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PATIENT

CENTERED

MEDICAL HOME

PCMH Guide

Sessions 3 and 7

Patient-Centered Medical Home Guide

Aprima PRM 2016 July 18, 2016

© 2016 Aprima Medical Software, Inc. All rights reserved. Confidential and Proprietary. Aprima is a registered trademark of Aprima Medical Software. All other trademarks are the property of their respective holders. Reference Number: 1157.01

2 Ref: 1157.01

Ref: 1157.01 3

Contents

Introduction ................................................................................................. 5

PCMH Content and Scoring ............................................................................ 5

Prevalidated Autocredit and Practice Support ......................................................... 8

PCMH Configuration ....................................................................................... 10

Identify Practice as PCMH Participant ............................................................. 10

Required Patient Information ....................................................................... 10

PCMH Information Document ........................................................................ 11

PCMH Charting ............................................................................................. 11

Charting for Standard 1: Enhanced Access and Continuity .......................................... 12

Element A: Patient-Centered Appointment Access (Must-pass element) ..................... 12

Element B: 24/7 Access to Clinical Advice ........................................................ 13

Element C: Electronic Access ....................................................................... 14

Charting for Standard 2: Team-Based Care ............................................................ 17

Element A: Continuity ................................................................................ 17

Element B: Medical Home Responsibilities ........................................................ 18

Element C: Culturally and Linguistically Appropriate Services ................................. 19

Element D: The Practice Team (Must-pass element) ............................................ 20

Charting for Standard 3: Population Health Management ........................................... 22

Element A: Patient Information ..................................................................... 22

Element B: Clinical Data ............................................................................. 24

Element C: Comprehensive Health Assessment ................................................... 28

Element D: Use Data for Population Management (Must-pass element) ...................... 31

Element E: Implement Evidence-Based Decision-Support ....................................... 42

Charting for Standard 4: Plan and Manage Care ...................................................... 52

Element A: Identify Patients for Care Management .............................................. 52

Element B: Care Planning and Self-Care Support (Must-pass element) ....................... 54

Element C: Medication Management ............................................................... 55

Element D: Use Electronic Prescribing ............................................................. 58

Element E: Support Self-Care and Shared Decision-Making ..................................... 60

Charting for Standard 5: Track and Coordinate Care ................................................ 64

Element A: Test Tracking and Follow-Up .......................................................... 64

Element B: Referral Tracking and Follow-Up (Must-pass element) ............................ 70

Element C: Coordinate Care Transitions ........................................................... 71

4 Ref: 1157.01

Charting for Standard 6: Measure and Improve Performance ....................................... 75

Element A: Measure Clinical Quality Performance ............................................... 75

Element B: Measure Resource Use and Care Coordination ...................................... 85

Element C: Measure Patient/Family Experience ................................................. 89

Element D: Implement Continuous Quality Improvement (Must-pass element) .............. 90

Element E: Demonstrate Continuous Quality Improvement..................................... 91

Element F: Report Performance .................................................................... 92

Element G: Use Certified EHR Technology ........................................................ 93

Ref: 1157.01 5

Introduction

Aprima PRM 2016 includes features and functionality that you can use to meet patient- centered medical home (PCMH) requirements and earn the points needed to achieve ‘recognized’ status by the National Committee for Quality Assurance (NCQA).

The information given here about the PCMH Recognition program is general. If your practice is working toward achieving or maintaining Recognition status, then it is your responsibility to understand the NCQA requirements and determine how you will achieve them. Information about NCQA’s PCMH Recognition program is available from the NCQA website at: http://www.ncqa.org/Programs/Recognition/Practices/PatientCenteredMedicalHomePCMH.a spx

If your practice has or is working toward achieving PCMH status, you should identify your participation in your database. This ensures that the PCMH reports generate with the necessary data.

PCMH Content and Scoring

The current content and scoring guidelines for NCQA’s PCMH recognition were defined in 2014.

Aprima PRM 2016 is prevalidated by NCQA to receive 28.24 points in autocredit toward NCQA’s PCMH 2014 scoring. Aprima PRM 2016 also received a supporting designation for a number of factors in the PCMH 2014 standards. Autocredit is transferrable to customers that are seeking NCQA’s PCMH recognition. You must be actively utilizing the reviewed capabilities associated with Aprima PRM 2016, including any optionally licensed third-party services required for those capabilities, in order to be eligible for transfer of the awarded autocredit.

Recognition Levels

NCQA has three levels of recognition. These levels are based upon points earned in six standards. Each standard includes a number of elements, each of which is assigned a certain number of points. There is one critical must-pass element in each of the six standards. All other elements are optional.

Level of Qualifying Points Required Must-Pass Elements 50% or greater performance

Not recognized 0 to 34 Less than 6

Level 1 35 to 59 6 of 6

Level 2 60 to 84 6 of 6

Level 2 85 to 100 6 of 6

http://www.ncqa.org/Programs/Recognition/Practices/PatientCenteredMedicalHomePCMH.aspx

http://www.ncqa.org/Programs/Recognition/Practices/PatientCenteredMedicalHomePCMH.aspx

6 Ref: 1157.01

Standards and Elements

The table below identifies each standard and its elements. The table also identifies the maximum number of points that may be obtained for each element and the subtotal available for the standard.

Standard Element Points

1 Enhance Access and Continuity

A. Patient-Centered Appointment Access (Must- pass element)

4.5

B. 24/7 Access to Clinical Advice 3.5

C. Electronic Access 2.0

Subtotal 10.0

2. Team-Based Care A. Continuity 3.0

B. Medical Home Responsibilities 2.5

C. Culturally and Linguistically Appropriate Services

2.5

D. The Practice Team (Must-pass element) 4.0

Subtotal 12.0

3. Population Health Management

A. Patient Information 3.0

B. Clinical Data 4.0

C. Comprehensive Health Assessment 5.0

D. Use Data for Population Management (Must- pass element)

5.0

E. Implement Evidence-Based Decision-Support 4.0

Subtotal 20.0

4. Plan and Manage Care A. Identify Patients for Care Management 4.0

B. Care Planning and Self-Care Support (Must- pass element)

4.0

C. Medication Management 4.0

D. Use Electronic Prescribing 3.0

Ref: 1157.01 7

Standard Element Points

E. Support Self-Care and Shared Decision- Making

5.0

Subtotal 20.0

5. Track and Coordinate Care

A. Test Tracking and Follow-Up 6.0

B. Referral Tracking and Follow-Up (Must-pass element)

6.0

C. Coordinate Care Transitions 6.0

Subtotal 18.0

6. Measure and Improve Performance

A. Measure Clinical Quality Performance 3.0

B. Measure Resource Use and Care Coordination 3.0

C. Measure Patient/Family Experience 4.0

D. Implement Continuous Quality Improvement (Must-pass element)

4.0

E. Demonstrate Continuous Quality Improvement

3.0

F. Report Performance 3.0

G. Use Certified EHR Technology 0.0

Subtotal 20.0

Total 100.0

8 Ref: 1157.01

Prevalidated Autocredit and Practice Support

The table below shows a summary of the prevalidation points awarded to Aprima PRM 2016 and the autocredit and practice support factors. The following tables list each factor in a standard and element. Aprima’s prevalidation status is shown for each factor.

Please note that autocredit and practice support points may depend upon the use of optionally purchased third-party products and services. Autocredit and practice support points may also depend upon using specific conditions and workflows.

Points Approved

Standard and Element Autocredit Factors

Practice Support Factors

1. Patient-Centered Access

A. Patient-Centered Appointment Access (Must Pass)

1-5

0.87 B. 24/7 Access to Clinical Advice 1 3-4

2.00 C. Electronic Access 2-6 1

2. Team-Based Care

1.50 A. Continuity 1-2

B. Medical Home Responsibilities 1-8

0.62 C. Culturally and Linguistically Appropriate Services

4 1-2

D. The Practice Team (Must Pass) 4

3. Population Health Management

2.25 A. Patient Information 1-7,9 8,10-14

1.00 B. Clinical Data 6,7,11 1-5, 8-10

C. Comprehensive Health Assessment 1-10

5.00 D. Use Data for Population Health Management (Must Pass)

1-5

4.00 E. Implementing Evidence-Based Decision Support

1-6

Ref: 1157.01 9

Points Approved

Standard and Element Autocredit Factors

Practice Support Factors

4. Care Management and Support

A. Identify Patients for Care Management 1-6

B. Care Planning and Self-Care Support (Must Pass)

1-5

C. Medication Management 1-6

1.50 D. Use Electronic Prescribing 3-4 1-2

1.25 E. Support Self-Care and Shared Decision Making 2,4 1,3,5-6

5. Care Coordination and Care Transitions

0.00 A. Test Tracking and Follow-Up 3-5,9,10 1,2,6-8

0.00 B. Referral Tracking and Follow-Up (Must Pass) 5-6 7-10

C. Coordinate Care Transitions 1-2 3,7

6. Performance Measurement and Quality Improvement

3.00 A. Measure Clinical Quality Performance 1-4

3.00 B. Measure Resource Use and Care Coordination 1-2

C. Measure Patient/Family Experience

D. Implement Continuous Quality Improvement (Must Pass)

E. Demonstrate Continuous Quality Improvement 1-3

2.25 F. Report Performance 1-2

0.00 G. Use Certified EHR Technology 1,3-9 2,10

# of Total Points

# of Total Factors

# Total Factors

28.24 60 82

10

Ref: 1157.01

PCMH Configuration

There are a number of tasks that you must perform in the application to configure it for PCMH. These tasks must be performed by an administrative super user or other user with the necessary security rights. Please refer to the Administrative User’s Guide or the online help for information and instructions on security.

This document only describes the configuration that is specific to PCMH. Many of the application’s standard functions and features are used to meet PCMH requirements. These functions and features must be setup in your database. However, since PCMH does not require any specific setup or configuration, instructions for configuring standard features are not included in this document. Please refer to the Administrative User’s Guide or the online help for setup and configuration instructions.

Some PCMH requirements are aligned with Meaningful Use measures, and you may use the application’s Meaningful Use reports has part of your PCMH documentation. Some Meaningful Use measures do require specific configuration in order to meet the measure requirements and to properly populate the Meaningful Use reports. Please refer to Aprima’s Meaningful Use Guide for 2015 for specific setup and configuration instruction.

Identify Practice as PCMH Participant

Identifying your practice as a PCMH participant ensures that the PCMH reports generate with the necessary data.

1. Tools menu → Configure Practice Settings

2. On the Practice tab, select the PCMH Participant checkbox.

Required Patient Information

When participating in PCMH, you must enter the following information in the Patient window for all patients. If a patient declines to give you certain information, such as race or ethnicity, you may select an entry such as ‘Not Provided’.

Date of birth

Sex

Race

Ethnicity

Preferred language

Telephone numbers

Email address

Ref: 1157.01 11

PCMH Information Document

PCMH requires that you give new patients, or their families or caregivers, information about the role and responsibilities of a patient-centered medical home. This document must include:

Specific services patients can expect from the practice.

Whom to contact for specific concerns, questions and information.

The roles of the care team.

Your office hours and after-hours contact information.

Your PCMH information document may be a standard preprinted brochure, a letter to the patient, or any other type of document that contains the required information.

The application includes a document formatting model that you may use as the basis for your PCMH information document. If you choose to use this document, you must edit it to include information specific to your practice.

You can use your PCMH document formatting model to generate the document for a patient when making an appointment or when checking in or out for an appointment. You may also create a dynamic procedure note that includes generation of the document, and associate that procedure note with any new patient E&M codes that your practice uses.

PCMH Charting

The sections below list the standards and elements of the NCQA PCMH Recognition program, and identify ways in which you can use the application to meet requirements and/or document how you have met the requirements.

The use of these features and functions alone does not necessarily meet the full requirements of any NCQA element, nor does simply using the feature or function necessarily meet any aspect of an element’s requirements. For example, you can use the scheduling functionality of the application to define appointment types for same-day appointments and to include those appointment types on a calendar template and calendar. However, the application does not prevent users from scheduling appointments in those timeslots in advance.

Several PCMH elements and factors are similar to Meaningful Use and/or Clinical Quality Measure (CQM) measures. PCMH elements and factors that are similar to Meaningful Use or CQM measures are identified in the sections below. Please note PCMH elements and factors may refer to Meaningful Use Stage 1, Stage 2, or Modified Stage 2 measures and objectives.

12 Ref: 1157.01

Charting for Standard 1: Enhanced Access and Continuity

Element A: Patient-Centered Appointment Access (Must-pass element)

The practice has a written process and defined standards for providing appointments, and regularly assesses its performance on the following factors.

Factors 1-2:

1. Providing same-day appointments for routine and urgent care. (Critical Factor).

2. Providing routine and urgent-care appointments outside regular business hours.

Prevalidation Status: Practice Support

Functionality:

Completely configure one or more calendars, including defining appointment types for same- day appointments and urgent care appointments and using them on calendar templates that you then associate with calendars.

Factor 3: Providing alternative types of clinical encounters.


Functionality:

Use different clinical note types, such as Order Note and Full Note Composer (FNC) for different types of encounters. You can define custom clinical note types that suit your practice’s needs for various types of encounters.

Factor 4: Availability of appointments.


Functionality:

Use the PCMH Appointment Availability report to monitor the availability of appointments.

Ref: 1157.01 13

Factor 5: Monitoring no-show rates.


Functionality:

Use the PCMH Appointment Status Statistics report to monitor no-show rates.

Factor 6: Acting on identified opportunities to improve access.


Functionality:

Use the PCMH Appointment Availability, PCMH Appointment Status Statistics, and PCMH Appointment Type Statistics reports to identify trends in your appointment availability and use.

You must create your own documentation to show an improvement process for your practice.

Element B: 24/7 Access to Clinical Advice

The practice has a written process and defined standards for providing access to clinical advice and continuity of medical record information at all times, and regularly assesses its performance on the following factors.

Factor 1: Providing continuity of medical record information for care and advice when office is closed.

Prevalidation Status: Autocredit

Functionality:

Use the Microsoft® Remote Desktop™ functionality to access your Aprima PRM database when not in your office.

Factor 2: Providing timely clinical advice by telephone. (Critical Factor)

Prevalidation Status: Not Applicable

Functionality:

You must create your own documentation to support this factor. This is outside of Aprima PRM (or any EHR).

14 Ref: 1157.01

Factor 3: Providing timely clinical advice using a secure, interactive electronic system.


Functionality:

You must configure the Aprima Patient Portal to enable patient messaging. You must also configure the routing of various types of patient messages to the appropriate user groups.

You must also establish Patient Portal user IDs and passwords for patients or their responsible parties so that they may access their information on the Portal.

Factor 4: Documenting clinical advice in patient records.


Functionality:

You must configure the formatting models used for Review Past Notes and One Page Summary to include the message types that your practice uses for patient messaging.

Element C: Electronic Access

The following information and services are provided to patients/families/caregivers, as specified, through a secure electronic system.

Factor 1: More than 50 percent of patients have online access to their health information within four business days of when the information is available to the practice.


Functionality:

You must configure the Aprima Patient Portal to enable patients or their responsible parties to view their clinical summary, including associating a document formatting model that qualifies as a clinical summary to the Patient Portal.


Use the Meaningful Use Stage 2 Report for Core Measure 7 Sub Measure 1 to document the percentage of patients who use the Portal to access this information.

Ref: 1157.01 15

Factor 2: More than 5 percent of patients view, and are provided the capability to download their health information or transmit their health information to a third party.


Functionality:

You must configure the Aprima Patient Portal to enable patients or their responsible parties to view their clinical summary, including associating a document formatting model that qualifies as a clinical summary to the Patient Portal.


Use the Meaningful Use Stage 2 Report for Core Measure 7 Sub Measure 2 to document the percentage of patients who use the Portal to download or transmit their information.

Factor 3: Clinical summaries are provided within 1 business day for more than 50 percent of office visits.


Functionality:

You must provide a clinical summary document using a document formatting model that is designated as a qualifying clinical summary, within one business day of the visit. To qualify as a clinical summary, the document must include diagnostic test results, problem list (diagnoses), medication list, and medication allergy list, and may include other information as appropriate.

There are several ways you can meet this measure’s requirement.

Print the visit checkout plan at the conclusion of the visit, and give the document or file to the patient. The system-defined Checkout Plan formatting model is defined as a clinical summary, and is the default checkout plan document. You can select another formatting model for the checkout plan on the User Settings window.

Use the document generation functionality to print a summary document or generate a file of the summary document within one day of the patient’s visit, and give the document or file to the patient. The consolidated clinical data architecture document (C- CDA) is by definition designated as clinical summary document. Your administrative super user may have defined formatting models for document generation that are designed as a clinical summary document.

If your practice is using the Aprima Patient Portal, which enables patients to access information through a secure website, then you may use the Portal to meet this requirement. To do this, you must select the Allow Patients to View Clinical Summary option on the Configure Patient Portal Settings window. When you do this, you will select the document formatting model to be used for all clinical summaries made available to

16 Ref: 1157.01

patients through the portal. Then you must create a user ID and password for the patient. The patient’s user ID and password must be active prior to or within one business day of the patient’s visit.

Use the Meaningful Use Stage 2 Report for Core Measure 8 to document the percentage of patients who received a clinical summary within one day of their office visit.

Factor 4: A secure message was sent by more than 5 percent of patients.


Functionality:

You must configure the Aprima Patient Portal to enable patient messaging. You must also create web accounts for your patients and/or responsible parties.

At least 5 percent of your patients and/or responsible parties must send a message to the provider through the Patient Portal. It is important to recognize that the message must be sent from the Portal. This can be a new message or a response to a message sent to the patient.

Please note that demographic changes made by patients on the Portal do not count as a message sent by the patient.

Use the Meaningful Use Stage 2 Report for Core Measure 17 to document the percentage of patients who received a secure message from your practice.

Factor 5: Patients have two-way communication with the practice.


Functionality:

You must configure the Aprima Patient Portal to enable patient messaging. You must also configure message routing for the Portal, and identify the appropriate user groups to receive each type of message that is enabled.

Factor 6: Patients can request appointments, prescription refills, referrals and test results.


Functionality:

You must configure the Aprima Patient Portal to enable requests for appointments and prescription refills and to enable viewing lab results. You must also configure message routing for the Portal, and identify the appropriate user groups to receive messages for appointment requests and prescription refill requests.

Ref: 1157.01 17


You must approve lab results in order for them to be viewed by patients through the Patient Portal.

Charting for Standard 2: Team-Based Care Element A: Continuity

The practice provides continuity of care for patients/families by the following services.

Factor 1: Assisting patients/families to select a personal clinician and documenting the selection in practice records.


Functionality:

Identify the provider in your practice who has primary responsibility for the patient. Do this in the Practice Provider field on the Patient window.

Factor 2: Monitoring the percentage of patient visits with selected clinician or team.


Functionality:

Use the PCMH Patient Primary Physician Visit report to monitor the percentage of patient visits that are with the patient’s primary practice provider.

Factor 3: Having a process to orient new patients to the practice.


Functionality:


18 Ref: 1157.01

Factor 4: Collaborating with the patient/family to develop/implement a written care plan for transitioning from pediatric care to adult care.


Functionality:


Element B: Medical Home Responsibilities

The practice has a process for informing patients/families about the role of the medical home and gives patients/families materials that contain the following information.

Factors 1-8:

1. The practice is responsible for coordinating patient care across multiple settings.

2. Instructions for obtaining care and clinical advice during office hours and when the office is closed.

3. The practice functions most effectively as a medical home if patients provide a complete medical history and information about care obtained outside the practice.

4. The care team provides access to evidence-based care, patient/family education and self- management support.

5. The scope of services available within the practice including how behavioral health needs are addressed.

6. The practice provides equal access to all of their patients regardless of source of payment.

7. The practice gives uninsured patients information about obtaining coverage.

8. Instructions on transferring records to the practice, including a point of contact at the practice.


Functionality:

You can either modify the system-defined PCMH Info Sheet document formatting model or create your own document formatting model to include the required information for your practice.

Then you must generate the document for each patient.

You can then use the PCMH Generated Documents report to document the percentage of patients to whom you gave the document.

Ref: 1157.01 19

You do not have to use the application’s document generation functionality to meet the requirements of this factor. You may have printed brochures that you give to patients or provide the information in some other manner. If you use another method that is outside of Aprima PRM, then you must create your own documentation to support this factor.

Element C: Culturally and Linguistically Appropriate Services

The practice engages in activities to understand and meet the cultural and linguistic needs of its patients/families by performing the following activities.

Factor 1: Assessing the diversity of its population.


Functionality:

You must enter patient demographic information, such as gender, race, ethnicity, and language, in the Patient window.

Use the PCMH Patient Information report to assess and document the diversity of your patient population.

Factor 2: Assessing the language needs of its population.


Functionality:

You must enter patients’ preferred language in the Patient window.

Use the PCMH Patient Information report to assess and document the percentage of patients whose language is identified.

Factor 3: Providing interpretation or bilingual services to meet the language needs of its population.


When a patient requires translation services, you must identify this in the patient record. Do this by selecting the Translator Required checkbox in the Patient window.

You must create your own documentation to support how and when your practice provides interpretation, translation, or bilingual services to patients. This is outside of Aprima PRM (or any EHR).

20 Ref: 1157.01

Factor 4: Providing printed materials in the languages of its population.


Functionality:

Autocredit for this factor is dependent upon the use of the optionally purchased education forms from Persivia™.

The Persivia education forms are available in both English and Spanish. Both the English and Spanish versions of a form have the same English title when searching for the form in a patient visit note so the form is listed twice in the search results. When Spanish is the selected language for a patient (in the Patient window), then, when available, the Spanish version of the form is automatically assigned to the patient visit note when you select an education form, regardless of which of the two you select. You can override this language selection if desired when printing or displaying the education form. If the selected language for the patient is anything other than Spanish, then the English version of the form is always assigned, regardless of which of the two you select.

Please note that the automatic language selection only works for education forms provided by Persivia, and only works with English and Spanish, the two languages in which Persivia provides forms. This does not work for user-defined education forms which your practice has added to the database.

You may create your own documents in any language and upload them as education forms. However, autocredit for this measure is not available when using your own education forms.

When using your own custom education forms, you must select the education form in the language that is appropriate for the patient. Automatic language selection is not available for custom education forms.

Use the PCMH Patient Education Form report to document which education forms were given to which patients.

Element D: The Practice Team (Must-pass element)

Factors 1-3:

1. Defining roles for clinical and nonclinical team members.

2. Identifying the team structure and the staff who lead and sustain team based care.

3. Holding scheduled patient care team meetings or a structured communication process focused on individual patient care. (Critical Factor)


Ref: 1157.01 21

Functionality:

You must create your own documentation to support these factors. These activities are outside of Aprima PRM (or any EHR).

Factor 4: Using standing orders for services.


Functionality:

Use common problem palettes and procedure panels to document standing orders within Aprima PRM.

Factors 5-10:

5. Training and assigning members of the care team to coordinate care for individual patients.

6. Training and assigning members of the care team to support patients/families/caregivers in self-management, self-efficacy and behavior change.

7. Training and assigning members of the care team to manage the patient population.

8. Holding scheduled team meetings to address practice functioning.

9. Involving care team staff in the practice’s performance evaluation and quality improvement activities.

10. Involving patients/families/caregivers in quality improvement activities or on the practice’s advisory council.


Functionality:

You must create your own documentation to support these factors. These activities are outside of Aprima PRM (or any EHR).

22 Ref: 1157.01

Charting for Standard 3: Population Health Management

Element A: Patient Information

The practice uses an electronic system to record patient information, including capturing information for factors 1–13 as structured (searchable) data for more than 80 percent of its patients.

Factors 1-7:

1. Date of birth.

2. Sex.

3. Race.

4. Ethnicity.

5. Preferred language.

6. Telephone numbers.

7. E-mail address.


Functionality:

You must enter the required information in the patient record using the Patient window.

Use the PCMH Patient Information report to document the demographic statistics.

Factor 8: Occupation (NA for pediatric practices).


Functionality:

Enter the patient’s occupation in the Patient Demographics window’s Employment tab.

Ref: 1157.01 23

Factor 9: Dates of previous clinical visits.


Functionality:

Visit dates are automatically recorded and can be viewed using the system-defined formatting models used in the Review Past Notes and One Page Summary windows or through the Visit Center window. Visit dates may also be included in documents generated from formatting models that include visit dates.

Factors 10-11:

10. Legal guardian/health care proxy.

11 Primary caregiver.


Functionality:

If the patient has a guardian or a primary care giver, then identify that person in the Patient Demographics window’s Contacts tab using the system-defined Care Giver or Guardian contact relationship.

Factor 12: Presence of advance directives (NA for pediatric practices).


Functionality:

Use the Advance Directive ) icon in the Patient Demographics window or document linking to attach and identify an advance directive to a patient record. You must use the system- defined Advance Directive attachment type.

Factor 13: Health insurance information.


Functionality:

Enter the patient’s insurance payer and plan and insurance subscriber information in the Account window. Access the Account window from the Patient Demographics window’s Accounts tab.

24 Ref: 1157.01

Factor 14: Name and contact information of other health care professionals involved in patient’s care.


Functionality:

Use Patient/Provider Tracking and Referrals to identify other health care professionals involved in a patient’s past or current care.

You must enter providers’ names and contact information in the Provider window. Use the Medical Services Provider window to enter name and contact information for entities such as imaging centers, surgical centers, etc.

Element B: Clinical Data

The practice uses an electronic system with the functionality in factors 6 and 7 and records the information in factors 1–5 and 8–11 as structured (searchable) data.

Factor 1: An up-to-date problem list with current and active diagnoses for more than 80 percent of patients.


Functionality:

You must enter at least one active diagnosis in the Dx tab of Full Note Composer or other clinical note type window, or have an active entry in the Problem/Diagnosis History category of the Hx tab. If the patient has not been diagnosed with any particular problem or disease, then in the Hx tab problem history category, select the “*Denies Any Medical Problems” entry.

To meet the goal, you must properly enter a diagnosis or problem for more than 80 percent of your qualifying patients seen during the reporting period.

Use the Meaningful Use Stage 1 report for Core Measure 3 to document the percentage of patients with an up-to-date problem list.

Factor 2: Allergies, including medication allergies and adverse reactions, for more than 80 percent of patients.


Functionality:

You must either enter allergy information in the drug, environmental, and food allergy categories on the Hx tab of Full Note Composer or other clinical note type window, or select the No Known Allergies entry in each allergy category.

Ref: 1157.01 25

To meet the measure’s goal, you must enter drug allergy information or indicate no known allergies for more than 80 percent of your qualifying patients seen during the reporting period.

Use the Meaningful Use Stage 1 report for Core Measure 6 to document the percentage of patients with drug allergy information. Please note that this report does not include environmental and food allergy information.

Factor 3: Blood pressure, with the date of update, for more than 80 percent of patients 3 years and older.


Functionality:

Although the information is required per patient, not per visit, you must enter the blood pressure in at least one visit note during the reporting period. Enter the patient’s vital signs in the Vitals tab of Full Note Composer or other clinical note type window. You must enter this information in the system-defined data fields.

Use the Meaningful Use Stage 2 report for Core Measure 4 sub-measure 3. Please note that when using this report as documentation for this measure, entries in custom data fields for vitals do not count.

Factor 4: Height/length for more than 80 percent of patients.


Functionality:

Although the information is required per patient, not per visit, you must enter the height or length in at least one visit note during the reporting period. Enter the patient’s vital signs in the Vitals tab of Full Note Composer or other clinical note type window. You must enter this information in the system-defined data fields.

Use the Meaningful Use Stage 2 report for Core Measure 4 sub-measure 2. Please note that when using this report as documentation for this measure, entries in custom data fields for vitals do not count. Please also note that this report only includes patients for whom both height (or length) and weight are entered.

26 Ref: 1157.01

Factor 5: Weight for more than 80 percent of patients.


Functionality:

Although the information is required per patient, not per visit, you must enter the weight in at least one visit note during the reporting period. Enter the patient’s vital signs in the Vitals tab of Full Note Composer or other clinical note type window. You must enter this information in the system-defined data fields.

Use the Meaningful Use Stage 2 report for Core Measure 4 sub-measure 2. Please note that when using this report as documentation for this measure, entries in custom data fields for vitals do not count. Please also note that this report only includes patients for whom both height (or length) and weight are entered.

Factor 6: System calculates and displays BMI.


Functionality:

The application calculates and displays the patient’s BMI when both height and weight are entered in a visit note. Enter the patient’s vital signs in the Vitals tab of Full Note Composer or other clinical note type window. You must enter this information in the system-defined data fields.

Factor 7: System plots and displays growth charts (length/height, weight and head circumference) and BMI percentile (0-20 years) (NA for adult practices).


Functionality:

For patients 20 years old or younger, you can plot and display the height, weight, and BMI in growth charts. To plot the growth chart, you must have entered the information in at least one visit note. Enter the patient’s vital signs in the Vitals tab of Full Note Composer or other clinical note type window. You must enter this information in the system-defined data fields.

Ref: 1157.01 27

Factor 8: Status of tobacco use for patients 13 years and older for more than 80 percent of patients.


Functionality:

Enter the patient’s use or non-use of tobacco in the Hx tab, Social History category, in Full Note Composer or other clinical note type window. This entry must be active during the reporting period.

Use the Meaningful Use Stage 2 report for Core Measure 5 to document the percentage of patients whose use of tobacco is documented. Please be aware that this report only includes the tobacco history answers that are associated with the SNIOMED codes required by Meaningful Use. SNOMED codes are not required for PCMH.

Factor 9: List of prescription medications with date of updates for more than 80 percent of patients.


Functionality:

You must either:

Enter prescriptions through the SIG Writer window and print or electronically submit the prescriptions, or

Enter a medication in the Medication History category of the Hx tab of Full Note Composer or other clinical note type window or in the Patient History window, or

Select the Patient Takes No Medications checkbox in the Medication History category on the Hx tab of Full Note Composer or other clinical note type window or the Patient History window.

To meet the goal, you must enter prescriptions or indicate no medications taken for more than 80 percent of your qualifying patients seen during the reporting period.

At least one medication history entry must be active for the patient at the end of the reporting period.

Use the Meaningful Use Stage 1 report for Core Measure 5 to document the percentage of patients with medication entries.

28 Ref: 1157.01

Factor 10: More than 20 percent of patients have family history recorded as structured data.


Functionality:

Enter family health history information in either the Patient History window or the Hx tab of Full Note Composer or other clinical note type window using the Family History category. The information for the relative may include entering one or more diseases or may include the No Known Diseases checkbox.

Use the Meaningful Use Stage 2 report for Menu Set Measure 4 to document the percentage of patients with family history entries. Please note that this Meaningful Use measure counts history entered for first-degree relatives only. Therefore, this report only includes patients who have at least one family history for a first-degree relative. PCMH does not require that family history entries be for first-degree relatives.

Factor 11: At least one electronic progress note created, edited and signed by an eligible professional for more than 30 percent of patients with at least one office visit.


Functionality:

You, the provider, must create, edit, or sign your patient visit notes within Aprima PRM. To be counted, the visit note must include an E&M code on the SP tab of Full Note Composer or other clinical note type window.

Visit notes may be accessed from the Review Past Notes, One Page Summary, and Visit Center windows. Visit note dates and information may also be included in documents generated from formatting models that include visit dates.

Element C: Comprehensive Health Assessment

To understand the health risks and information needs of patients/families, the practice collects and regularly updates a comprehensive health assessment that includes the following.

Factor 1: Age- and gender appropriate immunizations and screenings.


Functionality:

Use the application’s clinical decision support (CDS) rules and vaccine administration record for this factor.

Ref: 1157.01 29

The application includes a number of system-defined CDS rules for childhood immunizations. You may create additional CDS rules for your practice.

The application also includes system-defined vaccine administration records for both adult and pediatric immunizations. The system-defined vaccine administration records include the vaccinations and vaccine schedule recommend by the Centers for Disease Control and Prevention (CDC). You may create your own vaccine administration record with the appropriate immunizations and schedules for your practice, or you may modify to the system- defined vaccine administration records to include additional immunizations.

Factor 2: Family/social/cultural characteristics.


Functionality:

Enter the patient’s family, social, and cultural information using the social history category in either the Patient History window or the Hx tab of Full Note Composer or other clinical note type window.

Factor 3: Communication needs.


Functionality:

Enter the patient’s communication needs using the functional assessment history category in either the Patient History window or the Hx tab of Full Note Composer or other clinical note type window.

Factor 4: Medical history of patient and family history.


Functionality:

Enter the patient’s medical history using the problem/diagnosis history category in either the Patient History window or the Hx tab of Full Note Composer or other clinical note type window. Enter the patient’s family history in the family history category.

30 Ref: 1157.01

Factor 5: Advance care planning (NA for pediatric practices).


Functionality:

Use the Advance Directive ) icon in the Patient Demographics window or document linking to attach and identify an advance directive to a patient record. You must use the system- defined Advance Directive attachment type.

Factor 6: Behaviors affecting health.


Functionality:

Enter the patient’s behaviors affecting health using the social history category in either the Patient History window or the Hx tab of Full Note Composer or other clinical note type window.

Factor 7: Mental health/substance use history of patient and family.


Functionality:

Enter the patient’s mental health/substance use using the social history category in either the Patient History window or the Hx tab of Full Note Composer or other clinical note type window. Enter the patient’s family’ mental health/substance use in the family history category.

Factor 8: Developmental screening using a standardized tool (NA for practices with no pediatric patients).


Functionality:

Enter developmental screening information in Full Note Composer or another clinical note type window using the Assessment tab and either custom form layouts for assessments based on standardized tool or assessment form layouts in the optionally purchased Bright Futures™ from the AAP content.

Ref: 1157.01 31

Factor 9: Depression screening for adults and adolescents using a standardized tool.


Functionality:

Enter depression screening information in Full Note Composer or another clinical note type window using the Assessment tab and either the system-defined PHQ-2 and PHQ-9 assessments or custom form layouts for assessments based on standardized tools.

Factor 10: Assessment of health literacy.


Functionality:

Generate the system-defined REALM-SF Examiner Record formatting model to assess the patient’s health literacy.

Then enter the assessment results in Full Note Composer or another clinical note type window using the Assessment tab and either the system-defined REALM-SF Examiner Record assessment.

Element D: Use Data for Population Management (Must-pass element)

At least annually the practice proactively identifies populations of patients and reminds them, or their families/caregivers, of needed care based on patient information, clinical data, health assessments and evidence-based guidelines including the following.

Factor 1: At least two different preventive care services.


Functionality:

Please note that to receive autocredit, you must use the specific preventive care services described here.

Blood Pressure Screening

Patients must be 18 years old or older before the start of the measurement period. Patients do not already have an active diagnosis of hypertension.

Patients who were screened for high blood pressure AND a recommended follow-up plan is documented as indicated if the blood pressure is pre-hypertensive or hypertensive.

32 Ref: 1157.01

To report on this measure, you must enter the patient’s blood pressure (both systolic and diastolic values) in the Vitals tab of Full Note Composer or other clinical note type window. Use the system-defined blood pressure fields (Blood Pressure 1, 2, 3, or 4). These observation items for these blood pressure fields are associated with the appropriate LOINC codes.

The blood pressure measurement from the most recent visit is used to report on this measure. When that visit contains more than one blood pressure measurement, then the measurement with the lowest systolic and diastolic blood pressure is used.

This measure looks at both the systolic and diastolic pressures to determine the follow-up needed for the patient. So, if either the patient’s systolic pressure or diastolic pressure are equal to or greater than the criteria, then you must perform the specified follow-up actions. This is also true when the blood pressure from the prior year is considered. The blood pressure was high in the prior year if either the systolic pressure was 140 or higher or the diastolic pressure was 90 or higher. It is not necessary for both the systolic and the diastolic pressure to be higher than the target.

If the patient’s blood pressure is between 120/80 and 140/90, then within one day of the visit, you must either:

Order referral to another provider, or

Document a plan to retest the blood pressure within a year and document lifestyle change recommendations that may include diet, exercise, weight loss, and alcohol consumption.

If the patient’s blood pressure is 140/90 or greater, but has not been high (or was not taken) in the year prior to this visit, then within one day of the visit, you must either:


Document a plan to retest the blood pressure within four weeks and document lifestyle change recommendations that may include diet, exercise, weight loss, and alcohol consumption.

If the patient’s blood pressure is 140/90 or greater, and has been high in the year prior to this visit, then within one day of the visit, you must either:


Document a plan to retest the blood pressure within four weeks and document lifestyle change recommendations that may include diet, exercise, weight loss, and alcohol consumption, and either

Write a prescription for medication, or

Order a screening or test, such as a comprehensive metabolic panel or an electrocardiogram.

To chart a referral to another provider, you must order the referral by entering a procedure code that is associated with a qualifying SNOMED code. The system-defined Referral Order procedure code is associated with SNOMED code 306253008. You may associate other procedure codes with more specific qualifying SNOMED codes as needed. Enter the procedure code in either the SP or the SO tab of Full Note Composer or other clinical note type window.

Ref: 1157.01 33

SNOMED: 134403003, 183516009, 183561008, 183856001, 306206005, 306253008, or 308470006

You may also create the referral from Patient/Provider Tracking. When you create the referral in this way, you must create the referral within one day of the visit date and associate it with the visit.

To chart that you plan to retest the blood pressure, you must have one or more custom procedure codes and associate them with a qualifying SNOMED code that indicates the timeframe for the follow up test. Enter the procedure in the SP tab of Full Note Composer or other clinical note type window. Please note that simply entering the referral in Referral Tracking or Patient Provider Tracking will not count for this measure.

SNOMED codes for retest within 4 weeks: 183617005, 183618000, 183619008, 183620002,

183621003, 183622005, 183623000

SNOMED codes for retest within 1 year: 61342007, 183617005, 183618000, 183619008, 183620002, 183621003, 183622005, 183623000, 183624006, 183625007, 183626008, 183627004, 183628009, 300042001

For diet, exercise, weight loss, or alcohol consumption recommendations, counseling, or education, you must chart an appropriate procedure. Select the desired procedure code in the SP or SO tab of Full Note Composer or other clinical note type window. If the procedure code is associated with an education form, such as for counseling, then selecting the education form from the Education Form slider will add the procedure code to the SP tab.

Alcohol

SNOMED: 24165007, 38670004, 390857005, 408947007, 413473000, 417096006, 419822006,

431260004

Diet

HCPCS: G8417, S9452, S9470

SNOMED: 11816003, 14044002, 31002004, 40546006, 54123004, 61310001, 103699006,

169411000, 182922004, 182954008, 182955009, 182956005, 182960008, 183061003, 183065007, 183070000, 183071001, 226164007, 281085002, 284071006, 284352003, 304491008, 305849009, 306163007, 361231003, 370847001, 386464006, 386619000, 386620006, 410114009, 410171007, 410177006, 410270001, 413315001, 418995006, 424753004, 443288003

Exercise

HCPCS: S9451

SNOMED: 281090004, 304507003, 304549008, 386291006, 386292004, 386373004, 386463000,

410289001

34 Ref: 1157.01

Lifestyle

SNOMED: 313204009, 364706004, 39155009, 415510005, 443402002, 60134006

Weight Loss

HCPCS: S9449

SNOMED: 170795002, 266724001, 268523001, 275919002, 401003006, 408289007, 410200000

To use medication as part of the follow-up plan, you must prescribe a qualifying medication as the follow up plan. Write the prescription through the SIG Writer window, and then either print it or submit it electronically.

To chart a screening or test, you must enter a procedure code that is associated with a qualifying SNOMED code. You may enter the in either the SP or the SO tab of Full Note Composer or other clinical note type window.

CPT: 80047, 80048, 80050, 80053, or 80069

SNOMED: 2278000, 5540006, 8879006, 15373003, 18207002, 20501000, 27171005, 27260001, 28317006, 36793009, 59573005, 60218003, 68994006, 70901006, 71878006, 73668004, 82912006, 88480006, 102811001, 105362001, 113075003, 127800008, 164846002, 167181009, 167182002, 167183007, 167222005, 167470001, 251838003, 259295006, 271000000, 271075006, 271236005, 271240001, 290127004, 301119002, 301120008, 304048005, 312468003, 312472004, 313502007, 313936008, 365616005, 365618006, 365756002, 365757006, 365760004, 390963002, 390964008, 420155008, 444164000, 444275009, 444336003

This measure looks at both the systolic and diastolic pressures. Either the patient’s systolic pressure or diastolic pressure must be equal to or greater than the criteria to move to the next level.

Use the CQM report for measure CMS 022 to document the preventive care services.

Body Mass Index (BMI) Screening

For denominator 1, the patient must be between 18 and 64 years old before the beginning of the measurement period.

For denominator 2, the patient must be 65 years of age or older before the beginning of the measurement period. The patient must have at least one eligible encounter during the measurement period.

For both denominators, the patient must have at least one eligible encounter during the measurement period. Eligible encounters do not include encounters where the patient is receiving palliative care, refuses BMI measurement, the patient is in an urgent or emergent medical situation where time is of the essence and to delay treatment would jeopardize the

Ref: 1157.01 35

patient’s health status, or there is any other reason documented in the medical record by the provider explaining why BMI measurement was not appropriate.

To report on this measure, you must enter the patient’s height and weight in the Vitals tab of the patient visit note window. The BMI is calculated automatically from the height and weight entries, and then displayed on the Vitals tab and charted in the visit note. The application determines the appropriate LOINC code to associate with the BMI based on the patient’s age.

If there is a medical reason for not calculating the BMI, then you must enter one of the following HCPCS procedure codes and enter an appropriate negation reason on that procedure.

HCPCS for BMI: G8938, G8421, G8417, G8418, G8419, G8420, G8422, G8938

If the BMI is out of the established normal range, then you must establish a follow up plan, which may include medication, procedures, counseling, or a referral to another qualifying medical services provider.

To document the follow-up plan using a procedure, counseling, or referral, use a procedure code that is associated with a qualifying SNOMED code. You may enter the procedure code in either the SP or the SO tab of Full Note Composer or other clinical note type window.

If the procedure code you want has been associated with an education form, such as for counseling, then selecting the education form from the Education Form slider will add the procedure code to the SP tab.

The education form assigned to the patient must be associated with a patient communication type of Overweight or Underweight. Please note that since only one patient communication type can be associated with an education form, you must have separate forms for these conditions. If you use an education form on a general topic, such as nutrition, for both underweight and overweight, then you must have two copies of education form in your database.

Above Normal Follow Up

CPT: 43644, 43645, 43770, 43771, 43772, 43773, 43774, 43842, 43843, 43845, 43846, 43847,

43848, 97804, 98960, 99078

HCPCS: G8417, S9449, S9451, S9452, S9470

SNOMED: 304549008, 307818003, 361231003, 370847001, 386291006, 386292004, 386373004, 386463000, 386464006, 401003006, 410177006, 413315001, 418995006, 424753004, 443288003

36 Ref: 1157.01

Above Normal Referral

SNOMED: 103698003, 103699006, 183515008, 183524004, 183583007, 185359002, 305922005,

306136006, 306163007, 306164001, 306165000, 306166004, 306167008, 306168003, 306226009, 306227000, 306252003, 306344004, 306353006, 306354000, 308459004, 308470006, 308477009, 390864007, 390866009, 390893007, 408289007, 410160006, 416790000, 424203006, 91251008

Below Normal Follow Up

HCPCS: G8418, S9449, S9452, S9470

SNOMED: 386464006, 404923009, 410177006, 413315001, 418995006, 424753004, 429095004, 443288003

Below Normal Referral

SNOMED: 91251008, 103698003, 103699006, 183515008, 183524004, 183583007, 185359002,

305922005, 306136006, 306163007, 306164001, 306165000, 306166004, 306167008, 306168003, 306226009, 306227000, 306252003, 306344004, 306353006, 306354000, 308459004, 308470006, 308477009, 390866009, 390893007, 408289007, 410160006, 416790000, 424203006

To document the follow-up plan using a medication, write a prescription for an appropriate medication using the SIG Writer window. Then print or electronically submit the prescription.

Use the CQM report for measure CMS 069 to document the preventive care services.

Factor 2: At least two different immunizations.


Functionality:

Please note that to receive autocredit, you must use the specific immunizations described here.

Pneumonia Vaccination

Patients 65 years of age and older with a visit during the measurement period.

Please note that the E&M codes 99211 and 99243 do not count for this measure.

Patients who have ever received a pneumococcal vaccination.

To report on this measure, you must document the administration of the pneumonia vaccine or document it in the patient’s history. The vaccination may have been given at any time prior to or during the measurement period.

Ref: 1157.01 37

To document the pneumonia immunization, enter the administration using a procedure code associated to an appropriate SNOMED code. Enter the procedure in the SP tab of Full Note Composer or other clinical note type window. Then document the vaccination details in the vaccine administration record.

You may also document the pneumonia immunization by using a type of vaccine associated with the qualifying CVX code. Identify the type of vaccine when documenting the vaccine details in the vaccine administration record.

To document a vaccination given in the past, you must use a type of vaccine associated with the qualifying CVX code. Enter the vaccination in the vaccination history category in the Hx tab of Full Note Composer or in the Patient History window. Then, identify the type of vaccine when documenting the vaccine details in the vaccine administration record.

CVX: 33

SNOMED for administering the vaccination: 12866006, 394678003

Use the CQM report for measure CMS 127 to document the pneumonia immunizations.

Influenza Immunization

Patients aged 6 months and older, and seen for a visit between October 1 and March 31.

The patient must have a visit during flu season, which is defined as October of the prior year through March of the current year.

The patient must also have one, or in some circumstances two, additional visits during the reporting period.

Patients who received an influenza immunization OR who reported previous receipt of an influenza immunization.

To report on this measure, you must document the administration of the flu immunization, or enter it in the vaccine history category. The vaccine must have been administered between October of the prior year and March of the current year.

To document the influenza immunization, enter the vaccination in the vaccine administration record using one of the following CPT codes or a procedure code associated with a SNOMED code. Enter the procedure in the SP tab of Full Note Composer or other clinical note type window. Then document the vaccination details in the vaccine administration record.

To document a vaccination given in the past, you must use a type of vaccine associated with the qualifying CVX code. Enter the vaccination in the vaccination history category in the Hx tab of Full Note Composer or in the Patient History window. Then, identify the type of vaccine when documenting the vaccine details in the vaccine administration record. Please note that you must make this entry in a visit during the flu season.

CPT: 90656, 90658, 90660, 90661, 90662, 90664, 90666, 90667, 90668

38 Ref: 1157.01

SNOMED: 86198006, 442333005

CVX: 111, 135, 140, 141, 144, 149, 150

Use the CQM report for measure CMS 147 to document the influenza immunizations.

Factor 3: At least three different chronic or acute care services.


Functionality:

Please note that to receive autocredit, you must use the specific chronic or acute care services described here.

Improvement in Blood Pressure

All patients aged 18-85 years of age, who had at least one outpatient visit in the first six months of the measurement year, who have a diagnosis of hypertension documented during that outpatient visit, and who have uncontrolled baseline blood pressure at the time of that visit.

Enter the hypertension diagnosis with a qualifying diagnosis code or diagnosis code associated with a SNOMED code in the Dx tab of Full Note Composer or other clinical note type window or enter a problem associated with a qualifying SNOMED code in the problem history category in the Hx tab of Full Note Composer or the Patient History window.

ICD-9: 401.0, 401.1, 401.9

ICD-10: I10

SNOMED: 10725009, 1201005, 276789009, 371125006, 429457004, 46481004, 48146000, 56218007, 59621000, 59720008, 65518004, 78975002

To report on this measure, you must enter the patient’s blood pressure in the Vitals tab of Full Note Composer or other clinical note type window. You must enter both systolic and diastolic values, but this measure is only concerned with the systolic entry.


Please note that if the patient has a visit in the first six months of the reporting period and their blood pressure is not high at that time and they do not have a diagnosis or problem of hypertension, then the patient will not be counted for this measure even if the patient’s blood press is high in a visit in during the last six months of the year.

Patients whose follow-up systolic blood pressure is at least 10 mmHg less than their baseline blood pressure or is adequately controlled (systolic blood pressure is less than 140 mmHg).

Ref: 1157.01 39

If a follow-up blood pressure reading is not recorded during the measurement year, the patient’s blood pressure is assumed “not improved.”

To report on this measure, the patient must have a second visit that:

Is at least six months after the first visit,

Is within the reporting period,

Is with the same provider as the first visit, and

Includes a blood pressure reading.

Enter the patient’s blood pressure in the Vitals tab of Full Note Composer or other clinical note type window. You must enter both systolic and diastolic values, but this measure is only concerned with the systolic entry.

Use the system-defined blood pressure fields (Blood Pressure 1, 2, 3, or 4). These observation items for these blood pressure fields are associated with the appropriate LOINC codes.


Use the CQM report for measure CMS 065 to document the percentage of patients whose blood pressure improved.

Poor Control of Hemoglobin A1c

Patients 18-75 years of age with diabetes with a visit during the measurement period.

Enter the diabetes diagnosis with a qualifying diagnosis code or diagnosis code associated with a SNOMED code in the Dx tab of Full Note Composer or other clinical note type window or enter a problem associated with a qualifying SNOMED code in the problem history category in the Hx tab of Full Note Composer or the Patient History window.

ICD-9: 250.00, 250.01, 250.02, 250.03, 250.10, 250.11, 250.12, 250.13, 250.20, 250.21,

250.22, 250.23, 250.30, 250.31, 250.32, 250.33, 250.41, 250.42, 250.43, 250.50, 250.51, 250.52, 250.53, 250.60, 250.61, 250.62, 250.63, 250.70, 250.71, 250.72, 250.73, 250.80, 250.81, 250.82, 250.83, 250.90, 250.91, 250.92, 250.93, 648.01, 648.02, 648.03, 648.04

ICD-10: E10.10, E10.11, E10.21, E10.22, E10.29, E10.311, E10.319, E10.321, E10.329, E10.331, E10.339, E10.341, E10.349, E10.351, E10.359, E10.36, E10.39, E10.40, E10.41, E10.42, E10.43, E10.44, E10.49, E10.51, E10.52, E10.59, E10.610, E10.618, E10.620, E10.621, E10.622, E10.628, E10.630, E10.638, E10.641, E10.649, E10.65, E10.69, E10.8, E10.9, E11.00, E11.01, E11.21, E11.22, E11.29, E11.311, E11.319, E11.321, E11.329, E11.331, E11.339, E11.341, E11.349, E11.351, E11.359, E11.36, E11.39, E11.40, E11.41, E11.42, E11.43, E11.44, E11.49, E11.51, E11.52, E11.59, E11.610, E11.618, E11.620, E11.621, E11.622, E11.628, E11.630, E11.638, E11.641,

40 Ref: 1157.01

E11.649, E11.65, E11.69, E11.8, E11.9, O24.011, O24.012, O24.013, O24.019, O24.02, O24.03, O24.111, O24.112, O24.113, O24.119, O24.12, O24.13

SNOMED: 4783006, 9859006, 23045005, 28032008, 44054006, 46635009, 75682002, 76751001,

81531005, 190330002, 190331003, 190368000, 190369008, 190372001, 190389009, 190390000, 199223000, 199225007, 199226008, 199227004, 199228009, 199229001, 199230006, 237599002, 237618001, 237626009, 237627000, 313435000, 313436004, 314771006, 314772004, 314893005, 314894004, 314902007, 314903002, 314904008, 359642000, 359939009

Patients whose most recent HbA1c level (performed during the measurement period) is >9.0%. Patients who do not have an HbA1c level entered during the measurement period are also included in the numerator. Please note that for this measure, a low numerator is the desired outcome.

To report on this measure, you must order or perform an A1c test and then either enter the test results or receive them through an interface. You must associate the results with the order, and give them a status of Resulted or Approved.

The A1c test results must be entered as discrete, quantifiable data. Enter the results in the Patients Results window using a lab template enabling you to enter the HGB A1c value. Results stored in the database as text notes or an image file cannot be used for reporting.

You must associate a LOINC code to the A1C test. There are two ways to do this. You can enter the LOINC on the test item on each lab template for both manually entered and electronic results. Do this inthe Lab Template window. The second way is easy if you have several templates. You can enter the LOINC on the A1C test in the Observation Item window. This associates the LOINC to all A1C test items in all lab templates.

The LOINC codes for this result are 17855-8, 17856-6, 4548-4.

Use the CQM report for measure CMS 122 to document the percentage of patients whose HGB A1c is under control.

Appropriate Medications for Asthma

The patient must be between 5 and 64 years old. The patient must have at least one visit during the measurement period.

You must identify patients with asthma with an appropriate ICD-10 code or with a SNOMED code associated with an ICD-9 code. The diagnosis may be entered in the Problem/Diagnosis category in the Patient History window or in Dx tab of Full Note Composer or other clinical note type window, but the diagnosis must be active.

ICD-10 Codes: J45.30, J45.31, J45.32, J45.40, J45.41, J45.42, J45.50, J45.51, J45.52

SNOMED Codes: 426656000, 426979002, 427295004

Ref: 1157.01 41

To report on this measure, you must prescribe an asthma medication. To report the asthma medication, write the prescription through the SIG Writer window or prescription refill message and print the prescription or send it electronically.

The diagnosis for persistent asthma cannot be made inactive or resolved prior to the start of the measurement period.

Use the CQM report for measure CMS 126 to document the percentage of patients using appropriate medications for asthma.

Factor 4: Patients not recently seen by the practice.


Functionality:

Use recall and reminder notices to monitor and process reminders for follow up visits or procedures and to process recall notices when needed. Patient recall entries may be created automatically by the application and may be created by users.

You can send recall and reminder notices through the Patient Portal for patients who have Portal accounts. For patients who do not have Portal accounts, you can export a list of names and addresses so that you can create mailing labels or letters to send to the patients. You can also contact patients by phone, and then update the patient recall entries.

The application includes the following system-defined recall types. You can create a recall entry for a patient using any recall type desired.

CDS: These patient recall entries are created automatically when a user generates the CDS Reminders report. Because the report generates letters or messages to patients with Portal accounts, the notification for these recall entries is done at the same time.

Patient by Condition: This patient recall type will be used in a future release to automatically create recall entries by generating a report.

Return Visit: These patient recall entries are created automatically when a provider defines a return visit in the Plan tab of a clinical note type window, and associates a patient recall entry with that return visit.

Use the Patient Recall window to monitor patient recall entries, send reminders, and update entries.

42 Ref: 1157.01

Factor 5: Medication monitoring or alert.


Functionality:

No data entry is required to report on this factor. However, the practice and individual providers must turn on drug-drug and drug-allergy screening. Configure drug screening in the Configure Practice Settings window’s Drug Screening tab and in the Provider window’s Drug Screening tab. It is recommended that you print a screen capture of the Configure Practice Settings window’s and Provider window’s Drug Screening tab, and keep these screen shots with your Meaningful Use documentation.

To meet the goal, you must attest Yes that drug interaction checks are performed by the application and that you review the interaction information provided by the check.

Element E: Implement Evidence-Based Decision-Support

The practice implements clinical decision support (e.g., point-of-care reminders) following evidence-based guidelines for the following.

Factor 1: A mental health or substance use disorder. (Critical Factor)


Functionality:

Please note that to receive autocredit, you must use the depression as the mental health disorder.

The patient must be 12 years and older at the beginning of the measurement period. The patient must have at least one eligible visit during the measurement period.

This measure requires that you perform an appropriate depression screening. When the screening result is positive, you must chart the appropriate diagnosis.

To chart the screening, you must enter a procedure code in either the SP or the SO tab of Full Note Composer or other clinical note type window. The procedure code you use must be associated with:

A LOINC code identifying the screening (adult or adolescent) and

A SNOMED code indicating whether the screening results were positive or negative.

The LOINC code for the screening indicates whether the screening was for an adult or an adolescent. Since a procedure code may only be associated with one LOINC code, then you must use different procedure codes for adult and adolescent screenings. If you use the same procedure for both adults and adolescents, then you must create a custom procedure code record for one of the age groups.

Ref: 1157.01 43

Because the results of the screening are indicated by the SNOMED code associated with the procedure code, you must have two procedure code records for the CPT or HCPCS code used for the screening. One must be associated with the SNOMED code for positive results, and one must be associated with the SNOMED code for negative results. Therefore, you must create a custom procedure code record for one of the results.

Important: A procedure code may be associated with two SNOMED codes. However, you cannot associate both the SNOMED code for positive results and the SNOMED code for negative results to the same procedure code. If you do, the application will not be able to correctly identify the results for a given patient.

Because you may need to have one or more custom procedure codes in order to correctly identify the screening and its results, it is recommended that you include the procedures in your charge ticket.

LOINC: 73831-0 or 73832-8

SNOMED Positive Result: 428181000124104

SNOMED Negative Result: 428171000124102

When the screening result is positive, you must chart the diagnosis with a qualifying ICD-9 or ICD-10 code or a diagnosis code associated with a qualifying SNOMED code for depression in the Dx tab of Full Note Composer or other clinical note type window.

SNOMED: 162004, 832007, 1196001, 1499003, 2506003, 2618002, 3109008, 3530005, 4441000,

5703000, 9340000, 10875004, 10981006, 13313007, 13581000, 13746004, 14183003, 14495005, 15193003, 15639000, 16295005, 16506000, 17782008, 18818009, 19300006, 19527009, 19694002, 20250007, 20960007, 21900002, 22121000, 22407005, 25922000, 26203008, 26530004, 28475009, 28663008, 28884001, 29929003, 30520009, 30687003, 30935000, 31446002, 33078009, 33380008, 34315001, 35481005, 35489007, 35846004, 36170009, 36474008, 36583000, 36923009, 38368003, 38451003, 38694004, 39809009, 40379007, 40568001, 40926005, 41552001, 41832009, 41836007, 42925002, 43568002, 43769008, 45479006, 46229002, 48589009, 48937005, 49468007, 49512000, 51637008, 53049002, 53607008, 54761006, 55516002, 59617007, 61403008, 63249007, 63778009, 64731001, 65042007, 66344007, 66631006, 67711008, 68569003, 69392006, 70546001, 71294008, 71336009, 71984005, 73471000, 73867007, 74686005, 75084000, 75360000, 75752004, 75837004, 76441001, 77486005, 77911002, 78269000, 78640000, 78667006, 79298009, 79584002, 81319007, 81319007, 82998009, 83176005, 83225003, 84760002, 85080004, 85248005, 86058007, 87203005, 87512008, 87950005, 111485001, 191610000, 191611001, 191613003, 191616006, 191618007, 191620005, 191621009, 191623007, 191625000, 191627008, 191629006, 191630001, 191632009, 191634005, 191636007, 191638008, 191639000, 191641004, 191643001, 191659001, 192080009, 192362008, 231444002, 231504006, 231542000, 268621008, 319768000, 320751009, 370143000, 371596008, 371599001, 371600003, 371604007, 430852001, 442057004

ICD-9: 290.13, 290.21, 290.43, 296.21, 296.22, 296.23, 296.24, 296.25, 296.26, 296.31, 296.32, 296.33, 296.34, 296.36, 296.82, 298.0, 300.4, 301.12, 309.0, 309.1, 309.28, 311

44 Ref: 1157.01

ICD-10: F31.11, F31.12, F31.13, F31.2, F31.73, F31.74, F31.9, F01.51, F32.0, F32.1, F32.2, F32.3, F32.4, F32.5, F32.8, F32.9, F33.0, F33.1, F33.2, F33.3, F33.42, F33.9, F34.1, F43.21, F43.23

Then you must establish a follow up plan that includes one of the following:

Medication,

Additional screening, or

Referral to another qualifying medical services provider.

To use medication as the follow-up plan, you must prescribe a qualifying medication as the follow up plan. Write the prescription through the SIG Writer window, and then either print it or submit it electronically.

To chart the additional screening, you must enter a procedure code that is associated with a qualifying SNOMED code. You may enter the procedure in either the SP or the SO tab of Full Note Composer or other clinical note type window.

SNOMED for Suicide Risk Assessment: 225337009

SNOMED codes for the follow up plan: 5694008, 5694008, 88848003, 88848003, 91310009,

91310009, 372067001, 372067001, 385721005, 385721005, 385724002, 385724002, 385725001, 385725001, 385726000, 385726000, 385727009, 385727009, 385887004, 385887004, 385889001, 385889001, 385890005, 385890005, 401277000, 401277000, 410223002, 410223002, 410224008, 410224008, 410225009, 410225009, 410226005, 410226005, 410227001, 410227001, 410228006, 410228006, 410229003, 410229003, 410230008, 410230008, 410231007, 410231007, 410232000, 410232000, 410233005, 410233005, 410234004, 410234004, 425604002, 425604002, 439141002, 439141002

To use a referral as the follow-up plan, you must order the referral by entering a procedure code that is associated with a qualifying SNOMED code.

SNOMED codes for depression referral: 183524004, 183583007, 183851006, 183866009,

305922005, 306136006, 306137002, 306226009, 306227000, 306252003, 306291008, 306294000, 308459004, 308477009, 309627007, 390866009, 401174001, 429387009, 61801003, 14129001, 183524004, 183528001, 183583007, 183866009, 305922005, 306136006, 306137002, 306138007, 306204008, 306226009, 306227000, 306252003, 306294000, 308459004, 308477009, 390866009, 401174001, 408293001, 429387009, 61801003

Use the CQM report for measure CMS 002 to document the percentage of patients who were screened for depression.

Ref: 1157.01 45

Factor 2: A chronic medical condition.


Functionality:

Please note that to receive autocredit, you must use diabetes as the chronic medical condition and you must perform or order the eye and foot exams described here.

Diabetes Foot Exam


Enter the diabetes diagnosis with a qualifying diagnosis code or diagnosis code associated with a SNOMED code in the Dx tab of Full Note Composer or other clinical note type window or enter a problem associated with a qualifying SNOMED code in the problem history category in the Hx tab of Full Note Composer or the Patient History window. This diagnosis or problem must be active.

ICD-9: 250.00, 250.01, 250.02, 250.03, 250.10, 250.11, 250.12, 250.13, 250.20, 250.21,

250.22, 250.23, 250.30, 250.31, 250.32, 250.33, 250.41, 250.42, 250.43, 250.50, 250.51, 250.52, 250.53, 250.60, 250.61, 250.62, 250.63, 250.70, 250.71, 250.72, 250.73, 250.80, 250.81, 250.82, 250.83, 250.90, 250.91, 250.92, 250.93, 648.01, 648.02, 648.03, 648.04

ICD-10: E10.10, E10.11, E10.21, E10.22, E10.29, E10.311, E10.319, E10.321, E10.329, E10.331, E10.339, E10.341, E10.349, E10.351, E10.359, E10.36, E10.39, E10.40, E10.41, E10.42, E10.43, E10.44, E10.49, E10.51, E10.52, E10.59, E10.610, E10.618, E10.620, E10.621, E10.622, E10.628, E10.630, E10.638, E10.641, E10.649, E10.65, E10.69, E10.8, E10.9, E11.00, E11.01, E11.21, E11.22, E11.29, E11.311, E11.319, E11.321, E11.329, E11.331, E11.339, E11.341, E11.349, E11.351, E11.359, E11.36, E11.39, E11.40, E11.41, E11.42, E11.43, E11.44, E11.49, E11.51, E11.52, E11.59, E11.610, E11.618, E11.620, E11.621, E11.622, E11.628, E11.630, E11.638, E11.641, E11.649, E11.65, E11.69, E11.8, E11.9, O24.011, O24.012, O24.013, O24.019, O24.02, O24.03, O24.111, O24.112, O24.113, O24.119, O24.12, O24.13

SNOMED: 4783006, 9859006, 23045005, 28032008, 44054006, 46635009, 75682002, 76751001,

81531005, 190330002, 190331003, 190368000, 190369008, 190372001, 190389009, 190390000, 199223000, 199225007, 199226008, 199227004, 199228009, 199229001, 199230006, 237599002, 237618001, 237626009, 237627000, 313435000, 313436004, 314771006, 314772004, 314893005, 314894004, 314902007, 314903002, 314904008, 359642000, 359939009

Patients who received a foot exam during the measurement period. The foot exam must include a visual inspection, a sensory exam, and a pulse exam.

To report on this measure, you must order or perform all three of the required exams. You may chart the exams using procedure codes that are associated with the SNOMED codes for the exams.

46 Ref: 1157.01

Pulse exam: 91161007

Sensory exam: 134388005

Visual exam: 401191002

The procedure codes 2028-F and G9226 are associated with the proper SNOMED codes, and configured to report as a complete foot exam (visual, sensory, and pulse).

Use the CQM report for measure CMS 123 to document the percentage of patients for whom you performed or ordered a foot exam.

Diabetes Eye Exam


Enter the diagnosis with a qualifying diagnosis code or diagnosis code associated with a SNOMED code in the Dx tab of Full Note Composer or other clinical note type window or enter a problem associated with a qualifying SNOMED code in the problem history category in the Hx tab of Full Note Composer or the Patient History window.

ICD-9: 250.00, 250.01, 250.02, 250.03, 250.10, 250.11, 250.12, 250.13, 250.20, 250.21,

250.22, 250.23, 250.30, 250.31, 250.32, 250.33, 250.41, 250.42, 250.43, 250.50, 250.51, 250.52, 250.53, 250.60, 250.61, 250.62, 250.63, 250.70, 250.71, 250.72, 250.73, 250.80, 250.81, 250.82, 250.83, 250.90, 250.91, 250.92, 250.93, 648.01, 648.02, 648.03, 648.04


SNOMED: 4783006, 9859006, 23045005, 28032008, 44054006, 46635009, 75682002, 76751001, 81531005, 190330002, 190331003, 190368000, 190369008, 190372001, 190389009, 190390000, 199223000, 199225007, 199226008, 199227004, 199228009, 199229001, 199230006, 237599002, 237618001, 237626009, 237627000, 313435000, 313436004, 314771006, 314772004, 314893005, 314894004, 314902007, 314903002, 314904008, 359642000, 359939009

Ref: 1157.01 47

Patients with an eye screening for diabetic retinal disease. This includes diabetics who had one of the following:

A retinal or dilated eye exam by an eye care professional in the measurement period or

A negative retinal exam (no evidence of retinopathy) by an eye care professional in the year prior to the measurement period.

Please note that the exam must be performed by an ophthalmologist or optometrist.

To perform or order the procedure, enter the appropriate procedure code on the SP or SO tab. If entered on the SO tab, you must also give the results a status of Resulted or Approved.

You may also create a procedure history category, and then include the procedure in that history category in the Hx tab of Full Note Composer or the Patient History window. A procedure performed in the year prior to the reporting period counts for this measure only if the results were negative.

Negative findings must be entered through a lab template using Patient Results. The observation item associated with the lab template must have the SNOMED code for the retinal or dilated eye exam, and the value of the result must be “Neg” or “Negative”. The application automatically populates the appropriate SNOMED code for a negative finding when the value of the result includes the text “Neg” or “Negative”.

You must enter the SNOMED in the Observation Item window.

SNOMED codes: 6615001, 252779009, 252780007, 252781006, 252782004, 252783009,

252784003, 252788000, 252789008, 252790004, 274795007, 274798009, 308110009, 314971001, 314972008, 410451008, 410452001, 410453006, 410455004, 420213007, 425816006, 427478009

Use the CQM report for measures CMS 131 to document the percentage of patients for whom you performed or ordered an eye exam.

Factor 3: An acute condition.


Functionality:

Please note that to receive autocredit, you must use pharyngitis as the acute medical condition.

Children 2-18 years of age who had an outpatient or emergency department (ED) visit with a diagnosis of pharyngitis during the measurement period and an antibiotic ordered on or three days after the visit.

48 Ref: 1157.01

You must diagnosis the patient with pharyngitis using one of the diagnosis codes below during a visit within the measurement period.

ICD-9: 034.0, 462, 463

ICD-10: J02.8, J02.9, J03.80, J03.81, J03.90, J03.91

SNOMED: 1532007, 17741008, 40766000, 43878008, 55355000, 58031004, 195655000,

195656004, 195657008, 195658003, 195659006, 195660001, 195662009, 195666007, 195667003, 195668008, 195669000, 195670004, 195671000, 195672007, 195673002, 195676005, 195677001, 232399005, 232400003, 302911003, 363746003

Then you must prescribe an antibiotic within 3 days following the visit.

To report the antibiotic, write a prescription for an antibiotic using the SIG writer window and print the prescription or send it electronically. The antibiotic must be dispensed within three days after the qualifying visit.

Children with a group A streptococcus test in the 7-day period from 3 days prior through 3 days after the diagnosis of pharyngitis.

To report on this measure, you must prescribe an antibiotic and order a group A streptococcus (strep) test and enter the test results.

To report the antibiotic, write a prescription for an antibiotic using the SIG writer window and print the prescription or send it electronically.

To report the strep test, order the test and then either enter the test results or receive them through an interface and give them a status of Resulted or Approved.

The strep test results not received through an interface must be entered as discrete, quantifiable data. Enter the results in the Patients Results window using a lab template enabling you to enter the strep value. Results stored in the database as text notes or image file cannot be used for reporting.

You must associate a LOINC code to the strep test item on each lab template for both manually entered and electronic results. LOINC codes for this result are listed below.

LOINC: 626-2, 5036-9, 6559-9, 6556-5, 6557-3, 6558-1, 11268-0, 17656-0, 18481-2, 31971-5,

49610-9, 60489-2, 68954-7

Use the CQM report for measure CMS 146 to document the number of patients who were appropriately tested for pharyngitis.

Ref: 1157.01 49

Factor 4: A condition related to unhealthy behaviors.


Functionality:

Please note that to receive autocredit, you must use the tobacco use as the unhealthy behavior.

The patient must be 18 years old or older.

This measure generally requires two office visits during the measurement period. Some types of office visits require only one during the measurement period.

To report on this measure, you must enter the patient’s use or non-use of tobacco in the Hx tab, Social History category, in the patient visit note. Then when the patient is a tobacco user, you must provide cessation counseling or prescribe an approved cessation medication.

To report the patient’s smoking history, enter the patient’s use or non-use of tobacco in the Hx tab, Social History category, in Full Note Composer or other clinical note type window. The tobacco history answer selected must be associated with a qualifying SNOMED code in order to qualify. The following system-defined tobacco history answers are associated with the correct SNOMED codes.

Current every day smoker (SNOMED code 449868002)

Current some day smoker (SNOMED code 428041000124106)

Former smoker (SNOMED code 8517006)

Never smoker (SNOMED code 266919005)

Smoker, current status unknown (SNOMED code 77176002)

Heavy tobacco smoker (SNOMED code 428071000124103)

Light tobacco smoker (SNOMED code 428061000124105)

Has never smoked or chewed tobacco (SNOMED code 266919005)

If you have entered the patient’s tobacco use in a prior measurement period and that use has not changed, then you must select the checkbox for the Social History category indicating that you have reviewed the patient’s history, including tobacco use.

When the patient is a tobacco user, then you must either:

Enter CPT code 99406 or 99407 or HCPCS code G0436 to document the cessation counseling, or

Prescribe an approved cessation medication.

50 Ref: 1157.01

If you typically use an education form with or for cessation counseling, then you can associate the appropriate procedure code with the education form so that selecting the education form from the Education Form slider in Full Note Composer or other clinical note type will add the procedure code to the SP tab. The education form must also be associated with the Smoking Cessation patient communication type.

Smoking and tobacco use counseling to the patient is reported using CPT code 99406 (smoking and tobacco cessation counseling visit; intermediate, greater than 3 minutes up to 10 minutes) or code 99407 (smoking and tobacco cessation counseling visit; intensive, greater than 10 minutes).

Remember that these CPT codes are E&M codes, so if you use them along with another E&M code, you must include in the visit note proper documentation supporting the use of the procedure code. Counseling lasting less than 3 minutes is considered part of an evaluation and management (E/M) service and is not paid separately. Proper documentation for codes 99406 and 99407 includes the total time spent and what was discussed, including cessation techniques, resources and follow-up.

The counseling services must be provided by a physician or other qualified health professional and must be provided face-to-face. Some Medicaid programs have not yet adopted payment for these codes.

If you are using the optionally licensed Persivia education forms, the Persivia Smoking Cessation form is recommended. This education form is associated with HCPCS code G0436. This procedure code is associated with the SNOMED code 225323000 which qualifies for this measure.

If you not using the Persivia education forms, then it is recommended that you associate the HCPCS code G0436 to the custom-defined education form that you use for this purpose.

Write the prescription through the SIG Writer window, and either print or electronically submit the prescription.

Use the CQM report for measure CMS 138 to document the percentage of patients who were screened for tobacco use.

Factor 5: Well child or adult care.


Functionality:

Please note that to receive autocredit, you must use the childhood immunization status as described here to document well child care.

The patient must turn 2 years old during the measurement period. The patient must have at least one visit during the measurement period.

Ref: 1157.01 51

To report on this measure, you must document the administration of the each of the required vaccines.

To document an immunization, enter the administration using the appropriate CPT code for that immunization and enter the vaccination details in the Vaccine Administration Record. This can be done in the patient visit note or in the Patient History, Immunization History category. The vaccine type for the vaccination must be associated with the appropriate CVX code.

All vaccinations must be given according to the recommended schedule for the vaccine.

Patient refusal is not considered valid reporting for this measure. These patients will be counted in the denominator.

Use the CQM report for measure CMS 117 to document the percentage of patients with current immunization status.

Factor 6: Overuse/appropriateness issues.


Functionality:

Please note that to receive autocredit, you must use imaging studies for low back pain as described here.

Also note that this is a ‘negative’ measure, so a clinical decision support (CDS) rule is not appropriate.

The patient must be between 18 and 50 years old.

The patient must be given a diagnosis of low back pain during an outpatient or emergency department visit. This visit must occur prior to the last 28 days of the measurement period (that is, within the first 337 days of the measurement period). You must diagnosis the patient with lower back pain using a qualifying ICD-9 or SNOMED code. Enter the diagnosis code in the Dx tab of Full Note Composer or other clinical note type window.

ICD-9: 721.3, 722.10, 722.32, 722.52, 722.93, 724.02, 724.03, 724.2, 724.3, 724.5, 724.6,

724.70, 738.5, 739.3, 739.4, 846.0, 846.1, 846.2, 846.3, 846.8, 846.9, 847.2

ICD-10: M43.27, M43.28, M46.46, M46.47, M47.26, M47.27, M47.28, M47.816, M47.817, M47.818, M47.896, M47.897, M47.898, M48.06, M48.07, M51.26, M51.27, M51.36, M51.37, M51.46, M51.47, M51.86, M51.87, M53.2X7, M53.2X8, M53.3, M53.86, M53.87, M53.88, M54.30, M54.31, M54.32, M54.40, M54.41, M54.42, M54.5, M54.89, M54.9, M99.03, M99.04, M99.23, M99.33, M99.43, M99.53, M99.63, M99.73, S33.6XXA, S33.8XXA, S33.9XXA,

SNOMED: 161894002, 202794004, 247368002, 267067009, 267982002, 278860009, 278862001, 279039007, 279040009, 279041008, 279042001, 300957005

52 Ref: 1157.01

Patients are excluded from the denominator of this measure if they have:

A diagnosis of cancer any time in their history, or

A diagnosis of trauma, IV drug abuse, or neurologic impairment during the 12-month period prior to the visit in which lower back pain is diagnosed, or

A diagnosis of low back pain within the 180 days prior to the visit in which lower back pain is diagnosed.

To report on this measure, the patient would not have a CT scan, MRI, or x-ray of the lower spine performed within 28 days of diagnosis of low back pain.

To ensure accurate reporting, you must associate the procedure codes for all CT scans, MRIs, x-rays, and other imaging studies of the lower spine with one of the following LOINC codes.

LOINC Codes: 24665-2, 24929-2, 24930-0, 24963-1, 24964-9, 24965-6, 24967-2, 24968-0,

24969-8, 24970-6, 24971-4, 24972-2, 24975-5, 24977-1, 24984-7, 30620-9, 30678-7, 30679- 5, 30713-2, 30714-0, 30715-7, 30716-5, 30717-3, 30773-6, 30774-4, 30775-1, 30776-9, 30777-7, 30778-5, 30797-5, 30854-4, 30855-1, 30883-3, 30884-1, 36058-6, 36059-4, 36060- 2, 36069-3, 36100-6, 36110-5, 36111-3, 36245-9, 36246-7, 36247-5, 36332-5, 36390-3, 36391-1, 36392-9, 36402-6, 36520-5, 36521-3, 36522-1, 36647-6, 36670-8, 36674-0, 36681- 5, 36688-0, 36735-9, 36946-2, 36949-6, 36990-0, 36992-6, 37003-1, 37009-8, 37011-4, 37073-4, 37078-3, 37101-3, 37105-4, 37132-8, 37172-4, 37208-6, 37232-6, 37256-5, 37257- 3, 37259-9, 37260-7, 37261-5, 37288-8, 37300-1, 37340-7, 37341-5, 37342-3, 37351-4, 37353-0, 37355-5, 37356-3, 37357-1, 37509-7, 37515-4, 37516-2, 37651-7, 37652-5, 37653- 3, 37658-2, 37659-0, 37660-8, 37974-3, 37975-0, 38008-9, 38060-0, 38061-8, 38121-0, 38123-6, 38124-4, 39049-2, 39061-7, 39063-3, 39067-4, 39333-0, 39340-5, 39367-8, 42163- 6, 42378-0, 42379-8, 42401-0, 42403-6, 42406-9, 42407-7, 42408-5, 42410-1, 42411-9, 42413-5, 42424-2, 42425-9, 42426-7, 42427-5, 42428-3, 42429-1, 42472-1, 42690-8, 42692- 4, 42698-1, 43569-3, 43784-8, 43791-3, 44114-7, 44178-2, 44179-0, 44194-9, 44196-4, 44203-8, 44206-1, 46340-6, 47382-7, 47984-0, 48436-0, 48452-7, 48469-1, 48473-3, 69116- 2, 69264-0, 69273-1, 70928-7

Use the CQM report for measure CMS 166 to document the percentage of patients who did not receive an imaging study for low back pain.

Charting for Standard 4: Plan and Manage Care Element A: Identify Patients for Care Management

The practice establishes a systematic process and criteria for identifying patients who may benefit from care management. The process includes consideration of the following items.

Ref: 1157.01 53

Factor 1: Behavioral health conditions.


Functionality:

You must create one or more custom form layouts for assessments for behavioral health conditions.

Enter the behavioral health assessment in Full Note Composer or another clinical note type window using the Assessment tab and your assessment form layouts.

Then enter the appropriate diagnosis in the Dx tab of Full Note Composer or another clinical note type window

Factor 2: High cost/high utilization.


Functionality:

Use the Patients and Lab Results report to identify patients by diagnosis/medication that require procedures or medications that reflect increased healthcare costs.

Factor 3: Poorly controlled or complex conditions.


Functionality:

Use the Patients and Diagnosis report to identify patients by diagnosis that have lab results that remain outside of the normal range.

Factor 4: Social determinants of health.


Functionality:

Enter the patient’s social determinants of health in the Hx tab, DSM IV Axis IV history category, in Full Note Composer or other clinical note type window. This entry must be active during the reporting period.

Factor 5: Referrals by outside organizations (e.g., insurers, health system, ACO), practice staff or patient/family/caregiver.


54 Ref: 1157.01

Functionality:

Use Patient/Provider Tracking to identify the referring provider or medical services provider for a patient. You must use identify the provider role as Referring Provider.

You must enter referring providers’ names and contact information in the Provider window. Use the Medical Services Provider window to enter name and contact information for entities such as imaging centers, surgical centers, etc.

Use the Referral Source field in the Patient window’s Additional tab to identify non-provider entities, such as insurance payer, accountable care organization (ACO), family, friends, or the like.

Factor 6: The practice monitors the percentage of the total patient population identified through its process and criteria. (Critical Factor)


Functionality:

Use the Patient Visit Excel report to view patients within the specified population. This report enables you to view all patients within a specified time frame.

Element B: Care Planning and Self-Care Support (Must-pass element)

The care team and patient/family/caregiver collaborate (at relevant visits) to develop and update an individual care plan that includes the following features for at least 75 percent of the patients identified in Element A.

Factors 1-5:

1. Incorporates patient preferences and functional/lifestyle goals.

2. Identifies treatment goals.

3. Assesses and addresses potential barriers to meeting goals.

4. Includes a self-management plan.

5. Is provided in writing to the patient/family/caregiver.


Functionality:

You can use the Care Planning tab in a clinical note type window to enter:

Patient preferences and functional/lifestyle goals

Treatment goals

Potential barriers to meeting goals

Ref: 1157.01 55

Strategies for addressing potential barriers to meeting goals

Self-care plan

To use the Care Planning tab, you must create or modify a clinical note type window to include the tab. Then make that clinical note type window available to providers through their user settings definition.

Use the PCMH Excel Visits with Care Planning report to calculate the percentage of patients for whom you have documented this information.

Element C: Medication Management

The practice has a process for managing medications, and systematically implements the process in the following ways.

Factors 1-2:

1. Reviews and reconciles medications for more than 50 percent of patients received from care transitions. (Critical Factor)

2. Reviews and reconciles medications with patients/families for more than 80 percent of care transitions.


Functionality:

To be included for this factor, the patient must have transitioned to you. This could include, but is not limited to:

A first encounter with a new patient.

A patient referred to you by another provider.

A patient for whom you receive a C-CDA file for the patient.

To identify a patient as transitioning, you must select the “Patient has been seen by another provider” checkbox in the Medication History category of the Hx tab of Full Note Composer or other clinical note type window.

To report on these factors for the transitioning patients, you must perform the medication reconciliation. There are several ways that you can do this.

You can reconcile that patient’s medication history in the application with a document listing the patient’s medication. You must then scan the document, and attach it to the visit note.

56 Ref: 1157.01

You can download the patient’s electronic medication history, import the electronic medication history, and reconcile that medication history with the medication history in your patient record. To download the medication history, providers must be enrolled with the Surescripts pharmacy clearinghouse.

Downloading the electronic medication history may be done automatically for appointments scheduled in advance, or may be done on demand from the Appointment window, Patient Demographics window, or Full Note Composer or other clinical note type window. Importing and reconciling the electronic medication history and the medication history in the patient record is done from the Import Medication History window.

You can receive a C-CDA for the patient, and import the patient’s medication history from it, and reconcile that medication history with the medication history in your patient record.

Then in the Hx tab of Full Note Composer or other clinical note type window, select the checkbox for Transition of Care. This checkbox will be automatically selected if you made any changes while reconciling the electronic medication history within Full Note Composer or other clinical note type. If you do medication reconciliation from the Patient History window, then you must select this checkbox within Full Note Composer.

Please note that you must select the checkbox for Transition of Care in the Hx tab of Full Note Composer or other clinical note type window before you complete the visit note. Once you have marked the visit note as completed, you cannot select this checkbox.

To meet the measure’s goal, you must reconcile the medication history for more than 50 percent of the qualifying patients who transition into your care during the reporting period.

Use the Meaningful Use Stage 2 report for Core Measure 14 to document the percentage of transitioning patients for whom you reviewed and reconciled medications.

Factor 3: Provides information about new prescriptions to more than 80 percent of patients/families/caregivers.


Functionality:

When writing a prescription in the SIG Writer window, you must include the drug monograph as an education form. When you check the Include Monograph checkbox, information about the drug is listed in the Education Forms section of the Plan tab.

Ref: 1157.01 57

Factor 4: Assesses understanding of medications for more than 50 percent of patients/families/caregivers, and dates the assessment.


Functionality:

You must create one or more custom form layouts for these assessments. Then, enter the assessment information in Full Note Composer or another clinical note type window using the Assessment tab and your custom form layouts for the assessments.

Factor 5: Assesses response to medications and barriers to adherence for more than 50 percent of patients, and dates the assessment.


Functionality:

You must create one or more custom form layouts for these assessments. Then, enter the assessment information in Full Note Composer or another clinical note type window using the Assessment tab and your custom form layouts for the assessments.

Use the PCMH Medication Monitoring report to review discontinue reasons.

Factor 6: Documents over-the-counter medications, herbal therapies and supplements for more than 50 percent of patients, and dates updates.


Functionality:

Enter over-the-counter medications, herbal therapies, and supplements in the medication history category in either the Patient History window or the Hx tab of Full Note Composer or other clinical note type window.

The application’s preconfigured drug database is supplied by First DataBank contains many counter medications, herbal therapies, and supplements. You may also create custom medications for any item not included in the drug database. Please be aware that custom medications do not trigger drug screening.

58 Ref: 1157.01

Element D: Use Electronic Prescribing

The practice uses an electronic prescription system with the following capabilities.

Factor 1: More than 50 percent of eligible prescriptions written by the practice are compared to drug formularies and electronically sent to pharmacies.


Functionality:

An E&M visit during the reporting period is not necessary for a patient to be included for this objective. Prescriptions must be written during the reporting period. This is determined by the prescription date, not the visit date.

To report on this objective, you must obtain drug formulary information for 50 percent of permissible prescriptions within 30 days prior to writing the prescription. You must also then submit the prescription electronically.

Drug formulary information is obtained from the Surescripts pharmacy clearinghouse. The request may be done automatically by a job within the application. The job requests and obtains drug formulary information for patients with scheduled appointments for the following day. Requests are also automatically made when an electronic refill request is received and when a user creates a refill request message.

The request may also be made on demand by any user from the Appointment window or from Patient Demographics when a patient did not have an appointment scheduled in advance, such as a walk-in visit or a same day appointment.

The prescription counts for the prescribing provider on the prescription, even if another provider or user enters and submits the prescription.

Write the prescription through the SIG Writer window or refill a prescription from the prescription refill message, and then submit it electronically through the Surescripts pharmacy clearinghouse. Prescriptions sent through Surescripts to fax-only pharmacies meet the requirements for this measure. Prescriptions which are faxed to a pharmacy using a fax service do not meet the requirements for this measure.

This measure applies only to prescriptions for medications that may be electronically prescribed. Prescriptions that are not applicable for this measure include:

Controlled substances

Complex (stepped) prescriptions

User-defined medications

Non-dispensable medications, such as bulk aspirin

Administered medications

Samples given

Ref: 1157.01 59

The prescription status must be either Transmitted Successfully or Queued for Transmission.

You may use the Track Prescriptions window (Tools menu → Track Rx) to review and troubleshoot your prescriptions. You can use this window to search for electronically prescribed medications. You may need to change the Maximum Items Returned in the filtering criteria to get an accurate count for a patient or time period.

Use the Meaningful Use Stage 2 2015 Report for Objective 4 to document the percentage of eligible prescriptions written by the practice that were compared to drug formularies and electronically sent to pharmacies.

Factor 2: Enters electronic medication orders in the medical record for more than 60 percent of medications.


Functionality:

An E&M visit during the reporting period is not necessary for a patient to be included for any of the measures in this objective.

The prescription must be written or the order placed within the reporting period. This is determined by the date on the prescription or the order, not the date of the associated visit.

The user writing the prescription or placing the laboratory or radiology order must be identified in the database as a licensed healthcare professional. Aprima PRM determines this by whether the user is marked as a licensed healthcare professional in the database (List Editor → System → User → Settings tab). If the user is not a provider, then the user must also have clinical delegate security for the provider (List Editor → System → Provider → Clinical Delegate Security tab).

You must write a prescription through the SIG Writer window or refill message, and either print it or submit it electronically through the Surescripts pharmacy clearinghouse.

To meet the measure’s medication goal, as the provider or licensed healthcare professional, you must enter the prescription in the SIG Writer window or refill message for more than 60 percent of your qualifying prescriptions during the reporting period. The prescription counts for the prescribing provider identified on the prescription.

You may use the Track Prescriptions window (Tools menu → Track Rx) to review and troubleshoot your prescriptions.

Use the Meaningful Use Stage 2 2015 Report for Objective 3, Measure 1 to document the electronic medication orders in the medical record.

60 Ref: 1157.01

Factor 3: Performs patient-specific checks for drug-drug and drug-allergy interactions.


Functionality:

You must configure drug-drug and drug-allergy screening for the practice and for providers. It is recommended that you print a screen capture of the Configure Practice Settings window’s and Provider window’s Drug Screening tab, and keep these screen shots with your Meaningful Use documentation. To meet the goal, you must attest Yes that drug interaction checks are performed by the application and that you review the interaction information provided by the check.

Factor 4: Alerts prescribers to generic alternatives.


Functionality:

When prescribing a medication, you may use the Find Dispensable Drug window to search for the desired medication. Select the Include Brand Name and the Include Generic Name checkboxes to include all alternatives in the search. When there are alternatives for a medication, the AKA column will include a hyperlink to those alternatives.

Once you have a selected a medication and accessed the SIG Writer window, you can review the patient’s formulary information to identify generic alternatives.

Element E: Support Self-Care and Shared Decision-Making

The practice has, and demonstrates use of, materials to support patients and families/caregivers in self-management and shared decision making. The practice performs the following activities.

Factor 1: Uses an EHR to identify patient-specific education resources and provide them to more than 10 percent of patients.


Functionality:

To report on this measure, you must attach an appropriate educational form to the visit note and then either print it for the patient or make it available to the patient from the Patient Portal. Selecting and attaching the education forms is done from the Education Form slider in Full Note Composer or other clinical note type window or during the checkout process. You may print the forms from the slider or the front desk staff may print them from the Checkout window when discharging the patient.

Ref: 1157.01 61

If you are using the Aprima Patient Portal and you have configured it to allow patients to view education materials, then any education form associated to a visit note is available to a patient with a Portal account. These education forms count toward this measure without being printed.

To meet the measure’s goal, you must provide educational forms to more than 10 percent of your qualifying patients seen during the reporting period.

You may attach the educational form to the visit note and give it to the patient before, during, or after the Meaningful Use reporting period. However, the date on which you attach it cannot be earlier than the first date of the calendar year of the reporting period, and it cannot be later than the date of your attestation.

Please note:

The Patient Medication Summary report is not an education form, and so does not count as an education form, even though it appears in the Education Forms slider.

When using the Patient Portal, the patient account should be created prior to or on the date of the patient visit and must be active.

Use the Meaningful Use Stage 2 2015 Report for Objective 6 to document the percentage of patients who received an education form.

Factor 2: Provides educational materials and resources to patients.


Functionality:

Attach an appropriate educational form to a patient visit note, and then either print it for the patient or make it available to the patient from the Patient Portal. Selecting and attaching the education forms is done from the Education Form slider in Full Note Composer or other clinical note type window or during the checkout process. You may print the forms from the slider or the front desk staff may print them from the Checkout window when discharging the patient.

If you are using the Aprima Patient Portal and you have configured it to allow patients to view education materials, then any education form associated to a visit note is available to a patient with a Portal account.

62 Ref: 1157.01

Factor 3: Provides self-management tools to record self-care results.


Functionality:

Define custom education forms or document formatting models for self-management tools, such as a blood pressure log or finger stick glucose monitoring log.

Then, in a patient visit note, you must assign the appropriate education form or generate the appropriate document for the self-management tool.

Factor 4: Adopts shared decision making aids.


Functionality:

You may access a shared decision making website (such as the Mayo Clinic’s http://shareddecisions.mayoclinic.org/) from your Desktop by configuring a web part.

Use the following process to a web part for accessing your shared decision making website.

1. Tools → Configure My Desktop

2. In the Primary Control field for the desired pane, select Web Part.

3. Select the OK button to close the window and return to the Desktop.

4. On the Desktop, select the Edit Web Part button.

5. In the entry field, enter the following HTML code, including the URL for your shared decision making website in the appropriate location.

<a href="http://shareddecisions.mayoclinic.org/"> Shared Decision Making

6. Select the Save Web Parts button. The application or gadget will appear in the Web Part pane of your Desktop.

Factor 5: Offers or refers patients to structured health education programs, such as group classes and peer support.


Functionality:

There are several ways to document a referral to another provider or medical service provider:

You can create a referral entry using the Create Referral dynamic procedure note from Full Note Composer or other clinical note type window. This is the recommended method.

You can create a referral entry from the Patient/Provider Tracking window.

http://shareddecisions.mayoclinic.org/

http://shareddecisions.mayoclinic.org/

Ref: 1157.01 63

You can create a referral entry from the Referral Tracking window.

When creating the patient/provider tracking entry for a referral, you must identify the referred to provider’s role as Specialist, Other, or a custom-defined provider role.


For group appointments, you must completely configure one or more calendars, including defining appointment types for group visits and using them on calendar templates that you then associate with calendars.

Factor 6: Maintains a current resource list on five topics or key community service areas of importance to the patient population including services offered outside the practice and its affiliates.


Functionality:

Use the Medical Services Provider window to enter name and contact information for community service providers and other resources. You may create medical services types to categories providers and resources for specific topics or service areas.

You can then refer patients to these community services areas by:

Creating a referral entry using the Create Referral dynamic procedure note from Full Note Composer or other clinical note type window. This is the recommended method.

Creating a referral entry from the Patient/Provider Tracking window.

Creating a referral entry from the Referral Tracking window.

Factor 7: Assesses usefulness of identified community resources.


Functionality:


64 Ref: 1157.01

Charting for Standard 5: Track and Coordinate Care Element A: Test Tracking and Follow-Up

The practice has a documented process for and demonstrates that it performs the following activities.

Factors 1-2:

1. Tracks lab tests until results are available, flagging and following up on overdue results. (Critical Factor)

2. Tracks imaging tests until results are available, flagging and following up on overdue results. (Critical Factor)


Functionality:

Track lab and clinical orders and their results in the Result Status/Result window. This window displays information for both manually entered results and results received via electronic interface. You can search for and review lab results for more than one patient at a time. You can define a filter or filters for selecting the lab orders and results that you commonly review.

It is recommended that you review all orders with a status of Ordered at least once a week. Then you can follow up on any orders for which you have not received results.

Factors 3-4:

3. Flags abnormal lab results, bringing them to the attention of the clinician.

4. Flags abnormal imaging results, bringing them to the attention of the clinician.


Functionality:

Lab result messages and the Result Status/Result window identify abnormal results. Critical, abnormal, and alert results for the lab order appear red.

Ref: 1157.01 65

Factor 5: Notifies patients/families of normal and abnormal lab and imaging test results.


Functionality:

You must configure the Aprima Patient Portal to enable viewing of lab results.


Factor 6: Follows up with the inpatient facility about newborn hearing and newborn blood-spot screening (NA for adults).


Functionality:

Use the system-defined Newborn Screening Follow-Up clinical decision support (CDS) rule to identify newborns needing these tests. Use the Clinical Decision Support slider in Full Note Composer or other clinical note type window to view and action the rule.

Factor 7: More than 30 percent of laboratory orders are electronically recorded in the patient record.


Functionality:

An E&M visit during the reporting period is not necessary for a patient to be included in this factor.

You must chart a procedure with the procedure code type of Lab. The procedure code must also be defined to generate an order. You may chart the procedure in either the SP or SO tab of Full Note Composer or other clinical note type window. To meet the goal, you must enter orders for more than 30 percent of your lab test orders. The order counts for the ordering provider identified in the order.

Laboratory procedures with a CPT code in the 80000 range have the procedure code type Lab and are defined to generate an order. If you create custom procedure codes for lab test orders, you must give them the correct procedure code type and define them to generate an order.

The procedure code must be defined to generate an order at the time that you chart the procedure. If the procedure code is not set to generate an order, then the application will not generate an order when you chart the procedure. Orders cannot be generated retroactively.

66 Ref: 1157.01

When considering your numbers, please be aware that:

Orders that are deleted do not count for this measure.

Procedures with a negation reason entered are not counted since they are not ordered.

Future orders are counted if the future date on the order is included in your reporting period.

Use the Meaningful Use Stage 2 2015 Report for Objective 3, Measure 2 to document the percentage of laboratory orders that are electronically recorded in the patient record.

Factor 8: More than 30 percent of radiology orders are electronically recorded in the patient record.


Functionality:

An E&M visit during the reporting period is not necessary for a patient to be included in this factor.

You must chart a procedure with the procedure code type of Radiology. The procedure code must also be defined to generate an order. You may chart the procedure in either the SP or SO tab of Full Note Composer or other clinical note type window. To meet the goal, you must enter orders for more than 30 percent of your radiology orders. The order counts for the ordering provider identified in the order.

Radiology procedures with a CPT code in the 70000 range have the procedure code type Radiology and are defined to generate an order. If you create custom procedure codes for radiology orders, you must give them the correct procedure code type and define them to generate an order.



Orders that are deleted do not count for this measure.

Procedures with a negation reason entered are not counted since they are not ordered.


Use the Meaningful Use Stage 2 2015 Report for Objective 3, Measure 3 to document the percentage of radiology orders that are electronically recorded in the patient record.

Ref: 1157.01 67

Factor 9: Electronically incorporates more than 55 percent of all clinical lab test results into structured fields in medical record.


Functionality:

An E&M visit during the reporting period is not necessary for a patient to be included for this measure. The order must be placed within the reporting period. This is determined by the date on the order, not the date of the associated visit.

You must order the desired lab test using the appropriate procedure code, and then either enter the test results or receive them through an interface as structured data.

You must chart a procedure with the procedure code type of Lab or the results that are associated to the procedure must have an attachment type of Lab Results. The procedure code must also be defined to generate an order.

Laboratory procedures with a CPT code in the 80000 range have the procedure code type Lab, and are defined to generate an order. If you create custom procedure codes for lab orders, you must give them the correct procedure code type and define them to generate an order.


You may chart the procedure in either the SP or SO tab of Full Note Composer, Order Note, or other clinical note type window. The order counts for the ordering provider identified in the order.

All results, whether entered or received, must have a status of Resulted or Approved, and must have the attachment type of Lab Results.

The test results, whether entered by a user or received through an interface, must be entered in a lab template as discrete, quantifiable data. Enter the results in the Patients Results window using a lab template enabling you to enter the result values in a positive/negative or numerical format.

Results must be:

Numeric, or

Numbers (e.g., 1, 0.1, -1, >1, <1, 1+, 1/2, etc.)

Reference range of numeric results (e.g., 2-6)

Numeric ratio (e.g., 1:2)

The symbols “+” or “-“, or

Text beginning with “Pos” or “Neg”

68 Ref: 1157.01

To meet the goal, you must receive through an interface or properly enter lab test results for more than 55 percent of the clinical lab test ordered for qualifying patients seen during the reporting period.

Please note:

Simply attaching the scanned lab report does not meet this requirement. The results must be entered in a lab template.

Only lab orders that are resulted with a positive/negative or a numeric value are counted for this measure.

Orders that have been cancelled or deleted are not counted for this measure.

Results may be received or entered after the reporting period, but must be available when the reporting data is generated for submission.

Use the Meaningful Use Stage 2 report for Core Measure 10 to document the percentage of all clinical lab test results entered into structured fields in patient medical records.

Factor 10: More than 10 percent of scans and tests that result in an image are accessible electronically.


Functionality:

An E&M visit during the reporting period is not necessary for a patient to be included for this measure. The order must be placed within the reporting period. This is determined by the date on the order, not the date of the visit in which the order is placed.

You must order imaging procedures through the application using either the SP or SO tab in Full Note Composer, Order Note, or another clinical note type. The procedure code used to place the order must have the procedure code type of Radiology.


You can report on this measure in several ways.

You can store the images in the database.

You can have access to an external PACS (picture archiving and communication system) that enables you to access the images. Many imaging centers and hospitals provide ordering providers with online access to their PACS. For the PACS to qualify for this measure, you must be able to configure access to it from Aprima PRM in such a way that you are able to directly access a particular patient’s images from the patient’s chart. Please see the Configure the Patient URL Launcher for PACS System Access section of this document for instructions. Please contact Support if you need assistance.

You can have an interface to an external PACS. The interface receives information about the image, and associates it with the image order as a result that is accessible through the

Ref: 1157.01 69

Patient Results window. The Patient Results window then enables you to directly access the image for the order in the external PACS. An interface requires custom development and implementation. Please contact Support if you want an interface.

You can have an interface to a DICOM (digital imaging and communications in medicine) image system. Some medical service providers send messages that include a link that enables you to access an image stored in their own repository. Others send messages that include the DICOM image file. You can then directly access the image in the DICOM system through an icon on the Patient toolbar in the Patient Demographics, Full Note Composer or other clinical note type window, or Review Past Notes window. An interface requires custom development and implementation. Please contact Support if you want an interface.

To store the images in the database, you must attach the result image to the order using the SP/SO association in the Document Linking window or through the order Results window. The image file must be one of the following file types: .bmp, .dcm, .dic, .dicom, .gif, .jpg, .jpeg, .tiff, .tif, .pdf, .htm, and .html.

If you have an interface with a DICOM (digital imaging and communications in medicine) image system or you access an external PACS (picture archiving and communication system) via a context-sensitive URL, then you must identify this on the procedure code for imaging procedures. This is defined using the Image Results Directly Accessible checkbox on the Procedure Code window. This is necessary because the application cannot count the images, and you must attest to having access.

If you have an interface to an external PACS (picture archiving and communication system) that generates a results message with a hyperlink button that accesses the image, then you do not need to identify this on the procedure code. This is because the application actually receives a hyperlink to the image as a result, which can be counted.

The DICOM interface or patient URL launcher functionality must also be configured in your user settings definition so that you can access the PACS or DICOM system from any window

that includes the Patient toolbar. To access the DICOM or PACS, select the icon from the toolbar.

To meet this measure’s goal, you must store in the database or have direct access to more than 10 percent of your image order results.


Orders that are cancelled or deleted do not count for this measure.


Results may be received or entered after the reporting period, but must be available when the reporting data is generated for submission.

Use the Meaningful Use Stage 2 report for Menu Set Measure 3 to document the percentage of scans and tests that resulted in an image that are accessible electronically.

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Element B: Referral Tracking and Follow-Up (Must-pass element)

The practice performs the following activities.

Factors 1-4:

1. Considers available performance information on consultants/specialists when making referral recommendations.

2. Maintains formal and informal agreements with a subset of specialists based on established criteria.

3. Maintains agreements with behavioral healthcare providers.

4. Integrates behavioral healthcare providers within the practice site.


Functionality:


Factors 5-6:

5. Gives the consultant or specialist the clinical question, the required timing and the type of referral.

6. Gives the consultant or specialist pertinent demographic and clinical data, including test results and the current care plan.


Functionality:

Configure formatting models and CCD document definitions to use when referring patients to consultants or specialists.

Factor 7: Has the capacity for electronic exchange of key clinical information+ and provides an electronic summary of care record to another provider for more than 50 percent of referrals.


Functionality:

Use Direct messaging to send and receive information for referrals.

You must enter providers’ names and Direct message addresses in the Provider window. Use the Medical Services Provider window to enter name and Direct message addresses for entities such as imaging centers, surgical centers, etc.

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Factors 8-10:

8. Tracks referrals until the consultant or specialist’s report is available, flagging and following up on overdue reports. (Critical Factor)

9. Documents co-management arrangements in the patient’s medical record.

10. Asks patients/families about self-referrals and requesting reports from clinicians.


Functionality:

Use Patient/Provider Tracking and Referrals to identify other health care professionals involved in a patient’s past or current care.


Element C: Coordinate Care Transitions

The practice performs the following activities.

Factor 1: Proactively identifies patients with unplanned hospital admissions and emergency department visits.


Functionality:

Autocredit is available for this factor only if you have a custom interface with the hospital and/or emergency facility through which you receive CCDA files for patients.

Please contact your sales representative or email [email protected]. If you would like to have a custom interface developed for the hospital and/or emergency facility.

Factor 2: Shares clinical information with admitting hospitals and emergency departments.


Functionality:

Autocredit is available for this factor if you are using Direct messaging or if you have a custom interface with the hospital and/or emergency facility through which you send and receive CCDA files for patients.

mailto:[email protected]

72 Ref: 1157.01

To use Direct messaging, you must use the Medical Services Provider window to enter name and Direct message addresses for hospitals and emergency care facilities.


Factor 3: Consistently obtains patient discharge summaries from the hospital and other facilities.


Functionality:

Autocredit is available for this factor only if you have a custom interface with the hospital and/or emergency facility through which you receive CCDA files for patients.


Factor 4: Proactively contacts patients/families for appropriate follow-up care within an appropriate period following a hospital admission or emergency department visit.


Functionality:

You must create your own documentation to support this factor.

Factor 5: Exchanges patient information with the hospital during a patient’s hospitalization.


Functionality:


Factor 6: Obtains proper consent for release of information and has a process for secure exchange of information and for coordination of care with community partners.


Functionality:




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Factor 7: Exchanges key clinical information with facilities and provides an electronic summary-of-care record to another care facility for more than 50 percent of patient transitions of care.


Functionality:

To report on this objective, you must satisfy both measure 1 and 2.

An E&M visit during the reporting period is not necessary for a patient to be included for this objective.

For a patient to be included in the denominator, you must identify the patient as a transition- of-care patient by creating an active referral entry referring the patient to another provider during the reporting period.

There are several ways to create a referral entry.

You can create a referral entry using the Create Referral dynamic procedure note from Full Note Composer or other clinical note type window. This is the recommended method.

You can create a referral entry from the Patient/Provider Tracking window.

You can create a referral entry from the Referral Tracking window.

There are several things to keep in mind when creating the patient/provider tracking entry and the referral entry associated to it.

The patient/provider tracking entry must identify the referred to provider’s role as Specialist, Other, or a custom-defined provider role. (It cannot be Primary Care or Referring Provider.)

The referral entry must be created during the reporting period.

The referral entry must include the requesting provider (that is, the provider originating the referral).

Referral entries with a status of Historical Reference or of Relationship are not included.

To satisfy the first measure of this objective, you must generate a clinical summary document for a visit, a continuity of care document (CCD), or a consolidated clinical data architecture document (C-CDA) for the patient, and associate it with the referral.

The clinical summary, CCD, or C-CDA document that you generate must contain the patient’s diagnostic test results, problem list (diagnoses), medication list, and medication allergy list, and may include other information as appropriate. The formatting model for a clinical summary document must be defined as a clinical summary. CCD and C-CDA documents are, by definition, clinical summaries.

To satisfy the second measure of this objective, you must electronically transmit that summary of care document or file to the referred to physician or medical services provider 10 percent of your referrals.

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Electronically transmitting the summary of care document is most easily and most securely done using Direct messaging, but the use of Direct messaging is not required.

You may transmit the summary of care document or file before, during, or after the Meaningful Use reporting period. However, the date of the transmission cannot be earlier than the first date of the calendar year of the reporting period, and it cannot be later than the date of your attestation.

The easiest way to satisfy both measures of this objective is to use the Create Referral dynamic procedure note. When you complete the procedure note, you create the referral, select a document, generate it, and use Direct messaging to send it to the referred to physician.

If you do not use the dynamic procedure note, then you must use the document generation functionality to generate and send the document.

In the Generate Patient Document window, you must select the referral entry with which the document is to be associated.

In the Send Documents window, you must select the disclosure reason ‘Referral’.

Also in the Send Documents window, you can select the Direct messaging option and the Direct message address for the referred to provider.

If you choose to use some form of electronic transmission other than Direct messaging through the application, then you must ensure that the transmission method you choose is valid for this objective. You must also recognize that the application cannot count your transmissions or associate them to referrals. Therefore, you must fully document each transmission. Keep a transaction log of transmissions, and clearly show the association of the referral, the clinical document, and the recipient. Your transaction log will be required to support your attestation, and may be needed in the event of an audit. Please see the Supporting Documentation for Meaningful Use Attestation section of this guide and the CMS website for more information.

Please note:

When using a clinical summary, the formatting model for the clinical summary document must be defined as a clinical summary before the document is generated. This setting is not retroactive, and does not apply to documents generated from the formatting model before the setting was selected.

If you have an incoming referral that has associated referral entries, these will be included in the count. To remove them, change the referral entry status to ‘Relationship’.

Use the Meaningful Use Stage 2 2015 Report for Objective 5 to document the percentage of transitioning patients for whom you exchanged key clinical information with other facilities and for whom you provided an electronic summary-of-care record to another care facility.

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Charting for Standard 6: Measure and Improve Performance

Element A: Measure Clinical Quality Performance

At least annually, the practice measures or receives data on the following.

Factor 1: At least two immunization measures.


Functionality:

Clinical Quality Measures:

Please note that to receive autocredit, you must use the specific immunizations described here.

Pneumonia Vaccination Status

Patients 65 years of age and older with a visit during the measurement period.

Please note that the E&M codes 99211 and 99243 do not count for this measure.

Patients who have ever received a pneumococcal vaccination.

To report on this measure, you must document the administration of the pneumonia vaccine or document it in the patient’s history. The vaccination may have been given at any time prior to or during the measurement period.

To document the pneumonia immunization, enter the administration using a procedure code associated to an appropriate SNOMED code. Enter the procedure in the SP tab of Full Note Composer or other clinical note type window. Then document the vaccination details in the vaccine administration record.

You may also document the pneumonia immunization by using a type of vaccine associated with the qualifying CVX code. Identify the type of vaccine when documenting the vaccine details in the vaccine administration record.

To document a vaccination given in the past, you must use a type of vaccine associated with the qualifying CVX code. Enter the vaccination in the vaccination history category in the Hx tab of Full Note Composer or in the Patient History window. Then, identify the type of vaccine when documenting the vaccine details in the vaccine administration record.

CVX: 33

SNOMED for administering the vaccination: 12866006, 394678003

76 Ref: 1157.01

Use the CQM report for measure CMS 127 to document the percentage of patients who received a pneumonia vaccination.

Influenza Immunization

Patients aged 6 months and older, and seen for a visit between October 1 and March 31.

The patient must have a visit during flu season, which is defined as October of the prior year through March of the current year.

The patient must also have one, or in some circumstances two, additional visits during the reporting period.

Patients who received an influenza immunization OR who reported previous receipt of an influenza immunization.

To report on this measure, you must document the administration of the flu immunization, or enter it in the vaccine history category. The vaccine must have been administered between October of the prior year and March of the current year.

To document the influenza immunization, enter the vaccination in the vaccine administration record using one of the following CPT codes or a procedure code associated with a SNOMED code. Enter the procedure in the SP tab of Full Note Composer or other clinical note type window. Then document the vaccination details in the vaccine administration record.

To document a vaccination given in the past, you must use a type of vaccine associated with the qualifying CVX code. Enter the vaccination in the vaccination history category in the Hx tab of Full Note Composer or in the Patient History window. Then, identify the type of vaccine when documenting the vaccine details in the vaccine administration record. Please note that you must make this entry in a visit during the flu season.

CPT: 90656, 90658, 90660, 90661, 90662, 90664, 90666, 90667, 90668

SNOMED: 86198006, 442333005

CVX: 111, 135, 140, 141, 144, 149, 150

Use the CQM report for measure CMS 147 to document the percentage of patients who received an influenza vaccination.

Factor 2: At least two other preventive care measures.


Functionality:


Ref: 1157.01 77

Screening for High Blood Pressure

Patients must be 18 years old or older before the start of the measurement period. Patients do not already have an active diagnosis of hypertension.

Patients who were screened for high blood pressure AND a recommended follow-up plan is documented as indicated if the blood pressure is pre-hypertensive or hypertensive.

To report on this measure, you must enter the patient’s blood pressure (both systolic and diastolic values) in the Vitals tab of Full Note Composer or other clinical note type window. Use the system-defined blood pressure fields (Blood Pressure 1, 2, 3, or 4). These observation items for these blood pressure fields are associated with the appropriate LOINC codes.


This measure looks at both the systolic and diastolic pressures to determine the follow-up needed for the patient. So, if either the patient’s systolic pressure or diastolic pressure are equal to or greater than the criteria, then you must perform the specified follow-up actions. This is also true when the blood pressure from the prior year is considered. The blood pressure was high in the prior year if either the systolic pressure was 140 or higher or the diastolic pressure was 90 or higher. It is not necessary for both the systolic and the diastolic pressure to be higher than the target.

If the patient’s blood pressure is between 120/80 and 140/90, then within one day of the visit, you must either:


Document a plan to retest the blood pressure within a year and document lifestyle change recommendations that may include diet, exercise, weight loss, and alcohol consumption.

If the patient’s blood pressure is 140/90 or greater, but has not been high (or was not taken) in the year prior to this visit, then within one day of the visit, you must either:


Document a plan to retest the blood pressure within four weeks and document lifestyle change recommendations that may include diet, exercise, weight loss, and alcohol consumption.

If the patient’s blood pressure is 140/90 or greater, and has been high in the year prior to this visit, then within one day of the visit, you must either:


Document a plan to retest the blood pressure within four weeks and document lifestyle change recommendations that may include diet, exercise, weight loss, and alcohol consumption, and either

Write a prescription for medication, or

78 Ref: 1157.01

Order a screening or test, such as a comprehensive metabolic panel or an electrocardiogram.

To chart a referral to another provider, you must order the referral by entering a procedure code that is associated with a qualifying SNOMED code. The system-defined Referral Order procedure code is associated with SNOMED code 306253008. You may associate other procedure codes with more specific qualifying SNOMED codes as needed. Enter the procedure code in either the SP or the SO tab of Full Note Composer or other clinical note type window.

SNOMED: 134403003, 183516009, 183561008, 183856001, 306206005, 306253008, or

308470006

You may also create the referral from Patient/Provider Tracking. When you create the referral in this way, you must create the referral within one day of the visit date and associate it with the visit.

To chart that you plan to retest the blood pressure, you must have one or more custom procedure codes and associate them with a qualifying SNOMED code that indicates the timeframe for the follow up test. Enter the procedure in the SP tab of Full Note Composer or other clinical note type window. Please note that simply entering the referral in Referral Tracking or Patient Provider Tracking will not count for this measure.

SNOMED codes for retest within 4 weeks: 183617005, 183618000, 183619008, 183620002,

183621003, 183622005, 183623000

SNOMED codes for retest within 1 year: 61342007, 183617005, 183618000, 183619008, 183620002, 183621003, 183622005, 183623000, 183624006, 183625007, 183626008, 183627004, 183628009, 300042001

For diet, exercise, weight loss, or alcohol consumption recommendations, counseling, or education, you must chart an appropriate procedure. Select the desired procedure code in the SP or SO tab of Full Note Composer or other clinical note type window. If the procedure code is associated with an education form, such as for counseling, then selecting the education form from the Education Form slider will add the procedure code to the SP tab.

Alcohol

SNOMED: 24165007, 38670004, 390857005, 408947007, 413473000, 417096006, 419822006,

431260004

Diet

HCPCS: G8417, S9452, S9470

SNOMED: 11816003, 14044002, 31002004, 40546006, 54123004, 61310001, 103699006,

169411000, 182922004, 182954008, 182955009, 182956005, 182960008, 183061003, 183065007, 183070000, 183071001, 226164007, 281085002, 284071006, 284352003, 304491008, 305849009, 306163007, 361231003, 370847001, 386464006, 386619000,

Ref: 1157.01 79

386620006, 410114009, 410171007, 410177006, 410270001, 413315001, 418995006, 424753004, 443288003

Exercise

HCPCS: S9451

SNOMED: 281090004, 304507003, 304549008, 386291006, 386292004, 386373004, 386463000,

410289001

Lifestyle

SNOMED: 313204009, 364706004, 39155009, 415510005, 443402002, 60134006

Weight Loss

HCPCS: S9449

SNOMED: 170795002, 266724001, 268523001, 275919002, 401003006, 408289007, 410200000

To use medication as part of the follow-up plan, you must prescribe a qualifying medication as the follow up plan. Write the prescription through the SIG Writer window, and then either print it or submit it electronically.

To chart a screening or test, you must enter a procedure code that is associated with a qualifying SNOMED code. You may enter the in either the SP or the SO tab of Full Note Composer or other clinical note type window.

CPT: 80047, 80048, 80050, 80053, or 80069

SNOMED: 2278000, 5540006, 8879006, 15373003, 18207002, 20501000, 27171005, 27260001, 28317006, 36793009, 59573005, 60218003, 68994006, 70901006, 71878006, 73668004, 82912006, 88480006, 102811001, 105362001, 113075003, 127800008, 164846002, 167181009, 167182002, 167183007, 167222005, 167470001, 251838003, 259295006, 271000000, 271075006, 271236005, 271240001, 290127004, 301119002, 301120008, 304048005, 312468003, 312472004, 313502007, 313936008, 365616005, 365618006, 365756002, 365757006, 365760004, 390963002, 390964008, 420155008, 444164000, 444275009, 444336003

This measure looks at both the systolic and diastolic pressures. Either the patient’s systolic pressure or diastolic pressure must be equal to or greater than the criteria to move to the next level.

Use the CQM report for measure CMS 022 to document the percentage of patients who were screened for high blood pressure.

Tobacco Use Screening

The patient must be 18 years old or older.

80 Ref: 1157.01

This measure generally requires two office visits during the measurement period. Some types of office visits require only one during the measurement period.

To report on this measure, you must enter the patient’s use or non-use of tobacco in the Hx tab, Social History category, in the patient visit note. Then when the patient is a tobacco user, you must provide cessation counseling or prescribe an approved cessation medication.

To report the patient’s smoking history, enter the patient’s use or non-use of tobacco in the Hx tab, Social History category, in Full Note Composer or other clinical note type window. The tobacco history answer selected must be associated with a qualifying SNOMED code in order to qualify. The following system-defined tobacco history answers are associated with the correct SNOMED codes.

Current every day smoker (SNOMED code 449868002)

Current some day smoker (SNOMED code 428041000124106)

Former smoker (SNOMED code 8517006)

Never smoker (SNOMED code 266919005)

Smoker, current status unknown (SNOMED code 77176002)

Heavy tobacco smoker (SNOMED code 428071000124103)

Light tobacco smoker (SNOMED code 428061000124105)

Has never smoked or chewed tobacco (SNOMED code 266919005)

If you have entered the patient’s tobacco use in a prior measurement period and that use has not changed, then you must select the checkbox for the Social History category indicating that you have reviewed the patient’s history, including tobacco use.

When the patient is a tobacco user, then you must either:

Enter CPT code 99406 or 99407 or HCPCS code G0436 to document the cessation counseling, or

Prescribe an approved cessation medication.

If you typically use an education form with or for cessation counseling, then you can associate the appropriate procedure code with the education form so that selecting the education form from the Education Form slider in Full Note Composer or other clinical note type will add the procedure code to the SP tab. The education form must also be associated with the Smoking Cessation patient communication type.

Smoking and tobacco use counseling to the patient is reported using CPT code 99406 (smoking and tobacco cessation counseling visit; intermediate, greater than 3 minutes up to 10 minutes) or code 99407 (smoking and tobacco cessation counseling visit; intensive, greater than 10 minutes).

Remember that these CPT codes are E&M codes, so if you use them along with another E&M code, you must include in the visit note proper documentation supporting the use of the procedure code. Counseling lasting less than 3 minutes is considered part of an evaluation and

Ref: 1157.01 81

management (E/M) service and is not paid separately. Proper documentation for codes 99406 and 99407 includes the total time spent and what was discussed, including cessation techniques, resources and follow-up.

The counseling services must be provided by a physician or other qualified health professional and must be provided face-to-face. Some Medicaid programs have not yet adopted payment for these codes.

If you are using the optionally licensed Persivia education forms, the Persivia Smoking Cessation form is recommended. This education form is associated with HCPCS code G0436. This procedure code is associated with the SNOMED code 225323000 which qualifies for this measure.

If you not using the Persivia education forms, then it is recommended that you associate the HCPCS code G0436 to the custom-defined education form that you use for this purpose.

Write the prescription through the SIG Writer window, and either print or electronically submit the prescription.

Use the CQM report for measure CMS 138 to document the percentage of patients who were screened for tobacco use.

Factor 3: At least three chronic or acute care clinical measures.


Functionality:

Please note that to receive autocredit, you must use the specific chronic and acute care services described here.

Poor Control of Hemoglobin A1c

Use the CQM report for measure CMS 122 to document the percentage of patients who had hemoglobin A1c > 9.0% during the measurement year.


Enter the diabetes diagnosis with a qualifying diagnosis code or diagnosis code associated with a SNOMED code in the Dx tab of Full Note Composer or other clinical note type window or enter a problem associated with a qualifying SNOMED code in the problem history category in the Hx tab of Full Note Composer or the Patient History window.

ICD-9: 250.00, 250.01, 250.02, 250.03, 250.10, 250.11, 250.12, 250.13, 250.20, 250.21,

250.22, 250.23, 250.30, 250.31, 250.32, 250.33, 250.41, 250.42, 250.43, 250.50, 250.51, 250.52, 250.53, 250.60, 250.61, 250.62, 250.63, 250.70, 250.71, 250.72, 250.73, 250.80, 250.81, 250.82, 250.83, 250.90, 250.91, 250.92, 250.93, 648.01, 648.02, 648.03, 648.04

82 Ref: 1157.01


SNOMED: 4783006, 9859006, 23045005, 28032008, 44054006, 46635009, 75682002, 76751001, 81531005, 190330002, 190331003, 190368000, 190369008, 190372001, 190389009, 190390000, 199223000, 199225007, 199226008, 199227004, 199228009, 199229001, 199230006, 237599002, 237618001, 237626009, 237627000, 313435000, 313436004, 314771006, 314772004, 314893005, 314894004, 314902007, 314903002, 314904008, 359642000, 359939009

Patients whose most recent HbA1c level (performed during the measurement period) is >9.0%. Patients who do not have an HbA1c level entered during the measurement period are also included in the numerator. Please note that for this measure, a low numerator is the desired outcome.

To report on this measure, you must order or perform an A1c test and then either enter the test results or receive them through an interface. You must associate the results with the order, and give them a status of Resulted or Approved.

The A1c test results must be entered as discrete, quantifiable data. Enter the results in the Patients Results window using a lab template enabling you to enter the HGB A1c value.

Results stored in the database as text notes or an image file cannot be used for reporting.

You must associate a LOINC code to the A1C test. There are two ways to do this. You can enter the LOINC on the test item on each lab template for both manually entered and electronic results. This is done in the Lab Template window. The second way is easy if you have several templates. You can enter the LOINC on the A1C test in the Observation Item window. This associates the LOINC to all A1C test items in all lab templates.

The LOINC codes for this result are 17855-8, 17856-6, 4548-4.

Use the CQM report for measure CMS 163 to document the percentage of patients with diabetes whose LDL-C was adequately controlled.

Urine Protein Screening for Diabetes


Enter the diagnosis with a qualifying diagnosis code or diagnosis code associated with a SNOMED code in the Dx tab of Full Note Composer or other clinical note type window or enter a problem associated with a qualifying SNOMED code in the problem history category in the Hx tab of Full Note Composer or the Patient History window.

Ref: 1157.01 83

ICD-9: 250.00, 250.01, 250.02, 250.03, 250.10, 250.11, 250.12, 250.13, 250.20, 250.21, 250.22, 250.23, 250.30, 250.31, 250.32, 250.33, 250.41, 250.42, 250.43, 250.50, 250.51, 250.52, 250.53, 250.60, 250.61, 250.62, 250.63, 250.70, 250.71, 250.72, 250.73, 250.80, 250.81, 250.82, 250.83, 250.90, 250.91, 250.92, 250.93, 648.01, 648.02, 648.03, 648.04


SNOMED: 4783006, 9859006, 23045005, 28032008, 44054006, 46635009, 75682002, 76751001,

81531005, 190330002, 190331003, 190368000, 190369008, 190372001, 190389009, 190390000, 199223000, 199225007, 199226008, 199227004, 199228009, 199229001, 199230006, 237599002, 237618001, 237626009, 237627000, 313435000, 313436004, 314771006, 314772004, 314893005, 314894004, 314902007, 314903002, 314904008, 359642000, 359939009

Patients with a screening for nephropathy or evidence of nephropathy during the measurement period.

To report on this measure, you must either diagnose the patient with nephropathy, or order or perform urine screening and then enter the results, or order or perform a procedure that indicates nephropathy. For this measure, a prescription for an ACE inhibitor or ARB medication is also an indication of nephropathy.

To use the diagnosis, enter the diagnosis code in the Dx tab of Full Note Composer or other clinical note type window.

ICD-9: 250.40, 250.41, 250.42, 250.43

ICD-10: E08.21, E08.22, E08.29, E09.21, E09.22, E09.29, E10.21, E10.22, E10.29, E11.21, E11.22, E11.29, E13.21, E13.22, E13.29

SNOMED: 38046004, 127013003, 236499007, 236500003, 401110002, 420514000, 420715001, 421305000, 421986006, 445170001

To use the urine screening, perform the urine screening, and then either enter the test results or receive them through an interface and give them a status of Resulted or Approved.

Test results not received through an interface must be entered as discrete, quantifiable data. Enter the results in the Patients Results window using a lab template enabling you to enter the urine microalbumin value. Results stored in the database as text notes or image file cannot be used for reporting.

84 Ref: 1157.01

You must associate a LOINC code to the test item on each lab template for both manually entered and electronic results.

Microalbumin LOINC: 1755-8, 1753-3, 1754-1, 1757-4, 2887-8, 2888-6, 2889-4, 2890-2, 9318-7,

11218-5, 12842-1, 13705-9, 13801-6, 14585-4, 14956-7, 14957-5, 14958-3, 14959-1, 18373-1, 20621-9, 21059-1, 21482-5, 26801-1, 27298-9, 30003-8, 30000-4, 30001-2, 32209-9, 32294-1, 32551-4, 34366-5, 35663-4, 40486-3, 40662-9, 40663-7, 43605-5, 43606-3, 43607-1, 44292-1, 47558-2, 49023-5, 50949-7, 53121-0, 53532-8, 53530-2, 53531-0, 56553-1, 57369-1, 58448-2, 58992-9, 59159-4, 60678-0, 63474-1

Macroalbumin LOINC: 1753-3, 24356-8, 24357-6, 39264-7, 50556-0, 50564-4, 50949-7, 57019-2, 57020-0, 58077-9

To use a procedure that indicates nephropathy, you must enter a qualifying procedure code or a procedure code that is associated with a qualifying SNOMED code. You may enter the procedure in either the SP or the SO tab of Full Note Composer or other clinical note type window.

Dialysis education SNOMED: 59596005, 66402002, 385972005

Dialysis services CPT: 90920, 90921, 90924, 90925, 90935, 90937, 90940, 90945, 90947

Dialysis services HCPCS: 108241001

Dialysis services SNOMED: 676002, 10848006, 11932001, 14684005, 34897002, 57274006, 67970008, 68341005, 71192002, 108241001, 180273006, 225230008, 225231007, 233575001, 233576000, 233577009, 233578004, 233579007, 233580005, 233581009, 233582002, 233583007, 233584001, 233585000, 233586004, 233587008, 233588003, 233589006, 233590002, 238316008, 238317004, 238318009, 238319001, 238321006, 238322004, 238323009, 265764009, 288182009, 302497006, 427053002, 428648006, 439278006, 439976001

ESRD Monthly Outpatient Services CPT: 90957, 90958, 90959, 90960, 90961, 90962, 90965, 90966, 90969, 90970, 90989, 90993, 90997, 90999, 99512

Kidney transplant CPT: 50340, 50360, 50365, 50370, 50380

Kidney transplant SNOMED: 175899003, 175901007, 175902000, 236138007, 313030004, 48994000, 52213001, 70536003, 88930008

Other Services Related to Dialysis SNOMED: 3257008, 73257006, 233591003, 385970002, 385971003, 385973000, 406168002

Vascular access for dialysis CPT: 36145, 36147, 36148, 36800, 36810, 36815, 36818, 36819, 36820, 36821, 36831, 36832, 36833

Vascular access for dialysis SNOMED: 676002, 7459007, 22800003, 34163007, 54817007, 61160002, 61740001, 63421002, 69380006, 79827002, 80634002, 180272001, 180277007, 225892009, 233468004, 233471007, 233472000, 233547003, 238314006, 238315007, 271418008, 426340003, 427992007, 428118009, 431418000, 431440009, 431781000, 432509002, 432654009, 434435000, 438341004, 438342006, 439241008, 439322008, 439349008, 439534001, 443683004, 448591002, 449400003

Ref: 1157.01 85

To use medication as an indicator of nephropathy, enter the prescription for an ACE inhibitor or ARB medication in the SIG Writer window, and print or electronically submit the prescription.

Use the CQM report for measure CMS 134 to document the percentage of patients with diabetes who had a nephropathy screening test or evidence of nephropathy during the measurement period.

Factor 4: Performance data stratified for vulnerable populations (to assess disparities in care).


Functionality:

The CQM report (QRDA Summary) shows patient demographic data (race, gender, ZIP code) to identify population stratification.

Element B: Measure Resource Use and Care Coordination

At least annually, the practice measures or receives quantitative data on the following.

Factor 1: At least two measures related to care coordination.


Functionality:


Receipt of Specialist Report for Referrals

The patient must have at least one visit during the measurement period.

You must order the referral. This can be done in either of the following ways.

In the visit note, enter a procedure code that is associated with a qualifying SNOMED code.

Create the referral from Patient/Provider Tracking. When you create the referral in this way, you must associate the referral with the visit.

The system-defined Referral Order procedure code is associated with SNOMED code 306253008. You may associate other procedure codes with more specific qualifying SNOMED codes as needed. Enter the procedure code in either the SP or the SO tab of Full Note Composer or other clinical note type window.

86 Ref: 1157.01

SNOMED codes for the referral: 54395008, 103697008, 103699006, 183515008, 183517000, 183528001, 183529009, 183530004, 183541002, 183555005, 183557002, 183561008, 183567007, 183569005, 183591003, 183878008, 183879000, 183880002, 183881003, 183882005, 183884006, 183885007, 183886008, 183887004, 183888009, 183889001, 183890005, 183891009, 183892002, 183893007, 183894001, 183895000, 183896004, 183897008, 183899006, 183900001, 183901002, 183902009, 183903004, 183904005, 183905006, 183906007, 183907003, 183908008, 183909000, 183910005, 183911009, 183913007, 183914001, 183915000, 183916004, 266747000, 274410002, 306160005, 306161009, 306162002, 306253008, 306254002, 306255001, 306256000, 306257009, 306258004, 306259007, 306260002, 306261003, 306262005, 306263000, 306264006, 306265007, 306266008, 306267004, 306268009, 306269001, 306270000, 306271001, 306272008, 306273003, 306274009, 306275005, 306276006, 306277002, 306278007, 306279004, 306280001, 306281002, 306282009, 306284005, 306285006, 306286007, 306287003, 306288008, 306289000, 306290009, 306291008, 306293006, 306294000, 306295004, 306296003, 306297007, 306298002, 306299005, 306300002, 306301003, 306302005, 306303000, 306304006, 306305007, 306306008, 306307004, 306308009, 306309001, 306310006, 306311005, 306312003, 306313008, 306314002, 306315001, 306316000, 306317009, 306318004, 306320001, 306338003, 306351008, 306352001, 306353006, 306354000, 306355004, 306356003, 306357007, 306358002, 306359005, 306360000, 306361001, 306736002, 307063001, 307777008, 308447003, 308449000, 308450000, 308451001, 308452008, 308453003, 308465004, 308469005, 308470006, 308471005, 308472003, 308473008, 308474002, 308475001, 308476000, 308477009, 308478004, 308479007, 308480005, 308481009, 308482002, 308483007, 308484001, 308485000, 309046007, 309627007, 309629005, 310515004, 312487009, 312488004, 390807002, 406158007, 406159004, 408285001, 415277000, 416116000, 425971006, 429365000, 428441000124100, 428451000124103, 428461000124101, 428471000124108, 428481000124106, 428491000124109, 428541000124104

When you receive the consultation report from the referred to physician or medical service provider, you must attach the consultation report to the referral record using Document Linking. You must use the attachment type Consultation Report when attaching the report to the referral. The Consultation Report attachment type has the SNOMED code 371530004 in the ID field.

Please note that referral entries with a status of Historical Reference or of Relationship are not included.

Use the CQM report for measure CMS 50 to document the percentage of referrals for which you received the specialist’s report.

Medication Reconciliation for Transitioning Patients

To be included for this factor, the patient must have transitioned to you. This could include, but is not limited to:

A first encounter with a new patient.

A patient referred to you by another provider.

A patient for whom you receive a C-CDA file for the patient.

Ref: 1157.01 87

To identify a patient as transitioning, you must select the “Patient has been seen by another provider” checkbox in the Medication History category of the Hx tab of Full Note Composer or other clinical note type window.

To report on these factors for the transitioning patients, you must perform the medication reconciliation. There are several ways that you can do this.

You can reconcile that patient’s medication history in the application with a document listing the patient’s medication. You must then scan the document, and attach it to the visit note.

You can download the patient’s electronic medication history, import the electronic medication history, and reconcile that medication history with the medication history in your patient record. To download the medication history, providers must be enrolled with the Surescripts pharmacy clearinghouse.

Downloading the electronic medication history may be done automatically for appointments scheduled in advance, or may be done on demand from the Appointment window, Patient Demographics window, or Full Note Composer or other clinical note type window. Importing and reconciling the electronic medication history and the medication history in the patient record is done from the Import Medication History window.

You can receive a C-CDA for the patient, and import the patient’s medication history from it, and reconcile that medication history with the medication history in your patient record.

Then in the Hx tab of Full Note Composer or other clinical note type window, select the checkbox for Transition of Care. This checkbox will be automatically selected if you made any changes while reconciling the electronic medication history within Full Note Composer or other clinical note type. If you do medication reconciliation from the Patient History window, then you must select this checkbox within Full Note Composer.

Please note that you must select the checkbox for Transition of Care in the Hx tab of Full Note Composer or other clinical note type window before you complete the visit note. Once you have marked the visit note as completed, you cannot select this checkbox.

To meet the measure’s goal, you must reconcile the medication history for more than 50 percent of the qualifying patients who transition into your care during the reporting period.

Use the Meaningful Use Stage 2 report for Core Measure 14 to document the percentage of transitioning patients for whom you reviewed and reconciled medications.

Factor 2: At least two utilization measures affecting health care costs.


Functionality:


88 Ref: 1157.01

Appropriate Testing for Children with Pharyngitis

Children 2-18 years of age who had an outpatient or emergency department (ED) visit with a diagnosis of pharyngitis during the measurement period and an antibiotic ordered on or three days after the visit.

You must diagnosis the patient with pharyngitis using one of the diagnosis codes below during a visit within the measurement period.

ICD-9: 034.0, 462, 463

ICD-10: J02.8, J02.9, J03.80, J03.81, J03.90, J03.91

SNOMED: 1532007, 17741008, 40766000, 43878008, 55355000, 58031004, 195655000,

195656004, 195657008, 195658003, 195659006, 195660001, 195662009, 195666007, 195667003, 195668008, 195669000, 195670004, 195671000, 195672007, 195673002, 195676005, 195677001, 232399005, 232400003, 302911003, 363746003

Then you must prescribe an antibiotic within 3 days following the visit.

To report the antibiotic, write a prescription for an antibiotic using the SIG writer window and print the prescription or send it electronically. The antibiotic must be dispensed within three days after the qualifying visit.

Children with a group A streptococcus test in the 7-day period from 3 days prior through 3 days after the diagnosis of pharyngitis.

To report on this measure, you must prescribe an antibiotic and order a group A streptococcus (strep) test and enter the test results.

To report the antibiotic, write a prescription for an antibiotic using the SIG writer window and print the prescription or send it electronically.

To report the strep test, order the test and then either enter the test results or receive them through an interface and give them a status of Resulted or Approved.

The strep test results not received through an interface must be entered as discrete, quantifiable data. Enter the results in the Patients Results window using a lab template enabling you to enter the strep value. Results stored in the database as text notes or image file cannot be used for reporting.

You must associate a LOINC code to the strep test item on each lab template for both manually entered and electronic results. LOINC codes for this result are listed below.

LOINC: 626-2, 5036-9, 6559-9, 6556-5, 6557-3, 6558-1, 11268-0, 17656-0, 18481-2, 31971-5,

49610-9, 60489-2, 68954-7

Use the CQM report for measure CMS 146 to document the percentage of patients appropriately tested for pharyngitis.

Ref: 1157.01 89

Appropriate Treatment for Children with Upper Respiratory Infection (URI)

The patient must be between 3 months and 18 years of age.

The patient must have an outpatient or emergency department visit with a diagnosis of upper respiratory infection (URI) during the measurement period. You must diagnosis the patient with an upper respiratory infection using a qualifying ICD-9 or SNOMED code. Enter the diagnosis code in the Dx tab of Full Note Composer or other clinical note type window.

ICD-9 codes: 460, 465.0, 465.8, 465.9

ICD-10: J00, J06.0, J06.9

SNOMED codes: 195708003, 281794004, 54150009, 54398005, 55355000, 78337007, 82272006

To report on this measure, you must not write a prescription for an antibiotic on the date of the visit or within three days of the visit.

Patients for whom an antibiotic prescription is written are included in the denominator, but not in the numerator.

Use the CQM report for measure CMS 154 to document the percentage of patients appropriately tested for upper respiratory infection.

Element C: Measure Patient/Family Experience

At least annually, the practice obtains feedback from patients/families on their experiences with the practice and their care.

Factor 1: The practice conducts a survey (using any instrument) to evaluate patient/family experiences on at least three of the following categories: Access, Communication, Coordination, Whole person care/self-management support.


Functionality:

You can create user-defined patient questionnaires that you can assign to patients with Aprima Patient Portal accounts.

You must configure the Aprima Patient Portal, and establish Patient Portal user IDs and passwords for patients or their responsible parties so that they may access the questions on the Portal.

90 Ref: 1157.01

Factor 2: The practice uses the PCMH version of the CAHPS Clinician & Group Survey Tool.


Functionality:

NCQA provides a CAHPS survey tool. This is outside of Aprima PRM.

Factor 3: The practice obtains feedback on experiences of vulnerable patient groups.


Functionality:

You must create your own workflows and documentation to support this factor. This is outside of Aprima PRM (or any EHR).

Factor 4: The practice obtains feedback from patients/families through qualitative means.


Functionality:

You must create your own workflows and documentation to support this factor. This is outside of Aprima PRM (or any EHR).

Element D: Implement Continuous Quality Improvement (Must-pass element)

The practice uses an ongoing quality improvement process to perform the following activities.

Factors 1-7:

1. Set goals and analyze at least three clinical quality measures from Element A.

2. Act to improve at least three clinical quality measures from Element A.

3. Set goals and analyze at least one measure from Element B.

4. Act to improve at least one measure from Element B.

5. Set goals and analyze at least one patient experience measure from Element C.

6. Act to improve at least one patient experience measure from Element C.

7. Set goals and address at least one identified disparity in care/service for identified vulnerable populations.


Ref: 1157.01 91

Functionality:

You must create your own workflows and documentation to support these factors. These are outside of Aprima PRM (or any EHR).

Element E: Demonstrate Continuous Quality Improvement

The practice demonstrates continuous quality improvement by performing the following activities.

Factor 1: Measuring the effectiveness of the actions it takes to improve the measures selected in Element D.


Functionality:

Generate and archive the CQM report for CMS 146 and CMS 154 on a regular basis. Then compare the report results.

Factor 2: Achieving improved performance on at least two clinical quality measures.


Functionality:

Generate and archive the CQM report for CMS 022 and CMS 138 on a regular basis. Then compare the reports results to verify improvement.

Factor 3: Achieving improved performance on one utilization or care coordination measure.


Functionality:

Generate and archive the CQM report for CMS 050 on a regular basis. Then compare the reports results to verify improvement.

Generate and archive the Meaningful Use Stage 2 report for Core Measure 14 on a regular basis. Then compare the reports results to verify improvement.

92 Ref: 1157.01

Factor 4: Achieving improved performance on at least one patient experience measure.


Functionality:


Element F: Report Performance

The practice produces performance data reports using measures from Elements A, B and C and shares the following information.

Factors 1-2:

1. Individual clinician performance results with the practice.

2. Practice-level performance results with the practice.


Functionality:

Users may configure their Desktop window to display the Meaningful Use report. They can generate the report on their Desktop at will for a specific provider or for all the providers in the practice.

Factor 3: Individual clinician or practice-level performance results publicly.


Functionality:


Factor 4: Individual clinician or practice-level performance results with patients.


Functionality:


Ref: 1157.01 93

Element G: Use Certified EHR Technology

The practice uses a certified EHR system.

Factor 1: The practice uses an EHR system (or modules) that has been certified and issued a CMS certification ID.


Functionality:

Aprima PRM 2015 EHR (electronic health record) and PM (practice management), version 15.0.1, has received Meaningful Use Stages 1 and 2 certification as a Complete EHR for use in ambulatory care settings from InfoGard (www.infogard.com), an accredited ONC-ACB certification body. This Complete EHR is 2014 Edition compliant and has been certified by an ONC-ACB in accordance with the applicable certification criteria adopted by the Secretary of Health and Human Services. This certification does not represent an endorsement by the U.S. Department of Health and Human Services or guarantee receipt of incentive payments.

The application’s original certification was received on August 5, 2013, and the original InfoGuard certification number was IG-2999-13-0024. The application’s most recent certification was received on December 1, 2015.

The CMS EHR Certification ID is 1314E01RBJXGEAT.

Factor 2: The practice conducts a security risk analysis of its EHR system (or modules), implements security updates as necessary and corrects identified security deficiencies.


Functionality:

You must conduct or review an annual security risk analysis in accordance with the requirements under 45 CFR 164.308(a)(1) and implemented security updates as necessary and corrected identified security deficiencies as part of its risk management process.

CMS has provided guidance on the security risk analysis for Meaningful Use, which has similar requirements to PCMH. This guidance is available on their website at http://www.cms.gov/Regulations-and- Guidance/Legislation/EHRIncentivePrograms/Downloads/SecurityRiskAssessment_FactSheet_U pdated20131122.pdf

The Office of the National Coordinator for Health Information Technology (ONC), the HHS Office for Civil Rights (OCR), and the HHS Office of the General Counsel (OGC) have developed a security risk assessment tool that you may use as part of your risk analysis process. You may download the security risk assessment tool from the HealthIT.gov website

http://www.infogard.com/

http://www.cms.gov/Regulations-and-Guidance/Legislation/EHRIncentivePrograms/Downloads/SecurityRiskAssessment_FactSheet_Updated20131122.pdf



94 Ref: 1157.01

using the link below. Please note that this measure does not require the use of the security risk assessment tool. It is simply available to you for guidance and assistance.

http://www.healthit.gov/providers-professionals/security-risk-assessment-tool

Keep a copy of your security risk analysis report and documentation of security updates implemented as a result of the analysis with your PCMH documentation. This may be needed in case of an audit.


Factor 3: The practice demonstrates the capability to submit electronic syndromic surveillance data to public health agencies electronically.


Functionality:

To meet the measure’s goal, you must attest that you are in active engagement with a public health agency to submit syndromic surveillance data.

Your first step is to ensure that you are registered with your public health agency for the intention of ongoing syndromic surveillance data submission. You must do this within the first 60 days of your reporting period.

Determine with the public health agency which diagnosis codes you must report, and the frequency of reporting required by the agency.

You must determine how your public health agency receives syndromic surveillance data, and then configure your database appropriately. If your public health agency can receive the standard HL7 syndromic surveillance information messages produced by the application, then you may configure your database to send these messages. Please refer to the Configure Syndromic Surveillance Reporting section of this guide for instructions.

Please note that after receiving your first syndromic surveillance message files, the public health agency may inform you that the files do not meet the agency’s requirements. The agency may, for example, require additional data be included. You must then contact your sales representative to request a custom interface with your public health agency. Development and testing of the custom interface will take some time. Therefore, it is recommended that you begin this process as soon as possible.

To submit data, you must enter diagnoses in patient visit notes. Then generate the Export Patient Diagnosis Data report for the diagnosis or diagnoses of interest. You must generate the report at the frequency required by your public health agency.

The Export Patient Diagnosis Data report generates a file for each patient with the selected diagnosis. Depending on your syndromic surveillance configuration, the files are either transmitted to the public health agency and or stored on your server. If files are stored on the server, then you must upload them to the public health agency.

http://www.healthit.gov/providers-professionals/security-risk-assessment-tool

Ref: 1157.01 95

Factor 4: The practice demonstrates the capability to identify and report cancer cases to a public health central cancer registry electronically.


Functionality:

Autocredit for this factor will be available only after Aprima PRM 2016 achieves certification for reporting to cancer registries.

Factor 5: The practice demonstrates the capability to identify and report specific cases to a specialized registry (other than a cancer registry) electronically.


Functionality:

You must enter diagnosis or other data to be reported to the registry in Full Note Composer or other clinical note type.

To comply with this measure, you must:

1. Search for a specialized registry in your area, if you are not already aware of one’s existence.

If a registry does exist in your area, then go to step 2.

If there is no registry, you are excluded from this measure.

2. Contact your state or local specialized registry to determine whether they can accept HL7 immunization files.

If so, go to step 3.

If your local immunization registry cannot accept HL7 files through an interface, then you are excluded from this measure.

3. Contact Support to set up the interface to the registry.

4. Once the interface is in place, submit the data regularly throughout the reporting period.

Use the Meaningful Use Stage 2 Report for Menu Set Measure 6 to document the percentage of specific cases reported to a specialized registry.

Factor 6: The practice reports clinical quality measures to Medicare or Medicaid agency, as required for Meaningful Use.


Functionality:

You must generate the CQM report and submit your files to CMS as required for Meaningful Use participation.

96 Ref: 1157.01

Factor 7: The practice demonstrates the capability to submit data to immunization registries or immunization information systems electronically.


Functionality:

You must enter information for administered immunizations in the Vaccine Administration

Record ) from Full Note Composer or other clinical note type.

To meet the measure’s goal, you must attest that you are in active engagement to submit data to a specialized registry.

To comply with this measure, then your first step is to ensure that you are registered with your state registry for the intention of ongoing immunization data submission. You must do this within the first 60 days of your reporting period.

Then, to obtain an interface, you must:

1. Search for an immunization registry in your area, if you are not already aware of one’s existence.

If a registry does exist in your area, then go to step 2.

If there is no registry, you are excluded from this measure.

2. Contact your state or local immunization registry to determine whether they can accept HL7 immunization files.

If so, go to step 3.

If your local immunization registry cannot accept HL7 files through an interface, then you are excluded from this measure.

3. Contact Support to set up the interface to the registry.

4. Once the interface is in place, submit the data regularly throughout the reporting period.

Factors 8-9

8. The practice has access to a health information exchange.

9. The practice has bidirectional exchange with a health information exchange.


Functionality:

Autocredit is available for this factor only if you have an interface with a health information exchange.

If you have an interface with a health information exchange, then you will have an HL7 partner record that enables and documents that interface.

Ref: 1157.01 97

Factor 10: The practice generates lists of patients, and based on their preferred method of communication, proactively reminds more than 10 percent of patients/families/caregivers about needed preventive/follow-up care.


Functionality:

Recall and reminder notices enable you to monitor and process reminders for follow up visits or procedures and to process recall notices when needed. Patient recall entries may be created automatically by the application and may be created by users.

You can send recall and reminder notices through the Patient Portal for patients who have Portal accounts. For patients who do not have Portal accounts, you can export a list of names and addresses so that you can create mailing labels or letters to send to the patients. You can also contact patients by phone, and then update the patient recall entries.

The application includes the following system-defined recall types. You can create a recall entry for a patient using any recall type desired.

CDS: These patient recall entries are created automatically when a user generates the CDS Reminders report. Because the report generates letters or messages to patients with Portal accounts, the notification for these recall entries is done at the same time.

Patient by Condition: This patient recall type will be used in a future release to automatically create recall entries by generating a report.

Return Visit: These patient recall entries are created automatically when a provider defines a return visit in the Plan tab of a clinical note type window, and associates a patient recall entry with that return visit.