Meaningful Use Hello Health v7 Guide for Eligible Professionals. Stage 2

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1 Meaningful Use Hello Health v7 Guide for Eligible Professionals Stage 2

2 Table of Contents Introduction 3 Meaningful Use 3 Terminology 4 Computerized Provider Order Entry (CPOE) for Medication, Laboratory and Radiology Orders [Core] 5 Generate and Transmit Permissible Prescriptions Electronically (erx) [Core] 11 Record Demographics [Core] 15 Record Vital Signs [Core] 18 Record Smoking Status [Core] 21 Clinical Decision Support Rule [Core] 24 Provide Patients the Ability to View, Download and Transmit (VDT) their Health Information [Core] 28 Clinical Summaries [Core] 31 Protect Electronic Health Information [Core] 35 Clinical Lab Test Results [Core] 37 Clinical Lab Test Results [Core] 37 Patient Lists [Core] 39 Patient Reminders [Core] 42 Patient-Specific Education Resources [Core] 47 Medication Reconciliation [Core] 51 Transition of Care Summary [Core] 56 Immunization Registries Data Submission [Core] 63 Secure Electronic Messaging [Core] 65 Syndromic Surveillance Data Submission [Menu] 67 Record Electronic Notes in Patient Records [Menu] 69 Imaging Results Accessible through EHR (Radiology Orders) [Menu] 72 Record Patient Family Health History [Menu] 75

3 Hello Health Meaningful Use Guide for Eligible Professionals Stage 2 3 Introduction Meaningful Use The Medicare and Medicaid EHR Incentive Programs provide a financial incentive for achieving "Meaningful Use", which is the use of certified EHR technology to reach health and efficiency goals. This section provides an overview of the Stage 2 of EHR Meaningful Use Core and Menu Objectives for Eligible Professionals (EPs), as outlined by CMS, which are intended to set a baseline for electronic data capture and information sharing. For Stage 2, eligible professionals must report on the following: 1. All 17 core objectives; 2. 3 menu objectives that they select. 3. +CQM The Meaningful Use objectives are grouped into five patient-driven domains that relate to health outcomes policy priorities. As depicted below, each core and menu objective is aligned with one of the following domains: 1. D1 - Improve Quality, Safety, Efficiency - CPOE for Medication, Laboratory and Radiology Orders (core) - E-Prescribing (core) - Record Demographics (core) - Record Vital Signs (core) - Record Smoking Status (core) - Clinical Decision Support (core) - Clinical Lab Test Results (core) - Patient List (core) - Patient Reminders (core) - Record Patient Family Health History (menu) - Imaging Results (menu) - Record Electronic Notes in Patient Records (menu) D2 - Engage Patients and Families - Clinical Summaries (core) - Patient Electronic Access (VDT) (core) - Patient-specific Education Resources (core) - Use Electronic Messaging (core)

4 Hello Health Meaningful Use Guide for Eligible Professionals Stage 2 4 D3 - Improve Care Coordination - Medication Reconciliation (core) - Transition of Care with Summary of Care (core) D4 - Improve Public and Population Health - Immunization Registries Data Submission (core) - Syndromic Surveillance Data Submission (menu) D5 - Ensure Privacy and Security for Personal Health Information - Protect Electronic Health Information (core) For more details, see the following guide Terminology Patient Seen often refers to "all unique patients seen by the EP during the EHR reporting period" For Hello Health, Patient Seen means patients: o o o o o With at least one appointment for the reporting period (date range); For any visit type (office, home, phone, IM or video); If visit status is NOT Cancel, nor No show: Regardless of visit documentation status (whether or not visit is Finished (signed)); Unique patient, that is, if a patient is seen by a provider more than once during the EHR reporting period, then it is for purposes of measurement that the patient is only counted once in the denominator for the measure.

5 Hello Health Meaningful Use Guide for Eligible Professionals Stage 2 5 Computerized Provider Order Entry (CPOE) for Medication, Laboratory and Radiology Orders [Core] Overview Objective Use computerized provider order entry (CPOE) 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. Attestation Requirements Measure More than 60 percent of medication orders, 30 percent of laboratory orders, and 30 percent of radiology orders created by the EP during the EHR reporting period are recorded using computerized provider order entry. / / Exclusion Medication Orders Number of medication orders created by the EP during the EHR reporting period. Number of medication orders in the denominator entered using CPOE. Exclusion Any EP who writes fewer than 100 medication orders during the EHR reporting period. Laboratory Orders Number of laboratory orders created by an EP during the EHR reporting period. Number of laboratory orders in the denominator recorded using CPOE. Exclusion Any EP who writes fewer than 100 laboratory orders during the EHR reporting period.

6 Hello Health Meaningful Use Guide for Eligible Professionals Stage 2 6 Radiology / Imaging Orders Number of radiology orders created by an EP during the EHR reporting period. Number of radiology orders in the denominator recorded using CPOE. Exclusion Any EP who writes fewer than 100 radiology orders during the EHR reporting period. How to Meet the MU Attestation Using Hello Health Medication Orders You can document prescriptions (medication orders) in a visit s documentation, under the Current Medications subsection in the EHR, or the Prescriptions section: 1. Click Add new; 2. Select or search for a medication in the pop-up window by entering the name of the medication or the RxNorm code (not shown). Enter the required information for your prescription; 3. Click Prepare Rx; 4. Click either Save Prescription or Send erx.

7 Hello Health Meaningful Use Guide for Eligible Professionals Stage 2 7 Laboratory Orders You can document laboratory orders in a visit s documentation, either in the Labs section of the patient record, or in the Labs dashboard (tab): 1. Click Add Lab and then select Add Lab Order (or New if in the Labs dashboard); 2. Complete the required information; 3. Click Order.

8 Hello Health Meaningful Use Guide for Eligible Professionals Stage 2 8 Radiology Orders You can document radiology orders in a visit s documentation, either in the Orders section of the patient record, or in the Orders dashboard (tab):

9 Hello Health Meaningful Use Guide for Eligible Professionals Stage Click Add Order (or Create Order if in the Orders dashboard); 2. Choose Radiology as the order Type; 3. Complete the required information; 4. Click Save (or Send if enabled to send via Direct messages). and explained for Hello Health Medication Orders Number of prescriptions (medication orders), Rx or erx, created in the reporting period. Number of prescriptions (medication orders), Rx or erx, created in the reporting period. Laboratory Orders Number of lab orders created in the reporting period and lab results received in Hello Health during the reported period that were not ordered in Hello Health. Number of lab orders created in the reporting period. Radiology Orders Number of Radiology orders created in the reporting period. Number of Radiology orders created in the reporting period.

10 Hello Health Meaningful Use Guide for Eligible Professionals Stage 2 10 Hints, Tips and Additional Information A medication order can only be documented into Hello Health if the Rx or erx is created in Hello Health. Therefore, for the alternate measure, the score in the Hello Health Meaningful Use Report will always be 100%. It is the provider s responsibility, if some prescriptions are created outside Hello Health, to keep track of them and to adjust the denominator in the attestation form; Electronic transmittal of the medication order is not a requirement for meeting the measure of this objective. However, a separate objective addresses the electronic transmission of prescriptions; A radiology order can only be documented into Hello Health if the order is created in Hello Health. Therefore, the score in the Hello Health Meaningful Use report will always be 100%. It is the provider s responsibility, if some radiology orders are created outside Hello Health, to keep track of them and to adjust the denominator in the attestation form. For more details, see CMS information Guidance/Legislation/EHRIncentivePrograms/downloads/Stage2_EPCore_1_CPOE_MedicationOrders.pdf

11 Hello Health Meaningful Use Guide for Eligible Professionals Stage 2 11 Generate and Transmit Permissible Prescriptions Electronically (erx) [Core] Overview Objective Generate and transmit permissible prescriptions electronically (erx). Attestation Requirements Measure More than 50 percent of all permissible prescriptions, or all prescriptions, written by the EP are queried for a drug formulary and transmitted electronically using certified EHR technology. / / Exclusions Number of prescriptions written for drugs requiring a prescription in order to be dispensed other than controlled substances during the EHR reporting period. Number of prescriptions in the denominator generated, queried for a drug formulary and transmitted electronically. Exclusions Providers who write fewer than 100 prescriptions during the reporting period OR who do not have a pharmacy within their organization and for whom there are no pharmacies that accept electronic prescriptions within 10 miles of their practice location, at the start of their EHR reporting period, would be excluded from this requirement.

12 Hello Health Meaningful Use Guide for Eligible Professionals Stage 2 12 How to Meet the MU Attestation Using Hello Health To create and send an electronic prescription, a few options are available: From the visit documentation, you can create a prescription (medication order) by adding it from the Care plan section: In the patient record, under the Current Medications subsection of the EHR or in the Prescriptions section; Note that if not in the patient record, you can still create and send electronic prescriptions from the erx dashboard (tab). If you are already in the patient record, select either the Add new medication in the EHR or the Prescriptions subsection in the patient record. If you are not in the patient record, click the erx tab at the top of the screen. o Search and select a patient, then click Create Rx. In the pop-up window, search and select the required medication (not shown).

13 Hello Health Meaningful Use Guide for Eligible Professionals Stage Enter in the prescription information; 2. Click Prepare Rx; 3. Verify and choose the correct pharmacy; 4. Click Send erx. Note that this measure requires that electronic prescriptions be queried for a drug formulary. The default setting when implementing Hello Health is to enable formulary check with electronic prescribing. When drug formulary is enabled, the Drug formulary information is located above the prescription info and you can click on View coverage for details (see image above). If you are unsure this feature is turned on for your practice, contact the Customer Experience Team; and Explained for Hello Health All prescriptions (medication orders) created, Rx and erx, in the reporting period, except prescriptions for controlled substance (permissible prescriptions). All electronically sent prescriptions (erx) in the reporting period created while Drug formulary check was enabled.

14 Hello Health Meaningful Use Guide for Eligible Professionals Stage 2 14 Hints, Tips and Additional Information Instances where patients specifically request a paper prescription may not be excluded from the denominator of this measure. The denominator includes all prescriptions written by the EP during the EHR reporting period; The concept of only permissible prescriptions refers to the current restrictions established by the Department of Justice on electronic prescribing for controlled substances in Schedule II-V. o The substances in Schedule II-V can be found at o Any prescription not subject to these restrictions would be permissible. For more details, see CMS information Guidance/Legislation/EHRIncentivePrograms/downloads/Stage2_EPCore_2_ePrescribing.pdf

15 Hello Health Meaningful Use Guide for Eligible Professionals Stage 2 15 Record Demographics [Core] Overview Objective Record all of the following demographics: (A) Preferred language; (B) Gender; (C) Race; (D) Ethnicity; (E) Date of birth. Attestation Requirements Measure More than 80 percent of all unique patients seen by the EP have demographics recorded as structured data. / Number of unique patients seen by the EP during the EHR reporting period. Number of patients in the denominator who have all the elements of demographics (or a specific exclusion if the patient declined to provide one or more elements or if recording an element is contrary to state law) recorded as structured data.

16 Hello Health Meaningful Use Guide for Eligible Professionals Stage 2 16 How to Meet the MU Attestation Using Hello Health In the Demographics section, you can record, change and access patient demographics under the Basic Information subsection: 1. Click Basic Information; 2. Enter the patient s date of birth, gender, ethnicity, race and preferred language. If the patient chooses not to specify or does not know the information, make sure to select the Declined to specify option; 3. Click Save. and Explained for Hello Health Patients seen. Patients seen with all of the following demographic fields documented: (A) Preferred language; (B) Gender; (C) Race; (D) Ethnicity; (E) Date of birth.

17 Hello Health Meaningful Use Guide for Eligible Professionals Stage 2 17 Hints, Tips and Additional Information If a patient declines to provide all or part of the demographic information, or if capturing a patient s ethnicity or race is prohibited by state law, such a notation entered as structured data would count as an entry for purposes of meeting the measure. In regards to patients who do not know their ethnicity, EPs should treat these patients the same way as patients who decline to provide race or ethnicity: by identifying, in the patient record, that the patient declined to provide this information; EPs are not required to communicate with the patient in his or her preferred language in order to meet the measure of this objective; Please note that race and ethnicity codes in Hello Health follow current federal standards published by the Office of Management and Budget: For more details, see CMS information Guidance/Legislation/EHRIncentivePrograms/downloads/Stage2_EPCore_3_RecordingDemographics.pdf

18 Hello Health Meaningful Use Guide for Eligible Professionals Stage 2 18 Record Vital Signs [Core] Overview Objective Record and chart changes in the following vital signs: height/length and weight (no age limit); blood pressure (ages 3 and over); calculate and display body mass index (BMI); and plot and display growth charts for patients 0-20 years, including BMI. Attestation Requirements Measure More than 80 percent of all unique patients seen by the EP have blood pressure (for patients age 3 and over only) and/or height and weight (for all ages) recorded as structured data. / / Exclusion Number of unique patients (age 3 or over for blood pressure) seen by the EP during the EHR reporting period. Number of patients in the denominator who have at least one entry of their height, weight and blood pressure (age 3 and over) recorded as structured data. Exclusion Any EP who: 1. Does not see patients 3 years or older is excluded from recording blood pressure; 2. Believes that all three vital signs of height, weight, and blood pressure have no relevance to their scope of practice is excluded from recording them; 3. Believes that height/length and weight are relevant to their scope of practice, but blood pressure is not, is excluded from recording blood pressure; 4. Believes that blood pressure is relevant to their scope of practice, but height/length and weight are not, is excluded from recording height/length and weight.

19 Hello Health Meaningful Use Guide for Eligible Professionals Stage 2 19 How to Meet the MU Attestation Using Hello Health Vitals can be documented in the visit documentation: You can also record, change and access patient vitals directly in the Vitals section: 1. Click Add Vitals at the top-right hand corner of the screen; 2. Fill in the height, weight and blood pressure; 3. Click Save.

20 Hello Health Meaningful Use Guide for Eligible Professionals Stage 2 20 and Explained for Hello Health All Vitals in Scope Patients seen. Patients seen 3 years old or older who have at least one entry of their height, weight and blood pressure recorded; and Patients seen less than 3 years old who have at least one entry of their length and weight recorded. If Height and Weight are Out of Scope (Only Blood Pressure within Scope) Patients seen 3 years old or older. Patients seen 3 years old or older who have at least one entry of their blood pressure recorded. If Blood Pressure is Out of Scope (Only Height and Weight within Scope) Patients seen. Patients seen, regardless of age, who have at least one entry of their height / length and weight recorded. Hints, Tips and Additional Information The only information required to be input by the provider is the height, weight, and blood pressure of the patient. The certified EHR technology will calculate BMI and the growth chart if applicable to the patient based on age; Height, weight, and blood pressure do not have to be updated by the EP at every patient encounter. The EP can make the determination based on the patient s individual circumstances as to whether height, weight, and blood pressure need to be updated. For more details, see CMS information Guidance/Legislation/EHRIncentivePrograms/downloads/Stage2_EPCore_4_RecordVitalSigns.pdf

21 Hello Health Meaningful Use Guide for Eligible Professionals Stage 2 21 Record Smoking Status [Core] Overview Objective Record smoking status for patients 13 years old or older. Attestation Requirements Measure More than 80 percent of all unique patients 13 years old or older seen by the EP have smoking status recorded as structured data. / / Exclusion Number of unique patients age 13 or older seen by the EP during the EHR reporting period. Number of patients in the denominator with smoking status recorded as structured data. Exclusion Providers who do not see any patients 13 years old or older.

22 Hello Health Meaningful Use Guide for Eligible Professionals Stage 2 22 How to Meet the MU Attestation Using Hello Health From the EHR section, you can record, change and access the patient s smoking status. 1. In the EHR section, scroll down to the Social History section until you see the Smoking Status subsection; You can also document the Smoking Status through the EHR Summary in the visit documentation. 2. Select a status from the drop-down menu. If the status is unknown, make sure to specify Unknown if ever smoked. and Explained for Hello Health Patients seen age 13 years old or older. Patients seen age 13 years old or older with smoking status recorded as structured data (i.e. selected from the smoking status drop-down menu).

23 Hello Health Meaningful Use Guide for Eligible Professionals Stage 2 23 Hints, Tips and Additional Information You must select one of the options in the drop-down menu to qualify for Meaningful Use. You can also add free text, but free text alone is not enough; The date when the smoking status is documented is not important; This is a check of the medical record for patients 13 years old or older. If this information is already available in the medical record through certified EHR technology, an inquiry does not need to be made every time a provider sees a patient 13 years old or older. The frequency of updating this information is left to the provider and guidance is already provided from several sources in the medical community. For more details, see CMS information Guidance/Legislation/EHRIncentivePrograms/downloads/Stage2_EPCore_5_RecordSmokingStatus.pdf

24 Hello Health Meaningful Use Guide for Eligible Professionals Stage 2 24 Clinical Decision Support Rule [Core] Overview Objective Use clinical decision support to improve performance on high-priority health conditions. Attestation Requirements Measure 1 Implement 5 clinical decision support interventions related to 4 or more clinical quality measures, at a relevant point in patient care for the entire EHR reporting period. Measure 2 Enable the functionality for drug-drug and drug-allergy interaction checks for the entire EHR reporting period. Exclusion for Measure 2 Any EP who writes fewer than 100 medication orders during the EHR reporting period. Yes / No Eligible professionals (EPs) must attest (Yes) to having implemented one clinical decision support rule for the length of the reporting period to meet the measure.

25 Hello Health Meaningful Use Guide for Eligible Professionals Stage 2 25 How to Meet the MU Attestation Using Hello Health Hello Health has the ability to program clinical decision support that can trigger on-screen notifications, for providers, that appear at the top of the patient record (see the image below) when providers encounter patients with or without certain clinical conditions. You should implement the rules (reminders) that make sense for your practice. Some system reminders are predefined, which you can either enable or disable, but you can also create your own clinical decision reminders. In the Admin section, you can create and/or enable Clinical Decision Reminders: 1. At the top-right hand corner of the screen, click on Admin. Then, under the Settings tab, click on Clinical Decision Reminders; 2. Select the applicable checkbox to activate the reminders or click the pencil icon and choose Edit to modify a reminder (system rules cannot be edited); 3. You can also click Add new to add new clinical decision support reminders relevant for your practice. Complete the relevant fields and click Save;

26 Hello Health Meaningful Use Guide for Eligible Professionals Stage 2 26 Reminder: To create a rule, you must first create a query in the Advanced Search section. 4. Click Save. Hello Health also comes with the ability to automatically check for potentially adverse drug-drug or drugallergy interactions. This functionality is turned on as a default setting. When adding a medication, you will be alerted if there are potential interactions. To view a description of the interactions, click View Interactions.

27 Hello Health Meaningful Use Guide for Eligible Professionals Stage 2 27 and Explained for Hello Health Not applicable. Hints, Tips and Additional Information Regarding the four (4) CDS interventions that must relate to clinical quality measures (CQM), the EP is not limited to the CQMs reported in Hello Health, but can choose any relevant CQM for the practice. If none of the CQMs are applicable to an EP's scope of practice, the EP should implement CDS interventions that he or she believes will drive improvements in the delivery of care for the highpriority health conditions relevant to their patient population; CMS will not issue additional guidance on the selection of appropriate clinical decision support rules for Stage 2 Meaningful Use. This determination is best left to the EP taking into account their workflow, patient population, and quality improvement efforts; The need for inclusion of attributes for each CDS intervention also applies to drug-drug and drugallergy interventions as well as interventions based on self-generated evidence; Drug-drug and drug-allergy interaction alerts are separate from the 5 clinical decision support interventions and do not count towards the 5 required for this first measure. The Drug-drug and drug-allergy interaction checks functionality must be turned on for the entire reporting period. If unsure whether you have this feature turned on, ask the Customer Experience Team. For more details, see CMS information Guidance/Legislation/EHRIncentivePrograms/downloads/Stage2_EPCore_6_ClinicalDecisionSupport.pdf

28 Hello Health Meaningful Use Guide for Eligible Professionals Stage 2 28 Provide Patients the Ability to View, Download and Transmit (VDT) their Health Information [Core] Overview Replaces the Stage 1 core objective for EPs of Provide patients with an electronic copy of their health information. Objective Provide patients the ability to view online, download and transmit their health information within four business days of the information being available to the EP. Attestation Requirements Measure 1 More than 50 percent of all unique patients seen by the EP during the EHR reporting period are provided timely (available to the patient within 4 business days after the information is available to the EP) online access to their health information, with the ability to view, download, and transmit to a third party. Measure 2 More than 5 percent of all unique patients seen by the EP during the EHR reporting period (or their authorized representatives) view, download, or transmit to a third party their health information. / / Exclusions Measure 1 Number of unique patients seen by the EP during the EHR reporting period. 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. Exclusions (1) Any EP who neither orders nor creates any of the information listed for inclusion as part of both measures, except for Patient name and Provider's name and office contact information, may exclude both measures. (2) Any EP who conducts 50 percent or more of his or her patient encounters in a county that does not have 50 percent or more of its housing units with 3 Mbps broadband availability, according to the latest information available from the FCC on the first day of the EHR reporting period, may exclude only the second measure.

29 Hello Health Meaningful Use Guide for Eligible Professionals Stage 2 29 How to Meet the MU Attestation Using Hello Health Once patients have access to the patient portal (PortalConnect) and have an active membership plan, they are able to view, download and transmit their health information. Patients (or authorized representatives) can automatically access PortalConnect once they have created an account at a self check-in kiosk; or, you can send account activation instructions directly to patients from Hello Health. You can tell a patient has access to PortalConnect if the picture border is green and/or if the PHR Access information in the PortalConnect subsection indicates: This patient has access to PortalConnect: You can send the activation key directly to the patient from the PortalConnect section of the patient record menu. 1. Under Account Settings, click Send Account Activation Instructions or Send to patient; 2. Enter the address and click Send by .

30 Hello Health Meaningful Use Guide for Eligible Professionals Stage 2 30 and Explained for Hello Health Measure 1 Patients seen. Patients (*) who were able to access their Health Information in PortalConnect in the 4 days following their visit (i.e. patient had or had had a membership plan and has access to PortalConnect). Measure 2 Patients seen. Patients seen who (*) have accessed the Health Information Summary section in PortalConnect (whether viewed, downloaded or transmitted). (*) Whether the patient or a representative with authorized PortalConnect access such as a patient s guardian. Hints, Tips and Additional Information The information must be made available online unless the provider believes that substantial harm may arise from disclosing particular health information in this manner; To meet this measure more easily, encourage your patients to register to PortalConnect for a trial period and to access PortalConnect at least once for them to see the value of being subscribed to a membership plan. Transmit refers to an electronic transmission according to any transport standard(s) (SMTP, FTP, REST, SOAP, etc.); that is, the relocation of physical electronic media (for example, USB, CD) does not qualify as transmission although the movement of the information from online to the physical electronic media will be a download. With PortalConnect, the patient can easily enter the Direct address of a recipient and electronically transmit their Health Summary. For more details, see CMS information Guidance/Legislation/EHRIncentivePrograms/downloads/Stage2_EPCore_7_PatientElectronicAccess.pdf

31 Hello Health Meaningful Use Guide for Eligible Professionals Stage 2 31 Clinical Summaries [Core] Overview Objective Provide clinical summaries for patients for each office visit. Attestation Requirements Measure Clinical summaries provided to patients or patient-authorized representatives within one business day for more than 50 percent of office visits. / / Exclusion Number of office visits by the EP during the EHR reporting period. Clinical summaries provided to patients or patient-authorized representatives within one (1) business day for more than 50 percent of office visits.. Exclusion EPs who have no office visits during the EHR reporting period would be excluded from this requirement.

32 Hello Health Meaningful Use Guide for Eligible Professionals Stage 2 32 How to Meet the MU Attestation Using Hello Health From the menu icon in the visit documentation, select Export Clinical Summary or, in the Patient record menu, under the Export / Import subsection, you can export a clinical summary for the patient to view: 1. Follow the prompts in the pop-up window: a. In the Purpose field, select Patient Request; b. Modify, if relevant, the delay in which you provide the summary to the patient following the patient visit; c. Enter a Reason; the reason is optional and only used to document export audits (visible to the provider only, not to the patient); d. Select the sections you wish to include (by default, all are selected); e. Select the visit to export; f. Specify if you want to view as HTML or PDF and if you want to download the XML; g. Click the Export button.

33 Hello Health Meaningful Use Guide for Eligible Professionals Stage 2 33 and Explained for Hello Health Number of office visits (*) during the reporting period. Number of office visits (*) in the denominator for which: Patient (or representative) had access to their health information in PortalConnect within one day following their visit (i.e. patient had or has had a membership plan and had access to PortalConnect); or A clinical summary was exported within 1 business day with Patient request selected as the purpose. (*) Excluding visits with a Cancelled or No show status.

34 Hello Health Meaningful Use Guide for Eligible Professionals Stage 2 34 Hints, Tips and Additional Information The clinical summary can be provided through a patient portal, secure , electronic media such as CD or USB fob, or printed copy. If the EP chooses an electronic media, they would be required to provide the patient a paper copy upon request; If an EP believes that substantial harm may arise from the disclosure of particular information, an EP may choose to withhold that particular information from the clinical summary; Providers should not charge patients a fee to provide a clinical summary to a patient without PortalConnect access; When a patient visit lasts several days and the patient is seen by multiple EPs, a single clinical summary at the end of the visit can be used to meet the Meaningful Use objective for Provide clinical summaries for patients after each office visit. Make sure to document the information when a patient office visit is cancelled or when the patient does not show up for a visit so that the denominator calculated in Hello Health correctly reflects actual office visits; To meet this measure more easily, encourage your patients to register to PortalConnect for a trial period and to access PortalConnect at least once for them to see the value of being subscribed to a membership plan. For more details, see CMS information Guidance/Legislation/EHRIncentivePrograms/downloads/Stage2_EPCore_8_ClinicalSummaries.pdf

35 Hello Health Meaningful Use Guide for Eligible Professionals Stage 2 35 Protect Electronic Health Information [Core] Overview Objective Protect electronic health information created or maintained by the certified EHR technology through the implementation of appropriate technical capabilities. Attestation Requirements Measure Conduct or review a security risk analysis in accordance with the requirements under 45 CFR (a)(1) and implement security updates as necessary and correct identified security deficiencies. Yes / No Eligible professionals (EPs) must attest (Yes) to having conducted or reviewed a security risk analysis in accordance with the requirements under 45 CFR (a)(1) and implemented security updates as necessary and corrected identified security deficiencies prior to or during the EHR reporting period to meet this measure. How to Meet the MU Attestation Using Hello Health Hello Health possesses the capabilities and standards of the required MU security measures D1 to D8: Auditable events and tamper-resistance; Audit reports; Amendments; Automatic log-off; Emergency access; End-user device encryption; Integrity; Authentication, access control, and authorization.

36 Hello Health Meaningful Use Guide for Eligible Professionals Stage 2 36 Hints, Tips and Additional Information EPs must conduct or review a security risk analysis of certified EHR technology and implement updates as necessary at least once prior to the end of the EHR reporting period and attest to that conduct or review. The testing could occur prior to the beginning of the first EHR reporting period. However, a new review would have to occur for each subsequent reporting period; A security update would be required if any security deficiencies were identified during the risk analysis. A security update could be updated software for certified EHR technology to be implemented as soon as available, changes in workflow processes or storage methods, or any other necessary corrective action that needs to take place in order to eliminate the security deficiency or deficiencies identified in the risk analysis. For more details, see CMS information Guidance/Legislation/EHRIncentivePrograms/downloads/Stage2_EPCore_9_ProtectElectronicHealthInfo.p df

37 Hello Health Meaningful Use Guide for Eligible Professionals Stage 2 37 Clinical Lab Test Results [Core] Overview Objective Incorporate clinical lab test results into EHR as structured data. Attestation Requirements Measure More than 55 percent of all clinical lab test results ordered by the EP during the EHR reporting period for which results are either in a positive/negative or numerical format are incorporated in certified EHR technology as structured data. / / Exclusion Number of lab tests ordered during the EHR reporting period by the EP for which results are expressed in a positive or negative affirmation or as a number. Number of lab test results for which results are expressed in a positive or negative affirmation or as a number which is incorporated as structured data. Exclusion If an EP orders no lab tests for which results are either in a positive/negative or numeric format during the EHR reporting period, they would be excluded from this requirement. EPs must select No next to the appropriate exclusion, then click the Apply button in order to attest to the exclusion.

38 Hello Health Meaningful Use Guide for Eligible Professionals Stage 2 38 How to Meet the MU Attestation Using Hello Health The Labs section must be enabled in the platform and orders must be sent out electronically. Please contact the Customer Experience Team to enable this functionality. and Explained for Hello Health Number of lab tests ordered during the EHR reporting period. Number of lab test results received in Hello Health that are expressed in a positive or negative affirmation. Hints, Tips and Additional Information All lab results received through Hello Health, expressed in a positive or negative affirmation or as a number, are incorporated as structured data; If you order labs (paper requisition or other) for which lab results are not received through the Hello Health lab feature, you must adjust the denominator for your Meaningful Use attestation. For more details, see CMS information Guidance/Legislation/EHRIncentivePrograms/downloads/Stage2_EPCore_10_ClinicalLabTestResults.pdf

39 Hello Health Meaningful Use Guide for Eligible Professionals Stage 2 39 Patient Lists [Core] Overview Objective Generate lists of patients by specific conditions (which are listed in the active patient s problem list) to use for quality improvement, reduction of disparities, research, or outreach. Attestation Requirements Measure Generate at least one report listing patients of the EP with a specific condition. Yes / No Eligible professionals (EPs) must attest (Yes) to having generated at least one report listing patients of the EP with a specific condition to meet this measure.

40 Hello Health Meaningful Use Guide for Eligible Professionals Stage 2 40 How to Meet the MU Attestation Using Hello Health Hello Health features advanced search tools which enable providers to search within their patient panel for patients who have a given condition reported in the patient EHR. 1. Go to the patient panel; 2. Select the Advanced Search option; 3. Enter the criteria for your search; 4. Click Search (you may also save your query for later use); 5. Results are shown as a patient list, showing only patients that have or have had the precise medical condition reported in their EHR. and Explained for Hello Health Not applicable.

41 Hello Health Meaningful Use Guide for Eligible Professionals Stage 2 41 Hints, Tips and Additional Information This objective does not dictate the report(s) that must be generated. An EP is best positioned to determine which reports are most useful to their care efforts; The report generated could cover every patient whose records are maintained using certified EHR technology or a subset of those patients at the discretion of the EP; Queries may be saved for future use. For more details, see CMS information Guidance/Legislation/EHRIncentivePrograms/downloads/Stage2_EPCore_11_PatientLists.pdf

42 Hello Health Meaningful Use Guide for Eligible Professionals Stage 2 42 Patient Reminders [Core] Overview Objective Use clinically relevant information to identify patients who should receive reminders for preventive/follow-up care and send these patients the reminders, per patient preference. Attestation Requirements Measure More than 10 percent of all unique patients who have had 2 or more office visits with the EP within the 24 months before the beginning of the EHR reporting period were sent a reminder, per patient preference when available. / / Exclusion Number of unique patients who have had two or more office visits with the EP in the 24 months prior to the beginning of the EHR reporting period. Number of patients in the denominator who were sent a reminder per patient preference when available during the EHR reporting period. Exclusion Any EP who has had no office visits in the 24 months before the EHR reporting period.

43 Hello Health Meaningful Use Guide for Eligible Professionals Stage 2 43 How to Meet the MU Attestation Using Hello Health Patients can be selected from the patient panel by performing an Advanced Search. From the resulting patient listing, click the Actions menu and select Create patient reminder. Enter the required information and click Create.

44 Hello Health Meaningful Use Guide for Eligible Professionals Stage 2 44 The new task is created and available from the task list. Click on the main patient Reminder tasks to see subtasks for all patients. You can also create a Patient reminder task for one patient at a time. To indicate that a reminder was sent to the patient, complete the task by editing it and make sure to specify the Preferred Contact Method was used if such is the case.

45 Hello Health Meaningful Use Guide for Eligible Professionals Stage 2 45 You can also indicate that a reminder was sent to the patient by selecting Complete Task in the pencil icon menu (when completing from the pencil icon menu, the assumption is that the Preferred Contact Method has been used): and Explained for Hello Health Number of active unique patients who have had at least 2 visits with provider in the 2 years preceding the start of the reporting period. Number of patients in the denominator with at least 1 patient reminder task completed sent per patient preferred contact method in the reporting period (regardless of the task creation date).

46 Hello Health Meaningful Use Guide for Eligible Professionals Stage 2 46 Hints, Tips and Additional Information This measure is based on your active panel. If there are patients in your panel who are no longer under your care, be sure to contact the Customer Experience Team so that the status of these patients is accurately changed to inactive; EPs meet the aspect of per patient preference of this objective if they are accommodating reasonable requests in accordance with the HIPAA Privacy Rule, as specified at 45 CFR (b), which is the guidance established for accommodating patient requests; Patients may decline to provide their preferred communication medium in which case the provider may select the communication medium; An EP should use clinically relevant information stored within the certified EHR to identify patients who should receive reminders; When you click on the task, the patient list for whom you have created the reminder opens. Clicking the blue pencil icon to the right hand side of the patient list enables the provider to send a secure message to that patient; You can also send secure messages to all patients at once from the panel. Run the same query used to create the Patient Reminder task, click on the Actions menu and select Send message. For more details, see CMS information Guidance/Legislation/EHRIncentivePrograms/downloads/Stage2_EPCore_12_PreventiveCare.pdf

47 Hello Health Meaningful Use Guide for Eligible Professionals Stage 2 47 Patient-Specific Education Resources [Core] Overview Objective Use clinically relevant information from Certified EHR Technology to identify patient-specific education resources and provide those resources to the patient. Attestation Requirements Measure Patient-specific education resources identified by Certified EHR Technology 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. / / Exclusion Number of unique patients with office visits by the EP during the EHR reporting period. Number of patients in the denominator who are provided patient-specific education resources identified by the Certified EHR Technology. Exclusion Any EP who has no office visits during the EHR reporting period.

48 Hello Health Meaningful Use Guide for Eligible Professionals Stage 2 48 How to Meet the MU Attestation Using Hello Health The Patient Education section of the patient record makes it possible for you to send patient education to your patients. The system automatically generates a list of topics that could be of interest to each patient based on the medications, conditions and labs ordered through the patient s chart. Hello Health is using MedlinePlus as a source of educational material, and you can also create your own Patient Education suggestions with educational material of your choice. In the patient record, select the Patient Education section, then click Select & Send Content. Select the relevant patient education information and click Next.

49 Hello Health Meaningful Use Guide for Eligible Professionals Stage 2 49 Add a message for the patient and click Send. The message will be sent by secure message to the patient. and Explained for Hello Health Patients seen at the office (i.e. Office visit only). Patients seen, with an Office visit, who are provided patient education-specific resources including VIS content sent upon documentation of an immunization (regardless of date content was sent).. Hints, Tips and Additional Information When sending a patient VIS upon documentation of a vaccine in Hello Health, this counts as relevant patient education; For patients who are not online, if you print the content for them (whether your own or MedlinePlus), you can still use the Patient Education section to document that you have provided them with the information, as if they were online patients. Also, if you give patients educational material coming from other sources about a topic that is listed by the system but that is not covered by MedlinePlus (gray topic in the Patient Education Selector dialog), Hello Health will record this information as having been sent to them; In addition to the Medline education material that is automatically available in Hello Health, you can also create your own patient education suggestions. Go to the Admin section and access the Patient Education subsection under Settings. Refer to the Hello Health version 7 video for more information.

50 Hello Health Meaningful Use Guide for Eligible Professionals Stage 2 50 For more details, see CMS information Guidance/Legislation/EHRIncentivePrograms/downloads/Stage2_EPCore_13_PatientSpecificEdRes.pdf

51 Hello Health Meaningful Use Guide for Eligible Professionals Stage 2 51 Medication Reconciliation [Core] Overview Objective The EP who receives a patient from another setting of care or provider of care or believes an encounter is relevant should perform medication reconciliation. Attestation Requirements Measure 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. / / Exclusion Number of transitions of care during the EHR reporting period for which the EP was the receiving party of the transition. Number of transitions of care in the denominator where medication reconciliation was performed. Exclusion Any EP who was not the recipient of any transitions of care during the EHR reporting period.

52 Hello Health Meaningful Use Guide for Eligible Professionals Stage 2 52 How to Meet the MU Attestation Using Hello Health From the Export / Import subsection, you can import a Summary Care Record from which you will then be able to launch a clinical reconciliation. If you have a Direct messaging account with Hello Health, you can also receive summaries of care for transitioned patients in your secure messages. Click Summary Care Record and select the file to import and open: 1. Specify the purpose of the import (in this case, it is for Patient referral); 2. Enter the Referrer information; 3. Ensure that the Reconcile now checkbox is selected;

53 Hello Health Meaningful Use Guide for Eligible Professionals Stage Click Import. During reconciliation, data to reconcile is grouped by Medications, Allergies and Problems; 1. There is the option to import all data; this is particularly useful when a new patient transitions into the provider s care; 2. There is the option to add and remove entries individually using the +/- buttons; 3. You can click Expand All or click an individual item in one of the lists to see more details about the item; 4. When you have completed the reconciliation for all 3 sections, click Save. You can also receive a summary of care through Direct messaging, in a secure message. If a clinical document is attached to a secure message, the Clinical Document indication tells you that this file can be imported and reconciled. Click the file name or select Import Clinical Document in the pencil icon menu. Note that when importing from the Messages tab, you will need to select the patient name.

54 Hello Health Meaningful Use Guide for Eligible Professionals Stage 2 54 To help you keep track of imported summaries of care and patient referrals, you can link an import to a patient visit. For an imported summary of care, in the Audits section, use the pencil icon menu and choose Link to Visit. and Explained for Hello Health Number of imported summaries of care in the reporting period for which the selected purpose is Patient Referral, whether summary of care was received through Direct messaging (in your secure messages) or you have imported the file directly in the patient record. Number of imported summaries of care in the reporting period for which the selected purpose is Patient Referral and for which the provider accessed the Clinical Reconciliation dialog.

55 Hello Health Meaningful Use Guide for Eligible Professionals Stage 2 55 Hints, Tips and Additional Information To be able to receive Direct messages in your Hello Health secure message mail box, you need to use a Hello Health Direct address; Note that you can choose to import first and reconcile later. For instance, a staff member may be responsible to import the summary of care, and when the provider is ready, from the Audits section, you can use the pencil icon and select Reconcile. Also, reconciliation can be performed outside of the reporting period; If you receive referrals with a summary of care in a non-standard format that cannot be imported into Hello Health and/or, if you conduct a medication reconciliation manually, you can adjust the denominators and numerators consequently when attesting to the measure. For more details, see CMS information Guidance/Legislation/EHRIncentivePrograms/downloads/Stage2_EPCore_14_MedicationReconciliation.pdf

56 Hello Health Meaningful Use Guide for Eligible Professionals Stage 2 56 Transition of Care Summary [Core] Overview Objective The EP who transitions their patient to another setting of care or provider of care or refers their patient to another provider of care should provide summary care record for each transition of care or referral. Attestation Requirements Measure 1 Provide a summary of care record for more than 50 percent of transitions of care and referrals. Measure 2 Provide a summary of care record for more than 10 percent of the total number of transitions and referrals either (a) electronically transmitted using a certified EHR to a recipient or (b) where the recipient receives the summary of care record via exchange facilitated by an organization that is an ehealth Exchange (formerly NwHIN exchange) participant or in a manner that is consistent with the governance mechanism ONC establishes for the ehealth Exchange. Measure 3 EPs must also satisfy one of the following criteria: Conduct one or more successful electronic exchanges of a summary of care document, as part of which is counted in Measure 2 with a recipient who has EHR technology that was developed/designed by a different EHR technology developer than the sender s EHR technology; Conduct one or more successful tests with the CMS designated test EHR during the EHR reporting period. / / Exclusion Measure 1 Number of transitions of care and referrals during the EHR reporting period for which the EP was the transferring or referring provider. Number of transitions of care and referrals in the denominator where a summary of care record was provided.

57 Hello Health Meaningful Use Guide for Eligible Professionals Stage 2 57 Measure 2 Number of transitions of care and referrals during the EHR reporting period for which the EP was the transferring or referring provider. (a) Number of transitions of care and referrals in the denominator where a summary of care record was electronically transmitted using a certified EHR to a recipient; (b) Number of transitions of care and referrals in the denominator where the recipient receives the summary of care record via exchange facilitated by an organization that is a NwHIN Exchange participant; (c) Number of transitions of care and referrals in the denominator where the recipient receives the summary of care record in a manner that is consistent with the governance mechanism ONC establishes for the nationwide health information network. Exclusion If an EP does not transfer a patient to another setting or refer a patient to another provider during the EHR reporting period, then they would be excluded from this requirement. EPs must select No next to the appropriate exclusion and then click the Apply button in order to attest to the exclusion. Measure 3 Yes / No

58 Hello Health Meaningful Use Guide for Eligible Professionals Stage 2 58 How to Meet the MU Attestation Using Hello Health There are 2 ways to document the transition of your patients to another provider or setting of care: 1. Create a Referral order (either Add order in a visit care plan or Create Order from the Orders dashboard); 2. Export a Summary of Care from the Export/Import section and specify that the purpose is Patient Referral. When creating a referral order, make sure to select Referral as the type, to document the patient who is being referred, the Order (subject), the Reason for referral and to select a Recipient: Once all these fields are documented, you will notice that you can include a Summary of Care record as an attachment. Note that the Summary of Care is generated automatically and will include the Patient and Reason for referral that is documented in the order.

59 Hello Health Meaningful Use Guide for Eligible Professionals Stage 2 59 If you and the recipient have Direct addresses, in addition to being able to save the order, you are able to send the information by Direct messaging to the recipient.

60 Hello Health Meaningful Use Guide for Eligible Professionals Stage 2 60 Transition of care to another provider or unit of care can also be documented by exporting the Summary of Care from the Export/Import section. 1. For a selected patient, go to the Export/Import section; 2. Select Summary Care Record under Export.

61 Hello Health Meaningful Use Guide for Eligible Professionals Stage Select Patient Referral as the Purpose; 2. Provide the Refer to information; 3. Add a Reason as necessary (the Reason will be included in the Summary of Care under the Reason for referral section; 4. Review the list of sections you want to export; 5. Select the desired View and Download options; 6. Click Export. Note that exporting a Summary of Care will automatically create a Referral order with the attached Summary of Care and will appear in the Orders dashboard tab. and Explained for Hello Health Measure 1 Number of Referral Orders created in the reporting period. Number of Referral Orders created in the reporting period that includes a Summary of Care.

62 Hello Health Meaningful Use Guide for Eligible Professionals Stage 2 62 Measure 2 Number of Referral Orders created in the reporting period. Number of Referral Orders created in the reporting period that includes a Summary of Care and that were sent electronically using Direct Messaging. Measure 3 Not applicable Hints, Tips and Additional Information To use Direct messaging, you need to have a Hello Health Direct address; The EP can either send an electronic or paper copy of the summary of care record directly to the next provider or provide it to the patient to deliver to the next provider, as long as the patient can reasonably be expected to do so. However, to document the transition of care and the fact that the summary of care was provided, you should create an order with the attached summary of care anyway, or make sure to adjust your numerator and denominator accordingly in your attestation form; If the provider to whom the referral is made or to whom the patient is transitioned has access to the medical record maintained by the referring provider, the summary of care record would not need to be provided and that patient should not be included in the denominator for transitions of care; When creating a Referral order, this increases the denominator. Make sure to attach the summary of care to also increase the numerator. The summary of care does not have to be attached immediately, as long as you edit the order to attach the relevant summary of care before the end of the reporting period. For more details, see CMS information Guidance/Legislation/EHRIncentivePrograms/downloads/Stage2_EPCore_15_SummaryCare.pdf

63 Hello Health Meaningful Use Guide for Eligible Professionals Stage 2 63 Immunization Registries Data Submission [Core] Overview Objective Capability to submit electronic data to immunization registries or immunization information systems and actual submission according to applicable law and practice. Attestation Requirements Measure Successful ongoing submission of electronic immunization data from a certified EHR to an immunization registry or immunization information system for the entire EHR reporting period. Exclusion Any EP that meets one or more of the following criteria may be excluded from this objective: (1) The EP does not administer any of the immunizations to any of the populations for which data is collected by their jurisdiction's immunization registry or immunization information system during the EHR reporting period; (2) The EP operates in a jurisdiction for which no immunization registry or immunization information system is capable of accepting the specific standards required for a certified EHR at the start of their EHR reporting period; (3) The EP operates in a jurisdiction where no immunization registry or immunization information system provides information timely on capability to receive immunization data; or: (4) The EP operates in a jurisdiction for which no immunization registry or immunization information system that is capable of accepting the specific standards required by a certified EHR at the start of their EHR reporting period can enroll additional EPs.

64 Hello Health Meaningful Use Guide for Eligible Professionals Stage 2 64 How to Meet the MU Attestation Using Hello Health If you are in a jurisdiction where an immunization registry is capable of accepting a certified EHR data according to the required standards, make sure to first sign up with the registry and contact the Customer Experience Team to plan your integration. Once integrated with your state immunization registry, all relevant immunization entries (added, updated or deleted) will automatically be sent. and Explained for Hello Health Not applicable. Hints, Tips and Additional Information Sign-up delays with the immunization registries vary from one registry to another. Make sure to sign up early so that an integration can be completed on time for your practice if you are planning to meet this Meaningful Use objective; Your registry will be the contact for any confirmation about completion of this measure, so make sure to save documentation of all communication with your registry for your records. In determining whether the PHA has the capacity, CMS anticipates developing a centralized repository for this information, including a deadline for the PHA to submit information. If the PHA fails to provide information to this centralized repository by the deadline, the provider could claim the exclusion. In the event that we are unable to develop a centralized repository, providers will make the determination of PHA capacity by working directly with the PHA as is currently the case for Stage 1 of Meaningful Use. For more details, see CMS information Guidance/Legislation/EHRIncentivePrograms/downloads/Stage2_EPCore_16_ImmunizationRegistriesData Submission.pdf

65 Hello Health Meaningful Use Guide for Eligible Professionals Stage 2 65 Secure Electronic Messaging [Core] Overview Objective Use secure electronic messaging to communicate with patients on relevant health information. Attestation Requirements Measure A secure message was sent using the electronic messaging function of a certified EHR by more than 5 percent of unique patients (or their authorized representatives) seen by the EP during the EHR reporting period. / / Exclusion Number of unique patients seen by the EP during the EHR reporting period. The number of patients or patient-authorized representatives in the denominator who send a secure electronic message to the EP that is received using the electronic messaging function of a certified EHR during the EHR reporting period. Exclusion Any EP who has no office visits during the EHR reporting period, or any EP who conducts 50 percent or more of his or her patient encounters in a county that does not have 50 percent or more of its housing units with 3 Mbps broadband availability according to the latest information available from the FCC on the first day of the EHR reporting period.

66 Hello Health Meaningful Use Guide for Eligible Professionals Stage 2 66 How to Meet the MU Attestation Using Hello Health Patients can only send you secure messages if they have a PortalConnect membership plan. and Explained for Hello Health Patients seen. Patients seen from whom the provider has received at least one secure message in the reporting period. Hints, Tips and Additional Information There is no expectation that the EP must personally respond to electronic messages to the patient; As patient replies also count as messages sent by the patients, to entice your patients to send secure messages, use Secure Messages as a means to remind patients of upcoming appointments and ask them to confirm through secure messages as well. Reminder: you can use Advanced Search to create a list of patients with coming appointments and use the Send message option to send a reminder to all those patients. For more details, see CMS information Guidance/Legislation/EHRIncentivePrograms/downloads/Stage2_EPCore_17_UseSecureElectronicMessa ging.pdf

67 Hello Health Meaningful Use Guide for Eligible Professionals Stage 2 67 Syndromic Surveillance Data Submission [Menu] Overview Objective Capability to submit electronic syndromic surveillance data to public health agencies and actual submission according to applicable law and practice. Attestation Requirements Measure Successful ongoing submission of electronic syndromic surveillance data from a certified EHR to a public health agency for the entire EHR reporting period. Yes / No Ongoing submission was already achieved for an EHR reporting period in a prior year and continues throughout the current EHR reporting period. Registration with the PHA or other body to whom the information is being submitted of intent to initiate ongoing submission was made by the deadline (within 60 days of the start of the EHR reporting period) and ongoing submission was achieved. Registration of intent to initiate ongoing submission was made by the deadline and the EP or hospital is still engaged in testing and validation of ongoing electronic submission. Registration of intent to initiate ongoing submission was made by the deadline and the EP or hospital is awaiting invitation to begin testing and validation. Exclusion Any EP that meets one or more of the following criteria may be excluded from this objective: (1) The EP is not in a category of providers that collect ambulatory syndromic surveillance information on their patients during the EHR reporting period; (2) The EP operates in a jurisdiction for which no public health agency is capable of receiving electronic syndromic surveillance data in the specific standards required by a certified EHR at the start of their EHR reporting period; (3) The EP operates in a jurisdiction where no public health agency provides information timely on capability to receive syndromic surveillance data; or: (4) The EP operates in a jurisdiction for which no public health agency that is capable of accepting the specific standards required by a certified EHR at the start of their EHR reporting period can enroll additional EPs.

68 Hello Health Meaningful Use Guide for Eligible Professionals Stage 2 68 How to Meet the MU Attestation Using Hello Health If you are in a jurisdiction where a public health agency is capable of accepting a certified EHR data according to the required standards, make sure to first sign up with the agency and contact the Customer Experience Team to plan your integration. Once integrated with your state agency, all relevant diagnoses will automatically be sent when finishing a visit. and Explained for Hello Health Not applicable. Hints, Tips and Additional Information Sign-up delays with the agencies may vary. Make sure to sign up early so that an integration can be completed on time for your practice if you are planning to meet this Meaningful Use objective; In determining whether the PHA has the capacity, CMS anticipates developing a centralized repository for this information, including a deadline for the PHA to submit information. If the PHA fails to provide information to this centralized repository by the deadline, the provider could claim the exclusion. In the event that we are unable to develop a centralized repository, providers will make the determination of PHA capacity by working directly with the PHA as is currently the case for Stage 1 of Meaningful Use. For more details, see CMS information Guidance/Legislation/EHRIncentivePrograms/downloads/Stage2_EPMenu_1_SyndromicSurveillanceDataS ub.pdf

69 Hello Health Meaningful Use Guide for Eligible Professionals Stage 2 69 Record Electronic Notes in Patient Records [Menu] Overview Objective Record electronic notes in patient records. Attestation Requirements Measure Enter at least one electronic progress note created, edited and signed by an EP for more than 30 percent of unique patients with at least one office visit during the EHR reporting period. The text of the electronic note must be text searchable and may contain drawings and other content. / / Exclusion Number of unique patients with at least one office visit during the EHR reporting period for EPs during the EHR reporting period. The number of unique patients in the denominator who have at least one electronic progress note from an eligible professional recorded as text searchable data. Exclusion Any EP who has no office visits during the EHR reporting period.

70 Hello Health Meaningful Use Guide for Eligible Professionals Stage 2 70 How to Meet the MU Attestation Using Hello Health You must first add a visit for the patient from either the Scheduling or the Visits section of the patient record. To document the visit note: 1. Click the visit date in the patient visit list; 2. Document relevant sections of the visit documentation; 3. When completed, click Finish and enter your password to sign the visit note. and Explained for Hello Health Patients seen at the office (i.e. Office visit only) Patients seen, with an Office visit, for whom there is at least one finished visit in the patient record.

71 Hello Health Meaningful Use Guide for Eligible Professionals Stage 2 71 Hints, Tips and Additional Information Only the EP with whom the visit is scheduled can edit and sign the visit; An EP or authorized provider may author, edit and sign the note in any manner including dictation, conversion of written notes to text searchable notes, direct entry into the EHR or any other method as long as the end result is a text searchable note that is the information that the EP or authorized provider wanted to note; Non-searchable notes do not qualify, but this does not mean that all of the content has to be character text. For more details, see CMS information Guidance/Legislation/EHRIncentivePrograms/downloads/Stage2_EPMenu_2_ElectronicNotes.pdf

72 Hello Health Meaningful Use Guide for Eligible Professionals Stage 2 72 Imaging Results Accessible through EHR (Radiology Orders) [Menu] Overview Objective Imaging results consisting of the image itself and any explanation or other accompanying information are accessible through a certified EHR. Attestation Requirements Measure More than 10 percent of all tests for which the result is one or more images ordered by the EP during the EHR reporting period are accessible through a certified EHR. / / Exclusion Number of tests for which the result is one or more images ordered by the EP during the EHR reporting period. The number of results in the denominator that is accessible through a certified EHR. Exclusion Any EP who orders less than 100 tests for which the result is an image during the EHR reporting period; or any EP who has no access to electronic imaging results at the start of the EHR reporting period.

73 Hello Health Meaningful Use Guide for Eligible Professionals Stage 2 73 How to Meet the MU Attestation Using Hello Health Refer to the CPOE (Computerized Provider Order Entry) section for how to create Radiology Orders in Hello Health. Once results are available, edit the order to attach the images to the order: 1. Select Edit in the pen icon menu 2. In the Order dialog, click Add Attachment 3. Select Browse Computer Files or Browse Library Files 4. Choose the file to attach 5. Change the Order status to To Be Reviewed or Completed

74 Hello Health Meaningful Use Guide for Eligible Professionals Stage 2 74 and Explained for Hello Health Number of Radiology Orders created in the reporting period. Number of Radiology Orders created in the reporting period for which results (file) were attached to the order and the status is either To be reviewed or Completed. Hints, Tips and Additional Information Radiology Orders cannot be deleted, but you can cancel an order in which case this order will not be taken into account in the denominator; There are no limitations on the resolution of the image; Storing the images natively in Hello Health is one way to make them accessible through a certified EHR, but there are many other ways and native storage is not required by the objective and measure; For more details, see CMS information Guidance/Legislation/EHRIncentivePrograms/downloads/Stage2_EPMenu_3_ImagingResults.pdf

75 Hello Health Meaningful Use Guide for Eligible Professionals Stage 2 75 Record Patient Family Health History [Menu] Overview Objective Record patient family health history as structured data. Attestation Requirements Measure More than 20 percent of all unique patients seen by the EP during the EHR reporting period have a structured data entry for one or more first-degree relatives. / / Exclusion Number of unique patients seen by the EP during the EHR reporting period. The number of patients in the denominator with a structured data entry for one or more first-degree relatives. Exclusion Any EP who has no office visits during the EHR reporting period.

76 Hello Health Meaningful Use Guide for Eligible Professionals Stage 2 76 How to Meet the MU Attestation Using Hello Health A patient s family history can be documented in the EHR section of the patient record, in the Family History subsection:

77 Hello Health Meaningful Use Guide for Eligible Professionals Stage First, click the Add a family member link; 2. Complete the relevant demographic information; 3. Click Save; 4. Click the Add new link that appears below the family member information to document medical conditions for this family member.