CHCANYS NYS HCCN. Meaningful Use Stage ecw Data Capture and Configuration. March 12, Stephanie Rose, HCNNY Desiree Railine, HCNNY

Transcription

1 CHCANYS NYS HCCN Meaningful Use Stage ecw Data Capture and Configuration March 12, 2015 Stephanie Rose, HCNNY Desiree Railine, HCNNY

2 Agenda Meaningful Use Stage 1 Refresher Best practice configuration and workflows for referrals and transitions of care MU Update UDS Update ICD10 Update 2

3 Stage 1 Core Measures 3

4 Meaningful Use Stage 1 Requirements 4

5 CPOE Objective: Computer provider order entry (CPOE) for medications Measure: More than 30% of patients with at least one medication in their medication list must have at least one medication ordered through CPOE 5

6 Order Medication from ecw Progress Notes > Treatment > Add Telephone/Web Encounter > Rx tab > Select Rx Telephone/Web Encounter > Virtual Visit tab > Treatment > Add 6

7 Problem List Objective: Maintain up to date problem list of current and active diagnoses Measure: More than 80% of patients have at least one entry recorded as structured data 7

8 Adding to the Problem List In the Assessments window Clicking the PL box after selecting an assessment will add that diagnosis to the problem list without having to access the problem list window 8

9 Access the Problem List From the Assessments window, click Problem List button Note the Problem List band will have a red exclamation mark and a red arrow will appear next to a problem that has not been assessed in over one year. From the right chart panel, click on the ellipsis button 9

10 Document No Problems If the patient doesn t have any problems, you must check the box labeled No known problems 10

11 eprescribing Objective: Generate and transmit permissible prescriptions electronically Measure: More than 40% are transmitted electronically using certified EHR technology 11

12 eprescribe From the Treatment window or a Telephone Encounter, click on the green arrow next to the Send Rx button Choose eprescribe Rx from the drop down options 12

13 Active Medication List Objective: Maintain active medication list Measure: More than 80% of patients have at least one entry recorded as structured data 13

14 Current Medications Practice Default Mid Office Tab Current Medication: turning this feature on reduces the amount of data entry 14

15 Current Medications When opening the progress note for the visit for the first time, the system will prompt the user and ask if they want to carry forward the current medications 15

16 Adding Current Medications Add the patient s current medications using the Add Medication box Update the medication status Check Verified box. If not taking any medications, check the Verified box 16

17 Current Medications Once the medication verified box is checked, it is automatically noted in the progress note. 17

18 Active Medication Allergy Objective: Maintain active medication allergy list Measure More than 80% of patients have at least one entry recorded as structured data 18

19 Adding Allergies The Browse Rx button must be used when adding a medication allergy. This triggers the drug allergy checking feature in the system. 19

20 Verify Allergies If a patient has no allergies recorded, check the NKDA checkbox Recommend that providers check the box labeled Allergies verified after all allergies have been added/edited 20

21 Measure: Demographics Objective: Record patient demographics (sex, race, ethnicity, date of birth, and preferred language) Measure: More than 50% of patients demographic data is recorded as structured data 21

22 Recorded during registration 22

23 Set Mandatory Fields 23

24 ecw Pre defined Mandatory Fields 24

25 Set Additional Info as Mandatory 25

26 Additional Info as Mandatory Forces the staff to open the Additional Info screen during the registration process 26

27 Measure: Vitals Objective: Record vital signs and chart changes (height, weight, blood pressure, body mass index, and growth charts for children) Measure: More than 50% of patients have height, weight, and patient >3 also have their blood pressure recorded as structured data Option to exclude all 3, BP only or Ht/Wt only if outside scope of practice. 27

28 Remember to configure your vitals! Height Weight Blood Pressure BMI Index BMI Percentile 28

29 Click on the Growth Charts button to access the growth charts 29

30 30

31 Smoking Objective: Record smoking status for patients 13 years of age or older Measure: More than 50% of patients 13 years of age or older have smoking status recorded as structured data 31

32 Smoking Smart Form Tobacco Control via the SF drop down on the patient dashboard Tobacco Use line item in the Social History section of the progress note 32

33 Remember to map your smoking smart form! 33

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35 Patient Portal Feature Settings Enable Personal Health Record, Medical Record: set to Yes from drop down 35

36 Electronic Access New 2014 Objective Provide patients the ability to view online, download and transmit their health information within four business days of the information being available to the EP. 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. 36

37 Measure Numerator Patients that satisfy the denominator are included in this numerator if they are web enabled any time before, during, or within four (4) business days of the appointment from the Patient Information window (Also include declines*) Denominator Patients that have an outpatient appointment created for them during the reporting period

38 Workflow Non Web Enabled Patient Registration Web Enable from the Options Button Appointments Offer to web enable the patient during check in. Change the appointment status to Arrived and the Web Enable Pop Up should appear Web Enable the Patient or Check the box next to and indicate reason with the drop down if they do not want to be web enabled 38

39 Web Enable Patient Registration Registration - Patient Information/Options button/web Enable 39

40 Web Enable Patient Scheduling Change appointment status to arrive enter in pop up web enable box 40

41 Document Decline Reason Scheduling Best practice - Set the field to mandatory 41

42 Patient Access to the Portal Patients can view their patient portal two ways Logging into the patient portal with their username and password from a computer Downloading the HEALOW app for their smart phone from the app store (iphone and Android) 42

43 HEALOW contains all of their important health information, including labs, imaging studies, and procedures, recent vital signs, allergies, medical problems, immunizations, and more 43

44 Visit Summary Objective: For individual professionals, provide patients with clinical summaries for each office visit Measure: Clinical summaries provided to patients for more than 50% of all office visits within 3 business days 44

45 Visit Summary From within the progress note, click on the green arrow on the print button Choose Print Visit Summary option Visit summary is automatically sent to portal for patients that are web enabled. 45

46 Visit Summary From the appointment on the Schedule, right click on the appointment Choose Print Visit Summary option 46

47 Visit Summary Choose the desired categories Click Print Preview Item Key provides default Continuity of Care Record (CCR) that has all MU requirements 47

48 Visit Summary Click within the document to make desired edits prior to printing Click the print icon to print the visit summary 48

49 Drug Drug &Drug Allergy Checking Objective: Implement drug drug and drug allergy interaction checks Measure: Functionality is enabled for these checks for the entire reporting period 49

50 This function is enabled for all users in ecw To edit: File Settings My Settings 50

51 User Settings Tab Pop up Drug Interaction Window when Interaction is: choose the desired setting 51

52 CDSS (Clinical Decision Support System) Objective: Implement one clinical decision support rule and ability to track compliance with the rule Measure: One clinical decision support rule implemented 52

53 Enable CDSS File CDSS Measure Configuration 53

54 Click pink box labeled Disabled to change to Enabled. The box will turn green. Keep screen shots for audit purposes. (Note: This action alone meets Meaningful Use!) 54

55 Satisfying Elements 1. Click on the Question mark, 2. Click on Satisfying Elements. 3. Start typing the name of the test(s) that are not LOINC d that you want included. 4. Check box(es) and click Map 55

56 Risk Assessment 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. Keep a copy of the updated version for audit purposes. 56

57 Stage 1 Menu Measures 2014 Submit 5 out of 9 57

58 Clinical Lab Test Results Objective: More than 40% of all clinical lab tests results ordered by the eligible professional during the EHR reporting period whose results are either in a positive/negative or numerical format must be incorporated in certified EHR technology as structured data. Measure: More than 40% of all clinical lab tests results ordered by the eligible professional during the EHR reporting period whose results are either in a positive/negative or numerical format must be incorporated in certified EHR technology as structured data. 58

59 How to meet this measure 1. In House Labs Manually enter the value in the yellow grid for the attribute(s). The Received box must be checked and the Result Date Entered. 2. External Labs without an Interface Manually enter the value in the yellow grid for the attribute(s). The Received box must be checked and the Result Date Entered. 3. Lab Interface Values populate the yellow grid, checked received and result date should automatically be entered. 59

60 In House/Manually Entered Received box checked and result date field populated Values populate in the grid are structured. 60

61 Lab Attributes From the EMR menu, point to Labs, DI & Procedures and click Labs. The Labs window opens. Highlight the lab and click Attribute Codes at the bottom of the window. The lab window opens Click on the AttrCode Button and the green drop down arrow to select Update and see the lab company number 61

62 Patient Reminders Objective: Send reminders to patients (per patient preference) for preventive and follow up care for patients 65 and older or 5 and younger Measure: More than 20% of all unique patients 65 years or older or 5 years old or younger were sent an appropriate reminder during the EHR reporting period 62

63 ecw Calculation Denominator Are 5 years old or younger OR 65 years old or older; And Patient had at least 2 appointments with the provider; Or have the provider listed as their PCP in demographics Numerator Letter template with the Follow Ups, Health Maintenance, or Preventive Care Category selected; Or emessenger Voice/text message using a template where Health Maintenance has been selected from the Category drop down list; Or emessage from the Patient Portal with the Preventive/Follow up care message box checked 63

64 Patient Reminders Types of reminders that Qualify: Letters Follow up Health Maintenance Preventive Care Health Maintenance voice or text message Preventive or Follow Up care e message Alert reminders from the Patient Portal 64

65 Patient Reminders: Letters From the Registry Band, click on one of the following icons: Patient Recall Lookup Encounters Registry 65

66 Patient Reminders: Letter s cont d Age range: 0 5 or Sex: Both Choose Desired Letter Run Letter 66

67 Patient Reminders: Letter Category Be sure your letters have the appropriate category. To add a category select the letter, Click Update Letter Template and select the category. 67

68 Patient Reminders: Voice or Text The Messenger Template window can be accessed from one of the following locations: Practice Band Office Visits Icon Check box next to patient Messenger button 68

69 Patient Reminders: Voice or Text cont d Practice Band Office Visits Icon green arrow next to Messenger button All patients 69

70 Patient Reminders: Voice or Text cont d Practice Band Resource Schedule Icon right click on appointment Messenger 70

71 Patient Reminders: Voice or Text cont d Patient HUB Messenger Send Voice Message 71

72 Patient Reminders: Messenger Template Highlight the desired message template From the send button, choose Send voice Send SMS/Text 72

73 Patient Reminders: emsg From the Registry icon on the Registry Band, use the filters to the generate your list of patients. Then click the Send emessage button. 73

74 Patient Reminders: Portal Alerts Enable the Alert reminders Admin Patient Portal Settings Feature Settings 74

75 Patient Education Objective: Use certified HER technology to identify patient specific education resources and provide those resources to the patient, if appropriate. Measure: Provide more than 10% of all unique patients seen by the eligible professional patient specific education resources 75

76 Education Credit Print Rx education from the Treatment window Print education via Adam, Krames or Healthwise from Treatment Publish Adam or Healthwise education to the portal from Treatment Order education from the Order Set Print Custom Education from Treatment (ends with Stage 2) Structured Data in Preventive Medicine > Counseling > Patient Education > Patient education material given: > Yes (Must be Boolean and mapped -ends with Stage 2) 76

77 Print RX Education 77

78 Print/Publish Purchased Education 78

79 Print Patient Education: Common Send Check the box to print the education materials from the common send window button before hitting the send button. 79

80 Add Education to an Order Set Add a PDF document to the Order Set under Education. EMR Menu>Order Set Administration Select the order set from the drop down list Click Add next to the PDF Heading under Patient Education Section 80

81 Order Patient Education from an Order Set From the Progress Notes, navigate to the Order Set When the Order Set opens, check the box next to the patient education material and click Order To Print, click on the PDF icon at the bottom in the Patient Education section. When the document appears, click the Print icon and provide to the patient 81

82 Summary of Care for Outgoing Referrals Measure The eligible professional who transitions or refers their patient to another setting of care or provider of care must provide a summary of care record for more than 50% of transitions of care and referrals. 82

83 Numerator/Denominator Numerator The number referrals where a summary of care record (medical summary or Progress Notes) was provided. The referral must be printed, faxed or sent P2P with attachments Denominator The number referrals during the EHR reporting period for which the eligible professional was listed as the Referral From Provider on the ecw Referral. A referral counts if it was printed, faxed or sent via P2P 83

84 Exclusion Providers are excluded from this measure if they transfer patients to another setting or refer patients to another provider less than 100 times during the reporting period. 84

85 Workflow Always attach the clinical summary or the progress note by clicking on the checkbox This can be automated through Practice Default settings if the referral is created from the Progress Note. Referral Clerks and/or providers should be sure they select the Print with Attachment, Fax with Attachment or P2P with Attachment option (otherwise it doesn t count!) 85

86 Attachment Automation File menu>settings>practice Defaults>Front Office tab Check the Attach Medical Summary by Default option on the Front Office Tab You can also automate the Progress Note as well 86

87 Workflow Check to see that the attachment button has a paperclip. If it does not, click ON Attachments button to add medical summary and/or progress note. Check box for medical summary 87

88 Workflow Click on the green arrow next to the Send Referral button. Print with Attachment Fax with Attachment For the P2P option, choose Send Electronically For P2P referrals, attachments must consist of Progress Notes and a CCD/CCR. 88

89 Drug Formulary Check Objective: Implement drug formulary checks Measure: Drug formulary check system is implemented and has access to at least one internal and external drug formulary for the entire reporting period 89

90 Things to Remember.. Controlled by a security setting: RxHub Formulary Data Import Data for formulary checking will be available to the extent that the relevant payers or pharmacy benefit managers (PBMs) are providing complete data to Surescripts. 90

91 To Set Formulary from the Appointment Window: Click on Rx Eligibility button or the Check hyperlink on the right chart panel 91

92 Rx Eligibility Window Click directly on the line of desired insurance. The eligibility information will then appear. 92

93 Set Formulary Setting the formulary will activate the formulary information and will display whenever the Rx window is accessed. 93

94 Set the Formulary from the eprecribing Window 94

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96 After the Formulary is set, the emoticons represent the formulary on the Add Medication window Green = formulary Red = not in formulary? = unknown Not shown: if a drug is not part of the formulary and the payer has an alternative that is covered, that drug name will be listed as a hyperlink above the Selected Rx section of the window. 96

97 Generate a List of Patients Objective: Generate lists of patients by specific conditions to use for quality improvement, reduction of disparities, research or outreach Measure: Generate at least one report listing patients for the eligible professional with a specific condition. Self-attestation measure Keep a copy of the CSV/Excel file and the criteria in your audit file with the provider s name on it 97

98 Workflow Registry band>registry Enter the criteria on the tabs for the report such as age, gender, diagnosis Click Run New (you can also run a subset) 98

99 Immunization Registry Test/Submission Objective: Capability to submit electronic data to immunization registries or Immunization Information Systems and actual submission in accordance with applicable law and practice Measure: Practice must perform at least one test of a certified EHR technology's capacity to submit electronic data to immunization registries and follow up submission if the test is successful except where prohibited in accordance with state law and practice. Eligible professionals are excluded from this measure if they administer no immunizations during the EHR reporting period or where no immunization registry has the capacity to receive the information electronically. 99

100 Workflow Access the Immunizations window using one of the following methods: From the Patient Hub, click Immunizations. From the Progress Notes, click Immunizations in the Patient Dashboard at the top of the window. 100

101 Workflow Generate Immunization Record (test) Generate a new immunization if none exist ensure the CVX Code and Dosage fields are populated. Click Generate Immunization Record Save the file 101

102 Submit to Immunization Registry Test Site Follow the directions from the Immunization Registry website on submitting test files Keep screenshots and confirmations for audit purposes One test per Health Center if Successful then you have to follow up with additional submissions 102

103 Syndromic Surveillance Submit electronic syndromic surveillance data to public health agencies when available, except where prohibited in accordance with state law and practice Threshold: Attestation one test performed 103

104 Stage 1 Syndromic Surveillance Measure Providers must perform 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 except where prohibited in accordance with state law and practice. Exclusions Eligible professionals are excluded from this measure if they do not collect any reportable syndromic information on their patients during the EHR reporting period or do not submit such information to any public health agency that has the capacity to receive the information electronically. 104

105 Stage 1 Syndromic Surveillance Requirements If you have access to a syndromic surveillance registry Submit one test (keep screen shot) Follow up submissions if successful eclinicalworks Setup HL7 files must be submitted to the appropriate Public Health agency. Any Progress Notes that you want to submit must have ICD codes associated with them. All necessary setup is performed by eclinicalworks at this time. 105

106 2014 Clinical Quality Measures 106

107 2014 Clinical Quality Measures Must report on 9 out of 64 measures Recommended Core Quality Measures are encouraged but not required 9 for Adult 9 for Pediatrics Selected CQMs must cover at least 3 of the National Quality Strategy domains 107

108 Core Adult CQM 108

109 Pediatric CQM 109

110 MAQ Dashboard Don t forget Don t forget to configure your MAQ Dashboard for the Meaningful Use Stage AND select the CQMs! 110

111 Best practice configuration and workflows for referrals and transitions of care GROUP DISCUSSION 111

112 Referral Discussion Provider creates referral and sends to Referral Clerk/staff to schedule appointment and follow up on referrals Provider solely responsible Other 112

113 Referral Tracking Close the loop PCMH and MU CQM implications Are you monitoring the R Jelly Bean How are you monitoring the Outstanding referrals Have you added structured data for tracking Are you successful with Close the loop 113

114 CMS 50 Closing the Referral Loop The percentage of patients with referrals for which the referring provider receives a report from the provider from whom the patient was referred. 114

115 CMS 50 Closing the Referral Loop ecw Denominator Medical Office visit with a referral to a specialist Refer To provider must be recorded Referral Status = Consult Pending or Addressed 115

116 CMS 50 Closing the Referral Loop ecw Numerator Referrals marked as Addressed during the reporting period where a consult report was received during the reporting period. Check Received Date box and select date; OR Record in Referral Structured Data as either Clinical Consultation Report Received Report of clinical encounter received Confirmatory consultation report 116

117 One Option for PCMH and MU Track information the practice needs and the structured data for MU. Referral staff can use this to track their progress 117

118 Transition of Care Options Front End checks Transition of Care Checkbox for New patients and specific visit types Clinical Staff Check Transition of Care Checkbox in Chief Complaints if patients indicates they were seen by a specialist, at the hospital or ER recently Other

119 MU Update 119

120 Attestations Due by 3/31/15 Be sure to review all of your eligible providers to determine who you can submit for 2014 Complete prerequisites for new provider Eligibility Volume numbers for Medicaid volume Audit Prepatations 120

121 Stage 1 Audits Providers are starting to receive audit letters for their 90 day Stage 1 attestations. They are looking for substantial amounts of data 121

122 Stage 2 Issues Send Referrals Electronically Patient Portal Access FQHC patients frequently do not have access to a computer or smart phone High levels of distrust of storing data in a patient portal due to other major organizations that have been hacked. Public Health Registries Cancer Registry as an optional vendor certification requirement Lack of Syndromic Registry options Lack of State support for out of state Special Registries 122

123 Upstate Public Health News DOH just informed me on Monday that they are working on a Specialized Registry FAQ that should assist Providers caught in this dilemma. It's currently being approved by the NY Medicaid EHR Incentive Program and they should have a response in the next 3 4 business days. DARTNet specifications have been sent to DOH with a request to approve or provide some assistance for upstate. 123

124 UDS Discussion GROUP DISCUSSION OF 2014 ISSUES AND CONCERNS 124

125 2015 Proposed Changes PAL Patient Characteristics Table 4 Number of dually eligible Medicare and Medicaid patients Quality 6B The number of children age 6 9 at elevated risk for cavities who received a dental sealant on a permanent first molar tooth. (NQF 2508) Quality 7 Only report on Hba1c<8 and HbA1c>9 (NQF and Health People 2020 alignment) ICD10 125

126 ICD 10 CHCANYS TRAINING OPPPORTUNITIES Priority Management Group CHCANYS has partnered with the Priority Management Group (PMG) to offer a discounted ICD 10 training package that includes on demand and live web based training sessions, live discussions, and online tools to support FQHCs through the transition, pre, during, and postimplementation of ICD 10. On February 12, 2015, CHCANYS and PMG hosted a webinar to provide an overview of the ICD 10: Ready, Set, Go! training package. To access the recorded webinar, please contact Ilana Sackler Berner at iberner@chcanys.org or To purchase PMG s ICD 10: Ready, Set, Go! training package, please contact Liliana Heredia at Lheredia@chcanys.org Other Resources For information about additional training opportunities, please contact Ilana Sackler Berner at iberner@chcanys.org or

127 ICD10 ecw Tools ICD9 ICD10 GEMS mapping tool IMO Smart Search Request through ecw On Demand Activation under the Admin Band Provider will select the ICD code within the progress note and IMO will send the selected ICD9 or ICD10 codes V10 has a global effective date with an insurance override that can be configured. Watch for ecw ICD10 webinars and training information on the support portal 127

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129 Additional Resources ecw Support Portal Webinars Manuals CMS and Guidance/Legislation/EHRIncentivePrograms/index.html?re direct=/ehrincentiveprograms/ 129

130 NYS-HCCN Ask the Experts Forum 1. If you do not have an account, the link will take you to the login screen so you can create an account. 2. Choose the options for NYS-HCCN members only 3. You will need to wait for an from the CHCANYS system administrator approving your account before you ll be able to log in for the first time. 4. When you get a confirmation, return to this link to log in. Posting a Question 1. Click on a relevant category, e.g., Meaningful Use Data Capture for eclinical Works 2. Click the New Topic button in the top right, type a question (message body optional) and submit the form. a. The question will appear on the list of questions for your selected category. 130

131 We appreciate your feedback! Please take survey using the link below T9DZ 131

132 About HCNNY HCNNY is a Health Center Controlled Network that provides support to member and non member health centers utilizing eclinicalworks. Please contact Stephanie Rose at srose@hcnny.org if you are interesting in utilizing our training services or obtaining more information about the benefits of becoming a HCNNY member. 132