medisys ehr meaningful use measure power point 3.14.11

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‘Meaningful Use’

This presentations is intended to provide a general overview. It is not intended to serve as legal or consulting advice. For the latest details, please refer to CMS and other carrier links and publications for more

information.

EHREHR v1.0

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CMS Path to Incentive Payments

1. Determine Eligibility for program (s)2. Select a Program (Medicare or Medicaid)3. Register4. Become a Meaningful User per specifications5. Attest

https://www.cms.gov/EHRIncentivePrograms/10_PathtoPayment.asp#TopOfPage

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Two EHR Incentive Programs: Medicaid & Medicare

l CMS interactive eligibility Q&A at:http://www.cms.gov/EHRIncentivePrograms/15_Eligibility.asp#TopOfPage

l CMS EHR Registration Site Offers Guidelines

l ALREC Assistance

l Medicaid Assistance -http://onehealthrecord.alabama.gov/

l EHR Information Center: 1-888-734-6433

Determine Eligibility

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Electronic Health Records Adoption

l Use Available Resources:Alabama Regional Extension Center

Consulting services, education, and other assistance to achieve meaningful use

One Health Record – Alabama Medicaidhttp://www.onehealthrecord.alabama.gov/contact.aspx

CMS Website & Alabama Region Contacthttp://www.cms.gov/EHRIncentivePrograms/CMS Region 4 – [email protected] HITECH Inquiry line: 404-562-7347

l Subscribe to CMS Listserv (covers EHR Incentive)https://service.govdelivery.com/service/subscribe.html?code=USCMS_627

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Eligibility Determined Program SelectedTime to Register

l Medicare Registration Now Open -https://ehrincentives.cms.gov

– CMS Encourages to register as soon as possible* – Registration can occur before having a certified EHR

l State Medicaid Registration:– Initiate Medicaid registration at CMS’ registration, complete process

through state Medicaid agency– Alabama Medicaid registration scheduled to begin April, 2011

*Note: You can only change your program participation choice (Medicare or Medicaid) once after receiving an

incentive payment before 2015.

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Registration via EHR Incentive Website

l Name, Address, Phonel Taxpayer ID & NPI numberl NPPES/NPI Web User name & password.l Program selection (Medicare or Medicaid)l State selection for Medicaidl Registration ID print upon completion (no other confirmation)

– IF Medicaid, after 24 hrs continue registration at State site

Link to CMS Registration Site:

http://www.cms.gov/EHRIncentivePrograms/20_RegistrationandAttestation.asp#TopOfPage

Currently, EP must perform Medicare registration. In May, CMS is expected to allow EP to designate someone like a practice

administrator to be able to register and attest on their behalf.

Medicaid Incentive Registration

l Once registered on CMS, continue registration at onehealthrecord.gov

l Worksheet and “Let’s Get Started” link soon to be available to providers– Alabama License– EHR Certification Number– Select Adopt, Implement or Upgrade– Ability to attach a document to show “adopt,

implement or upgrade”

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Eligibility Determined Program Selected RegisteredBecome a Meaningful User

Based on Program selected:l Medicaid - States vary, Adopt, implement,

upgrade option 1st year participationl Medicare - National implement, Must demonstrate

Meaningful Use Year 1

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Adopt/Implement/Upgraded

l Adopted: Acquired and installed certified EHR technology. (show evidence of installation)

l Implemented: Began using certified EHR technology. (provide staff training or data entry of patient demographic information into EHR.)

l Upgraded: Expanded existing technology to meet certification requirements. (upgrade to certified EHR technology or add new functionality to meet the definition of certified EHR technology.)

Medicaid 1st Year Participation:

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Meaningful Use: Objectives 2011 & 2012

l To meet certain objectives/measures l Reporting Period – 90 days 1st year, entire year

reporting subsequent years– 2011 – Providers report by attestation– 2012 – Providers required to electronically submit to CMS

l Providers report 20 of the 25 Meaningful Use Objectives:

– 15 Core Objectives– Select 5 “Menu” Objectives

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Core & Menu Measures Stage 1

– Steps in MediSYS EHR (pre-recorded sessions are also being made available)

– Report / Attestl Reporting Period First Year - continuous 90 Daysl Some Measures require % (Numerator/Denominator)

– Definitions of Numerator/Denominator vary by measurel Some Measures require YES/NOl Reporting may vary by Provider

– Provider using MediSYS EHR for all Patient Encounters –l MediSYS EHR reports will perform calculations

– Assistance Provided by MediSYS / ALREC membershipRefer to: CMS Measures Published:https://www.cms.gov/EHRIncentivePrograms/Downloads/EP-MU-TOC-

Core-and-MenuSet-Objectives.pdf

Measure Reporting may vary by Provider

l IMPORTANT - individual Provider usage of electronic records for encounters (i.e. all encounters entered into MediSYS EHR, partial use of MediSYS EHR for patient encounters, etc.) will determine if the denominator for some of the measures, as defined by CMS, will need to be compiled from another reporting source outside of MediSYS EHR. This applies to the measures on the follow slides that have the word “Denominator” in red: Core Measures: 3, 5, 6, 7, 8. 9,13 and Menu Measures: 4, 5, 6

l Please contact us for specifics or if you have any questions.

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Core Measure 1 of 15CPOE for Medication OrdersMeasure Quick Steps Report / AttestMore than 30% of unique patients seen have at least one med order using computerized provider order entry (CPOE) for medication orders.

1. Patient Encounter2. Electronic eRX tied

to Encounter3. Complete

Encounter for Automatic Calculation

Report: Percentages (CPOE) lNumerator/DenominatorlResulting % >30%

Exclusion: EP writes fewer than 100 RX

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Core Measure 2 of 15 Drug Interaction Checks

Measure Quick Steps Report / AttestEP has enabled drug-drug and drug-allergy interaction checks for entire reporting period.

1. Settings/Drug Severity Alerts:

Set up by provider: drug/drug, drug/allergy, drug/disease

1. Patient Encounter or Patient Chart

2. Interactions displayed at time of eRX

Report: Not Applicable

Attest: YES / NO

Exclusion: No Exclusion

Core Measure 2 – Drug Interaction Checks (1 of 2)

Core Measure 2 – Drug Interaction Checks (2 of 2)

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Core Measure 3 of 15Maintain Problem List

Measure Quick Steps Report / AttestFor more than 80% of unique patients maintain up-to-date problem list of current & active diagnosis.

1. Patient Encounter2. Assessment Tab3. Add Diagnosis4. Selected

Diagnosis: þ Problem (to add to

patient’s current Problem List)

Report:Percentages (Up-to-Date Problem List)lNumerator/DenominatorlResulting % >80%


‘Up-to-Date’’ means list populated with most recent diag. known by EP.

Core Measure 3 – Maintain Up-to-date Problem List

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Core Measure 4 of 15Generate & Transmit Permissible Prescriptions Electronically (eRX)

Measure Quick Steps Report / AttestFor more than 40% generate & transmit permissible prescriptions electronically (eRX)

1. Prescriptions Tab or Planning Tab

2. ePrescribe button to electronically transmit eRX

Report: Percentages (Generate and Transmit eRX)

•Numerator/Denominator•Resulting >40%

Tip: REPORT Applicable G-Codes for the appropriate # of events tied to an Encounter.

Core Measure 4 – Generate & Transmit eRX

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Core Measure 5 of 15Maintain Active Medication List

Measure Quick Steps Report / AttestMaintain Active Medication List for more than 80% of all unique patients seen by EP.

1. Patient Encounter2. Constitutionals Tab3. Medication List 4. Perform one of the

following: ePrescribe, enter Meds, update Meds or indicate No Meds.

5. Check: þ Medications ReviewedComplete Encounter

Report: Percentages (Active Medication List)lNumerator/DenominatorlResulting % >80%


Core Measure 5 – Active Medication List

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Core Measure 6 of 15Active Medication Allergy List

Measure Quick Steps Report / AttestMaintain Active Medication Allergy list for more than 80% of unique patients seen.

1. Patient Encounter2. Constitutional Tab3. Add allergy / reaction

orþ No known Allergy

1. þ Allergies Reviewed2. Complete Encounter

Report: Percentages (Active Medication Allergy List)lNumerator/DenominatorlResulting % >80%

Exclusion: No ExclusionSnomed Database for Allergic Reactions

Core Measure 6 – Medication Allergy List

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Core Measure 7 of 15Record Demographics

Measure Quick Steps Report / AttestFor more than 50% of unique patient seen,record all of the following demographics:lPreferred languagelGenderlRacelEthnicitylDOB

1. MediSYS PM Patient Account

if not, using MediSYS PM, enter demographics in EHR Patient Medical Record (all elements)

Report: Percentages (Record Demographics)lNumerator/DenominatorlResulting % >50%


Core Measure 7 – Record Demographics (MediSYS PM M2)

Core Measure 7 – Record Demographics (1 of 2)

Core Measure 7 – Record Demographics (2 of 2)

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Core Measure 8 of 15Record Vital Signs

Measure Quick Steps Report / AttestFor more than 50% of unique patients seen 2 yrs or older, Record & chart changes in following vital signs: lHeight lWeightlBPlBMIlplot & display growth charts children 2-20, including BMI

1. Patient Encounter2. Constitutional

Tab3. Record Vitals4. Complete

Encounter

Report: Percentages (Vitals, BMI, Growth Charts)lNumerator/DenominatorlResulting % >50%

Exclusion: EP who see no patients 2 yrs or older, or who believes all 3 vital signs have no relevance to scope of their practice

MediSYS EHR will calculate BMI when height & weight are entered.

Patients age 2-20 display Growth Charts in Patient Chart Tab

Core Measure 8 – Record Vital Signs

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Core Measure 9 of 15Record Smoking Status

Measure Quick Steps Report / AttestMore than 50% of all unique patients 13 yrs or older seen have smoking status recorded as structured data.

1. Patient Encounter2. PFSH3. Wellness Initiatives:

Smoking Status (select from dropdown which includes unknown)

4. Select Counseling5. Complete Encounter

Report: Percentages (Record Smoking Status)lNumerator/DenominatorlResulting % >50%

Exclusion: EP who sees no patients 13 years or older.

Core Measure 9 – Record Smoking Status

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Core Measure 10 of 15 Clinical Quality Measures (CQMs)

Measure Quick Steps Report / AttestReport 6 Ambulatory Clinical Quality Measures to CMS in the manner specified by CMS

1. EP performs & document according to applicable Clinical Quality measures

2. Complete Encounter

No CMS requirement of a minimum numerator /denominator or exclusion fields. The value may be zero.

YES / NO


Clinical Quality Measures for Medicare EHR also apply to Medicaid EHR incentive program that are

also in CHIPRA initial Core Measure Set.

Measure Steward: NQF – National Quality Forum

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• 3 required core measures (substituting alternate core measures where necessary)

• 3 additional measures (selected from a set of 38 clinical quality measures). Per CMS: It is acceptable to have a '0' denominator provided the EP does not have an applicable population. CMS is currently working with EHR vendors on reporting.

Core Measure 10 of 15 Report 6 Clinical Quality Measures

A plan is to be developed to integrate the EHR incentive program with PQRI by 1/1/12.

Please Review the Details on Clinical Quality Measures that apply to your provider at :http://www.cms.gov/apps/ama/license.asp?file=/QualityMeasures/Downloads/E

P_MeasureSpecifications.zip

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MU #10 – Clinical Quality MeasuresNeed 3 CORE Sets

l Hypertension – Blood Pressure Measurement NQF 0013

l Preventive Care and Screening Pair NQF 0028– a) Tobacco Use Assessment– b) Tobacco Cessation Intervention

l Adult Weight Screening & Follow up NQF 0421(PQRI 128)

Alternate CORE Setsl Weight Assessment & Counseling for Children & Adolescents

NQF 0024

l Preventive Care & Screening – Influenza Immunization for Patients 50 or older NQF 0041 (PQRI 110)

l Childhood Immunization Status NQF 0038

Clinical Quality Measures - Core

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Core Measure 11 of 15 Clinical Decision Support Rule

Measure Quick Steps Report / AttestImplement one clinical decision support rule.

1. Setup one Clinical Decision Support rule in: Settings / CDS

2. Select: Preventive, Disease, Meds, Allergy, Labs

3. Associated reminders displayed on Orders Tab


YES / NO


Drug/Drug & Drug/Allergy alerts

CANNOT be use for this measure.

Core Measure 11 – Clinical Decision Support Rule

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Core Measure 12 of 15Electronic Copy of Health Information

Measure Quick Steps Report / AttestMore than 50% of all patients who request an electronic copy of their health information provided it within 3 business days. (including diagnostic test results, problem list, med list, med allergies)

Patient PortalPatient Selects Option to:

Download Full CCD

OR Patient ChartCreate a CCDClick on: þ Patient Requested

Report: Percentages (Patient Request)lNumerator/Denominator lResulting % >50%

Exclusion: EP who has no requests from patient of their agents for an electronic copy of PHI during reporting period.

CCD – Continuity of Care Document

Rev. 3.22.11

Best Practice : If provider does not have Patient Portal, for all Patients WHO REQUEST electronic copy, Create CCD & Click Patient Requested

Core Measure 12 – Electronic Copy of Health Information (1 of 2)

Core Measure 12 – Electronic Copy of Health Information (2 of 2)

Best Practice : If provider does not have Patient Portal, for all Patients WHO REQUEST electronic copy: Create CCD & Click Patient Requested

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Core Measure 13 of 15Clinical Summaries

Measure Quick Steps Report / AttestFor more than 50% of all office visits, clinical summaries provided to patients within 3 business days.

Click Print Superbill: Encounter or Chart

And/OR

Patient Portal*Patient Selects Option to:

Download Single Visit CCD

Report: Percentages (Clinical Summary Report)lNumerator/DenominatorlResulting % >50%

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

Office visits include separate, billable encounters that result from E&M code-see details.

Best Practice : At end of ALL Office Visit Encounters Click: Print Superbill

*Having Portal will NOT automatically satisfy this measure. Patient must download single visit CCD to count in numerator.Rev. 3.22.11

Core Measure 13 – Clinical Summaries (1 of 2)

Best Practice : At end of Encounter - Click: Print Superbill on all Office Visits.Note: clicking “Print Superbill” also completes the Encounter

Core Measure 13 – Clinical Summaries (2 of 2)

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Core Measure 14 of 15 Electronic Exchange Key Clinical Information

Measure Quick Steps Report / AttestPerformed at least one testof certified EHR technology’s capacity to electronically exchange key clinical information(i.e. problem list, med list, med allergies, test results) among providers of care & patient authorized entities electronically.

1. Patient Encounter

2. Complete Encounter

3. Create a CCD4. Exchange with

appropriate entity


YES / NO

Exclusion: No ExclusionCCD - Continuity of Care Document– Includes

problem list, med list, med allergies, test results)

Core Measure 14 – Electronic Exchange of Clinical Information (1 of 2)

Core Measure 14 – Electronic Exchange of Clinical Information (2 of 2)

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Core Measure 15 of 15 Protect Electronic Health Information

Measure Quick Steps Report / Attest

EP must attest to conducting a review of security risk analysis in accordance with the requirements under 45 CFR 164.308(a)(1) & implement security deficiencies as part of its risk management process.

1. Conduct the Security Risk Analysis

2. MediSYS EHR Settings: establish practice-defined security settings for: “inactivity timeout”, password security settings, etc.


YES / NO


Core Measure 15 – Protect Electronic Health Information

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Pick 5 “Menu” Set Objectives

1. Implement Drug-formulary checks2. Incorporate clinical lab test results as structured data 3. Generate lists of patients by specific condition4. Send reminders to patients per patient preference for preventive/follow

up care5. Provide patients timely electronic access to their health info. 6. Use certified EHR technology to identify patient-specific education

resources and provide to patient, if appropriate7. Medication reconciliation 8. Summary of care record for each transition of care/referral9. Capability to submit electronic data to immunization

registries/systems.*10. Capability to provide electronic syndromic surveillance data to public

agencies*

*At least 1 public health objective must be selected

Menu Set

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Menu Set Measure 1 of 10 Implement Drug Formulary Checks

Menu Measure Quick Steps Report / Attest

The EP has enabled drug formulary checks and has access to at least one internal or external formulary for the entire EHR reporting period.

1. Electronically prescribe via MediSYS EHR


YES / NO

Exclusion: EP who writes fewer than 100 RX during reporting period.

MediSYS EHR Uploads Latest Formularies

Menu Set Measure 1 – Drug Formulary Checks

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Menu Set Measure 2 of 10 Incorporate Lab Test Results in EHR

Menu Measure Quick Steps Report / AttestMore than 40% of all clinical lab test results ordered by the EP during the EHR reporting period are incorporated in certified EHR technology as structured data.


2. Order Tab3. Order Lab4. Lab ResultsEntered (interface

or data-entry)

Report: Percentages (Incorporate Lab Results)lNumerator/DenominatorlResulting % >40%

Exclusion: EP who orders no lab tests whose results are either in a positive /negative or numeric format during the reporting period

Menu Set Measure 2 – Clinical Lab Test Results (1 of 2)

Menu Set Measure 2 – Clinical Lab Test Results (2 of 2)

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Menu Set Measure 3 of 10 Generate Lists of Patients by Specific Condition

Menu Measure “Quick Steps Report / AttestGenerate at least one report listing patients of the EP with a specific condition.

1. Report : Patient List (Diagnosis / Problem)

2. Select Report Format3. Print

Report: Patient List (Diagnosis/Problem)

YES / NO

Exclusion: No exclusion

Printing this report from EHR satisfies this measure.

Menu Set Measure 3 – Patient Lists Specific Condition

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Menu Set Measure 4 of 10 Send Patient Reminders for Follow-up

Menu Measure Quick Steps Report / AttestMore than 20% of all patients 65 years or older or 5 years old or younger were sent an appropriate reminder during the EHR reporting period per patient preference for preventive/follow-up care.

1. Patient Record2. Select: Patient

Preferred Communication Method

3. EHR Report4. Patient Reminder

List5. Report Format6. Print

Reports: Patient Reminder List: Allergies, Demographics, Lab Results, Medications, Problems

Percentage (Patient Reminder)

lNumerator/DenominatorlResulting % >20%

Exclusion: EP who has no patients 65 yrs old or older or 5 years old or younger with records maintained using certified EHR technology.

MediSYS EHR includes Patient Record field to indicate Communication Preference (i.e. Patient Portal,

phone, etc.)

Menu Set Measure 4 – Patient Reminders for Preventive/Follow-up Care (1 of 2)

Menu Set Measure 4 – Patient Reminders for Preventive/Follow-UP Care (2 of 2)

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Menu Set Measure 5 of 10 Patient Electronic Access to Health InformationMenu Measure Quick Steps Report / AttestMore than 10% of all unique patients seen by the EP are provided timely (within 4 bus. days) electronic access to their health information (including lab results, problem list, med list, & allergies).

Patient Portal Report: Percentages (Timely Access)

lNumerator/Denominator•Resulting % >10%

Exclusion: EP that neither orders nor creates lab tests or information that would be contained in problem list, med list, med allergy list, or other info. during report period.

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Menu Set Measure 6 of 10 Patient-Specific Education Resources

Menu Measure Quick Steps Report / AttestMore than 10% of all unique patients seen by EP are provided patient-specific education resources.

1. Patient Encounter2. Planning Tab3. Patient Education4. Select: Print

Report: Percentages (Patient-Specific Education)lNumerator/DenominatorlResulting % >10%

Exclusion: No exclusion

Practice generated Patient Education or optional Krames Patient Education

Printing Patient Education sends calculation to report

Menu Set Measure 6 – Patient-specific Education Resources

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Menu Set Measure 7 of 10 Medication Reconciliation

Menu Measure “2” Quick Steps Report / AttestFor more than 50% of transitions of care, EP who receives a patient from another setting of care or provider of care believes an encounter is relevant should perform medication reconciliation.

1. Check Patient2. þ Check:

“Referred by”, enter refer name

3. Patient Encounter4. Constitutionalsþ Meds Reviewed

Report: Percentages (Medication Reconciliation)lNumerator/DenominatorlResulting % >50%

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

Menu Set Measure 7 – Medication Reconciliation (1 of 3)

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Menu Set Measure 8 of 10 Transition of Care Summary

Menu Measure “2”Quick Steps Report / AttestThe 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% of transitions of care and referrals.


2. Planning Tab3. Referral, Select

Refer provider4. þ Summary of

Care Provided5. Check

Assessment6. Complete

Encounter7. Post Visit: Create

a CCD

Report: Percentages (Patient Summary Record)lNumerator/DenominatorlResulting % >50%

Exclusion: An EP who neither transfers a patient to another setting nor refers a patient to another provider during the EHR reporting period.

Menu Set Measure 8 – Transition of Care Summary (1 of 2)

Menu Set Measure 8 – Transition of Care Summary (2 of 2)

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Menu Set Measure 9 of 10 Immunization Registries Data Submission*

Menu Measure Quick Steps Report / AttestPerformed at least one test of certified EHRtechnology’s capacity to submit electronic data to immunization registries and follow up submission if the test is successful.

1. Medical Record2. Chart Tab:

Immunization History

3. Click: Export Immunization

4. Save file5. Encrypt file

YES / NO

Exclusion: An EP who administers no immunizations during the EHR reporting period or where no immunization registry has the capacity to receive the information electronically.

*At least 1 public health objective (menu 9 or 10) must be selected.

ADPH (formerly Immprint) now in testing –Immunization orders electronically submitted via Orders Tab and Updating ADPH through

Chart / Import

Measure 9 – Immunization Registries Data Submission

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Menu Set Measure 10 of 10 Syndromic Surveillance Data Submission*Menu Measure Quick Steps Report / AttestPerformed at least one test of certified EHRtechnology’s capacity to provide electronic syndromic surveillance data to public health agencies and follow-up submission if the test is successful.

1. Submission of Immunization as describe in previous slide (measure 9) satisfies this measure as well.

YES / NO

Exclusion: An EP who does not collect syndromic information on their patients during the EHR reporting period or does not submit such information to any public health agency that has the capacity to receive the information electronically.

*At least 1 public health objective must be selected

Measure 10 – Syndromic Surveillance Data Submission

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Patient Portal – Patient Electronic Access for MU Measures

l Medications – View Current Medication list and history– Submit refill requests to physicians– Physicians can either approve or deny refill request directly from Inbox,

electronically send approved prescriptions to pharmacy, and notify patients real-time of status

l Messaging– Patients can submit messages to physicians and staff members– Staff can reply to patient and/or forward to other staff members for action

l Labs– Physicians can forward selected lab results to patients for review with

attached commentsl Demographics/Scheduling

– Patients can view current patient demographics– Patients can send a message requesting a new appointment and view

existing scheduled appointments

Report Tracker

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Thank you!

Disclaimer:

This seminar is intended to provide a general overview. It is not intended to serve as legal or consulting advice. For the latest details, please refer to CMS and other carrier links and publications for more information.

The MedConnect/MediSYS Electronic Health Record software (Software) was certified as a 2011/2012 compliant Complete EHR by Drummond Group, Inc., an ONC-ATCB, in accordance with the applicable certification criteria adopted by the Secretary of the U.S. Department of Health and Human Services (HHS). The 2011/2012 criteria support the Stage 1 meaningful use measures required to qualify eligible providers and hospitals for funding under the Health Information Technology for Economic and Clinical Health (HITECH) Act.

To achieve ‘meaningful use’ providers must take specific action for each measure, therefore MedConnect/MediSYS is not responsible nor does MedConnect/MediSYS guarantee (i) the ability of users of the Software to demonstrate meaningful use as such term may be defined pursuant to the HITECH Act or its implementing regulations or (ii) the receipt of any form of incentive payments, including Medicare and/or Medicaid incentive payments under the HITECH Act.

medisys ehr meaningful use measure power point 3.14.11

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