prognocis meaningful use guidelines
DESCRIPTION
PrognoCIS™ EMRMeaningful Use TrainingFor Meaningful Use properties/configuration, please email us at [email protected]. For process training, please contact our training department at (727) 238-3367 or email us at [email protected] Bullets• Q&A will follow the presentation– Please save your questions until the end• Some features are dependent upon certain settings and configuration you will have to f/up with Bizmatics– 1-on-1 Meaningful Use Implementation sessioTRANSCRIPT
PrognoCIS™ EMR
Meaningful Use Training
For process training, please contact our training department at (727) 238-3367 or email us at [email protected].
For Meaningful Use properties/configuration, please email us at [email protected].
Housekeeping Bullets • Q&A will follow the presentation
– Please save your questions until the end
• Some features are dependent upon certain settings and configuration you will have to f/up with Bizmatics – 1-on-1 Meaningful Use Implementation session after this webinar
– Email: [email protected]
• Please mute your phones or laptop speakers – On GTM Navigation Toolbar, click the microphone ( ) or the Mute All
button ( )
– On telephone, click the Mute button
– Remember to un-mute for Q&A
The Medicare EHR Incentive Program for Eligible Providers (EP) runs from 2011 – 2016. For 2011, EP’s must demonstrate meaningful use for a 90 consecutive day reporting period. EP’s can participate for the entire duration of 5 years within this time span.
Medicare Meaningful Use
CMS Requirements: • Register for the EHR Incentive Program • Meet meaningful use criteria for 90 consecutive days during 2011
• Subsequent years will require an entire year of compliant data • Attest using CMS web-based system by keying in numerator/denominator values
PrognoCIS Requirements • Upgrade EMR to v2b2 (CCHIT-certified) or higher • Notify [email protected] to enable your properties, eRx, and Rx-hub • Weekly tracking via reports and dashboards
https://www.cms.gov/EHRIncentivePrograms/35_Basics.asp#TopOfPage
• Maximum reimbursement for 5-year period is $44,000 • EP must have incurred minimum revenue $24,000 in given year • EP who also qualify for Medicaid must choose one or the other
Medicare EHR Payment Schedule for EP’s:
The Medicaid EHR Incentive Program for Eligible Providers (EP) runs from 2011 – 2021. States and territories can voluntarily offer the Medicaid EHR program. EP’s can partici- pate for a duration of 6 years within this time span.
Medicaid Meaningful Use
CMS Requirements: • Register for the EHR Incentive Program • Adopt & implement a meaningful-use certified EHR system within the practice
• 2011 has not specific number of days; otherwise entire year of data is required. • Attest using CMS web-based system by keying in numerator/denominator values
PrognoCIS Requirements • Upgrade EMR to v2b2 (CCHIT-certified) or higher • Notify [email protected] to enable your properties, eRx, and Rx-hub • Weekly tracking via reports and dashboards
https://www.cms.gov/EHRIncentivePrograms/35_Basics.asp#TopOfPage
Medicaid EHR Payment Schedule for EP’s:
• Maximum reimbursement for 6-year period is $63,750 • EP must have a minimum of 30% Medicaid-eligible patient population • EP who also qualify for Medicare must choose one or the other
Eligible Providers (EP) http://www.cms.gov/EHRIncentivePrograms/15_Eligibility.asp#TopOfPage
To verify requirements of eligibility, please go to the above link. There is also a link to Frequently Asked Questions (FAQ’s) to elaborate on the conditions of eligibility for each program. A provider who is hospital-based cannot qualify for the program. If your practice has multiple providers, each provider may individually register and attest for his/her own incentive.
MD, DO but not ARNP, PA
Registration Links: https://ehrincentives.cms.gov/hitech/login.action http://www.youtube.com/user/CMSHHSgov?feature=mhum#p/u/0/sKngNjd8Iuc
PrognoCIS™ EHR Certification Number: https://onc-chpl.force.com/ehrcert (e.g.: 30000001SWUGEAS) Note: A unique Certification Number will be generated for each EP.
Registration for EHR Incentive
Some Important Dates: • January 3, 2011 earliest registration for eligible providers (EP) • April 18, 2011 earliest eligible date to begin attestation • October 1, 2011 last day to begin 90-day Reporting Period • February 29, 2012 last day for eligible providers to register and attest to receive incentive payment for 2011
CMS Home Page for EHR Incentive Programs: http://www.cms.gov/EHRIncentivePrograms/60_RegulationsNotices.asp
Our clients are already receiving ARRA reimbursements regularly!
The 90-Day Reporting Period The date on which an Eligible Provider actually registers for the EHR Incentive Program with CMS has no bearing on the 90-days selected to gather the data. As soon as you have implemented your EHR, you can start gathering data for any desired period of 90 consecutive days. You may register at any time even if you have already begun gathering your data. As you complete your attestation with CMS, then you will actually declare the specific 90-days you chose. The attestation data that you enter at that time must reflect those 90-days.
Medicare-only requirement
Documentation Conventions
Exclusion: Any EP who…
Measure 1 %-Y/N
Encounter TOC a
• - denotes the required value you must enter on CMS when doing your attestation. – * Y / N = yes or no PrognoCIS provides the faculty
– * %’s = numerator (value) must be entered
• - denotes who can be excluded from reporting on this measure; or lists additional references qualifying data, or relevant properties.
• - denotes the screen or menu option within PrognoCIS where the measure occurs; or lists required properties/additional references.
• - denotes extra/qualifying information or training steps relevant to the PrognoCIS requirements for compliance with the measure.
• - denotes icon or field of relevance on screen inside PrognoCIS.
• - denotes an important FYI/remark
Core Measures
• Use CPOE for entering medication orders • Drug/drug and drug/allergy Interaction checks • Maintain up-to-date problem list of current/active diagnoses • E-prescribing of permissible prescriptions • Maintain active medication list • Maintain active medication allergies list • Record specific defined demographics • Record and chart specific defined vital signs • Record smoking status for patients 13 years or older • Report ambulatory clinical quality measures to CMS or to the state • Implement at least 1 clinical decision support rule for specialty & track it • Provide patients with an electronic copy of their health information • Provide patients with clinical summaries for each visit • Sharing of key clinical information amongst care providers & other agencies • EHR technical security to protect electronic health information
http://www.cms.gov/EHRIncentivePrograms/Downloads/EP-MU-TOC.pdf
15 Mandatory
CPOE (Computerized Physician Order Entry)
Exclusion: Any EP who writes fewer than 100 prescriptions during the 90-day reporting period.
Encounter TOC a Prescription CPOE a Rx
Measure 1 %’s
More than 30% of all unique patients with at least 1 medication order must have the prescription entered using CPOE in a digital, structured format directly into the medical record by a licensed healthcare professional.
This measure does not consider the method of transmission or getting the Rx to the pharmacy. It is based solely on entering the drug details.
The EP must implement drug-drug and drug-allergy interaction checking for the entire reporting period. Note: The measure does not require that indications exist.
Drug Interaction Validation
Prescription a Update Drug rx.check.drugdiseaseinteraction; rx.check.drugdruginteraction
rx.drugdiseaseinteraction.severitylevel; rx.drugdruginteraction.severitylevel
Measure 2 Y / N
This feature can be disabled at a later time; however, it must be enabled during the entire reporting period of meaningful use.
Problem List of Diagnoses
Face Sheet a Past Medical History facesheet.explicit.review
More than 80% of all unique patients seen by an EP, maintain at least one entry or an indication that no problems are known as structured data.
Measure 3 %’s
A list of current and active as well as past diagnoses relevant to the current care of the patient. The provider must keep this list up to date.
Do not leave blank as
regards ICD
Physician can auto-populate ICD to PMH from Assessment as applicable.
More than 40% of all permissible prescriptions* written by EP are transmitted
electronically using EHR technology.
e-Prescribing
Exclusion: Any EP who writes fewer than 100 prescriptions during the 90-day reporting period.
Prescription a eRx icon http://www.deadiversion.usdoj.gov/schedules/orangebook/e_cs_sched.pdf
Measure 4 %’s
eRx indicator for Pharmacy
and Drug*
(MU Denominator) All prescriptions written during the reporting period.
(MU Numerator) All permissible eRx drugs that were ordered eRx.
More than 80% of all unique patients seen by EP, maintain at least one entry (or an indication that that patient is not currently prescribed any medication) recorded as structured data.
Medication List
Face Sheet a Current Medication facesheet.explicit.review
Measure 5 %’s
Do not leave blank
The EP is not required to update this list at every contact with the
patient and can update it at his/her clinical discretion.
Drug details are not required (e.g.: Dose, Frequency, etc.).
Medication Allergy List
Face Sheet a Allergy facesheet.explicit.review; patient.set.noknown.flags
Measure 6 %’s
More than 80% of all unique patients seen by EP, maintain at least one entry (or an indication that that patient has no known medication allergies) recorded as structured data.
The EP is not required to update this list at every contact with the patient.
Non-medication allergies may also be present; however, the measure requires only that drug allergies be documented.
Do not leave blank as to
Drug Allergies
Demographics More than 50% of all unique patients seen by an EP must have all five demographic fields (i.e.: DOB, Gender, Preferred Language, Ethnicity, and Race) recorded as structured data.
Patient Register a Other Info
Measure 7 %’s
http://www.whitehouse.gov/sites/default/files/omb/assets/information_and_regulatory_affairs/re_app-a-update.pdf
“Unknown” or “Patient Refused to Disclose” are acceptable notations when applicable.
Vitals History
Encounter TOC a Vitals vital.height.testcode; vital.weight.testcode; vital.bp.testcode
More than 50% of all unique patients 2 years or older seen by an EP, the height, weight, blood pressure, & BMI must be recorded as structured data. Plot and display growth charts for children 2-20 years including BMI.
Exclusion: Any EP who sees no patients 2 years or older, or who believes all 3 vital signs have no relevance in the scope of his or her practice.
Measure 8 %’s
Ht, Wt, & BP must be data-entry BMI will be calculated by EHR Growth chart is not requirement of attestation
Smoking Status
Face Sheet a Social History vital.smoking.testcode
More than 50% of all unique patients 13 years or older seen by an EP, must have smoking status recorded as structured data.
Exclusion: Any EP who sees no patients 13 years or older (i.e.: infant-care pediatricians).
Measure 9 %’s
Clinical Quality Measures Successfully report ambulatory clinical quality measures selected by CMS in the manner specified by CMS.
Measure 10 %’s
• 44 total Clinical Quality Measures have been defined • EP must report a total (minimum) of 6 (w/a possible maximum of 9^) • 3 mandatory Core measures
• ^If the denominator of 1 = 0, you must chose an alternate > 0 • ^3 Alternate Core CQMs (if needed)
• 38 additional Clinical Quality Measures • Excluding the 3 core/3 alternate core measures • EP must choose 3 of these • “0” is an acceptable denominator value if applicable for the EP
CQM Electronic Specifications
https://www.cms.gov//QualityMeasures/03_ElectronicSpecifications.asp#TopOfPage
CQM Implementation Guide http://www.cms.gov/QualityMeasures/Downloads/QMEPCQMLog.pdf?agree=yes&next=Accept
For future implementation
2012…+...
Clinical Quality Measures (cont’d)
https://www.cms.gov/apps/ama/license.asp?file=/QualityMeasures/Downloads/EP_MeasureSpecifications.zip
Measure 10 %’s
Required Core Measures
Report a Tabular a Clinical Quality Measures (The specific measures selected are not defined within PrognoCIS).
NQF0421 = 18-65, BMI last 6 mos. NQF0013 = 18> w/HTN, BP x 2 OV NQF0028 = 18> 2 OV, smoking status
No % requirements
for 2011.
Clinical Decision Support Implement one clinical decision support rule relevant to specialty or high clinical priority along with the ability to track compliance with that rule.
Encounter a Expression pop-up (based upon defined trigger)
Role-based login.expression.applicablefor property
Measure 11 Y/N
CMS does not issue guidance as to the specifics for these rules. EP must base them upon work- flow, patient population, and quality improvement efforts.
Creating Expressions Clinical Decision Support rules alert the clinician based on the Event and/or HPI Complaint defined to trigger them in conjunction with the conditions defined.
Settings a Configuration a Workflow a Expressions
Measure 11 Y/N
Trigger
Conditions
The Rule
Electronic PHI (The Request)
Exclusion: Any EP who has no requests from patients or their agents for an
electronic copy of PHI during the 90-day reporting period.
More than 50% of all patients who request an electronic copy of their health information receive it within 3 business days; at no charge to the patient. Patient requests ePHI (MU Denominator): Messages a Compose Send to designated person within the practice Select Patient *Select Health Information Request Action *Specify Due in Days 3 *Select Add to Patient Medical records check box
Message a Compose
Measure 12 %’s
Diagnostic test results Problem list Medications list Medication allergies
Electronic PHI (Processing it) Measure 12 %’s
User generates the ePHI file (MU Numerator):
Messages a Inbox Click Zoom button ( ), which invokes Letters Out screen
If Patient Portal is implemented: The PHI will be available under Visit Summary. Check the Done box in the Inbox.
If no Patient Portal: Letter Template FHR will default Note: If no FHR template is defined, you can select one in the pick list. Click the Attach button Select the Formal Health Record Select Download File icon Assign a password Note: Password must be provided to the patient. Save the encrypted file to your local or server drive File can be copied to thumb drive, burned to CD, or zipped/emailed to the patient. Check the Done box in the Inbox. Message a Inbox
For patient portal, be sure to include email address in Patient Register and assign a User ID/Password to the patient.
Electronic PHI (Completing it)
Patient a Letters Out a FHR Property fhr.show must = Y
Measure 12 %’s
Clinical Summaries
Encounter TOC a Encounter Close or Patient Portal Define OV codes in arra.ov.cpt.codes property
prognocis.meaningful.summary.template = Summary format allow.directprint.letters = N for Printer Select dialog
Clinical summaries provided to patients for more than 50% of all office visits within 3 business days; at no charge to the patient.
Exclusion: Any EP who has no office visits during the 90-day reporting period.
Measure 13 %’s
MU Summary button n/a when Patient
Portal is active & pt has email or Enc > 3
days old.
Office Visit – a separate billable encounter resulting from E&M services provided to patient as defined in applicable property.
Share Key Clinical Info - Export
Capability to exchange key clinical information among providers of care and patient authorized entities electronically. EP must have performed at least 1 test using this feature during the reporting period.
Patient Review a Patient XML
Measure 14 Y/N
Patient a Review Patient XML Enter the patient details Enter the clinic details Export the CCD file
File must be XML – cannot
be PDF.
Diagnostic test results Problem list Medications list Medication allergies
Share Key Clinical Info - Export (cont’d)
Once the file is exported, a password (which must be shared with the recipient) must be assigned to encrypt the data.
Patient Review a Patient XML
Assign a password Save the file Note: Based on patient name/export date .exe file.
Copy to thumb drive or CD
Unique legal entities Separate EHR systems Test doesn’t have to be real data
Patient Review a CCD/CCR
Share Key Clinical Info - Import Measure 14 Y/N
Patient a Review CCD/CCR Click paper clip icon Browse to the .exe file Click attach button Select the “I” record Enter password The data will display
Capability to exchange key clinical information among providers of care and patient authorized entities electronically. EP must have performed at least 1 test using this feature during the reporting period.
Protect Electronic Health Info Protect electronic health information created or maintained by the certified EHR
technology through the implementation of appropriate technical capabilities.
Measure 15 Y/N
FYI – In order to receive our CCHIT certification, PrognoCIS had to pass all such required tests.
FREEBIE!
Questions & Answers
15 Core Measures Review
Menu Set Measures
5 out of the 10
• Drug Formulary Checks • Clinical Lab Test Results • Patient Lists by Conditions • Patient Reminders • Timely Electronic Access to PHI (Portal only) • Patient-specific education resources • Medication Reconciliation for patients transitioned from other provider of care • Summary of Care Record to other providers of care for patients transitioned • *Submit electronic data to immunization registries • *Submit electronic syndromic surveillance data to public health agencies
http://www.cms.gov/EHRIncentivePrograms/Downloads/EP-MU-TOC.pdf
*Note: One of the 5 optional menu set measures must be either measure #9 or #10.
Your choices do not have to be indicated within PrognoCIS; however, you will indicate those you select during attestation.
Free!
Free!
Drug Formulary Checks EP must have enabled this functionality and has access to at least one internal or
external formulary for the entire reporting period.
Exclusion: Any EP who writes fewer than 100 prescriptions during the 90-day reporting period.
Menu Set 1 Y/N
Prescription a enter drug a Update
Freebie! Rx-Hub
required
More than 40% of all clinical lab test results ordered by EP using EHR during the reporting period whose results are either positive/negative or numerical format
are incorporated into EHR technology structured data.
Clinical Lab Test Results
Exclusion: An EP who orders no lab tests whose results are either in a positive/negative or numeric
format during the EHR reporting period.
Encounter TOC a Lab Result
Menu Set 2 %’s
Cannot be scanned to
Document List.
(MU Denominator) All Lab Tests ordered during reporting period. (MU Numerator) All Lab Results entered into structured data either by hand or by HL7 interface.
Generate at least one report listing patients of the EP with a specific condition to use for quality improvement, reduction of disparities, research, or outreach.
Patient Lists by Condition
Reports a Tabular
Menu Set 3 Y/N
FREEBIE!
Patient Reminders More than 20% of all patients 65 years or older or 5 years old or younger were
sent an appropriate reminder (for preventive/f-up care) during the EHR period.
Exclusion: An EP who has no patients 65 years old or older or 5 years old or younger.
Settings a Processes a Appointment Mails
Menu Set 4 %’s
Patients must have a valid email address on Patient Register.
Exclusion: Any EP that neither orders nor creates lab tests or information that would be contained in the problem list,
medication list, medication allergy list.
Timely Electronic Access to PHI At least 10% of all unique patients seen by EP are provided timely electronic access (4 business days) to their health information subject to the EP’s discretion to withhold certain information. This includes lab results, problem list, medication lists, and allergies.
Patient Portal (FYI: If you do not have the portal, you
cannot choose this option.)
Menu Set 5 %’s
Patients must have a User ID & Password in order to access the
portal during the 90-days.
Requires Portal.
Education Resources More than 10% of all unique patients seen by EP are provided patient-specific education resources, as identified within the EHR.
Encounter TOC a Education Home Page a Check-out Documents
Menu Set 6 %’s
Home Page Select Check-out Docs icon Select ED Type docs
The Education Master can be defined to trigger automated or manual addition of educational materials to an encounter based on activity on the chart.
Settings a Configuration a Clinic a Education
Education Master Menu Set 6 %’s
Trigger
For more than 50% of patients transitioned into the care of the EP, if the EP believes an encounter is relevant, he should perform a medication reconciliation to identify the most accurate list of medications the patient is taking including dose, frequency, and route by comparing to external documentation of meds.
Medication Reconciliation
Face Sheet a Current Medication a
Menu Set 7 %’s
Exclusion: An EP who was not the recipient of any transitions of care during the reporting period.
(MU Denominator) – all new patients within reporting period. (MU Numerator) – clicking the “H” button then “OK” or “Yes” on the pop-up.
Freebie! Rx-Hub
required
Summary of Care Record For more than 50% of patients transitioned from the EP or referred to another provider of care, the EP shall provide a summary care record (electronically) for each transition or referral.
Encounter TOC a Order Sheet a Consults
Exclusion: An EP who neither transfers to another setting of care nor refers to another provider during the reporting period.
Menu Set 8 %’s
Order the Consult (MU Denominator)
EP requests consult on Assessment Consult ordered via Order Sheet Referral generated via Letters Out
Summary of Care Record – Letters Out Once the Consult is created, the Summary of Care file can be exported in a XML file to be shared with the other provider or setting of care to which the patient is being transitioned or referred.
Patient a Letters Out
Generate the Referral
Select letter template Assign referring provider Complete the referral letter
After the referral is generated, the Continuity of Care Document (CCD) can be generated by exporting it as a password-protected XML file.
Encounter Review a Patient XML
Summary of Care Record – Patient XML
Generate the CCD (MU Numerator) Enter the pertinent details Export the CCD File Assign a password/save it Burn to CD or thumb drive
Capability to submit electronic data to immunization registries or immunization information systems; actual submission according to applicable law & practice. EP must have performed at least 1 test of this feature during the reporting period.
Immunization Registries
Encounter Face Sheet a Vaccinations
Exclusion: An EP who administers no immunizations or where no immunization registry has the capacity to receive the information electronically.
Menu Set 9 Y/N
Note: EP must select either Menu Set #9 or #10.
Does your state accept this data electronically?
Capability to submit electronic syndromic surveillance data to public health agencies and actual submission according to applicable law and practice. EP must have performed at least 1 test of this feature during the reporting period. .
Settings a Biosurveillance HL7 Export
Syndromic Surveillance
Exclusion: An EP who does not collect any reportable syndromic information on their patients during the reportable period or does not submit such information to any public health agency that has the capacity to receive the information electronically.
Menu Set 10 Y/N
Note: EP must select either Menu Set #9 or #10.
Questions & Answers
10 Menu Set Measures Review
Meaningful Use Encounter Validation Before closing an encounter, the Encounter Meaningful Dashboard can be viewed to identify compliance at the encounter level.
Encounter Close a Arra Dashboard icon
Note: You may not ever get all green “thumbs-up”, so do not panic! Not all measures will apply at the encounter level.
Sometimes, RED
will be OK!
Meaningful Use Tabular Report Use this tabular report to monitor the different Core and Menu Set Measures for which you will be attesting after the 90-day reporting period. These are the values you will enter into CMS when doing your attestation.
Reports a Tabular a Meaningful Use By Provider x 90-day Period
arra.mu.reqd.srnos – by Measure sequence
Numerator – number of patients that meet the criteria Denominator – total number of patients for the 90-days that qualify for the measure (not necessarily compliant) Exclusions may = 0 or be < minimum required.
*Meaningful Use Dashboard
prognocis.show.dashboard
Dashboard icon
Core Measures Dashboard Graphically displays the 15 mandatory Core Measures with regards to your compliance for each individual measure within the reporting period.
All 15 of these are Required
Remember those measures you are excluding may show “in the red” or =
0, which is acceptable.
Menu Set Measures Dashboard Graphically displays the 10 optional Menu Set Measures with regards to your compliance for each individual measure within the reporting period.
Remember these measures are optional, thus those you do not choose may show “in the red”
or = 0, which is acceptable. Choose 5
out of these 10
Dashboard Features While viewing the dashboard, shortcut links are available to enable you to easily view the numerator/denominator values as well as detailed definition of each measure. Provider drop-down list allows you to generate
statistics for each individual EP in the practice.
View Details displays a summary of the CMS definition & minimum percentage to qualify.
Tooltip summarizes the numerator and denominator values for the specific measure.
Date Range is the 90-day reporting period.
The Attestation to CMS
Any time after you have completed the 90-day reporting period, you can submit your attestation on-line with CMS. During this process, you must key the actual numerical values for each measure (i.e.: “numerator” and “denominator”) and whether or not you are excluding yourself where applicable.
Report a Tabular a Meaningful Use Contact: [email protected]
Our clients are already receiving ARRA reimbursements regularly!
Log in to the CMS Attestation System Select Attestation tab a Attest a Start Attestation button Complete the questionnaire
Enter your EHR Certification & Start/End Dates of 90-day period Enter values for the 15 Core Measures Select then enter values for the optional 5 Menu Set Measures Enter values for the 3 Core Clinical Quality Measures
If numerator of any = 0, report on alternate core CQM as well Select then enter values for the optional 3 Clinical Quality Measures
Review the Summary for completeness Monitor the status until you receive your check!
Starting the Attestation w/CMS http://www.cms.gov/EHRIncentivePrograms/Downloads/EP_Attestation_User_Guide.pdf
CMS Registration & Attestation System https://ehrincentives.cms.gov/hitech/login.action
http://www.cms.gov/EHRIncentivePrograms/Downloads/EP_Attestation_User_Guide.pdf
The Attestation Questionnaire
http://www.cms.gov/EHRIncentivePrograms/Downloads/EP_Attestation_User_Guide.pdf
CMS Registration & Attestation System https://ehrincentives.cms.gov/hitech/login.action
Completing the Attestation w/CMS
Ready…Set…Go! Decide on the measures you are going to report on
15 mandatory Core Measures 5 additional Menu Set Measures (out of 10 possible)
Decide the 90-days you will use for your reporting period Implement appropriate workflow/processes to gather the data Register on CMS Complete your attestation on CMS when applicable Collect your reimbursement from the US Government!
Contact us to arrange for your personal Meaningful Use implementation and system configuration by emailing @
Practice name Physician name(s) Name, Phone #,Time Zone