Copyright. Last updated: September 28, 2017 MicroMD EMR Objective Measure Calculations Manual: Performance Year 2017

Transcription

1 Objective Measure Calculations Performance Year 2017

2 Trademarks Because of the nature of the material, numerous hardware and software products are mentioned by their trade names in this publication. All product names referenced herein are trademarks of their respective companies. The marks MICROMD, HENRY SCHEIN, and the HENRY SCHEIN LOGO are registered trademarks of HS TM, LLC, a subsidiary of Henry Schein, Inc. Copyright Descriptions quoted at the beginning of each section belong to the Centers for Medicaid and Medicare. This document is covered by the terms and conditions of the license agreement and/or the non-discloser agreement and may only be reproduced if allowed by the terms of that agreement or with written consent of Henry Schein, Inc. Last updated: September 28, 2017 MicroMD EMR Objective Measure Calculations Manual: Performance Year Henry Schein Medical Systems, Inc. All rights reserved.

3 Table of Contents Preface How This Manual is Organized....i Conventions Used in This Manual....i Cross-References....i Text You Type Using the Keyboard....i Keys You Press and Buttons You Click....i Dialog Box, Application Window Titles, and Field Names....i Warnings, Notes and Tips....ii Chapter 1: Overview Performance Year Medicare Advancing Care Information Category Scoring Overview Base Score Performance Score Bonus Score Medicaid Objectives and Measures Chapter 2: Advancing Care Information - Transition Objective: Electronic Prescribing Objective: Health Information Exchange Objective: Medication Reconciliation Patients Who Quality for the Measure (Denominator) Patients Who Meet the Measure (Numerator) Objective: Patient Electronic Access Measure: Provide Patient Access Patients Who Qualify for the Measure (Denominator) Patients Who Meet the Measure (Numerator) Measure: View, Download and Transmit (VDT) Patients Who Qualify for the Measure (Denominator) Patients Who Meet the Measure (Numerator) Objective: Patient-Specific Education Patients Who Qualify for the Measure (Denominator) Patients Who Meet the Measure (Numerator) Objective: Protect Patient Health Information Objective: Public Health Reporting Measure: Immunization Registry Reporting Measure: Syndromic Surveillance Reporting Measure: Specialized Registry Reporting Objective: Secure Messaging Chapter 3: Advancing Care Information Objective: Coordination of Care Through Patient Engagement Measure: View, Download and Transmit (VDT) Patients Who Qualify for the Measure (Denominator) Patients Who Meet the Measure (Numerator) Measure: Secure Messaging MicroMD EMR Objective Measure Calculations Manual: Performance Year 2017 TOC.1

4 Table of Contents Patients Who Qualify for the Measure (Denominator) Patients Who Meet the Measure (Numerator) Measure: Patient-Generated Health Data Patients Who Qualify for the Measure (Denominator) Patients Who Meet the Measure (Numerator) Objective: Electronic Prescribing Patients Who Qualify for the Measure (Denominator) Patients Who Meet the Measure (Numerator) Objective: Health Information Exchange Measure: Send a Summary of Care Patients Who Qualify for the Measure (Denominator) Patients Who Meet the Measure (Numerator) Measure: Request/Accept Summary of Care Patients Who Qualify for the Measure (Denominator) Patients Who Meet the Measure (Numerator) Measure: Clinical Information Reconciliation Patients Who Qualify for the Measure (Denominator) Patients Who Meet the Measure (Numerator) Objective: Patient Electronic Access Measure: Provide Patient Access Patients Who Qualify for the Measure (Denominator) Patients Who Meet the Measure (Numerator) Measure: Patient-Specific Education Patients Who Qualify for the Measure (Denominator) Patients Who Meet the Measure (Numerator) Objective: Protect Patient Health Information Objective: Public Health and Clinical Data Registry Reporting Measure: Immunization Registry Reporting Measure: Syndromic Surveillance Reporting Measure: Electronic Case Reporting Measure: Public Health Registry Reporting Measure: Clinical Data Registry Reporting Chapter 4: Medicaid Modified Stage 2 Objectives Objective 1: Protect Patient Health Information Objective 2: Clinical Decision Support Measure 1 (Implement Decision Support Rules) Measure 2 (Enable and Implement Drug Interaction Checks) Objective 3: Computerized Provider Order Entry (CPOE) Measure 1 (CPOE - Medication Order) Patients Who Qualify for the Measure (Denominator) Patients Who Meet the Measure (Numerator) Measure 2 (CPOE - Laboratory Order) Patients Who Qualify for the Measure (Denominator) Patients Who Meet the Measure (Numerator) Measure 3 (CPOE - Radiology Order) Patients Who Qualify for the Measure (Denominator) Patients Who Meet the Measure (Numerator) Objective 4: Electronic Prescribing (erx) Patients Who Qualify for the Measure (Denominator) Patients Who Meet the Measure (Numerator) TOC.2 MicroMD EMR Objective Measure Calculations Manual: Performance Year 2017

5 Table of Contents Objective 5: Health Information Exchange Patients Who Qualify for the Measure (Denominator) Patients Who Meet the Measure (Numerator) Objective 6: Patient-Specific Education Patients Who Qualify for the Measure (Denominator) Patients Who Meet the Measure (Numerator) Objective 7: Medication Reconciliation Patients Who Qualify for the Measure (Denominator) Patients Who Meet the Measure (Numerator) Objective 8: Patient Electronic Access Measure 1 (Patient Electronic Access) Patients Who Qualify for the Measure (Denominator) Patients Who Meet the Measure (Numerator) Measure 2 (View, Download, and Transmit) Patients Who Qualify for the Measure (Denominator) Patients Who Meet the Measure (Numerator) Objective 9: Secure Electronic Messaging Patients Who Qualify for the Measure (Denominator) Patients Who Meet the Measure (Numerator) Objective 10: Public Health Reporting Measure 1 (Immunization Registry Reporting) Measure 2 (Syndromic Surveillance Reporting) Measure 3 (Specialized Registry Reporting) Chapter 5: Medicaid Stage 3 Objectives Objective 1: Protect Patient Health Information Objective 2: Electronic Prescribing Patients Who Qualify for the Measure (Denominator) Patients Who Meet the Measure (Numerator) Objective 3: Clinical Decision Support Measure 1 (Clinical Decision Support Interventions) Measure 2 (Drug-Drug and Drug-Allergy Interaction Checks) Objective 4: Computerized Provider Order Entry (CPOE) Measure 1 (CPOE - Medication Order) Patients Who Qualify for the Measure (Denominator) Patients Who Meet the Measure (Numerator) Measure 2 (CPOE - Laboratory Order) Patients Who Qualify for the Measure (Denominator) Patients Who Meet the Measure (Numerator) Measure 3 (CPOE - Radiology Order) Patients Who Qualify for the Measure (Denominator) Patients Who Meet the Measure (Numerator) Objective 5: Patient Electronic Access to Health Information Measure 1 (Timely Access and Access Through an API) Patients Who Qualify for the Measure (Denominator) Patients Who Meet the Measure (Numerator) Measure 2 (Identify and Provide Patient-Specific Education Online) Patients Who Qualify for the Measure (Denominator) Patients Who Meet the Measure (Numerator) Objective 6: Coordination of Care Through Patient Engagement Measure 1 (View, Download, and Transmit) MicroMD EMR Objective Measure Calculations Manual: Performance Year 2017 TOC.3

6 Table of Contents Patients Who Qualify for the Measure (Denominator) Patients Who Meet the Measure (Numerator) Measure 2 (Secure Messaging) Patients Who Qualify for the Measure (Denominator) Patients Who Meet the Measure (Numerator) Measure 3 (Patient-Generated Health Data) Patients Who Qualify for the Measure (Denominator) Patients Who Meet the Measure (Numerator) Objective 7: Health Information Exchange Measure 1 (Send a Summary of Care) Patients Who Qualify for the Measure (Denominator) Patients Who Meet the Measure (Numerator) Measure 2 (Request/Accept Summary of Care) Patients Who Qualify for the Measure (Denominator) Patients Who Meet the Measure (Numerator) Measure 3 (Clinical Information Reconciliation) Patients Who Qualify for the Measure (Denominator) Patients Who Meet the Measure (Numerator) Objective 8: Public Health and Clinical Data Registry Reporting Measure 1 (Immunization Registry Reporting) Measure 2 (Syndromic Surveillance Reporting) Measure 3 (Electronic Case Reporting) Measure 4 (Public Health Registry Reporting) Measure 5 (Clinical Data Registry Reporting) TOC.4 MicroMD EMR Objective Measure Calculations Manual: Performance Year 2017

7 Preface From all of us on your MicroMD support team, thank you for selecting MicroMD as your practice management solution. This manual is an in-depth reference to the Advancing Care Information category of the Medicare Quality Payment Program, and the Objectives and Measures for the Medicaid EHR Incentive Program as related to MicroMD EMR. This manual does not cover in full the main MicroMD EMR application, nor does it cover hardware setup, networking, or installation of the program. How This Manual is Organized We have organized this manual according to the incentive program and stage. Each chapter in the manual reflects the objectives and measures for that stage of the program. This is a reference guide and designed to help you troubleshoot your reporting numbers. It should guide you to the locations where you need to populate information in MicroMD. For in-depth information on using the EMR, please refer to the main MicroMD EMR User s Reference Manual. Conventions Used in This Manual Before using this manual, it is important to understand the typographical conventions used to identify and describe information. Cross-References Cross-references to chapters, sections, page numbers, headings, etc. are shown in an italic typeface. e.g., Refer to Conventions Used in This Manual page i. Text You Type Using the Keyboard Text that you type using the keyboard is shown in a Courier typeface. e.g., Type Anthony Smith in the Name field. Keys You Press and Buttons You Click Keys that you press on the keyboard and buttons/icons that you click with the mouse are shown in a bold sans-serif typeface. e.g., Press Enter. e.g., Click OK to continue. Dialog Box, Application Window Titles, and Field Names The titles of dialog boxes and application windows are shown in italics. Field names and selections made from drop-down menus, etc. are also shown in italics. e.g., The Print Preview dialog box appears. e.g., Select Commercial Insurance from the drop-down list. MicroMD EMR Objective Measure Calculations Manual: Performance Year 2017 i

8 Preface Conventions Used in This Manual Warnings, Notes and Tips Warnings, notes and tips appear throughout the manual. They provide additional information important for you to know about a topic. Warning Table A warning alerts you to a severe situation, a potential for data loss, or other critical information about the actions discussed in the instructions. Note Table A note highlights some important information you need to know to use the features of the system correctly or to get the results you expect. Tip Table This type of tip highlights helpful information you may not know about the system or feature. This type of tip contains a reference to some related information or a related feature on another page or in another section of the manual. ii MicroMD EMR Objective Measure Calculations Manual: Performance Year 2017

9 Overview The purpose of this guide is to explain the data used to calculate the measures within the objectives of the Medicare Advancing Care Information category and in the Medicaid EHR Incentive Program that MicroMD EMR supports. The guide was designed to help you troubleshoot how or why a patient does or does not appear in the denominator or numerator of each objective s measure(s). For details on setting up MicroMD or using the system, please refer to the main MicroMD EMR User s Reference Manual. Performance Year 2017 This guide relates to Performance Year 2017 that you will report at the beginning of This affects your incentive payments (or penalties) for the Medicare or Medicaid services you perform in all of Performance Reporting Payments/Penalities Medicare Advancing Care Information Category For 2017, The Centers for Medicare and Medicaid (CMS) changed the Physician Quality Reporting System (PQRS), Medicare EHR incentive program, and the Value-Based Modifier. They renamed the new program to the Quality Payment Program (QPP). Within the Quality Payment Program are two tracks: the Meritbased Incentive Payment System (MIPS) and the Alternative Payment Model (APM). MicroMD EMR helps you report for certain measures in the MIPS track. The Cost category replaces the Value-Based Modifier; however, while CMS will calculate the category in 2017, they will not use this to determine your payment adjustment at this time. CMS also instituted a comprehensive scoring method and divided the QPP into four categories: Quality, Improvement Activities, Advancing Care Information, and Cost (not yet used).the Centers for Medicare and Medicaid (CMS) have created a web site for the Quality Payment Program. You can find detailed information about QPP and MIPS on the CMS web site: For more details on MicroMD and QPP, let the QPP Task Force help. Visit the QPP Information Center on the MicroMD Lounge at MicroMD EMR Objective Measure Calculations Manual: Performance Year

10 Chapter 1. Overview Medicare Advancing Care Information Category The previous PQRS program was replaced with the Quality category of the MIPS track. The Medicare EHR Incentive program objectives and measures (popularly known as Meaningful Use and Stage 2 Modified ) were translated into the Advancing Care Information category (or ACI ). The PQRS program and the Medicare EHR Incentive Program no longer exist in Scoring Overview Your overall MIPS score, the score that determines how much you get paid in 2019, consists of four categories: Quality, Improvement Activities, Advancing Care Information, and Cost. Each category represents a percentage of your overall MIPS score. For the Advancing Care Information category, all of your performance for the objectives and measures represents 25% of your overall MIPS score. CMS has broken down the Advancing Care Information score into three portions with their own scores that allow you the flexibility to meet the full 25%. For the sake of illustration since we ll be talking a lot about percentages, we ll translate your overall MIPS score to points: 100% = 100 points. The Advancing Care Information Category is worth 25% of your overall MIPS score, which is 25 points. The percentages that we discuss within this manual relate to those 25 points. For example, the Base Score is worth 50% of your ACI score, which is 50% of 25 points. That would be 12.5 points toward your full 25 points. Here is your potential: Base Score = 50% of your 25 points = 12.5 points Performance Score = up to 90% of your 25 points = up to 22.5 points Bonus Score = up to 15% of your 25 points = up to 3.75 points These scores total more than 25 points, which allows providers and practices the flexibility to meet the requirements of the objectives and measures based on how they actually work. Base Score Your Base Score represents those measures that all eligible clinicians must report. Your Base Score is worth 50% of your Advancing Care Information category score, meaning 12.5 points. This is a pretty 1.2 MicroMD EMR Objective Measure Calculations Manual: Performance Year 2017

11 Medicare Advancing Care Information Category Chapter 1. Overview straightforward score. These are required measures, and when you report on all of them, you receive 50% of your total 25 points. If you don t report on one of the measures, you receive 0% of your total 25 points. If you do not report on one of these required measures, your Base Score will be zero and your Performance Score is automatically zero. Performance Score Your Performance Score is where you have a great opportunity to increase your Advancing Care Information category score toward 25 points. Not all Advancing Care Information measures provide you with a Performance Score. Only some of them do. Depending on your performance (your numerator and denominator) in the performance-eligible measures and whether you choose the Advancing Care Information measures or the 2017 Advancing Care Information Transition measures, you have a range of percentages you can receive up to 10% (or 20% for the transition measures). The numerator and denominator for each of the eligible measures play a key role in determining your Performance Score. For example, if your numerator/denominator on the Provide Patient Access measure is 250/500, your performance rate is 50%. Using the scale below, the percentage you receive of your 25 points for performance of this measure is 5%. Total up your performance on any of the eligible measures, and you ll have your Performance Score. Table 1.1 Performance Rate Calculations* Individual Measure Performance Score Performance Rate Range for Advancing Care Information Measures Performance Score for 2017 Advancing Care Information Transition Measures Performance Rate 1% 10% 1% 2% Performance Rate 11% 20% 2% 4% Performance Rate 21% 30% 3% 6% Performance Rate 31% 40% 4% 8% Performance Rate 41% 50% 5% 10% Performance Rate 51% 60% 6% 12% Performance Rate 61% 70% 7% 14% Performance Rate 71% 80% 8% 16% Performance Rate 81% 90% 9% 18% Performance Rate 91% 100% 10% 20% * Elizabeth S. Holland, Adam Richards, MIPS: Advancing Care Information Deep Dive Webinar, page 36, Centers for Medicare and Medicaid Services, April 4, 2017, MIPS-and-APMs/MIPS-ACI-Deep-Dive-Webinar-Slides.pdf. MicroMD EMR Objective Measure Calculations Manual: Performance Year

12 Chapter 1. Overview Medicaid Objectives and Measures Bonus Score Now, for your Bonus Score. There are two additional percentages you can receive to help you reach your total 25 points: You can receive a single 5% bonus (or 1.25 points) for reporting on at least one of the Public Health and Clinical Data Registry Reporting Measures. You can also receive a single 10% bonus (or 2.5 points) for using MicroMD EMR to report on at least one of a specific set of activities from the Improvement Activities category of MIPS (regardless of weight). For more details on Improvement Activities, please visit the CMS QPP web site: MicroMD EMR does not calculate a score for you regarding your Bonus Score. It is an attestationonly score. Medicaid Objectives and Measures MicroMD EMR can also help you report on your Medicaid EHR Incentive Program Objectives and Measures for Modified Stage 2 and for Stage 3. The Centers for Medicare and Medicaid (CMS) have created a web site for the Medicaid EHR Incentive Program. You can find information on the two stages for 2017 in the following locations: Modified Stage 2: Guidance/Legislation/EHRIncentivePrograms/Stage2MedicaidModified_Require.html Stage 3: Guidance/Legislation/EHRIncentivePrograms/Stage3Medicaid_Require.html 1.4 MicroMD EMR Objective Measure Calculations Manual: Performance Year 2017

13 Advancing Care Information - Transition The 2017 Advancing Care Information Transition Objectives and Measures provide eligible clinicians with the flexibility to use the certified software they currently have to meet the requirements of MIPS during the transition to the new Medicare incentive payment model. The Advancing Care Information (ACI) category of the new Merit-based Incentive Payment System (MIPS) for Medicare replaces the Medicare EHR Incentive Program previously known as Meaningful Use. In the previous program, you had core measures and a menu set of measures. You also had goal percentages. This is no longer the case. Within the ACI category of MIPS, you have measures required for your Base Score; measures that provide you with an additional Performance Score (some of which are also those required for your Base Score); and measures that provide you with a Bonus Score. These three scores make up the ACI Category portion (25%) of your overall MIPS score. Please see page 1.2 for more details about scoring within the ACI category. The objective measures described in this chapter reflect those requirements ONLY for the 2017 transitional year. (There is also a set of Objective Measures that pertain to 2017 and beyond. You can find those in Chapter 3.) You can use either set of measures, but not a combination of both. You must upgrade to the most current release of MicroMD EMR version 13.5 or higher to report on the 2017 Advancing Care Information Transition objectives and measures. You cannot use version 13.0 or lower. Objective: Electronic Prescribing There is only a single measure in this transition objective: e-prescribing. This 2017 Advancing Care Information Transition Objective measure is the same as the Advancing Care Information measure. Please refer to page 2.1. This measure is required to receive your Base Score. Objective: Health Information Exchange There is only a single measure in this transition objective: Health Information Exchange. This 2017 Advancing Care Information Transition Objective measure is the same as the Advancing Care Information measure called Send a Summary of Care. Please see page 3.6 for more information. This measure is required to receive your Base Score. MicroMD EMR Objective Measure Calculations Manual: Performance Year

14 Chapter 2. Advancing Care Information - Transition Objective: Medication Reconciliation This measure provides you with a Performance Score up to 20% (page 1.3). Objective: Medication Reconciliation There is only a single measure for this transition objective: Medication Reconciliation. This ACI transition measure evaluates the following: The MIPS eligible clinician performs medication reconciliation for at least one transition of care in which the patient is transitioned into the care of the MIPS eligible clinician. This measure provides you with a Performance Score up to 10% (page 1.3). Patients Who Quality for the Measure (Denominator) The denominator for this transition measure is Number of transitions of care or referrals during the performance period for which the MIPS eligible clinician was the recipient of the transition or referral or has never before encountered the patient. In MicroMD EMR, each Transition of Care (In) entry created for the patient appears in the denominator. The provider must appear in the Received By field for the entry; the correct department and clinic must also appear in the Department/Clinic field; and the date in the Begin Date field must fall within the measurement period. You can find a list of incoming transitions of care in the following locations: Desktop tab > My Workflow > Transition of Care Charts tab > main menu > Chart > Workflow Communication > Transition of Care Medical Information tab > Miscellaneous > Transition of Care In You can create a Transition of Care from within the Referral-in Order window. Simply click the Transition of Care button. Patients Who Meet the Measure (Numerator) The numerator for this transition measure is The number of transitions of care or referrals in the denominator where medication reconciliations were performed. In MicroMD EMR, you must perform this reconciliation from the Data Reconciliation window. You can access the Data Reconciliation window from one of the following locations: Transition of Care (In) Window: When you click the Import C-CDA/CCR/CCD button on the Transition of Care (In) window, the system opens the Data Reconciliation window. You can find the Transition of Care (In) window from one of the following locations: - Desktop tab > My Workflow > Transition of Care - Charts tab > main menu > Chart > Workflow Communication > Transition of Care 2.2 MicroMD EMR Objective Measure Calculations Manual: Performance Year 2017

15 Objective: Patient Electronic Access Chapter 2. Advancing Care Information - Transition - Medical Information tab > Miscellaneous > Transition of Care In You can create a Transition of Care from within the Referral-in Order window. Simply click the Transition of Care button. Open the patient s chart > Chart menu > Export/Import Chart (C-CDA/CCR/CCD) > Import Once you are on the Data Reconciliation window, make sure you have the correct transition selected in the Transition of Care drop-down. At this point, if you need to import the CDA, you can. To review the information, click the Review button in the Medication header in the Current MedInfo pane to receive credit for reviewing the patient s information. Be sure to click the Apply button to commit your actions. If you have the Apply auto-review on medical information user preference set to Yes (under Tools > User Preferences > Medical Information), MicroMD EMR does not display the Reviewed button. When you stay on the window for the amount of time you set in your preferences, the system automatically marks the lists as reviewed for you. Objective: Patient Electronic Access The measures within this objective evaluate your patient s access to their electronic health information, as well as your engagement with your patients or their authorized representatives regarding the patient's care. In order to track data for the measures of this objective, the practice must use the MicroMD Patient Portal. Please contact your local authorized MicroMD reseller for purchasing and setup information. Measure: Provide Patient Access This 2017 Advancing Care Information Transition measure evaluates the following: At least one patient seen by the MIPS eligible clinician during Measure: the performance period is provided timely access to view online, download, and transmit to a third party their health information subject to the MIPS eligible clinician s discretion to withhold certain information. This measure is required to receive your Base Score. MicroMD EMR Objective Measure Calculations Manual: Performance Year

16 Chapter 2. Advancing Care Information - Transition Objective: Patient Electronic Access This measure provides you with a Performance Score up to 20% (page 1.3). Patients Who Qualify for the Measure (Denominator) The denominator for this transition measure is The number of unique patients seen by the MIPS eligible clinician during the performance period. In MicroMD EMR, a patient must have an encounter created in MicroMD EMR where the Service Date on the encounter falls within the measurement period. You can find a list of an individual patient s encounters in the patient s chart on the Summary tab in the EMR. Patients Who Meet the Measure (Numerator) The denominator for this transition measure is The number of patients in the denominator (or patient authorized representative) who are provided timely access to health information to view online, download, and transmit to a third party. In MicroMD EMR, the numerator reflects the number of patients within the denominator for whom your practice has published information to the patient through the Patient Portal within four business days of the item s entry or edit in the patient s chart. You can provide updates to the Patient Portal in the following ways: Publishing the Patient s C-CDA/CCR/CCD: You can publish the patient s electronic chart from within their chart in the main menu under Chart > Export/Import Chart (C-CDA/CCR/CCD) > Publish. Portal Updates: The Portal Updates section of the Desktop populates automatically when providers add or change information in the patient's chart that requires an update to the patient s portal account. When a user selects the patient(s) and clicks the Queue CDA button, the system processes all of the selected updates. Once complete, the patient(s) counts for the Numerator of this measure. Although you choose sections to release to the Patient Portal and make visible to the patient, choosing individual sections is not compliant with using the EMR in a meaningful way. Please refer to the MicroMD Patient Portal Guide for details on publishing patient information and the Portal Updates section of the Desktop. 2.4 MicroMD EMR Objective Measure Calculations Manual: Performance Year 2017

17 Objective: Patient Electronic Access Chapter 2. Advancing Care Information - Transition Measure: View, Download and Transmit (VDT) This 2017 Advancing Care Information Transition measure evaluates the following: At least one patient seen by the MIPS eligible clinician during the performance period (or patientauthorized representative) views, downloads or transmits their health information to a third party during the performance period. This measure provides you with a Performance Score up to 10% (page 1.3). Patients Who Qualify for the Measure (Denominator) The denominator for this transition measure is the Number of unique patients seen by the MIPS eligible clinician during the performance period. In MicroMD EMR, a patient must have an encounter created in MicroMD EMR where the Service Date on the encounter falls within the measurement period. You can find a list of an individual patient s encounters in the patient s chart on the Summary tab in the EMR. Patients Who Meet the Measure (Numerator) The numerator for this transition measure is the The number of unique patients (or their authorized representatives) in the denominator who have viewed online, downloaded, or transmitted to a third party the patient s health information during the performance period. In MicroMD EMR, the numerator reflects the number of patients within the denominator who have accessed the electronic chart document that you uploaded to their Patient Portal account. The patient must access the Records tab of their Patient Portal account and click either the View button, one of the Download buttons, or the Transmit button. To meet this measure, you must first provide the patient with their electronic chart information in one of the following ways: Publishing the Patient s C-CDA/CCR/CCD: You can publish the patient s electronic chart from within their chart in the main menu under Chart > Export/Import Chart (C-CDA/CCR/CCD) > Publish. Portal Updates: The Portal Updates section of the Desktop populates automatically when providers add or change information in the patient's chart that requires an update to the patient s portal account. When a user selects the patient(s) and clicks the Queue CDA button, the system processes all of the selected updates. Once complete, the patient(s) counts for the Numerator of this measure. Although you choose sections to release to the Patient Portal and make visible to the patient, choosing individual sections is not compliant with using the EMR in a meaningful way. Please refer to the MicroMD Patient Portal Guide for details on publishing patient information. MicroMD EMR Objective Measure Calculations Manual: Performance Year

18 Chapter 2. Advancing Care Information - Transition Objective: Patient-Specific Education Objective: Patient-Specific Education There is only a single measure in this transition objective: Patient-Specific Education. This ACI transition measure evaluates the following: The MIPS eligible clinician must use clinically relevant information from CEHRT to identify patient-specific educational resources and provide access to those materials to at least one unique patient seen by the MIPS eligible clinician. This measure provides you with a Performance Score up to 10% (page 1.3). Patients Who Qualify for the Measure (Denominator) The denominator for this measure is The number of unique patients seen by the MIPS eligible clinician during the performance period. In MicroMD EMR, a patient must have an encounter created in MicroMD EMR where the Service Date on the encounter falls within the measurement period. You can find a list of an individual patient s encounters in the patient s chart on the Summary tab in the EMR. MicroMD includes only those patients who have encounters with billable line items. Patients Who Meet the Measure (Numerator) The numerator is The number of patients in the denominator who were provided access to patientspecific educational resources using clinically relevant information identified from CEHRT during the performance period. In MicroMD EMR, the patient s encounter from the denominator must have an entry on the Plan tab of the encounter that indicates Patient Education was provided to the patient during the visit. MicroMD EMR comes built with education associated with many diagnoses. You can also associate documentation to any diagnosis as you prefer. The system also contains rules you can create to access specific patient education materials and automatically pop-up an alert for you. You can provide education materials to the patient from the following locations: Within an encounter > Administration tab > Patient Education Desktop Tools > Patient Education Chart Tools > Patient Education Medical Information tab > Miscellaneous > Patient Education Please refer to the main MicroMD EMR User s Reference Manual for more details on using these features. 2.6 MicroMD EMR Objective Measure Calculations Manual: Performance Year 2017

19 Objective: Protect Patient Health Information Chapter 2. Advancing Care Information - Transition Objective: Protect Patient Health Information There is only a single measure for this objective: Security Risk Analysis. This 2017 Advancing Care Information Transition Objective measure is the same as the Advancing Care Information measure. Please see page This measure is required to receive your Base Score. Objective: Public Health Reporting The measures within this objective evaluate if the provider is in active engagement with public health agencies or clinical data registries. and whether the provider reports immunization history, syndromic surveillance data, and/or information to a specialized registry. All of the measures within this objective are attestationonly. You simply provide a Yes or No answer. Measure: Immunization Registry Reporting This 2017 Advancing Care Information Transition Objective measure is the same as the Advancing Care Information measure. Please see page This measure provides you with a Performance Score of either 0 (if you attest No ) or 10% (if you attest yes ). See page 1.2 for more details on scoring. Measure: Syndromic Surveillance Reporting This 2017 Advancing Care Information Transition Objective measure is the same as the Advancing Care Information measure. Please see page This measure is one of the measures that can provide you with the single Bonus Score of 5% (page 1.4). Measure: Specialized Registry Reporting This 2017 Advancing Care Information Transition Objective measure evaluates the following: The MIPS eligible clinician is in active engagement to submit data to a specialized registry. This measure is one of the measures that can provide you with the single Bonus Score of 5% (page 1.4). MicroMD does not currently have features to support this specialized reporting. MicroMD EMR Objective Measure Calculations Manual: Performance Year

20 Chapter 2. Advancing Care Information - Transition Objective: Secure Messaging Objective: Secure Messaging There is only a single measure in this transition objective: Secure Messaging. This 2017 Advancing Care Information Transition Objective measure is the same as the Advancing Care Information measure. Please refer to page 3.3. This measure provides you with a Performance Score up to 10% (page 1.3). 2.8 MicroMD EMR Objective Measure Calculations Manual: Performance Year 2017

21 Objective: Secure Messaging Chapter 2. Advancing Care Information - Transition MicroMD EMR Objective Measure Calculations Manual: Performance Year

22 Chapter 2. Advancing Care Information - Transition Objective: Secure Messaging *** THIS PAGE INTENTIONALLY LEFT BLANK FOR DOUBLE-SIDED PRINTING. *** 2.10 MicroMD EMR Objective Measure Calculations Manual: Performance Year 2017

23 Advancing Care Information The Advancing Care Information (ACI) category of the new Merit-based Incentive Payment System (MIPS) for Medicare replaces the Medicare EHR Incentive Program previously known as Meaningful Use. In the previous program, you had core measures and a menu set of measures. You also had goal percentages. This is no longer the case. Within the ACI category of MIPS, you have measures required for your Base Score; measures that provide you with an additional Performance Score (some of which are also those required for your Base Score); and measures that provide you with a Bonus Score. These three scores make up the ACI Category portion (25%) of your overall MIPS score. Please see page 1.2 for more details about scoring within the ACI category. The objective measures described in this chapter reflect those requirements in 2017 and beyond. There is also a set of Objective Measures that pertain ONLY to the 2017 transitional year. You can find those in Chapter 2. You can use either set of measures, but not a combination of both. You must upgrade to the most current release of MicroMD EMR version 13.5 or higher to report on Advancing Care Information objectives and measures. You cannot use version 13.0 or lower. Objective: Coordination of Care Through Patient Engagement The measures within this objective evaluate your engagement with your patients or their authorized representatives regarding the patient's care. These measures are not required for your Base Score, but they can provide you with a Performance Score. Measure: View, Download and Transmit (VDT) This Advancing Care Information measure evaluates the following: During the performance period, at least one unique patient (or patient-authorized representatives) seen by the MIPS eligible clinician actively engages with the EHR made accessible by the MIPS eligible clinician. A MIPS eligible clinician may meet the measure by either (1) view, download or transmit to a third party their health information; or (2) access their health information through the use of an API that can be used by applications chosen by the patient and configured to the API in the MIPS eligible clinician s CEHRT; or (3) a combination of (1) and (2). This measure provides you with a Performance Score up to 10% (page 1.3). MicroMD EMR Objective Measure Calculations Manual: Performance Year

24 Chapter 3. Advancing Care Information Objective: Coordination of Care Through Patient Engagement In order to track data for this measure, the practice must use the MicroMD Patient Portal. Please contact your local authorized MicroMD reseller for purchasing and setup information. Patients Who Qualify for the Measure (Denominator) The denominator for this measure is the Number of unique patients seen by the MIPS eligible clinician during the performance period. In MicroMD EMR, a patient must have an encounter created in MicroMD EMR where the Service Date on the encounter falls within the measurement period. You can find a list of an individual patient s encounters in the patient s chart on the Summary tab in the EMR. Patients Who Meet the Measure (Numerator) The numerator for this measure is The number of unique patients (or their authorized representatives) in the denominator who have viewed online, downloaded, or transmitted to a third party the patient s health information during the performance period and the number of unique patients (or their authorized representatives) in the denominator who have accessed their health information through the use of an API during the performance period. In MicroMD EMR, the numerator reflects the number of patients within the denominator who have accessed the electronic chart document that you uploaded to their Patient Portal account. The patient must access the Records tab of their Patient Portal account and click either the View button, one of the Download buttons, or the Transmit button. When using the MicroMD EMR API, practices create accounts for their patients to access data from the EMR. The system knows when the patient views, downloads, or transmits their health data. To meet this measure, you must first provide the patient with their electronic chart information in one of the following ways: Publishing the Patient s C-CDA/CCR/CCD: You can publish the patient s electronic chart from within their chart in the main menu under Chart > Export/Import Chart (C-CDA/CCR/CCD) > Publish. Portal Updates: The Portal Updates section of the Desktop populates automatically when providers add or change information in the patient's chart that requires an update to the patient s portal account. When a user selects the patient(s) and clicks the Queue CDA button, the system processes all of the selected updates. Once complete, the patient(s) counts for the Numerator of this measure. Although you choose sections to release to the Patient Portal and make visible to the patient, choosing individual sections is not compliant with using the EMR in a meaningful way. 3.2 MicroMD EMR Objective Measure Calculations Manual: Performance Year 2017

25 Objective: Coordination of Care Through Patient Engagement Chapter 3. Advancing Care Information For API purchasing and setup information, please contact Henry Schein Medical Systems. Please refer to the MicroMD Patient Portal Guide for details on publishing patient information. Measure: Secure Messaging This ACI measure evaluates the following: For at least one unique patient seen by the MIPS eligible clinician during the performance period, a secure message was sent using the electronic messaging function of CEHRT to the patient (or the patientauthorized representative), or in response to a secure message sent by the patient (or the patientauthorized representative). This measure provides you with a Performance Score up to 10% (page 1.3). In order to track data for this measure, the practice must use the MicroMD Patient Portal. Please contact your local authorized MicroMD reseller for purchasing and setup information. Patients Who Qualify for the Measure (Denominator) The denominator for this measure is the Number of unique patients seen by the MIPS eligible clinician during the performance period. In MicroMD EMR, a patient must have an encounter created in MicroMD EMR where the Service Date on the encounter falls within the measurement period. You can find a list of an individual patient s encounters in the patient s chart on the Summary tab in the EMR. Patients Who Meet the Measure (Numerator) The numerator for this measure is The number of patients in the denominator for whom a secure electronic message is sent to the patient (or patient-authorized representative) or in response to a secure message sent by the patient (or patient-authorized representative), during the performance period. In MicroMD EMR, you simply need to respond to a patient s message through your account on the MicroMD Patient Portal; or you can send the patient a portal message from anywhere you see the Publish drop-down button (select Message Only from the drop-down button). Please refer to the MicroMD Patient Portal Guide for details on messaging. MicroMD EMR Objective Measure Calculations Manual: Performance Year

26 Chapter 3. Advancing Care Information Objective: Coordination of Care Through Patient Engagement Measure: Patient-Generated Health Data This ACI measure evaluates the following: Patient-generated health data or data from a non-clinical setting is incorporated into the CEHRT for at least one unique patient seen by the MIPS eligible clinician during the performance period. This measure provides you with a Performance Score up to 10% (page 1.3). Patients Who Qualify for the Measure (Denominator) The denominator for this measure is the Number of unique patients seen by the MIPS eligible clinician during the performance period. In MicroMD EMR, a patient must have an encounter created in MicroMD EMR where the Service Date on the encounter falls within the measurement period. You can find a list of an individual patient s encounters in the patient s chart on the Summary tab in the EMR. Patients Who Meet the Measure (Numerator) The numerator for this measure is The number of patients in the denominator for whom data from non-clinical settings, which may include patient-generated health data, is captured through the CEHRT into the patient record during the performance period. In MicroMD EMR, there are a few ways for you to get a patient s health information into their chart from an outside source: Patient Sends Information through the Patient Portal: The patient can send updated information to your practice through the Patient Portal. You must then right-click the attachment and do one of the following: - Select Import from the pop-up menu. This opens the Data Reconciliation window where you can incorporate the discrete data into the patient s chart. - Select Attach to Chart from the pop-up menu. This opens the Add Attachment window where you can add the document to the patient s chart. Be sure that you have Patient Generated Health Data selected from the Type drop-down on the Add Attachment window when you go this route. You can access mail sent from the Patient Portal from the following locations: - Desktop tab > Mail - Chart menu in the patient s chart > Workflow Communication > Mail Add a Patient-Generated Health Data Attachment: The patient has an attachment in their chart associated with Patient Generated Health Data selected from the Type drop-down. You can add an attachment from a variety of locations in MicroMD EMR. You can find the list of attachments in the patient s chart in the following location: - Medical Information tab > Miscellaneous > Attachments 3.4 MicroMD EMR Objective Measure Calculations Manual: Performance Year 2017

27 Objective: Electronic Prescribing Chapter 3. Advancing Care Information Objective: Electronic Prescribing There is only a single measure for this objective: e-prescribing. For this objective measure, there must be: At least one permissible prescription written by the MIPS eligible clinician is queried for a drug formulary and transmitted electronically using CEHRT. This measure is required to receive your Base Score. Patients Who Qualify for the Measure (Denominator) The denominator for this measure is the Number of prescriptions written for drugs requiring a prescription in order to be dispensed other than controlled substances during the performance period; or number of prescriptions written for drugs requiring a prescription in order to be dispensed during the performance period. In MicroMD EMR, all prescriptions you write count toward the denominator. You simply write prescriptions using the Prescription Pad or from within an encounter on the Medications tab. The Date Created on the prescription should fall within the reporting period. Patients Who Meet the Measure (Numerator) The numerator for this measure is The number of prescriptions in the denominator generated, queried for a drug formulary, and transmitted electronically using CEHRT. In MicroMD EMR, all of your electronic prescriptions count toward your numerator for this ACI Objective Measure. The system automatically queries drug formulary for you based on the patient s insurance and displays the information for you. EPCS prescribers have the option in this measure to include electronic prescriptions of controlled substances in their performance. Be sure to add the Include EPCS as permissible user function to the EPCS provider s user account in the MicroMD EMR Manager. Please see the main MicroMD EMR User s Reference Manual for details on using the Electronic Prescription module. MicroMD EMR Objective Measure Calculations Manual: Performance Year

28 Chapter 3. Advancing Care Information Objective: Health Information Exchange Objective: Health Information Exchange There are three measures within the Health Information Exchange objective. These measures evaluate your ability to send patients to other providers and care facilities, as well as receive patients from other sources, while maintaining the patient s health data from those sources. All documentation you send out must contain as much information about the patient as possible. For example, if the patient has no known chronic problems, make sure there is a No known problem entry in their Problem List. Measure: Send a Summary of Care This ACI measure evaluates the following: For at least one transition of care or referral, the MIPS eligible clinician that transitions or refers their patient to another setting of care or health care clinician (1) creates a summary of care record using CEHRT; and (2) electronically exchanges the summary of care record. This measure is required to receive your Base Score. This measure provides you with a Performance Score up to 10% (page 1.3). Patients Who Qualify for the Measure (Denominator) The denominator for this measure is the Number of transitions of care and referrals during the performance period for which the MIPS eligible clinician was the transferring or referring clinician. In MicroMD EMR, each Transition of Care (Out) entry created in your system appears in the denominator. The provider must appear in the Sent By field for the entry; the correct department and clinic must also appear in the Department/Clinic field; and the date in the Begin Date field falls within the measurement period. You can find a list of outgoing transitions of care in the following locations: Desktop tab > My Workflow > Transition of Care Charts tab > main menu > Chart > Workflow Communication > Transition of Care You can also create a Transition of Care from within the Add Referral Order window. Simply click the Transition of Care button. 3.6 MicroMD EMR Objective Measure Calculations Manual: Performance Year 2017

29 Objective: Health Information Exchange Chapter 3. Advancing Care Information Patients Who Meet the Measure (Numerator) The numerator for this measure is The number of transitions of care and referrals in the denominator where a summary of care record was created using CEHRT and exchanged electronically. In MicroMD EMR, you must create a mail message and attach the patient's chart data to the message. From within a new mail message, you can click the Chart Data button in the ribbon bar. You can access the Mail section from your Desktop or the patient s Workflow Communication window. You can also click the Mail button on the Transition of Care window. Measure: Request/Accept Summary of Care This ACI measure evaluates the following: For at least one transition of care or referral received or patient encounter in which the MIPS eligible clinician has never before encountered the patient, the MIPS eligible clinician receives or retrieves and incorporates into the patient s record an electronic summary of care document. This measure is required to receive your Base Score. This measure provides you with a Performance Score up to 10% (page 1.3). Patients Who Qualify for the Measure (Denominator) The denominator for this measure is the Number of patient encounters during the performance period for which a MIPS eligible clinician was the receiving party of a transition or referral or has never before encountered the patient and for which an electronic summary of care record is available. In MicroMD EMR, in order for the patient to appear in the Denominator for the Receive/Accept Summary of Care objective measures, several items need to be in place: You must first create a Transition of Care (In) entry in the patient s chart. The provider must appear in the Received By field for the entry. The correct department and clinic must appear in the Department/Clinic field. The date in the Begin Date field must fall within the measurement period. You can enter a transition in one of the following areas: - Desktop tab > My Workflow > Transition of Care - Charts tab > main menu > Chart > Workflow Communication > Transition of Care - Medical Information tab > Miscellaneous > Transition of Care In You can also create a Transition of Care from within the Referral-in Order window. Simply click the Transition of Care button. MicroMD EMR Objective Measure Calculations Manual: Performance Year

30 Chapter 3. Advancing Care Information Objective: Health Information Exchange You must then request and receive the patient s CDA from the transitioning physician or facility. Once you receive the patient s CDA, either through mail or import that CDA into the patient s chart, the Summary of Care Status drop-down must be set to Received. You must be sure to select the appropriate Transition of Care entry when importing the patient s CDA. MicroMD EMR can detect if you have received the patient's CDA through the Surescripts Clinical Interoperability Network (CIN) or if you have already imported the document. The system changes the Summary of Care Status drop-down automatically to Received. Do not change the Summary of Care Status drop-down manually. The transition will not count for the measure if you do. You must create an encounter and link it to the Transition of Care (In) entry. There is a dropdown on the Encounter Header called Transition of Care (if applicable). If there is only a single Transition of Care (In) entry for that patient, the system automatically defaults to that entry. Patients Who Meet the Measure (Numerator) The numerator for this measure is the Number of patient encounters in the denominator where an electronic summary of care record received is incorporated by the clinician into the CEHRT. Once you receive the patient s CDA, in order to the include that patient in the Numerator, you must incorporate the data from the imported file into their chart. To do this, you must be sure to perform the following: Open the Transition of Care (In) entry and click the Import C-CDA/CCR/CCD button on the Transition of Care (In) window. From within the encounter, you can get to the list of incoming Transitions of Care for the patient using the Medical Info button in the Encounter Ribbon. Click Miscellaneous and choose Transition of Care In from the available options. On the Data Reconciliation window that opens, be sure to select the appropriate transition from the Transition of Care drop-down (if it isn t already selected). Select the appropriate CDA from the drop-down and click the Load button. Review the data from the file and add any data you want to incorporate into the patient s chart. Once you click the Apply button, you have incorporated the data into the patient's chart and the patient should appear in the Numerator. 3.8 MicroMD EMR Objective Measure Calculations Manual: Performance Year 2017

31 Objective: Health Information Exchange Chapter 3. Advancing Care Information Verify the Summary of Care Status drop-down on the Transition of Care (In) window is set to Incorporated and click OK. Measure: Clinical Information Reconciliation This ACI measure evaluates the following: For at least one transition of care or referral received or patient encounter in which the MIPS eligible clinician has never before encountered the patient, the MIPS eligible clinician performs clinical information reconciliation. The MIPS eligible clinician must implement clinical information reconciliation for the following three clinical information sets: (1) Medication. Review of the patient s medication, including the name, dosage, frequency, and route of each medication. (2) Medication allergy. Review of the patient s known medication allergies. (3) Current Problem list. Review of the patient s current and active diagnoses. This measure provides you with a Performance Score up to 10% (page 1.3). Patients Who Qualify for the Measure (Denominator) The denominator for this measure is the Number of transitions of care or referrals during the performance period for which the MIPS eligible clinician was the recipient of the transition or referral or has never before encountered the patient. In MicroMD EMR, each Transition of Care (In) entry created for the patient appears in the denominator. The provider must appear in the Received By field for the entry; the correct department and clinic must also appear in the Department/Clinic field; and the date in the Begin Date field must fall within the measurement period. You can find a list of incoming transitions of care in the following locations: Desktop tab > My Workflow > Transition of Care Charts tab > main menu > Chart > Workflow Communication > Transition of Care Medical Information tab > Miscellaneous > Transition of Care In You can create a Transition of Care from within the Referral-in Order window. Simply click the Transition of Care button. Patients Who Meet the Measure (Numerator) The numerator for this measure is The number of transitions of care or referrals in the denominator where the following three clinical information reconciliations were performed: Medication list, medication allergy list, and current problem list. In MicroMD EMR, you must perform this reconciliation from the Data Reconciliation window. The measure requires that you compare two sources of information: the patient s chart and another source. That source can be an imported CDA, or that source can be the patient sitting in front of you. MicroMD EMR Objective Measure Calculations Manual: Performance Year

32 Chapter 3. Advancing Care Information Objective: Patient Electronic Access You can access the Data Reconciliation window from one of the following locations: Transition of Care (In) Window: When you click the Import C-CDA/CCR/CCD button on the Transition of Care (In) window, the system opens the Data Reconciliation window. You can find the Transition of Care (In) window from one of the following locations: - Desktop tab > My Workflow > Transition of Care - Charts tab > main menu > Chart > Workflow Communication > Transition of Care - Medical Information tab > Miscellaneous > Transition of Care In You can create a Transition of Care from within the Referral-in Order window. Simply click the Transition of Care button. Open the patient s chart > Chart menu > Export/Import Chart (C-CDA/CCR/CCD) > Import Once you are on the Data Reconciliation window, make sure you have the correct transition selected in the Transition of Care drop-down. At this point, if you need to import the CDA, you can. To review the information, click the Review button in the Medication, Medication Allergies, and Problem List headers in the Current MedInfo pane to receive credit for reviewing the patient s information. Be sure to click the Apply button to commit your actions. If you have the Apply auto-review on medical information user preference set to Yes (under Tools > User Preferences > Medical Information), MicroMD EMR does not display the Reviewed button. When you stay on the window for the amount of time you set in your preferences, the system automatically marks the lists as reviewed for you. Objective: Patient Electronic Access The measures within this objective evaluate your patient s access to their electronic health information and whether you provide patient-specific education materials. Measure: Provide Patient Access This ACI measure evaluates the following: For at least one unique patient seen by the MIPS eligible clinician: (1) The patient (or the patientauthorized representative) is provided timely access to view online, download, and transmit his or her health information; and (2) The MIPS eligible clinician ensures the patient's health information is available for the patient (or patient-authorized representative) to access using any application of their choice that is configured to meet the technical specifications of the Application Programing Interface (API) in the MIPS eligible clinician's CEHRT. This measure is required to receive your Base Score MicroMD EMR Objective Measure Calculations Manual: Performance Year 2017

33 Objective: Patient Electronic Access Chapter 3. Advancing Care Information This measure provides you with a Performance Score up to 10% (page 1.3). In order to track data for this measure, the practice must use the MicroMD Patient Portal. Please contact your local authorized MicroMD reseller for purchasing and setup information. Patients Who Qualify for the Measure (Denominator) The denominator for this measure is The number of unique patients seen by the MIPS eligible clinician during the performance period. In MicroMD EMR, a patient must have an encounter created in MicroMD EMR where the Service Date on the encounter falls within the measurement period. You can find a list of an individual patient s encounters in the patient s chart on the Summary tab in the EMR. Patients Who Meet the Measure (Numerator) The numerator for this measure is The number of patients in the denominator (or patient authorized representative) who are provided timely access to health information to view online, download, and transmit to a third party and to access using an application of their choice that is configured meet the technical specifications of the API in the MIPS eligible clinician's CEHRT. In MicroMD EMR, the numerator reflects the number of patients within the denominator for whom your practice has published information to the patient through the Patient Portal within 48 hours of the item s entry or edit in the patient s chart. You can provide the patient with their electronic chart information in one of the following ways: Publishing the Patient s C-CDA/CCR/CCD: You can publish the patient s electronic chart from within their chart in the main menu under Chart > Export/Import Chart (C-CDA/CCR/CCD) > Publish. Provide Access through the MicroMD API: When using the MicroMD EMR API, practices create accounts for their patients to access data from the EMR. Patients always have access to their information so those patients automatically count in the Numerator. For API purchasing and setup information, please contact Henry Schein Medical Systems. Portal Updates: The Portal Updates section of the Desktop populates automatically when providers add or change information in the patient's chart that requires an update to the patient s portal account. When a user selects the patient(s) and clicks the Queue CDA button, MicroMD EMR Objective Measure Calculations Manual: Performance Year

34 Chapter 3. Advancing Care Information Objective: Patient Electronic Access the system processes all of the selected updates. Once complete, the patient(s) counts for the Numerator of this measure. Although you choose sections to release to the Patient Portal and make visible to the patient, choosing individual sections is not compliant with using the EMR in a meaningful way. Please refer to the MicroMD Patient Portal Guide for details on publishing patient information. Measure: Patient-Specific Education This ACI measure evaluates the following: The MIPS eligible clinician must use clinically relevant information from CEHRT to identify patient-specific educational resources and provide electronic access to those materials to at least one unique patient seen by the MIPS eligible clinician. This measure provides you with a Performance Score up to 10% (page 1.3). Patients Who Qualify for the Measure (Denominator) The denominator for this measure is The number of unique patients seen by the MIPS eligible clinician during the performance period. In MicroMD EMR, a patient must have an encounter created in MicroMD EMR where the Service Date on the encounter falls within the measurement period. You can find a list of an individual patient s encounters in the patient s chart on the Summary tab in the EMR. Patients Who Meet the Measure (Numerator) The numerator for this measure is The number of patients in the denominator who were provided electronic access to patient-specific educational resources using clinically relevant information identified from CEHRT during the performance period. In MicroMD EMR, the numerator reflects the number of patients from within the denominator for whom you have added patient education to their chart using the information bubble icon ( ) in one of the following locations: Encounter > Assessment tab Medical Information tab > Medical > Problem List Encounter > Plan tab > Labs tab > when adding a diagnosis to the laboratory order Encounter > Bill Builder window > Patient Education (based on Assessment tab) Encounter > Medication tab 3.12 MicroMD EMR Objective Measure Calculations Manual: Performance Year 2017

35 Objective: Patient Electronic Access Chapter 3. Advancing Care Information Medical Information tab > Medical > Medications The system adds a link for the education materials (if available) to the patient s electronic chart when you publish to their Patient Portal account. MicroMD EMR also includes in the Numerator those patients for whom you have published patient education from within the Patient Portal where the published date on that education is after the published date of the first instance of patient education during the measurement period. MicroMD EMR Objective Measure Calculations Manual: Performance Year

36 Chapter 3. Advancing Care Information Objective: Protect Patient Health Information Objective: Protect Patient Health Information There is only a single measure for this objective: Security Risk Analysis. For this objective measure, you must: Conduct or review a security risk analysis in accordance with the requirements in 45 CFR (a)(1), including addressing the security (to include encryption) of ephi data created or maintained by CEHRT in accordance with requirements in 45 CFR (a)(2)(iv) and 45 CFR (d)(3), implement security updates as necessary, and correct identified security deficiencies as part of the MIPS eligible clinician s risk management process. This measure is required to receive your Base Score. The Security Risk Analysis measure is attestation-only. If you do not perform this measure and attest to it, your Base Score for the measure will be zero. Since your Base Score is zero, your Advancing Care Information category score is automatically zero, which affects your overall MIPS score. Please see page 1.2 for more details on scoring. MicroMD EMR is only part of your compliance with this measure. For details on the security features in MicroMD, please visit the MicroMD Lounge at You can also contact your local authorized MicroMD reseller for details on the security features within MicroMD. We recommend the following resources as you learn more about the Security Risk Analysis: U.S. Department of Health and Human Services - The Security Rule web page: - Breach Notification Rule web page: National Institute of Standards and Technology - HIPAA Security Rule Toolkit User Guide : - HIPAA Security Rule Toolkit Download : Federal Trade Commission - Complying with the FTC's Health Breach Notification Rule web page: MicroMD EMR Objective Measure Calculations Manual: Performance Year 2017

37 Objective: Public Health and Clinical Data Registry Reporting Chapter 3. Advancing Care Information Objective: Public Health and Clinical Data Registry Reporting The measures within this objective evaluate if the provider is in active engagement with public health agencies or clinical data registries and whether the provider reports immunization history, syndromic surveillance data, and/or electronic case information. All of the measures within this objective are attestationonly. You simply provide a Yes or No answer. Active engagement for this objective means that the provider is somewhere in the process of testing and sending production data to a public health agency (PHA) or clinical data registry (CDR), depending on the measure, or is currently sending production data to a PHA or CDR. There are three levels of active engagement from the Centers for Medicare and Medicaid that demonstrate the Eligible Clinician s compliance with each of the measures in this objective: Active Engagement Option 1 Completed Registration to Submit Data: The provider has registered with a public health agency or clinical data registry (depending on the measure) to submit data. This registration must be completed within 60 days after the start of the EHR reporting period. In this option, the provider is waiting for an invitation to send test data. You do not have to re-submit a registration if you are already registered and waiting for testing. Active Engagement Option 2 Testing and Validation: This level means that the provider is currently testing and validating the data submission. The provider must respond to any questions or requests from the public health agency or clinical data registry (depending on the measure) within 30 days, and if they fail to do so two times during the reporting period, the provider will not meet the measure. Active Engagement Option 3 Production: At this active engagement level, the provider has completed all of the testing and is now submitting their electronic data to the public health agency or clinical data registry (depending on the measure). Measure: Immunization Registry Reporting This ACI measure evaluates the following: The MIPS eligible clinician is in active engagement with a public health agency to submit immunization data and receive immunization forecasts and histories from the public health immunization registry/immunization information system (IIS). This measure provides you with a Performance Score of either 0 (if you attest No ) or 10% (if you attest yes ). See page 1.2 for more details on scoring. MicroMD EMR Objective Measure Calculations Manual: Performance Year

38 Chapter 3. Advancing Care Information Objective: Public Health and Clinical Data Registry Reporting In order to submit registry reporting through the EMR, you must use the appropriate state-specific immunization registry interface. Please contact your local authorized MicroMD reseller for purchasing and setup information. Once you have the interface installed, set up, tested and finally in production, the submission is typically automatic to the registries (depending on the interface). You can manage your immunization files from the Administrative Panel of the Desktop. Find the Immunization Monitoring in the following location: Desktop tab > Administration button > Administrative Panel > Immunization Monitoring Measure: Syndromic Surveillance Reporting This ACI measure evaluates the following: The MIPS eligible clinician is in active engagement with a public health agency to submit syndromic surveillance data from a non-urgent care ambulatory setting where the jurisdiction accepts syndromic data from such settings and the standards are clearly defined. This measure is one of the measures that can provide you with the single Bonus Score of 5% (page 1.4). In order to submit registry reporting through the EMR, you must use the appropriate interface. Please contact your local authorized MicroMD reseller for purchasing and setup information. Once you have the interface installed, set up, tested and finally in production, you can submit your surveillance files from the Administrative Panel of the Desktop. Find the Surveillance Monitoring in the following location: Desktop tab > Administration button > Administrative Panel > Surveillance Monitoring You can also export a file from the MicroMD EMR Manager in the following location: Communication > Health Surveillance > Export Now button Measure: Electronic Case Reporting This ACI measure evaluates the following: The MIPS eligible clinician is in active engagement with a public health agency to electronically submit case reporting of reportable conditions. This measure is one of the measures that can provide you with the single Bonus Score of 5% (page 1.4). MicroMD EMR does not provide support for this measure at this time MicroMD EMR Objective Measure Calculations Manual: Performance Year 2017

39 Objective: Public Health and Clinical Data Registry Reporting Chapter 3. Advancing Care Information Measure: Public Health Registry Reporting This ACI measure evaluates the following: The MIPS eligible clinician is in active engagement with a public health agency to submit data to public health registries. This measure is one of the measures that can provide you with the single Bonus Score of 5% (page 1.4). MicroMD EMR does not provide support for this measure at this time. Measure: Clinical Data Registry Reporting This ACI measure evaluates the following: The MIPS eligible clinician is in active engagement to submit data to a clinical data registry. This measure is one of the measures that can provide you with the single Bonus Score of 5% (page 1.4). MicroMD EMR does not provide support for this measure at this time. MicroMD EMR Objective Measure Calculations Manual: Performance Year

40 Chapter 3. Advancing Care Information Objective: Public Health and Clinical Data Registry Reporting 3.18 MicroMD EMR Objective Measure Calculations Manual: Performance Year 2017

41 Medicaid Modified Stage 2 Objectives In order to attest to the Medicaid EHR Incentive Program Modified Stage 2 Objectives and Measures, eligible professionals (EPs) must use MicroMD EMR Version 13.5, which is certified to the 2015 Edition of the Health Information Technology Certification Criteria. According to CMS: All providers who have not successfully demonstrated meaningful use in a prior year and are seeking to demonstrate meaningful use for the first time in 2017 to avoid the 2018 payment adjustment must attest to Modified Stage 2 objectives and measures. Objective 1: Protect Patient Health Information Objective 1 requires that you Protect electronic protected health information (ephi) created or maintained by the CEHRT through the implementation of appropriate technical capabilities. To measure your compliance with this objective, CMS requires that you Conduct or review a security risk analysis in accordance with the requirements in 45 CFR (a)(1), including addressing the security (to include encryption) of ephi created or maintained by CEHRT in accordance with requirements under 45 CFR (a)(2)(iv) and 45 CFR (d)(3), and implement security updates as necessary and correct identified security deficiencies as part of the EP s risk management process. The Security Risk Analysis measure is attestation-only. MicroMD EMR is only part of your compliance with this measure. For details on the security features in MicroMD, please visit the MicroMD Lounge at You can also contact your local authorized MicroMD reseller for details on the security features within MicroMD. We also recommend the following resources as you learn more about the Security Risk Analysis: U.S. Department of Health and Human Services - The Security Rule web page: - Breach Notification Rule web page: National Institute of Standards and Technology - HIPAA Security Rule Toolkit User Guide : - HIPAA Security Rule Toolkit Download : MicroMD EMR Objective Measure Calculations Manual: Performance Year

42 Chapter 4. Medicaid Modified Stage 2 Objectives Objective 2: Clinical Decision Support Federal Trade Commission - Complying with the FTC's Health Breach Notification Rule web page: Objective 2: Clinical Decision Support Objective 2 requires that you Use clinical decision support to improve performance on high-priority health conditions. To measure your compliance with this objective, CMS has outlined two separate measures and eligible professionals must satisfy both measures to meet the objective. The measures within the Clinical Decision Support Objective are attestation-only (i.e., a yes or no answer). MicroMD EMR does not track your performance. Measure 1 (Implement Decision Support Rules) For Measure 1 of this objective, CMS requires that providers: Implement five clinical decision support interventions related to four or more clinical quality measures at a relevant point in patient care for the entire EHR reporting period. Absent four clinical quality measures related to an EP s scope of practice or patient population, the clinical decision support interventions must be related to high-priority health conditions. You can review the history of rules applied to a patient s chart in the CDS History section (on the Medical Information tab under Miscellaneous). In MicroMD EMR, you can implement rules that appear throughout the system using the Rule Manager (under Tools > Rule Manager in the main menu). Please refer to the main MicroMD EMR User s Reference Manual for more details on the Rule Manager. Measure 2 (Enable and Implement Drug Interaction Checks) For Measure 2 of this objective, CMS requires that providers The EP has enabled and implemented the functionality for drug-drug and drug-allergy interaction checks for the entire EHR reporting period. In MicroMD EMR, make sure you are a Surescripts provider. Drug-to-drug and drug-to-allergy interaction checks are part of the MicroMD EMR electronic prescribing functionality. Your practice controls the alerts that display from the MicroMD EMR Manager, and if you have the appropriate user permission on your user account, you can set the level of alerts that appear for you personally under Tools > User Preferences > Prescriptions. 4.2 MicroMD EMR Objective Measure Calculations Manual: Performance Year 2017

43 Objective 3: Computerized Provider Order Entry (CPOE) Chapter 4. Medicaid Modified Stage 2 Objectives If you write fewer than 100 medication orders during the reporting period, you can take an exclusion for this Measure 2. Please refer to the main MicroMD EMR User s Reference Manual for more details on the Prescription Module. Objective 3: Computerized Provider Order Entry (CPOE) Objective 3 requires that you Use computerized provider order entry for medication, laboratory, and radiology orders directly entered by any licensed healthcare professional who can enter orders into the medical record per state, local, and professional guidelines. To measure your compliance with this objective, CMS has outlined three separate measures, and you must satisfy ALL THREE measures for this objective, either with performance or with an exclusion. Within MicroMD EMR, your Reached percentage for each measure will always be 100% since there is no other way to enter an order except through the application. If you write fewer than 100 medication orders, fewer than 100 laboratory orders, and/or fewer than 100 radiology orders during the reporting period, you can take an exclusion for the related measure. Measure 1 (CPOE - Medication Order) For Measure 1 of this objective, CMS requires that More than 60 percent of medication orders created by the EP during the EHR reporting period are recorded using computerized provider order entry. Patients Who Qualify for the Measure (Denominator) The denominator for this measure is the Number of medication orders created by the EP during the EHR reporting period. In MicroMD EMR, the denominator displays the number of prescriptions written in the system where the date the prescription was written falls within the date range you selected in the Date Range fields on the Stage Two Modified Report window. You can find the Date column in the Change History of the prescription when you right-click the prescription and select Change History [This Entry] from the pop-up menu: Desktop > Prescriptions Medical Information tab > Medical > Medications MicroMD EMR Objective Measure Calculations Manual: Performance Year

44 Chapter 4. Medicaid Modified Stage 2 Objectives Objective 3: Computerized Provider Order Entry (CPOE) Medical Information tab > Orders > Referral Orders For referral orders, be sure you have a check mark next to Include Referral Orders in MU CPOE in the MicroMD EMR Manager (under System Settings > Practice Settings). Patients Who Meet the Measure (Numerator) The numerator for this measure is the The number of orders in the denominator recorded using CPOE. In MicroMD EMR, the numerator will always match the denominator since the only way to enter a prescription is through the application. 4.4 MicroMD EMR Objective Measure Calculations Manual: Performance Year 2017

45 Objective 3: Computerized Provider Order Entry (CPOE) Chapter 4. Medicaid Modified Stage 2 Objectives Measure 2 (CPOE - Laboratory Order) For Measure 2, CMS requires that More than 30 percent of laboratory orders created by the EP during the EHR reporting period are recorded using computerized provider order entry. Patients Who Qualify for the Measure (Denominator) The denominator for this measure is the Number of laboratory orders created by the EP during the EHR reporting period. In MicroMD EMR, the denominator displays the number of laboratory orders whose Recorded On date falls within the date range you selected in the Date Range fields on the Stage Two Modified Report window. You can find the Recorded On date in the yellow notes area for the order or in the Date column when you right-click the order and select Change History [This Entry]: Desktop > Orders Medical Information tab > Orders > Laboratory Orders Medical Information tab > Orders > Referral Orders For referral orders, be sure you have a check mark next to Include Referral Orders in MU CPOE in the MicroMD EMR Manager (under System Settings > Practice Settings). Patients Who Meet the Measure (Numerator) The numerator for this measure is the The number of orders in the denominator recorded using CPOE. In MicroMD EMR, the numerator will always match the denominator since the only way to enter a laboratory order is through the application. Measure 3 (CPOE - Radiology Order) For Measure 3, CMS requires that More than 30 percent of radiology orders created by the EP during the EHR reporting period are recorded using computerized provider order entry. Patients Who Qualify for the Measure (Denominator) The denominator for this measure is the Number of radiology orders created by the EP during the EHR reporting period. In MicroMD EMR, the denominator displays the number of radiology orders whose Recorded On date falls within the date range you selected in the Date Range fields on the Stage Two Modified Report window. You can find the Recorded On date in the yellow notes area for the order or in the Date column when you right-click the order and select Change History [This Entry]: Desktop > Orders MicroMD EMR Objective Measure Calculations Manual: Performance Year

46 Chapter 4. Medicaid Modified Stage 2 Objectives Objective 4: Electronic Prescribing (erx) Medical Information tab > Orders > Procedure Orders The radiology order must use a procedure code within the range of through Medical Information tab > Orders > Referral Orders For referral orders, be sure you have a check mark next to Include Referral Orders in MU CPOE in the MicroMD EMR Manager (under System Settings > Practice Settings). Patients Who Meet the Measure (Numerator) The numerator for this measure is the The number of orders in the denominator recorded using CPOE. In MicroMD EMR, the numerator will always match the denominator since the only way to enter a radiology order is through the application. Objective 4: Electronic Prescribing (erx) Objective 4 requires that you Generate and transmit permissible prescriptions electronically (erx). To measure your compliance with this objective, CMS requires that More than 50 percent of permissible prescriptions written by the EP are queried for a drug formulary and transmitted electronically using CEHRT. Your Reached percentage (numerator over denominator) must be more than 50% to meet this measure. The patient must have at least one encounter with a Service Date that falls within the date range selected in the Date Range fields on the Stage Two Modified Report window to be included in this Objective Measure. If a specific provider appears in the Provider drop-down of the Stage Two Modified Report window, MicroMD EMR only counts prescriptions if the prescribing provider had an encounter with the selected patient during the date range selected in the Date Range fields on the Stage Two Modified Report window. 4.6 MicroMD EMR Objective Measure Calculations Manual: Performance Year 2017

47 Objective 4: Electronic Prescribing (erx) Chapter 4. Medicaid Modified Stage 2 Objectives Permissible prescriptions in MicroMD EMR includes all prescriptions that can be sent through the Surescripts network electronically. EPCS providers have the option to include electronic prescriptions of controlled substances in their performance. Be sure there is a check mark in the Include EPCS as permissible user function (which is checked by default) on the EPCS provider s user account in the MicroMD EMR Manager. If you prescribe fewer than 100 permissible prescriptions during the reporting period, you can take an exclusion for this measure. You can also take an exclusion if you do not have a pharmacy within 10 miles of your practice that accepts electronic prescriptions, and you have no pharmacy within your organization. Patients Who Qualify for the Measure (Denominator) The denominator for this measure is the Number of permissible prescriptions written during the EHR reporting period for drugs requiring a prescription in order to be dispensed. This measure includes in the denominator ALL prescriptions written by the eligible professional, regardless if the prescription was handwritten or sent electronically. In MicroMD EMR, the denominator displays the number of prescriptions written in the system where the date the prescription was written falls within the date range you selected in the Date Range fields on the Stage Two Modified Report window. You can find the Date column in the Change History of the prescription when you right-click the prescription and select Change History [This Entry] from the pop-up menu: Desktop > Prescriptions Medical Information tab > Medical > Medications Patients Who Meet the Measure (Numerator) The numerator for this measure is The number of prescriptions in the denominator generated, queried for a drug formulary, and transmitted electronically using CEHRT. MicroMD EMR Objective Measure Calculations Manual: Performance Year

48 Chapter 4. Medicaid Modified Stage 2 Objectives Objective 5: Health Information Exchange In MicroMD EMR, all prescriptions that you process electronically (click Send on the Prescription Processor window) count toward your numerator for this Objective Measure. The system automatically queries drug formulary for you based on the patient s insurance and displays the information for you. Please see the main MicroMD EMR User s Reference Manual for details on Electronic Prescriptions. Objective 5: Health Information Exchange Objective 5 requires that The EP who transitions their patient to another setting of care or provider of care or refers their patient to another provider of care provides a summary care record for each transition of care or referral. To measure your compliance with this objective, CMS requires that The EP that transitions or refers their patient to another setting of care or provider of care must (1) use CEHRT to create a summary of care record; and (2) electronically transmit such summary to a receiving provider for more than 10 percent of transitions of care and referrals. Your Reached percentage (numerator over denominator) must be more than 10% to meet this measure. You can take an exclusion for this measure if you have fewer than 100 transfers to another setting or referrals to another provider during the EHR reporting period. Patients Who Qualify for the Measure (Denominator) The denominator is the Number of transitions of care and referrals during the EHR reporting period for which the EP was the transferring or referring provider. In MicroMD EMR, each Transition of Care (Out) entry created in your system appears in the denominator. The provider must appear in the Sent By field for the entry; the correct department and clinic must also appear in the Department/Clinic field; and the date in the Begin Date field falls within the measurement period. You can find a list of outgoing transitions of care in the following locations: Desktop tab > My Workflow > Transition of Care Charts tab > main menu > Chart > Workflow Communication > Transition of Care You can also create a Transition of Care from within the Add Referral Order window. Simply click the Transition of Care button. Patients Who Meet the Measure (Numerator) The numerator is The number of transitions of care and referrals in the denominator where a summary of care record was created using CEHRT and exchanged electronically. In MicroMD EMR, you must do the following to meet the requirements of the numerator: 4.8 MicroMD EMR Objective Measure Calculations Manual: Performance Year 2017

49 Objective 6: Patient-Specific Education Chapter 4. Medicaid Modified Stage 2 Objectives Export the C-CDA/CCR/CCD: You can export the patient s C-CDA/CCR/CCD when you create the Transition of Care. Be sure to click the Export C-CDA/CCR/CCD button on the Transition of Care (Out) window. Mail the Exported Chart: Once you export the patient s chart, you need to create a mail message and attach the files. On the Transition of Care window, you can click the Mail button. Please refer to the main MicroMD EMR User s Reference Manual for more in-depth details on Transitions of Care. Objective 6: Patient-Specific Education Objective 6 requires that the provider Use clinically relevant information from CEHRT to identify patientspecific education resources and provide those resources to the patient. To measure your compliance with this objective, CMS requires that Patient-specific education resources identified by CEHRT are provided to patients for more than 10 percent of all unique patients with office visits seen by the EP during the EHR reporting period. Your Reached percentage (numerator over denominator) must be more than 10% to meet this measure. You can take an exclusion for these measures if you have no office visits during the reporting period. Patients Who Qualify for the Measure (Denominator) The denominator for this measure is the Number of unique patients with office visits seen by the EP during the EHR reporting period. In MicroMD EMR, a patient must have an encounter created in MicroMD EMR where the Service Date on the encounter falls within the measurement period. You can find a list of an individual patient s encounters in the patient s chart on the Summary tab in the EMR. Patients Who Meet the Measure (Numerator) The numerator is the Number of patients in the denominator who were provided patient-specific education resources identified by the CEHRT. In MicroMD EMR, the patient s encounter from the denominator must have an entry on the Plan tab of the encounter that indicates Patient Education was provided to the patient during the visit. MicroMD EMR comes built with education associated with many diagnoses. You can also associate documentation to any diagnosis as you prefer. The system also contains rules you can create to access specific patient education materials and automatically pop-up an alert for you. You can provide education materials to the patient from the following locations: Within an encounter > Administration tab > Patient Education Desktop Tools > Patient Education Chart Tools > Patient Education MicroMD EMR Objective Measure Calculations Manual: Performance Year

50 Chapter 4. Medicaid Modified Stage 2 Objectives Objective 7: Medication Reconciliation Medical Information tab > Miscellaneous > Patient Education Please refer to the main MicroMD EMR User s Reference Manual for more details on using these features. Objective 7: Medication Reconciliation Objective 7 requires that The EP who receives a patient from another setting of care or provider of care or believes an encounter is relevant performs medication reconciliation. To measure your compliance with this objective, CMS requires that The EP performs medication reconciliation for more than 50 percent of transitions of care in which the patient is transitioned into the care of the EP. Your Reached percentage (numerator over denominator) must be more than 50% to meet this measure. You can take an exclusion for this measure if you did not receive any transitions of care during the EHR reporting period. Patients Who Qualify for the Measure (Denominator) The denominator is the Number of transitions of care during the EHR reporting period for which the EP was the receiving party of the transition. In MicroMD EMR, each Transition of Care (In) entry created for the patient appears in the Denominator for each of these measures. The provider must appear in the Received By field for the entry; the correct department and clinic must also appear in the Department/Clinic field; and the date in the Begin Date field must fall within the measurement period. You can find a list of incoming transitions of care in the following locations: Desktop tab > My Workflow > Transition of Care Charts tab > main menu > Chart > Workflow Communication > Transition of Care Medical Information tab > Miscellaneous > Transition of Care In You can also create a Transition of Care from within the Referral-in Order window. Simply click the Transition of Care button. Patients Who Meet the Measure (Numerator) The numerator for this objective is The number of transitions of care in the denominator where medication reconciliation was performed. In MicroMD EMR, you must perform this reconciliation from the Data Reconciliation window. You can access the Data Reconciliation window from one of the following locations: 4.10 MicroMD EMR Objective Measure Calculations Manual: Performance Year 2017

51 Objective 8: Patient Electronic Access Chapter 4. Medicaid Modified Stage 2 Objectives Transition of Care (In) Window: When you click the Import C-CDA/CCR/CCD button on the Transition of Care (In) window, the system opens the Data Reconciliation window. You can find the Transition of Care (In) window from one of the following locations: - Desktop tab > My Workflow > Transition of Care - Charts tab > main menu > Chart > Workflow Communication > Transition of Care - Medical Information tab > Miscellaneous > Transition of Care In You can create a Transition of Care from within the Referral-in Order window. Simply click the Transition of Care button. Open the patient s chart > Chart menu > Export/Import Chart (C-CDA/CCR/CCD) > Import Make sure you have the correct transition selected in the Transition of Care drop-down. Click the Review button in the Medication header in the Current MedInfo pane to receive credit for reviewing the patient s information. Be sure to click the Apply button to commit your actions. If you have the Apply auto-review on medical information user preference set to Yes (under Tools > User Preferences > Medical Information), MicroMD EMR does not display the Reviewed button. When you stay on the window for the amount of time you set in your preferences, the system automatically marks the lists as reviewed for you. Objective 8: Patient Electronic Access Objective 8 requires that the eligible professional Provide patients the ability to view online, download, and transmit their health information within 4 business days of the information being available to the EP. To measure your compliance with this objective, CMS has outlined two separate measures and eligible professionals must satisfy both measures to meet the objective. In order to track data for the measures of this objective, the practice must use the MicroMD Patient Portal, as well as a direct address through Surescripts Clinical Interoperability Network (CIN). Please contact your local authorized MicroMD reseller for purchasing and setup information. Measure 1 (Patient Electronic Access) The first measure of compliance with this objective requires that More than 50 percent of all unique patients seen by the EP during the EHR reporting period are provided timely access to view online, MicroMD EMR Objective Measure Calculations Manual: Performance Year

52 Chapter 4. Medicaid Modified Stage 2 Objectives Objective 8: Patient Electronic Access download, and transmit to a third party their health information subject to the EP s discretion to withhold certain information. You can also take an exclusion for this measure if you neither order nor create any of the information required for this measure, except the patient s name and the provider s name and contact information. You can also take an exclusion if the housing in your county does not have 4Mbps broadband availability. Please see the CMS web site for more details on this exclusion. Patients Who Qualify for the Measure (Denominator) The denominator for this measure is the Number of unique patients seen by the EP during the EHR reporting period. In MicroMD EMR, a patient must have an encounter created in MicroMD EMR where the Service Date on the encounter falls within the measurement period. You can find a list of an individual patient s encounters in the patient s chart on the Summary tab in the EMR. Patients Who Meet the Measure (Numerator) The numerator for this measure is The number of patients in the denominator who have access to view online, download and transmit their health information within 4 business days after the information is available to the EP. In MicroMD EMR, the numerator reflects the number of patients within the denominator for whom your practice has published information to the patient through the Patient Portal within four business days of the item s entry or edit in the patient s chart. You must re-publish the patient s information to the Patient Portal whenever there are changes to the following information: Provider s name and office contact information (MicroMD EMR Manager) Demographics (Demographics tab > Personal Details) Immunizations (Medical Information tab > Health Maintenance > Immunizations) Laboratory Results (Medical Information tab > Medical > Laboratory Results) Laboratory Tests (Medical Information tab > Orders > Laboratory Orders) Medication Allergies (Medical Information tab > Medical > Allergies) Medications (Medical Information tab > Medical > Medications) Problem List (Medical Information tab > Medical > Problem List) Procedures (Medical Information tab > Medical > Medications) Smoking Status (Medical Information tab > Histories > Habits) Social History (Medical Information tab > Histories > Social History) Vital Signs (Medical Information tab > Medical > Vital Signs) You can provide updates to the Patient Portal in the following ways: 4.12 MicroMD EMR Objective Measure Calculations Manual: Performance Year 2017

53 Objective 8: Patient Electronic Access Chapter 4. Medicaid Modified Stage 2 Objectives Publishing the Patient s C-CDA/CCR/CCD: You can publish the patient s electronic chart from within their chart in the main menu under Chart > Export/Import Chart (C-CDA/CCR/CCD) > Export. You can also right-click in any of the sections above and select Queue or Publish from the pop-up menu. Portal Updates: Any time your practice wants to send information to the patient s chart, you can add the information to the Portal Updates section of the Desktop in MicroMD EMR. Please refer to the MicroMD Patient Portal Guide for more details on publishing patient information. Measure 2 (View, Download, and Transmit) The second measure of compliance with the objective requires that For an EHR reporting period in 2017, more than 5 percent of unique patients seen by the EP during the EHR reporting period (or his or her authorized representatives) view, download or transmit to a third party their health information during the EHR reporting period. Patients Who Qualify for the Measure (Denominator) The denominator for the measure is the Number of unique patients seen by the EP during the EHR reporting period. In MicroMD EMR, a patient must have an encounter created in MicroMD EMR where the Service Date on the encounter falls within the measurement period. You can find a list of an individual patient s encounters in the patient s chart on the Summary tab in the EMR. Patients Who Meet the Measure (Numerator) The numerator for the measure is The number of patients in the denominator who view, download, or transmit to a third party their health information. In MicroMD EMR, the numerator reflects the number of patients within the denominator who have accessed the electronic chart document that you uploaded to their Patient Portal account. The patient must access the Records tab of their Patient Portal account and click either the View button, one of the Download buttons, or the Transmit button. To meet this measure, you must first provide the patient with their electronic chart information in one of the following ways: Publishing the Patient s C-CDA/CCR/CCD: You can publish the patient s electronic chart from within their chart in the main menu under Chart > Export/Import Chart (C-CDA/CCR/CCD) > Publish. Portal Updates: The Portal Updates section of the Desktop populates automatically when providers add or change information in the patient's chart that requires an update to the patient s portal account. When a user selects the patient(s) and clicks the Queue CDA button, MicroMD EMR Objective Measure Calculations Manual: Performance Year

54 Chapter 4. Medicaid Modified Stage 2 Objectives Objective 8: Patient Electronic Access the system processes all of the selected updates. Once complete, the patient(s) counts for the Numerator of this measure. Although you choose sections to release to the Patient Portal and make visible to the patient, choosing individual sections is not compliant with using the EMR in a meaningful way. Please refer to the MicroMD Patient Portal Guide for details on publishing patient information MicroMD EMR Objective Measure Calculations Manual: Performance Year 2017

55 Objective 9: Secure Electronic Messaging Chapter 4. Medicaid Modified Stage 2 Objectives Objective 9: Secure Electronic Messaging Objective 9 requires that eligible professionals Use secure electronic messaging to communicate with patients on relevant health information. To measure your compliance with this objective, CMS requires that For an EHR reporting period in 2017, for more than 5 percent of unique patients seen by the EP during the EHR reporting period, a secure message was sent using the electronic messaging function of CEHRT to the patient (or the patientauthorized representative), or in response to a secure message sent by the patient (or the patientauthorized representative) during the EHR reporting period. Your Reached percentage (numerator over denominator) must be more than 5% to meet this measure. You can take an exclusion for these measures if you have no office visits during the measurement period, or if the housing in your county does not have 4Mbps broadband availability. Please see the CMS web site for more details on this exclusion. Patients Who Qualify for the Measure (Denominator) The denominator for this measure is Number of unique patients seen by the EP during the EHR reporting period. In MicroMD EMR, a patient must have an encounter created in MicroMD EMR where the Service Date on the encounter falls within the measurement period. You can find a list of an individual patient s encounters in the patient s chart on the Summary tab in the EMR. Patients Who Meet the Measure (Numerator) The numerator for the measure is The number of patients in the denominator for whom a secure electronic message is sent to the patient (or patient-authorized representative), or in response to a secure message sent by the patient (or patient-authorized representative). In MicroMD EMR, you simply need to respond to a patient s message through your account on the MicroMD Patient Portal; or you can send the patient a portal message from anywhere you see the Publish dropdown button (select Message Only from the drop-down button). Please refer to the MicroMD Patient Portal Guide for details on messaging. Objective 10: Public Health Reporting Objective 10 requires that The EP is in active engagement with a public health agency to submit electronic public health data from CEHRT except where prohibited and in accordance with applicable law and practice. MicroMD EMR Objective Measure Calculations Manual: Performance Year

56 Chapter 4. Medicaid Modified Stage 2 Objectives Objective 10: Public Health Reporting To measure your compliance with this objective, CMS has outlined three separate measures and eligible professionals must satisfy both measures to meet the objective. The measures within the Public Health Reporting objective are attestation-only. MicroMD EMR does not track your performance. There are several scenarios in which you can take an exclusion for any or all of the measures within this objective. Please see the Medicaid EHR Incentive Program Modified Stage 2 specification for this measure: Guidance/Legislation/EHRIncentivePrograms/Downloa ds/medicaidepstage2_obj10.pdf Measure 1 (Immunization Registry Reporting) This measure of the Public Health Reporting objective requires that The EP is in active engagement with a public health agency to submit immunization data. In order to submit registry reporting through the EMR, you must use the appropriate state-specific immunization registry interface. Please contact your local authorized MicroMD reseller for purchasing and setup information. Once you have the interface installed, set up, tested and finally in production, the submission is typically automatic to the registries (depending on the interface). You can manage your immunization files from the Administrative Panel of the Desktop. Find the Immunization Monitoring in the following location: Desktop tab > Administration button > Administrative Panel > Immunization Monitoring Measure 2 (Syndromic Surveillance Reporting) The second measure in the Public Health Reporting objective requires that The EP is in active engagement with a public health agency to submit syndromic surveillance data. In order to submit registry reporting through the EMR, you must use the appropriate interface. Please contact your local authorized MicroMD reseller for purchasing and setup information. Once you have the interface installed, set up, tested and finally in production, you can submit your surveillance files from the Administrative Panel of the Desktop. Find the Surveillance Monitoring in the following location: Desktop tab > Administration button > Administrative Panel > Surveillance Monitoring You can also export a file from the MicroMD EMR Manager in the following location: 4.16 MicroMD EMR Objective Measure Calculations Manual: Performance Year 2017

57 Objective 10: Public Health Reporting Chapter 4. Medicaid Modified Stage 2 Objectives Communication > Health Surveillance > Export Now button Measure 3 (Specialized Registry Reporting) The third measure in the Public Health Reporting objective requires that The EP is in active engagement to submit data to a specialized registry. MicroMD EMR does not provide support for this measure at this time. MicroMD EMR Objective Measure Calculations Manual: Performance Year

58 Chapter 4. Medicaid Modified Stage 2 Objectives Objective 10: Public Health Reporting *** THIS PAGE INTENTIONALLY LEFT BLANK FOR DOUBLE-SIDED PRINTING. *** 4.18 MicroMD EMR Objective Measure Calculations Manual: Performance Year 2017

59 Medicaid Stage 3 Objectives In order to attest to the Medicaid EHR Incentive Program Stage 3 Objectives and Measures, you must use MicroMD EMR Version 13.5, which is certified to the 2015 Edition of the Health Information Technology Certification Criteria. You must upgrade to the most current release of MicroMD EMR version 13.5 or higher to report on Medicaid Stage 3 objectives and measures. You cannot use version 13.0 or lower. According to CMS: All providers who have not successfully demonstrated meaningful use in a prior year and are seeking to demonstrate meaningful use for the first time in 2017 to avoid the 2018 payment adjustment must attest to Modified Stage 2 objectives and measures. Please see Chapter 5 for details on the Medicaid Modified Stage 2 Objectives and Measures. Objective 1: Protect Patient Health Information Objective 1 requires that you Protect electronic protected health information (ephi) created or maintained by the CEHRT through the implementation of appropriate technical, administrative, and physical safeguards. To measure your compliance with this objective, CMS requires that you Conduct or review a security risk analysis in accordance with the requirements under 45 CFR (a)(1), including addressing the security (including encryption) of data created or maintained by CEHRT in accordance with requirements under 45 CFR (a)(2)(iv) and 45 CFR (d)(3), implement security updates as necessary, and correct identified security deficiencies as part of the provider s risk management process. The Security Risk Analysis measure is attestation-only. MicroMD EMR is only part of your compliance with this measure. For details on the security features in MicroMD, please visit the MicroMD Lounge at You can also contact your local authorized MicroMD reseller for details on the security features within MicroMD. We also recommend the following resources as you learn more about the Security Risk Analysis: U.S. Department of Health and Human Services - The Security Rule web page: - Breach Notification Rule web page: MicroMD EMR Objective Measure Calculations Manual: Performance Year

60 Chapter 5. Medicaid Stage 3 Objectives Objective 2: Electronic Prescribing National Institute of Standards and Technology - HIPAA Security Rule Toolkit User Guide : - HIPAA Security Rule Toolkit Download : Federal Trade Commission - Complying with the FTC's Health Breach Notification Rule web page: Objective 2: Electronic Prescribing Objective 2 requires that you Generate and transmit permissible prescriptions electronically (erx). To measure your compliance with this objective, CMS requires that More than 60 percent of all permissible prescriptions written by the EP are queried for a drug formulary and transmitted electronically using CEHRT. Your Reached percentage (numerator over denominator) must be more than 60% to meet this measure. The patient must have at least one encounter with a Service Date that falls within the date range selected in the Date Range fields on the Stage 3 Report window to be included in this Objective Measure. If a specific provider appears in the Provider drop-down of the Stage 3 Report window, MicroMD EMR only counts prescriptions if the prescribing provider had an encounter with the selected patient during the date range selected in the Date Range fields. EPCS prescribers have the option in this measure to include electronic prescriptions of controlled substances in their performance. Be sure to add the Include EPCS as permissible user function to the EPCS provider s user account in the MicroMD EMR Manager. If you prescribe fewer than 100 permissible prescriptions during the measurement period, you can take an exclusion for this measure. Please see the CMS web site for more on available exclusions. 5.2 MicroMD EMR Objective Measure Calculations Manual: Performance Year 2017

61 Objective 3: Clinical Decision Support Chapter 5. Medicaid Stage 3 Objectives Patients Who Qualify for the Measure (Denominator) The denominator for this measure is the Number of prescriptions written for drugs requiring a prescription in order to be dispensed other than controlled substances during the EHR reporting period; or number of prescriptions written for drugs requiring a prescription in order to be dispensed during the EHR reporting period. In MicroMD EMR, the denominator displays the number of prescriptions written in the system where the date the prescription was written falls within the date range you selected in the Date Range fields on the Stage 3 Report window. You can find the Date column in the Change History of the prescription when you right-click the prescription and select Change History [This Entry] from the pop-up menu: Desktop > Prescriptions Medical Information tab > Medical > Medications Patients Who Meet the Measure (Numerator) The numerator for this measure is The number of prescriptions in the denominator generated, queried for a drug formulary, and transmitted electronically using CEHRT. In MicroMD EMR, all prescriptions that you process electronically (click Send on the Prescription Processor window) count toward your numerator for this Objective Measure. The system automatically queries drug formulary for you based on the patient s insurance and displays the information for you. Please see the main MicroMD EMR User s Reference Manual for details on using the Electronic Prescription module. Objective 3: Clinical Decision Support Objective 3 requires that you Implement clinical decision support (CDS) interventions focused on improving performance on high-priority health conditions. To measure your compliance with this objective, CMS has outlined two separate measures and eligible providers must satisfy both measures to meet the objective. The measures within the Clinical Decision Support Objective are attestation-only. MicroMD EMR does not track your performance. Measure 1 (Clinical Decision Support Interventions) For Measure 1 of this objective, CMS requires that providers Implement five clinical decision support interventions related to four or more CQMs at a relevant point in patient care for the entire EHR reporting period. Absent four CQMs related to an EP s scope of practice or patient population, the clinical decision support interventions must be related to high priority health conditions. MicroMD EMR Objective Measure Calculations Manual: Performance Year

62 Chapter 5. Medicaid Stage 3 Objectives Objective 4: Computerized Provider Order Entry (CPOE) In MicroMD EMR, you can implement rules that appear throughout the system using the Rule Manager (under Tools > Rule Manager in the main menu). Please refer to the main MicroMD EMR User s Reference Manual for more details on using the Rule Manager. Measure 2 (Drug-Drug and Drug-Allergy Interaction Checks) For Measure 2 of this objective, CMS requires that providers The EP has enabled and implemented the functionality for drug-drug and drug-allergy interaction checks for the entire EHR reporting period. In MicroMD EMR, make sure you are a Surescripts provider. Drug-to-drug and drug-to-allergy interaction checks are part of the MicroMD EMR electronic prescribing functionality. Your practice controls the alerts that display from the MicroMD EMR Manager, and if you have the appropriate user permission on your user account, you can set the level of alerts that appear for you personally under Tools > User Preferences > Prescriptions. If you write fewer than 100 medication orders during the measurement period, you can take an exclusion for Measure 2. Please refer to the main MicroMD EMR User s Reference Manual for more details on the Prescription Module. Objective 4: Computerized Provider Order Entry (CPOE) Objective 4 requires that you Use computerized provider order entry (CPOE) for medication, laboratory, and diagnostic imaging orders directly entered by any licensed healthcare professional, credentialed medical assistant, or a medical staff member credentialed to and performing the equivalent duties of a credentialed medical assistant, who can enter orders into the medical record per state, local, and professional guidelines. To measure your compliance with this objective, CMS has outlined three separate measures, and you must satisfy ALL THREE measures for this objective, either with performance or with an exclusion. Within MicroMD EMR, your Reached percentage for each measure will always be 100% since there is no other way to enter an order except through the application. If you write fewer than 100 medication orders, fewer than 100 laboratory orders, and/or fewer than 100 diagnostic imaging orders during the measurement period, you can take an exclusion for the related measure. 5.4 MicroMD EMR Objective Measure Calculations Manual: Performance Year 2017

63 Objective 4: Computerized Provider Order Entry (CPOE) Chapter 5. Medicaid Stage 3 Objectives Measure 1 (CPOE - Medication Order) For Measure 1 of this objective, CMS requires that More than 60 percent of medication orders created by the EP during the EHR reporting period are recorded using computerized provider order entry. Patients Who Qualify for the Measure (Denominator) The denominator for this measure is the Number of medication orders created by the EP during the EHR reporting period. In MicroMD EMR, the denominator displays the number of prescriptions written in the system where the date the prescription was written falls within the date range you selected in the Date Range fields on the Stage 3 Report window. You can find the Date column in the Change History of the prescription when you right-click the prescription and select Change History [This Entry] from the pop-up menu: Desktop > Prescriptions Medical Information tab > Medical > Medications Medical Information tab > Orders > Referral Orders For referral orders, be sure you have a check mark next to Include Referral Orders in MU CPOE in the MicroMD EMR Manager (under System Settings > Practice Settings). Patients Who Meet the Measure (Numerator) The numerator for this measure is the The number of orders in the denominator recorded using CPOE. In MicroMD EMR, the numerator will always match the denominator since the only way to enter a prescription is through the application. Measure 2 (CPOE - Laboratory Order) For Measure 2, CMS requires that More than 60 percent of laboratory orders created by the EP during the EHR reporting period are recorded using computerized provider order entry. Patients Who Qualify for the Measure (Denominator) The denominator for this measure is the Number of laboratory orders created by the EP during the EHR reporting period. In MicroMD EMR, the denominator displays the number of laboratory orders whose Recorded On date falls within the date range you selected in the Date Range fields on the Stage 3 Report window. You can find the Recorded On date in the yellow notes area for the order or in the Date column when you right-click the order and select Change History [This Entry]: Desktop > Orders Medical Information tab > Orders > Laboratory Orders Medical Information tab > Orders > Referral Orders MicroMD EMR Objective Measure Calculations Manual: Performance Year

64 Chapter 5. Medicaid Stage 3 Objectives Objective 4: Computerized Provider Order Entry (CPOE) For referral orders, be sure you have a check mark next to Include Referral Orders in MU CPOE in the MicroMD EMR Manager (under System Settings > Practice Settings). Patients Who Meet the Measure (Numerator) The numerator for this measure is the The number of orders in the denominator recorded using CPOE. In MicroMD EMR, the numerator will always match the denominator since the only way to enter a laboratory order is through the application. Measure 3 (CPOE - Radiology Order) For Measure 3, CMS requires that More than 60 percent of diagnostic imaging orders created by the EP during the EHR reporting period are recorded using computerized provider order entry. Patients Who Qualify for the Measure (Denominator) The denominator for this measure is the Number of diagnostic imaging orders created by the EP during the EHR reporting period. In MicroMD EMR, the denominator displays the number of diagnostic imaging orders whose Recorded On date falls within the date range you selected in the Date Range fields on the Stage 3 Report window. You can find the Recorded On date in the yellow notes area for the order or in the Date column when you right-click the order and select Change History [This Entry]: Desktop > Orders Medical Information tab > Orders > Procedure Orders The radiology imaging order must use a procedure code within the range of through Medical Information tab > Orders > Referral Orders For referral orders, be sure you have a check mark next to Include Referral Orders in MU CPOE in the MicroMD EMR Manager (under System Settings > Practice Settings). Patients Who Meet the Measure (Numerator) The numerator for this measure is the The number of orders in the denominator recorded using CPOE. In MicroMD EMR, the numerator will always match the denominator since the only way to enter a diagnostic imaging order is through the application. 5.6 MicroMD EMR Objective Measure Calculations Manual: Performance Year 2017

65 Objective 5: Patient Electronic Access to Health Information Chapter 5. Medicaid Stage 3 Objectives Objective 5: Patient Electronic Access to Health Information Objective 5 requires that The EP provides patients (or patient-authorized representative) with timely electronic access to their health information and patient- specific education. To measure your compliance with this objective, CMS has outlined two separate measures, and you must satisfy both measures in order to meet this objective. In order to track data for the measures of this objective, the practice must use the MicroMD Patient Portal. Please contact your local authorized MicroMD reseller for purchasing and setup information. You can take an exclusion for these measures if you have no office visits during the measurement period, or if the housing in your county does not have 4Mbps broadband availability. Please see the CMS web site for more details on this exclusion. Measure 1 (Timely Access and Access Through an API) For Measure 1 of this objective, CMS requires that For more than 80 percent of all unique patients seen by the EP: 1. The patient (or the patient-authorized representative) is provided timely access to view online, download, and transmit his or her health information; and 2. The provider ensures the patient s health information is available for the patient (or patientauthorized representative) to access using any application of their choice that is configured to meet the technical specifications of the Application Programming Interface (API) in the provider s CEHRT. Your Reached percentage (numerator over denominator) must be more than 80% to meet this measure. Patients Who Qualify for the Measure (Denominator) The denominator for this measure is The number of unique patients seen by the EP during the EHR reporting period. In MicroMD EMR, a patient must have an encounter created in MicroMD EMR where the Service Date on the encounter falls within the measurement period. You can find a list of an individual patient s encounters in the patient s chart on the Summary tab in the EMR. Patients Who Meet the Measure (Numerator) The numerator for this measure is The number of patients in the denominator (or patient authorized representative) who are provided timely access to health information to view online, download, and MicroMD EMR Objective Measure Calculations Manual: Performance Year

66 Chapter 5. Medicaid Stage 3 Objectives Objective 5: Patient Electronic Access to Health Information transmit to a third party and to access using an application of their choice that is configured to meet the technical specifications of the API in the provider s CEHRT. In MicroMD EMR, the numerator reflects the number of patients within the denominator for whom your practice has published information to the patient through the Patient Portal within 48 hours of the item s entry or edit in the patient s chart. You can provide updates to the Patient Portal in the following ways: Publishing the Patient s C-CDA/CCR/CCD: You can publish the patient s electronic chart from within their chart in the main menu under Chart > Export/Import Chart (C-CDA/CCR/CCD) > Publish. Provide Access through the MicroMD API: When using the MicroMD EMR API, practices create accounts for their patients to access data from the EMR. Patients always have access to their information so those patients automatically count in the Numerator. For API purchasing and setup information, please contact Henry Schein Medical Systems. Portal Updates: The Portal Updates section of the Desktop populates automatically when providers add or change information in the patient's chart that requires an update to the patient s portal account. When a user selects the patient(s) and clicks the Queue CDA button, the system processes all of the selected updates. Once complete, the patient(s) counts for the Numerator of this measure. Although you choose sections to release to the Patient Portal and make visible to the patient, choosing individual sections is not compliant with using the EMR in a meaningful way. Please refer to the MicroMD Patient Portal Guide for details on publishing patient information and the Portal Updates section of the Desktop. Measure 2 (Identify and Provide Patient-Specific Education Online) For Measure 2 of this objective, CMS requires that The EP must use clinically relevant information from CEHRT to identify patient-specific educational resources and provide electronic access to those materials to more than 35 percent of unique patients seen by the EP during the EHR reporting period. Your Reached percentage (numerator over denominator) must be more than 35% to meet this measure. 5.8 MicroMD EMR Objective Measure Calculations Manual: Performance Year 2017

67 Objective 5: Patient Electronic Access to Health Information Chapter 5. Medicaid Stage 3 Objectives Patients Who Qualify for the Measure (Denominator) The denominator for this measure is The number of unique patients seen by the EP during the EHR reporting period. In MicroMD EMR, a patient must have an encounter created in MicroMD EMR where the Service Date on the encounter falls within the measurement period. You can find a list of an individual patient s encounters in the patient s chart on the Summary tab in the EMR. Patients Who Meet the Measure (Numerator) The numerator is The number of patients in the denominator who were provided electronic access to patient-specific educational resources using clinically relevant information identified from CEHRT during the EHR reporting period. In MicroMD EMR, the numerator reflects the number of patients from within the denominator for whom you have added patient education to their chart using the information bubble icon ( ) in one of the following locations: Encounter > Assessment tab Medical Information tab > Medical > Problem List Encounter > Medication tab Medical Information tab > Medical > Medications The system adds a link for the education materials (if available) to the patient s electronic chart when you publish their CDA. MicroMD EMR also includes in the Numerator those patients for whom you have published patient education from within the Patient Portal where the published date on that education is after the published date of the first instance of patient education during the measurement period. Providers may continue to provide paper-based education materials or non-linked documents; however, those methods no longer count for the Numerator of Measure 2. MicroMD EMR Objective Measure Calculations Manual: Performance Year

68 Chapter 5. Medicaid Stage 3 Objectives Objective 6: Coordination of Care Through Patient Engagement Objective 6: Coordination of Care Through Patient Engagement Objective 6 requires that you Use CEHRT to engage with patients or their authorized representatives about the patient s care. To measure your compliance with this objective, CMS has outlined three separate measures, and you must attest to all three measures and meet the thresholds for at least two of the measures to meet the objective. In order to track data for this measure, the practice must use the MicroMD Patient Portal. Please contact your local authorized MicroMD reseller for purchasing and setup information. You can take an exclusion for these measures if you have no office visits during the measurement period, or if the housing in your county does not have 4Mbps broadband availability. Please see the CMS web site for more details on this exclusion. Measure 1 (View, Download, and Transmit) As the first measure of your compliance with the objective, CMS requires that For an EHR reporting period in 2017, more than 5 percent of all unique patients (or their authorized representatives) seen by the EP actively engage with the electronic health record made accessible by the provider and either 1. View, download or transmit to a third party their health information; or 2. Access their health information through the use of an API that can be used by applications chosen by the patient and configured to the API in the provider's CEHRT; or 3. A combination of (1) and (2) Your Reached percentage (numerator over denominator) must be more than 5% to meet this measure in the 2017 and 2018 measurement periods (more than 10% in 2019 and beyond). Patients Who Qualify for the Measure (Denominator) The denominator for this measure is the Number of unique patients seen by the EP during the EHR reporting period. In MicroMD EMR, a patient must have an encounter created in MicroMD EMR where the Service Date on the encounter falls within the measurement period. You can find a list of an individual patient s encounters in the patient s chart on the Summary tab in the EMR MicroMD EMR Objective Measure Calculations Manual: Performance Year 2017

69 Objective 6: Coordination of Care Through Patient Engagement Chapter 5. Medicaid Stage 3 Objectives Patients Who Meet the Measure (Numerator) The numerator for this measure is the The number of unique patients (or their authorized representatives) in the denominator who have viewed online, downloaded, or transmitted to a third party the patient s health information during the EHR reporting period and the number of unique patients (or their authorized representatives) in the denominator who have accessed their health information through the use of an API during the EHR reporting period. In MicroMD EMR, the numerator reflects the number of patients within the denominator who have accessed the electronic chart document that you uploaded to their Patient Portal account. The patient must access the Records tab of their Patient Portal account and click either the View button, one of the Download buttons, or the Transmit button. When using the MicroMD EMR API, practices create accounts for their patients to access data from the EMR. The system knows when the patient views, downloads, or transmits their health data. To meet this measure, you must first provide the patient with their electronic chart information in one of the following ways: Publishing the Patient s C-CDA/CCR/CCD: You can publish the patient s electronic chart from within their chart in the main menu under Chart > Export/Import Chart (C-CDA/CCR/CCD) > Publish. Portal Updates: The Portal Updates section of the Desktop populates automatically when providers add or change information in the patient's chart that requires an update to the patient s portal account. When a user selects the patient(s) and clicks the Queue CDA button, the system processes all of the selected updates. Once complete, the patient(s) counts for the Numerator of this measure. Although you choose sections to release to the Patient Portal and make visible to the patient, choosing individual sections is not compliant with using the EMR in a meaningful way. For API purchasing and setup information, please contact Henry Schein Medical Systems. Please refer to the MicroMD Patient Portal Guide for details on publishing patient information. MicroMD EMR Objective Measure Calculations Manual: Performance Year

70 Chapter 5. Medicaid Stage 3 Objectives Objective 6: Coordination of Care Through Patient Engagement Measure 2 (Secure Messaging) As the second measure of your compliance with the objective, CMS requires that For an EHR reporting period in 2017, more than 5 percent of all unique patients seen by the EP during the EHR reporting period, a secure message was sent using the electronic messaging function of CEHRT to the patient (or the patient authorized representative), or in response to a secure message sent by the patient or their authorized representative. Your Reached percentage (numerator over denominator) must be more than 5% to meet this measure in the 2017 and 2018 measurement periods (more than 25% in 2019 and beyond). Patients Who Qualify for the Measure (Denominator) The denominator for this measure is the Number of unique patients seen by the EP during the EHR reporting period. In MicroMD EMR, a patient must have an encounter created in MicroMD EMR where the Service Date on the encounter falls within the measurement period. You can find a list of an individual patient s encounters in the patient s chart on the Summary tab in the EMR. Patients Who Meet the Measure (Numerator) The numerator for this measure is The number of patients in the denominator for whom a secure electronic message is sent to the patient (or patient-authorized representative) or in response to a secure message sent by the patient (or patient-authorized representative), during the EHR reporting period. In MicroMD EMR, you simply need to respond to a patient s message through your account on the MicroMD Patient Portal; or you can send the patient a portal message from anywhere you see the Publish drop-down button (select Message Only from the drop-down button). Please refer to the MicroMD Patient Portal Guide for details on messaging. Measure 3 (Patient-Generated Health Data) As the final measure of your compliance with the objective, CMS requires that Patient generated health data or data from a nonclinical setting is incorporated into the CEHRT for more than 5 percent of all unique patients seen by the EP during the EHR reporting period. Your Reached percentage (numerator over denominator) must be more than 5% to meet this measure. Patients Who Qualify for the Measure (Denominator) The denominator for this measure is the Number of unique patients seen by the EP during the EHR reporting period MicroMD EMR Objective Measure Calculations Manual: Performance Year 2017

71 Objective 7: Health Information Exchange Chapter 5. Medicaid Stage 3 Objectives In MicroMD EMR, a patient must have an encounter created in MicroMD EMR where the Service Date on the encounter falls within the measurement period. You can find a list of an individual patient s encounters in the patient s chart on the Summary tab in the EMR. Patients Who Meet the Measure (Numerator) The numerator for this measure is The number of patients in the denominator for whom data from non-clinical settings, which may include patient-generated health data, is captured through the CEHRT into the patient record during the EHR reporting period. In MicroMD EMR, there are a few ways for you to get a patient s health information into their chart from an outside source: Patient Sends Information through the Patient Portal: The patient can send updated information to your practice through the Patient Portal. You must then right-click the attachment and do one of the following: - Select Import from the pop-up menu. This opens the Data Reconciliation window where you can incorporate the discrete data into the patient s chart. - Select Attach to Chart from the pop-up menu. This opens the Add Attachment window where you can add the document to the patient s chart. Be sure that you select Patient Generated Health Data from the Type drop-down on the Add Attachment window when you go this route. You can access mail sent from the Patient Portal from the following locations: - Desktop tab > Mail - Chart menu in the patient s chart > Workflow Communication > Mail Add a Patient-Generated Health Data Attachment: The patient has an attachment in their chart associated with Patient Generated Health Data selected from the Type drop-down. You can add an attachment from a variety of locations in MicroMD EMR. You can find the list of attachments in the patient s chart in the following location: - Medical Information tab > Miscellaneous > Attachments Objective 7: Health Information Exchange Objective 7 requires that The EP provides a summary of care record when transitioning or referring their patient to another setting of care, receives or retrieves a summary of care record upon the receipt of a transition or referral or upon the first patient encounter with a new patient, and incorporates summary of care information from other providers into their EHR using the functions of CEHRT. To measure your compliance with this objective, CMS has outlined three separate measures, and you must attest to all three measures and meet the thresholds for at least two of the measures to meet the objective. Measure 1 (Send a Summary of Care) As the first measure of your compliance with the objective, CMS requires that For more than 50 percent of transitions of care and referrals, the EP that transitions or refers their patient to another setting of care or provider of care: 1. Creates a summary of care record using CEHRT; and MicroMD EMR Objective Measure Calculations Manual: Performance Year

72 Chapter 5. Medicaid Stage 3 Objectives Objective 7: Health Information Exchange 2. Electronically exchanges the summary of care record Your Reached percentage (numerator over denominator) must be more than 50% to meet this measure. You can take an exclusion for these measures if you have no office visits during the measurement period, or if the housing in your county does not have 4Mbps broadband availability. Please see the CMS web site for more details on this exclusion. Patients Who Qualify for the Measure (Denominator) The denominator is the Number of transitions of care and referrals during the EHR reporting period for which the EP was the transferring or referring provider. In MicroMD EMR, each Transition of Care (Out) entry created in your system appears in the denominator. The provider must appear in the Sent By field for the entry; the correct department and clinic must also appear in the Department/Clinic field; and the date in the Begin Date field falls within the measurement period. You can find a list of outgoing transitions of care in the following locations: Desktop tab > My Workflow > Transition of Care Charts tab > main menu > Chart > Workflow Communication Patients Who Meet the Measure (Numerator) The numerator is The number of transitions of care and referrals in the denominator where a summary of care record was created using certified EHR technology and exchanged electronically. In MicroMD EMR, you must create a mail message and attach the patient's chart data to the message. From within a new mail message, you can click the Chart Data button in the ribbon bar. You can access the Mail section from your Desktop or the patient s Workflow Communication window. You can also click the Mail button on the Transition of Care window. Measure 2 (Request/Accept Summary of Care) As the second measure of your compliance with the objective, CMS requires that For more than 40 percent of transitions or referrals received and patient encounters in which the provider has never before encountered the patient, the EP incorporates into the patient s EHR an electronic summary of care document. Your Reached percentage (numerator over denominator) must be more than 40% to meet this measure MicroMD EMR Objective Measure Calculations Manual: Performance Year 2017

73 Objective 7: Health Information Exchange Chapter 5. Medicaid Stage 3 Objectives You can take an exclusion for this measure if the total transitions or referrals you receive and the encounters for patients you ve never seen is fewer than 100 during the measurement period. You can also take an exclusion if the housing in your county does not have 4Mbps broadband availability. Please see the CMS web site for more details on this exclusion. Patients Who Qualify for the Measure (Denominator) The denominator for this measure is the Number of patient encounters during the EHR reporting period for which an EP was the receiving party of a transition or referral or has never before encountered the patient and for which an electronic summary of care record is available. In MicroMD EMR, in order for the patient to appear in the Denominator for the Receive/Accept Summary of Care objective measures, several items need to be in place: You must first create a Transition of Care (In) entry in the patient s chart. The provider must appear in the Received By field for the entry. The correct department and clinic must appear in the Department/Clinic field. The date in the Begin Date field must fall within the measurement period. You can enter a transition in one of the following areas: - Desktop tab > My Workflow > Transition of Care - Charts tab > main menu > Chart > Workflow Communication > Transition of Care - Medical Information tab > Miscellaneous > Transition of Care In You can also create a Transition of Care from within the Referral-in Order window. Simply click the Transition of Care button. You must then request and receive the patient s CDA from the transitioning physician or facility. Once you receive the patient s CDA, either through mail or import that CDA into the patient s chart, the Summary of Care Status drop-down must be set to Received. You must be sure to select the appropriate Transition of Care entry when importing the patient s CDA. MicroMD EMR can detect if you have received the patient's CDA through the Surescripts Clinical Interoperability Network (CIN) or if you have already imported the document. Do not change the Summary of Care Status drop-down manually. The transition will not count for the measure if you do. MicroMD EMR Objective Measure Calculations Manual: Performance Year

74 Chapter 5. Medicaid Stage 3 Objectives Objective 7: Health Information Exchange You must create an encounter and link it to the Transition of Care (In) entry. There is a dropdown on the Encounter Header called Transition of Care (if applicable). If there is only a single Transition of Care (In) entry for that patient, the system automatically defaults to that entry. Patients Who Meet the Measure (Numerator) The numerator for this measure is the Number of patient encounters in the denominator where an electronic summary of care record received is incorporated by the provider into the certified EHR technology. Once you receive the patient s CDA, in order to the include that patient in the Numerator, you must incorporate the data from the imported file into their chart. To do this, you must be sure to perform the following: Open the Transition of Care (In) entry and click the Import C-CDA/CCR/CCD button on the Transition of Care (In) window. From within the encounter, you can get to the list of incoming Transitions of Care for the patient using the Medical Info button in the Encounter Ribbon. Click Miscellaneous and choose Transition of Care In from the available options. On the Data Reconciliation window that opens, be sure to select the appropriate transition from the Transition of Care drop-down (if it isn t already selected). Select the appropriate CDA from the drop-down and click the Load button. Review the data from the file and add any data you want to incorporate into the patient s chart. Once you click the Apply button, you have incorporated the data into the patient's chart and the patient should appear in the Numerator. Verify the Summary of Care Status drop-down on the Transition of Care (In) window changed automatically to Incorporated and click OK. Measure 3 (Clinical Information Reconciliation) As the final measure of your compliance with the objective, CMS requires that For more than 80 percent of transitions or referrals received and patient encounters in which the provider has never before encountered the patient, the EP performs a clinical information reconciliation. The provider must implement clinical information reconciliation for the following three clinical information sets: 1. Medication. Review of the patient s medication, including the name, dosage, frequency, and route of each medication. 2. Medication allergy. Review of the patient s known medication allergies. 3. Current Problem list. Review of the patient s current and active diagnoses. Your Reached percentage (numerator over denominator) must be more than 80% to meet this measure MicroMD EMR Objective Measure Calculations Manual: Performance Year 2017

75 Objective 7: Health Information Exchange Chapter 5. Medicaid Stage 3 Objectives You can take an exclusion for this measure if the total transitions or referrals you receive and the encounters for patients you ve never seen is fewer than 100 during the measurement period. Patients Who Qualify for the Measure (Denominator) The denominator for this measure is the Number of transitions of care or referrals during the EHR reporting period for which the EP was the recipient of the transition or referral or has never before encountered the patient. In MicroMD EMR, each Transition of Care (In) entry created for the patient appears in the denominator. The provider must appear in the Received By field for the entry; the correct department and clinic must appear in the Department/Clinic field; and the date in the Begin Date field must fall within the measurement period. You can find a list of incoming transitions of care in the following locations: Desktop tab > My Workflow > Transition of Care Charts tab > main menu > Chart > Workflow Communication > Transition of Care Medical Information tab > Miscellaneous > Transition of Care In You can create a Transition of Care from within the Referral-in Order window. Simply click the Transition of Care button. Patients Who Meet the Measure (Numerator) The numerator for this measure is The number of transitions of care or referrals in the denominator where the following three clinical information reconciliations were performed: medication list, medication allergy list, and current problem list. In MicroMD EMR, you must perform this reconciliation from the Data Reconciliation window. You can access the Data Reconciliation window from one of the following locations: Transition of Care (In) Window: When you click the Import C-CDA/CCR/CCD button on the Transition of Care (In) window, the system opens the Data Reconciliation window. You can find the Transition of Care (In) window from one of the following locations: - Desktop tab > My Workflow > Transition of Care - Charts tab > main menu > Chart > Workflow Communication > Transition of Care - Medical Information tab > Miscellaneous > Transition of Care In You can create a Transition of Care from within the Referral-in Order window. Simply click the Transition of Care button. Open the patient s chart > Chart menu > Export/Import Chart (C-CDA/CCR/CCD) > Import Make sure you have the correct transition selected in the Transition of Care drop-down. Click the Review button in the Medication, Medication Allergies, and Problem List headers in the Current MicroMD EMR Objective Measure Calculations Manual: Performance Year

76 Chapter 5. Medicaid Stage 3 Objectives Objective 8: Public Health and Clinical Data Registry Reporting MedInfo pane to receive credit for reviewing the patient s information. Be sure to click the Apply button to commit your actions. If you have the Apply auto-review on medical information user preference set to Yes (under Tools > User Preferences > Medical Information), MicroMD EMR does not display the Reviewed button. When you stay on the window for the amount of time you set in your preferences, the system automatically marks the lists as reviewed for you. Objective 8: Public Health and Clinical Data Registry Reporting Objective 8 requires that The EP is in active engagement with a public health agency or clinical data registry to submit electronic public health data in a meaningful way using certified EHR technology, except where prohibited, and in accordance with applicable law and practice. To measure your compliance with this objective, CMS has outlined five separate measures of which eligible practitioners MUST attest to at least two measures. All of the measures within this objective are attestationonly. You simply provide a Yes or No answer. Active engagement for this objective means that the provider is somewhere in the process of testing and sending production data to a public health agency (PHA) or clinical data registry (CDR), depending on the measure, or is currently sending production data to a PHA or CDR. There are three levels of active engagement from the Centers for Medicare and Medicaid that demonstrate the Eligible Clinician s compliance with each of the measures in this objective: Active Engagement Option 1 Completed Registration to Submit Data: The provider has registered with a public health agency or clinical data registry (depending on the measure) to submit data. This registration must be completed within 60 days after the start of the EHR measurement period. In this option, the provider is waiting for an invitation to send test data. You do not have to re-submit a registration if you are already registered and waiting for testing. Active Engagement Option 2 Testing and Validation: This level means that the provider is currently testing and validating the data submission. The provider must respond to any questions or requests from the public health agency or clinical data registry (depending on the measure) within 30 days, and if they fail to do so two times during the measurement period, the provider will not meet the measure. Active Engagement Option 3 Production: At this active engagement level, the provider has completed all of the testing and is now submitting their electronic data to the public health agency or clinical data registry (depending on the measure) MicroMD EMR Objective Measure Calculations Manual: Performance Year 2017

77 Objective 8: Public Health and Clinical Data Registry Reporting Chapter 5. Medicaid Stage 3 Objectives Measure 1 (Immunization Registry Reporting) To measure your compliance with the objective, CMS requires that The EP is in active engagement with a public health agency to submit immunization data and receive immunization forecasts and histories from the public health immunization registry/immunization information system (IIS). In order to submit registry reporting through the EMR, you must use the appropriate state-specific immunization registry interface. Please contact your local authorized MicroMD reseller for purchasing and setup information. Once you have the interface installed, set up, tested and finally in production, the submission is typically automatic to the registries (depending on the interface). You can manage your immunization files from the Administrative Panel of the Desktop. Find the Immunization Monitoring in the following location: Desktop tab > Administration button > Administrative Panel > Immunization Monitoring Measure 2 (Syndromic Surveillance Reporting) To measure your compliance with the objective, CMS requires that The EP is in active engagement with a public health agency to submit syndromic surveillance data from an urgent care setting. In order to submit registry reporting through the EMR, you must use the appropriate interface. Please contact your local authorized MicroMD reseller for purchasing and setup information. Once you have the interface installed, set up, tested and finally in production, you can submit your surveillance files from the Administrative Panel of the Desktop. Find the Surveillance Monitoring in the following location: Desktop tab > Administration button > Administrative Panel > Surveillance Monitoring You can also export a file from the MicroMD EMR Manager in the following location: Communication > Health Surveillance > Export Now button Measure 3 (Electronic Case Reporting) To measure your compliance with the objective, CMS requires that The EP is in active engagement with a public health agency to submit case reporting of reportable conditions. MicroMD EMR does not provide support for this measure at this time. Measure 4 (Public Health Registry Reporting) To measure your compliance with the objective, CMS requires that The EP is in active engagement with a public health agency to submit data to public health registries. MicroMD EMR does not provide support for this measure at this time. MicroMD EMR Objective Measure Calculations Manual: Performance Year

78 Chapter 5. Medicaid Stage 3 Objectives Objective 8: Public Health and Clinical Data Registry Reporting Measure 5 (Clinical Data Registry Reporting) To measure your compliance with the objective, CMS requires that The EP is in active engagement to submit data to a clinical data registry. MicroMD EMR does not provide support for this measure at this time MicroMD EMR Objective Measure Calculations Manual: Performance Year 2017

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