharts

Data Export

Data Export - Scheduled

Data Export Location Configuration

Data Export Security

Physician Problem List - Removing a Problem

Physician Problem List - Changing a Diagnosis

Physician Problem List - Adding a New Problem

Health History - Implantable Devices

Active Medication List

Medication Allergy List

https://userareas.cpsi.com/userareas/presentations/dp_mu3.htm



Family Health History - Record

Family Health History - Edit Attestation Disclaimer: Meaningful Use attestation confirms the use of a certified Electronic Health Record (EHR) to regulatory standards over a specified period of time. Evident and TruBridge Meaningful Use certified products, recommended processes and supporting documentation are based on Evident’s interpretation of the Meaningful Use regulations, technical specifications and vendor specifications provided by CMS, ONC and NIST. Each client is solely responsible for its attestation being a complete and accurate reflection of its EHR use during the attestation period and that any records needed to defend the attestation in an audit are maintained. With the exception of vendor documentation that may be required in support of a client’s attestation, Evident and TruBridge bear no responsibility for attestation information submitted by the client.