Achieving Meaningful Use with Centricity Electronic Medical Record

Transcription

1 GE Healthcare Achieving Meaningful Use with Centricity Electronic Medical Record Version 9.8 Revised July 2015 Centricity EMR DOC General Electric Company

2 All information is subject to change without notice. This information is the confidential and proprietary information of General Electric Company. Unauthorized duplication is strictly prohibited. Centricity is a registered trademark of General Electric Company.

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4 Introduction Centricity Electronic Medical Record (EMR) version 9.8 includes Functional (Meaningful Use) and Clinical Quality Measure reporting based on final ONC 1 criteria and CMS 2 requirements. The release is ONC-ACB certified 2014 edition ONC certification criteria, which support Stages 1 and 2 of Meaningful Use, and includes features and functionality designed to successfully demonstrate Meaningful Use as specified in the CMS EHR 3 Incentive Program. For a high-level summary of Functional Measures linked to new features in this release and supporting reports, see What s New in Centricity Electronic Medical Record version 9.8 in your documentation library. This guide highlights those product features that support reporting for Meaningful Use measures. Complete and Modular EHR Certification Information Centricity EMR version 9.8 was certified as a Complete EHR and Modular EHR for Ambulatory. Please click the following link to see the full disclosure of this certification: What's New in this Revision This page highlights the changes made in this revision of the Meaningful Use user guide. Click the measure or topic title to go to the topic. July 2015 Revision Stage 1 Functional Measures Stage 1: 11 Patient Electronic Access (Core) Added Note in Workflow: "CQR calculations are based on the federal CMS guidelines. Individual state regulations are not reflected." Stage 2 Functional Measures Stage 2: 07 Patient Electronic Access (Core) Added Note in Workflow: "CQR calculations are based on the federal CMS guidelines. Individual state regulations are not reflected." Clinical Quality Measures CMS Clinical Quality Measures Updated Required Supplemental Data Elements: "Supplemental data elements for each measure are used to stratify the patient population in the QRDA III file, which is used for electronic submission. Blank values translate to a category of OTHER, which is sufficient for MU-only filing." Conditional Action Metrics (CAM) Updated this sentence: "The Orders kit included in CCC Basic v1.1 or CCC v9.0 release contains pre-coded calls for the following orders associated with Meaningful Use measures." CMS56 / PQRS 376 Functional Status Assessment for Hip Replacement Added a table in Calculation to show time period samples based on the reporting period. CMS122 / NQF 0059 / PQRS 1 / GPRO DM-2 Diabetes: Hemoglobin A1c Poor Control 1 Office of the National Coordinator for Health Information Technology 2 Centers for Medicare and Medicaid Services 3 Electronic Health Records 1

5 Updated Measure Data Requirements table for Numerator: Removed observation term "GLYCO HCG". CMS135 / NQF 0081 / PQRS 5 Heart Failure (HF): Angiotensin-Converting Enzyme (ACE) Inhibitor or Angiotensin Receptor Blocker (ARB) Therapy for Left Ventricular Systolic Dysfunction (LVSD) Added in Denominator: "and who had 2 or more office visits." Updated Measure Data Requirements table for Numerator: "Observation terms can be used if they are mapped to value sets." CMS163 / NQF 0064 / PQRS 2 Diabetes: Low Density Lipoprotein (LDL) Management Updated Workflows: "GE recommends using the listed observation terms to record LDL-C tests." Previous Revisions This page highlights the changes made to the previous revisions of the Meaningful Use user guide. Click the measure or topic title to go to the topic. June 2015 Revision Physician Quality Reporting System Updated the summary for the 2015 program year. Seen by Updated Functional Measures Document Type: Added this Note: "Documents co-signed at least one day after the original signature will not be associated with the EP unless they are appended." Stage 1 Functional Measures For these CPOE measures, added Note in Setup: "If you updated an EP's credentialed status and need that to take affect historically in CQR, you will need to reset your CQR subscriptions to resend data. You may contact GE Support for assistance with your reset." Stage 1: 01 CPOE for Medication Orders - All Active Medications (Core) Stage 1: 01 CPOE for Medication Orders (Alternate) - Prescribed Medications Only (Core) For these measures, added Note in Numerator: "All EPs get credit." Stage 1: 07 Record Demographics (Core) Stage 1: 08 Record Vital Signs (Core) Stage 1: 09 Record Smoking Status (Core) Stage 1: 04 Patient Reminders (Menu) Stage 2 Functional Measures For these CPOE measures, added Note in Setup: "If you updated an EP's credentialed status and need that to take affect historically in CQR, you will need to reset your CQR subscriptions to resend data. You may contact GE Support for assistance with your reset." Stage 2: 01 CPOE for Medication Orders Stage 2: 01 CPOE for Radiology Orders Stage 2: 01 CPOE for Laboratory Orders For these measures, added Note in Numerator: "All EPs get credit." Stage 2: 03 Record Demographics (Core) Stage 2: 04 Record Vital Signs (Core) Stage 2: 05 Record Smoking Status (Core) Stage 2: 12 Preventive Care (Core) (Patient Reminders) Stage 2: 04 Family Health History (Menu) 2

6 Core Stage 2: 07 Patient Electronic Access (Core) Updated Workflows Measure 2: Added this Note: "If you use Centricity Patient Portal, the patient must have a Responsible Provider in Registration so that the Event ID will be logged. This is required until the SureScripts version 6.5 release." Updated Numerator Measure 2: Added "before" to the measurement period. Added, "All EPs get credit for this event." Stage 2: 17 Use Secure Electronic Messaging (Core) Updated Numerator: Added, "All EPs get credit for this event." Clinical Quality Measures For these quality measures, added Note: "Medications with no start date will not be counted." CMS134 / NQF 0062 / PQRS 119 Diabetes: Urine Protein Screening: in Numerator. CMS135 / NQF 0081 / PQRS 5 Heart Failure (HF): Angiotensin-Converting Enzyme (ACE) Inhibitor or Angiotensin Receptor Blocker (ARB) Therapy for Left Ventricular Systolic Dysfunction (LVSD): in Numerator. CMS136 / NQF 0108 / PQRS 366 ADHD: Follow-Up Care for Children Prescribed Attention-Deficit/Hyperactivity Disorder (ADHD) Medication: in Denominator 2 and Denominator Exclusions 1 & 2 CMS144 / NQF 0083 / PQRS 8 / GPRO HF-6 Heart Failure (HF): Beta-Blocker Therapy for Left Ventricular Systolic Dysfunction (LVSD): in Numerator. CMS146 / NQF 0002 / PQRS 66 Appropriate Testing for Children with Pharyngitis: in Denominator Exclusion CMS153 / NQF0033 / PQRS 310 Chlamydia Screening for Women: in Denominator CMS154 / NQF 0069 / PQRS 65 Appropriate Treatment for Children with Upper Respiratory Infection (URI): in Denominator Exclusion CMS164 / NQF 0068 / PQRS 204 / GPRO IVD-2 Ischemic Vascular Disease (IVD): Use of Aspirin or Another Antithrombotic: in Numerator. CMS56 / PQRS 376 Functional Status Assessment for Hip Replacement Updated Measure Data Requirements table to indicate that Orders should have status of "Complete". CMS61 / PQRS 316 Preventive Care and Screening: Cholesterol Fasting Low Density Lipoprotein (LDL-C) Test Performed Added in Denominators 1, 2, & 3: "The observation term value must have a unit of % to be counted." CMS65 / PQRS 373 Hypertension: Improvement in blood pressure Added Note in Requirements: "In the case of a 90 days or quarterly reporting situation, the numerator is always zero, so using this measure is not recommended unless reporting for a full year." CMS117 / NQF0038 / PQRS 240 Childhood Immunization Status Updated Measure Data Requirements table: added "CVX codes listed in the value set recorded in immunization table" for Medication Administeredrows in Numerator GE Preferred Terms column. CMS122 / NQF 0059 / PQRS 1 / GPRO DM-2 Diabetes: Hemoglobin A1c Poor Control Added in Numerator: "The observation term value must have a unit of % to be counted." CMS125 / NQF 0031 / PQRS 112 / GPRO PREV-5 Breast Cancer Screening Updated Measure Data Requirements table: added "Observation term: Mammogram" in Numerator; removed "Order with LNC- prefix for LOINC code " CMS126 / NQF 0036 / PQRS 311 Use of Appropriate Medications for Asthma Patients 5-64 Note. These updates apply to all the age ranges of this measure. Added in Calculation: For qualifying diagnosis, "Unspecified asthma" (J45.909) does not count. Added Note in Numerator: "Dispensed medication is documented as samples given as the prescribing method and distributed to the patient during the office visit." Added in Numerator: "For more information regarding the CMS guidance for a future solution, click this link: 3

7 Added in Numerator: "You can also check the home page of the ONC Issue Tracking System at this link:oncprojecttracking.org." Added in Workflow: "It must have "persistent"in the problem description and ICD-9 codes must be mapped to ICD-10 codes in persistent asthma value set." CMS127 / NQF 0043 / PQRS 111 / GPRO PREV-8 Pneumonia Vaccination Status for Older Adults Added in Workflow: "The vaccine information may be preloaded but CQR will not show a result until the patient is seen in the office." Updated Measure Data Requirements table: added "CVX codes listed in the value set recorded in immunization table" for Medication Administeredrow in Numerator GE Preferred Terms column. CMS130 / NQF 0034 / PQRS 113 / GPRO PREV-6 Colorectal Cancer Screening Updated Measure Data Requirements table for Numerator to add the Observation terms: COLONOSCOPY, FLEX SIGMOID and SIGMOID. Also added a Note for Numerator, "CQR does not currently recognize observation terms for "Procedure Performed" but it will in the MU 2015 update for CQR. We recommend that you continue to use observation terms until CQR is updated." CMS135 / NQF 0081 / PQRS 5 Heart Failure (HF): Angiotensin-Converting Enzyme (ACE) Inhibitor or Angiotensin Receptor Blocker (ARB) Therapy for Left Ventricular Systolic Dysfunction (LVSD) Added in Denominator: "The observation term value must have a unit of % to be counted." CMS136 / NQF 0108 / PQRS 366 ADHD: Follow-Up Care for Children Prescribed Attention- Deficit/Hyperactivity Disorder (ADHD) Medication Added Note in Denominators 1 & 2: "Dispensed medication is documented as samples given as the prescribing method and distributed to the patient during the office visit. Samples with dispense quantity of 0 will count." CMS142 / NQF 0089 / PQRS 19 Diabetic Retinopathy: Communication with the Physician Managing Ongoing Diabetes Care Added in Denominator: "who had 2 or more office visits". Updated Measure Data Requirements table to indicate that Orders should have status of "Complete". Also added "Observations" in Workflow for Macular Edema Findings in Numerator. CMS144 / NQF 0083 / PQRS 8 / GPRO HF-6 Heart Failure (HF): Beta-Blocker Therapy for Left Ventricular Systolic Dysfunction (LVSD) Added in Denominator: "and who had 2 or more office visits or has been discharged". Added in Denominator: "The observation term value must have a unit of % to be counted." Updated Measure Data Requirements table to add data elements for "Initial Patient Population: Patients with Two or more Qualified Encounters" and "Initial Patient Population: Patients with One or more Qualified Encounters". Also added that Diagnosis or Encounter "starts before or during measurement period" in the Initial Patient Population and Denominator sections. CMS146 / NQF 0002 / PQRS 66 Appropriate Testing for Children with Pharyngitis Updated Measure Data Requirements table to add observation terms to the Numerator Laboratory Test. Removed Laboratory Test from Initial Patient Population. CMS147 / NQF 0041 / PQRS 110 / GPRO PREV-7 Preventive Care and Screening: Influenza Immunization Updated influenza vaccine given indication in Calculation: Added "CVX 149 or 150" to the list. Added a table in Calculation to provide examples of eligible and ineligible encounters based on the reporting period. Updated Denominator: "All patients aged 6 months and older in the initial patient population and seen for a visit between October 1 and March 31 (based on full year reporting period)." Added Note in Workflow: "To ensure credit for 2015 for historic vaccines, you must complete a service order with code SCT Patient communicated history of influenza vaccination with order date equal to the order date for the encounter." Updated Measure Data Requirements table: added "CVX codes listed in the value set recorded in immunization table" for Medication Administered row in Numerator GE Preferred Terms column. CMS155 / NQF0024 / PQRS 239 Weight Assessment and Counseling for Nutrition and Physical Activity for Children and Adolescents 4

8 Added in Denominator: " Per CMS, the population criteria allows any EP, regardless of specialty, to count if they record encounters listed in the Measure Data Requirements table below." CMS164 / NQF 0068 / PQRS 204 / GPRO IVD-2 Ischemic Vascular Disease (IVD): Use of Aspirin or Another Antithrombotic Updated Measure Data Requirements table: added "Medication must utilize a start date. Do not use Approximate check box." in Numerator Workflow Incorporation column. CMS166 / NQF 0052 / PQRS 312 Use of Imaging Studies for Low Back Pain Added Note in Workflow: "Patients will be included in this measure if they present initially with back pain on an office visit during the measurement period. If the back pain is pre-existing, make sure to note an appropriate start date prior to the visit. Patients with low back pain starting at least 28 days earlier than the visit date can be counted in the numerator." Appendix Appendix: MU Event ID Added a table that lists MU Event IDs, Event Names, and their corresponding functional measures. May 2015 Revision Eligible Professional (EP) Removed references to responsible provider as the Eligible Professional (EP). Any user who signs for a document or its appends is counted as EP. Updated sentence: "For encounter- and patient-based measures, any user who signs for a document or its appends is counted as EP regarding "seen by" concept." Seen By Updated descriptions for "Document Type" "E&M Service Order" and "SNOMED-CT Order". Stage 1 Functional Measures Core Stage 1: 01 CPOE for Medication Orders - All Active Medications (Core) Updated Workflows: "Centricity EMR version or later and CQR version or later count prescriptions for the provider when entered by a credentialed user if that user is not the EP." Stage 1: 04 e-prescribing (erx) (Core) Updated Description to include refills for permissible prescriptions. Updated Setup: "Clinical staff entering prescriptions and refills must be configured as "Credentialed" in Setup > Settings prior to sending data to CQR." Stage 1: 08 Record Vital Signs (Core) Updated Numerators 1 and 2 to indicate height must be recorded at least once in the patient's chart before (within the last 5 years), during, or after the reporting period. Menu Stage 1: 07 Transition of Care Summary (Menu) Updated Setup: "You must add a secure electronic address for external service providers associated with referral and test orders to send as Transition of Care. Doing this updates the MU Activity log and counts the TOC in CQR." Stage 2 Functional Measures Core Stage 2: 04 Record Vital Signs (Core) 5

9 Updated Numerators 1 and 2 to indicate height must be recorded at least once in the patient's chart before (within the last 5 years), during, or after the reporting period. Stage 2: 15 Summary of Care (Core) (Transition of Care or TOC) Updated Setup: "You must add a secure electronic address for external service providers associated with referral and test orders to send as Transition of Care. Doing this updates the MU Activity log and counts the TOC in CQR." Menu No updates for the Menu measures. Clinical Quality Measures CMS50 / PQRS 374 Closing the Referral Loop: Receipt of Specialist Report Added sentence in Workflow: "The Referral Order in the Numerator is the same as the one in the Initial Patient Population (Denominator). The Referral Order status should be Complete." Updated Measure Data Requirements table to indicate that Orders should have status of "Complete". CMS123 / NQF 0056 / PQRS 163 Diabetes: Foot Exam Updated Numerator to indicate that foot exam, sensory exam and pulse exam are required. Updated Measure Data Requirements table to indicate that Orders should have status of "Complete". Also added a Note for Numerator 1: "CQR does not currently recognize observation terms but it will in the MU 2015 update for CQR. We recommend that you continue to use observation terms until CQR is updated." CMS127 / NQF 0043 / PQRS 111 GPRO PREV-8 Pneumonia Vaccination Status for Older Adults Updated Measure Data Requirements table to indicate that Orders should have status of "Complete". CMS147 / NQF 0041 / PQRS 110 GPRO PREV-7 Preventive Care and Screening: Influenza Immunization Added Note in Denominator: "The data elements for this measure are dependent upon the patient having two or more office visit encounters or one preventative care encounter during the measurement period." Also added that in some cases, the patient must have two visits to qualify in the initial patient population. Updated Measure Data Requirements table to indicate that Orders should have status of "Complete". Also added in the Numerator that a completed service order with SNOMED code from value set can be used for immunizations given prior to the encounter. CMS155 / NQF0024 / PQRS 239 Weight Assessment and Counseling for Nutrition and Physical Activity for Children and Adolescents Updated Measure Data Requirements table to indicate that Orders should have status of "Complete"."Also added a Note for Numerator 1: "CQR does not currently recognize observation terms but it will in the MU 2015 update for CQR. We recommend that you continue to use observation terms until CQR is updated." Updated Measure Data Requirements table for Numerator 2 to add the Observation term: DIET COUNSEL. April 2015 Revision Stage 1 Functional Measures Core Stage 1: 01 CPOE for Medication Orders - All Active Medications (Core) Added to Workflows: "CQR version or later counts prescriptions for the provider when entered by a credentialed user if that user is not the EP." Note. Previously, CQR did not count a prescription toward the measure if entered by another user even if signed by the provider. Stage 1: 11 Patient Electronic Access (Core) 6

10 Updated the Calculation Description. Updated Workflows: "Patients declining patient portal access...". Added Best Practices to indicate specific holidays, as well as weekend days, are not counted as business days for this measure. Stage 1: 12 Clinical (Visit) Summaries (Core) Added to Best Practices: "Holidays that fall on Saturday are counted as the prior Friday. Holidays that fall on Sunday are counted as the following Monday." Menu Stage 1: 04 Patient Reminders (Menu) Updated Setup: "Create a folder to store letter templates directly under the Enterprise folder with the word "actionable" as part of the title." Removed Patient of Provider - reference to 3 years. Stage 1: 06 Medication Reconciliation (Menu) Updated documented medication reconciliation - includes the following observation term: MEDS REVIEW, where the value is Done (case-sensitive). Stage 2 Functional Measures Core Stage 2: 07 Patient Electronic Access (Core) Updated Workflows Measure 1: "Patients declining patient portal access..." Added Best Practices to indicate specific holidays, as well as weekend days, are not counted as business days for this measure. Stage 2: 08 Clinical (Visit) Summaries (Core) Added to Best Practices: "Holidays that fall on Saturday are counted as the prior Friday. Holidays that fall on Sunday are counted as the following Monday." Stage 2: 12 Preventive Care (Core) (Patient Reminders) Updated Setup: "Create a folder to store letter templates directly under the Enterprise folder with the word "actionable" as part of the title." Updated Numerator: "If a patient was seen twice by a provider within 2 years, the provider will get credit for this measure even if the patient s other provider was the one who sent the letter." Stage 2: 14 Medication Reconciliation (Core) Updated documented medication reconciliation - includes the following observation term: MEDS REVIEW, where the value is Done (case-sensitive). Menu No updates for the Menu measures. Clinical Quality Measures No updates for the Clinical Quality measures. Achieving Meaningful Use There are four parts to achieving Meaningful Use: Part 1 involves applying at the CMS EHR Incentive Program web site for either the Medicare or Medicaid EHR incentive programs. Part 2 involves "possessing" certified EHR technology that is applicable to your stage of meaningful use and the core and menu measures to which you will be attesting. 7

11 Part 3 involves using the applicable certified EHR technology in a meaningful way as defined in both the functional and quality measure specifications for your selected reporting period, meeting specific measures for each item as well as submitting clinical quality measure information as required. Part 4 requires Eligible Professionals organizations to attest to (and report on) using certified EHR technology and meeting functional measure and clinical quality measure requirements for their selected reporting period within a defined period of time. GE Healthcare offers certified EHR capabilities and Web-based reporting and data submission services designed to assist your Eligible Professionals in achieving and attesting to Meaningful Use. Physician Quality Reporting System Physician Quality Reporting System (PQRS) is a quality reporting program that encourages individual eligible professionals (EPs) and group practices to report information on the quality of care to Medicare. Beginning in 2015, the program will apply a negative payment adjustment to EPs and PQRS group practices who did not satisfactorily report data on quality measures for covered professional services in Those who report satisfactorily for the 2015 program year will avoid the 2017 PQRS negative payment adjustment. The Meaningful Use and PQRS clinical quality measures (CQMs) are aligned, so measure details for PQRS may be found under the Clinical Quality Measure section in this guide. A single dashboard view in CQR displays both the Meaningful Use and PQRS measures. For a list of PQRS and CQM measures, see CMS Clinical Quality Measures. For more information about the PQRS program, click this link to the CMS.gov web site: Instruments/PQRS/index.html?redirect=/PQRS/. Supporting Documentation For Audits Eligible professionals (EP) who receive an EHR incentive payment for either the Medicare or Medicaid EHR Incentive Program potentially may be subject to an audit. Supporting documentation to support attestation data for meaningful use objectives and clinical quality measures must be available for an audit. The documentation can be in either paper or electronic format, and must be retained for six years after the attestation. You should not assume that the documentation is automatically stored. For more information on ways to save or store documentation (for example, screenshots or print form), see the section, "Preparing and Maintaining Documentation," in the CMS document Supporting Documentation For Audits. Please click the following CMS document link to learn more about preparing documentation in case of a CMS audit - Supporting Documentation For Audits: Guidance/Legislation/EHRIncentivePrograms/Downloads/EHR_SupportingDocumentation_Audits.pdf Centricity Clinical Quality Reporting Centricity Clinical Quality Reporting (CQR) is the EMR 2014 edition certified reporting solution for the Meaningful Use Functional Measures and Clinical Quality Measures. CQR enhances and replaces the MQIC and Crystal Reports reporting solutions used for EMR. It calculates measures using provider data continually collected and sent from the application to the CQR system. Hosted by GE, the web-based CQR can be accessed by opening a web browser and entering the CQR URL used by your site. Note. For information on installing and configuring Meaningful Use interfaces to communicate with the application and interface engine to send clinical data, see Managing Interfaces with Centricity Electronic Medical Record. Note. For information on setting up your organization with CQR, click the Need Help? button on the registration page of the CQR web site: 8

12 Reporting Dashboard Summary The dashboard view used by CQR shows percentages of measures met for either Stage 1 or Stage 2 of the Meaningful Use Functional Measures or Clinical Quality Measures. The measure logic for PQRS and CQM are aligned. The dashboard displayed for CQMs is the same for PQRS. Note. Additional clinical quality measures that are not yet certified may appear on the dashboard view. Make sure that the measures you view are the certified measures for which you are attesting. For the list of certified clinical quality measures, see CMS Clinical Quality Measures. For functional measures, each measure shows denominator, numerator (met and unmet), and numerator recorded (Addition Counts). If a patient does not meet the denominator criteria, the patient may appear in numerator recorded, but will not be in the numerator. If a clinical quality measure is configured by the provider, the per provider population-based dashboard for this measure appears when the provider logs on to the Clinical Quality Reporting web site. Each measure shows percentage-based calculations based on the measure specification for initial patient population, denominator, numerator (met and unmet), and denominator exclusions and exceptions. From the summary view of each measure, you can navigate to view a list of patients by name, age and ID contributing to each calculation. This list allows you to review their charts to identify opportunities to enhance care or other factors affecting the levels of either functional measures or clinical quality measures. System Alert. Please ensure you understand the measure requirements, reporting functionality and that you monitor the quality of the data entered into the application and accuracy of the information in the Reporting Dashboard. Please contact GE Support if you have any concerns or questions. Eligible Professional (EP) Meaningful Use for ambulatory care is based on attestation by individual eligible professionals, so the CQR dashboard view displays data for the selected provider. For encounter- and patient-based measures, any user who signs for a document or its appends is counted as EP regarding "seen by" concept. Eligible professionals serving as preceptors The CQR dashboard views link eligible professionals to measured activities when they are users who sign for a document or its appends. You can include encounters documented in a residency workflow where a preceptor is signing off on a resident s document. Seen by Most Meaningful Use measure calculations are based on the concept seen by. In the application, seen by includes an encounter or other direct interaction with a patient where you have entered an order or used a document type included in the Seen By value set or a custom document type added to the global chart document view Patient Encounter (MU). You can view this value set in Setup Settings under System > Data Mapping. On the emeasures tab, select GE Functional Measures > Seen By to see mapped codes. To view or change custom document types in the global Patient Encounter (MU) document view, go to Setup Settings > Chart > Document Views. This global view is hidden by default in the providers document views list. MU Functional Measures There are three ways a patient might be counted as seen by in the application for Functional Measures: Document Type - The default document types used for the encounter include Office Visit, Office Procedure, or Home Care Report, which are mapped to Patient Encounter and Home Visit codes in the Seen By value set. These default document types can be removed from the Patient Encounter (MU) view. Custom document types added to this view are automatically mapped to the SNOMED Patient Encounter 9

13 code SCT Custom document types to this view that were added in the Meaningful Use Stage 1 release are also mapped on upgrade. Note. Documents co-signed at least one day after the original signature will not be associated with the EP unless they are appended. Note. Any user who signs for a document or its appends is counted as the Eligible Provider (EP) regarding "seen by" concept. Only add document types to the Patient Encounter (MU) view that you use to document patient encounters. E&M Service Order A service order for an E&M code included in the Seen By value set has been entered and signed during the encounter.the authorizing provider of the service order is the EP given credit. The GE value set "GE Office Visit" and "GE Seen by" can be viewed in the data mapping section of Setup Settings. The order must be in Complete status to be counted. SNOMED-CT Order A service order for the following code has been entered and signed during the encounter: SCT This is the SNOMED Patient Encounter code. Use this approach when you use document types other than mapped document types or if you do not use standard E&M codes as your service orders. For example, use this if you are not recording any billing in the application or sending orders to an external billing system. The order must be in Complete status to be counted AND the Authorizing Provider must be the EP. GE recommends the EP be associated as the authorizing provider on an order to ensure consistent counting of patients associated with the provider between CQMs and functional measures. MU Clinical Quality Measures There are two ways a patient might be counted as seen by in the application for Clinical Quality Measures: E&M Service Order A service order for an E&M code contained in the Seen By value set has been entered and signed during the encounter. The GE value set "GE Office Visit" and "GE Seen by" can be viewed in the data mapping section of Setup Settings. The order must be in the Complete status to be counted AND the Authorizing Provider must be the EP. SNOMED-CT Order A service order for the following code has been entered and signed during the encounter: SCT This is the SNOMED Patient Encounter code. Use this approach if you do not use standard E&M codes as your service orders. The order must be in the Complete status to be counted AND the Authorizing Provider must be the EP. GE recommends the EP be associated as the authorizing provider on an order to ensure consistent counting of patients associated with the provider between CQMs and functional measures. Global features support Meaningful Use 2014 edition reporting Global features and enhancements support the application in capturing and reporting all Meaningful Use functional and quality measure data. CCDA-compliant document format. All documents and messages generated for communicating clinical information to patients, providers, and for Meaningful Use functional measure reporting conform with CCDA or Consolidated Clinical Document Architecture standard as required for Meaningful Use. Common Event Model architecture. In this release enhanced architecture supports continuous, systemwide identification of events that contribute to Meaningful Use measures and continuous queuing and sending of data for analysis and reporting to new Web-based Clinical Quality Reporting services. Based on qualifying events such as document or clinical list signature, data that contributes to Meaningful Use calculations is logged, queued, processed (to apply required formatting), and then sent to an interface engine or third-party server. From there the data is sent for analysis to the Clinical Quality Reporting site. MUActivitylog. Beginning in this release, the MUActivityLog records event details needed for Meaningful Use numerator or denominator calculations. For Meaningful Use events that occurred before upgrade, 10

14 such as encounters counting towards the Seen By denominator, the information might be stored in other tables, but is still used as part of measure calculations. Note. Meaningful Use calculation events cannot be disabled in Auditing. You can enable or disable other audited user events. For details, see online help. Configurable subscriptions send/receive electronic data required for Meaningful Use. Subscriptions customized configuration files enable you to send patient clinical information to be shared with external systems in standard formats and to have those activities counted towards Meaningful Use. Standard subscriptions are included with the application. They must be set up in Setup and in your interface engine before they can be used. Using Meaningful Use subscriptions Outbound subscriptions rely on interfaces provided by your interface engine to pull queued data from the application database, put it in a format that can be consumed by an external system, and send the data to that system. Note. For each subscription, Centricity Services will help you configure your interface engine to communicate with the external system. Part of the configuration is done within the application and part within the interface engine. Contact GE or your Value-Added Reseller to schedule an integration setup session. For detail of the implementation process, see Configuring data exchange for Meaningful Use 2014 subscriptions and HL7 messages in Managing Interfaces with Centricity EMR. Available Meaningful Use subscriptions Seven subscriptions support Meaningful Use requirements: Meaningful Use Reporting subscriptions Clinical Quality Measures Reporting Collects patient data for the provider for Meaningful Use Stages 1-2 for a specified period and sends in CCDA format to the Centricity Quality Reporting (CQR) Web site for analysis. Meaningful Use Functional Measures Reporting Collects data related provider performance against Meaningful Use Stage 1-2 measures for a specified period and sends in JSON format to Centricity Quality Reporting Web site for analysis. Note. The first time these subscription run, all relevant patient data for each provider (typically for the past two years) is gathered and transferred to the Web site via a configured interface engine. Subsequently, only relevant data from the last run date to the current date is sent. Subscriptions meeting specific measure requirements Export Charts To meet Data Portability requirements, this subscription lets you package one or more patient charts identified in the Inquiries module for transfer a designated endpoint outside your system. The interface engine pulls and formats patient charts returned in an Inquiry in CCD/CCDA format and stores the files to a folder you specify. You can then package and move the files to a location where another system can acquire the charts. For detailed instructions, click F1 in the Inquiries module. Clinical Visit Summary To meet requirements of Core Measure 8 Clinical Summary, this subscription queues patient chart in CCDA Progress Note format in a document that meets provider's custom settings. Queued visit summaries are retrieved by the interface engine and sent to specified patients via or configured Patient Portal. Transition of Care To meet requirements of Core Measure 15 Summary of Care, this subscription queues patient charts marked as transitions of care in CCDA format and provider's custom settings. Queued data is retrieved by the interface engine and sent to specified providers for referrals, tests, and transfers of care. 11

15 Immunization Registry To meet requirements of Core Measure 16 Immunization Registries Data Submission, this subscription queues patient immunization data in HL7 ADT^A03 and A04 message format. Your interface engine pulls queued data and sends to a configured public health registry. Public Health Registry To meet requirements of Menu Measure 1 Syndromic Surveillance Data Submission, this subscription queues patient immunization data in HL VXU message format. Sends patient information to one or more configured public health agencies. The interface pulls patient data from the application database from configured urgent care locations and sends in HL ADT03 and ADT04 messages. Create / edit subscriptions in Setup Settings Subscriptions are managed in Setup at System > Interoperability >Configuration, where you can create, edit (schedule), and enable subscriptions. You must also configure the corresponding subscription interface in your interface engine. This work is done by GE or your Value-Added Reseller. Note. You must have the Common Event Model > ACCESS Subscription Modification and Monitoring privileges to configure and manage subscriptions. 12

16 Changes in clinical terminology data model All required Meaningful Use terminologies are supported. These terminologies are: This terminology is used... SNOMED CT LOINC In these application components... Problems Family History (including relationship) Smoking Status Procedures Note. SNOMED-CT codes do not display in the User Interface, but are mapped in the database and are visible in the C-CDA, Clinical Summaries, and when patients view online, download and transmit their health information. Observations: Lab Results, Vital Signs, and more RxNorm Medications Medication Allergies erx NCPDP 10.6 CVX Immunizations (added MU Stage 1) MVX Immunizations (added MU Stage 1) Administered Medications (added Stage 2) ICD-9, ICD-10, CPT, HCPCS Legacy usage + MU 2014 ICD-9 is not a required terminology but is still available. UCUM, UNII ICD-10 can be used for encounter (billing) diagnosis. CPT is used to identify office visit, procedures, imaging, lab orders, etc. For customers who do not use our Orders module, orderrelated information can be mapped from appropriate Observations to SNOMED-CT or CPT. Units of Measure, Non-medication allergies ISO, OMB Language (ISO), Race, and Ethnicity (OMB) For Meaningful Use Stage 2, Medi-Span is also included, to support formalized interaction checking on immunizations, not required previously. 13

17 Mapping data for Meaningful Use To support Clinical Quality Measure (CQM) and Meaningful Use reporting, the application provides mappings for all observation terms (numeric and string values) to expected codes in value sets required by CMS and ONC. Note. What are value sets? Lists of specific values (terms and their codes) derived from standard vocabularies used to define clinical concepts such as patients with diabetes, clinical visit, reportable diseases. In Meaningful Use reporting, value sets are used to define the patient populations to be included in denominators and numerators when computing a clinical quality measure and some functional measures. For more information, go to This mapping ensures that data captured in the application is sent for reporting or other purposes in standard codes and values and that all your data is included in measure calculations. Note. No mapping is required for Problems, Medications and Allergies, because these values are already stored to values expected by CMS and ONC. Custom observations and order codes created for your site will not be counted unless they are also mapped to the required codes. You can use the Data Mapping tool located in Setup Settings, go to System > Data Mapping to create these mappings locally for your site. On this tool you can see which codes are expected by CMS and ONC for different measures and which observations have already been mapped to those codes. You can also identify unmapped terms and map them to a selected code. Be careful when you create custom mappings. Incorrectly mapping observation terms to controlled clinical vocabularies such as SNOMED CT or RxNorm can result in inaccurate CQM calculations. Inaccurate CQM calculations will lead to the submission of inaccurate attestation data to CMS. For example, if you map the term for Hepatitis B Antigen to the LOINC code for Hemoglobin A1C, the numerator for the Diabetes ecqms that assesses recommended screening and assessment of Diabetes using Hemoglobin A1C will be incorrect. See the Centricity EMR online Help for instructions on using the Data Mapping tool. Note. Important. Map your custom observations to values that are counted BEFORE you begin sending Meaningful Use data to the Clinical Quality Reporting Web site. If you create the data mappings later, to have terms counted you must restart the Clinical Quality Measure Reporting subscription and resend the initial bulk export of all patient information to the site. This can be very time-consuming. This export gathers mapped data and replaces any unmapped values on the CQR site. 14

18 MU CORE Checklist form This form is part of the CCC Basic package available with the product. Open this form during a patient encounter to check the visit for clinical information relevant to key Meaningful Use measures that you might have overlooked. Missing clinical list items, orders, vital signs, and smoking status can be added directly from this form. You can also access Clinical Reconciliation and generate a Clinical Visit Summary for the patient directly from the form. If a Transition of Care document needs to be generated, this form notifies you and provides a link to jump to the Orders module to complete document generation. 15

19 Stage 1: CMS Functional Measures The CMS has defined required Core and optional Menu functional measures to demonstrate Meaningful Use: Core Set - 13 required objectives and corresponding measures. Menu Set - 9 optional objectives and measures. Most functional measures require a calculation based on a numerator and a denominator, a few require only Yes/No attestation. System Alert. Your organization is solely responsible for determining whether your Eligible Professionals meet the requirements for Meaningful Use and ensuring the accuracy of any Meaningful Use attestation. Ensure you understand the measure requirements, reporting functionality and that you monitor the quality of the data entered into the application. The Core Set of required measures includes: 01 CPOE for Medication Orders 02 Use Drug-drug / Drug-allergy Interaction-checking 03 Maintain Problem List 04 e-prescribing (erx) 05 Active Medication List 06 Medication Allergy List 07 Record Demographics 08 Record Vital Signs 09 Record Smoking Status 10 Implement One Clinical Decision Support Rule 11 Patient Electronic Access 12 Clinical (Visit) Summaries 13 Protect Electronic Health Information Note. Starting in 2014, the following changes were applied to these Meaningful Use measures for Stage 1: Patient Electronic Access was moved from the Menu set to the Core set as part of a new consolidated patient access objective and measure. Report Clinical Quality Measures to CMS or State is no longer part of the Core set but is a separate required attestation requirement. Provide Electronic Copy of Health Information was combined with Patient Electronic Access as part of a new consolidated patient access objective and measure. Exchange Key Clinical Information Electronically among Providers of Care is no longer a Meaningful Use objective/measure. The Menu Set of optional measures includes: 01 Implement Drug Formulary Checks 02 Clinical Lab Test Results 03 Generate Patient Lists by Specific Condition 04 Patient Reminders 05 Patient-specific Education Resources 06 Medication Reconciliation 07 Transition of Care Summary 08 Test Capacity to Send Electronic Data to Immunization Registry 16

20 09 Test Capacity to Submit Electronic Data to Public Health Agencies Note. Starting in 2014, Patient Electronic Access was moved from the Menu set to the Core set as part of a new consolidated patient access objective and measure. Note. You must report on 5 Menu Set measures including one population and public health measure. References Click this link to view a table with links to the specifications of the Stage 1 Eligible Professional (EP) Meaningful Use Core and Menu Measures. EHR Incentive Program Specification: TableOfContents.pdf Click this link to view a table that summarizes the changes to the Stage 1 Meaningful Use objectives. EHR Incentive Program Specification: Guidance/Legislation/EHRIncentivePrograms/Downloads/Stage1ChangesTipsheet.pdf 17

21 Stage 1: 01 CPOE for Medication Orders - All Active Medications (Core) Requirements Source 42 CFR 495.6(d)(1) Objective Use computerized provider order entry (CPOE) for medication orders directly entered by any licensed healthcare professional or credentialed medical assistant who is authorized to enter orders into the medical record, according to state, local and professional guidelines. Note. Credentialing for a medical assistant must come from an organization other than the organization employing the medical assistant. Measure More than 30 percent of all unique patients with at least one medication in their medication list seen by the EP have at least one medication order entered using CPOE. Optional Alternate: More than 30 percent of medication orders created by the EP during the EHR reporting period are directly entered by an authorized healthcare professional using CPOE. See CPOE for Medication Orders (Alternate) Prescribed Medications Only (Core) for more details. Exclusion Any EP who writes fewer than 100 prescriptions during the EHR reporting period. References EHR Incentive Program Specification: Medication_Orders.pdf Calculation Description Percentage of patients seen by the EP in the reporting period who had at least one active medication on their medication list and for whom an authorized healthcare professional used CPOE to generate a prescription at least once. Denominator Count 1 for every patient seen by the EP and where the patient's chart has at least one active medication. active medication - Any medication recorded in the chart that is a coded drug or uncoded medication classified as a drug (and not DME). The onset date must either be blank or on or before the last day of the measure reporting period; if there is an end date, it must be on or after the first day of the measure reporting period. Numerator Of the patients in the denominator, count 1 for every patient where the patient's chart has at least one prescription that was a CPOE medication order. authorized healthcare professional- Any licensed healthcare professional or credentialed medical assistant, who is authorized to enter orders into the medical record, according to state, local and professional 18

22 guidelines. Credentialing for a medical assistant must come from an organization other than the organization employing the medical assistant. CPOE medication order - A medication order entered into the chart by an authorized healthcare professional using one of the following Prescribing Methods available within the application: Electronic, Fax to pharmacy, Print then fax to pharmacy, Print then give to patient, Print then mail to patient, Print then mail to pharmacy,or Telephone. written by - Eligible professional is the user selected as Authorized By for the prescription. Setup, workflows, and best practices Setup Enter required Authorized Healthcare Professional user attributes Authorized healthcare professionals must be designated as Licensed or Credentialed. For chart access, check (Legally authorized to enter CPOE orders)on the Meaningful Use Attributes section on Chart Access tab. In order to be a CPOE-qualified user the licensed health care provider must select the option from User Management and enter the states they are licensed in and (optional) the effective dates of their licenses. 1 From Setup > Settings select Users > Users > Edit a user. 2 Select Eligible Professional and/or Licensed or Credentialed (Legally authorized to enter CPOE orders). For Eligible Professional, select the Program, Stage, Reporting Year, and Attested fields. For Licensed or Credentialed, click New and select the licensing state, then (optional) set the Effective and End dates of the license or credential. Note. If you updated an EP's credentialed status and need that to take affect historically in CQR, you will need to reset your CQR subscriptions to resend data. You may contact GE Support for assistance with your reset. Workflow Prescribe medication, Refill medication, Medication administration request Note that User who enters the prescription record must be an authorized healthcare professional. To receive MU credit, an eligible professional must be the Authorizing Provider on the prescription. Centricity EMR version or later and CQR version or later count prescriptions for the provider when entered by a credentialed user if that user is not the EP. These prescribing methods do not qualify as CPOE-defined prescribing methods: Handwritten, Samples Given, Refax, Reprint, Historical. If an order is canceled, the order is excluded from the denominator and numerator. 19

23 Stage 1: 01 CPOE for Medication Orders (Alternate) - Prescribed Medications Only (Core) Requirements Source 42 CFR 495.6(d)(1) Objective Use computerized provider order entry (CPOE) for medication orders directly entered by any licensed healthcare professional or credentialed medical assistant who is authorized to enter orders into the medical record, according to state, local and professional guidelines. Note. Credentialing for a medical assistant must come from an organization other than the organization employing the medical assistant. Measure Optional Alternate:More than 30 percent of medication orders created by the EP during the EHR reporting period are directly entered by an authorized healthcare professional using CPOE. For the primary measure CPOE for All Active Medications, see 01 CPOE for Medication Orders - All Active Medications (Core). Exclusion Any EP who writes fewer than 100 prescriptions during the EHR reporting period. Calculation Description Percent of medication orders created by the EP during the EHR reporting period that are directly entered by an authorized healthcare professional using CPOE. Denominator Count 1 for every medication order written by the EP. written by - Eligible professional is the user selected as Authorized By for the prescription. medication order - A prescription for a coded medication or uncoded medication classified as a drug (and not a DME nor OTC) entered into the chart using one of the following Prescribing Methods available within the application: Electronic, Fax to pharmacy, Print then fax to pharmacy, Print then give to patient, Print then mail to patient, Print then mail to pharmacy, Telephone or Handwritten. In addition, requests for administered medications entered through the medication administration form are included. Numerator Of the medication orders in the denominator, count 1 for every medication order that was a CPOE medication order during the reporting period. authorized healthcare professional- Any licensed healthcare professional or credentialed medical assistant, who is authorized to enter orders into the medical record, according to state, local and professional guidelines. Credentialing for a medical assistant must come from an organization other than the organization employing the medical assistant. CPOE medication order - A medication order entered into the chart by an authorized healthcare professional using one of the following Prescribing Methods available within the application: Electronic, Fax to pharmacy, 20

24 Print then fax to pharmacy, Print then give to patient, Print then mail to patient, Print then mail to pharmacy,or Telephone. References EHR Incentive Program Specification: Medication_Orders.pdf Setup, workflows, and best practices Setup Enter required Authorized Healthcare Professional user attributes Authorized healthcare professionals must be designated as Licensed (or Credentialed Medical Assistant). For chart access, check (Legally authorized to enter CPOE orders)on the Meaningful Use Attributes section on Chart Access tab. In order to be a CPOE-qualified user the licensed health care provider must select the option from User Management and enter the states they are licensed in and (optional) the effective dates of their licenses. 1 From Setup > Settings select Users > Users > Edit a user. 2 Select Eligible Professional and/or Licensed or Credentialed (Legally authorized to enter CPOE orders). For Eligible Professional, select the Program, Stage, Reporting Year, and Attested fields. For Licensed or Credentialed, click New and select the licensing state, then (optional) set the Effective and End dates of the license or credential. Note. If you updated an EP's credentialed status and need that to take affect historically in CQR, you will need to reset your CQR subscriptions to resend data. You may contact GE Support for assistance with your reset. Workflows Prescribe Medication, Refill Medication, Medication administration request Note that User who enters the prescription record must be an authorized healthcare professional. To receive MU credit, an eligible professional must be the Authorizing Provider on the prescription These prescribing methods do not qualify as CPOE-defined prescribing methods: Handwritten, Samples Given, Refax, Reprint, Historical. If an order is canceled, the order is excluded from the denominator and numerator. 21

25 Stage 1: 02 Use Drug-drug / Drug-allergy Interaction-checking (Core) Requirements Source 42 CFR 495.6(d)(2) Yes/No Attestation Only Objective Implement drug-drug and drug-allergy interaction checks. Measure The eligible professional has enabled this functionality for the entire EHR reporting period. Exclusion None References EHR Incentive Program Specification: Interaction_ChecksEP.pdf Setup, workflows, and best practices Setup Interaction checking is always enabled and active in the product; it cannot be disabled and requires no special configuration. Note. This information, that interaction checking is always active, may be of relevance if you are subject to a meaningful use audit. Workflows Prescribe Medication, Refill Medication, Change/Remove Medication While the application is able to check interactions between medications, medication allergies, and medications with diagnosis/age/gender, this measure only considers its ability to display interaction checking between two medications or a medication and an active medication allergy. Best practices Centricity EMR permits the organization to set an enterprise-wide level of severity for an interaction that requires the user to manually acknowledge and override the interaction to produce a prescription for a medication. This feature complies with the requirements for meeting this measure. GE recommends providers routinely review and acknowledge when an indicated medication/medication, allergy/medication interaction occurs. 22

26 Stage 1: 03 Maintain Problem List (Core) Requirements Source 42 CFR 495.6(d)(3) Objective Maintain an up-to-date problem list of current and active diagnoses. Measure More than 80 percent of all unique patients seen by the EP have at least one entry or an indication that no problems are known for the patient recorded as structured data. Exclusion None References EHR Incentive Program Specification: Problem_ListEP.pdf Calculation Description Percentage of patients seen by the EP in the reporting period whose problem list was maintained before, during, or after the reporting period. Denominator Count 1 for every patient seen by the eligible professional. Numerator Of the patients in the denominator, count 1 for every patient where the patient's chart has at least one active problem or an indication of No Known Problem before, during, or after the reporting period. active problem - A coded problem recorded in the chart of any problem type, except Status Post. The onset date must be blank or on or before the day of attestation; if there is an end date, it must be on or after the first day of the measure reporting period. The problems coded as ICD-9, ICD-10, and SNOMED CT are considered. No Known Problem - See the Data Mapping tool. Setup, workflows, and best practices Setup N/A Workflows Maintain Problem list 23

27 Add / Change Problems (any problem type except Status Post; must include 'ICD-' code) Check No Known Problems Generate Orders Under Potential Diagnoses list, select or add a new Problem to associate with the order. Check Add to Patient Problem List to ensure problems associated with orders are counted. For every patient seen, one of these conditions must be present to count for the eligible provider: At least one problem on the Problem List with either no start date, or a start date before the day of attestation. This Patient Has No Known Problems (NKPROB) is checked before the day of attestation. Best practices Review and update all patients active problems each visit to assure the accuracy and currency of the Active Problem list. All problems must have 'ICD-' codes. Problems with onset dates before the day of attestation (or no start date) are counted as active problems. It does not matter who added the problem(s) to the list. Measure calculation is not affected when Problem List Reviewed During This Update is checked. If all the patient s problems are resolved, check This Patient Has No Known Problems (NKPROB) when the last problem is removed. 24

28 Stage 1: 04 e-prescribing (erx) (Core) Requirements Source 42 CFR 495.6(d)(4) Objective Generate and transmit permissible prescriptions electronically (erx). Measure More than 40 percent of all permissible prescriptions written by the EP are transmitted electronically using certified EHR technology. Exclusion Any EP who: 1 Writes fewer than 100 prescriptions during the EHR reporting period. 2 Does not have a pharmacy within their organization and there are no pharmacies that accept electronic prescriptions within 10 miles of the EP's practice location at the start of his/her EHR reporting period. References EHR Incentive Program Specification: Calculation Description Percentage of permissible prescriptions (including refills) that were transmitted electronically during the reporting period. Denominator Count 1 for every permissible prescription written by the EP during the measure reporting period. permissible prescription - A prescription for a prescription-only (not OTC - over the counter) coded medication (and not DME) with quantity > 0 entered into the chart using the Centricity Advanced eprescribing available within the application. Note: Controlled substances class code 1-5, and prescribing methods Reprint, Re-Fax and Historical, are not included. Numerator Of the prescriptions in the denominator, count 1 for each where prescribing method is Electronic. 25

29 Setup, workflows, and best practices Setup Implement Centricity Advanced eprescribing - configure application and users for eprescribing. Clinical staff entering prescriptions and refills must be configured as "Credentialed" in Setup > Settings prior to sending data to CQR. Workflows (With eprescribing enabled) Prescribe medication, Refill medication Set the eligible professional as Authorized By when producing a prescription for medications permitted to be transmitted electronically. The measure does not assume that all medications can be electronically prescribed. Use prescribing method of Electronic for prescriptions that are not for: Controlled substances Over the counter (OTC) medications Over the counter supplies Reprint, Re-Fax and Historical The product meets all requirements with Centricity Advanced eprescribing. Best practices Always set the eligible professional as Authorized By when completing a prescription request. Use the Centricity Advanced eprescribing method whenever possible for medications permitted to be transmitted electronically. 26

30 Stage 1: 05 Active Medication List (Core) Requirements Source 42 CFR 495.6(d)(5) Objective Maintain active medication list. Measure More than 80 percent of all unique patients seen by the EP have at least one entry (or an indication that the patient is not currently prescribed any medication) recorded as structured data. Exclusion None References EHR Incentive Program Specification: Medication_List.pdf Calculation Description Percentage of patients seen by the EP in the reporting period whose medication list was maintained before, during, or after the reporting period. Denominator Count 1 for every patient seen by the eligible professional. Numerator Of the patients in the denominator, count 1 for every patient where the patient's chart has at least one active medication or an indication of No Known Medication before, during, or after the reporting period. active medication- Any medication recorded in the chart, coded or uncoded, as a drug. The onset date must either be blank or on or before the day of attestation; if there is an end date, it must be on or after the first day of the measure reporting period. No Known Medication- See the Data Mapping tool. Setup, workflows, and best practices Setup N/A Workflows Maintain Medication list, Add / Change Medication, Record No Known Medication For every patient seen, one of these conditions must be present to count for the eligible professional: 27

31 At least one medication on the Medication list with either no start date, or a start date before the day of attestation. This Patient Takes No Known Medications (NKMED) is checked before the day of attestation. Best practices Review and update all patients active medications each visit to assure the accuracy and currency of the Medication list. Medications with onset dates before the day of attestation (or no start date) are counted as active medications. It does not matter who added the medication(s) to the list. Measure calculation is not affected when Medications List Reviewed During This Update is checked. If all patient s medications are discontinued or ceased, check This Patient Takes No Known Medications (NKMED) when the last medications is removed. 28

32 Stage 1: 06 Medication Allergy List (Core) Requirements Source 42 CFR 495.6(d)(6) Objective Maintain active medication allergy list. Measure More than 80 percent of all unique patients seen by the EP have at least one entry (or an indication that the patient has no known medication allergies) recorded as structured data. Exclusion None References EHR Incentive Program Specification: Medication_Allergy_List.pdf Calculation Description Percentage of patients seen by the EP in the reporting period whose allergy list was maintained before, during, or after the reporting period. Denominator Count 1 for every patient seen by the eligible professional. Numerator Of the patients in the denominator, count 1 for every patient where the patient's chart has at least one active medication allergy or other allergy or an indication of No Known Allergy before, during, or after the reporting period. active allergy - Any allergy recorded in the chart, including food allergies, environmental allergies, RxNorm coded allergies, and medication allergies. The onset date must either be blank or on or before the day of attestation; if there is an end date, it must be on or after the first day of the measure reporting period. No Known Allergy - See the Data Mapping tool. Setup, workflows, and best practices Setup N/A Workflows Maintain Allergies list, Add / Change Allergy, Record No Known Allergy 29

33 For every patient seen, one of these conditions must be present to count for the eligible professional: At least one allergy (medication or non-medication) on the Allergies and Adverse Reactions list with either no start date, or a start date before the day of attestation. This Patient has No Known Allergies or Adverse Reactions (NKA) is checked before the day of attestation. Best practices Review and update all patients active allergies each visit to assure the accuracy and currency of the Allergies and Adverse Reactions list. Allergies with onset dates before the day of attestation (or no start date) are counted as active allergies. It does not matter who added the allerg(ies) to the list. Measure calculation is not affected when Allergies and Adverse Reactions List Reviewed During This Update is checked. If all patient s allergies are resolved, check This Patient has No Known Allergies or Adverse Reactions (NKA) when the last allergy is removed. 30

34 Stage 1: 07 Record Demographics (Core) Requirements Source 42 CFR 495.6(d)(7) Objective Record all of the following demographics: Preferred language Sex Race Ethnicity Date of birth Measure More than 50 percent of all unique patients seen by the EP have demographics recorded as structured data. Exclusion None References EHR Incentive Program Specification: Demographics.pdf Calculation Description Percentage of patients seen by the EP in the reporting period for whom the required demographics (preferred language, sex, race, ethnicity, and date of birth) were recorded in patient registration before, during, or after the reporting period. Denominator Count 1 for every patient seen by the eligible professional. Numerator Of the patients in the denominator, count 1 for every patient for whom all required demographics are recorded with OMB specific values before, during, or after the reporting period. Note. All EPs get credit. required demographics Include the following attributes: Date of Birth, Sex, Preferred Language, Race, Ethnicity. Race: For Race, you can record up to two race values. The OMB values include: 31

35 American Indian or Alaska Native Asian (Chinese, Filipino, or Japanese are mapped as sub-categories of Asian category) Black or African American Native Hawaiian or Other Pacific Islander White Patient Declined State Prohibited Note that the category Unspecified is not a standard OMB value. Hispanic, Multiracial, Other, or Undetermined are mapped as sub-categories of Unspecified. Ethnicity: The following defaults are the only acceptable values. Default system values: Hispanic or Latino Not Hispanic or Latino Patient Declined State Prohibited Note that the category Unspecified is not a standard OMB value. Other or Undetermined are mapped as subcategories of Unspecified. Language mappings All previous languages are carried forward and if possible are mapped to the ISO languages. Patient Declined is an acceptable value. Setup, workflows, and best practices Setup Mapping race and ethnicity For existing users who are upgrading, your previous race and ethnicity values are carried over just as entered in Registration, but will be mapped to new standard values for the purposes of measure calculation. Previous Other, Undetermined, or User defined values are also brought over as is and mapped to Unspecified in this release. You can change these records to a required value that will be counted if desired. Configuring Race and Ethnicity in Setup Race and Ethnicity values cannot be removed or altered in Setup, but you can create Race or Ethnicity subcategories and map them to a standard value. Sub-categories appear in Registration directly under the standard value to which they are mapped. Configure Race/Ethnicity values. Set up, add or change Race and Ethnicity sub-categories in Setup Settings > Registration > Ethnicity Sub-category and Setup Settings > Registration > Race Sub-category. For Race, you can record up to two race values. Avoid using Race values Hispanic, Other, Multiracial. These values are not compliant with the OMB standards for these concepts. To record non-compliant race values, create a custom race sub-category and map it to a standard OMB value, if possible. If it is not possible to map to a standard OMB value, you can map to the Unspecified category but it will not be counted as part of the Meaningful Use measure. Define and manage non-standard/custom race and ethnicity values as sub-categories. Map these sub-categories to standard race and ethnicity values. For example, you might record Chinese and Asian-Indian as sub-categories to the required standard of Asian. These sub-categories can be recorded on patient records and they will meet a required standard (Asian) and therefore, count for this measure. Modify your Check-In /Registration workflow to capture Ethnicity value where needed. 32

36 Set up LinkLogic. This setup is required IF you are exchanging data with an external PM system.linklogic automatically imports both values. Workflows Register patient, New /Change patient Best practices The system is pre-populated with values that meet EHR Incentive Specification guidelines: Race and ethnicity codes should follow current federal standards published by the Office of Management and Budget ( Document Date of Birth, Sex, Preferred Language, Race, Ethnicity values for patient in Registration manually or through electronic interface exchange of demographics data. Modify Check-in/Registration workflows to require staff to ask about race, ethnicity, and language preference in a professional and sensitive manner. Preferred language must be recorded to meet compliance as recorded data. If patient declines to provide Language, Race or Ethnicity, select list option Patient Declined. If collection of Race and Ethnicity is prohibited by law, select list option State Prohibited. These values meet the goal of structured data. Caution. Your system may include prior default values that do not map to OMB categories and are not counted to meet Meaningful Use criteria. New installations - Non-OMB default values are not included. Existing installations - If a value has been used for a patient, it cannot be removed from the system until all instances of its use have been removed from Registration. Recommended. If a patient wants to record more than one race, OMB requires that each race value be indicated separately.when registering a patient, you can record up to two race values. 33

37 Stage 1: 08 Record Vital Signs (Core) Requirements Source 42 CFR 495.6(d)(8) Objective Record and chart changes in the following vital signs: Height Weight Blood pressure Calculate and display body mass index (BMI) Plot and display growth charts for children 0-20 years, including BMI Measure More than 50 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 before, during, or after the reporting period. Exclusion Any EP who: 1 Sees no patients 3 years or older is excluded from recording blood pressure. 2 Believes that all 3 vital signs of height/length, 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. References EHR Incentive Program Specification: Vital_Signs.pdf Calculation Calculation 1 - All Vital Signs Description 1 Percentage of patients seen by the EP in the reporting period for whom the required vital signs (height, weight, and blood pressure) were recorded in their chart before, during, or after the reporting period. Denominator 1 Count 1 for every patient seen by the eligible professional. 34

38 Numerator 1 Of the patients in the denominator: Count 1 for every patient who meets either the qualifying age (for blood pressure) and for whom all required vitals are recorded at least once in the patient's chart before (within the last 5 years), during, or after the reporting period OR Count 1 for every patient who does not meet the qualifying age (for blood pressure) but for whom height and weight recorded at least once in the patient's chart before (within the last 5 years), during, or after the reporting period. qualifying age (blood pressure)- Any patient 3 years old or older at the time the patient is seen by the eligible professional. recorded - The required vitals entry date must be no later than the date of attestation. required vitals - Includes height, weight, and systolic and diastolic blood pressure. Note. All EPs get credit. Calculation 2 - Height and Weight Only Use this measure if Exclusion 1 and 3 apply to your practice. Description 2 Percentage of patients seen by the EP in the reporting period for whom height and weight were recorded in their chart before, during, or after the reporting period. Denominator 2 Count 1 for every patient is seen by the eligible professional. Numerator 2 Of the patients in the denominator, count 1 for every patient for whom height and weight are recorded at least once in the patient's chart before (within the last 5 years), during, or after the reporting period. recorded - The required vitals entry date must be no later than the date of attestation. Note. All EPs get credit. Calculation 3 - Blood Pressure Only Use this measure if Exclusion 4 applies to your practice. Description 3 Percentage of patients seen by the EP in the reporting period for whom systolic and diastolic blood pressure were recorded in their chart before, during, or after the reporting period. Denominator 3 Count 1 for every patient that meets the qualifying age (for blood pressure)and is seen by the eligible professional. qualifying age (blood pressure)- Includes any patient 3 years old or older at the time the patient is seen by the eligible professional. 35

39 Numerator 3 Of the patients in the denominator, count 1 for every patient for whom all systolic and diastolic blood pressure are recorded at least once in the patient's chart before, during, or after the reporting period. recorded - The required vitals entry date must be no later than the date of attestation. Note. All EPs get credit. Setup, workflows, and best practices Setup Confirm supported clinical content. Import latest clinical kits and confirm supported encounter forms are associated with your encounter types/documents. Confirm custom forms use observation terms mapped to value sets. Workflows Update Chart Use value set: Populate supported observation terms and make sure that they are mapped to the GE Vital Sign Selection value set. Growth charts/bmi calculation: Only height, weight, and blood pressure are required. The certified EHR technology will calculate BMI and the growth chart if applicable to patient based on age. Note: Required vitals need not be updated at every patient encounter. According to the EHR Incentive Program Specification: Height, weight, and blood pressure do not have to be updated by the eligible professional at every patient encounter. The eligible professional can make the determination based on the patient's individual circumstances as to whether height, weight, and blood pressure need to be updated. Best practices When clinically appropriate, record required height, weight, and blood pressure vitals as part of a patient visit. All standard vital signs encounter forms assist in documenting and recording these vitals. This measure references BMI (Body Mass Index) and growth chart data available for patients between the ages of 0 and 20 years. BMI is calculated using entered weight and height. The Growth Chart uses BMI plotted on the chart/graph. This functionality available for patients between 0 and 20 years old meets current requirements for this measure. If creating custom content or editing a vital signs form, store the data using the Observation terms: HEIGHT, Height (cm), WEIGHT, Weight (kg), BP DIASTOLIC, BP SYSTOLIC. Note: If you use other observation terms, map them to value sets. 36

40 Stage 1: 09 Record Smoking Status (Core) Requirements Source 42 CFR 495.6(d)(9) Objective Record smoking status for patients 13 years old or older. Measure More than 50 percent of all unique patients 13 years old or older seen by the EP have smoking status recorded as structured data. Exclusion Any EP who sees no patients 13 years old or older. References EHR Incentive Program Specification: Smoking_Status.pdf Calculation Description Percentage of patients seen by the EP in the reporting period for whom smoking status was recorded in their chart before, during, or after the reporting period. Denominator Count 1 for every patient that meets the qualifying age and is seen by the EP. qualifying age - Includes any patient 13 years old or older at the time the patient is seen by the eligible professional. Numerator Of the patients in the denominator, count 1 for every patient for whom a smoke status was recorded and signed in the patient's chart using smoke status observation terms with ONC-specified values before, during, or after the reporting period. smoke status - searches for the observation SMOK STATUS. ONC-specified values current every day smoker current some day smoker former smoker never smoker unknown if ever smoked smoker, current status unknown heavy tobacco smoker light tobacco smoker 37

41 Note. All EPs get credit. Setup, workflows, and best practices Setup Confirm supported clinical content. Import latest clinical kits and confirm supported encounter forms are associated with your encounter types/documents. Workflows Current product captures smoking status on the FH-SH-CCC, Hypertension Q&E-CCC, MU CORE Checklist, and Risk Factors-CCC encounter forms. In the FH-SH-CCC form, the smoking status field includes more detailed values specified in the final ARRA regulation 45CFR (a)(11). Update Chart - Only use encounter forms that include supported observations and observation values. Best practices Smoking Status can occur before the beginning or after the end of the period. This design is based on the EHR Incentive Program specification: If this information is already in the medical record available 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 provided already from several sources in the medical community. During routine patient visits, clinical interaction regarding smoking, and smoking cessation can be documented by any clinician working with the patient. The report does not count how often the patient is asked about smoking status. If a patient over the age of 13 has been asked this question and the answer is recorded using a valid observation term, the patient counts toward meeting the measure if they are seen within the reporting period regardless of whether they were asked during the reporting period. Use the Social History or Risk Factors Form during the interaction with the patient to record their response to smoking status and smoking questions. You can use the form for patients of any age, but only patients over the age of 13 are counted for this measure. If using alternative content or editing the FH-SH-CCC form component, use the Data Mapping tool to map SNOMED codes to the observation term SMOK STATUS. 38

42 Stage 1: 10 Implement One Clinical Decision Support Rule (Core) Requirements Source 42 CFR 495.6(d)(11) Yes/No Attestation Only Objective Implement one clinical decision support rule relevant to specialty or high clinical priority along with the ability to track compliance with that rule. Measure Implement one clinical decision support rule. Providers have considerable flexibility in meeting this measure. They need only attest they are using a clinical decision support rule. For example, anything that provides a notification qualifies, including a pop-up alert that requires a response or an indicator on a form showing an immunization, exam, or test due. Exclusion None References EHR Incentive Program Specification: Decision_Support_Rule.pdf Setup, workflows, and best practices Setup Optionally log decision support user actions. Although not required for attestation, to see how user decision support actions are captured by the system, go to Setup > Settings > System > Auditing and confirm that MEL Decision Support is in the Log Audit Events column. Workflows Various workflows support this measure including: Using Pop Up Alerts on charts that have been designated as needing a clinical intervention based on a treatment deficiency. Using Protocols for USPS or Treatment/Diagnostic related treatment interventions. Using content (such as CCC forms) that alerts or interacts with the provider based on clinical treatment needs or deficiencies. Best practices You must audit these actions but you do not need to count them to fulfill this measure requirement. The application provides MEL functions UserYesNo and UserOK in encounter forms, document templates, and patient banners to support decision support rules. System auditing automatically logs user responses to alerts and care suggestions created with MEL decision support functions. You can optionally track, record, and generate reports on the number of alerts responded to by a user. 39

43 Note: Drug-drug and drug-allergy interaction alerts cannot be used to meet this measure. EP s must implement one clinical decision support rule in addition to the drug-drug and drug-allergy interaction checks. 40

44 Stage 1: 11 Patient Electronic Access (Core) Requirements Source 42 CFR 495.6(e)(5)) Objective 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. Measure 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. Exclusion Any EP who neither orders nor creates any of the information listed for inclusion, except for "Patient name" and "Provider's name and office contact information, may exclude the measure. References EHR Incentive Program Specification: Calculation Description Percentage of all unique patients seen by the EP during the EHR reporting period who 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 during or after the reporting period, subject to the EP s discretion to withhold certain information. Denominator Count 1 for every unique patient seen by the EP during the EHR reporting period. Numerator Of the patients in the denominator, count 1 for every patient who has timely (within 4 business days after the information is available to the EP) online access to their health information during or after the reporting period. When the patient chart is updated and signed, and PATPORTALPIN is on the update, the MUActivityLog 1 will record that portal access was provided. 1 Beginning with this version, the MUActivityLog database table records event details needed for numerator or denominator calculations. Meaningful Use calculation events cannot be disabled. You can choose to enable or disable other user events from Auditing. For Meaningful Use events (for example, encounters that count towards the Seen By denominator) that occurred before the version upgrade, the information may be stored in other tables, but will still be used as part of measure calculations. 41

45 indication- The patient chart includes a value for PATPORTALPIN observation either prior to the start of the reporting period or dated no later than 4 business days after the patient s first encounter in the reporting period. PATPORTALPIN is an observation term used to indicate in the chart that a patient has been configured for access to Centricity Patient Portal. Only patients who are provided access for every visit in the reporting period will be counted. A PIN number does not need to be generated multiple times, only for at least the first visit for the patient or prior to the first visit in the reporting period. If a patient has subsequent visits in the reporting period they will still be counted. Setup, workflows, and best practices Setup To create a quick text entry to add the PATPORTALPIN observation term, go to Setup > Settings > Chart > Quick Text. Workflows Register patients - Add a step to your portal access workflow (for example, quick text) to note a value for PATPORTALPIN in the chart when you grant portal access to a patient. If you use Centricity Patient Portal, you do not need to use PATPORTALPIN. It will use a web service to log entries in the MUActivityLog when a patient registers for the portal. Patients declining patient portal access are eligible for counting in numerator if the patient is provided a method for future access without the need for further intervention by the practice; however, these patients are not counted unless that method is documented in PATPORTALPIN. Per CMS guidance, you must provide information to patients who decline access that will enable those patients to access portal at a later time without further intervention by the practice. CQR will count patients who declined access in the numerator whenever a value is included in the PATPORTALPIN observation. In order for those patients who declined access to be appropriately counted, You should enter into the PATPORTALPIN observation a value that corresponds to the method for providing future access. Examples of such values include: The access PIN - for patients whose later portal activation relies on such a PIN or "Portal access instructions given" - for patients whose later portal activation can be completed without the assistance of the practice by simply following a set of instructions in a handout. The proper activation method, and therefore the proper value to enter into PATPORTALPIN, depends on your portal. Note. For audit purposes, be sure to document your policy for ensuring that patients who declined access now will have access to the portal in the future without further interaction by the practice. Note. CQR calculations are based on the federal CMS guidelines. Individual state regulations are not reflected. Best practices The following holidays, as well as Saturday and Sunday, are not counted as business days. Holidays that fall on Saturday are counted as the prior Friday. Holidays that fall on Sunday are counted as the following Monday. New Year's Day - January 1st Birthday of Martin Luther King, Jr. - 3rd Monday of January Washington's Birthday - 3rd Monday of February Memorial Day - Final Monday of May Independence Day - July 4th Labor Day - 1st Monday of September Columbus Day - 2nd Monday of October Veterans Day - November 11th Thanksgiving - 4th Thursday of November Christmas Day - December 25th 42

46 Stage 1: 12 Clinical (Visit) Summaries (Core) Requirements Source 42 CFR 495.6(d)(13) Objective Provide clinical summaries for patients for each office visit. Measure Clinical summaries provided to patients for more than 50 percent of all office visits within 3 business days. Exclusion Any EP who has no office visits during the EHR reporting period. References EHR Incentive Program Specification: Summaries.pdf Calculation Description Percentage of office visits during the reporting period for which clinical visit summaries were provided to the patient within 3 business days. Value sets are used to identify encounters. See the Data Mapping tool. The Office Visit value set contains: Mapping to Document Types that will be considered Office Visit. CPT & SNOMED Codes for Office Visit. Denominator Count 1 for every office visit conducted by the EP during the reporting period. The data object is OfficeVisitSharedDenominator. It includes PID,PVID, eventdate (Clinical datetime), SDID, and document summary. Numerator Of the office visits in the denominator, count 1 for every visit where a clinical visit summary was provided to the patient within 3 business days or where the patient declined a CVS. Clinical visit summaries may be printed and given to the patient; saved to file to a portable media and given to the patient; or sent to the patient electronically in Centricity Clinical Messenger. The data object is ActivityLogEvent. There are two cases: Event ID 2 - ClinicalVisitSummaryProvided. The clinical visit summary is printed or saved to a file. Event ID ClinicalVisitSummary. Records an MU Activity log entry for each clinical visit summary sent to a patient. Requires SDID from the document.xid. ActivityLog.DeliveryMethod should be logged as SaveToFile, Printed, or Electronic. 43

47 Setup, workflows, and best practices Setup Migrate immunization data recorded in an earlier release to new data schema Immunizations stored with observation terms will not be included any CCDA document, including Clinical Visit Summary and Transition of Care documents. Make sure you have migrated your data before beginning to use this feature. Required permissions Users must have existing permissions Chart > Export Summary Documents and Chart > Export Unsigned Chart Data to generate and send clinical visit summaries. From Setup > Privileges, in Set Privileges for, do one of the following: Choose Role and select the specific role from the list. Choose User and click to search for and select a user. Select these two privilegesin the Chart folder: Export Summary Documents Export Unsigned Chart Data Workflows A qualifying office visit is based on values from Office Visit value sets. Office Visit value sets include document types and orders (CPT codes and SNOMED codes) associated with a visit. Printing, saving to file, or saving to a chart and electronically sending a generated Clinical Visit Summary CCDA document is logged and counted. These events are logged in the MUActivityLog 1 which is used for calculating the numerator for the measure. If sending electronically with Centricity Clinical Messenger, make sure the patient is linked to the provider in the patient chart and the patient has a valid associated in the application. Note. For more information about sending CVS electronically using Centricity Clinical Messenger, see Guide to Meaningful Use Stage 2 and other resources on the Kryptiq support site (support.kryptiq.com). The application provides the following new user workflows to support this measure: Generate a standard CCDA format Clinical Visit Summary based on an update or signed document related to an office visit. Customize a Clinical Visit Summary to exclude certain data if deemed appropriate. Include and count CVS Declined (PTDECLINECVS) observation if patient declines a summary.check CVS Declined in the MU CORE Checklist form. If a patient declines CVS, it is counted in the numerator when a document is signed at a later date, or recorded in an appended document. Send a clinical summary CCDA to patient portal using Centricity Clinical Messenger (Kryptiq), Patient On Line (GE), Medfusion, and EZAccess. Generating Clinical Visit Summary There are several ways to create a Clinical Visit Summary: 1 Beginning with this version, the MUActivityLog database table records event details needed for numerator or denominator calculations. Meaningful Use calculation events cannot be disabled. You can choose to enable or disable other user events from Auditing. For Meaningful Use events (for example, encounters that count towards the Seen By denominator) that occurred before the version upgrade, the information may be stored in other tables, but will still be used as part of measure calculations. 44

48 During an update - In an In Progress document, select Actions > Document > Create Clinical Visit Summary. From within a chart document Actions>Document>- Select a signed document, then right-click Create Clinical Visit Summary. From an encounter form On Patient Instructions - CCC, click Generate CVS. On MU Core Checklist, click Generate CVS. In a custom form, use MEL_GEN_CVS symbol to launch the Clinical visit Summary window from a custom encounter form. Reviewing the Clinical Visit Summary When you create a Clinical Visit Summary, a summary based on the selected document appears in a preview screen in CCDA format. Select links in the Table of Contents to review content in the document. Click Customize to select sections or values to exclude. To save and deliver the visit summary, click: Save to File to store to portable media. Print and give to the patient. Save to Chart and Close to save to the chart and send later via Centricity Clinical Messenger. Note. Save to File and Print actions also save the summary to the chart. Customizing the Clinical Visit Summary You can select sections of the document to exclude. A note appears in that section that the information is unavailable. You can also exclude individual clinical items under Laboratory Results,Problems, Medications, and Procedures. When you save the visit summary, the preview screen refreshes and you can check your changes. Additional customization options are also available when sending electronically with Centricity Clinical Messenger. See Guide to Meaningful Use Stage 2, available in PDF format on the Kryptiq support site. Reprinting/updating the summary If you print the summary and later wish to send an electronic version, you must regenerate it. If there have been no changes, the new summary will be identical. You can also update the summary to reflect recent changes by regenerating it. Clinical items retrieved for the summary are always current and active. Best practices It is standard practice to provide patients with information at the end of their visit, typically a list of their medications and instructions. Generating a Clinical Visit Summary for the patient and providing the CVS in print or electronically within 3 business days meets this measure. Appended Office Visit. When appending a visit note, do not change the document type to Office Visit. Leave the document as "Append"document type Append, to avoid inadvertently increment the denominator of the measure. If changed to Office Visit, then that will get counted toward the denominator, and a second CVS will be expected. The following holidays, as well as Saturday and Sunday, are not counted as business days. Holidays that fall on Saturday are counted as the prior Friday. Holidays that fall on Sunday are counted as the following Monday. New Year's Day - January 1st Birthday of Martin Luther King, Jr. - 3rd Monday of January Washington's Birthday - 3rd Monday of February Memorial Day - Final Monday of May Independence Day - July 4th Labor Day - 1st Monday of September Columbus Day - 2nd Monday of October 45

49 Veterans Day - November 11th Thanksgiving - 4th Thursday of November Christmas Day - December 25th 46

50 Stage 1: 13 Protect Electronic Health Information (Core) Requirements Source 42 CFR 495.6(d)(15) Yes/No Attestation Only Objective Protect electronic health information created or maintained by the certified EHR technology through the implementation of appropriate technical capabilities. 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 as part of its risk management process. Exclusion Any EP who has no office visits during the EHR reporting period. References EHR Incentive Program Specification: ProtectElectronicHealthInformation.pdf Setup, workflows, and best practices Setup N/A Workflows N/A Best practices Your organization must implement and maintain an internal security risk analysis or contract with another third party to analyze and maintain the security of your Centricity EMR network, clients and database. For an overview of the required security risk analysis, please see the following CMS document - Security Risk Analysis Tipsheet: Protecting Patients Health Information: Guidance/Legislation/EHRIncentivePrograms/Downloads/SecurityRiskAssessment_FactSheet_ Updated pdf Please refer to the Preparing and Maintaining Centricity Electronic Medical Record Systems guide for configuration information. Please see the following CMS document to learn more about preparing documentation in case of a CMS audit - Supporting Documentation For Audits: Guidance/Legislation/EHRIncentivePrograms/Downloads/EHR_SupportingDocumentation_Audits.pdf 47

51 Stage 1: 01 Implement Drug Formulary Checks (Menu) Requirements Source 42 CFR 495.6(e)(1)) Yes/No Attestation Only Objective Implement drug formulary checks. Measure The EP has enabled this functionality and has access to at least one internal or external formulary for the entire EHR reporting period. Exclusion Any EP who writes fewer than 100 prescriptions during the EHR reporting period. References EHR Incentive Program Specification: Formulary_Checks.pdf Setup, workflows, and best practices Setup N/A Workflows Prescribe Medications Centricity Advanced eprescribing supports electronic formulary checking. The system flags any prescription with a medication selected from the formulary alternatives list and removes the flag when the medication is replaced with one selected from the reference list. The value is FMYALTSELECTED in the MEDICATE table. You can run a query on this value to view formulary alternative use. 48

52 Stage 1: 02 Clinical Lab Test Results (Menu) Requirements Source 42 CFR 495.6(e)(2)) Objective Incorporate clinical lab-test results into EHR as structured data. Measure More than 40 percent of all clinical lab tests results ordered by the EP during the EHR reporting period whose results are either in a positive (pos)/negative (neg) or numerical format are incorporated in certified EHR technology as structured data. Description Percentage of lab result observations terms ordered during the reporting period, and received and stored as structured data during or after the reporting period. Exclusion An EP who orders no lab tests whose results are either in a positive/negative or numeric format during the EHR reporting period. References EHR Incentive Program Specification: Lab_Test_Results.pdf Calculation Description Percentage of documents with document type in the Structured Lab Results (MU) document view with a clinical date during the reporting period, where the Responsible Provider is the EP, and signed during or after the reporting period. Only documents with document types in this view that include structured lab results will count toward the measure. The view includes the Lab Report document type by default. Important: Only lab results entered into the application as observation terms manually or via HL7 interface can be counted for this calculation. The application cannot count lab results not entered as observation terms such as scanned attachments or free text notes. You can add unstructured results to the denominator manually and re-calculate the percentage before attesting. Denominator Count 1 for every lab test ordered during the EHR reporting period by the EP whose results are expressed in a positive or negative affirmation or as a number. linked - The eligible professional is any provider who signs the document that records the lab result whether entered manually or imported via the LinkLogic interface. 49

53 recorded - The clinical date and signed date of the document that records the lab result must both be within the reporting period. This ensures the lab result being measured is both ordered and received during the reporting period. (CMS FAQ 10642) structured - A document contains structured data if results are stored in the flowsheet with numeric for positive or negative format. Observation terms are filed in the lab folder or its subfolders (visible when adding or updating a flowsheet), including Lab, Chemistry, Coagulation, Hematology, Serology, Toxicology, Urinalysis, Genetics/fertility, Challenge tests, Blood bank, Newborn Screen, Microbiology. unstructured - When lab results are imported through the LinkLogic interface with an invalid cross-reference, they appear in the document with an exclamation mark (!) and are not visible in the flowsheet. In the database, these values are stored in the observation term with OBSHEAD.HDID of -1 (ZZ-GE-unk). results expression - The value of the lab result determines whether or not it can be expressed in a positive or negative affirmation or as a number: Positive or negative expression The structured lab result value must equal one of the following case-insensitive strings: Positive, negative, pos, neg, y, n, yes, no, true, false, T, F. Number The observation term value is computable based on standard accounting rules: Can contain numbers Cannot contain alpha characters Cannot contain any special characters except: A decimal point (.) anywhere in the string, occurring only once Numerator One or more commas (,) adjacent to a character in the string or as the first or last characters A minus sign (-) or dollar sign ($) as the first character in the string A set of parentheses enclosing a string, where an open parenthesis '(' is the first character and a close parenthesis ')' is the last character Count 1 for every lab test result which is expressed in a positive or negative affirmation or as a numeric result which is incorporated in CEHRT as structured data during or after the reporting period. Setup, workflows, and best practices Setup Set up a LinkLogic Lab Results Import relationship to receive lab results data from external labs. You must also configure a cross-reference file to translate laboratory information system (LIS) result codes to application observation terms. You might also need a cross-reference file to map application user IDs to external system user initials. See Managing Interfaces with Centricity Electronic Medical Record. For all workflows, consider creating a custom document type for lab results such as pathology that do not have numeric or positive/negative value. This prevents them from being counted in the denominator. If the EP changes the lab report to a different document type, such as Pathology Report, to indicate that it does not contain structured lab results, it is no longer counted in the denominator. Custom lab document types. Add any custom document types you use for lab reports to Structured Lab Results (MU) view. Workflows LinkLogic Lab Results import - Import and sign lab results to update the patient flowsheet and make them part of the chart. In the LinkLogic LabLink interface, some HL7 clinical document codes are mapped to the Lab Report document type on import. You may also have custom cross-reference files that map document codes to this or other standard document types or to custom document types. Check your implementation and cross-reference files to make certain imported lab results with structured results are mapped to document types in the new 50

54 Structured Lab Results (MU) view and that documents that do not include structured results, such as Pathology Report, are mapped to a document type that is not included in the view. Scanned file attachments - Use this workflow if you scan paper lab reports and attach files to the chart using File Attachment (from the Desktop) or if you use Centricity Document Management to create and manage remotely stored Lab Report file attachments. These results require manual capture for addition to MU reporting. For any value that is numeric, negative or positive, append and manually add observation values to the flowsheet or enter them in an encounter form designed for that purpose, such as Urinalysis or Lipids. Always use Lab Report document types when you attach or append documents, or change the document type for the appended document from "Append" to "Lab Reports". Preliminary lab results that are replaced with Final structured results are treated as Filed in Error in CQR and not counted in either the numerator or the denominator. 51

55 Stage 1: 03 Generate Patient Lists by Specific Condition (Menu) Requirements Source 42 CFR 495.6(e)(3)) Yes/No Attestation Only Objective Generate lists of patients by specific conditions 1 to use for quality improvement, reduction of disparities, research, or outreach. Measure Generate at least one report listing patients of the EP with a specific condition. Exclusion None References EHR Incentive Program Specification: Lists.pdf Setup, workflows, and best practices Setup Varies Workflows In Chart Reports > Inquiries, run an inquiry for patients with a specific condition. 1 Conditions in the patient Problem list. 52

56 Stage 1: 04 Patient Reminders (Menu) Requirements Source 42 CFR 495.6(e)(4)) Objective Send reminders to patients per patient preference for preventive/followup care. Measure More than 20 percent of all patients 65 years or older or 5 years old or younger were sent an appropriate reminder during the EHR reporting period. Exclusion An EP who has no patients 65 years old or older or 5 years old or younger with records maintained using certified EHR technology. References EHR Incentive Program Specification: Reminders.pdf Calculation Description Percentage of patients 65 years old or older or 5 years or younger at the beginning of the reporting period who were provided a patient reminder during the reporting period. Denominator Count 1 for every patient 65 years old or older or 5 years old or younger. The patients are not limited to those seen by the EP during the reporting period. qualifying age - Includes patients aged 5 or younger or 65 or older at the start of the measure reporting period. If a patient is not 6 years old at the start of the reporting period, then the patient is considered to be 5 years old. Example: 5 years and 8 months is included in the definition of 5 years old or younger. Numerator Of the patients in the denominator, count 1 for every patient who was sent an appropriate reminder during the reporting period. Note. All EPs get credit. Setup, workflows, and best practices Setup To add or change letters, go to Setup > Settings > System > Letters > Letter Templates. Create a folder to store letter templates directly under the Enterprise folder with the word "actionable" as part of the title. For example, a folder can have a title of "Actionable Reminders". Subfolders can be created under 53

57 the "actionable" folder. Letters created from templates stored in this folder or sub-folders are automatically counted for Meaningful Use. An actionable reminder is for preventive or follow-up care that prompts the patient to take a new action. For example, a reminder to a patient about her upcoming mammogram is not considered an actionable reminder because the patient has already scheduled the mammogram. However, a reminder to a patient that she is due for a mammogram and need to schedule one, is considered an actionable reminder because the patient must take a new action to schedule the appointment. Workflows Current product supports reminders through inquiries and letter templates. Note. You may need to modify the location of existing letters to use for this purpose. Changes do not retroactively apply to past audit events. Send reminders from the Inquiries module Configure and run an inquiry to create a list of patients, and then select Send Reminder in the Activity list to set up and print a reminder letter for each patient. The EP or user (on behalf of the EP) who generates the letter is counted in the numerator. Be aware that CQR will account for the full denominator of the measure, but will ONLY count numerators for patients sent Letters, whose preferred contact method is "Letter". When attesting, providers can use the list of Unmet patients in the numerator, create reminders according to the patients' preference and provide them to the patients. The providers can then add that number to the numerator when the providers attest. (EPs should keep a separate log or record for audit purposes). 54

58 Stage 1: 05 Patient-specific Education Resources (Menu) Requirements Source 42 CFR 495.6(e)(6)) Objective Use certified EHR technology to identify patient-specific education resources and provide those resources to the patient if appropriate. Measure More than 10 percent of all unique patients seen by the EP are provided patient-specific education resources. Exclusion None References EHR Incentive Program Specification: Specific_Education_Resources.pdf Calculation Description Percentage of all unique patients seen by the EP during the EHR reporting period who are provided patientspecific education resources before, during, or after the reporting period. Denominator Count 1 for every unique patient seen by the EP during the EHR reporting period. Numerator Of the patients in the denominator, count 1 for every patient who was provided patient-specific education resources before, during, or after the reporting period. Setup, workflows, and best practices Setup Go to Setup > Settings and select Web Services > Internet Sites. The Internet Sites window allows the administrator to change the vendor URL for the Patient Education site. Workflows Patient-specific education resources are available to print from a patient's problem list, medication list, or lab results. 1 Select a problem, medication, or result from the list. 2 Click Patient Education Lookup, the blue info button. The Patient Education window displays the available handouts. 55

59 3 Select the handout. 4 Click Print and give the handout to the patient. An alternate option for an application-suggested handout based on patient clinical information is the medication handout available when a prescription is recorded in the patient's chart. 1 Create a prescription for a medication using any prescribing method (if Historical, quantity and refill must have a value). 2 Check Print Handout. The system records prescribe record with value of Y in PRESCRIB.PRINTINFO. For prescription refills, select the Pt Info check box. 3 Sign the prescription. The system generates the handout. 4 Give the handout to the patient. The following related workflows cannot be measured in accordance with the meaningful use criteria and should NOT be used to meet meaningful use: Manually select a handout not recommended by the application. Generate medication handouts from the Find Medication window. Generate a handout for other than medications. Best practices If you customize the system to prompt a user to provide patient education based on elements of the patient's chart, GE recommends you create a custom report to capture this workflow for attestation. Note also that you must use the certified capabilities (with a focus on EHR identified educational materials) and, if you wish to rely on the system's meaningful use reporting, must use one of the specified workflows. 56

60 Stage 1: 06 Medication Reconciliation (Menu) Requirements Source 42 CFR 495.6(e)(7)) 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. 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 An EP who was not the recipient of any transitions of care during the EHR reporting period. References EHR Incentive Program Specification: Medication_Reconciliation.pdf Calculation Description Percentage of transitions of care (in) during the reporting period for which medication reconciliation was performed before, during, or after the reporting period. Denominator Count 1 for every transition of care during the reporting period for which the EP was the receiving party of the transition. transition of care indication - Check Encounter is Transition of Care on the Start Update or End Update window to indicate transition of care during the measure reporting period. linked - The eligible professional is any provider who signs the document associated with the transition of care indication. Note. A new patient's first visit (the first seen by encounter with a provider) automatically counts as a transition of care. Even if Encounter is Transition of Care is not checked, the first visit is included in the denominator. Numerator Of the transitions of care in the denominator, count 1 for each one where medication reconciliation was performed before, during, or after the reporting period. documented medication reconciliation - includes the following observation term: MEDS REVIEW, where the value is Done (case-sensitive). 57

61 Setup, workflows, and best practices Setup Use HTML Clinical Reconciliation encounter form to electronically reconcile medications, allergies, and problems. You have the ability to see and compare values from two or more sources and to merge them into the appropriate clinical list. Workflows Review documents to be reconciled in the Clinical Reconciliation HMTL encounter form The Clinical Reconciliation form is included in the new CCC-Basic clinical kit included in this release.this form is accessible from the following forms: CPOE A&P-CCC, HPI-CCC, Problems-CCC, and MU Core Checklist-CCC. When you start an update for a patient, you can view documents to be reconciled by clicking the Reconciliation button in any of these forms. In the form, select Documents to Reconcile at the top left in the form to view all documents received. In the form you can review imported Problems, Medications, and Allergies against the existing patient clinical lists, add them to the patient chart, and edit them. Once added to the list you can open any item to Edit its details or Remove it. Click Mark Reviewed to complete reconciliation and remove the document from the list. Once the document is completed, it cannot be re-reconciled. Note. A provider may also see imported documents for a patient on their Chart Desktop or note their presence in the patient s Document list when viewing the chart. To reconcile their content you must view them in the Clinical Reconciliation form. Mark an encounter as a Transition of Care at start or end of update If you know a visit is a transition of care, you can mark it when you start the update. But you may not know initially. For example, during a visit a patient may report a visit with another provider and show you new medications they received. In that case, to get credit for Meaningful Use, manually add the medication and check Meds Reviewed. Then check Encounter is Transition of Care on the End Update window. Note. A new patient's first visit (the first seen by encounter with a provider) automatically counts as a transition of care. Even if Encounter is Transition of Care is not checked, the first visit is included in the denominator. Send and receive TOC documents Use Centricity Clinical Messenger (Kryptiq) to send Transition of Care documents electronically to an external provider. After creating a TOC document in the patient chart, switch to the Desktop Messaging tab, and create a message from the sending provider to the external provider for the order. Open the patient chart (if necessary), then select and attach the TOC document and sign and send the message. Check on the Desktop Messaging tab for received TOC documents and save received TOC documents to the patient s chart. If there are clinical changes to reconcile, you can review and address them when you open the patient chart. New and changed MEL symbols for Clinical Reconciliation The following new symbols support clinical reconciliation: DOCUMENTTORECONCILE and GET_RECONCILE_ DOC_LIST are used in the reconciliation form to display the external documents. The Reconciliation form can be accessed with the following MEL statement in a custom form: {SHOW_HTML_ FORM(ccc_recon_server_path,"Reconciliation")}. 58

62 Note. In Centricity Advanced eprescribing, you can add historical medications to the medications list during medication reconciliation, however you must check Meds Reviewed to get credit in this report. 59

63 Stage 1: 07 Transition of Care Summary (Menu) Requirements Source 42 CFR 495.6(e)(8)) 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. Measure The EP who transitions or refers their patient to another setting of care or provider of care provides a summary of care record for more than 50 percent of transitions of care and referrals. Exclusion An EP who neither transfers a patient to another setting nor refers a patient to another provider during the EHR reporting period. References EHR Incentive Program Specification: of_care_summary.pdf Calculation Description Percentage of transitions of care (out)and referrals during the EHR reporting period by the EP to another setting of care or provider of care for which a summary of care record was provided during the reporting period. Denominator Count 1 for each transition of care or referral during the EHR reporting period for which the EP was the transferring or referring provider. transition of care indication - Order marked as Transition of Care. The authorizing provider of the order is the EP. The order date is during the reporting period. Numerator Of the transitions of care and referrals in the denominator, count 1 for each one where a summary of care record was provided during the reporting period. Summary of care records may be printed, saved to file, or sent electronically via Centricity Clinical Messenger or Qvera Interface Engine. 60

64 qualifying events - Includes Provide TOC Referral Summary entries in MUActivityLog 1 that are created and delivered using any of the following workflows: Click Save to File or Print in the Transition of Care preview window. An entry is added to the MUActivityLog with Delivery Method set to SaveToFile or Print. The event ID is 1 - SummaryOfCareTOCReferal Click Save to Chart & Close used in the Transition of Care preview window AND send TOC document electronically using a secure messaging system. An entry is added to the MUActivityLog with Delivery Method set to Electronic. The event ID is SummaryOfCareTOCReferal. required time frame - The EP is the authorizing provider for a TOC order where the order date was within the reporting period. Setup, workflows, and best practices In the previous Meaningful Use Stage 1 release, transitions of care were counted when the CARETRANSOUT observation was included in the chart document and a report or letter containing Chart Summary was either printed or faxed (audit events counted) or CCD chart summary was exported. In this release for MU 2014, the calculation is based on an order document marked as Transition of Care. A Transition of Care CCDA document is generated based on that document, signed by the referring/transferring provider, and is either printed, saved to file for transfer, or sent electronically. The EP or user (on behalf of the EP) who generates or delivers the TOC is counted in the numerator. Currently electronic transmission is handled by Centricity Clinical Messenger (Kryptiq) or Qvera Interface Engine (QIE) under the SOAP & XDR / XDM for Direct messaging standard. Whenever a transition of care document is sent directly using one of these electronic means it is logged and counted for Meaningful Use. These events are logged in the Patient MU Activity Log which is used for calculating the numerator for the measure. Note. Transitions of care or referrals to another provider within the same EHR system are not counted towards Meaningful Use. Setup The application provides the following new setup workflows to support this measure: Set up order categories / codes as Transition of Care Referral order categories are set as Transition of Care by default, so all referral order codes are automatically set and counted for Meaningful Use. Test order categories and codes may be set to be used as Transition of Care where including a CCDA transition of care document with the order is appropriate. Go to Setup > Settings and select Orders > Codes & Categories and select an order category and/or codes to modify. Add secure electronic address for approved service providers You must add a secure electronic address for external service providers associated with referral and test orders to send as Transition of Care. Doing this updates the MU Activity log and counts the TOC in CQR. Go to Setup > Settings > Orders > Service Providers and select a provider to modify. Enter a secure electronic address (DIRECT) for Service Providers to receive transition of care documents. Kryptiq or QIE use this field to send TOC documents to intended recipients. 1 Beginning with this version, the MUActivityLog database table records event details needed for numerator or denominator calculations. Meaningful Use calculation events cannot be disabled. You can choose to enable or disable other user events from Auditing. For Meaningful Use events (for example, encounters that count towards the Seen By denominator) that occurred before the version upgrade, the information may be stored in other tables, but will still be used as part of measure calculations. 61

65 Set a provider as an External Service Provider By default, users are designated as Internal Service Providers. Providers within your system who might receive transitions of care or referrals from within or outside the system can be designated as an External Service Provider for the purpose of Meaningful Use. A transition of care sent to an internal provider is not counted for Meaningful Use, because it is assumed providers within the same system have shared access to the patient chart. 1 Go to Setup > Settings>Orders > Service Providers. 2 Click New. The Add Service Provider window opens. 3 Complete the fields for the new service provider and click Save & Continue. The service providers listed in this file are set as External Service Providers. Required privileges Users must have existing privileges Chart > Export Summary Documents and Chart > Export Unsigned Chart Data to generate and send Transition of Care documents. From Setup > Privileges, in Set Privileges for, do one of the following: Choose Role and select the specific role from the list. Choose User and click to search for and select a user. Select these two privilegesin the Chart folder: Export Summary Documents Export Unsigned Chart Data Workflows Mark order as Transition of Care in Orders module and generate TOC document When you configure a referral or test order in the Orders module, you can set the document containing the order to be a Transition of Care (TOC) document and then generate and optionally customize the CCDA document.toc is based on a signed In Process order. 1 Create an order and confirm that it is set as Transition of Care. Be sure that Authorized By is the EP. Select Create Transition of Care Document and enter a reason on Reason.Select External on Referring To:.Set disposition to Admin Hold and sign the order. 2 Go to the Change Order window and click Save and Create to create the CCDA document. When a Transition of Care CCDA document is saved it appears beneath its parent document in the Document list like an appended document, however the Transition of Care CCDA is sent separately. The document type is Progress Exp: Transition of Care. Customizing Transition of Care CCDA When you create a transition of care document, it is based on the selected order and the patient s chart summary and appears in a preview screen in CCDA format. Select links in the Table of Contents to review content in the document. Click Customize to select sections or values to exclude. You can select sections of the document to exclude. A note appears in that section that the information is unavailable. You can also exclude individual clinical items under Laboratory Results, Problems, Medications, and Procedures. When you save the transition of care document, the preview screen refreshes and you can check your changes. 62

66 Note. Printing, saving to file, or electronically sending a generated TOC CCDA document is logged and counted. These events are logged in the MUActivityLog 1 which is used for calculating the numerator for the measures. Reprinting / updating the Transition of Care CCDA If you print the Transition of Care (TOC) CCDA and later wish to send an electronic version, you can either select the document using Centricity Clinical Messenger to send electronically, or you can regenerate the CCDA and save it to a file. If there have been no changes, the new TOC will be identical.you can also update the TOC to reflect recent changes by regenerating it. Clinical items retrieved for the TOC are always current and active. Send and receive TOC documents (Kryptiq, Qvera) In this release, you can use Centricity Clinical Messenger (Kryptiq) or Qvera Interface Engine (QIE) to send Transition of Care documents electronically to an external provider using a HISP. Work with your GE Sales representative, Centricity Services technical consultant, or Value-Added Reseller to plan and implement a configuration appropriate for your needs. Note. For more information about sending TOC using Centricity Clinical Messenger, see Guide to Meaningful Use Stage 2 and other resources on the Kryptiq support site (support.kryptiq.com). Sending TOC with Centricity Clinical Messenger After creating a TOC document in the patient chart, switch to the Desktop Messaging tab, and create a message from the sending provider to the external provider for the order. Open the patient chart (if necessary), then select and attach the TOC document and sign and send the message. Sending TOC with Qvera Interface Engine (QIE) When this QIE interface is implemented, LinkLogic automatically creates an HL7 ORM message when the order is signed and places it in a folder where QIE can pick it up. Using QIE to transmit orders electronically, you do not need to manually generate the CCDA after signing the order unless you want to customize the document. When QIE picks up the order message, it automatically generates the TOC document and saves it to the patient chart, which logs the TOC order for Meaningful Use. It includes the CCDA in the message before sending. Receiving TOC message with Centricity Clinical Messenger Check on the Desktop Messaging tab for received TOC documents and save the document to the patient s chart. If there are clinical changes to reconcile, you can review and address them when you open the patient chart. Receiving TOC message with Qvera (QIE) When a transition of care message is imported to the patient chart by QIE, a flag is placed on the Desktop of the provider to whom the document has been sent. The provider can open the patient chart and review the CCDA document and if necessary carry out required clinical reconciliation. 1 Beginning with this version, the MUActivityLog database table records event details needed for numerator or denominator calculations. Meaningful Use calculation events cannot be disabled. You can choose to enable or disable other user events from Auditing. For Meaningful Use events (for example, encounters that count towards the Seen By denominator) that occurred before the version upgrade, the information may be stored in other tables, but will still be used as part of measure calculations. 63

67 Stage 1: 08 Test Capacity to Send Electronic Data to Immunization Registry (Menu) Requirements Source 42 CFR 495.6(e)(1)) Yes/No Attestation Only Objective Capability to submit electronic data to immunization registries or immunization information systems and actual submission according to applicable law and practice. Measure Performed at least one test of certified EHR technology s capacity to submit electronic data to immunization registries and follow up submission if the test is successful (unless none of the immunization registries to which the EP submits such information has the capacity to receive the information electronically). Exclusion An EP who administers no immunizations during the EHR reporting period or where no immunization registry has the capacity to receive the information electronically. References EHR Incentive Program Specification: Immunization_Registries_Data_Submission.pdf Setup, workflows, and best practices Setup For setup information, see Migrating and managing immunization data in Centricity EMR 9.8. Immunization Registry subscription configured in Setup works with QIE interface engine to send HL7 VXU messages to a configured registry. The GE-supported mechanism is QIE. However, other transport mechanisms can be used. Import and enable Subscription in Setup In Setup, go to Interoperability > Configuration. Click F1 to get help on importing and enabling the subscription or interface to an immunization registry. The new permission Common Event Model > ACCESS Subscriptions Modification is required to manage subscriptions for MU interfaces. Workflows GE offers certified content exchange standards and implementation specifications for exchanging electronic health information using LinkLogic HL7 interfaces and Centricity Clinical Gateway interface engine. Centricity EHR applications support HL specifications for immunizations messaging. GE also meets required standards for representing electronic health information (HL7 Standard Code Set CVX -Vaccines Administered). See Managing Interfaces with Centricity EMR for information about the immunization registry interface. 64

68 If you choose to demonstrate sending immunizations data, you must use GE s certified methodology or, another methodology that is certified with ONC. You may be excluded if the registry you want to send information to cannot accept the information electronically as defined by the Meaningful Use certification requirements. Submission of actual patient data is not required for the test but is required for follow-up submission if the test is successful. A single test satisfies the objective where multiple providers use the same EHR technology at a single location. 65

69 Stage 1: 09 Test Capacity to Submit Electronic Data to Public Health Agencies (Menu) Requirements Source 42 CFR 495.6(e)(1)) Yes/No Attestation Only Objective Capability to submit electronic syndromic surveillance data to public health agencies and actual submission according to applicable law and practice. Measure Performed at least one test of certified EHR technology s capacity to provide electronic syndromic surveillance data to public health agencies and follow-up submission if the test is successful, (unless none of the public health agencies to which an EP submits such information has the capacity to receive the information electronically) except where prohibited. Exclusion An EP who does not collect any reportable syndromic information on their patients during the EHR reporting period, does not submit such information to any public health agency that has the capacity to receive the information electronically, or if it is prohibited. References EHR Incentive Program Specification: Syndromic_Surveillance_Data_SubmissionEP.pdf Setup, workflows, and best practices Setup Varies. Contact your Centricity Services technical consultant or Value-Added Reseller for help planning and implementing data exchange with public health agencies. Information is entered into an Urgent Care Management form and when the document is signed, data is sent to a configured public health agency. The Urgent Care Management encounter form is required to enter required values/codes. Public Health Registry subscription configured in Setup works with QIE interface engine to send HL7 ADT 04 and ADT 03 (Admit/Discharge) messages to a configured agency. The GE-supported mechanism is QIE. However, other transport mechanisms can be used. Import and enable Subscription in Setup In Setup go to Interoperability > Configuration. Click F1 to get help on importing and enabling the subscription or interface to a public health registry. The new permission Common Event Model > ACCESS Subscriptions Modification is required to manage subscriptions for MU interfaces. Workflows Current product certified for data submission in HL message format. 66

70 Submission of actual patient data is not required for the test but is required for follow-up submission if the test is successful. A single test satisfies the objective where multiple providers use the same EHR technology at a single location. 67

71 Stage 2: CMS Functional Measures - Core and Menu The CMS has defined required Core and optional Menu functional measures to demonstrate Meaningful Use: Core Set - 17 required objectives and corresponding measures. Menu Set - 6 optional objectives and measures. Most functional measures require a calculation based on a numerator and a denominator, a few require only Yes/No attestation. System Alert. Your organization is solely responsible for determining whether your Eligible Professionals meet the requirements for Meaningful Use and ensuring the accuracy of any Meaningful Use attestation. Ensure you understand the measure requirements, reporting functionality and that you monitor the quality of the data entered into the application. Core Set of required measures includes: 01 CPOE for Medication, Radiology, and Laboratory Orders (Core) 02 e-prescribing (erx) (Core) 03 Record Demographics (Core) 04 Record Vital Signs (Core) 05 Record Smoking Status (Core) 06 Clinical Decision Support Rule (Core) 07 Patient Electronic Access (Core) 08 Clinical Summaries (Core) 09 Protect Electronic Health Information (Core) 10 Clinical Lab-Test Results (Core) 11 Patient Lists (Core) 12 Preventive Care (Core) 13 Patient-Specific Education Resources (Core) 14 Medication Reconciliation (Core) 15 Summary of Care (Core) 16 Immunization Registries Data Submission (Core) 17 Use Secure Electronic Messaging (Core) Menu Set optional objectives and measures includes: 01 Syndromic Surveillance Data Submission (Menu) 02 Electronic Notes (Menu) 03 Imaging Results (Menu) 04 Family Health History (Menu) 05 Report Cancer Cases (Menu) (Not supported at this time) 06 Report Specific Cases (Menu) (Not supported at this time) Note. You must report on 3 measures from the Menu set. References Click this link to view a table with links to the specifications of the Stage 2 Eligible Professional (EP) Meaningful Use Core and Menu Measures. EHR Incentive Program Specification: 68

72 MeaningfulUseSpecSheet_TableContents_EPs.pdf 69

73 Stage 2: CMS Functional Measures - Core Core Set of required measures includes: 01 CPOE for Medication, Radiology, and Laboratory Orders (Core) 02 e-prescribing (erx) (Core) 03 Record Demographics (Core) 04 Record Vital Signs (Core) 05 Record Smoking Status (Core) 06 Clinical Decision Support Rule (Core) 07 Patient Electronic Access (Core) 08 Clinical Summaries (Core) 09 Protect Electronic Health Information (Core) 10 Clinical Lab-Test Results (Core) 11 Patient Lists (Core) (attestation only) 12 Preventive Care (Core) 13 Patient-Specific Education Resources (Core) 14 Medication Reconciliation (Core) 15 Summary of Care (Core) 16 Immunization Registries Data Submission (Core) 17 Use Secure Electronic Messaging (Core) References Click this link to view a table with links to the specifications of the Stage 2 Eligible Professional (EP) Meaningful Use Core and Menu Measures. EHR Incentive Program Specification: MeaningfulUseSpecSheet_TableContents_EPs.pdf 70

74 Stage 2: 01 CPOE for Medication, Laboratory and Radiology Orders - (Core) Requirements Objective Use computerized provider order entry (CPOE) for medication, laboratory, and radiology orders directly entered by any licensed healthcare professional or credentialed medical assistant who is authorized to enter orders into the medical record, according to state, local and professional guidelines. Note. Credentialing for a medical assistant must come from an organization other than the organization employing the medical assistant. Measure More than 60 percent of medication, 30 percent of laboratory, and 30 percent of radiology orders created by the EP during the EHR reporting period are recorded using CPOE. Exclusion Any EP who writes fewer than 100 medication, radiology, or laboratory orders during the EHR reporting period. References EHR Incentive Program Specification: EPCore_1_CPOE_MedicationOrders.pdf 71

75 Stage 2: 01 CPOE for Medication Orders Requirements Objective Use computerized provider order entry (CPOE) for medication orders directly entered by any licensed healthcare professional or credentialed medical assistant who is authorized to enter orders into the medical record, according to state, local and professional guidelines. Note. Credentialing for a medical assistant must come from an organization other than the organization employing the medical assistant. Measure 1 More than 60 percent of medication orders created by the EP during the EHR reporting period are recorded using CPOE. Calculation Description Percent of medication orders created by the EP during the EHR reporting period that are directly entered by an authorized healthcare professional using CPOE. Denominator Count 1 for every medication order written by the EP during the reporting period.. written by - Eligible professional is the user selected as Authorized By for the prescription. medication order - A prescription for a coded medication or uncoded medication classified as a drug (and not a DME nor OTC) entered into the chart using one of the following Prescribing Methods available within the application: Electronic, Fax to pharmacy, Print then fax to pharmacy, Print then give to patient, Print then mail to patient, Print then mail to pharmacy, Telephone or Handwritten. Requests for administered medications entered through the medication administration form are also counted. Numerator Of the medication orders in the denominator, count 1 for every medication order that was a CPOE medication order during the reporting period. authorized healthcare professional- Any licensed healthcare professional or credentialed medical assistant, who is authorized to enter orders into the medical record, according to state, local and professional guidelines. Credentialing for a medical assistant must come from an organization other than the organization employing the medical assistant. CPOE medication order - A medication order entered into the chart by an authorized healthcare professional using one of the following Prescribing Methods available within the application: Electronic, Fax to pharmacy, Print then fax to pharmacy, Print then give to patient, Print then mail to patient, Print then mail to pharmacy,or Telephone. Exclusion Any EP who writes fewer than 100 medication orders during the EHR reporting period. References EHR Incentive Program Specification: 72

76 EPCore_1_CPOE_MedicationOrders.pdf Setup, workflows, and best practices Setup Enter required Authorized Healthcare Professional user attributes Authorized healthcare professionals must be designated as Licensed (or Credentialed Medical Assistant). For chart access, check (Legally authorized to enter CPOE orders) on the Meaningful Use Attributes section on Chart Access tab. In order to be a CPOE-qualified user the licensed health care provider must select the option from User Management and enter the states they are licensed in and (optional) the effective dates of their licenses. 1 From Setup > Settings select Users > Users > Edit a user. 2 Select Eligible Professional and/or Licensed or Credentialed (Legally authorized to enter CPOE orders). For Eligible Professional, select the Program, Stage, Reporting Year, and Attested fields. For Licensed or Credentialed, click New and select the licensing state, then (optional) set the Effective and End dates of the license or credential. Note. If you updated an EP's credentialed status and need that to take affect historically in CQR, you will need to reset your CQR subscriptions to resend data. You may contact GE Support for assistance with your reset. Workflow Prescribe medication, Refill medication, Medication administration request Note that User who enters the prescription record must be an authorized healthcare professional. To receive MU credit, an eligible professional must be the Authorized By provider on the prescription These prescribing methods do not qualify as CPOE-defined prescribing methods: Handwritten, Samples Given, Refax, Reprint, Historical. If an order is canceled, the order is excluded from the denominator and numerator. 73

77 Stage 2: 01 CPOE for Radiology Orders Requirements Objective Use computerized provider order entry (CPOE) for radiology orders directly entered by any licensed healthcare professional or credentialed medical assistant who is authorized to enter orders into the medical record, according to state, local and professional guidelines. Note. Credentialing for a medical assistant must come from an organization other than the organization employing the medical assistant. Measure 2 More than 30 percent of radiology orders created by the EP during the EHR reporting period are recorded using CPOE. Calculation Description Percent of radiology orders created by the EP during the EHR reporting period that are directly entered by an authorized healthcare professional using CPOE. Denominator Count 1 for every radiology order written by the EP during the reporting period. written by - Eligible professional is the user selected as Authorized By for the radiology order. radiology order - Order for any imaging services that uses electronic product radiation. The EP can include orders for other types of imaging services that do not rely on electronic product radiation in this definition as long as the policy is consistent across all patient and for the entire EHR reporting period. Numerator Of the radiology orders in the denominator, count 1 for every radiology order entered into the chart by an authorized healthcare professional during the reporting period. authorized healthcare professional- Any licensed healthcare professional or credentialed medical assistant, who is authorized to enter orders into the medical record, according to state, local and professional guidelines. Credentialing for a medical assistant must come from an organization other than the organization employing the medical assistant. Exclusion Any EP who writes fewer than 100 radiology orders during the EHR reporting period. References EHR Incentive Program Specification: EPCore_1_CPOE_MedicationOrders.pdf Setup, workflows, and best practices Setup Enter required Authorized Healthcare Professional user attributes 74

78 Authorized healthcare professionals must be designated as Licensed (or Credentialed Medical Assistant). For chart access, check (Legally authorized to enter CPOE orders) on the Meaningful Use Attributes section on Chart Access tab. In order to be a CPOE-qualified user the licensed health care provider must select the option from User Management and enter the states they are licensed in and (optional) the effective dates of their licenses. 1 From Setup > Settings select Users > Users > Edit a user. 2 Select Eligible Professional and/or Licensed or Credentialed (Legally authorized to enter CPOE orders). For Eligible Professional, select the Program, Stage, Reporting Year, and Attested fields. For Licensed or Credentialed, click New and select the licensing state, then (optional) set the Effective and End dates of the license or credential. Note. If you updated an EP's credentialed status and need that to take affect historically in CQR, you will need to reset your CQR subscriptions to resend data. You may contact GE Support for assistance with your reset. Set Radiology order category/code classifications Radiology orders must be assigned the default classification of Radiology for new or existing services. The user must create or edit existing orders in the administration module. Go > Setup > Settings > Orders > Select Services or Test and Procedures. There are two options: The user can identify the classification Radiology at the category level which would apply to all orders in that category. OR The user can edit or add the Radiology classification at the individual order directory in the Change codes dialog. Workflow Use the Centricity Orders module to capture orders that have been classified as Radiology in the Orders setup. The status of an order must be Complete, In-Process, or Admin Hold. The user entering the order must be Licensed or Credentialed to enter CPOE orders, and set up as such in the user account. A qualifying order that has been signed and later modified by someone who is not licensed or credentialed, still counts in the numerator. If an order is canceled, the order is excluded from the denominator and numerator. 75

79 Stage 2: 01 CPOE for Laboratory Orders Requirements Objective Use computerized provider order entry (CPOE) for laboratory orders directly entered by any licensed healthcare professional or credentialed medical assistant who is authorized to enter orders into the medical record, according to state, local and professional guidelines. Note. Credentialing for a medical assistant must come from an organization other than the organization employing the medical assistant. Measure 3 More than 30 percent of laboratory orders created by the EP during the EHR reporting period are recorded using CPOE. Calculation Description Percentage of laboratory orders created by the EP during the EHR reporting period are recorded using CPOE. Denominator Count 1 for every laboratory order written by the EP during the reporting period. written by - Eligible professional is the user selected as Authorized By for the laboratory order. laboratory order - Order for any service provided by a laboratory. Numerator Of the laboratory orders in the denominator, count 1 for every laboratory order entered into the chart by an authorized healthcare professional during the reporting period. authorized healthcare professional- Any licensed healthcare professional or credentialed medical assistant, who is authorized to enter orders into the medical record, according to state, local and professional guidelines. Credentialing for a medical assistant must come from an organization other than the organization employing the medical assistant. Exclusion Any EP who writes fewer than 100 laboratory orders during the EHR reporting period. References EHR Incentive Program Specification: EPCore_1_CPOE_MedicationOrders.pdf Setup, workflows, and best practices Setup Enter required Authorized Healthcare Professional user attributes 76

80 Authorized healthcare professionals must be designated as Licensed (or Credentialed Medical Assistant). For chart access, check (Legally authorized to enter CPOE orders) on the Meaningful Use Attributes section on Chart Access tab. In order to be a CPOE-qualified user the licensed health care provider must select the option from User Management and enter the states they are licensed in and (optional) the effective dates of their licenses. 1 From Setup > Settings select Users > Users > Edit a user. 2 Select Eligible Professional and/or Licensed or Credentialed (Legally authorized to enter CPOE orders). For Eligible Professional, select the Program, Stage, Reporting Year, and Attested fields. For Licensed or Credentialed, click New and select the licensing state, then (optional) set the Effective and End dates of the license or credential. Note. If you updated an EP's credentialed status and need that to take affect historically in CQR, you will need to reset your CQR subscriptions to resend data. You may contact GE Support for assistance with your reset. Set Laboratory order category/code classifications Laboratory orders must be assigned the default classification of Laboratory for new or existing services. The user must create or edit existing orders in the administration module. Go > Setup > Settings > Orders > Select Services or Test and Procedures. There are two options: The user can identify the classification Laboratory at the category level which would apply to all orders in that category. OR The user can edit or add the Laboratory classification at the individual order directory in the Change codes dialog. Workflow Use the Centricity Orders module to capture orders that have been classified as Laboratory in the Orders setup. The status of an order must be Complete, In-Process, or Admin Hold. The user entering the order must be Licensed or Credentialed to enter CPOE orders, and set up as such in the user account. A qualifying order that has been signed and later modified by someone who is not licensed or credentialed, still counts in the numerator. If an order is canceled, the order is excluded from the denominator and numerator. 77

81 Stage 2: 02 e-prescribing (erx) (Core) Requirements Objective Generate and transmit permissible prescriptions electronically (erx). 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. Exclusion Any EP who: 1 Writes fewer than 100 prescriptions during the EHR reporting period. 2 Does not have a pharmacy within their organization and there are no pharmacies that accept electronic prescriptions within 10 miles of the EP's practice location at the start of his/her EHR reporting period. References EHR Incentive Program Specification: EPCore_2_ePrescribing.pdf Calculation Description Percentage of permissible prescriptions ordered by the EP that were queried for a drug formulary and transmitted electronically during the reporting period. Denominator Count 1 for every permissible prescription written by the EP during the measure reporting period. permissible prescription - A prescription for a prescription-only (not OTC - over the counter) coded medication (and not DME) with quantity > 0 entered into the chart using the Centricity Advanced eprescribing available within the application. Note: Controlled substances class code 1-5, and prescribing methods Reprint, Re-Fax and Historical, are not included. Numerator Of the prescriptions in the denominator, count 1 for each where prescribing method is Electronic and queried for a drug formulary. queried for a drug formulary - A prescription is queried for a drug formulary if electronic eligibility is checked and result is received using the Centricity Advanced eprescribing or if the patient has a formulary associated with their medical insurance. If there is no formulary available, the electronic prescription counts. 78

82 Setup, workflows, and best practices Setup Implement Centricity Advanced eprescribing - configure application and users for eprescribing. Workflows (With eprescribing enabled) Prescribe medication, Refill medication Set the eligible professional as Authorized By when producing a prescription for medications permitted to be transmitted electronically. The measure does not assume that all medications can be electronically prescribed. Use prescribing method of Electronic for prescriptions that are not for: Controlled substances Over the counter (OTC) medications Over the counter supplies Reprint, Re-Fax and Historical The product meets all requirements with Centricity Advanced eprescribing. Best practices Always set the eligible professional as Authorized By when completing a prescription request. Use the Centricity Advanced eprescribing method whenever possible for medications permitted to be transmitted electronically. 79

83 Stage 2: 03 Record Demographics (Core) Requirements Objective Record all of the following demographics: Preferred language Sex Race Ethnicity Date of birth Measure More than 80 percent of all unique patients seen by the EP have demographics recorded as structured data. Exclusion None References EHR Incentive Program Specification: EPCore_3_RecordingDemographics.pdf Calculation Description Percentage of patients seen by the EP in the reporting period for whom the required demographics (preferred language, sex, race, ethnicity, and date of birth) were recorded in patient registration before, during, or after the reporting period. Denominator Count 1 for every patient seen by the eligible professional. Numerator Of the patients in the denominator, count 1 for every patient for whom all required demographics are recorded with OMB specific values before, during, or after the reporting period. Note. All EPs get credit. required demographics Include the following attributes: Date of Birth, Sex, Preferred Language, Race, Ethnicity. Race: For Race, you can record up to two race values. The OMB values include: American Indian or Alaska Native Asian (Chinese, Filipino, or Japanese are mapped as sub-categories of Asian category) Black or African American Native Hawaiian or Other Pacific Islander White 80

84 Patient Declined State Prohibited Note that the category Unspecified is not a standard OMB value. Hispanic, Multiracial, Other, or Undetermined are mapped as sub-categories of Unspecified. Ethnicity: The following defaults are the only acceptable values. Default system values: Hispanic or Latino Not Hispanic or Latino Patient Declined State Prohibited Note that the category Unspecified is not a standard OMB value. Other or Undetermined are mapped as subcategories of Unspecified. Language mappings All previous languages are carried forward and if possible are mapped to the ISO languages. Patient Declined is an acceptable value. Setup, workflows, and best practices Setup Mapping race and ethnicity For existing users who are upgrading, your previous race and ethnicity values are carried over just as entered in Registration, but will be mapped to new standard values for the purposes of measure calculation. Previous Other, Undetermined, or User defined values are also brought over as is and mapped to Unspecified in this release. You can change these records to a required value that will be counted if desired. Configuring Race and Ethnicity in Setup Race and Ethnicity values cannot be removed or altered in Setup, but you can create Race or Ethnicity subcategories and map them to a standard value. Sub-categories appear in Registration directly under the standard value to which they are mapped. Configure Race/Ethnicity values. Set up, add or change Race and Ethnicity sub-categories in Setup Settings > Registration > Ethnicity Sub-category and Setup Settings > Registration > Race Sub-category. For Race, you can record up to two race values. Avoid using Race values Hispanic, Other, Multiracial. These values are not compliant with the OMB standards for these concepts. To record non-compliant race values, create a custom race sub-category and map it to a standard OMB value, if possible. If it is not possible to map to a standard OMB value, you can map to the Unspecified category but it will not be counted as part of the Meaningful Use measure. Define and manage non-standard/custom race and ethnicity values as sub-categories. Map these sub-categories to standard race and ethnicity values. For example, you might record Chinese and Asian-Indian as sub-categories to the required standard of Asian. These sub-categories can be recorded on patient records and they will meet a required standard (Asian) and therefore, count for this measure. Modify your Check-In /Registration workflow to capture Ethnicity value where needed. Set up LinkLogic. This setup is required IF you are exchanging data with an external PM system. LinkLogic automatically imports both values. Workflows Register patient, New /Change patient 81

85 Best practices The system is pre-populated with values that meet EHR Incentive Specification guidelines: Race and ethnicity codes should follow current federal standards published by the Office of Management and Budget ( Document Date of Birth, Sex, Preferred Language, Race, Ethnicity values for patient in Registration manually or through electronic interface exchange of demographics data. Modify Check-in/Registration workflows to require staff to ask about race, ethnicity, and language preference in a professional and sensitive manner. Preferred language must be recorded to meet compliance as recorded data. If patient declines to provide Language, Race or Ethnicity, select list option Patient Declined. If collection of Race and Ethnicity is prohibited by law, select list option State Prohibited. These values meet the goal of structured data. Note. Your system may include prior default values that do not map to OMB categories and are not counted to meet Meaningful Use criteria. New installations - Non-OMB default values are not included. Existing installations - If a value has been used for a patient, it cannot be removed from the system until all instances of its use have been removed from Registration. Recommended. If a patient wants to record more than one race, OMB requires that each race value be indicated separately.when registering a patient, you can record up to two race values. 82

86 Stage 2: 04 Record Vital Signs (Core) Requirements Objective Record and chart changes in the following vital signs: Height/Length Weight Blood pressure Calculate and display body mass index (BMI) Plot and display growth charts for patients 0-20 years, including BMI 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 Any EP who: 1 Sees no patients 3 years or older is excluded from recording blood pressure. 2 Believes that all 3 vital signs of height/length, 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. References EHR Incentive Program Specification: EPCore_4_RecordVitalSigns.pdf Calculation Calculation 1 - All Vital Signs Description 1 Percentage of patients seen by the EP in the reporting period for whom the required vital signs (height, weight, and blood pressure) were recorded in their chart before, during, or after the reporting period. Denominator 1 Count 1 for every patient seen by the eligible professional. Numerator 1 Of the patients in the denominator: Count 1 for every patient who meets either the qualifying age (for blood pressure) and for whom all required vitals are recorded at least once in the patient's chart before (within the last 5 years), during, or after the reporting period OR 83

87 Count 1 for every patient who does not meet the qualifying age (for blood pressure) but for whom height and weight recorded at least once in the patient's chart before (within the last 5 years), during, or after the reporting period. qualifying age (blood pressure)- Includes any patient 3 years old or older at the time the patient is seen by the eligible professional. recorded - The required vitals entry date must be no later than the date of attestation. required vitals - Includes height, weight, and systolic and diastolic blood pressure. Note. All EPs get credit. Calculation 2 - Height and Weight Only Use this measure if Exclusion 1 and 3 apply to your practice. Description 2 Percentage of patients seen by the EP in the reporting period for whom height and weight were recorded in their chart before, during, or after the reporting period. Denominator 2 Count 1 for every patient is seen by the eligible professional. Numerator 2 Of the patients in the denominator, count 1 for every patient for whom height and weight are recorded at least once in the patient's chart before (within the last 5 years), during, or after the reporting period. recorded - The required vitals entry date must be no later than the date of attestation. Note. All EPs get credit. Calculation 3 - Blood Pressure Only Use this measure if Exclusion 4 applies to your practice. Description 3 Percentage of patients seen by the EP in the reporting period for whom systolic and diastolic blood pressure were recorded in their chart before, during, or after the reporting period. Denominator 3 Count 1 for every patient that meets the qualifying age (for blood pressure) and is seen by the eligible professional. qualifying age (blood pressure)- Includes any patient 3 years old or older at the time the patient is seen by the eligible professional. Numerator 3 Of the patients in the denominator, count 1 for every patient for whom all systolic and diastolic blood pressure are recorded at least once in the patient's chart before, during, or after the reporting period. recorded - The required vitals entry date must be no later than the date of attestation. Note. All EPs get credit. 84

88 Setup, workflows, and best practices Setup Confirm supported clinical content. Import latest clinical kits and confirm supported encounter forms are associated with your encounter types/documents. Confirm custom forms use observation terms mapped to value sets. Workflows Update Chart Use value set: Populate supported observation terms and make sure that they are mapped to the GE Vital Sign Selection value set. Growth charts/bmi calculation: Only height, weight, and blood pressure are required. The certified EHR technology will calculate BMI and the growth chart if applicable to patient based on age. Note: Required vitals need not be updated at every patient encounter. According to the EHR Incentive Program Specification: Height, weight, and blood pressure do not have to be updated by the eligible professional at every patient encounter. The eligible professional can make the determination based on the patient's individual circumstances as to whether height, weight, and blood pressure need to be updated. Best practices When clinically appropriate, record required height, weight, and blood pressure vitals as part of a patient visit. All standard vital signs encounter forms assist in documenting and recording these vitals. This measure references BMI (Body Mass Index) and growth chart data available for patients between the ages of 0 and 20 years. BMI is calculated using entered weight and height. The Growth Chart uses BMI plotted on the chart/graph. This functionality available for patients between 0 and 20 years old meets current requirements for this measure. If creating custom content or editing a vital signs form, store the data using the Observation terms: HEIGHT, Height (cm), WEIGHT, Weight (kg), BP DIASTOLIC, BP SYSTOLIC. Note: If you use other observation terms, map them to value sets. 85

89 Stage 2: 05 Record Smoking Status (Core) Requirements Objective Record smoking status for patients 13 years old or older. 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 Any EP that neither sees nor admits any patients 13 years old or older. References EHR Incentive Program Specification: EPCore_5_RecordSmokingStatus.pdf Calculation Description Percentage of patients seen by the EP in the reporting period for whom smoking status was recorded in their chart before, during, or after the reporting period. Denominator Count 1 for every patient that meets the qualifying age and is seen by the EP. qualifying age - Includes any patient 13 years old or older at the time the patient is seen by the eligible professional. Numerator Of the patients in the denominator, count 1 for every patient for whom a smoke status was recorded and signed in the patient's chart using smoke status observation terms with ONC-specified values before, during, or after the reporting period. smoke status - searches for the observation SMOK STATUS. ONC-specified values current every day smoker current some day smoker former smoker never smoker unknown if ever smoked smoker, current status unknown heavy tobacco smoker light tobacco smoker Note. All EPs get credit. 86

90 Setup, workflows, and best practices Setup Confirm supported clinical content. Import latest clinical kits and confirm supported encounter forms are associated with your encounter types/documents. Workflows Current product captures smoking status on the FH-SH-CCC, Hypertension Q&E-CCC, MU Core Checklist, and Risk Factors-CCC encounter forms. In the FH-SH-CCC form, the smoking status field includes more detailed values specified in the final ARRA regulation 45CFR (a)(11). Update Chart - Only use encounter forms that include supported observations and observation values. Best practices During routine patient visits, clinical interaction regarding smoking, and smoking cessation can be documented by any clinician working with the patient. Smoking Status can be entered before the beginning or after the end of the reporting period. This design is based on the EHR Incentive Program specification: If this information is already in the medical record available 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 provided already from several sources in the medical community. The report does not count how often the patient is asked about smoking status. If a patient over the age of 13 has been asked this question and the answer is recorded using a valid observation term, the patient counts toward meeting the measure if they are seen within the reporting period regardless of whether they were asked during the reporting period. Use the Social History or Risk Factors form to record patient response to smoking status and smoking questions. You can use the form for patients of any age, but only patients over the age of 13 are counted for this measure. If using alternative content or editing the FH-SH-CCC form component, use the Data Mapping tool to map SNOMED codes to the observation term SMOK STATUS. 87

91 Stage 2: 06 Clinical Decision Support Rule (Core) Requirements Yes/No Attestation Only Objective Use clinical decision support to improve performance on high-priority health conditions. Measure 1 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. Measure 2 The EP has enabled and implemented the functionality for drug-drug and drug-allergy interaction checks for the entire EHR reporting period. Exclusion 2 For the second measure, any EP who writes fewer than 100 medication orders during the EHR reporting period. References EHR Incentive Program Specification: EPCore_6_ClinicalDecisionSupport.pdf Setup, workflows, and best practices Setup Measure 1 CDS interventions are based on any one or any combination of the following data elements: Problem list Medication list Medication allergy list Demographics Laboratory tests and values/results Vital signs Drug-Problem interaction checking Drug-Age interaction checking Drug-Gender interaction checking The administrator can configure a user's privilege by selecting CDS Access in the Settings tab and selecting Chart > Access Clinical Decision Support in the Privileges tab. Optionally log decision support user actions. Although not required for attestation, to see how user decision support actions are captured by the system, go to Setup > Settings > System > Auditing and confirm that MEL Decision Support is in the Log Audit Events column. 88

92 Workflows Measure 1 Various workflows support this measure including: Using Pop Up Alerts on charts that have been designated as needing a clinical intervention based on a treatment deficiency. Using Protocols for USPS or Treatment/Diagnostic related treatment interventions. Using content (such as CCC forms) that alerts or interacts with the provider based on clinical treatment needs or deficiencies. Best practices Measure 1 You must audit these actions but you do not need to count them to fulfill this measure requirement. The application provides MEL functions UserYesNo and UserOK in encounter forms, document templates, and patient banners to support decision support rules. System auditing automatically logs user responses to alerts and care suggestions created with MEL decision support functions. You can optionally track, record, and generate reports on the number of alerts responded to by a user. Note: Drug-drug and drug-allergy interaction alerts cannot be used to meet this measure. EP s must implement five clinical decision support rules in addition to the drug-drug and drug-allergy interaction checks. Setup Measure 2 Interaction checking is enabled by default and active in the product for all users. Workflows Measure 2 Prescribe Medication, Refill Medication, Change/Remove Medication While the application is able to check interactions between medications, medication allergies, and medications with diagnosis/age/gender, this measure only considers its ability to display interaction checking between two medications or a medication and an active medication allergy. Best practices Measure 2 Centricity EMR permits the organization to set an enterprise-wide level of severity for an interaction that requires the user to manually acknowledge and override the interaction to produce a prescription for a medication. This feature complies with the requirements for meeting this measure. GE recommends providers routinely review and acknowledge when an indicated medication/medication, allergy/medication interaction occurs. 89

93 Stage 2: 07 Patient Electronic Access (Core) Requirements Objective 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. 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. 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. Exclusion 2 Any EP who: 1 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 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 3Mbps 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. References EHR Incentive Program Specification: EPCore_7_PatientElectronicAccess.pdf Calculation Description Measure 1 Percentage of all unique patients seen by the EP during the EHR reporting period who 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 during or after the reporting period, subject to the EP s discretion to withhold certain information. Denominator Measure 1 Count 1 for every unique patient seen by the EP during the EHR reporting period. The data object is SeenBySharedDenominator. It includes PID,PVID, eventdate (Clinical datetime), SDID, and document summary. Numerator Measure 1 Of the patients in the denominator, count 1 for every patient who has timely (within 4 business days after the information is available to the EP) online access to their health information during or after the reporting period. 90

94 When the patient chart is updated and signed, and PATPORTALPIN is on the update, the MUActivityLog 1 will record that portal access was provided. indication- The patient chart includes a value for PATPORTALPIN observation either prior to the start of the reporting period or dated no later than 4 business days after the patient s first encounter in the reporting period. PATPORTALPIN is an observation term used to indicate in the chart that a patient has been configured for access to Centricity Patient Portal. Only patients who are provided access for every visit in the reporting period will be counted. A PIN number does not need to be generated multiple times, only for at least the first visit for the patient or prior to the first visit in the reporting period. If a patient has subsequent visits in the reporting period they will still be counted. Description Measure 2 Percentage of all unique patients seen by the EP during the EHR reporting period (or their authorized representatives) who view, download or transmit to a third party their health information. Denominator Measure 2 Count 1 for every unique patient seen by the EP during the EHR reporting period. The data object is SeenBySharedDenominator. It includes PID,PVID, eventdate (Clinical datetime), SDID, and document summary. Numerator Measure 2 Of the patients in the denominator, count 1 for every patient who has (or whose authorized representative has) viewed online, downloaded, or transmitted to a third party the patient s health information, before, during, or after the reporting period. The data object is ActivityLogEvent. The event IDs are: 511 PatientViewChart, 512 PatientDownloadChart, and 513 PatientTransmitChart. All EPs get credit for this event. Setup, workflows, and best practices Setup To create a quick text entry to add the PATPORTALPIN observation term, go to Setup > Settings > Chart > Quick Text. Workflows Measure 1 Register patients - Add a step to your portal access workflow (for example, quick text) to note a value for PATPORTALPIN in the chart when you grant portal access to a patient. If you use Centricity Patient Portal, you do not need to use PATPORTALPIN. It will use a web service to log entries in the MUActivityLog when a patient registers for the portal. Patients declining patient portal access are eligible for counting in numerator if the patient is provided a method for future access without the need for further intervention by the practice; however, these patients are not counted unless that method is documented in PATPORTALPIN.Per CMS guidance, You must provide information to patients who decline access that will enable those patients to access portal at a later time without further intervention by the practice. CQR will count patients who declined access in the numerator whenever a value is included in the PATPORTALPIN observation. In order for those patients who declined access to be appropriately counted, You should enter into the PATPORTALPIN observation a value that corresponds to the method for providing future access. Examples of such values include: 1 Beginning with this version, the MUActivityLog database table records event details needed for numerator or denominator calculations. Meaningful Use calculation events cannot be disabled. You can choose to enable or disable other user events from Auditing. For Meaningful Use events (for example, encounters that count towards the Seen By denominator) that occurred before the version upgrade, the information may be stored in other tables, but will still be used as part of measure calculations. 91

95 The access PIN - for patients whose later portal activation relies on such a PIN or "Portal access instructions given" - for patients whose later portal activation can be completed without the assistance of the practice by simply following a set of instructions in a handout. The proper activation method, and therefore the proper value to enter into PATPORTALPIN, depends on your portal. Note. For audit purposes, be sure to document your policy for ensuring that patients who declined access now will have access to the portal in the future without further interaction by the practice. Note. CQR calculations are based on the federal CMS guidelines. Individual state regulations are not reflected. Workflows Measure 2 Patients can view, download, and transmit their chart information from a certified Patient Portal. For example, from Centricity Patient Portal, a patient can view his or her chart and send (transmit) a copy via secure messaging. Note. If you use Centricity Patient Portal, the patient must have a Responsible Provider in Registration so that the Event ID will be logged. This is required until the SureScripts version 6.5 release. Note. Certified portals include Centricity Patient Portal (Kryptiq),Patient On Line (GE), Medfusion, and EZAccess. Best practices The following holidays, as well as Saturday and Sunday, are not counted as business days. Holidays that fall on Saturday are counted as the prior Friday. Holidays that fall on Sunday are counted as the following Monday. New Year's Day - January 1st Birthday of Martin Luther King, Jr. - 3rd Monday of January Washington's Birthday - 3rd Monday of February Memorial Day - Final Monday of May Independence Day - July 4th Labor Day - 1st Monday of September Columbus Day - 2nd Monday of October Veterans Day - November 11th Thanksgiving - 4th Thursday of November Christmas Day - December 25th 92

96 Stage 2: 08 Clinical (Visit) Summaries (Core) Requirements Objective Provide clinical summaries for patients for each office visit. Measure Clinical summaries provided to patients or patient-authorized representatives within one business day for more than 50 percent of office visits. Exclusion Any EP who has no office visits during the EHR reporting period. References EHR Incentive Program Specification: EPCore_8_ClinicalSummaries.pdf Calculation Description Percentage of office visits during the reporting period for which clinical visit summaries were provided to the patient or patient-authorized representative within 1 business day. Value sets are used to identify encounters. See the Data Mapping tool. The Office Visit value set contains: Mapping to Document Types that will be considered Office Visit. CPT & SNOMED Codes for Office Visit. Denominator Count 1 for every office visit conducted by the EP during the reporting period. Numerator Of the office visits in the denominator, count 1 for every visit where the patient or a patient-authorized representative was provided a clinical visit summary within 24 hours or where the patient declined a CVS. Note. Currently, weekend days are excluded; CVS must be generated within 24 hours to be counted. Clinical visit summaries may be printed and given to the patient; saved to external file, or sent to the patient electronically in Centricity Clinical Messenger. Setup, workflows, and best practices Setup Migrate immunization data recorded in an earlier release to new data schema Immunizations stored with observation terms will not be included in any CCDA document, including Clinical Visit Summary and Transition of Care documents. Make sure you have migrated your data before beginning to use this feature. Required permissions 93

97 Users must have existing permissions Chart > Export Summary Documents and Chart > Export Unsigned Chart Data to generate and send clinical visit summaries. From Setup > Privileges, in Set Privileges for, do one of the following: Choose Role and select the specific role from the list. Choose User and click to search for and select a user. Select these two privilegesin the Chart folder: Export Summary Documents Export Unsigned Chart Data Workflows A qualifying office visit is based on values from Office Visit value set that includes orders (CPT codes and SNOMED codes) associated with a visit. Printing, saving to file, or saving to a chart and electronically sending a generated Clinical Visit Summary CCDA document is logged and counted. These events are logged in the MUActivityLog 1 which is used for calculating the numerator for the measure. If sending electronically with Centricity Clinical Messenger, make sure the patient is linked to the provider in the patient chart and the patient has a valid associated in the application. Note. For more information about sending CVS electronically using Centricity Clinical Messenger, see Guide to Meaningful Use Stage 2 and other resources on the Kryptiq support site (support.kryptiq.com). The application provides the following new user workflows to support this measure: Generate a standard CCDA format Clinical Visit Summary based on an update or signed document related to an office visit. Customize a Clinical Visit Summary to exclude certain data if deemed appropriate. Include and count CVS Declined (PTDECLINECVS) observation if patient declines a summary. Check CVS Declined in the MU CORE Checklist form. If a patient declines CVS, it is counted in the numerator when a document is signed at a later date, or recorded in an appended document. Send a clinical summary CCDA to patient portal using Centricity Clinical Messenger (Kryptiq), Patient On Line (GE), Medfusion, and EZAccess. Generating Clinical Visit Summary There are several ways to create a Clinical Visit Summary: During an update - In an In Progress document, select Actions > Document > Create Clinical Visit Summary. From within a chart document Actions>Document>- Select a signed document, then right-click Create Clinical Visit Summary. From an encounter form On Patient Instructions - CCC, click Generate CVS. On MU Core Checklist, click Generate CVS. In a custom form, use MEL_GEN_CVS symbol to launch the Clinical visit Summary window from a custom encounter form. 1 Beginning with this version, the MUActivityLog database table records event details needed for numerator or denominator calculations. Meaningful Use calculation events cannot be disabled. You can choose to enable or disable other user events from Auditing. For Meaningful Use events (for example, encounters that count towards the Seen By denominator) that occurred before the version upgrade, the information may be stored in other tables, but will still be used as part of measure calculations. 94

98 Reviewing the Clinical Visit Summary When you create a Clinical Visit Summary, a summary based on the selected document appears in a preview screen in CCDA format. Select links in the Table of Contents to review content in the document. Click Customize to select sections or values to exclude. To save and deliver the visit summary, click: Save to File to store to portable media. Print and give to the patient. Save to Chart and Close to save to the chart and send later via Centricity Clinical Messenger. Note. Save to File and Print actions also save the summary to the chart. Customizing the Clinical Visit Summary You can select sections of the document to exclude. A note appears in that section that the information is unavailable. You can also exclude individual clinical items under Laboratory Results,Problems, Medications, and Procedures. When you save the visit summary, the preview screen refreshes and you can check your changes. Additional customization options are also available when sending electronically with Centricity Clinical Messenger. See Guide to Meaningful Use Stage 2, available in PDF format on the Kryptiq support site. Reprinting/updating the summary If you print the summary and later wish to send an electronic version, you must regenerate it. If there have been no changes, the new summary will be identical. You can also update the summary to reflect recent changes by regenerating it. Clinical items retrieved for the summary are always current and active. Best practices It is standard practice to provide patients with information at the end of their visit, typically a list of their medications and instructions. Generating a Clinical Visit Summary for the patient and providing the CVS in print or electronically within 1 business day meets this measure. Note. Currently, weekend days are excluded; CVS must be generated within 24 hours to be counted. If data to be included in the CVS has not been captured in the visit, generate the CVS within 24 hours to have it counted, but do not send to the patient. Generate another version when data is complete to give to the patient. Appended Office Visit. When appending a visit note, do not change the document type to Office Visit. Leave the document as "Append" document type Append, to avoid inadvertently incrementing the denominator of the measure. If changed to Office Visit, then that will get counted toward the denominator, and a second CVS will be expected. The following holidays, as well as Saturday and Sunday, are not counted as business days. Holidays that fall on Saturday are counted as the prior Friday. Holidays that fall on Sunday are counted as the following Monday. New Year's Day - January 1st Birthday of Martin Luther King, Jr. - 3rd Monday of January Washington's Birthday - 3rd Monday of February Memorial Day - Final Monday of May Independence Day - July 4th Labor Day - 1st Monday of September Columbus Day - 2nd Monday of October Veterans Day - November 11th Thanksgiving - 4th Thursday of November Christmas Day - December 25th 95

99 Stage 2: 09 Protect Electronic Health Information (Core) Requirements Yes/No Attestation Only Objective Protect electronic health information created or maintained by the certified EHR technology through the implementation of appropriate technical capabilities. Measure Conduct or review a security risk analysis in accordance with the requirements under 45 CFR (a)(1), including addressing the encryption/security of data at rest and implement security updates as necessary and correct identified security deficiencies as part of its risk management process. Exclusion None References EHR Incentive Program Specification: Guidance/Legislation/EHRIncentivePrograms/downloads/Stage2_EPCore_9_ProtectElectronicHealthInfo.pdf Setup, workflows, and best practices Setup N/A Workflows N/A Best practices Your organization must implement and maintain an internal security risk analysis or contract with another third party to analyze and maintain the security of your Centricity EMR network, clients and database. For an overview of the required security risk analysis, please see the following CMS document - Security Risk Analysis Tipsheet: Protecting Patients Health Information: Guidance/Legislation/EHRIncentivePrograms/Downloads/SecurityRiskAssessment_FactSheet_ Updated pdf Please refer to the Preparing and Maintaining Centricity Electronic Medical Record Systems guide for configuration information. Please see the following CMS document to learn more about preparing documentation in case of a CMS audit - Supporting Documentation For Audits: Guidance/Legislation/EHRIncentivePrograms/Downloads/EHR_SupportingDocumentation_Audits.pdf 96

100 Stage 2: 10 Clinical Lab Test Results (Core) Requirements Objective Incorporate clinical lab-test results into Certified EHR Technology (CEHRT) as structured data. Measure More than 55 percent of all clinical lab tests results ordered by the EP during the EHR reporting period whose results are either in a positive (pos)/negative (neg) or numerical format are incorporated in certified EHR technology as structured data. Exclusion An EP who orders no lab tests whose results are either in a positive/negative or numeric format during the EHR reporting period. References EHR Incentive Program Specification: EPCore_10_ClinicalLabTestResults.pdf Calculation Description Percentage of documents with document type in the Structured Lab Results (MU) document view with a clinical date during the reporting period, where the Responsible Provider is the EP, and signed during or after the reporting period. Only documents with document types in this view that include structured lab results will count toward the measure. The view includes the Lab Report document type by default. Important: Only lab results entered into the application as observation terms manually or via HL7 interface can be counted for this calculation. The application cannot count lab results not entered as observation terms such as scanned attachments or free text notes. You can add unstructured results to the denominator manually and re-calculate the percentage before attesting. Denominator Count 1 for every lab test ordered during the EHR reporting period by the EP whose results are expressed in a positive or negative affirmation or as a number. linked - The eligible provider is any provider who signs the document that records the lab result whether entered manually or imported via the LinkLogic interface. structured - A document contains structured data if results are stored in the flowsheet with numeric for positive or negative format. Observation terms are filed in the lab folder or its subfolders (visible when adding or updating a flowsheet), including Lab, Chemistry, Coagulation, Hematology, Serology, Toxicology, Urinalysis, Genetics/fertility, Challenge tests, Blood bank, Newborn Screen, Microbiology. unstructured - When lab results are imported through the LinkLogic interface with an invalid cross-reference, they appear in the document with an exclamation mark (!) and are not visible in the flowsheet. In the database, these values are stored in the observation term with OBSHEAD.HDID of -1 (ZZ-GE-unk). results expression - The value of the lab result determines whether or not it can be expressed in a positive or negative affirmation or as a number: Positive or negative expression 97

101 The structured lab result value must equal one of the following case-insensitive strings: Positive, negative, pos, neg, y, n, yes, no, true, false, T, F. Number The observation term value is computable based on standard accounting rules: Can contain numbers Can contain fractions Cannot contain alpha characters Cannot contain any special characters except: A decimal point (.) anywhere in the string, occurring only once Numerator One or more commas (,) adjacent to a character in the string or as the first or last characters A minus sign (-) or dollar sign ($) as the first character in the string A set of parentheses enclosing a string, where an open parenthesis '(' is the first character and a close parenthesis ')' is the last character Count 1 for every lab test result which is expressed in a positive or negative affirmation or as a numeric result which is incorporated in CEHRT as structured data during or after the reporting period. Setup, workflows, and best practices Setup Set up a LinkLogic Lab Results Import relationship to receive lab results data from external labs. You must also configure a cross-reference file to translate laboratory information system (LIS) result codes to application observation terms. You might also need a cross-reference file to map application user IDs to external system user initials. See Managing Interfaces with Centricity Electronic Medical Record. For all workflows, consider creating a custom document type for lab results such as pathology that do not have numeric or positive/negative value. This prevents them from being counted in the denominator. If the EP changes the lab report to a different document type, such as Pathology Report, to indicate that it does not contain structured lab results, it is no longer counted in the denominator. Custom lab document types. Add any custom document types you use for lab reports to Structured Lab Results (MU) view. Workflows LinkLogic Lab Results import - Import and sign lab results to update the patient flowsheet and make them part of the chart. In the LinkLogic LabLink interface, some HL7 clinical document codes are mapped to the Lab Report document type on import. You may also have custom cross-reference files that map document codes to this or other standard document types or to custom document types. Check your implementation and cross-reference files to make certain imported lab results with structured results are mapped to document types in the new Structured Lab Results (MU) view and that documents that do not include structured results, such as Pathology Report, are mapped to a document type that is not included in the view. Scanned file attachments - Use this workflow if you scan paper lab reports and attach files to the chart using File Attachment (from the Desktop) or if you use Centricity Document Management to create and manage remotely stored Lab Report file attachments. These results require manual capture for addition to MU reporting. For any value that is numeric, negative or positive, append and manually add observation values to the flowsheet or enter them in an encounter form designed for that purpose, such as Urinalysis or Lipids. Always use Lab Report document types when you attach or append documents, or change the document type for the appended document from "Append" to "Lab Reports". Preliminary lab results that are replaced with Final structured results are treated as Filed in Error in CQR and not counted in either the numerator or the denominator. 98

102 Stage 2: 11 Generate Patient Lists by Specific Condition (Core) Requirements Yes/No Attestation Only Objective Generate lists of patients by specific conditions 1 to use for quality improvement, reduction of disparities, research, or outreach. Measure Generate at least one report listing patients of the EP with a specific condition. Exclusion None References EHR Incentive Program Specification: EPCore_11_PatientLists.pdf Setup, workflows, and best practices Setup Varies. Workflows In Chart Reports > Inquiries, run an inquiry for patients with a specific condition. 1 Conditions in the patient Problem list. 99

103 Stage 2: 12 Preventive Care (Core) (Patient Reminders) Requirements 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. 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 clinically relevant reminder, per patient preference when available. Exclusion Any EP who has had no office visits in the 24 months before the EHR reporting period. References EHR Incentive Program Specification: EPCore_12_PreventiveCare.pdf Calculation Description Percentage of all unique patients who have had two or more office visits with the EP within the 24 months before the beginning of the EHR reporting period and who were provided a patient reminder per patient preference 1, when available during the reporting period. Denominator Count 1 for every unique patient who has had 2 or more office visits with the EP in the 24 months prior to the beginning of the EHR reporting period. Patient of Provider - Patient is seen by the eligible professional in the last 2 years prior to the start of the reporting period. The 2 years is based on the standard CMS new patient definition. Numerator Of the patients in the denominator, count 1 for every patient who was sent a reminder per patient preference, when available during the EHR reporting period. If a patient was seen twice by a provider within 2 years, the provider will get credit for this measure even if the patient s other provider was the one who sent the letter. Note. All EPs get credit. 1 The method of communication that patients prefer to receive their reminders such as (but not limited to) by mail, by phone or by secure messaging. 100

104 Setup, workflows, and best practices Setup To add or change letters, go to Setup > Settings > System > Letters > Letter Templates. Create a folder to store letter templates directly under the Enterprise folder with the word "actionable" as part of the title. For example, a folder can have a title of "Actionable Reminders". Subfolders can be created under the "actionable" folder. Letters created from templates stored in this folder or sub-folders are automatically counted for Meaningful Use. An actionable reminder is for preventive or follow-up care that prompts the patient to take a new action. For example, a reminder to a patient about her upcoming mammogram is not considered an actionable reminder because the patient has already scheduled the mammogram. However, a reminder to a patient that she is due for a mammogram and need to schedule one, is considered an actionable reminder because the patient must take a new action to schedule the appointment. Workflows Current product supports sending reminders through inquiries and letter templates. Note. You may need to modify the location of existing letters to use for this purpose. Changes do not retroactively apply to past audit events. Send reminders from the Inquiries module Configure and run an inquiry to create a list of patients, and then select Send Reminder in the Activity list to set up and print a reminder letter for each patient. The EP or user (on behalf of the EP) who generates the letter is counted in the numerator. Be aware that CQR will account for the full denominator of the measure, but will ONLY count in the numerator patients sent Letters, whose preferred contact method is "Letter". When attesting, providers can use the list of Unmet patients in the numerator, create reminders according to the patients' preference and provide them to the patients. The providers can then add that number to the numerator manually when attesting. (EPs should keep a separate log or record for audit purposes). 101