office ally ehr 24/7 meaningful use

Office Ally EHR 24/7 Meaningful Use

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Office Ally EHR 24/7

Meaningful Use

Getting Started


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Table of Contents

What is Meaningful Use …………………………………………………………………………………………………………….3

Enrolling with Medicare and Medicaid Incentive Programs ……………………………………………………….4

Who qualifies …………………………………………………………………………………………………………..4

How to Register ……………………………………………………………………………………………………….5

Using EHR 24/7 to meet Meaningful Use – Stage 1

Core Measures …………………………………………………………………………………………………………6

Menu Set Objectives ..….…….……………………………………………………………….…………………21

Clinical Quality Measures..….………………………………………………………………………..……….32

Glossary of Terms ……………………………………………………………………………………………………………………34

Acronyms ………………………………………………………………………………………………………………………………..37


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What is "Meaningful Use"?

(This is the definition provided by Centers for Medicare & Medicaid Services)

The American Recovery and Reinvestment Act of 2009 specify three main components of Meaningful Use:

1. The use of a certified EHR in a meaningful manner, such as e-prescribing. 2. The use of certified EHR technology for electronic exchange of health information to

improve quality of health care. 3. The use of certified EHR technology to submit clinical quality and other measures.

Simply put, "meaningful use" means providers need to show they're using certified EHR technology in ways that can be measured significantly in quality and in quantity.


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Enrolling with Medicare and Medicaid Incentive Programs

Who qualifies for the Incentive Program using Office Ally’s EHR 24/7 program

Eligible Professionals (EPs) –EPs may NOT be hospital-based (90% or more of services provided

in a hospital setting (inpatient or emergency room).

Medicare Eligible:

Doctors of Medicine or Osteopathy

Doctors of Dental Surgery or Dental Medicine

Doctors of Podiatric medicine

Dcotors of Optometry

Chiropractors

Medicaid Eligible:

Physicians

Nurse Practitioners

Certified Nurse – Midwife

Dentists

Physicians Assistants who practice in a Federally Qualified health Center (FQHC) or

Rural Health Center (RHC) that is led by a Physician Assistant

And

Have a minimum of 30% Medicaid patient volume (20% minimum for pediatrics)

Or

Practice predominantly in a FQHC or RHC and have at least 30% patient volume to

needy individuals


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Enrolling with Medicare and Medicaid Incentive Programs

How to Register

Log in using your NPPES User ID and Password.

You must have a National Plan and Provider Enumeration System (NPPES) web user

account. you must have an active National Provider Identifier (NPI)

(If you do not have an NPI or NPPES user account you will need to apply and/or create an

account by accessing the web address below.)

https://nppes.cms.hhs.gov/NPPES/Welcome.do

Click on the Registration tab and follow the instructions indicated on the screen to

complete the registration process.

https://nppes.cms.hhs.gov/NPPES/Welcome.do


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Core Measures


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Record Demographics

Eligible Professionals: Core Objectives

Measure

Enable a user to electronically record, modify and retrieve patient demographic data including preferred language, gender, race, ethnicity and date of birth.

More than 50% of all unique patients seen by the EP have demographics recorded as structured data.

Patient Demographics may be recorded in the following areas of the program:

Patient Charts / Edit. Dem.

Appointment / Check In


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Maintain Active Medication List

Eligible Professionals:

Core Objectives Measure

Maintain the patient’s active medication list

More than 80% of all unique patients seen by the EP have at least one entry (or an indication that the patient is not currently prescribed any medication) recorded as structured data

EHR 24/7 maintains an active mediation list and permits the provider to manage all medications

for the patient. The left panel provides a display of the current medication list. Providers may

search the provided Drug Search list to add medications. The provider may edit current

medications to change the status to inactive or resolved.


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Maintain Active Medication Allergy List



Maintain the patient’s active medication allergy list

More than 80% of all unique patients seen by the EP have at least one entry (or an indication that the patient has no known medication allergies) recorded as structured data

EHR 24/7 maintains an active mediation allergy list and permits the provider to manage all

medication allergies for the patient. The left panel provides a display of the current medication

allergy list. Providers may search the provided allergy Search list to add medication allergies.

The provider may edit current medication allergies to change the status to inactive or resolved.

The provider may also maintain the medication allergy list from the Allergy List from the

Medications link from the top of the Patient Chart.


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Record, Chart Changes in Vital Signs



Record and chart changes in vital signs:

Height Weight Blood pressure Calculate and display:

BMI Plot and display growth

charts for children 2–20 years, including BMI.

For more than 50% of all unique patients age 2 and over seen by the EP, the height, weight and blood pressure are recorded as structured data

On each patient's Progress Note EHR 24/7 provides the ability to record vital signs. All meaningful use vitals, vital graphs and growth charts are standard within the application. Vital signs are captured as structured data. Vital signs may also be recorded through the Short Form (Nurses Note.) The BMI is calculated automatically by clicking on the Calc. BMI button. BMI is based upon the patient's height and weight. Click on the View History & Graph to view and print the patient’s growth chart.


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Record Smoking Status for Patients Age 13 or Older



Record smoking status for patients 13 years old or older

More than 50% of all unique patients 13 years old or older seen by the EP have smoking status recorded as structured data

The smoking status is recorded as structured data in EHR 24/7 in various areas of the program. This information may be recorded through the Check-In process, by the Nurse or MA or as you are documenting the encounter in the Progress Note.

Appointment / Check-In

Short Form (Nurses Note) Progress Note


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Maintain an Up-To-Date Problem List of Current and Active Diagnoses



Maintain an up-to-date problem list of current and active diagnoses based on ICD–9–CM or SNOMED CT®.

More than 80% of all unique patients seen by the EP have at least one entry or an indication that no problems are known for the patient recorded as structured data.

EHR 24/7 provides a patient active problem list (based on ICD-9-CM) that is available at every patient encounter in the left panel and can be edited as needed. A full problem list is available to you.

The problem list may also be managed through the Progress Note / Problem List table within the patients chart.


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Use Computerized Physician Order Entry (CPOE)



Computerized physician order entry (CPOE) of medications

More than 30% of unique patients with at least one medication in their medication list seen by the EP have at least one medication order entered using CPOE

EHR 24/7 provides you the ability to order medications through the Progress Note by simply

clicking on the Online e-Prescription link. You will have the ability to electronically prescribe,

fax or print medications.


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Implement Drug-Drug and Drug-Allergy Interaction Checks



Drug-drug and drug-allergy interaction checks

The EP has enabled this functionality for the entire EHR reporting period

Drug-to-Drug and Drug-to-Allergy interaction checking are performed at the time of prescribing based upon the patient’s current medications and medication allergy list. In addition, the program also checks for any drug-disease contraindications. A notification of an adverse interaction will display for your review.


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Implement One Clinical Decision Support Rule



Implement one clinical decision support rule

Implement one clinical decision support rule relevant to specialty or high clinical priority along with the ability to track compliance that rule

EHR 24/7 includes the ability to monitor the care of patients and notify the provider of clinical priorities based upon the patient’s medical record. The clinical decision support rules are a predefined set of rules within the program. Simply click on the “Check Clinical Decisions” link located in various locations within the Progress Note. A notification pop-up window will display any found notifications for the patient.


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Capability to Exchange Key Clinical Information



Capability to exchange key clinical information among providers of care and patient-authorized entities electronically

Performed at least one test to electronically exchange key clinical information

EHR 24/7 provides the ability to export a CCD file and encrypt it for secure transmission. The EMR also provides the option to import a CCD or CCR file with an easily readable view.

This function is located in the Others section within the patient’s chart.


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Provide Clinical Summaries for Patients for Each Office Visit



Provide clinical summaries for patient for each office visit

Clinical summaries provided to patients for more than 50% of all office visits within 3 business days

EHR 24/7 provides the ability to generate a Patient Visit Summary. This information can easily be generated and printed for the patient.

Click on the References tab and hover over the Meaningful Use Reports. Click on the Patient Visit Summary link.

Select the patient and select from the drop down “Last Encounter” to provide the Patient Visit Summary. Click “Go” to generate the report.


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Provide Patients With an Electronic Copy of their Health Information, Upon

Request



Provide patients with an electronic copy of their health information, upon request

More than 50% of all patients of the EP who request an electronic copy of their health information are provided it within 3 business days

EHR 24/7 provides you the ability to generate a Patient Visit Summary to provide to a patient upon request. From the Document Center / Orders link click on Patient Requests. Click the ”Add Request” link and select the patient, provider and request type. From the Patient Request link click the print icon and the program will automatically generate the Patient Visit Summary with the required data elements. The date completed is automatically updated for the patient request.


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Report Ambulatory Clinical Quality Measures



Report a total of 6 ambulatory clinical quality measures to CMS (Medicare EHR Incentive Program) or States (Medicaid EHR Incentive Program)

For 2011, provide aggregate numerator, denominator, and exclusions through attestation as discussed in section II(A)(3) of this final rule

For 2012, electronically submit the clinical quality measures as discussed in section II(A)(3) of this final rule

EHR 24/7 allows you to generate, display and monitor whether you are meeting the standards for each measurement. The data displays the aggregate denominator and numerator for each objective measure and clinical quality measure by provider.

Access the report from the Meaningful Use Reports link in the References tab. Select the report from the list of Quality Measure reports and click the “Go” button to generate the report."


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Protect Electronic Health Information



Protect electronic health information created or maintained by the certified EHR technology through the implementation of appropriate technical capabilities.

Conduct or review a security risk analysis per 45 CFR 164.308 (a)(1) and implement security updates as necessary and correct identified security deficiencies as part of its risk management

EHR 24/7 is built upon the security standards outlined in the certification requirements for EHR vendors. It is important that practices take the necessary steps within their organization to ensure that they are protecting their electronic health information according to HIPAA guidelines.

As the gatekeeper of ePHI you have the responsibility to ensure the confidentiality, integrity, availability of ePHI and to reasonably protect such information from anticipated threats The following are necessary to meet the Meaningful Use requirement to “Protect Health Information:

User Log In – each user will need his/her own user name and password to log into EHR 24/7. The administrator will want to access the Admin Section in Manage Office and create the user name and assign system rights.

Emergency Access – as part of the step above you may designate if a specific user will have emergency access to the program. This will allow users who normally do not have access to specific information access in an emergency situation.

Automatic Log-off – EHR 24/7 is preset to automatic log off any user who has been idle for two (2) hours.

Security Audit Log Report – EHR 24/7 allows you to generate Security Audit Log reports from the Admin Section in Manage Office.

Software Updates – All updates for EHR 24/7 are implemented by Office Ally


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Menu Set


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Medication Reconciliation



Medication reconciliation The EP performs medication reconciliation for more than 50% of transitions of care in which the patient is transitioned into the care of the EP.

EHR 24/7 maintains an active patient medication list, which is available at every patient encounter. Click the ePrescribing button in the encounter/progress note. From the Pt. Details tab click the SureScripts Drug History link and select time frame for requested history. Click the “Request Prescription History” button

Medication Reconciliation may be managed simply by comparing a list of the patients medications provided from another source to the patients list of medications in EHR 24/7. If the reconciliation is completed manually access the MU Checklist and check that this has been

performed.


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Implement Drug Formulary Checks



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

Formulary checking is available as part of ePrescribing. Patient linked to a health plan will display which medications are in the formula upon drug search.


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Patient Specific Educational Resources



Use certified EHR technology to identify patient-specific education resources and provide to patient

More than 10% of all unique patients seen by the EP are provided patient-specific education resources

From the Document Center click on the Education Resources link. Click Add and record the Patient Education material you are distributing to the patient. From the View icon print the material for the patient. Access the MU Checklist and check the box indicating this was done.


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Summary Care Record



Summary of care record for each transition of care/referrals

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% of transitions of care and referrals

EHR 24/7 provides you the ability to generate a summary of care record to provide to other providers when transitioning care of a patient.

Access the Patient Visit Summary report from the Meaningful Use Reports located in the References tab. Select the patient and the encounter(s) to be included in the report from the drop down list and click the “Go” button to generate the report.


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Clinical Lab Test Results



Document clinical lab test results as structured data

More than 40% 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

Through the Lab Results section lab results can be recorded in a structured manner. Electronic results received from our associated labs are automatically recorded for you. For non-associated labs you will need to manually record the result values. You will have the ability to enter this information as structured data.

Locate the lab order from the list. From the Document Center you will want to search for the patient first. Click the pencil in the Add/Edit Manual Result column. Click the “Add Result” to expand the section. If you only received partial results you may “Save” the record and enter the additional results when received. If you have completed recording the results for all tests click “Finalize.”


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Provide Patients with Timely Electronic Access



Provide patients with timely electronic access to their health information

More than 10% of all unique patients seen by the EP are provided timely (available to the patient within four business days of being updated in the certified EHR technology) electronic access to their health information subject to the EP’s discretion to withhold certain information

EHR 24/7 patient portal PatientAlly provides patients access to their medical information. PatientAlly also provides patients the ability to communicate with the provider for their medical questions, eVisits, request appointments, submit intake forms, etc.


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Patient Reminders



Send reminders to patients per patient preference for preventive/follow up care

More than 20% of all unique patients 65 years or older or 5 years old or younger were sent an appropriate reminder during the EHR

Patient reminders may be generated according to criteria you set when generating the report. Simply select the criteria based on a full range of data elements including age, gender, medications, problems, procedures, etc. Simply access the report from the Meaningful Use Reports located in the References tab. As reminders are sent click the check box below the “Set as Sent” and enter the “Date Completed.” Click the “Set as Sent” button and the program will record and count the Patient Reminder toward you overall percentage.


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Patient Lists



Generate lists of patients by specific conditions

Generate at least one report listing

Patient Lists may be generated according to criteria you set when generating the report. Simply select the criteria based on a full range of data elements including age, gender, medications, problems, procedures, etc. Simply access the report from the Meaningful Use Reports located in the References tab.


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Submit Electronic Data to Immunization Registries



Capability to submit electronic data to immunization registries/systems (public health objective)

Performed at least one test to submit electronic data to immunization registries and follow up submission if the test is successful where accepted and required.

EHR 24/7 provides you the ability to report electronic data to immunizations registries using the Export Immunizations feature within the program. Simply access the report from the Meaningful Use Reports located in the References tab. Enter the date range for the reporting period and click “Go” to generate the report. Click the Export button and create a password when prompted.


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Syndromic Surveillance Data



Capability to provide electronic syndromic surveillance data to public health agencies (public health objective)

Performed at least one test to provide electronic syndromic surveillance data to public health agencies and follow-up submission if the test is successful where accepted and required

EHR 24/7 provides you the ability to report syndromic surveillance data to public health agencies using the Export feature within the program. Simply access the report from the Meaningful Use Reports located in the References tab. Enter the date range for the reporting period and click “Go” to generate the report. Click the Export button and create a password when prompted.


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Clinical Quality

Measures


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Clinical Quality Measures

Eligible professionals must report 6 clinical quality measures from a table of 44 which includes 3 core or alternate core, and 3 out of 38 from menu set.

EHR 24/7 will assist you with selecting the clinical information required to meet the CQM as you are completing the patients encounter/progress note. Each measure is codified within the program. As you enter pertinent clinical information (problems, procedures, etc.) the program will identify the possible CQMs related to the information populated. The program will recommend additional coding necessary to meet the measure and allow you to select appropriate clinical data. From the bottom of the encounter/progress note page click on the “NQF Recommendation” button.

Click “Select” for the appropriate CQM.

As you select codes from the displayed list they will populate in the Codes Selected box as well as in the appropriate section of the encounter/progress note.

Codes that do not populate in a field within the progress note will be displayed in the NQF Measure Codes section on the note.

Simply hit update on the encounter progress note to save your choices within the note.


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Glossary of Terms

Active Medication Allergy List – A list of medications to which a given patient has known allergies. Active Medication List – A list of medications that a given patient is currently taking. Allergy – An exaggerated immune response or reaction to substances that are generally not harmful. Appropriate Technical Capabilities – A technical capability would be appropriate if it protected the electronic health information created or maintained by the certified EHR technology. All of these capabilities could be part of the certified HER technology or outside systems and programs that support the privacy and security of certified EHR technology. Business Days – Business days are defined as Monday through Friday excluding federal or state holidays on which the EP or their respective administrative staffs are unavailable. Clinical Decision Support – HIT functionality that builds upon the foundation of an EHR to provide persons involved in care processes with general and person-specific information, intelligently filtered and organized, at appropriate times, to enhance health and health care. Clinical Summary – An after-visit summary that provides a patient with relevant and actionable information and instructions containing the patient name, provider’s office contact information, date and location of visit, an updated medication list, updated vitals, reason(s) for visit, procedures and other instructions based on clinical discussions that took place during the office visit, any updates to a problem list, immunizations or medications administered during visit, summary of topics covered/considered during visit, time and location of next appointment/testing if scheduled, or a recommended appointment time if not scheduled, list of other appointments and tests that the patient needs to schedule with contact information, recommended patient decision aids, laboratory and other diagnostic test orders, test/laboratory results (if received before 24 hours after visit), and symptoms. Computerized Provider Order Entry (CPOE) – CPOE entails the provider’s use of computer

assistance to directly enter medication 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.

Diagnostic Test Results – All data needed to diagnose and treat disease. Examples include, but are not limited to, blood tests, microbiology, urinalysis, pathology tests, radiology, cardiac imaging, nuclear medicine tests, and pulmonary function tests.


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Different Legal Entities – A separate legal entity is an entity that has its own separate legal existence. Indications that two entities are legally separate would include (1) they are each separately incorporated; (2) they have separate Boards of Directors; and (3) neither entity is owned or controlled by the other. Distinct Certified EHR Technology – Each instance of certified EHR technology must be able to be certified and operate independently from all the others in order to be distinct. Separate instances of certified EHR technology that must link to a common database in order to gain certification would not be considered distinct. However, instances of certified EHR technology that link to a common, uncertified system or component would be considered distinct. Instances of certified EHR technology can be from the same vendor and still be considered distinct. Exchange – Clinical information must be sent between different legal entities with distinct certified EHR technology and not between organizations that share a certified EHR technology. Distinct certified EHR technologies are those that can achieve certification and operate independently of other certified EHR technologies. The exchange of information requires that the eligible professional must use the standards of certified EHR technology as specified by the Office of the National Coordinator for Health IT, not the capabilities of uncertified or other vendor-specific alternative methods for exchanging clinical information. Medication Reconciliation -- The process of identifying the most accurate list of all medications that the patient is taking, including name, dosage, frequency, and route, by comparing the medical record to an external list of medications obtained from a patient, hospital, or other provider. Office Visit – Office visits include separate, billable encounters that result from evaluation and management services provided to the patient and include: (1) Concurrent care or transfer of care visits, (2) Consultant visits, or (3) Prolonged Physician Service without Direct (Face-To-Face) Patient Contact (tele-health). A consultant visit occurs when a provider is asked to render an expert opinion/service for a specific condition or problem by a referring provider. Patient Authorized Entities – Any individual or organization to which the patient has granted access to their clinical information. Examples would include an insurance company that covers the patient, an entity facilitating health information exchange among providers, or a personal health record vendor identified by the patient. A patient would have to affirmatively grant access to these entities. Patient-Specific Education Resources – Resources identified through logic built into certified EHR technology which evaluates information about the patient and suggests education resources that would be of value to the patient.


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Permissible Prescriptions – The concept of only permissible prescriptions refers to the current restrictions established by the Department of Justice on electronic prescribing for controlled substances in Schedule II-V. (The substances in Schedule II-V can be found at __). Any prescription not subject to these restrictions would be permissible.

Problem List – A list of current and active diagnoses as well as past diagnoses relevant to the current care of the patient. Public Health Agency -- An entity under the jurisdiction of the U.S. Department of Health and Human Services, tribal organization, State level and/or city/county level administration that serves a public health function. Preferred Language – The language by which the patient prefers to communicate. Prescription – The authorization by an EP to a pharmacist to dispense a drug that the pharmacist would not dispense to the patient without such authorization. Relevant Encounter – An encounter during which the EP performs a medication reconciliation due to new medication or long gaps in time between patient encounters or for other reasons determined appropriate by the EP. Essentially an encounter is relevant if the EP judges it to be so. (Note: Relevant encounters are not included in the numerator and denominator of the measure for this objective.) Specific Conditions -- Those conditions listed in the active patient problem list. Transition of Care – The movement of a patient from one setting of care (hospital, ambulatory primary care practice, ambulatory specialty care practice, long-term care, home health, rehabilitation facility) to another. Unique Patient – If a patient is seen by an EP more than once during the EHR reporting period, then for purposes of measurement that patient is only counted once in the denominator for the measure. All the measures relying on the term ‘‘unique patient’’ relate to what is contained in the patient’s medical record. Not all of this information will need to be updated or even be needed by the provider at every patient encounter. This is especially true for patients whose encounter frequency is such that they would see the same provider multiple times in the same EHR reporting period.

Up-to-date – The term ‘‘up-to-date’’ means the list is populated with the most recent diagnosis

known by the EP. This knowledge could be ascertained from previous records, transfer of

information from other providers, diagnosis by the EP, or querying the patient.


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Acronyms

CMS Centers for Medicare & Medicaid Services

CQM Clinical Quality Measures

BMI Body Mass Index

EHR Electronic Health Record

EIN Employer’s Identification Number

EP Eligible Professional

FQHC Federally Qualified Health Center

MA Medical Assistant

NQF National Quality Forum

PE Physician Extender

PQRI Physician Quality Reporting Initiative

RHC Rural Health Clinic

office ally ehr 24/7 meaningful use

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