MEANINGFUL USE TRAINING SCENARIOS GUIDE

Transcription

1 MEANINGFUL USE TRAINING SCENARIOS GUIDE A guide to the most common scenarios in becoming a Meaningful User with eclinicalworks Version 9.0. eclinicalworks, Rev D, April All rights reserved

2 Contents CONTENTS ABOUT THIS GUIDE 10 Product Documentation 10 Finding the Documents 10 Webinars 10 eclinicalworks Newsletter 11 Getting Support 11 Conventions 11 New Features 12 Enhanced Features 13 MEANINGFUL USE TRAINING SCENARIOS 14 Excluding Visit Types from Meaningful Use Calculations 14 Excluding Visit Statuses from Meaningful Use Calculations (a): Using CPOE for All Orders 16 Stage 1 Objective 16 Stage 1 Measure 16 eclinicalworks Calculations 17 Action Recommendations 17 Prescribing a Medication from the Classic Treatment Window 18 Prescribing a Medication from the Manage Prescriptions Window 19 Prescribing a Medication Using eclinisense 21 Prescribing a Medication Using a Template 23 Prescribing a Medication Using an Order Set (b): Generating and Transmitting e-prescriptions 26 Stage 1 Objective 26 Stage 1 Measure 26 eclinicalworks Calculations 26 Action Recommendations 27 Configuring the Synchronization of Faxed and e-prescribed Medications from eclinicalmobile 28 Registering Providers for e-prescribing 29 Selecting a Pharmacy in a Patient s Demographics 30 Generating and Transmitting a New e-prescription from the Progress Notes_ 31 Generating and Transmitting a New e-prescription from a Telephone/Web Encounter 33 Responding to an Electronic Refill Request 35 Transmitting and Faxing e-prescriptions Using eclinicalmobile (j): Calculate and Transmit CMS Quality Measures 40 Stage 1 Objective 40 Stage 1 Measure 40 eclinicalworks Calculations 41 Action Recommendations 42 NQF Adult Weight Screening and Follow-Up 42 Copyright eclinicalworks, LLC 2011, Meaningful Use Training Scenarios Guide 2

3 Contents Calculation Tables 43 Calculation Lists 44 Recording a Patient s Age 48 Indicating the Type of Encounter with a Visit Code 48 Configuring the Vitals Range for BMI 49 Recording BMI for a Patient 50 Recording BMI Management Follow-Up Using ICD/CPT/HCPCS Codes 51 Configuring BMI Management Follow-Up Care Plan Structured Data Items 52 Creating a Local Progress Notes Category while Mapping Structured Data_ 54 Creating a Local Progress Notes Item while Mapping Structured Data 55 Creating Local Structured Data Elements while Mapping Structured Data55 Recording a BMI Management Follow-Up Care Plan Using Structured Data 56 Manually Marking a Patient as Excluded 57 NQF 0028a - Tobacco Use Assessment 59 Calculation Tables 59 Calculation Lists 59 Configuring Tobacco Use Structured Data Items 61 Recording Patients Tobacco Use Using Structured Data 63 NQF 0028b - Tobacco Cessation Intervention 64 Calculation Tables 64 Calculation Lists 65 Configuring Tobacco Use Cessation Intervention Structured Data 67 Recording a Tobacco Use Cessation Intervention Using Structured Data 69 Recording the Prescription of a Smoking Cessation Medication 70 NQF Hypertension: Blood Pressure Measurement 71 Calculation Tables 71 Calculation Lists 72 Recording a Hypertension Diagnosis 73 Recording Patients Systolic and Diastolic Blood Pressure 73 NQF Weight Assessment and Counseling for Children and Adolescents 74 Calculation Tables 74 Calculation Lists 75 Recording a Procedure with a CPT/HCPCS Code 80 NQF Influenza Immunization for Patients 50 Years Old and Older _80 Calculation Tables 80 Calculation Lists 82 Associating a CVX Code with an Immunization 84 NQF Childhood Immunization Status 85 Calculation Tables 85 Calculation Lists 91 Recording an Active Diagnosis with ICD-9 Codes 115 Recording the Administration of an Immunization 116 NQF Diabetes: Hemoglobin HbA1c Poor Control 118 Calculation Tables 118 Calculation Lists 119 Recording the Prescription of a Medication Indicative of Diabetes 121 Recording a Diabetes Diagnosis 122 Copyright eclinicalworks, LLC 2011, Meaningful Use Training Scenarios Guide 3

4 Contents Associating LOINC Codes with Lab Attributes 123 Recording a Test Result as Structured Data 123 NQF Diabetes: LDL Management and Control 124 Calculation Tables 124 Calculation Lists 125 NQF Diabetes: Blood Pressure Management 127 Calculation Tables 127 Calculation Lists (e): Implement One Clinical Decision Support Rule 130 Stage 1 Objective 130 Stage 1 Measure 130 eclinicalworks Calculations 130 Action Recommendations 131 Setting Up Alerts 132 Creating Registry Alerts 134 Enabling CDSS Alerts on Progress Notes 136 Enabling Classic Alerts in the Right Chart Panel 137 Enabling CDSS Alerts in the Right Chart Panel 138 Using Alerts from the Patient Dashboard 138 Viewing Alerts from the Right Chart Panel 141 Using CDSS Alerts from the Progress Notes 141 Fulfilling the Numerator Criteria for a CDSS Alert 144 Fulfilling the Numerator Inclusion Criteria for a CDSS Alert (f): Providing an Electronic Copy of Health Information 149 Stage 1 Objective 149 Stage 1 Measure 149 eclinicalworks Calculations 149 Unique patients are included in the denominator if they clicked one of the following links on the Patient Portal: 149 Patients in the denominator are included in the numerator if their PHR loads successfully after they click one of the links to request it. 149 Action Recommendations 149 Enabling Personal Health Records on the Patient Portal 150 Web-Enabling a Patient 151 Scheduling the Synchronization of Health Information with the Patient Portal 155 Accessing Health Information on the Patient Portal (h): Providing Clinical Summaries 160 Stage 1 Objective 160 Stage 1 Measure 160 eclinicalworks Calculations 160 Patients in the denominator are included in the numerator if: 161 Action Recommendations 161 Enabling Visit Summaries on the Patient Portal 162 Printing a Visit Summary from the Resource Schedule 162 Printing a Visit Summary from the Progress Notes (a): Checking Drug Interactions 165 Stage 1 Objective 165 Stage 1 Measure 165 eclinicalworks Calculations 165 Action Recommendations 165 Copyright eclinicalworks, LLC 2011, Meaningful Use Training Scenarios Guide 4

5 Contents Viewing Drug Interactions from the Treatment Window (c): Recording Demographics 168 Stage 1 Objective 168 Stage 1 Measure 168 eclinicalworks Calculations 168 Action Recommendations 169 Checking Additional Info on the Patient Information Window 169 Configuring Demographic Mandatory Fields 170 Recording Basic Demographic Information 171 Recording Missing Demographic Information During Check-In (c): Maintaining Up-to-Date Problem Lists 175 Stage 1 Objective 175 Stage 1 Measures 175 eclinicalworks Calculations 175 Action Recommendations 175 Marking ICD Codes as Chronic 176 Indicating that a Patient has No Problems 177 Adding a Diagnosis to the Problem List During an Initial Visit 178 Adding a Diagnosis to the Problem List when Documenting an Encounter (d): Maintaining an Active Medications List 181 Stage 1 Objective 181 Stage 1 Measure 181 eclinicalworks Calculations 182 Action Recommendations 182 Documenting a Patient not Taking any Medications 182 Updating Patients Current Medications (e): Maintaining an Active Medication Allergy List 184 Stage 1 Objective 184 Stage 1 Measure 184 eclinicalworks Calculations 185 Action Recommendations 185 Documenting a Patient with No Known Drug Allergies 186 Documenting a Structured Allergy 187 Removing an Allergy from a Patient s Record 188 Viewing Harmful Allergic Interactions (f): Recording Vital Signs 190 Stage 1 Objective 190 Stage 1 Measure 190 eclinicalworks Calculations 191 Action Recommendations 192 Associating Vitals Fields with Vital Types 192 Marking Vitals Fields as Mandatory 193 Recording Vitals on Progress Notes 194 Displaying Growth Charts (g): Recording Smoking Status 197 Stage 1 Objective 197 Stage 1 Measure 197 eclinicalworks Calculations 197 Action Recommendations 198 Creating Smoking Status Structured Data Items 198 Recording Smoking Status Using Structured Data 200 Copyright eclinicalworks, LLC 2011, Meaningful Use Training Scenarios Guide 5

6 Contents (i): Exchanging Clinical Information Electronically Between Providers _ 200 Stage 1 Objective 200 Stage 1 Measure 200 eclinicalworks Calculations 201 Action Recommendations 201 Exporting a Continuity of Care Document 201 Importing a Continuity of Care Document (o)-(w): Complying with HIPAA Privacy and Security Rules 202 Stage 1 Objective 202 Stage 1 Measure 202 eclinicalworks Calculations 202 Action Recommendations 203 Configuring P.S.A.C. Categories 204 Configuring P.S.A.C. Permissions 205 Configuring Security Attributes by User 206 Configuring Security Attributes by Attribute 207 Configuring Security Attributes by Role 209 Enabling Role-Based Security 209 Creating a Role 210 Configuring a Role 211 Assigning Permissions to a Role 212 Configuring Rx Security for a Provider 213 Enabling Rx Security 214 Configuring Rx Security for a Provider 214 Configuring Authentication Settings 216 Configuring a Session Activity Timeout 216 Configuring an Authentication Failure Lockout 217 Configuring the Minimum Password Length 218 Requiring an Alpha-Numeric Password 219 Enforcing Password History 219 Requiring a Password Change 220 Viewing Admin Logs 221 Accessing the Login/Logout Logs 221 Accessing the Staff Demographics Logs 221 Marking a Chart as Confidential 221 Menu Set Objectives (b): Implementing Drug Formulary Checks 223 Stage 1 Objective 223 Stage 1 Measure 223 eclinicalworks Calculations 223 Action Recommendations 223 Checking Rx Eligibility and Setting Formularies from the Appointment Window 224 Checking Formularies from the Treatment Window 225 Viewing Rx Eligibility from Telephone Encounters (h): Incorporating Lab Test Results as Structured Data 229 Stage 1 Objective 229 Stage 1 Measure 229 eclinicalworks Calculations 229 Lab tests are included in the denominator if the Result Date is within the re- Copyright eclinicalworks, LLC 2011, Meaningful Use Training Scenarios Guide 6

7 Contents porting period. 229 Labs that are included in the denominator are also included in the numerator if: 229 Action Recommendations 230 Associating Attribute Codes with Labs 230 Marking Lab Test Results from the Interface as Received 231 Recording Lab Test Results as Structured Data (i): Generating Lists of Patients by Specific Conditions 234 Stage 1 Objective 234 Stage 1 Measure 234 eclinicalworks Calculations 234 Action Recommendations 234 Generating a List of Patients (d): Sending Reminders to Patients for Preventive and Follow-Up Care 236 Stage 1 Objective 236 Stage 1 Measure 236 eclinicalworks Calculations 237 Unique patients are included in the denominator if they: 237 Patients in the denominator are included in the numerator if they are sent one of the following types of reminders: 237 Action Recommendations 237 Creating Letter Templates 238 Configuring emessages on the Patient Portal 239 Configuring Patient Communication Settings 240 Filtering Registry Queries by Reminder Type 241 Creating Letters for Lists of Patients 242 Sending emessages through the Patient Portal 243 Sending Voice Messages with eclinicalmessenger (g): Providing Timely Electronic Access to Health Information 247 Stage 1 Objective 247 Stage 1 Measure 247 eclinicalworks Calculations 247 Patients in the denominator are included in the numerator if they have been web-enabled from the Patient Information window on or before the appointment date, or within four business days (excluding national, but not state, holidays) of the appointment date. 248 Action Recommendations (m): Providing Access to Patient-Specific Education 248 Stage 1 Objective 248 Stage 1 Measure 248 eclinicalworks Calculations 249 Patients in the denominator are included in the numerator if one of the following options is selected from the Treatment section of the Progress Notes: 249 Action Recommendations 249 Adding Patient Education to an Order Set 250 Uploading Patient Education to the Patient Portal 251 Viewing and Printing Patient Education from Order Sets 252 Viewing and Printing Patient Education from the Treatment Window (j): Performing Medication Reconciliation at Relevant Encounters 253 Copyright eclinicalworks, LLC 2011, Meaningful Use Training Scenarios Guide 7

8 Contents Stage 1 Objective 253 Stage 1 Measure 253 eclinicalworks Calculations 254 Patients in the denominator are included in the numerator if the Medication Verified box is checked in the Current Medications section of the Progress Notes. 254 Action Recommendations 254 Marking an Appointment as a Transition of Care Encounter (i): Providing a Summary of Care for Each Transition of Care and Referral 256 Stage 1 Objective 256 Stage 1 Measure 256 eclinicalworks Calculations 257 Referrals are included in the denominator if one of the following actions is performed on them during the reporting period: 257 Referrals in the denominator are included in the numerator if one of the following actions is performed on them during the reporting period: 257 Action Recommendations 257 Automatically Attaching Medical Summaries to Outgoing Referrals 258 Creating an Outgoing Referral with a Medical Summary (k): Submitting Electronic Data to Immunization Registries 261 Stage 1 Objective 261 Stage 1 Measure 261 eclinicalworks Calculations 261 Action Recommendations 261 Exporting Immunizations to State Registries (l): Submitting Electronic Syndromic Surveillance 263 Stage 1 Objective 263 Stage 1 Measure 263 eclinicalworks Calculations 263 Action Recommendations 263 System Administration Menu Set Objectives 268 Front Office 268 Setup Menu Set Objectives 268 Operation Menu Set Objectives 269 Mid Office 269 Setup Menu Set Objectives 269 Operation Menu Set Objectives 271 Patients Copyright eclinicalworks, LLC 2011, Meaningful Use Training Scenarios Guide 8

9 Contents Trademarks 272 Copyright 272 GLOSSARY 273 Copyright eclinicalworks, LLC 2011, Meaningful Use Training Scenarios Guide 9

10 ABOUT THIS GUIDE This document provides information related to Meaningful Use and how it is accomplished using the eclinicalworks unified EHR solution. Product Documentation The following documentation supports eclinicalworks Electronic Medical Record (EMR), Practice Management (PM), and/or additional software features: System Administration Users Guide Release Notes Front Office Users Guide Patient Portal Users Guide Electronic Medical Records Users eclinicalmessenger Users Guide Guide Billing Users Guide eclinicalmobile Users Guide P2P Users Guide ebo Metadata and Query Studio Users Guide ebo Canned Reports Users Guide ebo Canned Reports Users Guide Finding the Documents eclinicalworks Documentation is available from the my.eclinicalworks Customer Portal: Webinars For more information, take advantage of the free unlimited eclinicalworks webinars interactive seminars conducted online. These courses are presented by product trainers who are experts with eclinicalworks and all of its capabilities. To sign up for an eclinicalworks webinar go to: Copyright eclinicalworks, LLC 2011, Meaningful Use Training Scenarios Guide 10

11 About This Guide Getting Support eclinicalworks Newsletter To receive important, timely, and informative product notifications, subscribe to the eclinicalworks Newsletter ing list. To subscribe to the newsletter: Available on the my.eclinicalworks Customer Portal: Available on the eclinicalworks website: Click the direct link: eclinicalworks Newsletter Getting Support Send messages directly to eclinicalworks Support through the eclinicalworks Support Portal: You may also call or eclinicalworks Support: Phone: (508) Conventions This section list typographical conventions and describes the icons used to call out additional information and to indicate item keys, new features, and enhancements to the application. The following typographical conventions are used in this guide: Bold Italic Monospace Identifies options, keywords, and items in a description. Indicates variables, new terms and concepts, foreign words, or emphasis. Identifies examples of specific data values, and messages from the system, or information that you should actually type. Copyright eclinicalworks, LLC 2011, Meaningful Use Training Scenarios Guide 11

12 About This Guide New Features New Features The following features have been added to this documentation since the last revision: Excluding Visit Types from Meaningful Use Calculations on page 14 Excluding Visit Statuses from Meaningful Use Calculations on page 15 Transmitting and Faxing e-prescriptions Using eclinicalmobile on page 37 Creating Registry Alerts on page 134 Enabling Personal Health Records on the Patient Portal on page 150 Enabling Visit Summaries on the Patient Portal on page 162 Checking Additional Info on the Patient Information Window on page 169 Automatically Attaching Medical Summaries to Outgoing Referrals on page 258 Copyright eclinicalworks, LLC 2011, Meaningful Use Training Scenarios Guide 12

13 About This Guide Enhanced Features Enhanced Features The following features have been updated since the last publication of this document: All measures now include an eclinicalworks Calculations section All Clinical Quality Measures have been reformatted to enhance understanding (a): Using CPOE for All Orders on page (b): Generating and Transmitting e-prescriptions on page (j): Calculate and Transmit CMS Quality Measures on page 40 Recording a Tobacco Use Cessation Intervention Using Structured Data on page 69 Recording the Administration of an Immunization on page (e): Implement One Clinical Decision Support Rule on page (f): Providing an Electronic Copy of Health Information on page 149 Accessing Health Information on the Patient Portal on page (h): Providing Clinical Summaries on page (a): Checking Drug Interactions on page 165 Documenting a Patient with No Known Drug Allergies on page (c): Recording Demographics on page (i): Exchanging Clinical Information Electronically Between Providers on page 200 Importing a Continuity of Care Document on page (o)-(w): Complying with HIPAA Privacy and Security Rules on page (b): Implementing Drug Formulary Checks on page (h): Incorporating Lab Test Results as Structured Data on page (d): Sending Reminders to Patients for Preventive and Follow-Up Care on page 236 Creating Letter Templates on page (g): Providing Timely Electronic Access to Health Information on page (m): Providing Access to Patient-Specific Education on page 248 Adding Patient Education to an Order Set on page 250 Viewing and Printing Patient Education from Order Sets on page (j): Performing Medication Reconciliation at Relevant Encounters on page (i): Providing a Summary of Care for Each Transition of Care and Referral on page 256 Creating an Outgoing Referral with a Medical Summary on page (l): Submitting Electronic Syndromic Surveillance on page 263 Appendix F:Processes by Role on page 267 Copyright eclinicalworks, LLC 2011, Meaningful Use Training Scenarios Guide 13

14 MEANINGFUL USE TRAINING SCENARIOS This guide contains scenario-based examples of the workflow needed to become compliant for Meaningful Use measures. Some of the most common scenarios are outlined here, although the methods used may not always be the only way to complete a given task. Note: Users must have a version of eclinicalworks that has been certified for Meaningful Use in order to perform all tasks outlined in this document. It is recommended that all clients upgrade to eclinicalworks Version 9.0 The Final Rule Meaningful Use objectives are split into two groups: - These 15 objectives must all be satisfied in order to fulfill the Meaningful Use requirements. Menu Set Objectives - Providers can select 5 out of these 10 objectives that they wish to satisfy to fulfill the Meaningful Use requirements. At least one of the selected objectives must be in the Public Health category. Note: The objectives and measures listed here are for the 2011 Final Rule (Stage 1). These objectives and measures are subject to change in Stage 2 (2013) and again in Stage 3 (2015). Excluding Visit Types from Meaningful Use Calculations Scenario: You are creating a new Visit Type. You want to ensure that no encounters with this Visit Type are included in the calculations for Meaningful Use. Workflow: 1. From the Admin band in the left navigation pane, click the Admin icon. The Admin login window opens. 2. Enter your administrator password and click the Login button. The Admin window opens. 3. Click the User Admin folder in the left pane. The items in the User Admin folder display in the left pane. 4. Click the Visit Type Codes link in the left pane. The Visit Type Codes options display in the right pane. 5. Click the Add button. The Visit Codes options display in the right pane. 6. Check the Exclude from Meaningful Use Reporting box: Copyright eclinicalworks, LLC 2011, Meaningful Use Training Scenarios Guide 14

15 7. Enter any remaining information here as appropriate. 8. Click the Save button. This new Visit Type is created. Any encounter using this Visit Type is not included in the calculations for any Meaningful Use measure. Excluding Visit Statuses from Meaningful Use Calculations Scenario: You are creating a new Visit Status. You want to ensure that no encounters with this Visit Status are included in the calculations for Meaningful Use. Workflow: 1. From the Admin band in the left navigation pane, click the Admin icon. The Admin login window opens. 2. Enter your administrator password and click the Login button. The Admin window opens. 3. Click the User Admin folder in the left pane. The items in the User Admin folder display in the left pane. 4. Click the Visit Status Codes link in the left pane. Copyright eclinicalworks, LLC 2011, Meaningful Use Training Scenarios Guide 15

16 The Visit Status Codes options display in the right pane. 5. Click the Add button. The Visit Codes options display in the right pane. 6. Check the Exclude from Meaningful Use Reporting box: 7. Enter the rest of the information here as appropriate. 8. Click the Save button. This new Visit Status is created. Any encounter using this Visit Status is not included in the calculations for any Meaningful Use measure. All 15 of these objectives must be satisfied in order to fulfill the Meaningful Use requirements (a): Using CPOE for All Orders Stage 1 Objective Practices must use CPOE (Computerized Provider Order Entry) for medication orders directly entered by any licensed healthcare professional. Note: CPOE involves all methods of recording medications in a structured manner. This includes any use of Order Sets, Templates, e-prescription, eclinisense, and any other methods of manually ordering medications on the Treatment window of Progress Notes. Stage 1 Measure More than 30% of unique patients with at least one medication in their medication list seen by the eligible professional must have at least one medication order entered using CPOE. Denominator Patients in the reporting period where Medication Summary list is not null. Numerator Patients in the denominator where the Treatment section of the Progress Notes is not null. Copyright eclinicalworks, LLC 2011, Meaningful Use Training Scenarios Guide 16

17 Exclusions Eligible professionals are excluded from this measure if they write fewer than 100 prescriptions during the EHR reporting period. eclinicalworks Calculations Denominator Unique patients are included in the denominator if: An appointment has been created for them during the reporting period from the Resource Scheduling, Provider Schedule, or Office Visits window AND NOT A visit type or visit code with the exclusion flag enabled has been selected for this appointment Note: Virtual visits in telephone encounters are not counted as appointments. Patients with only Telephone Encounters are not included in the denominator for this measure. Numerator Patients that satisfy the denominator for this measure are included in the numerator if a medication has been recorded in the Treatment section of the Progress Notes. Exclusion Providers are excluded from satisfying this measure if they have recorded less than 100 medications in the Treatment section of the Progress Notes during the reporting period. Action Recommendations Policy Recommendations: Mid Office - Providers must use the eclinicalworks application for all prescription orders. Setup Recommendations: Mid Office - Ensure that all current medications are up to date. For more information, refer to (d): Maintaining an Active Medications List on page 181. Workflow Recommendations Mid Office - Perform one of the following actions to prescribe a medication in a structured manner: To prescribe a medication from the Treatment window using the Classic View, refer to the section titled Prescribing a Medication from the Classic Treatment Window on page 18. To prescribe a medication from the Treatment window using the Modern View, refer to the section titled Prescribing a Medication from the Manage Prescriptions Window on page 19. To prescribe a medication using eclinisense, refer to the section titled Prescribing a Medication Using eclinisense on page 21. To prescribe a medication electronically, refer to (b): Generating and Transmitting e-prescriptions on page 26. Copyright eclinicalworks, LLC 2011, Meaningful Use Training Scenarios Guide 17

18 To prescribe a medication using a template, refer to the section titled Prescribing a Medication Using a Template on page 23. To prescribe a medication using an Order Set, refer to the section titled Prescribing a Medication Using an Order Set on page 25. Additional Tips Additional setup and configuration may be necessary to use e-prescription with eclinicalworks. For more information on this, as well as on how to view the status of an e- prescription and determine the reason(s) for any transmission failures, refer to the Informed Prescribing Users Guide, which can be found at Prescribing a Medication from the Classic Treatment Window Scenario: Amy Smith needs a prescription for Tylenol. You must now order this medication from the classic Treatment window. Workflow: 1. From Amy s Progress Notes, click the Treatment link. The Treatment window opens. 2. Click the Add button in the Rx section: Copyright eclinicalworks, LLC 2011, Meaningful Use Training Scenarios Guide 18

19 Note: Medications can also be selected from Amy s current prescriptions by clicking the Cur Rx button, or from her prescription history by clicking the green arrow next to the Cur Rx button and selecting the Rx History option. The Select Rx window opens: 3. Enter Tylenol in the Find field. Results matching the text you enter display in the left pane in real time (as long as the Real Time Search box is checked). Note: To search within a user-defined subset of medications, selected a subset from the Type drop-down list. 4. Click the Tylenol option in the drop-down list. All available formulations of Tylenol are displayed in the top-right pane. 5. Click the appropriate formulation in the top-right pane. This medication is added to the Selected Rx pane at the bottom of the window. 6. Click the OK button. The Select Rx window closes and this medication is now ordered. For more information on all other options available on the classic Treatment window, refer to the Electronic Medical Records Users Guide, which can be found at my.eclinicalworks.com. Prescribing a Medication from the Manage Prescriptions Window Scenario: Amy Smith needs a prescription for Tylenol. You must now order this medication from the Manage Prescriptions window. Workflow: 1. From Amy s Progress Notes, click the Treatment link. The Treatment window opens. 2. Click the Add button in the Rx section: Copyright eclinicalworks, LLC 2011, Meaningful Use Training Scenarios Guide 19

20 The Manage Prescriptions window opens with the Add New Rx tab selected by default: 3. Enter Tylenol in the Find field. Results matching the text you enter display in a drop-down list in real time. Copyright eclinicalworks, LLC 2011, Meaningful Use Training Scenarios Guide 20

21 Note: To search within a user-defined subset of medications, selected a subset from the Type drop-down list. 4. Click the Tylenol option in the drop-down list. All available formulations of Tylenol are displayed in the top-right pane. 5. Click the appropriate formulation in the top-right pane. This medication is added under the selected assessment in the Selected Rx pane at the bottom of the window. 6. Click the OK button. The Manage Prescriptions window closes and the selected medication is populated on the Treatment window. 7. Click the Send Rx button at the bottom of the window and follow all prompts as necessary. This medication is now ordered and transmitted. For more information on all other options available on the Manage Prescriptions window, refer to the Electronic Medical Records Users Guide, which can be found at my.eclinicalworks.com. Prescribing a Medication Using eclinisense Scenario: Amy Smith needs a prescription for Tylenol. You must now order this medication using eclinisense. Note: In order to utilize eclinisense, an appropriate assessment must first be selected for this encounter. Workflow: 1. From any window in Amy s Progress Notes, click the eclinisense icon. Click the eclinisense button on the Treatment window: Copyright eclinicalworks, LLC 2011, Meaningful Use Training Scenarios Guide 21

22 The eclinisense window opens. 2. Select the assessment for which you want to prescribe Tylenol from the Assessment drop-down list. All possible orders recommended by eclinisense are displayed. Copyright eclinicalworks, LLC 2011, Meaningful Use Training Scenarios Guide 22

23 3. Check the box next to the appropriate Tylenol option. 4. Click the Apply button. Tylenol is now ordered for Amy Smith. For more information on all other options available on the eclinisense window, refer to the Electronic Medical Records Users Guide, which can be found at my.eclinicalworks.com. Prescribing a Medication Using a Template Scenario: Amy Smith has arthritis, and needs a prescription for Tylenol. You must now apply a template for arthritis to her encounter, which contains a prescription for Tylenol. Workflow: 1. From Amy Smith s Progress Notes, click the Templates button at the bottom of the window. The Copy And Merge Templates window opens: Copyright eclinicalworks, LLC 2011, Meaningful Use Training Scenarios Guide 23

24 2. Select the appropriate arthritis template in the bottom pane. Note: Ensure that the Treatment box is checked in the right pane, otherwise any prescriptions on this template will not be ordered when the template is applied. 3. Click the Merge Template button. This encounter is now overwritten with the information on this template, including an order for Tylenol. Note: To copy the information from this template without overwriting any existing information entered for this encounter, click the green arrow next to the Merge Template button to open a drop-down list and then click the Copy Template option. Copyright eclinicalworks, LLC 2011, Meaningful Use Training Scenarios Guide 24

25 Prescribing a Medication Using an Order Set Scenario: Amy Smith needs a prescription for Tylenol. You must now order this medication using an Order Set. Workflow: 1. From any window on Amy s Progress Notes, click the Order Sets icon: The Order Sets window opens. 2. Select the Order Set containing Tylenol from the Order Set drop-down list. 3. Click the tab above the Rx section for the appropriate assessment. 4. Check the box next to the Tylenol medication in the Rx section. 5. Click the Order button: Tylenol is now ordered for Amy Smith. Copyright eclinicalworks, LLC 2011, Meaningful Use Training Scenarios Guide 25

26 (b): Generating and Transmitting e- Prescriptions Note: Eligible professionals can participate in the 2011 PQRS Program, the 2011 erx Incentive Program, and the EHR Incentive Program at the same time, and may be eligible to receive incentives for multiple programs. For more information, refer to the following link: answers/detail/a_id/10474/kw/erx%20incentive%20program/session/ L3NpZC9felFwZUNvaw%3D%3D Stage 1 Objective Providers must be able to generate and transmit permissible prescriptions electronically to pharmacies. Stage 1 Measure More than 40% of all permissible prescriptions written by the eligible professional must be transmitted electronically. Note: The determination of whether a prescription is a permissible prescription for purposes of Meaningful Use should be made based on the guidelines for prescribing Schedule II controlled substances in effect when the notice of proposed rulemaking was published on January 13, eclinicalworks defines a prescription as the authorization by an EP to a pharmacist to dispense a drug that the pharmacist would not dispense to the patient without such authorization. Denominator The number of prescriptions written for medications requiring a prescription in order to be dispensed (other than controlled substances) during the EHR reporting period. Numerator The number of prescriptions in the denominator generated and transmitted electronically. Exclusions Eligible professionals are excluded from this measure if they prescribe fewer than 100 prescriptions during the EHR reporting period. eclinicalworks Calculations Denominator Medications are included in the denominator if one of the following actions is taken on them: Printed Faxed Transmitted electronically Copyright eclinicalworks, LLC 2011, Meaningful Use Training Scenarios Guide 26

27 Note: The following medications are excluded from being included in the denominator: Duplicate medications (re-printed, re-faxed, re-transmitted, or printed and also transmitted) Non-permissible (controlled) medications Numerator Medications that satisfy the denominator are included in the numerator if they have been transmitted using e-prescription. Note: The following medications are excluded from being included in the numerator: Duplicate medications (re-printed, re-faxed, re-transmitted, or printed and also transmitted) Non-permissible (controlled) medications Exclusion Providers are excluded from satisfying this measure if they have recorded less than 100 medications on the Treatment window in the Progress Notes. Action Recommendations Policy Recommendations: Mid Office - Whenever possible, providers must generate and transmit prescriptions electronically, rather than on paper. IMPTANT! Generating and transmitting a fax electronically does NOT constitute an electronic prescription. The e-prescription module within eclinicalworks must be used to satisfy this measure. eclinicalworks Setup Recommendations System Administration - If using eclinicalmobile, ensure that the synchronization of faxed and e-prescribed medications from eclinicalmobile has been configured. For more information, refer to the section titled Configuring the Synchronization of Faxed and e- Prescribed Medications from eclinicalmobile on page 28. System Administration - If using eclinicalmobile, ensure that the synchronization of faxed and e-prescribed medications from eclinicalmobile has been configured. For more information, refer to the section titled Configuring the Synchronization of Faxed and e- Prescribed Medications from eclinicalmobile on page 28. System Administration - Providers must be registered for e-prescription before they can prescribe medications electronically. For more information, refer to the section titled Registering Providers for e-prescribing on page 29. Front Office - All patients full address, primary care provider (or primary care giver), and pharmacy information must be recorded on the Patient Information window in order to enable providers to generate and transmit e-prescriptions quickly and efficiently. For more information on recording pharmacy information, refer to the section titled Selecting a Pharmacy in a Patient s Demographics on page 30. Copyright eclinicalworks, LLC 2011, Meaningful Use Training Scenarios Guide 27

28 Workflow Recommendations Mid Office - Follow the steps in one or more of the following sections as needed: To generate and transmit a new prescription from the Progress Notes, refer to the section titled Generating and Transmitting a New e-prescription from the Progress Notes on page 31. To generate and transmit a new prescription from a Telephone/Web Encounter, refer to the section titled Generating and Transmitting a New e-prescription from a Telephone/Web Encounter on page 33. To respond to an electronic refill request, refer to the section titled Responding to an Electronic Refill Request on page 35. To prescribe a medication using eclinicalmobile, refer to the section titled Transmitting and Faxing e-prescriptions Using eclinicalmobile on page 37. For more information on eclinicalmobile, refer to the eclinicalmobile Users Guide, which can be found at Additional Tips Additional setup and configuration may be necessary to use e-prescription with eclinicalworks. For more information on this, as well as on how to view the status of an e- prescription and determine the reason(s) for any transmission failures, refer to the Informed Prescribing Users Guide, which can be found at Configuring the Synchronization of Faxed and e- Prescribed Medications from eclinicalmobile Scenario: Faxed and e-prescribed medication synchronization has not yet been configured for eclinicalmobile. You must now configure this synchronization so that medications faxed and e-prescribed from eclinicalmobile are sent to pharmacies. Workflow: 1. From the Admin band in the left navigation pane, click the eclinicalmobile Portal Settings icon. The eclinicalmobile Portal Settings window opens. 2. Under the Synchronize heading in the left pane, click the Run link. The right pane refreshes with the eclinicalmobile Portal Tasks Schedule. 3. Check the box next to the Download Faxed prescriptions and eprescriptions from eclinicalmobile task: Copyright eclinicalworks, LLC 2011, Meaningful Use Training Scenarios Guide 28

29 4. Enter the number of minutes between each automatic synchronization in the Minutes field. Note: It is recommended that this tasks is scheduled to run every three (3) minutes. 5. Click the Schedule button. This task is now run automatically at its assigned interval. Note: Click the Refresh button to refresh and view the current Status of any tasks that have been run. Registering Providers for e-prescribing Scenario: Dr. Sam Willis has not yet been registered for e-prescription. You must now register him so that he can prescribe medications electronically for his patients. Workflow: 1. From the Tools menu, hover over the eprescription option to open a drop-down list. 2. From the drop-down list, click the Register Prescriber option. The Register eprescriber window opens with the Surescript - Retail radio button selected by default: Copyright eclinicalworks, LLC 2011, Meaningful Use Training Scenarios Guide 29

30 3. To register Dr. Willis for retail pharmacies, check one of the following boxes to the left of his name: R - Register Dr. Willis automatically. Surescripts generates an SPI number. MR - Register Dr. Willis manually. The SPI No field becomes editable and you must enter this provider s SPI number here (13 characters, all numbers, obtained from eclinicalworks Support). 4. Click the Apply button. Dr. Sam Willis is now registered to e-prescribe for retail pharmacies. 5. To register Dr. Willis for mail-order pharmacies, click the Surescripts - Mailorder radio button at the top of the window and then check one of the following boxes to the left of his name: R - Register Dr. Willis automatically. Surescripts generates an SPI number. MR - Register Dr. Willis manually. The SPI No field becomes editable and you must enter this provider s SPI number here (13 characters, all numberals, obtained from eclinicalworks Support). 6. Click the Apply button. Dr. Sam Willis is now registered to e-prescribe for mail-order pharmacies. Selecting a Pharmacy in a Patient s Demographics Scenario: Charles Smith does not have a pharmacy enabled for e-prescription selected in his demographics. You must now select a pharmacy for him that has been enabled for e- prescription. Copyright eclinicalworks, LLC 2011, Meaningful Use Training Scenarios Guide 30

31 Workflow: 1. From Charles Smith s Patient Information window, click the Additional Info button. The Patient Information - Additional Info window opens. 2. In the Pharmacies section at the bottom of the window, click the Add button. The Pharmacies window opens: 3. Highlight a pharmacy and click the OK button. Note: Not all pharmacies are set up to receive e-prescriptions. Pharmacies that are enabled for e-prescription are indicated by a black and red E icon in the E column. The Pharmacies window closes and the selected pharmacy is now added to Charles Smith s patient information. Generating and Transmitting a New e-prescription from the Progress Notes Scenario: Jill Smith is complaining of chronic headaches. You have decided to order prescriptionstrength Tylenol for this problem. You must now generate an electronic prescription for Tylenol and transmit it to her pharmacy. Workflow: 1. From the Treatment window in the Progress Notes, add the appropriate formulation of a prescription for Tylenol. 2. Click the arrow next to the Send Rx button at the bottom of the window to open a dropdown list. 3. Click the eprescribe Rx option. The eprescribe Rx window opens: Copyright eclinicalworks, LLC 2011, Meaningful Use Training Scenarios Guide 31

32 IMPTANT! Directions to the pharmacist can be entered into the Comments field. However, do not send any part of the prescription itself (SIG) in the Comments field, as this field is now displayed in all pharmacy computer applications. Note: If a patient does not have a pharmacy selected in their demographics, one can be selected here by clicking the More (...) button next to the Pharmacy Name field. This button can also be used to change the pharmacy for this transmission. Note: If the provider generating this e-prescription is being supervised, select the supervisor from the Supervising Provider drop-down list. 4. Since a generic substitute is acceptable in this situation, leave the Substitute Allowed box checked. Note: When transmitting multiple e-prescriptions at once, specific medications can be excluded from the transmission by unchecking the left-most box in their row. Note: To view a preview of this e-prescription, click the Show Preview Rx button. 5. Click the Send eprescription button. Copyright eclinicalworks, LLC 2011, Meaningful Use Training Scenarios Guide 32

33 IMPTANT! The pharmacy you send this prescription to MUST participate in e- prescription. Not all pharmacies are set up to receive and process e-prescriptions. The red and black E icon next to the pharmacy name indicates that they are enabled for e-prescription. A confirmation window displays to notify you that the e-prescription has been transmitted successfully. For more information on all available e-prescription options, refer to the Informed Prescribing Users Guide, which can be found at Generating and Transmitting a New e-prescription from a Telephone/Web Encounter Scenario: Jill Smith is complaining of chronic headaches. You have decided to order prescriptionstrength Tylenol for this problem. You must now generate an electronic prescription for Tylenol and transmit it to her pharmacy. Workflow: 1. From Jill Smith s Telephone/Web Encounter, click the Rx tab. The Rx options display. 2. Add the appropriate formulation of Tylenol. 3. Click the arrow next to the Send Rx button at the bottom of the window to open a dropdown list. 4. Click the eprescription Rx option. The eprescribe Rx window opens: Copyright eclinicalworks, LLC 2011, Meaningful Use Training Scenarios Guide 33

34 IMPTANT! Directions to the pharmacist can be entered into the Comments field. However, do not send any part of the prescription itself (SIG) in the Comments field, as this field is now displayed in all pharmacy computer applications. Note: If a patient does not have a pharmacy selected in their demographics, one can be selected here by clicking the More (...) button next to the Pharmacy Name field. This button can also be used to change the pharmacy for this transmission. Note: If the provider generating this e-prescription is being supervised, select the supervisor from the Supervising Provider drop-down list. 5. Since a generic substitute is acceptable in this situation, leave the Substitute Allowed box checked. Note: When transmitting multiple e-prescriptions at once, specific medications can be excluded from the transmission by unchecking the left-most box in their row. To view a preview of this e-prescription, click the Show Preview Rx button. 6. Click the Send eprescription button. Copyright eclinicalworks, LLC 2011, Meaningful Use Training Scenarios Guide 34

35 IMPTANT! The pharmacy you send this prescription to MUST participate in e- prescription. Not all pharmacies are set up to receive and process e-prescriptions. The red and black E icon next to the pharmacy name indicates that they are enabled for e-prescription. A confirmation window displays to notify you that the e-prescription has been transmitted successfully. For more information on all available e-prescription options, refer to the Informed Prescribing Users Guide, which can be found at Responding to an Electronic Refill Request Scenario: An electronic refill request for Fred Jockey s Zoloft prescription has been sent to you. You must now approve this refill request and transmit the prescription electronically. Workflow: 1. Click the E Quick-Launch button. The eprescriptions window opens. 2. Double-click on a refill request. The eprescribe Rx window opens: 3. Click one of the following radio buttons in the Response section: Copyright eclinicalworks, LLC 2011, Meaningful Use Training Scenarios Guide 35

36 Approved - Approve this refill request without any changes. Approved with Changes - Approve this refill request with changes. Denied - Deny this refill request. Denied New Rx to Follow - Indicate that the request is denied and that a new drug will be prescribed in its place. 4. If you approved the refill request without changes, provide details for the refill in the Refill Details pane: a. Click the number buttons to specify the number of refills allowed or enter the number in the field. b. Click the C button to clear the field. c. Check the PRN Refills check box to approve refills as needed. d. Enter notes in free text to accompany the response in the Notes field. 5. If you approved this refill request with changes, select a new medication using one of the following methods: Click the Select Rx button in the Best Matched Prescription section to select a new medication from the database. Click the Cur Rx button in the Best Matched Prescription section to select a new medication from this patient s current medications. Click the green arrow next to the Cur Rx button in the Best Matched Prescription section to open a drop-down list, and then select the Rx History option from the drop-down list to select a new medication from this patient s prescription history. 6. If you denied the request, provide details: a. Select a reason from the drop-down list in the Denied Reason pane. b. Enter notes to accompany the denial in the Notes field. 7. The Best Matched Prescription pane displays the details of the drug in the local database that is the best match for the drug that was originally prescribed. Note: The Best Matched Prescription message provides the most complete information possible to the provider and helps to document the refilled prescription details in the patient record. One factor that makes medication matching particularly challenging is the variability of the data received from the pharmacy, in particular data arriving in character strings rather than populated to discrete fields. For example: Drug Name = Zoloft 50mg tabs rather than Drug Name = Zoloft; Strength = 50 milligrams; Formulation = tablet. If a drug match cannot be found in the local database, this information appears in red and you must select the best match: Click Select Rx to select the best match from the local database. Click Cur Rx to view the patient's current prescriptions and select the best match from that list. 8. Click Send eprescription. The e-prescription is sent to the pharmacy. For more information on all available e-prescription options, refer to the Informed Prescribing Users Guide, which can be found at Copyright eclinicalworks, LLC 2011, Meaningful Use Training Scenarios Guide 36

37 Transmitting and Faxing e-prescriptions Using eclinicalmobile Scenario: Amy Smith needs a prescription for Tylenol. You must now order this medication using eclinisense. Workflow: 1. From the eclinicalmobile Home Page, click the Search Patients icon. The Search Patients page displays. 2. Select the Female option from the Gender drop-down list. 3. Enter Smith in the Last Name field and Amy in the First Name field and click the Search button. All patients named Amy Smith are displayed. 4. To access Amy s Patient Hub: iphone - Click anywhere in the appropriate Amy Smith s row. Smartphone - Click the blue last name link for the appropriate Amy Smith. Amy s Patient Hub displays. 5. Click the eprescription icon or link. The Prescription page displays: iphone: Smartphones: 6. To select the pharmacy to which you want to transmit or fax this prescription on the iphone: a. Click the Pharmacy heading. Copyright eclinicalworks, LLC 2011, Meaningful Use Training Scenarios Guide 37

38 The Pharmacy options display: b. To clear the text in the Pharmacy field, click the Clear button. c. Begin entering text into the Pharmacy field. As text is entered, the pharmacies that match the text pop-up below the Pharmacy field in real time. d. Click a pharmacy from the pop-up window. The address, phone number, and fax number for the selected pharmacy are populated automatically. When a pharmacy that does not accept e-prescriptions is selected, the eprescribe Rx button is grayed out. e. If necessary, alter the fax number in the Fax field. 7. To select the pharmacy to which you want to transmit or fax this prescription on smartphones: a. Click the Pharmacy heading. The Pharmacy options display: b. Enter the name of the pharmacy in the Pharmacy field. c. Click the More (...) button. All pharmacies that match the entered text display in a pop-up pane beneath the Pharmacies field. d. Click the name of the pharmacy in the pop-up pane. The address, phone number, and fax number for the selected pharmacy are populated automatically. When a pharmacy that does not accept e-prescriptions is selected, the eprescribe Rx button is grayed out. e. If necessary, alter the fax number in the Fax field. f. To check mail-order eligibility for this pharmacy, click the Check Mail Order Eligibility button. 8. If Amy is currently taking Tylenol, check the box next to Tylenol. To add a new prescription on the iphone: a. Enter Tylenol into the Add Rx field. Copyright eclinicalworks, LLC 2011, Meaningful Use Training Scenarios Guide 38

39 As text is entered, the prescriptions that match the text pop-up below the Add Rx field in real time. b. Click the Tylenol option on the pop-up window. The selected prescription is added beneath the Add Rx field. c. Check the box next to the Tylenol prescription to include it in this transmission or fax. To add a new prescription on a smartphone: a. Enter Tylenol into the Add Rx field. b. Click the More (...) button. All prescriptions that match the entered text display in a pop-up pane beneath the Add Rx field. c. Click the Tylenol option The selected prescription is added beneath the Add Rx field. d. Check the box next to the Tylenol prescription to include it in this transmission or fax. 9. To view any potentially harmful interactions, click the Interaction heading. All applicable allergies and interactions are displayed: 10. To transmit this prescription to the pharmacy electronically: a. Click the eprescribe Rx button. On the iphone, the eprescription screen opens. For smartphones, skip to step h. b. To prevent any previously selected medications from being transmitted, uncheck the Name box next to the appropriate medication(s). c. To change the strength of this medication, alter the text in the Strength field. d. Select the details for this medication from the drop-down lists provided. e. Determine whether a generic medication may be substituted for this prescription by clicking the appropriate radio button in the Substitute Allowed section. f. Enter any miscellaneous comments in the Comments field. g. To alter the information contained in the Web Encounter that is automatically created for this e-prescription, click the Web Encounter Details heading. The Web Encounter Details options display: Copyright eclinicalworks, LLC 2011, Meaningful Use Training Scenarios Guide 39

40 h. Optionally, enter the name of the person requesting this e-prescription in the Caller field. i. If necessary, alter the reason for this e-prescription in the Reason field. j. If necessary, alter the message in the Message field. k. Click the Send eprescription button. This e-prescription is now transmitted to the pharmacy. A Web Encounter is created and assigned to this user, notifying them of the e-prescription. All medications sent here are displayed under the Rx tab of the Web Encounter and are entered into the Rx History of the patient. Note: Controlled medications cannot be transmitted electronically from eclinicalmobile. 11. To fax this prescription to the pharmacy, click the Fax Rx button. IMPTANT! This fax is not sent directly from eclinicalmobile. An electronic copy of the fax is sent to the eclinicalworks application where, once a synchronization has been performed, the fax will be sent. To review this fax and check that it is sent properly, click the Fax Outbox icon under the Documents band in the eclinicalworks application. For more information on synchronizing information between eclinicalmobile and the eclinicalworks application, refer to the section titled Configuring the Synchronization of Faxed and e-prescribed Medications from eclinicalmobile on page (j): Calculate and Transmit CMS Quality Measures Stage 1 Objective Practices must report to CMS or to their state on the required Clinical Quality Measures (CQMs). Stage 1 Measure Providers must submit aggregate numerators, denominators, and exclusions for at least six measures, including: 3 Core Measures If the denominator of one or more Core Measures is 0, Alternative Core Measures can be substituted. Copyright eclinicalworks, LLC 2011, Meaningful Use Training Scenarios Guide 40

41 Note: Even if the denominator is 0 for all Alternate Core Measures as well, 3 total Core/Alternate Core Measures must be reported to CMS. 3 Additional Measures Note: Providers must select the three additional measures based on those that eclinicalworks has received certification on at the time of attestation. eclinicalworks plans to receive certification on additional measures throughout The measures for which eclinicalworks has received certification can be viewed at For more information on these measures, refer to Appendix A: Clinical Quality Measures on page 264. IMPTANT! eclinicalworks has been certified on the Clinical Quality Measures (CQMs) displayed here. Eligible providers MUST report ONLY on the CQMs for which eclinicalworks has been certified. This objective is NOT satisfied by submitting any CQM results for which ecw has not been certified. eclinicalworks is currently seeking certification on the remaining measures. The measures for which eclinicalworks has received certification can be viewed at /eclinicalworks.com/knowledge-center-meaningful-use.htm. Any additional CQMs that are developed and certified will be provided to practices through the MAQ Dashboard and is unlikely to require a version upgrade. For more information on the MAQ Dashboard, refer to the MAQ Dashboard FAQ document, which can be found at Note: It is acceptable to report a measure with a denominator of 0, provided the eligible provider does not have an applicable patient population. As part of your Meaningful Use attestation, Medicare requires an explanation as to why a CQM with a denominator of 0 is being reported. It is eclinicalworks understanding that reference to the available CQMs that are certified for eclinicalworks is an appropriate explanation. eclinicalworks Calculations eclinicalworks does not perform any calculations for this measure. The Clinical Quality Measures selected by the provider must be reported to CMS through self-attestation. Reporting on Clinical Quality Measures is available on the MAQ Dashboard. Each measure has their own calculations. For more information, refer to the Action Recommendations section below. Copyright eclinicalworks, LLC 2011, Meaningful Use Training Scenarios Guide 41

42 Action Recommendations Measures are calculated by eclinicalworks based on the following criteria: The final denominator is calculated by adding together the patients that meet all of the denominator criteria. Patients that meet the denominator criteria are not counted in the denominator if they: Do not meet the numerator criteria AND Meet the patient exclusion criteria Note: Not all measures have patient exclusion criteria. The performance calculation is calculated by dividing the number of patients that meet the numerator criteria by the number of patients in the final denominator. For measures with multiple patient populations, this process is repeated for each patient population and the results are each reported separately. For measures with multiple numerators, each numerator is calculated separately within each population, using any applicable paired patient exclusions. Refer to the following sections for more information on satisfying individual measures: Core Measures: NQF Adult Weight Screening and Follow-Up Tobacco Use Assessment and Cessation Intervention: NQF 0028a - Tobacco Use Assessment NQF 0028b - Tobacco Cessation Intervention NQF Hypertension: Blood Pressure Measurement Alternate Core Measures: NQF Weight Assessment and Counseling for Children and Adolescents NQF Influenza Immunization for Patients 50 Years Old and Older NQF Childhood Immunization Status Additional Measures: NQF Diabetes: Hemoglobin HbA1c Poor Control NQF Diabetes: LDL Management and Control NQF Diabetes: Blood Pressure Management NQF Adult Weight Screening and Follow-Up Description Providers must report the percentage of patients aged 18 years or older and who have had their BMI calculated in the past six months or during the current encounter. If the most recent BMI is outside normal parameters, a follow-up plan must be documented. Note: Two separate values are calculated and submitted for this measure. Copyright eclinicalworks, LLC 2011, Meaningful Use Training Scenarios Guide 42

43 Calculation Tables This section outlines how each denominator and numerator are calculated. For more detailed information on the steps required within the eclinicalworks application to satisfy each item, refer to the Calculation Lists section below. Denominator 1 65 years old or older AND One or more outpatient encounters Numerator 1 BMI >= 22 kg/m 2 and < 30 kg/m 2 BMI > 30 kg/m 2 BMI < 22 kg/m 2 A N D A N D Follow-up care plan for BMI management recorded Follow-up care plan for BMI management recorded Denominator 2 Between 18 and 65 years old AND One or more outpatient encounters Numerator 2 BMI >= 18.5 kg/m 2 and < 25 kg/m 2 BMI > 25 kg/m 2 A N D Follow-up care plan for BMI management recorded Copyright eclinicalworks, LLC 2011, Meaningful Use Training Scenarios Guide 43

44 Numerator 2 BMI < 18.5 kg/m 2 A N D Follow-up care plan for BMI management recorded Patient Exclusions Terminally ill O R Active diagnosis for pregnancy O R Any other patient, medical, or system reason for not performing a physical examination Calculation Lists These lists provide a link for to the appropriate steps involved in satisfying each item within the eclinicalworks application. For a more reader-friendly view of all possible methods of satisfying each denominator and numerator, refer to the Calculation Tables section above. Denominator 1 Patients must meet all of the following criteria: 65 years old or older For more information, refer to the section titled Recording a Patient s Age on page 48. AND One or more outpatient encounter recorded Note: The following E&M codes are considered by the system to be outpatient visits: 90801, 90802, 90804, 90805, 90806, 90807, 90808, 90809, 97001, 97003, 97802, 97803, 98960, 99201, 99202, 99203, 99204, 99205, 99211, 99212, 99213, 99214, 99215, 99324, 99325, 99326, 99327, 99328, 99334, 99335, 99336, 99337, 99341, 99342, 99343, 99344, 99345, 99347, 99348, 99349, You MUST select one of these codes for an encounter for a patient to be included in the denominator for this measure. For more information, refer to the section titled Indicating the Type of Encounter with a Visit Code on page 48. Numerator 1 Patients that meet any of the following criteria are included in the numerator: Patients with a BMI greater than or equal to 22 kg/m 2 and less than 30 kg/m 2 within six months of the recorded outpatient encounter. Note: The normal vital range for specific age ranges can be configured so that values outside of the specified range are highlighted in red to alert you. For more information, refer to the section titled Configuring the Vitals Range for BMI on page 49. Copyright eclinicalworks, LLC 2011, Meaningful Use Training Scenarios Guide 44

45 For more information on recording BMI, refer to the section titled Recording BMI for a Patient on page 50. Patients with a BMI greater than or equal to 30 kg/m 2 within six months of the recorded outpatient encounter AND A follow-up care plan for BMI management recorded. For more information on recording BMI management using ICD/CPT * /HCPCS codes, refer to the section titled Recording BMI Management Follow-Up Using ICD/CPT/ HCPCS Codes on page 51. For more information on recording BMI management follow-up care plans using Structured Data, refer to the section titled Recording a BMI Management Follow-Up Care Plan Using Structured Data on page 56. Note: In order to record a BMI management follow-up care plan using Structured Data, the appropriate community items must first be mapped to the desired local items. For more information on mapping BMI management follow-up care plan Structured Data items, refer to the section titled Configuring BMI Management Follow-Up Care Plan Structured Data Items on page 52. Patients with a BMI less than 22 kg/m 2 within six months of the recorded outpatient encounter Note: The normal vital range for specific age ranges can be configured so that values outside of the specified range are highlighted in red to alert you. For more information, refer to the section titled Configuring the Vitals Range for BMI on page 49. For more information on recording BMI, refer to the section titled Recording BMI for a Patient on page 50. AND A follow-up care plan for BMI management recorded. For more information on recording BMI management using ICD/CPT/HCPCS codes, refer to the section titled Recording BMI Management Follow-Up Using ICD/CPT/ HCPCS Codes on page 51. For more information on recording BMI management follow-up care plans using Structured Data, refer to the section titled Recording a BMI Management Follow-Up Care Plan Using Structured Data on page 56. *. CPT only 2010 American Medical Association. All rights reserved. Copyright eclinicalworks, LLC 2011, Meaningful Use Training Scenarios Guide 45

46 Note: In order to record a BMI management follow-up care plan using Structured Data, the appropriate community items must first be mapped to the desired local items. For more information on mapping BMI management follow-up care plan Structured Data items, refer to the section titled Configuring BMI Management Follow-Up Care Plan Structured Data Items on page 52. Denominator 2 Patients must meet all of the following criteria: Greater than or equal to 18 years old and less than 65 years old For more information, refer to the section titled Recording a Patient s Age on page 48. AND One or more outpatient encounter recorded Note: The following E&M codes are considered by the system to be outpatient visits: 90801, 90802, 90804, 90805, 90806, 90807, 90808, 90809, 97001, 97003, 97802, 97803, 98960, 99201, 99202, 99203, 99204, 99205, 99211, 99212, 99213, 99214, 99215, 99324, 99325, 99326, 99327, 99328, 99334, 99335, 99336, 99337, 99341, 99342, 99343, 99344, 99345, 99347, 99348, 99349, You MUST select one of these codes for an encounter for a patient to be included in the denominator for this measure. For more information, refer to the section titled Indicating the Type of Encounter with a Visit Code on page 48. Numerator 2 Patients that meet any of the following criteria are included in the numerator: Patients with a BMI greater than or equal to 18.5 kg/m 2 and less than 25 kg/m 2 within six months of the recorded outpatient encounter. Note: The normal vital range for specific age ranges can be configured so that values outside of the specified range are highlighted in red to alert you. For more information, refer to the section titled Configuring the Vitals Range for BMI on page 49. For more information on recording BMI, refer to the section titled Recording BMI for a Patient on page 50. Patients with a BMI greater than or equal to 25 kg/m 2 within six months of the recorded outpatient encounter AND Copyright eclinicalworks, LLC 2011, Meaningful Use Training Scenarios Guide 46

47 A follow-up care plan for BMI management recorded. For more information on recording BMI management using ICD/CPT * /HCPCS codes, refer to the section titled Recording BMI Management Follow-Up Using ICD/CPT/ HCPCS Codes on page 51. For more information on recording BMI management follow-up care plans using Structured Data, refer to the section titled Recording a BMI Management Follow-Up Care Plan Using Structured Data on page 56. Note: In order to record a BMI management follow-up care plan using Structured Data, the appropriate community items must first be mapped to the desired local items. For more information on mapping BMI management follow-up care plan Structured Data items, refer to the section titled Configuring BMI Management Follow-Up Care Plan Structured Data Items on page 52. Patients with a BMI less than 18.5 kg/m 2 within six months of the recorded outpatient encounter Note: The normal vital range for specific age ranges can be configured so that values outside of the specified range are highlighted in red to alert you. For more information, refer to the section titled Configuring the Vitals Range for BMI on page 49. For more information on recording BMI, refer to the section titled Recording BMI for a Patient on page 50. AND A follow-up care plan for BMI management recorded. For more information on recording BMI management using ICD/CPT/HCPCS codes, refer to the section titled Recording BMI Management Follow-Up Using ICD/CPT/ HCPCS Codes on page 51. For more information on recording BMI management follow-up care plans using Structured Data, refer to the section titled Recording a BMI Management Follow-Up Care Plan Using Structured Data on page 56. Note: In order to record a BMI management follow-up care plan using Structured Data, the appropriate community items must first be mapped to the desired local items. For more information on mapping BMI management follow-up care plan Structured Data items, refer to the section titled Configuring BMI Management Follow-Up Care Plan Structured Data Items on page 52. *. CPT only 2010 American Medical Association. All rights reserved. Copyright eclinicalworks, LLC 2011, Meaningful Use Training Scenarios Guide 47

48 Patient Exclusions The following patients are excluded from this measure: Patients that have been marked as terminally ill within six months of the outpatient encounter Patients that have an active pregnancy diagnosis Patients that have not had a physical examination performed for one of the following reasons: Patient reason Medical reason System reason IMPTANT! The system does not automatically recognize the exclusion criteria, so patients that meet ANY of the above criteria must be manually marked as excluded. For more information on manually marking patients as excluded, refer to the section titled Manually Marking a Patient as Excluded on page 57. Recording a Patient s Age The system looks at the Date of Birth field on the Patient Information window to determine patients ages. Front Office Workflow (for Denominators): 1. Click the Patient Lookup icon. 2. Click the New button to create a new patient. Highlight an existing patient and click the Patient Information button. The Patient Information window opens. 3. Enter the patient s date of birth in the Date of Birth field. 4. Enter all other applicable information and click the OK button. This patient s date of birth is saved and their age is calculated. Indicating the Type of Encounter with a Visit Code The system looks at the Billing section of the Progress Notes to determine the type of encounter you have had with a patient. Encounter type can be indicated using E&M, CPT *, or HCPCS codes. IMPTANT! E&M, CPT, and HCPCS codes MUST be entered on the Progress Notes in order to indicate the visit type in a way that will satisfy a CMS Quality Measure. The system does not recognize codes added on claims for these measures. Mid Office Workflow (for Denominators): 1. From the Progress Notes window, click the Visit Code link. The Billing window opens. 2. Click the Add E&M or the Add CPT button. *. CPT only 2010 American Medical Association. All rights reserved. Copyright eclinicalworks, LLC 2011, Meaningful Use Training Scenarios Guide 48

49 The Visit Code or Procedures, Immunizations window opens. 3. Click the category in the left pane that contains the applicable visit code. The visit codes in the selected category display to the right. 4. Select the appropriate visit code in the right pane. 5. Click the OK button. The visit code for this encounter is now recorded. Configuring the Vitals Range for BMI Vitals ranges can be configured so that any values entered outside of the normal range are highlighted. This provides an easy way to see when patients require follow-up care plans for BMI management. System Administration Workflow (Setup): 1. From the EMR menu, hover over the Vitals option to open a drop-down list. 2. From the drop-down list, click the Configure Vitals Range option. The Configure Vitals Range window opens with Range 1 selected by default in the Group drop-down list: 3. To configure the normal range for patients over 65: a. In the Age From field, enter 65. b. In the To field, enter 120 (or any age older than the oldest possible patient). c. In the Sex section, click the Both radio button. d. Enter 22 in the Low column for the BMI row. Copyright eclinicalworks, LLC 2011, Meaningful Use Training Scenarios Guide 49

50 e. Enter in the High column for the BMI row. f. Click the Save button. The normal BMI range for patients over 65 is now defined in the system. Any values outside of this range are displayed in red. 4. To configure the normal range for patients between age 18 and 64: a. Select the Range 2 option from the Group drop-down list. b. In the Age From field, enter 18. c. In the To field, enter 64. d. In the Sex section, click the Both radio button. e. Enter 18.5 in the Low column for the BMI row. f. Enter in the High column for the BMI row. g. Click the Save button. The normal BMI range for patients aged 18 to 64 is now defined in the system. Any values outside of this range are displayed in red. Recording BMI for a Patient The system looks at the Vitals section of the Progress Notes to determine the BMI for a patient. The BMI is calculated based on the information entered into the height and weight fields. Note: The BMI, Height, and Weight Vital items must be mapped in order for the system to recognize that this information has been recorded. For more information on mapping vitals, refer to the section titled Associating Vitals Fields with Vital Types on page 192. Mid Office Workflow (for Numerators): 1. From the Progress Notes window, click the Vitals link. The Vitals window opens. 2. Click in the Height field. If the Pop-up box is checked, the Height pop-up window opens. Otherwise, the Height field becomes editable. 3. Enter the height for this patient and, if entering this information on the pop-up window, click the Apply button. IMPTANT! Enter ONLY the appropriate numerical value in this field. Do not enter any additional text (such as provider initials, unit of measurement, etc.) in this field or this measure will not be satisfied. 4. Click in the Weight field. If the Pop-up box is checked, the Weight pop-up window opens. Otherwise, the Weight field becomes editable. 5. Enter the weight for this patient and, if entering this information on the pop-up window, click the Apply button. IMPTANT! Enter ONLY the appropriate numerical value in this field. Do not enter any additional text (such as provider initials, unit of measurement, etc.) in this field or this measure will not be satisfied. The BMI is automatically calculated and populated in the BMI field. Copyright eclinicalworks, LLC 2011, Meaningful Use Training Scenarios Guide 50

51 Recording BMI Management Follow-Up Using ICD/CPT/HCPCS Codes The system looks for specific ICD-9, CPT *, or HCPCS codes on the Progress Notes in order to determine if a BMI management follow-up care plan has been recorded. Mid Office Walkthrough (for Numerators): 1. From the Progress Notes window for the appropriate outpatient encounter, click the Procedure Codes link. The Billing window opens. 2. To add an ICD-9 code: a. Click the Add button in the Assessments section. The Select Assessments window opens. b. Click the category in the Assessments pane on the left that contains the applicable ICD-9 code. The ICD-9 codes in the selected category populate in the middle pane. c. Click the appropriate ICD-9 code in the middle pane. The selected ICD-9 code is added to the right pane. d. Click the OK button. Note: The following ICD-9 code is considered by the system to indicate that a BMI management follow-up care plan has been recorded: V65.3 You MUST select either this code or one of the CPT * /HCPCS codes listed below in order for a patient to be included in the numerator for this measure. *. CPT only 2010 American Medical Association. All rights reserved. The Select Assessments window closes and the selected ICD-9 code is recorded for the current encounter. To add a CPT or HCPCS code: a. Click the Add CPT button. The Procedures, Immunizations window opens. b. Click the category in the Billing Categories pane on the left that contains the applicable CPT or HCPCS code. The CPT/HCPCS codes in the selected category populate in the middle pane. c. Click the appropriate CPT/HCPCS code in the middle pane. *. CPT only 2010 American Medical Association. All rights reserved. Copyright eclinicalworks, LLC 2011, Meaningful Use Training Scenarios Guide 51

52 Note: The following CPT codes are considered by the system to indicate that a BMI management follow-up care plan has been recorded: 43644, 43645, 43770, 43771, 43772, 43773, 43774, 43842, 43843, 43845, 43846, 43847, 43848, 97804, 98961, 98962, The following HCPCS codes are considered by the system to indicate that a BMI management follow-up care plan has been recorded: G8417, S9449, S9451, S9452, S9470 You MUST either select one of these codes or one of the ICD-9 codes listed above in order for a patient to be included in the numerator for this measure. The selected CPT/HCPCS code is added to the bottom-right pane. d. Click the OK button. The Procedures, Immunizations window closes and the selected CPT/HCPCS code is recorded for the current encounter. Configuring BMI Management Follow-Up Care Plan Structured Data Items The appropriate Structured Data items must be properly mapped in order to record a BMI management follow-up care plan from the Preventive Medicine section of the Progress Notes. IMPTANT! These Structured Data items are automatically mapped for new installations of eclinicalworks. Only existing clients that are being upgraded must configure Structured Data items. New clients can use steps 1-3 to determine the Progress Note section, category, item, and Structured Data element(s) in which to record relevant information to satisfy this measure. Note: Most providers record this information in the Preventive Medicine section of the Progress Notes and that process is detailed in the section titled Recording a BMI Management Follow-Up Care Plan Using Structured Data on page 56. However, other sections of the Progress Notes can be used if the appropriate Structured Data items are mapped to the desired Progress Notes section. System Administrator Workflow (Setup): 1. From the Community menu, hover over the Mappings option to open a drop-down list. 2. From the drop-down list, click the Structured Data option. The Mapper window opens with the Structured Data section selected by default: Copyright eclinicalworks, LLC 2011, Meaningful Use Training Scenarios Guide 52

53 Note: Red text is used to indicate items related to measures available in eclinicalworks prior to Meaningful Use. It does NOT indicate items used in Meaningful Use measures. 3. To select a community item from the left pane: a. Select the Preventive Medicine option from the Section drop-down list. All available Preventive Medicine community items display in the left pane. b. Click the More (...) button next to the Category field. The Preventive Medicine Categories window opens. c. Highlight the Counseling category and click the OK button. All community items except the Counseling items are removed from the left pane. d. Click the More (...) button next to the Item field. The Items field opens. e. Highlight one of the following items and click the OK button: Care Goal Follow Up Plan Provider to Provider Communication The Structured Data elements for the selected item display in the left pane. f. If you selected the Care Goal Follow Up Plan item, highlight the BMI management provided element in the left pane. If you selected the Provider to Provider Communication item, highlight the Dietary consultation Order Provided element in the left pane. Note: Recording Structured Data for either of these elements will satisfy the measure. This process should be repeated in order to map both elements for use in the appropriate encounters. 4. Use the filters above the right pane to select the local Progress Notes section, category, item, and element to which you want to map the selected community element. IMPTANT! The local element must be the same type (indicated in the Type field) as the selected community element. Both of these elements must be of the Boolean type. Copyright eclinicalworks, LLC 2011, Meaningful Use Training Scenarios Guide 53

54 Note: This is often the same path followed in step 3, although any Progress Notes elements can be selected as long as they are mapped to the proper community elements. If the required local categories and/or items have not yet been created in the system, they can be created from this window. For more information, refer to one of the following sections: Creating a Local Progress Notes Category while Mapping Structured Data on page 54 Creating a Local Progress Notes Item while Mapping Structured Data on page 55 Creating Local Structured Data Elements while Mapping Structured Data on page Click the <MAP> button. The community item selected in the left pane is now mapped to the selected local item in the right pane. Mapped items are displayed in blue. Creating a Local Progress Notes Category while Mapping Structured Data Progress Notes categories must be created from the Mapper window if the desired local category is not yet present in the system. System Administrator Workflow (Setup): 1. From the Community menu, hover over the Mappings option to open a drop-down list. 2. From the drop-down list, click the Structured Data option. The Mapper window opens with the Structured Data section selected by default. 3. Select the section to which you want to add a category from the Section drop-down list in the Local pane on the right. The categories in the selected section are displayed in the right pane. 4. Click the More (...) button next to the Category field in the Local pane on the right. The Categories window for the selected section opens. 5. Click the New button. The New Item/Category window opens. 6. Enter a name for this category in the Category Name field. 7. Click the OK button. The new category is now created. Items and elements for this category must be created in order to map community elements. For more information, refer to the following sections: Creating a Local Progress Notes Item while Mapping Structured Data on page 55 Creating Local Structured Data Elements while Mapping Structured Data on page 55 Copyright eclinicalworks, LLC 2011, Meaningful Use Training Scenarios Guide 54

55 Creating a Local Progress Notes Item while Mapping Structured Data Progress Notes items must be created from the Mapper window if the desired local item is not yet present in the system. System Administrator Workflow (Setup): 1. From the Community menu, hover over the Mappings option to open a drop-down list. 2. From the drop-down list, click the Structured Data option. The Mapper window opens with the Structured Data section selected by default. 3. Select the section to which you want to add a category from the Section drop-down list in the Local pane on the right. The categories in the selected section are displayed in the right pane. 4. Click the More (...) button next to the Category field in the Local pane on the right. The Categories window for the selected section opens. 5. Highlight the category in which you want to create this item and click the OK button. The items in the selected category display in the right pane. 6. Click the More (...) button next to the Item field. The Items window opens. 7. Click the New button. The New Item/Category window opens. 8. Enter a name for this item in the Name field. 9. Click the OK button. The new item is now created. Elements for this category must be created in order to map community elements. For more information, refer to the section titled Creating Local Structured Data Elements while Mapping Structured Data on page 55. Creating Local Structured Data Elements while Mapping Structured Data Progress Notes elements must be created from the Mapper window if the desired local elements are not yet present in the system. System Administrator Workflow (Setup): 1. From the Community menu, hover over the Mappings option to open a drop-down list. 2. From the drop-down list, click the Structured Data option. The Mapper window opens with the Structured Data section selected by default. 3. Select the section to which you want to add a category from the Section drop-down list in the Local pane on the right. The categories in the selected section are displayed in the right pane. 4. Click the More (...) button next to the Category field in the Local pane on the right. The Categories window for the selected section opens. 5. Highlight the category in which you want to create Structured Data elements and click the OK button. Copyright eclinicalworks, LLC 2011, Meaningful Use Training Scenarios Guide 55

56 The items in the selected category display in the right pane. 6. Click the More (...) button next to the Item field. The Items window opens. 7. Highlight the item in which you want to create Structured Data elements and click the OK button. Any Structured Data elements associated with the selected item display in the right pane. 8. Click the Custom button beneath the Local pane on the right. The Structured Data window opens. 9. Click the Add button. The Structured Data window opens. 10. Enter the name of this element in the Name field. 11. Select a type for this element from the Type drop-down list. 12. Click the OK button. This element is now created. 13. Repeat steps 9-12 until all elements have been created. Recording a BMI Management Follow-Up Care Plan Using Structured Data BMI management follow-up care plans can be recorded on the Progress Notes as long as the appropriate Structured Data items have been mapped. Note: Structured Data items must be properly mapped in order for this process to satisfy the measure. For more information on mapping, refer to the section titled Configuring BMI Management Follow-Up Care Plan Structured Data Items on page 52. Most providers record this information in the Preventive Medicine section of the Progress Notes and that process is detailed here. However, other sections of the Progress Notes can be used if the appropriate Structured Data items are mapped to the desired Progress Notes section. Mid Office Workflow (for Numerators): 1. From the Progress Notes window, click the Preventive Medicine link. Note: The Visit Type for this appointment must be configured as a Physical Visit in order to access the Preventive Medicine section of the Progress Notes. The Preventive Medicine window opens. 2. Click the category (e.g., Counseling) in the left pane that contains the mapped Structured Data item. The items contained in the selected category display in the right pane. 3. Click in the Notes field for the item (e.g., Care Goal Follow Up Plan or Provider to Provider Communication) containing the mapped Structured Data element. The Preventive Notes window opens. 4. Select Yes from the Value drop-down list for the mapped Structured Data element (e.g., BMI management provided or Dietary consultation order provided): Copyright eclinicalworks, LLC 2011, Meaningful Use Training Scenarios Guide 56

57 A BMI management follow-up care plan has now been recorded for this patient. Manually Marking a Patient as Excluded Patients that meet certain exclusion criteria must be manually marked as excluded in order to prevent their inclusion in measure calculations. Mid Office Workflow (for Patient Exclusions): 1. From the Progress Notes window, click the CDSS tab in the Right Chart Panel. The CDSS and MU Clinical Measures Exclusions options display. 2. Click the red hand icon to the right of the appropriate measure: Copyright eclinicalworks, LLC 2011, Meaningful Use Training Scenarios Guide 57

58 The eclinicalworks window opens: 3. Click the radio button next to the appropriate reason for excluding this patient. If the Other Reason radio button is selected, enter the reason in the blank field here. 4. Click the Save button. This patient is excluded from the selected measure. Copyright eclinicalworks, LLC 2011, Meaningful Use Training Scenarios Guide 58

59 NQF 0028a - Tobacco Use Assessment Description Providers must report the percentage of patients aged 18 years or older that have been asked about their tobacco use at least once in the past two years. Calculation Tables This section outlines how each denominator and numerator are calculated. For more detailed information on the steps required within the eclinicalworks application to satisfy each item, refer to the Calculation Lists section below. Denominator Over 18 years old AND Two or more encounters of the following types: Office Visits Health and Behavior Assessment Occupational Therapy Psychiatric and Psychologic O R One or more encounter of the following types: Preventive Medicine Services 18 and Older Preventive - Individual Counseling Preventive Medicine Group Counseling Preventive Medicine Other Services Numerator Tobacco use recorded Calculation Lists These lists provide a link for to the appropriate steps involved in satisfying each item within the eclinicalworks application. For a more reader-friendly view of all possible methods of satisfying each denominator and numerator, refer to the Calculation Tables section above. Denominator Patients must meet the following criteria: 18 years old or older For more information, refer to the section titled Recording a Patient s Age on page 48. AND Copyright eclinicalworks, LLC 2011, Meaningful Use Training Scenarios Guide 59

60 Two encounters of the following types: Office Visits Health and Behavior Assessment Occupational Therapy Psychiatric and Psychologic Note: The following codes are considered by the system to be Office Visit encounters: 99201, 99202, 99203, 99204, 99205, 99212, 99213, 99214, Note: The following codes are considered by the system to be Health and Behavior Assessment encounters: 96150, Note: The following codes are considered by the system to be Occupational Therapy encounters: 97003, Note: The following codes are considered by the system to be Psychiatric and Psychologic encounters: 90801, 90802, 90804, 90805, 90806, 90807, 90808, 90809, 90810, 90811, 90812, 90813, 90814, 90815, 90845, For more information, refer to the section titled Indicating the Type of Encounter with a Visit Code on page 48. One encounter of the following types: Preventive Medicine Services 18 and Older Note: The following codes are considered by the system to be Preventive Medicine Services 18 and Older encounters: 99385, 99386, 99387, 99395, 99396, Preventive - Individual Counseling Note: The following codes are considered by the system to be Preventive - Individual Counseling encounters: 99401, 99402, 99403, Preventive Medicine Group Counseling Note: The following codes are considered by the system to be Preventive Medicine Group Counseling encounters: 99411, Copyright eclinicalworks, LLC 2011, Meaningful Use Training Scenarios Guide 60

61 Numerator Preventive Medicine Other Services Note: The following codes are considered by the system to be Preventive Medicine Other Services encounters: 99420, For more information, refer to the section titled Indicating the Type of Encounter with a Visit Code on page 48. Patients that have had their tobacco use recorded. For more information on recording patients tobacco use using Structured Data, refer to the section titled Recording Patients Tobacco Use Using Structured Data on page 63. Note: In order to record tobacco use using Structured Data, the appropriate community items must first be mapped to the desired local items. For more information on mapping tobacco use Structured Data items, refer to the section titled Configuring Tobacco Use Structured Data Items on page 61. Configuring Tobacco Use Structured Data Items The appropriate Structured Data items must be properly mapped in order to record a patient s tobacco use from the Progress Notes. Note: In order to map tobacco use Structured Data items, they must first be created in the local system. For more information, refer to the section titled Creating Smoking Status Structured Data Items on page 198. IMPTANT! These Structured Data items are automatically mapped for new installations of eclinicalworks. Only existing clients that are being upgraded must configure Structured Data items. New clients can use steps 1-3 to determine the Progress Note section, category, item, and Structured Data element(s) in which to record relevant information to satisfy this measure. Note: Most providers record this information in the Social History section of the Progress Notes and that process is detailed in the section titled Recording Patients Tobacco Use Using Structured Data on page 63. However, other sections of the Progress Notes can be used if the appropriate Structured Data items are mapped to the desired Progress Notes section. System Administrator Workflow (Setup): 1. From the Community menu, hover over the Mappings option to open a drop-down list. 2. From the drop-down list, click the Structured Data option. The Mapper window opens with the Structured Data section selected by default: Copyright eclinicalworks, LLC 2011, Meaningful Use Training Scenarios Guide 61

62 Note: Red text is used to indicate items related to measures available in eclinicalworks prior to Meaningful Use. It does NOT indicate items used in Meaningful Use measures. 3. To select a community item from the left pane: a. Select the Social History option from the Section drop-down list. All available Social History community items display in the left pane. b. Click the More (...) button next to the Category field. The Social History Categories window opens. c. Highlight the Tobacco Use category and click the OK button. All community items except the Tobacco Use items are removed from the left pane. d. Click the More (...) button next to the Item field. The Items field opens. e. Highlight the Smoking item and click the OK button: The Structured Data elements for the selected item display in the left pane. f. Highlight the Are you a: element in the left pane. 4. Use the filters above the right pane to select the local Progress Notes section, category, item, and element to which you want to map the selected community element. IMPTANT! The local element must have be the same type (indicated in the Type field) as the selected community element. Copyright eclinicalworks, LLC 2011, Meaningful Use Training Scenarios Guide 62

63 Note: This is often the same path followed in step 3, although any Progress Notes elements can be selected as long as they are mapped to the proper community elements. If the required local categories and/or items have not yet been created in the system, they can be created from this window. For more information, refer to one of the following sections: Creating a Local Progress Notes Category while Mapping Structured Data on page 54 Creating a Local Progress Notes Item while Mapping Structured Data on page 55 Creating Local Structured Data Elements while Mapping Structured Data on page Click the <MAP> button. The Mapper window opens. 6. To map the structured text options: a. Highlight a community text option in the left pane. b. Highlight the corresponding text option in the right pane. c. Click the <MAP> button. The selected community and local text options are now mapped. d. Repeat step 6a-6c until all community and local items have been mapped. Mapped items display in blue text. Recording Patients Tobacco Use Using Structured Data Tobacco use can be recorded on the Progress Notes as long as the appropriate Structured Data items have been mapped. Note: Structured Data items must be properly mapped in order for this process to satisfy the measure. For more information on mapping, refer to the section titled Configuring Tobacco Use Structured Data Items on page 61. Most providers record this information in the Social History section of the Progress Notes and that process is detailed here. However, other sections of the Progress Notes can be used if the appropriate Structured Data items are mapped to the desired Progress Notes section. Mid Office Workflow (for Numerators): 1. From the Progress Notes window, click the Social History link. The Social History window opens. 2. Click the category in the left pane that contains the mapped Structured Data item (e.g., Smoking). The items contained in the selected category display in the right pane. 3. Click in the Details field for the item (e.g., Are you a:) containing the mapped Structured Data elements. The Social History Notes window opens. 4. Select an option from the Value drop-down list in the appropriate row: Copyright eclinicalworks, LLC 2011, Meaningful Use Training Scenarios Guide 63

64 This patient s tobacco use is now recorded. NQF 0028b - Tobacco Cessation Intervention Description Providers must report the percentage of patients aged 18 years or older that have been identified as tobacco users within the past two years who have received tobacco cessation intervention. Calculation Tables This section outlines how each denominator and numerator are calculated. For more detailed information on the steps required within the eclinicalworks application to satisfy each item, refer to the Calculation Lists section below. Copyright eclinicalworks, LLC 2011, Meaningful Use Training Scenarios Guide 64

65 Denominator Over 18 years old AND Indicated tobacco use in past 2 years AND Two or more encounters of the following types: Office Visits Health and Behavior Assessment Occupational Therapy Psychiatric and Psychologic O R One or more encounter of the following types: Preventive Medicine Services 18 and Older Preventive - Individual Counseling Preventive Medicine Group Counseling Preventive Medicine Other Services Numerator Tobacco use cessation intervention performed Medication for smoking cessation ordered or active Calculation Lists These lists provide a link for to the appropriate steps involved in satisfying each item within the eclinicalworks application. For a more reader-friendly view of all possible methods of satisfying each denominator and numerator, refer to the Calculation Tables section above. Denominator Patients must meet the following criteria: 18 years old or older For more information, refer to the section titled Recording a Patient s Age on page 48. AND Indicated within the past two year that they use tobacco Copyright eclinicalworks, LLC 2011, Meaningful Use Training Scenarios Guide 65

66 For more information on indicating tobacco use, refer to the section titled Recording Patients Tobacco Use Using Structured Data on page 63. AND Two or more encounters of the following types: Office Visits Health and Behavior Assessment Occupational Therapy Psychiatric and Psychologic Note: The following codes are considered by the system to be Office Visit encounters: 99201, 99202, 99203, 99204, 99205, 99212, 99213, 99214, Note: The following codes are considered by the system to be Health and Behavior Assessment encounters: 96150, Note: The following codes are considered by the system to be Occupational Therapy encounters: 97003, Note: The following codes are considered by the system to be Psychiatric and Psychologic encounters: 90801, 90802, 90804, 90805, 90806, 90807, 90808, 90809, 90810, 90811, 90812, 90813, 90814, 90815, 90845, For more information, refer to the section titled Indicating the Type of Encounter with a Visit Code on page 48. One or more encounter of the following types: Preventive Medicine Services 18 and Older Note: The following codes are considered by the system to be Preventive Medicine Services 18 and Older encounters: 99385, 99386, 99387, 99395, 99396, Preventive - Individual Counseling Note: The following codes are considered by the system to be Preventive - Individual Counseling encounters: 99401, 99402, 99403, Preventive Medicine Group Counseling Copyright eclinicalworks, LLC 2011, Meaningful Use Training Scenarios Guide 66

67 Numerator Preventive Medicine Other Services For more information, refer to the section titled Indicating the Type of Encounter with a Visit Code on page 48. Patients must meet one of the following criteria: Tobacco use cessation intervention has been performed within the past two years For more information on recording tobacco use cessation interventions using Structured Data, refer to the section titled Recording a Tobacco Use Cessation Intervention Using Structured Data on page 69. Note: The following codes are considered by the system to be Preventive Medicine Group Counseling encounters: 99411, Note: The following codes are considered by the system to be Preventive Medicine Other Services encounters: 99420, Note: In order to record a tobacco use cessation intervention using Structured Data, the appropriate community items must first be mapped to the desired local items. For more information on mapping tobacco use cessation intervention Structured Data items, refer to the section titled Configuring Tobacco Use Cessation Intervention Structured Data on page 67. A smoking cessation medication has been ordered or is active within the past two years For more information, refer to the section titled Recording the Prescription of a Smoking Cessation Medication on page 70. Configuring Tobacco Use Cessation Intervention Structured Data The appropriate Structured Data items must be properly mapped in order to record tobacco use cessation interventions from the Progress Notes. IMPTANT! These Structured Data items are automatically mapped for new installations of eclinicalworks. Only existing clients that are being upgraded must configure Structured Data items. New clients can use steps 1-3 to determine the Progress Note section, category, item, and Structured Data element(s) in which to record relevant information to satisfy this measure. Note: Most providers record this information in the Preventive Medicine section of the Progress Notes and that process is detailed in the section titled Recording a Tobacco Use Cessation Intervention Using Structured Data on page 69. However, other sections of the Progress Notes can be used if the appropriate Structured Data items are mapped to the desired Progress Notes section. Copyright eclinicalworks, LLC 2011, Meaningful Use Training Scenarios Guide 67

68 System Administrator Workflow (Setup): 1. From the Community menu, hover over the Mappings option to open a drop-down list. 2. From the drop-down list, click the Structured Data option. The Mapper window opens with the Structured Data section selected by default: Note: Red text is used to indicate items related to measures available in eclinicalworks prior to Meaningful Use. It does NOT indicate items used in Meaningful Use measures. 3. To select a community item from the left pane: a. Select the Preventive Medicine option from the Section drop-down list. All available Preventive Medicine community items display in the left pane. b. Click the More (...) button next to the Category field. The Preventive Medicine Categories window opens. c. Highlight the Counseling category and click the OK button. All community items except the Counseling items are removed from the left pane. d. Click the More (...) button next to the Item field. The Items field opens. e. Highlight the Smoking item and click the OK button: The Structured Data elements for the selected item display in the left pane. f. Highlight the Patient Counseled on the dangers of tobacco use and urged to quit element in the left pane. 4. Use the filters above the right pane to select the local Progress Notes section, category, item, and element to which you want to map the selected community element. IMPTANT! The local element must have be the same type (indicated in the Type field) as the selected community element. Copyright eclinicalworks, LLC 2011, Meaningful Use Training Scenarios Guide 68

69 Note: This is often the same path followed in step 3, although any Progress Notes elements can be selected as long as they are mapped to the proper community elements. If the desired local categories and/or items have not yet been created in the system, they can be created from this window. For more information, refer to the sections titled Creating a Local Progress Notes Category while Mapping Structured Data on page 54, Creating a Local Progress Notes Item while Mapping Structured Data on page 55, or Creating Local Structured Data Elements while Mapping Structured Data on page Click the <MAP> button. The community item selected in the left pane is now mapped to the selected local item in the right pane. Mapped items are displayed in blue. Recording a Tobacco Use Cessation Intervention Using Structured Data Tobacco use cessation interventions can be recorded on the Progress Notes as long as the appropriate Structured Data items have been mapped. Note: Structured Data items must be properly mapped in order for this process to satisfy the measure. For more information on mapping, refer to the section titled Configuring Tobacco Use Cessation Intervention Structured Data on page 67. Most providers record this information in the Preventive Medicine section of the Progress Notes and that process is detailed here. However, other sections of the Progress Notes can be used if the appropriate Structured Data items are mapped to the desired Progress Notes section. Mid Office Workflow (for Numerators): 1. From the Progress Notes window, click the Preventive Medicine link. Note: The Visit Type for this appointment must be configured as a Physical Visit in order to access the Preventive Medicine section of the Progress Notes. The Preventive Medicine window opens. 2. Click the category (e.g., Counseling) in the left pane that contains the mapped Structured Data item. The items contained in the selected category display in the right pane. 3. Click in the Notes field for the item (e.g., Smoking) containing the mapped Structured Data element. The Preventive Notes window opens. 4. Select the date on which this patient was counseled from the Value drop-down list for the mapped Structured Data element (e.g., Patient counseled on the dangers of tobacco use and urged to quit): Copyright eclinicalworks, LLC 2011, Meaningful Use Training Scenarios Guide 69

70 A tobacco use cessation intervention has now been recorded for this patient. Recording the Prescription of a Smoking Cessation Medication As an alternative to recording tobacco use cessation intervention using Structured Data, the recording of an order or active prescription for smoking cessation medication also satisfies this measure. Mid Office Workflow (for Numerators): 1. From the Progress Notes window, click the Treatment link. The Treatment window opens. 2. Click the Add button. The Manage Prescriptions window opens with the Add New Rx tab selected. Note: These steps use the Modern View for the Manage Prescriptions window. 3. If necessary, check the box next to the appropriate assessment in the left pane. 4. Search for the appropriate medication using the Rx filters at the top of the window. A list of medications that match the selected criteria and entered text displays in a popup window beneath the Find field in real time. 5. Click the name of a medication in the pop-up window. All available dosages/formulations of the selected medication display in the top-right pane. 6. Click the appropriate dosage/formulation in the top-right pane. The selected dosage/formulation is added to the bottom-right pane. 7. Click the OK button. The Manage Prescriptions window closes and the selected dosage/formulation is added in the Rx section of the Treatment window with Start selected in the Comments field by default. 8. If necessary, use the Stop Date drop-down calendar to select the date that this prescription will end. Copyright eclinicalworks, LLC 2011, Meaningful Use Training Scenarios Guide 70

71 9. To print, fax, or transmit this prescription: a. Click the green arrow next to the Send Rx button to open a drop-down list. b. From the drop-down list, click the appropriate option for prescribing this medication. For more information on printing, faxing, and transmitting prescriptions, refer to the Electronic Medical Records Users Guide. 10. If this medication was prescribed in the past and you want to indicate it is an active medication: a. Click in the Comments field. If the Pop-up box is checked, the Comments window opens. b. Highlight the Continue option on the Comments window and click the Close button. If the Pop-up box is not checked, click in the Comments field to cycle through the available options until the Continue option displays. NQF Hypertension: Blood Pressure Measurement Description Providers must report the percentage of patients aged 18 years or older with an active hypertension diagnosis who have had their blood pressure recorded in at least two outpatient or nursing facility encounters. Calculation Tables This section outlines how each denominator and numerator are calculated. For more detailed information on the steps required within the eclinicalworks application to satisfy each item, refer to the Calculation Lists section below. Denominator Over 18 years old AND Active diagnosis for Hypertension AND Two or more outpatient or nursing facility encounters Numerator Systolic and diastolic blood pressure recorded in Vitals Copyright eclinicalworks, LLC 2011, Meaningful Use Training Scenarios Guide 71

72 Calculation Lists These lists provide a link for to the appropriate steps involved in satisfying each item within the eclinicalworks application. For a more reader-friendly view of all possible methods of satisfying each denominator and numerator, refer to the Calculation Tables section above. Denominator Patients must meet all of the following criteria: 18 years old or older For more information, refer to the section titled Recording a Patient s Age on page 48. AND Active Hypertension diagnosis For more information, refer to the section titled Recording a Hypertension Diagnosis on page 73. AND Two or more encounters of the following types: Outpatient Note: The following E&M codes are considered by the system to be outpatient encounters: 99201, 99202, 99203, 99204, 99205, 99212, 99213, 99214, 99215, 99241, 99242, 99243, 99244, 99245, 99324, 99325, 99326, 99327, 99328, 99334, 99335, 99336, 99337, 99341, 99342, 99343, 99344, 99345, 99347, 99348, 99349, Nursing Facility Numerator Note: The following E&M codes are considered by the system to be nursing facility encounters: 99304, 99305, 99306, 99307, 99308, 99309, For more information, refer to the section titled Indicating the Type of Encounter with a Visit Code on page 48. Patients with their systolic and diastolic blood pressure recorded in their Vitals Note: The BP Vital item must be mapped in order for the system to recognize that this information has been recorded. For more information on mapping vitals, refer to the section titled Associating Vitals Fields with Vital Types on page 192. For more information, refer to the section titled Recording Patients Systolic and Diastolic Blood Pressure on page 73. Copyright eclinicalworks, LLC 2011, Meaningful Use Training Scenarios Guide 72

73 Recording a Hypertension Diagnosis The system looks in the Assessments section of the Progress Notes to determine whether a patient has an active diagnosis for Hypertension. Mid Office Workflow (for Denominators): 1. From the Progress Notes window, click the Assessments link. The Assessments window opens. 2. Click the category in the Assessments pane on the left that contains the applicable Hypertension assessment. The assessments in the selected category populate in the top-right pane. 3. Click the appropriate assessment in the top-right pane. IMPTANT! The following ICD-9 codes are considered by the system to be Hypertension diagnoses: 401.0, 401.1, 401.9, , , , , , , , , , , , , , , , , , , , , , , , You MUST select one of these codes for a patient to be included in the denominator for this measure. The selected assessment is added to the bottom-right pane and is now considered active for this patient. Recording Patients Systolic and Diastolic Blood Pressure The system looks at the Vitals section of the Progress Notes to determine if the systolic and diastolic blood pressure has been recorded for a patient. Note: The BP Vital item must be mapped in order for the system to recognize that this information has been recorded. For more information on mapping vitals, refer to the section titled Associating Vitals Fields with Vital Types on page 192. Mid Office Workflow (for Numerators): 1. From the Progress Notes window, click the Vitals link. The Vitals window opens. 2. Click in the BP field. If the Pop-up box is checked, the BP pop-up window opens. Otherwise, the BP field becomes editable. 3. Enter the blood pressure for this patient in mmhg format (systolic/diastolic). IMPTANT! Enter ONLY the appropriate numerical value (#/#) in this field. Do not enter any additional text (such as provider initials, unit of measurement, etc.) in this field or this measure will not be satisfied. If the pop-up window is being used, a sitting or standing value can be selected from the drop-down list, but only a numerical value should be entered in the free-text field on the left. 4. If entering this information on the pop-up window, click the Apply button. The systolic and diastolic blood pressure for this patient is now recorded. Copyright eclinicalworks, LLC 2011, Meaningful Use Training Scenarios Guide 73

74 Note: If multiple blood pressure readings are taken on the same day, the default value is used for measure calculation. The latest value entered is the default value, and it is displayed in bold on the BP pop-up window. To make a different value the default value, highlight a value in the right pane on the Vitals pop-up window and click the Default button: NQF Weight Assessment and Counseling for Children and Adolescents Description Providers must report the percentage of patients between the ages of 2 and 17 who have had an outpatient visit with their PCP or OB/GYN and who have had evidence of BMI percentile documentation, counseling for nutrition, and counseling for physical activity during the measurement year. Calculation Tables This section outlines how each denominator and numerator are calculated. For more detailed information on the steps required within the eclinicalworks application to satisfy each item, refer to the Calculation Lists section below. Denominator Between 2 and 16 years old AND Outpatient office visit with PCP or OB/GYN AND NOT Active diagnosis for pregnancy O R Any pregnancy encounters Copyright eclinicalworks, LLC 2011, Meaningful Use Training Scenarios Guide 74

75 Numerator 1 BMI percentile recorded in Vitals Numerator 2 Received nutrition counseling Numerator 3 Received physical activity counseling Calculation Lists These lists provide a link for to the appropriate steps involved in satisfying each item within the eclinicalworks application. For a more reader-friendly view of all possible methods of satisfying each denominator and numerator, refer to the Calculation Tables section above. Denominator Patients must meet the following criteria: Greater than or equal to 2 years of age and less than or equal to 16 years of age For more information, refer to the section titled Recording a Patient s Age on page 48. AND An outpatient office visit recorded during the reporting period with a PCP or OB/GYN Note: The following CPT codes are considered by the system to be outpatient encounters: 99201, 99202, 99203, 99204, 99205, 99211, 99212, 99213, 99214, 99215, 99217, 99218, 99219, 99220, 99241, 99242, 99243, 99244, 99245, 99341, 99342, 99343, 99344, 99345, , 99384, 99385, 99386, 99387, 99394, 99395, 99396, 99397, 99401, 99402, 99403, 99404, 99411, 99412, 99420, 99429, 99455, The following ICD-9 codes are considered by the system to be outpatient encounters: V70.0, V70.3, V70.5, V70.6, V70.8, V70.9 The following ICD-9 codes are considered by the system to be OB/GYN codes: V24, V25, V26, V27, V28, V45.5, V61.5, V61.6, V61.7, V69.2, V72.3, V72.4 For more information, refer to the section titled Indicating the Type of Encounter with a Visit Code on page 48. AND NOT An active diagnosis for pregnancy Copyright eclinicalworks, LLC 2011, Meaningful Use Training Scenarios Guide 75

76 Pregnancy ICD Codes Patients with one of the following ICD codes recorded on their Progress Notes are NOT included in the denominator for this measure: 630, 631, 632, 633, 633.0, , , 633.1, , , 633.2, , , 633.8, , , 633.9, , , 634, 634.0, , , , 634.1, , , , 634.2, , , , 634.3, , , , 634.4, , , , 634.5, , , , 634.6, , , , 634.7, , , , 634.8, , , , 634.9, , , , 635, 635.0, , , , 635.1, , , , 635.2, , , , 635.3, , , , 635.4, , , , 635.5, , , , 635.6, , , , 635.7, , , , 635.8, , , , 635.9, , , , 636, 636.0, , , , 636.1, , , , 636.2, , , , 636.3, , , , 636.4, , , , 636.5, , , , 636.6, , , , 636.7, , , , 636.8, , , , 636.9, , , , 637, 637.0, , , , 637.1, , , , 637.2, , , , 637.3, , , , 637.4, , , , 637.5, , , , 637.6, , , , 637.7, , , , 637.8, , , , 637.9, , , , 638, 638.0, 638.1, 638.2, 638.3, 638.4, 638.5, 638.6, 638.7, 638.8, 638.9, 639, 639.0, 639.1, 639.2, 639.3, 639.4, 639.5, 639.6, 639.8, 639.9, 640, 640.0, , , , 640.8, , , , 640.9, , , , 641, 641.0, , , , 641.1, , , , 641.2, , , , 641.3, , , , 641.8, , , , 641.9, , , , 642, 642.0, , , , , , 642.1, , , , , , 642.2, , , , , , 642.3, , , , , , 642.4, , , , , , 642.5, , , , , , 642.6, , , , , , 642.7, , , , , , 642.9, , , , , , 643, 643.0, , , , 643.1, , , , 643.2, , , , 643.8, , , , 643.9, , , , 644, 644.0, , , 644.1, , , 644.2, , , 645, 645.1, , , , 645.2, , , , 646, 646.0, , , , 646.1, , , , , , 646.2, , , , , , 646.3, , , , 646.4, , , , , , 646.5, , , , , , 646.6, , , , , , 646.7, , , , 646.8, , , , , , 646.9, , , , 647, 647.0, , , , , , 647.1, , , , , , 647.2, , , , , , 647.3, , , , , , 647.4, , , , , , 647.5, , , , , , 647.6, , , , , , 647.8, , , , , , 647.9, , , , , , 648, 648.0, , , , , , 648.1, , , , , , 648.2, , , , , , 648.3, , , , , , 648.4, , , , , , 648.5, , , , , , 648.6, , , , , , 648.7, , , , , , 648.8, , , , , , 648.9, , , , , , 649, 649.0, , , , , , 649.1, , , , , , 649.2, , , , , , 649.3, , , , , , 649.4, , , , , , 649.5, , , , 649.6, , , , , , 649.7, , , , 650, 651, 651.0, , , 648.7, , , , , , 648.8, , , , , , 648.9, , , , , , 649, 649.0, , , , , , 649.1, , , , , , 649.2, , , , , , 649.3, , , , , , 649.4, , , , , , 649.5, , , , 649.6, (continued on next page) Copyright eclinicalworks, LLC 2011, Meaningful Use Training Scenarios Guide 76

77 Pregnancy ICD Codes (continued from previous page) , , , , 649.7, , , , 650, 651, 651.0, , , , 651.1, , , , 651.2, , , , 651.3, , , , 651.4, , , , 651.5, , , , 651.6, , , , 651.7, , , , 651.8, , , , 651.9, , , , 652, 652.0, , , , 652.1, , , , 652.2, , , , 652.3, , , , 652.4, , , , 652.5, , , , 652.6, , , , 652.7, , , , 652.8, , , , 652.9, , , , 653, 653.0, , , , 653.1, , , , 653.2, , , , 653.3, , , , 653.4, , , , 653.5, , , , 653.6, , , , 653.7, , , , 653.8, , , , 653.9, , , , 654, 654.0, , , , , , 654.1, , , , , , 654.2, , , , 654.3, , , , , , 654.4, , , , , , 654.5, , , , , , 654.6, , , , , , 654.7, , , , , , 654.8, , , , , , 654.9, , , , , , 655, 655.0, , , , 655.1, , , , 655.2, , , , 655.3, , , , 655.4, , , , 655.5, , , , 655.6, , , , 655.7, , , , 655.8, , , , 655.9, , , , 656, 656.0, , , , 656.1, , , , 656.2, , , , 656.3, , , , 656.4, , , , 656.5, , , , 656.6, , , , 656.7, , , , 656.8, , , , 656.9, , , , 657, 657.0, , , , 658, 658.0, , , , 658.1, , , , 658.2, , , , 658.3, , , , 658.4, , , , 658.8, , , , 658.9, , , , 659, 659.0, , , , 659.1, , , , 659.2, , , , 659.3, , , , 659.4, , , , 659.5, , , , 659.6, , , , 659.7, , , , 659.8, , , , 659.9, , , , 660, 660.0, , , , 660.1, , , , 660.2, , , , 660.3, , , , 660.4, , , , 660.5, , , , 660.6, , , , 660.7, , , , 660.8, , , , 660.9, , , , 661, 661.0, , , , 661.1, , , , 661.2, , , , 661.3, , , , 661.4, , , , 661.9, , , , 662, 662.0, , , , 662.1, , , , 662.2, , , , 662.3, , , , 663, 663.0, , , , 663.1, , , , 663.2, , , , 663.3, , , , 663.4, , , , 663.5, , , , 663.6, , , , 663.8, , , , 663.9, , , , 664, 664.0, , , , 664.1, , , , 664.2, , , , 664.3, , , , 664.4, , , , 664.5, , , , 664.6, , , , 664.8, , , , 664.9, , , , 665, 665.0, , , , 665.1, , , 665.2, , , , 665.3, , , , 665.4, , , , 665.5, , , , 665.6, , , , 665.7, , , , , 665.8, , , , , , 665.9, , , , , , 666, 666.0, , , , 666.1, , , , 666.2, , , , 666.3, , , , 667, 667.0, , , , 667.1, , , , 668, 668.0, , , , , , 668.1, , , , , , 668.2, , , , , , 668.8, , , , , , 668.9, , , , , , 669, 669.0, , , , , , (continued on next page) Copyright eclinicalworks, LLC 2011, Meaningful Use Training Scenarios Guide 77

78 AND NOT Any pregnancy encounters Pregnancy ICD Codes (continued from previous page)...,, , , , , , 669.2, , , , , , 669.3, , , , 669.4, , , , , , 669.5, , , 669.6, , , 669.7, , , 669.8, , , , , , 669.9, , , , , , 670, 670.0, , , , 671, 671.0, , , , , , 671.1, , , , , , 671.2, , , , , , 671.3, , , , 671.4, , , , 671.5, , , , , , 671.8, , , , , , 671.9, , , , , , 672, 672.0, , , , 673, 673.0, , , , , , 673.1, , , , , , 673.2, , , , , , 673.3, , , , , , 673.8, , , , , , 674, 674.0, , , , , , 674.1, , , , 674.2, , , , 674.3, , , , 674.4, , , , 674.5, , , , , , 674.8, , , , 674.9, , , , 675, 675.0, , , , , , 675.1, , , , , , 675.2, , , , , , 675.8, , , , , , 675.9, , , , , , 676, 676.0, , , , , , 676.1, , , , , , 676.2, , , , , , 676.3, , , , , , 676.4, , , , , , 676.5, , , , , , 676.6, , , , , , 676.8, , , , , , 676.9, , , , , , 677, 678, 678.0, , , , 678.1, , , , 679, 679.0, , , , , , 679.1, , , , , , V22, V22.0, V22.1, V22.2, V23, V23.0, V23.1, V23.2, V23.3, V23.4, V23.41, V23.49, V23.5, V23.7, V23.8, V23.81, V23.82, V23.83, V23.84, V23.85, V23.86, V23.89, V23.9, V28, V28.0, V28.1, V28.2, V28.3, V28.4, V28.5, V28.6, V28.8, V28.81, V28.82, V28.89, V28.9 Note: Patients with one of the following codes recorded on their Progress Notes are NOT included in the denominator for this measure: V24, V24.0, V24.2, V25, V25.01, V25.02, V25.03, V25.09, V26.81, V28, V28.3, V28.81, V28.82, V72.4, V72.40, V72.41, V72.42 Numerator 1 Patients are included in this numerator if they have had their BMI percentile recorded during the reporting period. For more information on recording BMI on the Vitals window, refer to the section titled Recording BMI for a Patient on page 50. Note: Both the BMI and BMI percentile must be configured properly in order for the BMI percentile to calculate. For more information on configuring vitals, refer to the section titled Associating Vitals Fields with Vital Types on page 192. Copyright eclinicalworks, LLC 2011, Meaningful Use Training Scenarios Guide 78

79 Note: BMI percentile can also be recorded by including one of the following ICD codes on the Progress Notes: V85.5, V85.51, V85.52, V85.53, V85.54 For more information on recording ICD codes on the Progress Notes, refer to the section titled Recording an Active Diagnosis with ICD-9 Codes on page 115. Numerator 2 Patients are included in this numerator if they have received nutrition counseling during the reporting period. Note: Nutrition counseling can be indicated by including one of the following CPT/ HCPCS codes on the Progress Notes: 97802, 97803, Nutrition counseling can also be indicated by including one of the following HCPCS codes on the Progress Notes: G0270, G0271, S9449, S9452, S9470 For more information on recording procedures with CPT/HCPCS codes, refer to the section titled Recording a Procedure with a CPT/HCPCS Code on page 80. Note: Nutrition counseling can be indicated by including the following ICD code on the Progress Notes: V65.3 For more information on recording ICD codes on the Progress Notes, refer to the section titled Recording an Active Diagnosis with ICD-9 Codes on page 115. Numerator 3 Patients are included in this numerator if they have received physical activity counseling during the reporting period. Note: Physical counseling can also be indicated by including one of the following HCPCS code on the Progress Notes: S9451 For more information on recording procedures with CPT/HCPCS codes, refer to the section titled Recording a Procedure with a CPT/HCPCS Code on page 80. Note: Nutrition counseling can be indicated by including the following ICD code on the Progress Notes: V65.41 For more information on recording ICD codes on the Progress Notes, refer to the section titled Recording an Active Diagnosis with ICD-9 Codes on page 115. Copyright eclinicalworks, LLC 2011, Meaningful Use Training Scenarios Guide 79

80 Recording a Procedure with a CPT/HCPCS Code CPT/HCPCS codes are recorded in the Procedures section of the Progress Notes window. Mid Office Workflow (for Numerators): 1. From the Progress Notes window, click the Procedure Codes link. The Billing window opens. 2. Click the Add CPT button. The Procedures, Immunizations window opens: 3. In the left pane, highlight the category containing the code you want to record. The codes contained in the selected category display in the center pane. 4. In the center pane, click a code. Note: You can search for a specific code using the filters above the center pane. For more information on these filters, refer to the Electronic Medical Records Users Guide. The selected code is added to the bottom-right pane. 5. Click the OK button. The selected code is now recorded on the Progress Notes. NQF Influenza Immunization for Patients 50 Years Old and Older Description Providers must report the percentage of patients aged 50 years old or older who have received an influenza immunization during the flu season (September through February). Calculation Tables This section outlines how each denominator and numerator are calculated. For more detailed information on the steps required within the eclinicalworks application to satisfy each item, refer to the Calculation Lists section below. Copyright eclinicalworks, LLC 2011, Meaningful Use Training Scenarios Guide 80

81 Denominator Over 50 years old AND Two outpatient encounters AND An influenza encounter O R One encounter of the following types: Preventive Medicine Services 40 and Older Preventive Medicine Group Counseling Preventive Medicine - Internal Counseling Preventive Medicine Other Services Nursing Facility Nursing Discharge Numerator Influenza immunization administered during influenza encounter Copyright eclinicalworks, LLC 2011, Meaningful Use Training Scenarios Guide 81

82 Patient Exclusions Allergic to eggs Allergic to influenza immunizations Adverse events related to influenza immunizations Intolerance for influenza immunizations Contraindications for influenza immunizations Declined to receive influenza immunizations Active diagnosis for influenza immunization contraindications Any other patient, medical, or system reason for not administering an influenza immunization Calculation Lists These lists provide a link for to the appropriate steps involved in satisfying each item within the eclinicalworks application. For a more reader-friendly view of all possible methods of satisfying each denominator and numerator, refer to the Calculation Tables section above. Denominator Patients must meet the following criteria: Greater than or equal to 50 years of age For more information, refer to the section titled Recording a Patient s Age on page 48. AND One of the following methods of indicating the proper encounter(s): Two outpatient encounters Note: The following codes are considered by the system to be outpatient encounters: 99201, 99202, 99203, 99204, 99205, 99212, 99213, 99214, 99215, 99241, 99242, 99243, 99244, 99245, 99324, 99325, 99326, 99327, 99328, 99334, 99335, 99336, 99337, 99341, 99342, 99343, 99344, 99345, 99347, 99348, 99349, For more information, refer to the section titled Indicating the Type of Encounter with a Visit Code on page 48. Copyright eclinicalworks, LLC 2011, Meaningful Use Training Scenarios Guide 82

83 One encounter of one of the following types: Preventive Medicine Services 40 and Older AND Note: The following codes are considered by the system to be Preventive Medicine Services 18 and Older encounters: 99386, 99387, 99396, Preventive Medicine Group Counseling Note: The following codes are considered by the system to be Preventive Medicine Group Counseling encounters: 99411, Preventive Medicine - Individual Counseling Note: The following codes are considered by the system to be Preventive Medicine - Individual Counseling encounters: 99401, 99402, 99403, Preventive Medicine Other Services Note: The following codes are considered by the system to be Preventive Medicine Other Services encounters: 99420, Nursing Facility Note: The following codes are considered by the system to be Nursing Facility encounters: 99304, 99305, 99306, 99307, 99308, 99309, Nursing Discharge Note: The following codes are considered by the system to be Nursing Discharge encounters: 99315, For more information, refer to the section titled Indicating the Type of Encounter with a Visit Code on page 48. An influenza encounter after or simultaneous to the reporting period Note: An influenza encounter in this instance is considered to be any encounter that uses one of the codes noted above in this denominator. For more information, refer to the section titled Indicating the Type of Encounter with a Visit Code on page 48. Copyright eclinicalworks, LLC 2011, Meaningful Use Training Scenarios Guide 83

84 Numerator Patients are included in the numerator if they have had an influenza immunization administered during an influenza encounter. For more information, refer to the section titled Recording the Administration of an Immunization on page 116. IMPTANT! The appropriate CVX code must be associated with this immunization in order to satisfy the measure. For more information, refer to the section titled Associating a CVX Code with an Immunization on page 84. Patient Exclusions The following patients are excluded from this measure: Patients with an allergy to eggs before or simultaneous to the influenza encounter Patients with an allergy to influenza immunizations before or simultaneous to the influenza encounter Patients with an adverse event related to influenza immunizations before or simultaneous to the influenza encounter Patients with an intolerance for influenza immunizations before or simultaneous to the influenza encounter Patients with a contraindication for influenza immunizations before or simultaneous to the influenza encounter Patients that have declined to receive an influenza immunization before or simultaneous to the influenza encounter Patients with an active diagnosis for an influenza immunization contraindication before or simultaneous to the influenza encounter Patients that have not received an influenza immunization for one of the following reasons: Patient reason Medical reason System reason IMPTANT! The system does not automatically recognize the exclusion criteria, so patients that meet ANY of the above criteria must be manually marked as excluded. For more information on manually marking patients as excluded, refer to the section titled Manually Marking a Patient as Excluded on page 57. Associating a CVX Code with an Immunization The appropriate CVX code must be associated with an immunization in order for that immunization to be included in eclinicalworks calculations for Clinical Quality Measures. System Admin Workflow (for Numerators): 1. From the EMR menu, hover over the Immunizations option to open a drop-down list. 2. From the drop-down list, click the Immunizations option. The Immunization window opens. 3. Click the New button. The New Immunization window opens. Copyright eclinicalworks, LLC 2011, Meaningful Use Training Scenarios Guide 84

85 4. Click the Sel button next to the CVX Code field: The CDC CPT CVX table window opens. 5. Highlight the appropriate CVX code and click the Select button. The CDC CPT CVS table window closes and the selected CVX code is populated in the CVX Code field on the New Immunization window. 6. Enter any additional information as required. 7. Click the OK button. This immunization is now created with an associated CVX code. NQF Childhood Immunization Status Description Providers must report the percentage of children 2 years of age who have had the following vaccinations by their second birthday: four (4) diphtheria, tetanus, and acellular pertussis (DTaP) three (3) polio (IPV); one measles, mumps, and rubella (MMR) two (2) H influenza type B (HiB) three (3) hepatitis B (Hep B) one (1) chicken pox (VZV) four (4) pneumococcal conjugate (PCV) two (2) hepatitis A (Hep A) two (2) or three (3) rotavirus (RV) two (2) influenza (flu) A separate percentage is calculated and reported to CMS for each vaccine, along with two additional combined percentages. Calculation Tables This section outlines how each denominator and numerator are calculated. For more detailed information on the steps required within the eclinicalworks application to satisfy each item, refer to the Calculation Lists section below. Copyright eclinicalworks, LLC 2011, Meaningful Use Training Scenarios Guide 85

86 Denominator Between 1 and 2 years old AND Outpatient office visit with PCP or OB/GYN Numerator 1 4 or more DTaP immunizations (between 42 days and 2 years old) AND NOT Allergic to DTaP vaccine O R Active diagnosis for encephalopathy O R Active diagnosis for progressive neurological disorder Numerator 2 3 or more IPV immunizations (between 42 days and 2 years old) AND NOT Allergic to IPV vaccine O R Allergic to neomycin O R Allergic to streptomycin O R Allergic to polymyxin Copyright eclinicalworks, LLC 2011, Meaningful Use Training Scenarios Guide 86

87 Numerator 3 1 or more IPV immunizations (between 42 days and 2 years old) 2 or more mumps immunizations (before 2 years old) A N D 2 or more measles immunizations (before 2 years old) A N D 2 or more rubella immunizations (before 2 years old) AND NOT AND NOT AND NOT Allergic to mumps vaccine Allergic to measles vaccine Allergic to rubella vaccine A resolved diagnosis for measles A N D 2 or more mumps immunizations (before 2 years old) A N D 2 or more rubella immunizations (before 2 years old) AND NOT AND NOT Allergic to mumps vaccine Allergic to rubella vaccine A resolved diagnosis for mumps A N D 2 or more measles immunizations (before 2 years old) A N D 2 or more rubella immunizations (before 2 years old) AND NOT AND NOT Allergic to measles vaccine Allergic to rubella vaccine A resolved diagnosis for rubella A N D 2 or more mumps immunizations (before 2 years old) A N D 2 or more measles immunizations (before 2 years old) AND NOT AND NOT Allergic to mumps vaccine Allergic to measles vaccine AND NOT Active diagnosis for cancer of lymphoreticular or histiocytic tissue O R Inactive diagnosis for cancer of lymphoreticular or histiocytic tissue O R Active diagnosis for asymptomatic HIV O R Active diagnosis for multiple myeloma O R Active diagnosis for leukemia O R Allergic to MMR vaccine O R Active diagnosis for cancer of immunodeficiency Copyright eclinicalworks, LLC 2011, Meaningful Use Training Scenarios Guide 87

88 Numerator 4 2 or more HiB immunizations (between 42 days and 2 years old) AND NOT Allergic to the HiB vaccine Numerator 5 3 or more Hepatitis B immunizations (before 2 years old) AND NOT Allergic to baker s yeast O R O R Resolved diagnosis for Hepatitis B Allergic to Hepatitis B vaccine Numerator 6 1 or more VZV immunizations (before 2 years old) O R Resolved diagnosis for chicken pox AND NOT Active diagnosis for cancer of lymphoreticular or histiocytic tissue O R Inactive diagnosis for cancer of lymphoreticular or histiocytic tissue O R Active diagnosis for asymptomatic HIV O R Active diagnosis for multiple myeloma O R Active diagnosis for leukemia O R Allergic to VZV vaccine O R Active diagnosis for cancer of immunodeficiency Numerator 7 4 or more pneumococcal immunizations (between 42 days and 2 years old) AND NOT Allergic to the pneumococcal vaccine Copyright eclinicalworks, LLC 2011, Meaningful Use Training Scenarios Guide 88

89 Numerator 8 2 or more Hepatitis A immunizations (before 2 years old) AND NOT O R Resolved diagnosis for Hepatitis A Allergic to Hepatitis A vaccine Numerator 9 2 or more rotavirus immunizations (between 42 days and 2 years old) AND NOT Allergic to the rotavirus vaccine Numerator 10 2 or more influenza immunizations (between 180 days and 2 years old) AND NOT Active diagnosis for cancer of lymphoreticular or histiocytic tissue O R Inactive diagnosis for cancer of lymphoreticular or histiocytic tissue O R Active diagnosis for asymptomatic HIV O R Active diagnosis for multiple myeloma O R Active diagnosis for leukemia O R Allergic to influenza vaccine O R Active diagnosis for cancer of immunodeficiency Copyright eclinicalworks, LLC 2011, Meaningful Use Training Scenarios Guide 89

90 Numerator 11 Numerator 1 AND 3 or more IPV immunizations (between 42 days and 2 years old) AND Numerator 3 AND Numerator 6 AND Numerator 5 A N D N O T Allergic to IPV vaccine Allergic to neomycin Allergic to streptomycin Numerator 12 Numerator 1 AND 3 or more IPV immunizations (between 42 days and 2 years old) AND Numerator 3 AND Numerator 6 AND Numerator 5 AND Numerator 7 A N D N O T Allergic to IPV vaccine Allergic to neomycin Allergic to streptomycin Copyright eclinicalworks, LLC 2011, Meaningful Use Training Scenarios Guide 90

91 Calculation Lists These lists provide a link for to the appropriate steps involved in satisfying each item within the eclinicalworks application. For a more reader-friendly view of all possible methods of satisfying each denominator and numerator, refer to the Calculation Tables section above. Denominator Patients must meet the following criteria: Greater than or equal to 1 years of age and less than 2 years of age (to capture all patients who will reach 2 years during the reporting period) For more information, refer to the section titled Recording a Patient s Age on page 48. AND An outpatient office visit recorded during the reporting period with a PCP or OB/GYN Note: The following CPT codes are considered by the system to be outpatient encounters: 99201, 99202, 99203, 99204, 99205, 99211, 99212, 99213, 99214, 99215, 99217, 99218, 99219, 99220, 99241, 99242, 99243, 99244, 99245, 99341, 99342, 99343, 99344, 99345, , 99384, 99385, 99386, 99387, 99394, 99395, 99396, 99397, 99401, 99402, 99403, 99404, 99411, 99412, 99420, 99429, 99455, The following ICD-9 codes are considered by the system to be outpatient encounters: V70.0, V70.3, V70.5, V70.6, V70.8, V70.9 The following ICD-9 codes are considered by the system to be OB/GYN codes: V24, V25, V26, V27, V28, V45.5, V61.5, V61.6, V61.7, V69.2, V72.3, V72.4 For more information, refer to the section titled Indicating the Type of Encounter with a Visit Code on page 48. Numerator 1 Patients are included in this numerator if they have received 4 or more counts of the DTaP vaccine on different dates starting at greater than or equal to 42 days after the patient s birth and ending less than 2 years after the patient s date of birth. For more information, refer to the section titled Recording the Administration of an Immunization on page 116. IMPTANT! The appropriate CVX code must be associated with this immunization in order to satisfy the measure. For more information, refer to the section titled Associating a CVX Code with an Immunization on page 84. AND NOT An allergy recorded for the DTaP vaccine For more information on recording allergies, refer to the section titled Documenting a Structured Allergy on page 187. Note: The appropriate CVX code must be associated with this immunization in order to satisfy the measure. For more information, refer to the section titled Associating a CVX Code with an Immunization on page 84. Copyright eclinicalworks, LLC 2011, Meaningful Use Training Scenarios Guide 91

92 An active diagnosis for encephalopathy Note: The following ICD-9 code is considered by the system to indicate an encephalopathy diagnosis: For more information, refer to the section titled Recording an Active Diagnosis with ICD- 9 Codes on page 115. An active diagnosis for progressive neurological disorder For more information, refer to the section titled Recording an Active Diagnosis with ICD- 9 Codes on page 115. Numerator 2 Patients are included in this numerator if they have received 3 or more counts of IPV on different dates starting at greater than or equal to 42 days after the patient s birth and ending less than 2 years after the patient s date of birth. For more information, refer to the section titled Recording the Administration of an Immunization on page 116. IMPTANT! The appropriate CVX code must be associated with this immunization in order to satisfy the measure. For more information, refer to the section titled Associating a CVX Code with an Immunization on page 84. AND NOT An allergy recorded for the IPV For more information on recording allergies, refer to the section titled Documenting a Structured Allergy on page 187. An allergy recorded for neomycin For more information on recording allergies, refer to the section titled Documenting a Structured Allergy on page 187. An allergy recorded for streptomycin For more information on recording allergies, refer to the section titled Documenting a Structured Allergy on page 187. An allergy recorded for polymyxin For more information on recording allergies, refer to the section titled Documenting a Structured Allergy on page 187. Numerator 3 Patients are included in this numerator if 1 or more counts of the MMR vaccine have been administered less than 2 years after the patient s date of birth. For more information, refer to the section titled Recording the Administration of an Immunization on page 116. Copyright eclinicalworks, LLC 2011, Meaningful Use Training Scenarios Guide 92

93 IMPTANT! The appropriate CVX code must be associated with this immunization in order to satisfy the measure. For more information, refer to the section titled Associating a CVX Code with an Immunization on page 84. Alternate Method 1: More than 1 count of the mumps vaccine administered less than two years after the patient s date of birth. For more information, refer to the section titled Recording the Administration of an Immunization on page 116. IMPTANT! The appropriate CVX code must be associated with this immunization in order to satisfy the measure. For more information, refer to the section titled Associating a CVX Code with an Immunization on page 84. AND NOT An allergy for the mumps vaccine AND For more information on recording allergies, refer to the section titled Documenting a Structured Allergy on page 187. More than 1 count of the measles vaccine administered less than two years after the patient s date of birth. For more information, refer to the section titled Recording the Administration of an Immunization on page 116. IMPTANT! The appropriate CVX code must be associated with this immunization in order to satisfy the measure. For more information, refer to the section titled Associating a CVX Code with an Immunization on page 84. AND NOT An allergy for the measles vaccine AND For more information on recording allergies, refer to the section titled Documenting a Structured Allergy on page 187. More than 1 count of the rubella vaccine administered less than two years after the patient s date of birth. For more information, refer to the section titled Recording the Administration of an Immunization on page 116. IMPTANT! The appropriate CVX code must be associated with this immunization in order to satisfy the measure. For more information, refer to the section titled Associating a CVX Code with an Immunization on page 84. AND NOT An allergy for the rubella vaccine For more information on recording allergies, refer to the section titled Documenting a Structured Allergy on page 187. Alternate Method 2: Copyright eclinicalworks, LLC 2011, Meaningful Use Training Scenarios Guide 93

94 A resolved diagnosis for measles AND More than 1 count of the mumps vaccine administered less than two years after the patient s date of birth. For more information, refer to the section titled Recording the Administration of an Immunization on page 116. IMPTANT! The appropriate CVX code must be associated with this immunization in order to satisfy the measure. For more information, refer to the section titled Associating a CVX Code with an Immunization on page 84. AND NOT An allergy for the mumps vaccine AND For more information on recording allergies, refer to the section titled Documenting a Structured Allergy on page 187. More than 1 count of the rubella vaccine administered less than two years after the patient s date of birth. For more information, refer to the section titled Recording the Administration of an Immunization on page 116. IMPTANT! The appropriate CVX code must be associated with this immunization in order to satisfy the measure. For more information, refer to the section titled Associating a CVX Code with an Immunization on page 84. AND NOT An allergy for the rubella vaccine For more information on recording allergies, refer to the section titled Documenting a Structured Allergy on page 187. Alternate Method 3: A resolved diagnosis for mumps AND More than 1 count of the measles vaccine administered less than two years after the patient s date of birth. For more information, refer to the section titled Recording the Administration of an Immunization on page 116. IMPTANT! The appropriate CVX code must be associated with this immunization in order to satisfy the measure. For more information, refer to the section titled Associating a CVX Code with an Immunization on page 84. AND NOT An allergy for the measles vaccine AND For more information on recording allergies, refer to the section titled Documenting a Structured Allergy on page 187. More than 1 count of the rubella vaccine administered less than two years after the patient s date of birth. Copyright eclinicalworks, LLC 2011, Meaningful Use Training Scenarios Guide 94

95 For more information, refer to the section titled Recording the Administration of an Immunization on page 116. IMPTANT! The appropriate CVX code must be associated with this immunization in order to satisfy the measure. For more information, refer to the section titled Associating a CVX Code with an Immunization on page 84. AND NOT An allergy for the rubella vaccine For more information on recording allergies, refer to the section titled Documenting a Structured Allergy on page 187. Alternate Method 4: A resolved diagnosis for rubella AND More than 1 count of the mumps vaccine administered less than two years after the patient s date of birth. For more information, refer to the section titled Recording the Administration of an Immunization on page 116. IMPTANT! The appropriate CVX code must be associated with this immunization in order to satisfy the measure. For more information, refer to the section titled Associating a CVX Code with an Immunization on page 84. AND NOT An allergy for the mumps vaccine AND For more information on recording allergies, refer to the section titled Documenting a Structured Allergy on page 187. More than 1 count of the measles vaccine administered less than two years after the patient s date of birth. For more information, refer to the section titled Recording the Administration of an Immunization on page 116. IMPTANT! The appropriate CVX code must be associated with this immunization in order to satisfy the measure. For more information, refer to the section titled Associating a CVX Code with an Immunization on page 84. AND NOT An allergy for the measles vaccine AND NOT For more information on recording allergies, refer to the section titled Documenting a Structured Allergy on page 187. An active diagnosis for cancer of lymphoreticular or histiocytic tissue Note: The following ICD-9 codes are considered by the system to indicate a cancer of lymphoreticular or histiocytic tissue diagnosis: 201, 202, 203 Copyright eclinicalworks, LLC 2011, Meaningful Use Training Scenarios Guide 95

96 For more information, refer to the section titled Recording an Active Diagnosis with ICD- 9 Codes on page 115. An inactive diagnosis for cancer of lymphoreticular or histiocytic tissue An active diagnosis for asymptomatic HIV Note: The following ICD-9 codes are considered by the system to indicate an asymptomatic HIV diagnosis: 042, V08 For more information, refer to the section titled Recording an Active Diagnosis with ICD- 9 Codes on page 115. An active diagnosis for multiple myeloma Note: The following ICD-9 code is considered by the system to indicate a multiple myeloma diagnosis: 203 For more information, refer to the section titled Recording an Active Diagnosis with ICD- 9 Codes on page 115. An active diagnosis for leukemia Note: The following ICD-9 codes are considered by the system to indicate a leukemia diagnosis: 200, 202, 204, 205, 206, 207, 208 For more information, refer to the section titled Recording an Active Diagnosis with ICD- 9 Codes on page 115. An allergy recorded for the MMR vaccine For more information on recording allergies, refer to the section titled Documenting a Structured Allergy on page 187. An active diagnosis for cancer of immunodeficiency Note: The following ICD-9 code is considered by the system to indicate a cancer of immunodeficiency diagnosis: 279 For more information, refer to the section titled Recording an Active Diagnosis with ICD- 9 Codes on page 115. Numerator 4 Patients are included in this numerator if they have received 2 or more counts of the HiB vaccine on different dates starting at greater than or equal to 42 days after the patient s birth and ending less than 2 years after the patient s date of birth. Copyright eclinicalworks, LLC 2011, Meaningful Use Training Scenarios Guide 96

97 For more information, refer to the section titled Recording the Administration of an Immunization on page 116. IMPTANT! The appropriate CVX code must be associated with this immunization in order to satisfy the measure. For more information, refer to the section titled Associating a CVX Code with an Immunization on page 84. AND NOT An allergy recorded for the HiB vaccine For more information on recording allergies, refer to the section titled Documenting a Structured Allergy on page 187. Numerator 5 Patients are included in this numerator if they have had one of the following: 3 or more counts of the Hepatitis B vaccine administered on different dates less than 2 years after the patient s date of birth. For more information, refer to the section titled Recording the Administration of an Immunization on page 116. Note: The appropriate CVX code must be associated with this immunization in order to satisfy the measure. For more information, refer to the section titled Associating a CVX Code with an Immunization on page 84. A resolved Hepatitis B diagnosis AND NOT An allergy recorded for baker s yeast For more information on recording allergies, refer to the section titled Documenting a Structured Allergy on page 187. An allergy recorded for the Hepatitis B vaccine For more information on recording allergies, refer to the section titled Documenting a Structured Allergy on page 187. Numerator 6 Patients are included in this numerator if they have had one of the following: 1 or more counts of a VZV administered less than 2 years after the patient s date of birth. For more information, refer to the section titled Recording the Administration of an Immunization on page 116. Note: The appropriate CVX code must be associated with this immunization in order to satisfy the measure. For more information, refer to the section titled Associating a CVX Code with an Immunization on page 84. A resolved chicken pox diagnosis AND NOT An active diagnosis for cancer of lymphoreticular or histiocytic tissue Copyright eclinicalworks, LLC 2011, Meaningful Use Training Scenarios Guide 97

98 Note: The following ICD-9 codes are considered by the system to indicate a cancer of lymphoreticular or histiocytic tissue diagnosis: 201, 202, 203 For more information, refer to the section titled Recording an Active Diagnosis with ICD-9 Codes on page 115. An inactive diagnosis for cancer of lymphoreticular or histiocytic tissue An active diagnosis for asymptomatic HIV Note: The following ICD-9 codes are considered by the system to indicate an asymptomatic HIV diagnosis: 042, V08 For more information, refer to the section titled Recording an Active Diagnosis with ICD-9 Codes on page 115. An active diagnosis for multiple myeloma Note: The following ICD-9 code is considered by the system to indicate a multiple myeloma diagnosis: 203 For more information, refer to the section titled Recording an Active Diagnosis with ICD-9 Codes on page 115. An active diagnosis for leukemia Note: The following ICD-9 codes are considered by the system to indicate a leukemia diagnosis: 200, 202, 204, 205, 206, 207, 208 For more information, refer to the section titled Recording an Active Diagnosis with ICD-9 Codes on page 115. An allergy recorded for the VZV For more information on recording allergies, refer to the section titled Documenting a Structured Allergy on page 187. An active diagnosis for cancer of immunodeficiency Note: The following ICD-9 code is considered by the system to indicate a cancer of immunodeficiency diagnosis: 279 For more information, refer to the section titled Recording an Active Diagnosis with ICD-9 Codes on page 115. Copyright eclinicalworks, LLC 2011, Meaningful Use Training Scenarios Guide 98

99 Numerator 7 Patients are included in this numerator if they have received 4 or more counts of the pneumococcal vaccine on different dates starting at greater than or equal to 42 days after the patient s birth and ending less than 2 years after the patient s date of birth. For more information, refer to the section titled Recording the Administration of an Immunization on page 116. IMPTANT! The appropriate CVX code must be associated with this immunization in order to satisfy the measure. For more information, refer to the section titled Associating a CVX Code with an Immunization on page 84. AND NOT An allergy recorded for the pneumococcal vaccine For more information on recording allergies, refer to the section titled Documenting a Structured Allergy on page 187. Numerator 8 Patients are included in this numerator if they have had one of the following: 2 or more counts of the Hepatitis A vaccine administered on different dates less than 2 years after the patient s date of birth. For more information, refer to the section titled Recording the Administration of an Immunization on page 116. Note: The appropriate CVX code must be associated with this immunization in order to satisfy the measure. For more information, refer to the section titled Associating a CVX Code with an Immunization on page 84. A resolved Hepatitis A diagnosis AND NOT An allergy recorded for the Hepatitis A vaccine For more information on recording allergies, refer to the section titled Documenting a Structured Allergy on page 187. Numerator 9 Patients are included in this numerator if they have received 2 or more counts of the rotavirus vaccine on different dates starting at greater than or equal to 42 days after the patient s birth and ending less than 2 years after the patient s date of birth. For more information, refer to the section titled Recording the Administration of an Immunization on page 116. IMPTANT! The appropriate CVX code must be associated with this immunization in order to satisfy the measure. For more information, refer to the section titled Associating a CVX Code with an Immunization on page 84. AND NOT An allergy recorded for the rotavirus vaccine For more information on recording allergies, refer to the section titled Documenting a Structured Allergy on page 187. Copyright eclinicalworks, LLC 2011, Meaningful Use Training Scenarios Guide 99

100 Numerator 10 Patients are included in this numerator if they have received 2 or more counts of the influenza vaccine on different dates starting at greater than or equal to 180 days after the patient s birth and ending less than 2 years after the patient s date of birth. For more information, refer to the section titled Recording the Administration of an Immunization on page 116. IMPTANT! The appropriate CVX code must be associated with this immunization in order to satisfy the measure. For more information, refer to the section titled Associating a CVX Code with an Immunization on page 84. AND NOT An active diagnosis for cancer of lymphoreticular or histiocytic tissue Note: The following ICD-9 codes are considered by the system to indicate a cancer of lymphoreticular or histiocytic tissue diagnosis: 201, 202, 203 For more information, refer to the section titled Recording an Active Diagnosis with ICD- 9 Codes on page 115. An inactive diagnosis for cancer of lymphoreticular or histiocytic tissue An active diagnosis for asymptomatic HIV Note: The following ICD-9 codes are considered by the system to indicate an asymptomatic HIV diagnosis: 042, V08 For more information, refer to the section titled Recording an Active Diagnosis with ICD- 9 Codes on page 115. An active diagnosis for multiple myeloma Note: The following ICD-9 code is considered by the system to indicate a multiple myeloma diagnosis: 203 For more information, refer to the section titled Recording an Active Diagnosis with ICD- 9 Codes on page 115. An active diagnosis for leukemia Note: The following ICD-9 codes are considered by the system to indicate a leukemia diagnosis: 200, 202, 204, 205, 206, 207, 208 For more information, refer to the section titled Recording an Active Diagnosis with ICD- 9 Codes on page 115. Copyright eclinicalworks, LLC 2011, Meaningful Use Training Scenarios Guide 100

101 An allergy recorded for the influenza vaccine For more information on recording allergies, refer to the section titled Documenting a Structured Allergy on page 187. An active diagnosis for cancer of immunodeficiency Note: The following ICD-9 code is considered by the system to indicate a cancer of immunodeficiency diagnosis: 279 For more information, refer to the section titled Recording an Active Diagnosis with ICD- 9 Codes on page 115. Numerator 11 4 or more counts of the DTaP vaccine administered on different dates starting at greater than or equal to 42 days after the patient s birth and ending less than 2 years after the patient s date of birth. For more information, refer to the section titled Recording the Administration of an Immunization on page 116. Note: The appropriate CVX code must be associated with this immunization in order to satisfy the measure. For more information, refer to the section titled Associating a CVX Code with an Immunization on page 84. AND NOT An allergy for the DTaP vaccine For more information on recording allergies, refer to the section titled Documenting a Structured Allergy on page 187. An active diagnosis for encephalopathy AND Note: The following ICD-9 code is considered by the system to indicate an encephalopathy diagnosis: For more information, refer to the section titled Recording an Active Diagnosis with ICD-9 Codes on page 115. An active diagnosis for progressive neurological disorder 3 or more counts of the IPV administered on different dates starting at greater than or equal to 42 days after the patient s birth and ending less than 2 years after the patient s date of birth. For more information, refer to the section titled Recording the Administration of an Immunization on page 116. Note: The appropriate CVX code must be associated with this immunization in order to satisfy the measure. For more information, refer to the section titled Associating a CVX Code with an Immunization on page 84. AND NOT Copyright eclinicalworks, LLC 2011, Meaningful Use Training Scenarios Guide 101

102 AND An allergy for the IPV For more information on recording allergies, refer to the section titled Documenting a Structured Allergy on page 187. An allergy for neomycin For more information on recording allergies, refer to the section titled Documenting a Structured Allergy on page 187. An allergy for streptomycin For more information on recording allergies, refer to the section titled Documenting a Structured Allergy on page or more counts of the MMR vaccine administered less than 2 years after the patient s date of birth. For more information, refer to the section titled Recording the Administration of an Immunization on page 116. Note: The appropriate CVX code must be associated with this immunization in order to satisfy the measure. For more information, refer to the section titled Associating a CVX Code with an Immunization on page 84. Alternate Method 1: More than 1 count of the mumps vaccine administered less than two years after the patient s date of birth. For more information, refer to the section titled Recording the Administration of an Immunization on page 116. o IMPTANT! The appropriate CVX code must be associated with this immunization in order to satisfy the measure. For more information, refer to the section titled Associating a CVX Code with an Immunization on page 84. AND AND NOT An allergy for the mumps vaccine For more information on recording allergies, refer to the section titled Documenting a Structured Allergy on page 187. More than 1 count of the measles vaccine administered less than two years after the patient s date of birth. For more information, refer to the section titled Recording the Administration of an Immunization on page 116. IMPTANT! The appropriate CVX code must be associated with this immunization in order to satisfy the measure. For more information, refer to the section titled Associating a CVX Code with an Immunization on page 84. AND NOT o An allergy for the measles vaccine Copyright eclinicalworks, LLC 2011, Meaningful Use Training Scenarios Guide 102

103 AND For more information on recording allergies, refer to the section titled Documenting a Structured Allergy on page 187. More than 1 count of the rubella vaccine administered less than two years after the patient s date of birth. For more information, refer to the section titled Recording the Administration of an Immunization on page 116. o AND NOT An allergy for the rubella vaccine For more information on recording allergies, refer to the section titled Documenting a Structured Allergy on page 187. Alternate Method 2: A resolved diagnosis for measles AND More than 1 count of the mumps vaccine administered less than two years after the patient s date of birth. For more information, refer to the section titled Recording the Administration of an Immunization on page 116. o IMPTANT! The appropriate CVX code must be associated with this immunization in order to satisfy the measure. For more information, refer to the section titled Associating a CVX Code with an Immunization on page 84. IMPTANT! The appropriate CVX code must be associated with this immunization in order to satisfy the measure. For more information, refer to the section titled Associating a CVX Code with an Immunization on page 84. AND AND NOT An allergy for the mumps vaccine For more information on recording allergies, refer to the section titled Documenting a Structured Allergy on page 187. More than 1 count of the rubella vaccine administered less than two years after the patient s date of birth. For more information, refer to the section titled Recording the Administration of an Immunization on page 116. IMPTANT! The appropriate CVX code must be associated with this immunization in order to satisfy the measure. For more information, refer to the section titled Associating a CVX Code with an Immunization on page 84. AND NOT o An allergy for the rubella vaccine For more information on recording allergies, refer to the section titled Documenting a Structured Allergy on page 187. Copyright eclinicalworks, LLC 2011, Meaningful Use Training Scenarios Guide 103

104 Alternate Method 3: A resolved diagnosis for mumps AND More than 1 count of the measles vaccine administered less than two years after the patient s date of birth. For more information, refer to the section titled Recording the Administration of an Immunization on page 116. o AND AND NOT An allergy for the measles vaccine For more information on recording allergies, refer to the section titled Documenting a Structured Allergy on page 187. More than 1 count of the rubella vaccine administered less than two years after the patient s date of birth. For more information, refer to the section titled Recording the Administration of an Immunization on page 116. o IMPTANT! The appropriate CVX code must be associated with this immunization in order to satisfy the measure. For more information, refer to the section titled Associating a CVX Code with an Immunization on page 84. IMPTANT! The appropriate CVX code must be associated with this immunization in order to satisfy the measure. For more information, refer to the section titled Associating a CVX Code with an Immunization on page 84. AND NOT An allergy for the rubella vaccine For more information on recording allergies, refer to the section titled Documenting a Structured Allergy on page 187. Alternate Method 4: A resolved diagnosis for rubella AND More than 1 count of the mumps vaccine administered less than two years after the patient s date of birth. For more information, refer to the section titled Recording the Administration of an Immunization on page 116. IMPTANT! The appropriate CVX code must be associated with this immunization in order to satisfy the measure. For more information, refer to the section titled Associating a CVX Code with an Immunization on page 84. AND NOT o An allergy for the mumps vaccine Copyright eclinicalworks, LLC 2011, Meaningful Use Training Scenarios Guide 104

105 AND For more information on recording allergies, refer to the section titled Documenting a Structured Allergy on page 187. More than 1 count of the measles vaccine administered less than two years after the patient s date of birth. For more information, refer to the section titled Recording the Administration of an Immunization on page 116. IMPTANT! The appropriate CVX code must be associated with this immunization in order to satisfy the measure. For more information, refer to the section titled Associating a CVX Code with an Immunization on page 84. AND NOT o AND NOT An allergy for the measles vaccine For more information on recording allergies, refer to the section titled Documenting a Structured Allergy on page 187. An active diagnosis for cancer of lymphoreticular or histiocytic tissue Note: The following ICD-9 codes are considered by the system to indicate a cancer of lymphoreticular or histiocytic tissue diagnosis: 201, 202, 203 For more information, refer to the section titled Recording an Active Diagnosis with ICD-9 Codes on page 115. An inactive diagnosis for cancer of lymphoreticular or histiocytic tissue An active diagnosis for asymptomatic HIV Note: The following ICD-9 codes are considered by the system to indicate an asymptomatic HIV diagnosis: 042, V08 For more information, refer to the section titled Recording an Active Diagnosis with ICD-9 Codes on page 115. An active diagnosis for multiple myeloma Note: The following ICD-9 code is considered by the system to indicate a multiple myeloma diagnosis: 203 For more information, refer to the section titled Recording an Active Diagnosis with ICD-9 Codes on page 115. An active diagnosis for leukemia Copyright eclinicalworks, LLC 2011, Meaningful Use Training Scenarios Guide 105

106 Note: The following ICD-9 codes are considered by the system to indicate a leukemia diagnosis: 200, 202, 204, 205, 206, 207, 208 For more information, refer to the section titled Recording an Active Diagnosis with ICD-9 Codes on page 115. An allergy recorded for the MMR vaccine For more information on recording allergies, refer to the section titled Documenting a Structured Allergy on page 187. An active diagnosis for cancer of immunodeficiency AND Note: The following ICD-9 code is considered by the system to indicate a cancer of immunodeficiency diagnosis: 279 For more information, refer to the section titled Recording an Active Diagnosis with ICD-9 Codes on page or more counts of the VZV administered less than two years after the patient s date of birth. For more information, refer to the section titled Recording the Administration of an Immunization on page 116. Note: The appropriate CVX code must be associated with this immunization in order to satisfy the measure. For more information, refer to the section titled Associating a CVX Code with an Immunization on page 84. A resolved diagnosis for chicken pox AND NOT An active diagnosis for cancer of lymphoreticular or histiocytic tissue Note: The following ICD-9 codes are considered by the system to indicate a cancer of lymphoreticular or histiocytic tissue diagnosis: 201, 202, 203 For more information, refer to the section titled Recording an Active Diagnosis with ICD-9 Codes on page 115. An inactive diagnosis for cancer of lymphoreticular or histiocytic tissue An active diagnosis for asymptomatic HIV Note: The following ICD-9 codes are considered by the system to indicate an asymptomatic HIV diagnosis: 042, V08 Copyright eclinicalworks, LLC 2011, Meaningful Use Training Scenarios Guide 106

107 AND For more information, refer to the section titled Recording an Active Diagnosis with ICD-9 Codes on page 115. An active diagnosis for multiple myeloma For more information, refer to the section titled Recording an Active Diagnosis with ICD-9 Codes on page 115. An active diagnosis for leukemia For more information, refer to the section titled Recording an Active Diagnosis with ICD-9 Codes on page 115. An allergy recorded for the influenza vaccine For more information on recording allergies, refer to the section titled Documenting a Structured Allergy on page 187. An active diagnosis for cancer of immunodeficiency For more information, refer to the section titled Recording an Active Diagnosis with ICD-9 Codes on page or more counts of the Hepatitis B vaccine administered on different dates less than two years after the patient s date of birth. For more information, refer to the section titled Recording the Administration of an Immunization on page 116. Note: The following ICD-9 code is considered by the system to indicate a multiple myeloma diagnosis: 203 Note: The following ICD-9 codes are considered by the system to indicate a leukemia diagnosis: 200, 202, 204, 205, 206, 207, 208 Note: The following ICD-9 code is considered by the system to indicate a cancer of immunodeficiency diagnosis: 279 Note: The appropriate CVX code must be associated with this immunization in order to satisfy the measure. For more information, refer to the section titled Associating a CVX Code with an Immunization on page 84. An active diagnosis for Hepatitis B Note: The following ICD-9 code is considered by the system to indicate a cancer of immunodeficiency diagnosis: 070.2, 070.3, V02.61 Copyright eclinicalworks, LLC 2011, Meaningful Use Training Scenarios Guide 107

108 For more information, refer to the section titled Recording an Active Diagnosis with ICD-9 Codes on page 115. A resolved diagnosis for Hepatitis B AND NOT An allergy for baker s yeast For more information on recording allergies, refer to the section titled Documenting a Structured Allergy on page 187. An allergy for the Hepatitis B vaccine For more information on recording allergies, refer to the section titled Documenting a Structured Allergy on page 187. Numerator 12 4 or more counts of the DTaP vaccine administered on different dates starting at greater than or equal to 42 days after the patient s birth and ending less than 2 years after the patient s date of birth. For more information, refer to the section titled Recording the Administration of an Immunization on page 116. Note: The appropriate CVX code must be associated with this immunization in order to satisfy the measure. For more information, refer to the section titled Associating a CVX Code with an Immunization on page 84. AND NOT An allergy for the DTaP vaccine For more information on recording allergies, refer to the section titled Documenting a Structured Allergy on page 187. An active diagnosis for encephalopathy AND Note: The following ICD-9 code is considered by the system to indicate an encephalopathy diagnosis: For more information, refer to the section titled Recording an Active Diagnosis with ICD-9 Codes on page 115. An active diagnosis for progressive neurological disorder 3 or more counts of the IPV administered on different dates starting at greater than or equal to 42 days after the patient s birth and ending less than 2 years after the patient s date of birth. For more information, refer to the section titled Recording the Administration of an Immunization on page 116. Note: The appropriate CVX code must be associated with this immunization in order to satisfy the measure. For more information, refer to the section titled Associating a CVX Code with an Immunization on page 84. Copyright eclinicalworks, LLC 2011, Meaningful Use Training Scenarios Guide 108

109 AND AND NOT An allergy for the IPV For more information on recording allergies, refer to the section titled Documenting a Structured Allergy on page 187. An allergy for neomycin For more information on recording allergies, refer to the section titled Documenting a Structured Allergy on page 187. An allergy for streptomycin For more information on recording allergies, refer to the section titled Documenting a Structured Allergy on page or more counts of the MMR vaccine administered less than 2 years after the patient s date of birth. For more information, refer to the section titled Recording the Administration of an Immunization on page 116. Note: The appropriate CVX code must be associated with this immunization in order to satisfy the measure. For more information, refer to the section titled Associating a CVX Code with an Immunization on page 84. Alternate Method 1: More than 1 count of the mumps vaccine administered less than two years after the patient s date of birth. For more information, refer to the section titled Recording the Administration of an Immunization on page 116. o IMPTANT! The appropriate CVX code must be associated with this immunization in order to satisfy the measure. For more information, refer to the section titled Associating a CVX Code with an Immunization on page 84. AND AND NOT An allergy for the mumps vaccine For more information on recording allergies, refer to the section titled Documenting a Structured Allergy on page 187. More than 1 count of the measles vaccine administered less than two years after the patient s date of birth. For more information, refer to the section titled Recording the Administration of an Immunization on page 116. IMPTANT! The appropriate CVX code must be associated with this immunization in order to satisfy the measure. For more information, refer to the section titled Associating a CVX Code with an Immunization on page 84. AND NOT Copyright eclinicalworks, LLC 2011, Meaningful Use Training Scenarios Guide 109

110 o AND An allergy for the measles vaccine For more information on recording allergies, refer to the section titled Documenting a Structured Allergy on page 187. More than 1 count of the rubella vaccine administered less than two years after the patient s date of birth. For more information, refer to the section titled Recording the Administration of an Immunization on page 116. o AND NOT An allergy for the rubella vaccine For more information on recording allergies, refer to the section titled Documenting a Structured Allergy on page 187. Alternate Method 2: A resolved diagnosis for measles AND More than 1 count of the mumps vaccine administered less than two years after the patient s date of birth. For more information, refer to the section titled Recording the Administration of an Immunization on page 116. o IMPTANT! The appropriate CVX code must be associated with this immunization in order to satisfy the measure. For more information, refer to the section titled Associating a CVX Code with an Immunization on page 84. IMPTANT! The appropriate CVX code must be associated with this immunization in order to satisfy the measure. For more information, refer to the section titled Associating a CVX Code with an Immunization on page 84. AND AND NOT An allergy for the mumps vaccine For more information on recording allergies, refer to the section titled Documenting a Structured Allergy on page 187. More than 1 count of the rubella vaccine administered less than two years after the patient s date of birth. For more information, refer to the section titled Recording the Administration of an Immunization on page 116. IMPTANT! The appropriate CVX code must be associated with this immunization in order to satisfy the measure. For more information, refer to the section titled Associating a CVX Code with an Immunization on page 84. AND NOT o An allergy for the rubella vaccine Copyright eclinicalworks, LLC 2011, Meaningful Use Training Scenarios Guide 110

111 For more information on recording allergies, refer to the section titled Documenting a Structured Allergy on page 187. Alternate Method 3: A resolved diagnosis for mumps AND More than 1 count of the measles vaccine administered less than two years after the patient s date of birth. For more information, refer to the section titled Recording the Administration of an Immunization on page 116. o AND AND NOT An allergy for the measles vaccine For more information on recording allergies, refer to the section titled Documenting a Structured Allergy on page 187. More than 1 count of the rubella vaccine administered less than two years after the patient s date of birth. For more information, refer to the section titled Recording the Administration of an Immunization on page 116. o IMPTANT! The appropriate CVX code must be associated with this immunization in order to satisfy the measure. For more information, refer to the section titled Associating a CVX Code with an Immunization on page 84. IMPTANT! The appropriate CVX code must be associated with this immunization in order to satisfy the measure. For more information, refer to the section titled Associating a CVX Code with an Immunization on page 84. AND NOT An allergy for the rubella vaccine For more information on recording allergies, refer to the section titled Documenting a Structured Allergy on page 187. Alternate Method 4: A resolved diagnosis for rubella AND More than 1 count of the mumps vaccine administered less than two years after the patient s date of birth. For more information, refer to the section titled Recording the Administration of an Immunization on page 116. IMPTANT! The appropriate CVX code must be associated with this immunization in order to satisfy the measure. For more information, refer to the section titled Associating a CVX Code with an Immunization on page 84. AND NOT Copyright eclinicalworks, LLC 2011, Meaningful Use Training Scenarios Guide 111

112 o AND An allergy for the mumps vaccine For more information on recording allergies, refer to the section titled Documenting a Structured Allergy on page 187. More than 1 count of the measles vaccine administered less than two years after the patient s date of birth. For more information, refer to the section titled Recording the Administration of an Immunization on page 116. IMPTANT! The appropriate CVX code must be associated with this immunization in order to satisfy the measure. For more information, refer to the section titled Associating a CVX Code with an Immunization on page 84. AND NOT o AND NOT An allergy for the measles vaccine For more information on recording allergies, refer to the section titled Documenting a Structured Allergy on page 187. An active diagnosis for cancer of lymphoreticular or histiocytic tissue Note: The following ICD-9 codes are considered by the system to indicate a cancer of lymphoreticular or histiocytic tissue diagnosis: 201, 202, 203 For more information, refer to the section titled Recording an Active Diagnosis with ICD-9 Codes on page 115. An inactive diagnosis for cancer of lymphoreticular or histiocytic tissue An active diagnosis for asymptomatic HIV Note: The following ICD-9 codes are considered by the system to indicate an asymptomatic HIV diagnosis: 042, V08 For more information, refer to the section titled Recording an Active Diagnosis with ICD-9 Codes on page 115. An active diagnosis for multiple myeloma Note: The following ICD-9 code is considered by the system to indicate a multiple myeloma diagnosis: 203 For more information, refer to the section titled Recording an Active Diagnosis with ICD-9 Codes on page 115. An active diagnosis for leukemia Copyright eclinicalworks, LLC 2011, Meaningful Use Training Scenarios Guide 112

113 Note: The following ICD-9 codes are considered by the system to indicate a leukemia diagnosis: 200, 202, 204, 205, 206, 207, 208 For more information, refer to the section titled Recording an Active Diagnosis with ICD-9 Codes on page 115. An allergy recorded for the MMR vaccine For more information on recording allergies, refer to the section titled Documenting a Structured Allergy on page 187. An active diagnosis for cancer of immunodeficiency AND Note: The following ICD-9 code is considered by the system to indicate a cancer of immunodeficiency diagnosis: 279 For more information, refer to the section titled Recording an Active Diagnosis with ICD-9 Codes on page 115. An allergy for polymyxin For more information on recording allergies, refer to the section titled Documenting a Structured Allergy on page or more counts of the VZV administered less than two years after the patient s date of birth. For more information, refer to the section titled Recording the Administration of an Immunization on page 116. Note: The appropriate CVX code must be associated with this immunization in order to satisfy the measure. For more information, refer to the section titled Associating a CVX Code with an Immunization on page 84. A resolved diagnosis for chicken pox AND NOT An active diagnosis for cancer of lymphoreticular or histiocytic tissue Note: The following ICD-9 codes are considered by the system to indicate a cancer of lymphoreticular or histiocytic tissue diagnosis: 201, 202, 203 For more information, refer to the section titled Recording an Active Diagnosis with ICD-9 Codes on page 115. An inactive diagnosis for cancer of lymphoreticular or histiocytic tissue An active diagnosis for asymptomatic HIV Copyright eclinicalworks, LLC 2011, Meaningful Use Training Scenarios Guide 113

114 AND For more information, refer to the section titled Recording an Active Diagnosis with ICD-9 Codes on page 115. An active diagnosis for multiple myeloma For more information, refer to the section titled Recording an Active Diagnosis with ICD-9 Codes on page 115. An active diagnosis for leukemia For more information, refer to the section titled Recording an Active Diagnosis with ICD-9 Codes on page 115. An allergy recorded for the influenza vaccine For more information on recording allergies, refer to the section titled Documenting a Structured Allergy on page 187. An active diagnosis for cancer of immunodeficiency For more information, refer to the section titled Recording an Active Diagnosis with ICD-9 Codes on page or more counts of the Hepatitis B vaccine administered on different dates less than two years after the patient s date of birth. For more information, refer to the section titled Recording the Administration of an Immunization on page 116. Note: The following ICD-9 codes are considered by the system to indicate an asymptomatic HIV diagnosis: 042, V08 Note: The following ICD-9 code is considered by the system to indicate a multiple myeloma diagnosis: 203 Note: The following ICD-9 codes are considered by the system to indicate a leukemia diagnosis: 200, 202, 204, 205, 206, 207, 208 Note: The following ICD-9 code is considered by the system to indicate a cancer of immunodeficiency diagnosis: 279 Note: The appropriate CVX code must be associated with this immunization in order to satisfy the measure. For more information, refer to the section titled Associating a CVX Code with an Immunization on page 84. A resolved diagnosis for Hepatitis B AND NOT Copyright eclinicalworks, LLC 2011, Meaningful Use Training Scenarios Guide 114

115 AND An allergy for baker s yeast For more information on recording allergies, refer to the section titled Documenting a Structured Allergy on page 187. An allergy for the Hepatitis B vaccine For more information on recording allergies, refer to the section titled Documenting a Structured Allergy on page or more counts of the pneumococcal vaccine administered on different dates starting at greater than or equal to 42 days after the patient s birth and ending less than 2 years after the patient s date of birth. For more information, refer to the section titled Recording the Administration of an Immunization on page 116. Note: The appropriate CVX code must be associated with this immunization in order to satisfy the measure. For more information, refer to the section titled Associating a CVX Code with an Immunization on page 84. AND NOT An allergy for the pneumococcal vaccine For more information on recording allergies, refer to the section titled Documenting a Structured Allergy on page 187. Recording an Active Diagnosis with ICD-9 Codes Active diagnoses are recorded in the Assessments section of the Progress Notes window using ICD-9 codes. Mid Office Workflow (for Numerators): 1. From the Progress Notes window, click the Assessments link. The Assessments window opens: Copyright eclinicalworks, LLC 2011, Meaningful Use Training Scenarios Guide 115

116 2. Optionally, select an ICD Group from the left pane that contains this ICD-9 code. The codes in the selected group display in the top-right pane. Note: You can search for specific codes using the drop-down lists and fields in the Find In (Assessments) section at the bottom-right of this window. For more information on searching for ICD codes, refer to the Electronic Medical Records Users Guide. 3. Click an ICD code in the top-right pane. The selected ICD code is added to the bottom-right pane. 4. Repeat steps 2-3 until all assessments have been selected for this patient. Recording the Administration of an Immunization Active diagnoses are recorded in the Assessments section of the Progress Notes window using ICD-9 codes. Mid Office Workflow (for Numerators): 1. From the Progress Notes window, click the Immunizations link. The Immunizations/Injections window opens. 2. Click the Add button. The Immunization Details window opens: 3. In the left pane, click the name of the immunization being administered. Note: To search for a specific immunization, enter its name in the Find field. The list of available immunizations is filtered in real time as you type. 4. To enter the dosage of this immunization: a. Select the unit of measurement from the Dose drop-down list on the right. b. Enter the number related to the unit of measurement in the Dose field on the left. c. Select the number of this dose from the Dose # drop-down list. 5. If this immunization was administered at a different time, enter the time it was administered in the Given Time field (in hh:mm:ss format). Copyright eclinicalworks, LLC 2011, Meaningful Use Training Scenarios Guide 116

117 6. To enter a lot number for this immunization: Enter the lot number for this immunization in the Lot Number field. Click the More (...) button next to the Lot Number field to select the lot number. from the Lot Numbers window. 7. Enter the date on the vaccine information statement in the Date On VIS field. 8. Enter the expiration date of this vaccine in the Exp. Date field. 9. Select the date this vaccine s information was read from the Read date drop-down list. 10. To select the provider that administered this vaccine: Note: If this was read on today s date, simply check the box in this field. Click the More (...) button next to the Given By field to select a provider Click the Me button to select yourself. 11. Select the location on the patient s body where this vaccine was administered from the Location drop-down list. 12. Select the date that this vaccine s information statement was given from the VIS Given drop-down list. Note: If this was given on today s date, simply check the box in this field. 13. Select the method used to administer this vaccine from the Route of Administration drop-down list. 14. Record whether this vaccination was given in the past by checking the appropriate box in the Vaccination Given in the Past? section. Note: If an immunization was given at another location, it can be indicated in eclinicalworks so that this patient satisfies this measure by checking the Vaccination Given in the Past? box and explaining in the Comments field. 15. Click the More (...) button next to the Read by field to select the provider that read this vaccine s information. 16. To record any induration from this immunization, select an option from the Induration drop-down list. 17. To record the impression of this immunization on the patient, select an option from the Impression drop-down list. 18. To finish recording the administration of this immunization: Click the OK button to save this information and close the Immunization Details window. Click the Save and New button to save this information and clear the Immunization Details window in order to record the administration of another immunization immediately. Copyright eclinicalworks, LLC 2011, Meaningful Use Training Scenarios Guide 117

118 NQF Diabetes: Hemoglobin HbA1c Poor Control Description Providers must report the percentage of patients between the ages of 18 and 75 with an active diabetes (type 1 or type 2) diagnosis who have an HbA1c greater than 9.0%. Calculation Tables This section outlines how each denominator and numerator are calculated. For more detailed information on the steps required within the eclinicalworks application to satisfy each item, refer to the Calculation Lists section below. Denominator Between 17 and 74 years old AND Medication for diabetes dispensed, ordered, or active O R Active diagnosis for diabetes AND Two outpatient or ophthalmology office visits Numerator HbA1c test results over 9.0% Copyright eclinicalworks, LLC 2011, Meaningful Use Training Scenarios Guide 118

119 Patient Exclusions Active diagnosis for polycystic ovaries Active diagnosis for gestational diabetes or steroid induced diabetes A N D N O T A N D Active diagnosis for diabetes AND One or more outpatient or ophthalmology office visits Medication for diabetes dispensed, ordered, or active AND NOT One or more outpatient or ophthalmology office visits Calculation Lists These lists provide a link for to the appropriate steps involved in satisfying each item within the eclinicalworks application. For a more reader-friendly view of all possible methods of satisfying each denominator and numerator, refer to the Calculation Tables section above. Denominator Patients must meet the following criteria: Greater than or equal to 17 years of age and less than or equal to 74 years of age For more information, refer to the section titled Recording a Patient s Age on page 48. AND One of the following methods of indicating the patient has diabetes: A medication dispensed, ordered, or active within two years of the end of the reporting period that is indicative of diabetes For more information, refer to the section titled Recording the Prescription of a Medication Indicative of Diabetes on page 121. Both of the following: Active diabetes (type 1 or type 2) diagnosis within two years of the end of the reporting period For more information, refer to the section titled Recording a Diabetes Diagnosis on page 122. AND Two outpatient or ophthalmology office visits recorded on two different dates during the reporting period Copyright eclinicalworks, LLC 2011, Meaningful Use Training Scenarios Guide 119

120 Numerator Note: The following codes are considered by the system to be outpatient encounters: 99201, 99202, 99203, 99204, 99205, 99212, 99213, 99214, 99215, 99241, 99242, 99243, 99244, 99245, 99324, 99325, 99326, 99327, 99328, 99334, 99335, 99336, 99337, 99341, 99342, 99343, 99344, 99345, 99347, 99348, 99349, The following codes are considered by the system to be ophthalmology encounters: 92002, 92003, 92004, 92005, 92006, 92007, 92008, 92009, 92010, 92011, 92012, 92013, For more information, refer to the section titled Indicating the Type of Encounter with a Visit Code on page 48. Patients with an HbA1c test result over 9.0% Note: LOINC codes must be linked to the appropriate lab attributes in order to satisfy this measure. The following LOINC codes must be mapped to the Hemoglobin A1c lab attribute: , , For more information, refer to the section titled Associating LOINC Codes with Lab Attributes on page 123. For more information, refer to the section titled Recording a Test Result as Structured Data on page 123. Patient Exclusions Patients with one of the following can be excluded from this measure: An active diagnosis for polycystic ovaries AND NOT An active diagnosis for diabetes AND One or more of the following encountered within two years of the reporting period end date: Outpatient Note: The following codes are considered by the system to be outpatient encounters: 99201, 99202, 99203, 99204, 99205, 99212, 99213, 99214, 99215, 99241, 99242, 99243, 99244, 99245, 99324, 99325, 99326, 99327, 99328, 99334, 99335, 99336, 99337, 99341, 99342, 99343, 99344, 99345, 99347, 99348, 99349, Ophthalmology Note: The following codes are considered by the system to be ophthalmology encounters: 92002, 92003, 92004, 92005, 92006, 92007, 92008, 92009, 92010, 92011, 92012, 92013, Copyright eclinicalworks, LLC 2011, Meaningful Use Training Scenarios Guide 120

121 All of the following: An active diagnosis for gestational diabetes or steroid induced diabetes within two years of the reporting period end date AND A medication dispensed, ordered, or active within two years of the end of the reporting period that is indicative of diabetes AND NOT An outpatient or ophthalmology encounter within two years of the reporting period end date IMPTANT! The system does not automatically recognize the exclusion criteria, so patients that meet this criteria must be manually marked as excluded. For more information on manually marking patients as excluded, refer to the section titled Manually Marking a Patient as Excluded on page 57. Recording the Prescription of a Medication Indicative of Diabetes As an alternative to recording a diabetes diagnosis, a medication indicative of diabetes can be recorded as being dispensed, ordered, or currently active. Note: The following medication types are considered to be indicative of diabetes when prescribed: Sulfonylureas Biguanides Alpha-Glucosidase Inhibitors Thiazolidinediones Meglitinides Amylinomimetics Incretin Mimetics Antidiabetics Agents, Miscellaneous Insulins Non-Sulfonylureas Miscellaneous Diabetic Agents Insulin The full list of medications indicative of diabetes can be viewed in the eclinicalworks application from Registry band > Registry icon > Rx tab > Drug Class drop-down list > Sel button > Diabetes Mellitus option > Show Drugs button. Mid Office Workflow (for Denominators): 1. From the Progress Notes window, click the Treatment link. The Treatment window opens. 2. Click the Add button. The Manage Prescriptions window opens with the Add New Rx tab selected. Note: These steps use the Modern View for the Manage Prescriptions window. 3. If necessary, check the box next to the appropriate assessment in the left pane. Copyright eclinicalworks, LLC 2011, Meaningful Use Training Scenarios Guide 121

122 4. Search for a medication using the Rx filters at the top of the window. A list of medications that match the selected criteria and entered text displays in a popup window beneath the Find field in real time. 5. Click the name of a medication in the pop-up window. All available dosages/formulations of the selected medication display in the top-right pane. 6. Click the appropriate dosage/formulation in the top-right pane. The selected dosage/formulation is added to the bottom-right pane. 7. Click the OK button. The Manage Prescriptions window closes and the selected dosage/formulation is added in the Rx section of the Treatment window with Start selected in the Comments field by default. 8. If necessary, click in the Stop Date field for this medication and select the date that this prescription will end from the drop-down calendar. 9. To print, fax, or transmit this prescription: a. Click the green arrow next to the Send Rx button to open a drop-down list. b. From the drop-down list, click the appropriate option for prescribing this medication. For more information on printing, faxing, and transmitting prescriptions, refer to the Electronic Medical Records Users Guide. 10. If this medication was prescribed in the past and you want to indicate it is an active medication: a. Click in the Comments field. If the Pop-up box is checked, the Comments window opens. b. Highlight the Continue option on the Comments window and click the Close button. If the Pop-up box is not checked, click in the Comments field to cycle through the available options until the Continue option displays. Recording a Diabetes Diagnosis As an alternative to recording the prescription of a medication indicative of diabetes, an ICD code for diabetes can be recorded in the Progress Notes to satisfy this measure. Note: Two outpatient or ophthalmology office encounters must also be recorded on two different dates during the reporting period in order to satisfy this measure for patients that have been diagnosed with diabetes. Mid Office Workflow (for Denominators): 1. From the Progress Notes window, click the Assessment link. The Assessments window opens. 2. Click the category in the Assessment pane on the left that contains the applicable ICD- 9 code. The ICD-9 codes in the selected category populate in the middle pane. 3. Click the appropriate ICD-9 code in the top-right pane. Copyright eclinicalworks, LLC 2011, Meaningful Use Training Scenarios Guide 122

123 Note: The following ICD-9 codes are considered by the system to indicate diabetes: 250, 250.0, , , , , , , , , , , , , , , , , 250.4, , , , , , , , , , , , , 250.7, , , , , 250.8, , , , , 250.9, , , , , 357.2, 362.0, , , , , , , , , 648.0, , , , , The selected ICD-9 code is added to the bottom-right pane and is now recorded for this patient. Associating LOINC Codes with Lab Attributes LOINC codes must be properly mapped to lab attributes in order to satisfy any measures requiring specific lab results. Mid Office Workflow (Setup): 1. From the EMR menu, hover over the Labs, DI & Procedures option to open a drop-down list. 2. From the drop-down list, click the Labs option. The Labs window opens. 3. Highlight a lab test and click the Attribute Codes button. A window opens displaying the lab items for the selected test. 4. Highlight a lab item and click the Update LOINC button. The Associate LOINC with test window opens. 5. Highlight the appropriate LOINC code and click the OK button. The Associate LOINC with test window closes and 6. Repeat steps 4-5 until all lab items have been associated with LOINC codes. 7. Click the OK button. The lab items window closes and all LOINC associations are now saved. 8. Repeat steps 3-7 for all lab tests. Recording a Test Result as Structured Data Once a test result has been received, the results must be entered in the Results section of the Lab Results window in order to satisfy a measure. IMPTANT! Scanned lab results will not calculate any measure. Results must be entered appropriately into the yellow grid on the Lab Results window in order to satisfy a measure. Mid Office Workflow (for Numerators): 1. Click the L Quick-Launch Button in the top-right corner of the application. The Labs/DI/Procedures window opens. Copyright eclinicalworks, LLC 2011, Meaningful Use Training Scenarios Guide 123

124 2. Use the filters at the top of the window to find the lab you want to enter results for and click the name of that lab. The Lab Results window opens. 3. Enter the results in the yellow row in the Results section. IMPTANT! Enter ONLY the appropriate numerical value in this field. Do not enter any additional text (such as provider initials, unit of measurement, etc.) in this field or this measure will not be satisfied. 4. After entering any other applicable information, check the Review box. 5. Click the OK button. The results for this lab test have now been recorded. NQF Diabetes: LDL Management and Control Description Providers must report the percentage of patients between the ages of 18 and 75 with an active diabetes (type 1 or type 2) diagnosis who have an LDL-C less than 100mg/dL. Calculation Tables This section outlines how each denominator and numerator are calculated. For more detailed information on the steps required within the eclinicalworks application to satisfy each item, refer to the Calculation Lists section below. Denominator Between 17 and 74 years old AND Medication for diabetes dispensed, ordered, or active O R Active diagnosis for diabetes AND Two outpatient or ophthalmology office visits Numerator 1 Any LDL-C test results recorded Numerator 2 LDL-C test results less than 100 mg/dl Copyright eclinicalworks, LLC 2011, Meaningful Use Training Scenarios Guide 124

125 Patient Exclusions Active diagnosis for polycystic ovaries Active diagnosis for gestational diabetes or steroid induced diabetes A N D N O T A N D Active diagnosis for diabetes AND One or more outpatient or ophthalmology office visits Medication for diabetes dispensed, ordered, or active AND NOT One or more outpatient or ophthalmology office visits Calculation Lists These lists provide a link for to the appropriate steps involved in satisfying each item within the eclinicalworks application. For a more reader-friendly view of all possible methods of satisfying each denominator and numerator, refer to the Calculation Tables section above. Denominator Patients must meet the following criteria: Greater than or equal to 17 years of age and less than or equal to 74 years of age For more information, refer to the section titled Recording a Patient s Age on page 48. One of the following methods of indicating the patient has diabetes: A medication dispensed, ordered, or active within two years of the end of the reporting period that is indicative of diabetes For more information, refer to the section titled Recording the Prescription of a Medication Indicative of Diabetes on page 121. Both of the following: Active Diabetes (type 1 or type 2) diagnosis within two years of the end of the reporting period For more information, refer to the section titled Recording a Diabetes Diagnosis on page 122. AND Two outpatient or ophthalmology office visits recorded on two different dates during the reporting period Copyright eclinicalworks, LLC 2011, Meaningful Use Training Scenarios Guide 125

126 Numerator 1 Note: The following E&M codes are considered by the system to be outpatient encounters: 99201, 99202, 99203, 99204, 99205, 99212, 99213, 99214, 99215, 99241, 99242, 99243, 99244, 99245, 99324, 99325, 99326, 99327, 99328, 99334, 99335, 99336, 99337, 99341, 99342, 99343, 99344, 99345, 99347, 99348, 99349, The following E&M codes are considered by the system to be ophthalmology encounters: 92002, 92003, 92004, 92005, 92006, 92007, 92008, 92009, 92010, 92011, 92012, 92013, For more information, refer to the section titled Indicating the Type of Encounter with a Visit Code on page 48. Patients with an LDL-C test result recorded in the system Note: LOINC codes must be linked to the appropriate lab attributes in order to satisfy this measure. The following LOINC codes must be mapped to the LDL-C lab attribute: , , , , , , , , For more information, refer to the section titled Associating LOINC Codes with Lab Attributes on page 123. For more information, refer to the section titled Recording a Test Result as Structured Data on page 123. Numerator 2 Patients with an LDL-C test result less than 100mg/dL Note: LOINC codes must be linked to the appropriate lab attributes in order to satisfy this measure. The following LOINC codes must be mapped to the LDL-C lab attribute: , , , , , , , , For more information, refer to the section titled Associating LOINC Codes with Lab Attributes on page 123. For more information, refer to the section titled Recording a Test Result as Structured Data on page 123. Patient Exclusions Patients with one of the following can be excluded from this measure: An active diagnosis for polycystic ovaries AND NOT An active diagnosis for diabetes AND One or more of the following encountered within two years of the reporting period end date: Copyright eclinicalworks, LLC 2011, Meaningful Use Training Scenarios Guide 126

127 Outpatient Note: The following E&M codes are considered by the system to be outpatient encounters: 99201, 99202, 99203, 99204, 99205, 99212, 99213, 99214, 99215, 99241, 99242, 99243, 99244, 99245, 99324, 99325, 99326, 99327, 99328, 99334, 99335, 99336, 99337, 99341, 99342, 99343, 99344, 99345, 99347, 99348, 99349, Ophthalmology Note: The following E&M codes are considered by the system to be ophthalmology encounters: 92002, 92003, 92004, 92005, 92006, 92007, 92008, 92009, 92010, 92011, 92012, 92013, All of the following: An active diagnosis for gestational diabetes or steroid induced diabetes within two years of the reporting period end date AND A medication dispensed, ordered, or active within two years of the end of the reporting period that is indicative of diabetes AND NOT An outpatient or ophthalmology encounter within two years of the reporting period end date IMPTANT! The system does not automatically recognize the exclusion criteria, so patients that meet this criteria must be manually marked as excluded. For more information on manually marking patients as excluded, refer to the section titled Manually Marking a Patient as Excluded on page 57. NQF Diabetes: Blood Pressure Management Description Providers must report the percentage of patients between the ages of 18 and 75 with an active diabetes (type 1 or type 2) diagnosis who have a blood pressure less than 140/90 mmhg. Calculation Tables This section outlines how each denominator and numerator are calculated. For more detailed information on the steps required within the eclinicalworks application to satisfy each item, refer to the Calculation Lists section below. Copyright eclinicalworks, LLC 2011, Meaningful Use Training Scenarios Guide 127

128 Denominator Between 17 and 74 years old AND Medication for diabetes dispensed, ordered, or active O R Active diagnosis for diabetes AND Two outpatient or ophthalmology office visits Numerator Blood pressure less than 140/90 mmhg Patient Exclusions Active diagnosis for polycystic ovaries Active diagnosis for gestational diabetes or steroid induced diabetes A N D N O T A N D Active diagnosis for diabetes AND One or more outpatient or ophthalmology office visits Medication for diabetes dispensed, ordered, or active AND NOT One or more outpatient or ophthalmology office visits Calculation Lists These lists provide a link for to the appropriate steps involved in satisfying each item within the eclinicalworks application. For a more reader-friendly view of all possible methods of satisfying each denominator and numerator, refer to the Calculation Tables section above. Denominator Patients must meet the following criteria: Greater than or equal to 17 years of age and less than or equal to 74 years of age For more information, refer to the section titled Recording a Patient s Age on page 48. Copyright eclinicalworks, LLC 2011, Meaningful Use Training Scenarios Guide 128

129 One of the following methods of indicating the patient has diabetes: A medication dispensed, ordered, or active within two years of the end of the reporting period that is indicative of diabetes For more information, refer to the section titled Recording the Prescription of a Medication Indicative of Diabetes on page 121. Both of the following: Active Diabetes (type 1 or type 2) diagnosis within two years of the end of the reporting period For more information, refer to the section titled Recording a Diabetes Diagnosis on page 122. AND Two outpatient or ophthalmology office visits recorded on two different dates during the reporting period Numerator Note: The following E&M codes are considered by the system to be outpatient encounters: 99201, 99202, 99203, 99204, 99205, 99212, 99213, 99214, 99215, 99241, 99242, 99243, 99244, 99245, 99324, 99325, 99326, 99327, 99328, 99334, 99335, 99336, 99337, 99341, 99342, 99343, 99344, 99345, 99347, 99348, 99349, The following E&M codes are considered by the system to be ophthalmology encounters: 92002, 92003, 92004, 92005, 92006, 92007, 92008, 92009, 92010, 92011, 92012, 92013, For more information, refer to the section titled Indicating the Type of Encounter with a Visit Code on page 48. Patients with a blood pressure less than 140/90 mmhg Note: The systolic value must be less than 140 AND the diastolic value must be less than 90 for a patient to be included in the numerator. For example, values of 130/100 or 150/80 would not satisfy the measure, but a value of 130/80 would. Note: The BP Vital item must be mapped in order for the system to recognize that this information has been recorded. For more information on mapping vitals, refer to the section titled Associating Vitals Fields with Vital Types on page 192. For more information, refer to the section titled Recording Patients Systolic and Diastolic Blood Pressure on page 73. Patient Exclusions Patients with one of the following can be excluded from this measure: An active diagnosis for polycystic ovaries AND NOT An active diagnosis for diabetes AND Copyright eclinicalworks, LLC 2011, Meaningful Use Training Scenarios Guide 129

130 One or more of the following encountered within two years of the reporting period end date: Outpatient Ophthalmology All of the following: Note: The following E&M codes are considered by the system to be outpatient encounters: 99201, 99202, 99203, 99204, 99205, 99212, 99213, 99214, 99215, 99241, 99242, 99243, 99244, 99245, 99324, 99325, 99326, 99327, 99328, 99334, 99335, 99336, 99337, 99341, 99342, 99343, 99344, 99345, 99347, 99348, 99349, Note: The following E&M codes are considered by the system to be ophthalmology encounters: 92002, 92003, 92004, 92005, 92006, 92007, 92008, 92009, 92010, 92011, 92012, 92013, An active diagnosis for gestational diabetes or steroid induced diabetes within two years of the reporting period end date AND A medication dispensed, ordered, or active within two years of the end of the reporting period that is indicative of diabetes AND NOT An outpatient or ophthalmology encounter within two years of the reporting period end date IMPTANT! The system does not automatically recognize the exclusion criteria, so patients that meet this criteria must be manually marked as excluded. For more information on manually marking patients as excluded, refer to the section titled Manually Marking a Patient as Excluded on page (e): Implement One Clinical Decision Support Rule Stage 1 Objective Implement one clinical decision support rule relevant to specialty or high clinical priority along with the ability to track compliance that rule. Stage 1 Measure Implement one clinical decision support rule. eclinicalworks Calculations eclinicalworks does not perform any calculations for this measure. The following methods are available to assist in decision making: Classic Alerts Copyright eclinicalworks, LLC 2011, Meaningful Use Training Scenarios Guide 130

131 Registry Alerts CDSS Alerts This measure is reported through self-attestation. Action Recommendations Policy Recommendations System Administration - All applicable alerts must be set up in the system so that providers are notified of actions that must be taken on patients. Mid Office - Providers should regularly check CDSS and/or Patient Alerts in order to track patients that are in need of care. eclinicalworks Setup Recommendations Mid Office - Perform one or more of the following tasks as needed: Providers must set up any alerts they would like to use from the EMR menu. For more information, refer to the section titled Setting Up Alerts on page 132. Providers must set up any Registry alerts they would like to use from the Registry. For more information, refer to the section titled Creating Registry Alerts on page 134. Providers must enable CDSS Alerts in the Progress Notes so that they can view patients that are in need of care. For more information, refer to the section titled Enabling CDSS Alerts on Progress Notes on page 136. Providers should enable the Alerts tab in the Right Chart Panel so that they can quickly view patients that are in need of care. For more information, refer to the section titled Enabling Classic Alerts in the Right Chart Panel on page 137. Providers should enable CDSS Alerts in the Right Chart Panel so that they can quickly view patients that are in need of care. For more information, refer to the section titled Enabling CDSS Alerts in the Right Chart Panel on page 138. Workflow Recommendations Mid Office - Perform one or more of the following actions as needed: To use classic alerts from the Patient Dashboard, refer to the section titled Using Alerts from the Patient Dashboard on page 138. To view classic alerts from the Right Chart Panel, refer to the section titled Viewing Alerts from the Right Chart Panel on page 141. To view CDSS Alerts from the Progress Notes window in order to determine whether any Quality Measures must be fulfilled, refer to the section titled Using CDSS Alerts from the Progress Notes on page 141. There are two main ways to use CDSS Alerts to satisfy Quality Measures: To fulfill the numerator criteria for a CDSS Alert, refer to the section titled Fulfilling the Numerator Criteria for a CDSS Alert on page 144. To fulfill the numerator inclusion criteria for a CDSS Alert, refer to the section titled Fulfilling the Numerator Inclusion Criteria for a CDSS Alert on page 146. Copyright eclinicalworks, LLC 2011, Meaningful Use Training Scenarios Guide 131

132 Setting Up Alerts Scenario: Your practice does not yet have an alert for patients diagnosed with diabetes. You must now create this diagnosis-specific alert for diabetes that is linked with an Order Set and includes an alert for a glucose lab test every two years. Workflow: 1. From the EMR menu, hover over the Alerts option to open a drop-down list. 2. From the drop-down list, click the Dx Specific Alerts option. The Dx Specific Alerts window opens. 3. Click the New button. The Dx Specific Alert window opens: 4. To select an ICD code for this alert: a. Click the Sel button next to the Name field. The ICD-9 Codes window opens. b. Search for and highlight a code (in this case, Diabetes). c. Click the OK button. The ICD-9 Codes window closes. The selected code is populated in the Name field and the description for that code is populated in the Description field on the Dx Specific Alert window. 5. If necessary, alter the description of this alert in the Description field. 6. To link this alert to an Order Set: a. Click the More (...) button next to the Order Set field. A drop-down list opens displaying all available Order Sets. b. Select an Order Set and click the OK button. The Order Sets drop-down list closes and the selected Order Set is populated in the Order Set field. Copyright eclinicalworks, LLC 2011, Meaningful Use Training Scenarios Guide 132

133 7. To add an alert for a glucose lab test every two years: a. Click the New button. The Dx Specific Alert window opens: b. Select the Labs option from the Type drop-down list. c. Click the Sel button next to the Entity Name field. The Labs window opens. d. Highlight the Glucose lab and click the OK button. The Labs window closes and the glucose lab is populated in the Entity Name field. e. Enter 2 in the Frequency free-text field on the left. f. Select year(s) from the Frequency drop-down list on the right. g. Enter the number of times this alert should be repeated in the Recurrence field. Note: The address for any online references can be entered in the Web Reference field. h. Click the Add button in the Provider List section. The Select Provider(s) window opens. i. Check the box(es) next to the provider(s) you want to be notified with this alert. j. Click the OK button. The Select Provider(s) window closes and the selected providers are populated in the Provider List section on the Dx Specific Alert window. k. Click the OK button. The Glucose lab alert is now created. Note: Many other types of labs, diagnostic imaging tests, immunizations, and prescriptions can also be added to this alert. 8. Click the OK button. Copyright eclinicalworks, LLC 2011, Meaningful Use Training Scenarios Guide 133

134 This alert is now created. Patients with diabetes who have not had a Glucose lab test in the past two years will have this alert displayed for the selected providers. For more information on the many other types of alerts available, refer to the Electronic Medical Records Users Guide, which can be found at Creating Registry Alerts Scenario: You must create a Registry alert for all male patients aged 50 years or older who have not had a prostate exam in the past year in order to identify the patients that are in need of preventive care. Workflow: 1. From the Registry band in the left navigation pane, click the Registry icon. The Registry window opens with the Demographics tab displayed: Note: The various filters and tabs on this window can be used to create lists of patients based on a wide variety of criteria. Registry alerts can be created for any of these lists. For more information on these filters and tabs, refer to the Registry section of the Electronic Medical Records Users Guide, which can be found at my.eclinicalworks.com. 2. Enter 50 in the left-most Age Range field. 3. Select Male from the Sex drop-down list. 4. Click the Run New button. All male patients aged 50 or older are displayed in the middle pane. The formula used to calculate results (based on the filters you have set) is displayed in the bottom pane: 5. Click the Labs/DI tab. The Labs/DI options display: 6. To select a lab: a. Click the Sel button next to the Labs field. The Labs window opens. Copyright eclinicalworks, LLC 2011, Meaningful Use Training Scenarios Guide 134

135 b. Highlight the Prostate exam and click the OK button. The Prostate exam is populated in the Labs field. c. Click the Cancel button. The Labs window closes. 7. Select a date one year before today s date from the left-most Results Date Range field. 8. Click the Run Subset (NOT) button. All patients in the existing list of results are filtered to include only patients that have not had a result for a Prostate exam entered into the system for the past year. 9. Click the Save Queries button. The Save Registry Report window opens: 10. Enter a name in the Name field (e.g., Prostate - Over 50). 11. Enter a description of this alert in the Report Criteria field (e.g., All male patients over 50 who have not had a prostate exam). 12. Check the CDSS Enabled box. The Report Criteria is now used as the CDSS Alert definition. For more information on all options available from this window, refer to the Electronic Medical Records Users Guide. 13. Click the OK button. This Registry alert is created. Registry alerts are displayed under the Registry Alerts section on the CDSS tab of the Right Chart Panel. Copyright eclinicalworks, LLC 2011, Meaningful Use Training Scenarios Guide 135

136 Note: Alerts may not display immediately after they have been created. Click the Update Registry Alerts link under the Registry Alerts section on the CDSS tab of the Right Chart Panel to ensure that all recently created Registry alerts are displayed. This action may take a long time and slow the performance of the system, so it is recommended to run this process after hours. Enabling CDSS Alerts on Progress Notes Scenario: CDSS Alerts must be enabled for each provider from My Settings in order to view them from the Progress Notes window. You must now enable this functionality. Workflow: 1. From the File menu, hover over the Settings option to open a drop-down list. 2. From the drop-down list, click the My Settings option. The My Settings window opens. 3. Click the Views tab. The Views options display. 4. In the Alerts row, click the CDSS radio button. Check the Both box: 5. Click the OK button. Copyright eclinicalworks, LLC 2011, Meaningful Use Training Scenarios Guide 136

137 CDSS Alerts are now enabled for this provider. Enabling Classic Alerts in the Right Chart Panel Scenario: An Alerts tab can be enabled for the Right Chart Panel on the Progress Notes window based on My Settings, which must be configured for each provider. You must now enable this tab. Workflow: 1. From the File menu, hover over the Settings option to open a drop-down list. 2. From the drop-down list, click the My Settings option. The My Settings window opens. 3. Click the Show/Hide tab. The Show/Hide options display. 4. Check the box above the Alerts tab: 5. Click the OK button. The Alerts tab is now enabled for the Right Chart Panel. Copyright eclinicalworks, LLC 2011, Meaningful Use Training Scenarios Guide 137

138 Enabling CDSS Alerts in the Right Chart Panel Scenario: A CDSS Alerts tab can be enabled for the Right Chart Panel on the Progress Notes window based on My Settings, which must be configured for each provider. You must now enable this tab. Workflow: 1. From the File menu, hover over the Settings option to open a drop-down list. 2. From the drop-down list, click the My Settings option. The My Settings window opens. 3. Click the Show/Hide tab. The Show/Hide options display. 4. Check the box above the CDSS tab: 5. Click the OK button. The CDSS tab is now enabled for the Right Chart Panel. Using Alerts from the Patient Dashboard Scenario: Jill Smith has come in for her latest appointment. She currently has alerts for CBC, Influenza, and Lipid Panel labs. She has chosen to delay her CBC lab for one month, would Copyright eclinicalworks, LLC 2011, Meaningful Use Training Scenarios Guide 138

139 not like to ever have the Influenza immunization performed, and has had a Lipid Panel performed one week ago. You must now record this information. Workflow: 1. From the Progress Notes window, click the Alerts link in the Patient Dashboard. The Alerts window opens. All alerts that are overdue or due in the next three months are displayed. A yellow triangle icon with an exclamation point displays to the left of any alerts that are overdue: 2. To suppress the alert for the CBC lab for one month: a. Highlight the CBC alert and click the Suppress button. A confirmation window opens. b. Click the Yes button. The Suppress window opens: c. Either enter a date one month from today in the Remind Next on field. Copyright eclinicalworks, LLC 2011, Meaningful Use Training Scenarios Guide 139

140 Click the 4W button to automatically populate the Remind Next on field with a date four weeks from today. d. Enter the reason for this suppression in the Notes field. e. Click the OK button. The Suppress window closes and this alert is now suppressed for one month. 3. To suppress the alert for the Influenza immunization forever: a. Check the box next to the Influenza immunization. b. Click the Never Remind button. The Influenza alert is removed from the alerts for this patient. 4. To record the last date the Lipid Panel was performed: a. Highlight the Lipid Panel lab and click the Last Done button. The Last Done Date window opens: b. Select a date one week before today s date using the Last Done drop-down calendar. Click the 1W button to automatically populate the Last Done field with a date one week before today s date. c. Enter the result of this immunization in the Result field. Note: The next date that this alert is due can be overridden or suppressed forever using the options at the bottom of this window. Any notes concerning this suppression can be entered in the Notes field. d. Click the OK button. The Last Done Date window closes and this alert is satisfied for now. Copyright eclinicalworks, LLC 2011, Meaningful Use Training Scenarios Guide 140

141 Viewing Alerts from the Right Chart Panel Scenario: You are currently seeing Amy Smith for her appointment. You must now check her Alerts to determine if she is in need of any specific care. Workflow: 1. Open Amy Smith s Progress Notes. 2. Click the Alerts tab. The alerts that are overdue or will be due in 3 months are displayed: For more information on satisfying these alerts, refer to the section titled Using Alerts from the Patient Dashboard on page 138. Using CDSS Alerts from the Progress Notes Scenario: You are currently seeing John Smith for his appointment. You must check his CDSS Alerts to determine if he is in need of any specific care. Workflow: 1. From the Progress Notes window, click the CDSS link in the Patient Dashboard. Note: This window can also be accessed from the Treatment window by clicking the CDSS button in the lower-right corner (to progress to the next window) or from the Billing window by clicking the CDSS button in the lower-left corner (to go back to the last window). The CDSS Alerts window opens: Copyright eclinicalworks, LLC 2011, Meaningful Use Training Scenarios Guide 141

142 The following statuses are available: Non-Compliant - The patient satisfies the denominator criteria for this Quality Measure, but not the numerator. This indicates that the patient needs care. Compliant - The patient satisfies both the numerator and the denominator for this Quality Measure. This indicates that the patient has received the appropriate care. Snoozed - The patient satisfies the denominator criteria for this Quality Measure, and the appropriate tests have been ordered to satisfy the numerator, but the results have not yet been received. This indicates that the appropriate care has been given, but more care may be necessary once the test results have been received. The Snoozed status lasts for 30 days before changing to either Compliant or Non-Compliant, depending on the information entered into the system. Only diagnoses in the Problem List with their W/U Status set to Confirmed are considered when calculating compliancy. Note: To print this information, click the printer icon in the lower-left corner of the window. 2. Select one of the following types of alerts to view from the Show drop-down list: All Alerts: Displays all alerts in the system. Overdue: Displays alerts that are past due for this patient. Due in 1 Month: Displays alerts that are due in one month for this patient. Due in 3 Months: Displays alerts that are due in three months for this patient. Suppressed: Displays alerts that have been suppressed for this patient. Note: Click the Measure Name for any alert to view the criteria that triggers it. 3. To select the status of an order: a. Select a status from the drop-down list to the right of the element to perform the action on. b. Click the disk icon to the right of the Status drop-down list. The selected status is saved for this element. The following statuses are available: Status Other Actions Ordered Action Taken Indicates that an action has been taken on this element that does not fit into any of the other status categories. Indicates that this element was ordered for this patient. Copyright eclinicalworks, LLC 2011, Meaningful Use Training Scenarios Guide 142

143 Status Historical Data Action Taken Selecting this status and clicking the disk icon displays information concerning the patient s history with this element. The exact action taken is different for each type of order: Rx - displays the most recent status chosen for this medication. Labs - opens the Lab Results window for the most recent date this lab was ordered for this patient. Diagnostic Imaging - opens the Diagnostic Imaging window for the most recent date this diagnostic imaging test was ordered for this patient. Procedures - opens the Procedures window for the most recent date this procedure was recorded for this patient. Immunizations - opens the Update Immunizations Details window for the most recent date this immunization was given to this patient. The Vaccination Given in the Past box is checked by default. Note: If a status for an element has been specified for this patient in the past, it is considered historical data. An H icon is added to the Order Set to indicate that the element is part of the patient s history. Note: Click the red hand icon to the right of an item to suppress that alert. 4. For quick Order Sets, click the down-facing arrow next to an item to order that item. 5. For regular Order Sets, click the OS icon to order elements from that Order Set. If more than one diagnosis is present in the patient s Problem List and the Linked Assessments for this Order Set, then a pop-up window opens: If there is only one diagnosis, it is applied automatically and no window opens. 6. To select the diagnoses to link to this Order Set: a. Check the box(es) next to the appropriate diagnoses. b. Click the OK button. The selected diagnoses are added to the Progress Notes. The Order Sets window opens c. Specify the elements to order. Providers may face the following specific scenarios when using CDSS Alerts: When the denominator criterion for a CDSS Alert is fulfilled for a patient, they are marked as Non-Compliant for that alert. Fulfilling the numerator criterion for a patient causes this alert to be marked as Compliant, indicating that the necessary care has been given. For more information on fulfilling the numerator criteria for a CDSS Alert, refer to the section titled Fulfilling the Numerator Criteria for a CDSS Alert on page 144. Copyright eclinicalworks, LLC 2011, Meaningful Use Training Scenarios Guide 143

144 Sometimes, the numerator criteria cannot be fulfilled right away for a patient, and the numerator inclusion criteria must be fulfilled first. If the numerator inclusion criterion is fulfilled for a CDSS Alert, then that alert is marked as Snoozed. This indicates that action has been taken on this alert, but more information or actions are needed before the numerator criteria can be fulfilled (e.g., a lab has been ordered, but the provider is awaiting the results). For more information on fulfilling the numerator inclusion criteria for a CDSS Alert, refer to the section titled Fulfilling the Numerator Inclusion Criteria for a CDSS Alert on page 146. Fulfilling the Numerator Criteria for a CDSS Alert Scenario: Amber is 25 years old and has not had her sexual history recorded in the past year. This has fulfilled the denominator for Quality Measure 1023-CT (Sexual History Taken), marking Amber as Non-Compliant for this CDSS Alert. In order to fulfill the numerator for this Quality Measure, a sexual history must be recorded for Amber. This will mark Amber as Compliant for this alert for the next 12 months. Workflow: 1. View information on this CDSS Alert using one of the following methods: a. From the Patient Dashboard, click the CDSS link. Note: CDSS Alerts must be enabled from the Views tab in Practice Defaults to use this method. For more information, refer to Enabling CDSS Alerts on Progress Notes on page 136. The CDSS Alerts window opens. b. Click the Sexual history taken Measure Name: A pop-up window displays with information on how this alert was triggered (denominator) and how to satisfy the alert (numerator): Copyright eclinicalworks, LLC 2011, Meaningful Use Training Scenarios Guide 144

145 a. From the Right Chart Panel, click the CDSS tab: Note: The CDSS tab on the Right Chart Panel must be enabled from the Show/Hide tab in Practice Defaults to use this method. For more information, refer to the section titled Enabling CDSS Alerts in the Right Chart Panel on page 138. The CDSS Alerts that pertain to this patient are displayed. b. Click the? icon to the right of the Sexual History Taken alert: A pop-up window displays with information on how this alert was triggered (denominator) and how to satisfy the alert (numerator). 2. Click the Social History link on the Progress Notes window. The Social History window opens. 3. Click in the Details column for the Sexual History row. The Social History Notes window opens. 4. Enter the appropriate information on Amber s sexual history. 5. Click the OK button. The Social History Notes window closes and the Sexual History information is recorded. 6. Click the X button in the upper-right of the Social History window. The Social History window closes and the numerator for this CDSS Alert is satisfied. 7. To view the current status of this alert and verify that the numerator for this alert has been satisfied, click the CDSS link in the Patient Dashboard. Copyright eclinicalworks, LLC 2011, Meaningful Use Training Scenarios Guide 145

146 The CDSS Alerts window opens with the status of the Sexual History Taken alert marked as Compliant. Fulfilling the Numerator Inclusion Criteria for a CDSS Alert Scenario: Frank is 42 years old, and he has just been diagnosed with Diabetes. This has fulfilled the denominator Quality Measure 350-CE - LDL Testing (High Risk), marking Frank as Non- Compliant. In order to fulfill the numerator for this Quality Measure, an LDL Cholesterol test must have been performed in the past 12 months. Since it is not certain whether the test will be performed successfully, once this test is ordered the CDSS Alert is marked as Snoozed. Frank will not be marked as Compliant until the test results are received and recorded in the system. Workflow: 1. Add an ICD Code for Diabetes to Frank s Problem List. The LDL Testing (High Risk) CDSS Alert is triggered. 2. View information on this CDSS Alert using one of the following methods: a. From the Patient Dashboard, click the CDSS link. Note: CDSS Alerts must be enabled from the Views tab in Practice Defaults to use this method. For more information, refer to Enabling CDSS Alerts on Progress Notes on page 136. The CDSS Alerts window opens. b. Click the LDL testing Measure Name: A pop-up window displays with information on how this alert was triggered (denominator) and how to satisfy the alert (numerator). a. From the Right Chart Panel, click the CDSS tab: Copyright eclinicalworks, LLC 2011, Meaningful Use Training Scenarios Guide 146

147 Note: The CDSS tab on the Right Chart Panel must be enabled from the Show/Hide tab in Practice Defaults to use this method. For more information, refer to the section titled Enabling CDSS Alerts in the Right Chart Panel on page 138. The CDSS Alerts that pertain to this patient are displayed. b. Click the? icon to the right of the Cholesterol screen (genl pop) alert: A pop-up window displays with information on how this alert was triggered (denominator) and how to satisfy the alert (numerator). 3. Having obtained the numerator for this alert, perform one of the following set of steps to satisfy that criteria: a. Manually order the required test by clicking the Lab Reports link on the Progress Notes window. The Labs window opens. b. Order an LDL Cholesterol test as you would normally. c. Click the OK button. The appropriate test is ordered for this patient. a. Use a linked Order Set from the CDSS Alerts window by clicking the CDSS link in the Patient Dashboard. Note: An appropriate Order Set must have already been linked to this Quality Measure to use this method. For more information on linking Order Sets with Quality Measures, refer to the refer to the Linking Order Sets with Measures section of the Electronic Medical Records Users Guide, which can be found at The CDSS Alerts window opens. b. Click the arrow in the Orders column of the LDL Testing (High Risk) row. If this is a quick Order Set (containing only one order) the test is automatically ordered. If this is not a quick Order Set, a pop-up window displays, allowing you to select the orders that you want to add to the Progress Notes. Copyright eclinicalworks, LLC 2011, Meaningful Use Training Scenarios Guide 147

148 a. Use a linked Order Set from the CDSS Alerts window by clicking the + icon next to the LDL Testing (High Risk) alert. Note: An appropriate Order Set must have already been linked to this Quality Measure to use this method. For more information on linking Order Sets with Quality Measures, refer to the refer to the Linking Order Sets with Measures section of the Electronic Medical Records Users Guide, which can be found at The Order Set associated with this alert is displayed. b. Click the arrow to the left of the Order Set. If this is a quick Order Set (containing only one order) the test is automatically ordered. If this is not a quick Order Set, a pop-up window displays, allowing you to select the orders that you want to add to the Progress Notes. 4. Once one of the methods in step 3. has been followed, click the CDSS link in the Patient Dashboard to view the current status of this alert. The LDL Testing (High Risk) alert is marked as Snoozed: After 30 days, the system recalculates the status of this alert based on the information entered into the system. If the results of the test have been received and recorded by this time the status will change to Compliant, indicating that all appropriate actions have been taken on this alert. If they have not, the status changes to Non-Compliant, indicating that another test needs to be ordered. Copyright eclinicalworks, LLC 2011, Meaningful Use Training Scenarios Guide 148

149 (f): Providing an Electronic Copy of Health Information Stage 1 Objective Patients must be provided with an electronic copy of their health information (including diagnostic test results, problem list, medication lists, and medication allergies) upon request. Stage 1 Measure More than 50% of all patients of the eligible professional who request an electronic copy of their health information must be provided it within three (3) business days. Denominator The number of patients of the eligible professional who request an electronic copy of their electronic health information four business days prior to the end of the EHR reporting period. Numerator The number of patients in the denominator who receive an electronic copy of their health information within three business days. Exclusions Eligible professionals are excluded from this measure if they do not receive any requests from patients or their agents for an electronic copy of patient health information during the EHR reporting period. eclinicalworks Calculations Denominator Unique patients are included in the denominator if they clicked one of the following links on the Patient Portal: Request your PHR PHR - Complete Report Numerator Patients in the denominator are included in the numerator if their PHR loads successfully after they click one of the links to request it. Exclusion Providers with no requests from patients for an electronic copy of their health information during the reporting period are excluded from satisfying this measure. Action Recommendations Policy Recommendations Mid Office - Providers should upload information for patients that request it within 72 hours to the Patient Portal. Copyright eclinicalworks, LLC 2011, Meaningful Use Training Scenarios Guide 149

150 eclinicalworks Setup Recommendations Front Office - Staff must perform the following actions: To enable Personal Health Reports (PHRs) on the Patient Portal, refer to the section titled Enabling Personal Health Records on the Patient Portal on page 150. To web-enable patients so that they have access to the Patient Portal, refer to the section titled Web-Enabling a Patient on page 151. Workflow Recommendations System Administration - The synchronization schedule for health information must be configured before information is exchanged between the eclinicalworks application and the Patient Portal. For more information, refer to the section titled Scheduling the Synchronization of Health Information with the Patient Portal on page 155. Patients - Patients can access any information that has been uploaded to the Patient Portal through the Internet. For more information, refer to the section titled Accessing Health Information on the Patient Portal on page 158. IMPTANT! This measure is satisfied for a patient once they have viewed their information on the Patient Portal. Additional Tips The Patient Portal, as well as patients Portal accounts, can be customized in various ways to meet the needs of your practice and your patients. For more information on the various available features, refer to the Patient Portal Users Guide, which can be found at my.eclinicalworks.com. Enabling Personal Health Records on the Patient Portal Scenario Your practice currently has the viewing of Personal Health Records (PHRs) on the Patient Portal disabled. You must now enable this feature so that patients can view their PHRs on the Patient Portal. Workflow: 1. From the Admin band in the left navigation pane, click the Patient Portal Settings icon. The Patient Portal Settings window opens. 2. Click the Feature Settings link in the left pane. The Feature Settings options display in the right pane. 3. Select the Yes option from the Enable Personal Health Record, Medical Record dropdown list: Copyright eclinicalworks, LLC 2011, Meaningful Use Training Scenarios Guide 150

151 4. Click the Save button. Personal Health Records are now available for your patients to view on the Patient Portal. Web-Enabling a Patient Scenario: Lisa McTest wants to be able to view his health information electronically. You must webenable her in eclinicalworks so that she can access the Patient Portal. Workflow: 1. Click on the Patient Lookup icon: The Patient Lookup window opens. 2. Search for Lisa McTest: Copyright eclinicalworks, LLC 2011, Meaningful Use Training Scenarios Guide 151

152 Web-enabled Note: A W in the Web column indicates that a patient is already web-enabled. 3. Highlight Lisa s name and click the Patient Information button. Note: If you double-click on Lisa s name, her Patient Hub will open, displaying her web-enabled status in the Web Enabled field: Lisa is not yet webenabled. Click the Info button to access the Patient Information window. The Patient Information window opens. 4. Click on the Options button at the bottom of the window to open a drop-down list: Copyright eclinicalworks, LLC 2011, Meaningful Use Training Scenarios Guide 152

153 5. Click the Web Enable option: Note: If Lisa had already been web-enabled, a check mark would be displayed to the left of the Web Enable option. The Patient Portal Account Management window opens: Copyright eclinicalworks, LLC 2011, Meaningful Use Training Scenarios Guide 153

154 Note: The patient s first name and last name with no spaces is populated automatically in the User Name field. 6. Either accept the default user name or enter a unique user name in the User Name field. 7. Enter a unique password for Lisa in the Password field. 8. Re-enter Lisa s password in the Confirm Password field. 9. Enter Lisa s address in the field. Note: This address will be used for all automated messages to Lisa regarding new messages sent to the patient s Portal account, new lab published information, appointment reminder notifications, etc. 10. Click the OK button. A confirmation window opens, asking Do you want to print information for the patient? 11. To print the Username and Password information to give to Lisa, click the Yes button. Click the No button to continue without printing. Note: The password is now encrypted in the system and it cannot be accessed again. It can be reset to a new password, however, if this password is forgotten. The Patient Portal Account Management window closes. 12. On the Patient Information window, click the OK button. Copyright eclinicalworks, LLC 2011, Meaningful Use Training Scenarios Guide 154

155 The Patient Information window closes and Lisa s web-enable status is now saved. If you open Lisa s Patient Hub, her web-enabled status is changed to Yes, and her e- mail address is displayed: address Web-enabled Scheduling the Synchronization of Health Information with the Patient Portal Scenario: You must configure the synchronization schedule for the Patient Portal so that patients health information is uploaded to the Patient Portal at regular intervals. Workflow: 1. From the Admin band in the left navigation pane, click the Patient Portal Settings icon. The Patient Portal Settings window opens. 2. Click the Run link in the Synchronize section: Copyright eclinicalworks, LLC 2011, Meaningful Use Training Scenarios Guide 155

156 The Web Portal Tasks Schedule window opens: 3. Check the box next to each task you want to schedule. Note: Check the top-most box to check all boxes at once. 4. Enter the number of minutes between each synchronization in the fields in the Interval column for each checked task. Copyright eclinicalworks, LLC 2011, Meaningful Use Training Scenarios Guide 156

157 In this example, several downloads have been scheduled to take place every five minutes throughout the day, the recommended interval for these tasks: Remaining tasks may be scheduled at various different intervals dependent upon need and resource utilization. For example, Uploading questionnaire data and administrative settings to the Web Portal should be done at implementation; The only other time it might be run is in the event that the practice needs a new questionnaire or modifications to an existing one. Because the need is not as critical, uploading information to lock the accounts of portal disabled patients need not be done as frequently as other tasks; therefore, the practice in the example has set this synchronization to occur every 100 minutes. Finally, because it is so system resource performance intensive, the Upload Provider/Pharmacy Data to Web Portal task should be scheduled no more often than every 2,000 to 4,000 minutes. 5. Click the Schedule button. The checked tasks are now scheduled as specified. Note: To stop a checked schedule that is currently running, click the Stop Schedule button. It is advisable to Stop the Schedule in the morning, before the practice becomes active. This will avoid any impact on tasks that may be running. The next-best choice would be at the end of the day, but be sure there are no tasks running when the Stop Schedule button is clicked. Note: To run the checked tasks now, click the Stop Schedule button to stop any tasks and prevent potential conflicts and then click the Run Now button. All checked tasks will run immediately; the system displays Running in the Status column until the synchronization is complete. Copyright eclinicalworks, LLC 2011, Meaningful Use Training Scenarios Guide 157

158 Note: To refresh the synchronization status of any tasks currently running, click the Refresh button. Accessing Health Information on the Patient Portal Scenario: John Smith wants to access the health information that you have uploaded to the Patient Portal. He must now follow these steps in order to access it. Workflow: 1. Open your Internet browser (Internet Explorer 7.0 or later is recommended). 2. Enter your practice s Patient Portal web address in the Address bar. 3. Press the Enter key on your keyboard. The Patient Portal login page displays: Note: Users that are not yet patients at this practice can pre-register their demographic information by clicking the Pre-Register link. 4. Enter the username provided for you by your practice in the Username field. 5. Enter the password provided for you by your practice in the Password field. Note: If you have forgotten your password, click the Forgot Password link to have it sent to your address. To reset your password to a new password, click the Reset Password link. 6. Click the Sign In button. The Patient Portal web page opens. If this is your first time logging into the Patient Portal, a disclaimer page displays. You must check the I have read the consent form... box and click the Agree button to proceed to the Patient Portal: Copyright eclinicalworks, LLC 2011, Meaningful Use Training Scenarios Guide 158

159 The Patient Portal Home Page displays. 7. Click one of the links in the Personal Health Record (PHR) section: Click one of the PHR links in the Review section of the left navigation pane: Copyright eclinicalworks, LLC 2011, Meaningful Use Training Scenarios Guide 159

160 (h): Providing Clinical Summaries Stage 1 Objective Clinical summaries of each encounter must be made available to all patients at the end of their encounters, so that they are aware of the information that was recorded. Stage 1 Measure Clinical summaries must be provided to patients for more than 50% of all office visits within three (3) business days. Denominator The number of unique patients seen by the eligible professional during the EHR reporting period. Numerator The number of patients in the denominator who are provided a clinical summary of their visit within three (3) business days. Exclusions Eligible professionals are excluded from this measure if they have no office visits during the EHR reporting period. eclinicalworks Calculations Denominator Unique patients are included in the denominator if: An appointment has been created for them during the reporting period from the Resource Scheduling, Provider Schedule, or Office Visits window AND NOT A visit type or visit code with the exclusion flag enabled has been selected for this appointment Note: Telephone encounters are not counted as appointments. Patients with only Telephone Encounters are not included in the denominator for this measure. Copyright eclinicalworks, LLC 2011, Meaningful Use Training Scenarios Guide 160

161 Numerator Patients in the denominator are included in the numerator if: They have been web-enabled from the Patient Information window within three business days (excluding federal, but not state, holidays) of their encounter IMPTANT! Your practice must enable Visit Summaries for the Patient Portal. For more information, refer to the Meaningful Use Training Scenarios Guide. The Print Visit Summary option is selected from one of the following areas: Print drop-down list on the Progress Notes Right-click on an appointment Exclusion Providers with no appointments recorded during the reporting period are excluded from satisfying this measure. Action Recommendations Policy Recommendations: Front Office - Staff should ask patients during the check-out process if they would like a summary of their encounter. If they would, a visit summary should then be printed for them. eclinicalworks Setup Recommendations Front Office - Staff must perform the following actions: To enable Medical Summaries on the Patient Portal, refer to the section titled Enabling Visit Summaries on the Patient Portal on page 162. To web-enable patients so that they have access to their visit summaries, refer to the section titled Web-Enabling a Patient on page 151. Workflow Recommendations Front Office - Staff must be able to print visit summaries for any patients that require them. For more information, refer to the section titled Printing a Visit Summary from the Resource Schedule on page 162. Mid Office - Providers must be able to print visit summaries for any patients that require them. For more information, refer to the section titled Printing a Visit Summary from the Progress Notes on page 164. Additional Tips The Patient Portal, as well as patients Portal accounts, can be customized in various ways to meet the needs of your practice and your patients. For more information on the various available features, refer to the Patient Portal Users Guide, which can be found at my.eclinicalworks.com. Copyright eclinicalworks, LLC 2011, Meaningful Use Training Scenarios Guide 161

162 Enabling Visit Summaries on the Patient Portal Scenario Your practice currently has the viewing of Visit Summaries on the Patient Portal disabled. You must now enable this feature so that patients can view their Visit Summaries on the Patient Portal. Workflow: 1. From the Admin band in the left navigation pane, click the Patient Portal Settings icon. The Patient Portal Settings window opens. 2. Click the Feature Settings link in the left pane. The Feature Settings options display in the right pane. 3. Select the Yes option from the Enable Visit Summary feature drop-down list: 4. Click the Save button. Visit Summaries are now available for your patients to view on the Patient Portal. Printing a Visit Summary from the Resource Schedule Scenario: John Smith is checking out after his latest encounter. He would like to view a visit summary for this encounter. Copyright eclinicalworks, LLC 2011, Meaningful Use Training Scenarios Guide 162

163 Workflow: 1. From the Resource Schedule, right-click on John Smith s appointment to open a dropdown list. 2. From the drop-down list, click the Print Visit Summary option. The Print Options window opens: Note: To exclude any types of information from the visit summary, uncheck the desired box(es). 3. Click the Print Preview button. The Visit Summary window opens. 4. Click the Print icon to print this summary: Print The visit summary for John Smith s encounter now prints. Copyright eclinicalworks, LLC 2011, Meaningful Use Training Scenarios Guide 163

164 Printing a Visit Summary from the Progress Notes Scenario: John Smith would like to go over his visit summary with you during the encounter. You must print it out so you can go over it with him. Workflow: 1. From John Smith s Progress Notes, click the green arrow next to the Print button to open a drop-down list. 2. From the drop-down list, click the Print Visit Summary option. The Print Options window opens: Note: To exclude any types of information from the visit summary, uncheck the desired box(es). 3. Click the Print Preview button. The Visit Summary window opens. 4. Click the Print icon to print this summary: Copyright eclinicalworks, LLC 2011, Meaningful Use Training Scenarios Guide 164

165 Print The visit summary for John Smith s encounter now prints (a): Checking Drug Interactions Stage 1 Objective All medications prescribed to patients must be checked against all other medications they are taking, as well as all known allergies/intolerances, in order to determine if there are any potentially harmful interactions. Stage 1 Measure The eligible professional must have enabled this functionality for the entire EHR reporting period. eclinicalworks Calculations eclinicalworks does not perform any calculations for this measure. Drug interaction checking is always enabled for all eclinicalworks users. No action is required to satisfy this measure. This measure is reported by self-attestation. Action Recommendations Policy Recommendations: Mid Office - At each encounter, providers must perform the following: Update the Allergies, Current Medications, and Assessment section of the Progress Notes with any new information and/or review the information in these sections for accuracy. Copyright eclinicalworks, LLC 2011, Meaningful Use Training Scenarios Guide 165

166 Note: Only structured allergies must be entered into the system. Nonstructured allergies and custom medications not linked to NDC codes will not trigger interaction warnings. Custom medications can be made structured by linking them with the appropriate NDC code. For more information, refer to the System Administration Users Guide, which can be found at my.eclinicalworks.com. Record any new prescriptions prescribed during each encounter in the Treatment section of the Progress Notes. Click the Interactions button on the Treatment window to view any potentially harmful drug interactions. eclinicalworks Setup Recommendations Mid Office - The following processes are recommended in order to catch all potentially harmful drug interactions: Enable the pop-up Drug Interaction window from the User Settings tab of the My Settings window. With this setting enabled, the Drug Interaction is opened automatically whenever an interaction is detected. The level of severity that causes this pop-up can also be configured. This setting can be enabled from My Settings for each user. For more information, refer to the System Administration Users Guide, which can be found at Maintain up-to-date Allergies, Current Medications, Assessments, and Problem Lists (For more information on maintaining Problem Lists, refer to the section titled (c): Maintaining Up-to-Date Problem Lists on page 175). Workflow Recommendations Mid Office - To view drug interactions on the Treatment window, refer to the section titled Viewing Drug Interactions from the Treatment Window on page 166. Additional Tips The Drug Interaction window can also be accessed from the following locations: OB Flowsheet - Rx tab Print Rx window Fax Rx window eprescribe Rx window Viewing Drug Interactions from the Treatment Window Scenario: Charles Smith has been diagnosed with an alcohol abuse problem in the past. He has also indicated an allergy to penicillin in a past encounter and is currently taking Coumadin. You are attempting to prescribe him amoxicillin and ibuprofen. Any potentially harmful interactions must now be checked. Copyright eclinicalworks, LLC 2011, Meaningful Use Training Scenarios Guide 166

167 Workflow: 1. From the Treatment window, click the Interactions button. The Treatment window opens. If proactive interaction checking is enabled, the Interactions button will be highlighted. The following colors are used to highlight the Interactions button: Yellow - Minor interaction(s) detected. Orange - Moderate interaction(s) detected. Red - Severe interaction(s) detected. Aqua Blue - General warning. 2. Click the Interactions button. The Drug Interactions window opens with the potential interaction between alcohol and ibuprofen noted: Note: The severity of an interaction can be adjusted by clicking one of the radio buttons in the Adjust Severity section to the right of an interaction. Note: Clicking the Time Stamp button creates a log of the user, date, and time that this interaction was checked. This is useful for verifying that a particular interaction was viewed by your practice, as well as indicating why a prescription may have been continued despite the interaction warning. Copyright eclinicalworks, LLC 2011, Meaningful Use Training Scenarios Guide 167

168 (c): Recording Demographics Stage 1 Objective All patients must have the following basic demographic information recorded within eclinicalworks: Preferred Language Gender Race Ethnicity Date of Birth Stage 1 Measure More than 50% of all unique patients seen by the eligible professional must have demographics recorded as structured data. Denominator The number of unique patients seen by the eligible professional during the EHR reporting period. Numerator The number of patients in the denominator who have all elements of demographics (or a specific exclusion if the patient declined to provide one or more elements or it recording an element is contrary to state law) recorded as structured data. eclinicalworks Calculations Denominator Unique patients are included in the denominator if: An appointment has been created for them during the reporting period from the Resource Scheduling, Provider Schedule, or Office Visits window AND NOT A visit type or visit code with the exclusion flag enabled has been selected for this appointment Note: Telephone encounters are not counted as appointments. Patients with only Telephone Encounters are not included in the denominator for this measure. Copyright eclinicalworks, LLC 2011, Meaningful Use Training Scenarios Guide 168

169 Numerator Patients that satisfy the denominator are included in the numerator if all of the following information is recorded on the Patient Information window: Date of Birth Gender Language Race Ethnicity Action Recommendations Policy Recommendations: Front Office - The basic demographic information for all patients must be recorded before their first encounter with the practice. eclinicalworks Setup Recommendations System Administration - Perform the following actions as required: The information entered on the Patient Information - Additional Info window (race, ethnicity, and language) can be checked for completion automatically whenever users attempt to close the Patient Information window. For more information, refer to the section titled Checking Additional Info on the Patient Information Window on page 169. The demographics fields that must be filled in for every patient must be configured. To configure this information, refer to the section titled Configuring Demographic Mandatory Fields on page 170. Note: In some states it is illegal to inquire about patients race and ethnicity. In these states, these questions are exempted from this portion of the measure. Workflow Recommendations Front Office - Perform one or more of the following actions as necessary: To record the basic demographic information for every patient, refer to the section titled Recording Basic Demographic Information on page 171. To record missing demographic information for a patient during check-in, refer to the section titled Recording Missing Demographic Information During Check-In on page 174. Checking Additional Info on the Patient Information Window Scenario: Currently, there is no reminder for users to enter race, ethnicity, and language information on the Patient Information - Additional Info window. You must now enable a setting for the entire practice that check this information before the Patient Information window can be closed. Copyright eclinicalworks, LLC 2011, Meaningful Use Training Scenarios Guide 169

170 Workflow: 1. From the File menu, hover over the Settings option to open a drop-down list. 2. From the drop-down list, click the Practice Defaults option. The Practice Defaults window opens. 3. Click the Options tab. The Options items display. 4. Check the Validate patient s Additional Info in Demographic section itself box: 5. Click the OK button. Entering information for race, ethnicity, and language is now required before users can exit the Patient Information window. Configuring Demographic Mandatory Fields Scenario: You can configure the demographics fields that are mandatory for your practice, in order to prevent any patients being entered into the system with inadequate information. Note: This is not required for the measure, and may not be desirable for every practice. Some patients are uncomortable providing certain information over the phone, and if that information is marked as mandatory, then a patient cannot be created in the system unless that information is entered. If any of the information required for Meaningful Use (and an address) is not entered here, then an alert displays when you attempt to check this patient in for an appointment. Copyright eclinicalworks, LLC 2011, Meaningful Use Training Scenarios Guide 170

171 Workflow: 1. From the Patient menu, click the Configure Demographics Mandatory Fields option. The Demographics Mandatory Fields window opens: 2. Check the boxes next to the following fields (at a minimum): Language Race Ethnicity Note: Fields without boxes are always mandatory and cannot be made optional. IMPTANT! In some states it is illegal to inquire about patients race and ethnicity. In these states, these questions are exempted from the measure and should not be made mandatory. 3. Click the OK button. The mandatory demographics fields for your practice are now configured. Recording Basic Demographic Information Scenario: Eric Kelley is not yet in the eclinicalworks system, and has come in for his first encounter at your practice. You must now enter his basic demographic information. Note: If any of the information required for Meaningful Use (and an address) is not entered here, then an alert displays when you attempt to check this patient in for an appointment. Copyright eclinicalworks, LLC 2011, Meaningful Use Training Scenarios Guide 171

172 Workflow: 1. Click the Patient Lookup icon at the top of the application: The Patient Lookup window opens: 2. Click the New button. The Patient Information window opens: 3. Enter the appropriate information in the fields here, especially the following fields: Last Name - Enter the patient s last name (in this case, Kelley) here. First Name - Enter the patient s first name (in this case, Eric) here. Date of Birth - Enter that patient s date (in mm/dd/yyyy format) and time (in 24- hour hh:mm:ss format) of birth here. Sex - Click the More (...) button next to this field to open the Gender Code window and select the appropriate gender code. Copyright eclinicalworks, LLC 2011, Meaningful Use Training Scenarios Guide 172

173 For more information on the other fields on this window, refer to the Front Office Users Guide, which can be found at 4. Click the Additional Info button. The Patient Information - Additional Info window opens: 5. Enter the appropriate information in the fields here, especially the following fields: Race - Select the race that best fits this patient from this drop-down list. One of the following options must be selected to satisfy the measure: American Indian or Alaska Native Asian Black or African American Native Hawaiian or Other Pacific Islander White Unreported/Refused to report Ethnicity - Select the ethnicity that best fits this patient from the drop-down list. One of the following options must be selected to satisfy the measure: Copyright eclinicalworks, LLC 2011, Meaningful Use Training Scenarios Guide 173

174 Hispanic or Latino Not Hispanic or Latino Unreported/Refused to report Language - Select the patient s preferred language from this drop-down list. For more information on the other fields and tabs on this window, refer to the Front Office Users Guide, which can be found at 6. Click the OK button. The Patient Information - Additional Info window closes. 7. On the Patient Information window, click the OK button. Eric Kelley is now created as a patient in the system. Recording Missing Demographic Information During Check-In Scenario: John Smith has not had all of the required demographic information recorded on the Patient Information window. You are now checking him into his appointment, and an MU Alert displays to notify you of this. You must now enter the missing information. Workflow: 1. From the Resource Scheduling window, open John Smith s appointment. The Billing Alert window opens with the MU Alert tab selected by default: 2. Enter the missing information in the field(s) here and click the Submit button. John Smith s demographics is updated with the entered information, and the Appointment window opens so you can proceed with the check-in process. Copyright eclinicalworks, LLC 2011, Meaningful Use Training Scenarios Guide 174

175 (c): Maintaining Up-to-Date Problem Lists Stage 1 Objective All diagnoses that represent current or chronic problems for patients must be added to their Problem List in order to track them. This list must be kept current by adding any problems to it immediately once they are known. Stage 1 Measures More than 80% of all unique patients seen by the eligible professional must have at least one entry or an indication that no problems are known for the patient recorded as structured data. Denominator The number of unique patients seen by the eligible professional during the reporting period. Numerator The number of patients in the denominator who have at least one entry or an indication that no problems are known for the patient recorded as structured data in their problem list. eclinicalworks Calculations Denominator Unique patients are included in the denominator if: An appointment has been created for them during the reporting period from the Resource Scheduling, Provider Schedule, or Office Visits window AND NOT A visit type or visit code with the exclusion flag enabled has been selected for this appointment Note: Telephone encounters are not counted as appointments. Patients with only Telephone Encounters are not included in the denominator for this measure. Numerator Patients that satisfy the denominator are included in the numerator if: An ICD code has been recorded on the Problem List The No known problems box is checked on the Problem List Action Recommendations Policy Recommendations: Mid Office - All providers should check on their next encounter with each patient, as well as on all new encounters, that all current and chronic problems are recorded in the eclinicalworks system using the techniques described below. Copyright eclinicalworks, LLC 2011, Meaningful Use Training Scenarios Guide 175

176 eclinicalworks Setup Recommendations System Administration - Any ICD codes that represent diagnoses that should always be added to the Problem List can be marked as chronic in order to have them automatically added to the Problem List whenever they are added to a patient s Progress Notes. For more information, refer to the section titled Marking ICD Codes as Chronic on page 176. Front Office - Patients must have their basic demographic information entered into the system in order to record any problems on their Problem List. Workflow Recommendations Mid Office - Follow the steps in one or more of the following sections as needed: To indicate that a patient has no current or chronic problems, follow the steps described in the section titled Indicating that a Patient has No Problems on page 177. To add a problem for a patient on their initial visit, follow the steps described in the section titled Adding a Diagnosis to the Problem List During an Initial Visit on page 178. To add a problem for a patient as a routine encounter, follow the steps described in the section titled Adding a Diagnosis to the Problem List when Documenting an Encounter on page 179. Additional Tips Problems can also be added to the Problem List without an encounter from the following locations: Patient Hub - Problems can be added in two ways from this window: Problem List button Overview Tab in the Right Chart Panel (if displayed) Received Faxes and Scanned Documents - Overview tab in the Right Chart Panel (if displayed) Lab and Diagnostic Imaging Results - Overview tab in the Right Chart Panel (if displayed) Telephone Encounters - Overview tab in the Right Chart Panel (if displayed) Marking ICD Codes as Chronic Scenario: The ICD code (diabetes) represents a chronic disease that should always be added to the patient s Problem List. You must mark this ICD code as chronic so that it is automatically added to patients Problem Lists whenever it is selected on the Progress Notes window. Workflow: 1. From the Billing menu, hover over the ICD option to open a drop-down list. 2. From the drop-down list, click the ICD Codes option. The ICD-9 Codes window opens: Copyright eclinicalworks, LLC 2011, Meaningful Use Training Scenarios Guide 176

177 3. Search for a code (in this case, diabetes) using the search fields at the top of the window. 4. Highlight a code (in this case, diabetes) and click the Update button. The ICD-9 Code window opens. 5. Check the Chronic box: 6. Click the OK button. The ICD code (diabetes) is now marked as chronic, and is automatically added to patients Problem Lists whenever it is entered on their Progress Notes. Indicating that a Patient has No Problems Scenario: Amy Smith has indicated that she has no current or chronic medical problems. You must now indicate this status in her Progress Notes. Copyright eclinicalworks, LLC 2011, Meaningful Use Training Scenarios Guide 177

178 Workflow: 1. From Amy Smith s Progress Notes, click the Assessments link. The Assessments window opens. 2. Click the Problem List button. The Problem List window opens. 3. Check the No known problems box: 4. Click the OK button. It is now indicated that Amy Smith has no current or chronic problems. Adding a Diagnosis to the Problem List During an Initial Visit Scenario: You are documenting an initial encounter for John Smith and want to enter any old problems he may have into the eclinicalworks system. He has mentioned that he has suffered from Asthma since he was a child. This diagnosis does not must be added to the Assessments section for this specific encounter, but it must be added to John s Problem List since it is a chronic problem. Workflow: 1. From the Progress Notes window, click the Overview tab in the Right Chart Panel if it is not already displayed. 2. Click the orange More (...) button in the Problem List heading: The Problem List window opens. 3. Click the Add button: The ICD-9 Codes window opens. 4. Search for asthma and highlight the ICD code ( in this case): Copyright eclinicalworks, LLC 2011, Meaningful Use Training Scenarios Guide 178

179 5. Click the OK button. The ICD-9 Codes window closes and the selected ICD code (493.90) is added to the Problem List window. 6. Click in the Clinical Status column to expose a drop-down list. 7. Select the clinical status for this diagnosis from the drop-down list (well-controlled in this case, since it has been diagnosed in the past and corrective measures have been taken). 8. Click the OK button. John Smith s problem with asthma is now recorded. Adding a Diagnosis to the Problem List when Documenting an Encounter Scenario: You are documenting an encounter for John Smith and have come to the Assessment portion of the Progress Notes. You have determined that he suffers from diabetes. This diagnosis must be added to John s current encounter, but also to his Problem List since it is a chronic problem. Copyright eclinicalworks, LLC 2011, Meaningful Use Training Scenarios Guide 179

180 Workflow: 1. From the Assessments window, search for diabetes and select the ICD code ( in this case) from the Assessments section: The Diabetes assessment is now displayed in the Selected Assessments section. 2. Check the PL box for the Diabetes row: Note: If the selected assessment has been marked Chronic, the PL box is checked automatically. For more information on marking assessments as Chronic, refer to the section titled Marking ICD Codes as Chronic on page 176. Diabetes (ICD code ) is now added to John Smith s Problem List. IMPTANT! Unchecking the PL box here will NOT remove a diagnosis from John Smith s Problem List. To remove a diagnosis from a patient s Problem List, click the Problem List button on this window and remove the diagnosis from the Problem List window that opens. Copyright eclinicalworks, LLC 2011, Meaningful Use Training Scenarios Guide 180

181 3. Click the Problem List button. The Problem List window opens, displaying all diagnoses on John Smith s Problem List. 4. Click in the blank cell to the right of the Onset Date column: The Select Date window opens. 5. Select an estimated date that this problem began. 6. Click in the W/U Status column to expose a drop-down list. 7. Select the work-up status for this problem (w/u pending in this case, since all necessary work-up has not been completed. 8. Click in the Clinical Status column to expose a drop-down list. 9. Select the clinical status for this diagnosis from the drop-down list (poorly-controlled in this case, since it has just been diagnosed; change this to well-controlled once it has been controlled). 10. Click the OK button. John Smith s problem with diabetes is now recorded (d): Maintaining an Active Medications List Stage 1 Objective Providers must maintain an up-to-date list of medications currently being taken by their patients. Stage 1 Measure More than 80% of all unique patients seen by the eligible professional must have at least one entry (or an indication that the patient is not currently prescribed any medication) recorded as structured data. Denominator The number of unique patients seen by the eligible professional during the EHR reporting period. Numerator The number of patients in the denominator who have a medication (or an indication that the patient is not currently prescribed any medication) recorded as structured data. Copyright eclinicalworks, LLC 2011, Meaningful Use Training Scenarios Guide 181

182 eclinicalworks Calculations Denominator Unique patients are included in the denominator if: An appointment has been created for them during the reporting period from the Resource Scheduling, Provider Schedule, or Office Visits window AND NOT A visit type or visit code with the exclusion flag enabled has been selected for this appointment Note: Telephone encounters are not counted as appointments. Patients with only Telephone Encounters are not included in the denominator for this measure. Numerator Patients that satisfy the denominator are included in the numerator if: A medication has been recorded in the Current Medications section of the Progress Notes The Medication Verified box is checked in the Current Medications section of the Progress Notes Action Recommendations Policy Recommendations: System Administration - Providers must ask their patients about the medications they are currently taking at each relevant encounter. IMPTANT! The Medication Verified box must be checked for every encounter. This indicates that the provider has inquired about the medication status of the patient, even if the list of current medications has not been updated. eclinicalworks Setup Recommendations eclinicalworks - All related setup is performed by eclinicalworks upon implementation. Workflow Recommendations Mid Office - Follow the steps in one or more of the following sections as needed: To record that a patient is not taking any medications, refer to the section titled Documenting a Patient not Taking any Medications on page 182. To verify patients medications at each encounter in order to keep them up to date, refer to the section titled Updating Patients Current Medications on page 183. Documenting a Patient not Taking any Medications Scenario: Amy Smith is not currently taking any medications. You must now indicate this information on her Progress Notes. Copyright eclinicalworks, LLC 2011, Meaningful Use Training Scenarios Guide 182

183 Workflow: 1. From Amy Smith s Progress Notes, click the Current Medications link. The Chief Complaints window opens. 2. In the Current Medications section, check the Medications Verified box while no medications are selected: Amy Smith s current medication status is now recorded. Note: The following text displays on the Progress Notes window under the Current Medication heading: None Updating Patients Current Medications Scenario: John Smith s current medications are being updated. It was previously documented that John was taking a nasal decongestant. He has notified you that he is no longer taking this medication, and that he is now taking acetaminophen. You must update his current medications to reflect this. Workflow: 1. From John Smith s Progress Notes, click the Current Medications link. The Chief Complaints window opens, with John s current medications displayed in the bottom pane: Copyright eclinicalworks, LLC 2011, Meaningful Use Training Scenarios Guide 183

184 2. Highlight the nasal decongestant and click the Remove button. A confirmation window opens. 3. Click the Yes button. The nasal decongestant is removed from John s list of current medications. 4. Click the Add button. The Select Rx window opens. 5. Search for acetaminophen and select it in the left pane. A list of available formulations for the selected medication display in the top-right pane. 6. Click the formulation in the top-right pane. The selected formulation is populated in the lower-right pane. 7. Click the OK button. The Select Rx window closes and the selected formulation of acetaminophen is added to the Current Medication pane of the Chief Complaints window: 8. Check the Medication Verified box. IMPTANT! The Medication Verified box MUST be checked at every encounter, regardless of whether or not any updates were made to the Current Medication list. For more information on the Current Medication section of the Chief Complaints window, refer to the Electronic Medical Records Users Group (e): Maintaining an Active Medication Allergy List Stage 1 Objective All allergies and intolerances for all patients must be recorded in their Progress Notes. Stage 1 Measure More than 80% of all unique patients seen by the eligible professional must have at least one entry (or an indication that the patient has no known medication allergies) recorded as structured data. Copyright eclinicalworks, LLC 2011, Meaningful Use Training Scenarios Guide 184

185 Denominator The number of unique patients seen by the eligible professional during the EHR period. Numerator The number of unique patients in the denominator who have at least one entry (or an indication that the patient has no known medication allergies) recorded as structured data in their medication allergy list. eclinicalworks Calculations Denominator Unique patients are included in the denominator if: An appointment has been created for them during the reporting period from the Resource Scheduling, Provider Schedule, or Office Visits window AND NOT A visit type or visit code with the exclusion flag enabled has been selected for this appointment Note: Telephone encounters are not counted as appointments. Patients with only Telephone Encounters are not included in the denominator for this measure. Numerator Patients that satisfy the denominator are included in the numerator if: An allergy has been recorded in the Allergies section of the Progress Notes The Allergies Verified box is checked in the Allergies section of the Progress Notes Action Recommendations Policy Recommendations: Mid Office - All providers should check on their next encounter with each patient, as well as on all new encounters, that all allergies and intolerances are recorded in the eclinicalworks system. IMPTANT! The Allergies Verified box must be checked for every encounter. This indicates that the provider has inquired about the allergy status of the patient, even if the list of allergies has not been updated. eclinicalworks Setup Recommendations eclinicalworks - eclinicalworks performs all necessary setup for this measure during the Implementation process. Workflow Recommendations Mid Office - Follow the steps in one or more of the following sections as needed: To record that a patient has no known drug allergies, refer to the section titled Documenting a Patient with No Known Drug Allergies on page 186. To record structure allergies, refer to the section titled Documenting a Structured Allergy on page 187. Copyright eclinicalworks, LLC 2011, Meaningful Use Training Scenarios Guide 185

186 To remove an allergy from a patient s record, refer to the section titled Removing an Allergy from a Patient s Record on page 188. To view potentially harmful drug interactions, refer to the section titled Viewing Harmful Allergic Interactions on page 189. Documenting a Patient with No Known Drug Allergies Scenario: Jill Smith has come in for her first encounter, and has indicated that she has no known drug allergies. You must record this information in her Progress Notes. Workflow: 1. From the Progress Notes window, click the Allergies/Intolerance link. The Past Medical History window opens. 2. In the Allergies section, click the N.K.D.A. box: Note: If any non-structured, non-drug allergies have been added, the N.K.D.A. box cannot be checked and the measure will not be satisfied for this patient. All allergies entered here must be Structured Data. The Allergies Verified box is automatically checked and Jill Smith s allergy status is now recorded. Copyright eclinicalworks, LLC 2011, Meaningful Use Training Scenarios Guide 186

187 IMPTANT! On each successive encounter, if no allergies have been discovered since the last encounter, then the Allergies Verified box must still be checked to record that you have asked this question. Documenting a Structured Allergy Scenario: John Smith has notified you that he is allergic to Diflucan. It gives him a rash when he takes it. You must now document this allergy and his reaction. Workflow: 1. From John Smith s Progress Notes, click the Allergies/Intolerance link. The Past Medical History window opens. 2. In the Allergies section, click the Add button. A blank row is added to the Allergies section. 3. Click in the Structured/Non Structured field to display a drop-down list. 4. Select the Structured option from this drop-down list. Note: Medications entered as Non Structured are not checked for potentially harmful interactions. 5. Click in the Agent/Substance field. The Select Rx window opens. 6. Click the medication category in the left pane that contains the appropriate medication. All medications in the selected category are displayed in the center pane: 7. Either scroll to the medication or begin entering the name of the medication in the Find field. 8. Click the medication in the center pane (in this case Diflucan): The selected drug is added to the right pane: Copyright eclinicalworks, LLC 2011, Meaningful Use Training Scenarios Guide 187

188 Note: If any other medications in the center pane are accidentally selected, they can be removed from the right pane by highlighting the medication and clicking the < button. 9. Click the OK button. The Select Rx window closes and Diflucan is added to the Agent/Substance field on the Past Medical History window. 10. Click in the Reaction field to expose a drop-down list. 11. Either type the reaction (in this case rash) into this field, or select the appropriate option from the drop-down list, if available. 12. Click in the Type field to expose a drop-down list. 13. Select the appropriate type of allergy from this drop-down list (in this case Allergy). 14. Since John Smith does not indicate that he suffers from any other allergies, check the Allergies Verified box. John Smith s allergy to Diflucan is now recorded. Removing an Allergy from a Patient s Record Scenario: It has been determined that John Smith s rash was not due to his use of Diflucan, which had previously been recorded as an allergy. You must now remove this allergy from his record. Workflow: 1. From John Smith s Progress Notes, click the Allergies/Intolerance link. The Past Medical History window opens. 2. In the Allergies section, highlight the Diflucan allergy. 3. Click the Remove button. A confirmation window opens. 4. Check the Allergies Verified box: Copyright eclinicalworks, LLC 2011, Meaningful Use Training Scenarios Guide 188

189 Note: If there are no other allergies listed for this patient, you must also check the N.K.D.A. box. 5. Click the OK button. Diflucan is now removed from the list of John Smith s allergies. Viewing Harmful Allergic Interactions Scenario: Mary Smith is allergic to penicillin, but this was not noticed when she was prescribed penicillin in this encounter. You must now check her allergies to determine if prescribing penicillin would be harmful to her. Workflow: 1. From Mary Smith s Progress Notes, click the Treatment link. The Treatment window opens, with the Allergies button highlighted in red to indicate a potentially harmful interaction: Copyright eclinicalworks, LLC 2011, Meaningful Use Training Scenarios Guide 189

190 2. Click the Allergies button. The Allergies window opens, displaying Mary s allergy to penicillin: 3. Due to this information, you must remove the prescription for penicillin and prescribe a different medication (f): Recording Vital Signs Stage 1 Objective All patients must have their basic vitals, including height, weight, BMI, blood pressure, and growth charts (for children 2-20 years old) recorded within eclinicalworks for each encounter. Stage 1 Measure For more than 50% of all unique patients age 2 and over seen by the eligible professional, height, weight and blood pressure must be recorded as structured data. Copyright eclinicalworks, LLC 2011, Meaningful Use Training Scenarios Guide 190

191 Denominator The number of unique patients age 2 or over seen by the eligible professional during the EHR reporting period. Numerator The number of patients in the denominator who have at least one entry of their height, weight, and blood pressure recorded as structured data. Exclusions Eligible professionals are excluded from this measure if they see no patients 2 years or older, or if they believe that all three vital signs (height, weight, and blood pressure) of their patients has no relevance to their scope of practice. eclinicalworks Calculations Denominator Unique patients two years old or older are included in the denominator if: An appointment has been created for them during the reporting period from the Resource Scheduling, Provider Schedule, or Office Visits window AND NOT A visit type or visit code with the exclusion flag enabled has been selected for this appointment Note: Telephone encounters are not counted as appointments. Patients with only Telephone Encounters are not included in the denominator for this measure. Numerator Patients that satisfy the denominator are included in the numerator if all of the following information is recorded in the Vitals section of the Progress Notes during the reporting period (this can be over multiple encounters): Height Weight Blood Pressure IMPTANT! These Vitals categories must be associated with the corresponding Vital Types (from EMR > Vitals > Configure Vitals) in order for patients to be counted in the numerator. Exclusion Providers are excluded from satisfying this measure if no encounters for patients over the age of 2 are created during the reporting period. Note: Any provider who believes that all three Vitals (height, weight, and blood pressure) do not have any relevance to their scope of practice are also excluded from this measure. This exclusion is reported by self-attestation. Copyright eclinicalworks, LLC 2011, Meaningful Use Training Scenarios Guide 191

192 Action Recommendations Policy Recommendations: Mid Office - Providers must record vitals information (at a minimum height, weight, BMI, blood pressure, and temperature) for all patient appointments, and plot and electronically display growth charts on demand for patients 2-20 years old. eclinicalworks Setup Recommendations System Administration - Vitals can be configured so that they are mapped to the appropriate Vital Type, and so that certain vital categories are mandatory: To associate vitals fields with appropriate vital types, refer to the section titled Associating Vitals Fields with Vital Types on page 192. IMPTANT! The Height, Weight, and BMI fields MUST be associated with the appropriate Vital Types in order to automatically calculate BMI. To mark specific vitals fields as mandatory, refer to the section titled Marking Vitals Fields as Mandatory on page 193. Workflow Recommendations Mid Office - Follow the steps in one or more of the following sections as needed: To record vitals for patients, refer to the section titled Recording Vitals on Progress Notes on page 194. To create growth charts for young patients, refer to the section titled Displaying Growth Charts on page 196. Associating Vitals Fields with Vital Types Scenario: The Height, Weight, and BMI vitals fields are not mapped to any Vital Types. You must now associate these fields with the appropriate Vital Types. Workflow: 1. From the EMR menu, hover over the Vitals option to open a drop-down list. 2. From the drop-down list, click the Configure Vitals option. The Configure Vitals window opens: Copyright eclinicalworks, LLC 2011, Meaningful Use Training Scenarios Guide 192

193 3. In the Ht row, select the Height option from the Standard Vital Type drop-down list. 4. In the Wt row, select the Weight option from the Standard Vital Type drop-down list. 5. In the BMI row, select the BMI option from the Standard Vital Type drop-down list. 6. Click the OK button. The Height, Weight, and BMI vitals fields have now been mapped to the appropriate Vital Types. Marking Vitals Fields as Mandatory Scenario: Blood Pressure (BP) is not already marked as mandatory for your practice. You must make the BP Vitals field mandatory. Workflow: 1. From the EMR menu, hover over the Vitals option to open a drop-down list. 2. From the drop-down list, click the Configure Vitals option. The Configure Vitals window opens. 3. In the BP row, check the box in the Mandatory column: Copyright eclinicalworks, LLC 2011, Meaningful Use Training Scenarios Guide 193

194 4. Click the OK button. The Blood Pressure vital has now been made mandatory for your practice. Recording Vitals on Progress Notes Scenario: John Smith has come in for his latest appointment, and you must now record his basic vitals. Workflow: 1. From John Smith s Progress Notes, click the Vitals link. The Vitals window opens: Copyright eclinicalworks, LLC 2011, Meaningful Use Training Scenarios Guide 194

195 Note: Uncheck the Pop-up box to manually enter values in these fields rather than using the pop-up user interface. 2. Click in the Wt(lbs) field. The Vitals Wt pop-up window displays. 3. Enter this patient s weight in your desired format and click the -> button. The patient s weight is converted to pounds (if a different measurement was used) and populated in the right pane. 4. Click the Apply button to enter this information. Click the Next button to move to the next Vitals category. 5. Repeat steps 3-5 for all categories (being sure to include height, weight, blood pressure, and temperature at a minimum; BMI will be calculated automatically based on height and weight). Note: Vitals can be captured with a Vitals diagnostic machine by clicking the Capture Vitals button. This feature must be configured before it can be used. For more information, refer to the Electronic Medical Records Users Guide, which can be found at 6. Check the Vitals Taken box once all vitals have been taken. John Smith s vitals are now recorded in the system. Copyright eclinicalworks, LLC 2011, Meaningful Use Training Scenarios Guide 195

196 Displaying Growth Charts Scenario: Timothy Smith, an 8-year-old patient, has come in for an appointment and his parents want to view his growth chart. You must now generate this chart and print it out for the parents. Workflow: 1. From Timothy Smith s Progress Notes, click the Vitals link. The Vitals window opens. 2. Enter Timothy s vitals. For more information on entering vitals, refer to the section titled Recording Vitals on Progress Notes on page Click the Growth Charts button at the bottom of the window. The Growth Chart window opens: 4. Click radio buttons and check boxes in the right pane to display the appropriate information. 5. Click the Print button. Timothy Smith s growth chart is now printed. Copyright eclinicalworks, LLC 2011, Meaningful Use Training Scenarios Guide 196

197 (g): Recording Smoking Status Stage 1 Objective The smoking status of every patient age 13 and up must be recorded in their Progress Notes, in order to assess any future complications from smoking. Stage 1 Measure More than 50% of all unique patients 13 years old or older seen by the eligible professional must have their smoking status recorded as structured data. Denominator The number of unique patients age 13 or older seen by the eligible professional during the EHR reporting period. Numerator The number of patients in the denominator with smoking status recorded as structured data. The following options must be available as Structured Data to record this information: Current smoker Former smoker Never smoker Current every day smoker Current some day smoker Smoker, current status unknown Unknown if ever smoked Exclusions Eligible professionals are excluded from this measure if they see no patients aged 13 years or older. eclinicalworks Calculations Denominator Unique patients thirteen years old or older are included in the denominator if: An appointment has been created for them during the reporting period from the Resource Scheduling, Provider Schedule, or Office Visits window AND NOT A visit type or visit code with the exclusion flag enabled has been selected for this appointment Note: Telephone encounters are not counted as appointments. Patients with only Telephone Encounters are not included in the denominator for this measure. Copyright eclinicalworks, LLC 2011, Meaningful Use Training Scenarios Guide 197

198 Numerator Patients that satisfy the denominator are included in the numerator if their smoking status is recorded as Structured Data on the Progress Notes. IMPTANT! This local Structured Data item must be mapped to the are you a: community item in order for a patient to be included in the numerator. For more information, refer to the section titled Configuring Tobacco Use Structured Data Items on page 61. Exclusion Providers are excluded from satisfying this measure if no encounters for patients over the age of 13 are created during the reporting period. Action Recommendations Policy Recommendations: Mid Office - Providers must ask patients their smoking history on the next appointment, and update this information on each applicable encounter. eclinicalworks Setup Recommendations System Administration - The appropriate community Structured Data elements must be mapped to local elements on the Progress Notes. For more information, refer to the section titled Configuring Tobacco Use Structured Data Items on page 61. Note: In order to map tobacco use Structured Data items, they must first be created in the local system. For more information, refer to the section titled Creating Smoking Status Structured Data Items on page 198. Workflow Recommendations Mid Office - The smoking status for patients can be recorded from the Progress Notes using Structured Data. For more information, refer to the section titled Recording Smoking Status Using Structured Data on page 200 Creating Smoking Status Structured Data Items Scenario: Structured Data items used to record patients smoking status must be created in the system so that they can be mapped to community items. Workflow: 1. From the Progress Notes window, click the Social History link. The Social History window opens. 2. Click the Tobacco Use category in the left pane. All available Tobacco Use options display in the right pane. 3. Click the green arrow next to the Custom button to open a drop-down list. 4. From the drop-down list, click the New Item option. The New Item/Category window opens. Copyright eclinicalworks, LLC 2011, Meaningful Use Training Scenarios Guide 198

199 5. Enter Smoking in the Name field. 6. Check the Structured box. 7. Click the OK button. The New Item/Category window closes and this new item is added to the bottom of the right pane on the Social History window. 8. Click in the Details column for the Smoking item. The Social History Notes window opens. 9. Click the Custom button. The main Structured Data window opens. 10. Click the Add button. The Structured Data pop-up window opens: 11. Enter Are you a: in the Name field. 12. Select the Structured Text option from the Type drop-down list. 13. To ensure that all providers record this information, check the Mandatory box. 14. Click the OK button. The Structured Data pop-up window closes and this item is added to the main Structured Data window. 15. Highlight this new item and click the Customize Structured Text button. The Structured text pop-up window opens. 16. Click the Add button to add a new blank row. 17. Add one of the following options: current smoker former smoker never smoker current every day smoker current some day smoker smoker, current status unknown unknown if ever smoked 18. Repeat steps until all of the listed options have been added. 19. Click the OK button. The tobacco use Structured Data items are now created in the system. Copyright eclinicalworks, LLC 2011, Meaningful Use Training Scenarios Guide 199

200 For more information on mapping these items, refer to the section titled Configuring Tobacco Use Structured Data Items on page 61. Recording Smoking Status Using Structured Data Scenario: Amy Smith smokes cigarettes some days, but not others. You must now record this smoking status in Amy s Progress Notes. Note: Tobacco use Structured Data items must be created in the system and mapped to community items before this feature can be used. For more information, refer to the sections titled Creating Smoking Status Structured Data Items on page 198 or Configuring Tobacco Use Structured Data Items on page 61. Workflow: 1. From the Progress Notes window, click the Social History link. The Social History window opens. 2. Click the Tobacco Use category in the left pane. The items contained in the Smoking category display in the right pane. 3. Click in the Details field for the Smoking item. The Social History Notes window opens. 4. Select the current some day smoker option from the Value drop-down list in the Are you a: row. Amy Smith s tobacco use is now recorded. Note: This objective is reported to CMS as a self-attestation (i): Exchanging Clinical Information Electronically Between Providers Stage 1 Objective Providers must be able to exchange key clinical information (such as Problem Lists, medication lists, medication allergies, and diagnostic test results) electronically with other providers. Stage 1 Measure Providers must perform at least one test with another provider in a separate office using a certified EHR. If the test is not successful, it must be repeated. This objective is reported to CMS through self-attestation, including details of the practice with which the practice was performed. Copyright eclinicalworks, LLC 2011, Meaningful Use Training Scenarios Guide 200

201 eclinicalworks Calculations eclinicalworks does not perform any calculations for this measure. Providers must perform at least one test of their ability to exchange key clinical information (such as Problem Lists, medication lists, allergies, test results, etc.). This measure is reported through self-attestation. Action Recommendations Policy Recommendations: Mid Office - Providers should upload the medical information of patients who have given consent to the appropriate portal whenever they are referred to another provider. The medical information for any patients referred to you should be downloaded from the appropriate portal before initiating the encounter. eclinicalworks Setup Recommendations System Administration - An XSL (.xsl) file titled CCD must be created on the C drive for each computer using CCDs in order to view XML (.xml) files in a human-readable format. Workflow Recommendations Mid Office - Perform one or more of the following actions as required: Clinical information can be exported from eclinicalworks as a Continuity of Care Document (CCD). For more information, refer to the section titled Exporting a Continuity of Care Document on page 201. Clinical information can be imported into eclinicalworks as a Continuity of Care Document (CCD). For more information, refer to the section titled Importing a Continuity of Care Document on page 202. Note: Once eclinicalworks P2P (Physician-to-Physician) has been certified, additional methods of importing and exporting clinical information will be available. For more information, refer to the eclinicalworks P2P Guide, which can be found at Exporting a Continuity of Care Document Scenario: John Smith is being referred from your practice to a specialist. You must now export his key clinical information in order to send it to the specialist. Workflow: 1. From the CCD menu, click the Export option. The Patient Lookup window opens. 2. Highlight John Smith s name and click the OK button. The Save the XML window opens. 3. Browse to the desired location on your local computer and save this XML file with a unique, easily identifiable name (e.g., LastName, FirstName - CurrentDate). A copy of the XML file displays in your default Internet browser. Copyright eclinicalworks, LLC 2011, Meaningful Use Training Scenarios Guide 201

202 4. This XML file must now be transmitted to the other provider through secured , or by copying it to a CD/USB flash drive. Importing a Continuity of Care Document Scenario: John Smith has been referred to your practice by another provider. You must now import the key clinical information received from the referring provider in a CCD format. Workflow: 1. Copy the CCD file received from the referring provider (either through or from a CD/USB flash drive) to your local computer. 2. From the CCD menu, click the Import option. The Open window opens. 3. Navigate to John Smith s CCD file on your local computer and click the Open button. The selected CCD file is now imported into the system, which determines that is belongs to John Smith by matching the basic demographic information contained in the CCD to the information contained in the local eclinicalworks database. This CCD document is imported into the Miscellaneous folder on the Patient Documents window. Note: If a matching patient is not found in the local eclinicalworks database, a new patient is created. New patients created erroneously can be merged with the existing account from the File menu (o)-(w): Complying with HIPAA Privacy and Security Rules Stage 1 Objective Practices must protect electronic health information created or maintained by the certified EHR technology through the implementation of appropriate technical capabilities. Stage 1 Measure Conduct or review a security risk analysis, implement security updates as necessary, and correct identified security deficiencies as part of a risk management process. eclinicalworks Calculations eclinicalworks does not perform any calculations for this measure. Providers must conduct or review a security risk analysis in accordance with the requirements under 45 CFR (a)(1). Providers must then implement security updates and correct security deficiencies as necessary. This measure is reported through self-attestation. Copyright eclinicalworks, LLC 2011, Meaningful Use Training Scenarios Guide 202

203 Action Recommendations Policy Recommendations: System Administration - Administrators should set up P.S.A.C. and security attribute permissions for all providers and staff members. eclinicalworks Setup Recommendations System Administration - Administrators should perform the following actions upon implementation: P.S.A.C.: To configure P.S.A.C. categories, refer to the section titled Configuring P.S.A.C. Categories on page 204. To configure P.S.A.C. permissions, refer to the section titled Configuring P.S.A.C. Permissions on page 205. Security Attributes: To configure security attributes by user, refer to the section titled Configuring Security Attributes by User on page 206. To configure security attributes by attribute, refer to the section titled Configuring Security Attributes by Attribute on page 207. To configure security attributes by role, refer to the section titled Configuring Security Attributes by Role on page 209. To configure Rx security for a provider, refer to the section titled Configuring Rx Security for a Provider on page 213. To configure Authentication Settings, refer to the section titled Configuring Authentication Settings on page 216. Workflow Recommendations System Administration - Admin Logs can be viewed in order to determine how users are accessing the system, refer to the section titled Viewing Admin Logs on page 221 Mid Office - Providers must mark Progress Notes with sensitive information as confidential. For more information, refer to the section titled Marking a Chart as Confidential on page 221. Additional Tips For additional information on these, as well as any other, security features within eclinicalworks, refer to the System Administration Users Guide, which can be found at For a description of each security attribute, you can hover over them in the system to display a pop-up tooltip, or you can refer to the Security Attributes and Logs document, which can be found at While the eclinicalworks software application provides the adequate and necessary tools to safeguard PHI (Protected Health Information), it is the obligation of each eligible provider to conduct an actual risk analysis/assessment. To help you reach the standard of conducting/reviewing a security risk analysis per Federal Rule 45 CFR (a)(1), we recommend the following websites as resources: Guidance on Risk Analysis Requirements under the HIPAA Security Rule - rafinalguidancepdf.pdf Privacy & Security Toolkit - topics_privacysecuritytoolkit.asp?faid=388&tid=4 Copyright eclinicalworks, LLC 2011, Meaningful Use Training Scenarios Guide 203

204 Reassessing Your Security Practices in a Health IT Environment: A Guide for Small Health Care Practices - PTARGS_0_10731_848086_0_0_18/SmallPracticeSecurityGuide-1.pdf Eligible Professional Meaningful Use Core Measures: Measure 15 of ProtectElectronicHealthInformation.pdf Configuring P.S.A.C. Categories Scenario: Your practice needs a P.S.A.C. category for HIV positive patients so that their charts are kept confidential. You must now create this category. Workflow: 1. From the File menu, click the P.S.A.C. Settings option. The Set Patient Security Access Codes window opens. 2. Click the Configure P.S.A.C. button: The Patient Security Access Codes (P.S.A.C.) window opens. 3. Click the New button: Copyright eclinicalworks, LLC 2011, Meaningful Use Training Scenarios Guide 204

205 The Chart Access Codes window opens: 4. Enter a name for this code in the Code field (in this case, HIV Patients). 5. Enter a description for this code in the Description field (in this case, HIV Patients). 6. Click the OK button. The HIV Patients P.S.A.C. is now created in the system. Configuring P.S.A.C. Permissions Scenario: Dr. Sam Willis does not yet have permission to view charts for patients with HIV. You must now give him permission for the HIV Patient P.S.A.C. category. Workflow: 1. From the File menu, click the P.S.A.C. Settings option. The Set Patient Security Access Codes window opens. 2. Click Dr. Willis name in the left pane. All available P.S.A.C. categories are displayed in the right pane. 3. Check the box next to the HIV Patient category: Copyright eclinicalworks, LLC 2011, Meaningful Use Training Scenarios Guide 205

206 4. Click the Save button. Dr. Sam Willis now has permission for charts marked with the HIV Patient P.S.A.C. category. Configuring Security Attributes by User Scenario: Rachael Smith is a nurse at your practice, but does not yet have permission to enter Vitals. You must now give Rachael permission to enter Vitals. Workflow: 1. From the File menu, click the Security Settings option. The Security Settings window opens, with the By User tab selected by default. 2. Highlight Rachael Smith s name in the left pane. All available security attributes display in the right pane: Copyright eclinicalworks, LLC 2011, Meaningful Use Training Scenarios Guide 206

207 3. Check the box next to the Vitals attribute: 4. Click the Save button. Rachael Smith now has permission to enter Vitals on the Progress Notes. Configuring Security Attributes by Attribute Scenario: Jen Smith and Kevin Smith are both Front Office staff members at your practice. They currently have permission to view Progress Notes, and you must now remove that permission so that they are not able to access patients medical information. Copyright eclinicalworks, LLC 2011, Meaningful Use Training Scenarios Guide 207

208 Workflow: 1. From the File menu, click the Security Settings option. The Security Settings window opens. 2. Click the By Security Attribute tab: The By Security Attribute options display. 3. Highlight the Progress Notes attribute in the left pane. All available users display in the right pane: 4. Uncheck the boxes next to Jen Smith and Kevin Smith: Copyright eclinicalworks, LLC 2011, Meaningful Use Training Scenarios Guide 208

209 5. Click the Save button. Jen Smith and Kevin Smith no longer have permission to view the Progress Notes. Configuring Security Attributes by Role Scenario: Not all Billing staff at your practice currently have access to Refunds. In order to give them all permission at once, you must: Enable Role-Based security from Practice Defaults. For more information, refer to the section titled Enabling Role-Based Security on page 209. Create a Billing role in the system. For more information, refer to the section titled Creating a Role on page 210. Add all Billing staff members at your practice to the Billing role. For more information, refer to the section titled Configuring a Role on page 211. Give permission for Refunds to the Billing role. For more information, refer to the section titled Assigning Permissions to a Role on page 212. Enabling Role-Based Security Workflow: 1. From the File menu, hover over the Settings option to open a drop-down list. 2. From the drop-down list, click the Practice Defaults option. The Practice Defaults window opens. 3. Click the General tab. The General options display. 4. In the Security Setting group box, click the Role Based radio button: Copyright eclinicalworks, LLC 2011, Meaningful Use Training Scenarios Guide 209

210 You can select user-based or role-based security setting. 5. Click the OK button. Role-based security is now enabled. Creating a Role Workflow: 1. From the File menu, click the Security Settings option. The Role Security Settings window opens, with the By Role tab displayed by default. 2. Click the Configure Roles button: Copyright eclinicalworks, LLC 2011, Meaningful Use Training Scenarios Guide 210

211 The Configure Roles window opens. 3. Click the Add Role button: The Configure Role window opens: 4. Enter a name for this role in the Role Name field (in this case, Billing). 5. Enter a description of this role in the Description field (in this case, Billing Staff). 6. Click the Save button. The Billing role is now created. Configuring a Role Workflow: 1. From the File menu, click the Security Settings option. The Role Security Settings window opens, with the By Role tab displayed by default. 2. Click the Role Membership button: Copyright eclinicalworks, LLC 2011, Meaningful Use Training Scenarios Guide 211

212 The Role Membership window opens. 3. Click the Billing role in the left pane. All available users display in the right pane: 4. Check the boxes next to all Billing staff members. 5. Click the Save button. The members of the Billing role are now configured. Assigning Permissions to a Role Workflow: 1. From the File menu, click the Security Settings option. The Role Security Settings window opens, with the By Role tab displayed by default. 2. Click the Billing role in the left pane. Copyright eclinicalworks, LLC 2011, Meaningful Use Training Scenarios Guide 212

213 All available security attributes display in the right pane: 3. Check the box next to the Refunds attribute: 4. Click the Save button. All Billing staff members now have permission for Refunds. Configuring Rx Security for a Provider Scenario: Dr. Sam Willis wants to configure the providers and staff members that can print and fax prescriptions he has made. You must now perform the following actions: Enable Rx Security from Practice Defaults. For more information, refer to the section titled Enabling Rx Security on page 214. Copyright eclinicalworks, LLC 2011, Meaningful Use Training Scenarios Guide 213

214 Configure the other providers and staff members that can print and fax prescriptions for Dr. Willis patients. For more information, refer to the section titled Configuring Rx Security for a Provider on page 214. Enabling Rx Security Workflow: 1. From the File menu, hover over the Settings option to open a drop-down list. 2. From the drop-down list, click the Practice Defaults option. The Practice Defaults window opens. 3. Click the General tab. The General options display. 4. Check the Enable Rx Security box: 5. Click the OK button. Rx Security is now enabled, adding an Rx Security button to the Security Settings window. Configuring Rx Security for a Provider Workflow: 1. From the File menu, click the Security Settings option. The Security Settings window opens. 2. Click the Rx Security button: Copyright eclinicalworks, LLC 2011, Meaningful Use Training Scenarios Guide 214

215 The Rx Security window opens: 3. To select a provider: a. Click the More (...) button next to the Provider field. The Providers List window opens. b. Highlight Sam Willis name and click the OK button. The Providers List window closes and Sam Willis name is populated in the Provider field on the Rx Security window. Note: The providers and staff members displayed here can be filtered by facility by clicking the More (...) button next to the Filter by Facility field to open the Facilities List window and then selecting a facility. 4. Check the boxes next to all staff members and providers that you want to have permission to prescribe medications to Sam Willis patients. 5. Click the Save button. Sam Willis Rx permissions are now configured. Copyright eclinicalworks, LLC 2011, Meaningful Use Training Scenarios Guide 215

216 Configuring Authentication Settings Scenario: The Authentication Settings have not yet been configured. You must now perform the following actions: To automatically log users out of the system after a certain period of inactivity, refer to the section titled Configuring a Session Activity Timeout on page 216. To lock users out of the system after a certain number of failed login attempts, refer to the section titled Configuring an Authentication Failure Lockout on page 217. To configure the minimum length of passwords, refer to the section titled Configuring the Minimum Password Length on page 218. To require that passwords contain both a number and a letter, refer to the section titled Requiring an Alpha-Numeric Password on page 219. To prevent staff members from using the same password that they have used in the past, refer to the section titled Enforcing Password History on page 219. To require that users change their password after a certain period of time, refer to the section titled Requiring a Password Change on page 220. Configuring a Session Activity Timeout Workflow: 1. From the File menu, hover over the Settings option. 2. From the drop-down list, click the Authentication Settings option. The Authentication Settings window opens. 3. Check the Session activity time out box: 4. Enter the time, in HH:MM:SS format, in the field here. 5. Click the OK button. The system will now time out and lock the program after the specified period of inactivity. Copyright eclinicalworks, LLC 2011, Meaningful Use Training Scenarios Guide 216

217 Configuring an Authentication Failure Lockout Workflow: 1. From the File menu, hover over the Settings option. 2. From the drop-down list, click the Authentication Settings option. The Authentication Settings window opens. 3. Check the Authentication failure lock out box: 4. Enter the number of failed attempts before a user is locked out in the field here. 5. Click the OK button. The system will now lock a user out of the application after they enter the wrong login information the specified number of times. Note: The system administrator account does not lock since the administrator is the only user who can unlock an account. For more information, on unlocking an account, refer to the System Administration Users Guide, which can be found at Copyright eclinicalworks, LLC 2011, Meaningful Use Training Scenarios Guide 217

218 Configuring the Minimum Password Length Workflow: 1. From the File menu, hover over the Settings option. 2. From the drop-down list, click the Authentication Settings option. The Authentication Settings window opens. 3. Check the Password Minimum Length box: 4. Enter the minimum number of required characters. 5. Click the OK button. The minimum password length is now set. If a user currently has a login with a password that is less than the minimum length set by the administrator, then they will receive the following prompt on their next login: Copyright eclinicalworks, LLC 2011, Meaningful Use Training Scenarios Guide 218

219 Requiring an Alpha-Numeric Password Workflow: 1. From the File menu, hover over the Settings option to open a drop-down list. 2. From the drop-down list, click the Authentication Settings option. The Authentication Settings window opens. 3. Check the Require Alphanumeric Password box: 4. Click the OK button. Users are now required to have passwords that contain at least one letter and at least one number. Enforcing Password History Workflow: 1. From the File menu, hover over the Settings option to open a drop-down list. 2. From the drop-down list, click the Authentication Settings option. The Authentication Settings window opens. 3. Check the Enforce password history box: Copyright eclinicalworks, LLC 2011, Meaningful Use Training Scenarios Guide 219

220 4. To enforce password history based on the number of past passwords: a. Click the Restrict last... Password(s) radio button. b. Enter the number of past passwords that cannot be used (e.g., if you entered 3 here, then a user cannot use any of the last three passwords they used when changing it). 5. To enforce password history based on length of time: a. Click the Restrict password(s) set in last... Month(s) radio button. b. Enter the number of months you want to prevent users from using passwords from (e.g., if you entered 3 here, then a user cannot use any of the passwords they have used in the past three months). 6. Click the OK button. Users are now prevented from using some of the same passwords as they have used in the past. Requiring a Password Change Workflow: 1. From the File menu, hover over the Settings option to open a drop-down list. 2. From the drop-down list, click the Authentication Settings option. The Authentication Settings window opens. 3. Check the Require password change... box: 4. Enter the number of days between mandatory password changes for users in the after every... days field. 5. Enter the number of days before a mandatory password change is required that a user is notified of the impending change in the Alert to change password... field. 6. Click the OK button. Users are now required to change their password on a set schedule, determined by the numbers entered. Copyright eclinicalworks, LLC 2011, Meaningful Use Training Scenarios Guide 220

221 Viewing Admin Logs Scenario: The Admin Logs have not been viewed yet this week. You must now view the following logs in order to assess how users are accessing the system: To access the Login/Logout Logs, refer to the section titled Accessing the Login/Logout Logs on page 221. To access the Staff Demographics Logs, refer to the section titled Accessing the Staff Demographics Logs on page 221. Accessing the Login/Logout Logs Workflow: 1. From the Admin band, click the Admin Logs option. The Admin Logs window opens. 2. Click the Login/Logout tab. A list of users login information displays, including: User Name and Status Computer Name and IP Address Login/Logout Time on Server and User Station Outcome Accessing the Staff Demographics Logs Workflow: 1. From the Admin band, click the Admin Logs option. The Admin Logs window opens. 2. Click the Staff Demographics tab. A list of users that have accessed Staff Demographics are displayed, with information including: Name of the staff member whose demographics were accessed Name of the user who accessed those demographics Action performed by the user Date and time this action was performed IP Address of the computer from which this action was performed Marking a Chart as Confidential Scenario: John Smith has been diagnosed as HIV positive. You must now add him to the HIV Patient P.S.A.C. category so that only the appropriate users will have permission to view this information. Copyright eclinicalworks, LLC 2011, Meaningful Use Training Scenarios Guide 221

222 Workflow: 1. From John Smith s Progress Notes, navigate to the Billing window by clicking the Next Appointment, Visit Code, or Procedure Codes link. The Billing window opens. 2. Click the green Confidential Chart button: The PSAC Groups window displays. 3. Highlight the HIV Patient Category Code and click the OK button: 4. Click the OK button. This chart for John Smith is now marked as confidential, and it can only be viewed by users with permission for the HIV Patient P.S.A.C. group. Note: The Confidential Chart button on the Billing window is now displayed in red for this encounter, indicating the chart is viewable by someone with permissions only. Copyright eclinicalworks, LLC 2011, Meaningful Use Training Scenarios Guide 222

223 Menu Set Objectives Menu Set Objectives 5 of the following 10 objectives must be satisfied in order to fulfill the Meaningful Use requirements. At least one of the selected objectives must be a public health objective. The following objectives are considered public health objectives: (k): Submitting Electronic Data to Immunization Registries (l): Submitting Electronic Syndromic Surveillance (b): Implementing Drug Formulary Checks Stage 1 Objective Practices must be able to check patients prescription eligibility, benefits, and formulary information. Stage 1 Measure The eligible professional must have enabled this functionality and have access to at least one internal or external drug formulary for the entire EHR reporting period. eclinicalworks Calculations eclinicalworks does not perform any calculations for this measure. Providers must enable drug formulary checking capabilities and access at least one internal or external formulary during the reporting period. This measure is reported through selfattestation. Exclusion Providers are excluded from this measure if they have recorded less than 100 medications in the Treatment section of the Progress Notes during the reporting period. Action Recommendations Policy Recommendations: Mid Office - Staff must check patients Rx eligibility before prescribing medications, in order to determine their coverage and liability. eclinicalworks Setup Recommendations System Administration - Providers must be registered for e-prescription in order to check Rx eligibility. For more information, refer to the section titled Registering Providers for e-prescribing on page 29. Note: Drug formulary functionality is available with e-prescribing installed. If you were an early adopter of e-prescribing and did not have eligibility and formulary functionality installed, you can add this through On-Demand Activation in Version 9.0. For more information on performing eligibility and formulary checks, refer to the Informed Prescribing Users Guide, which can be found at my.eclinicalworks.com. Copyright eclinicalworks, LLC 2011, Meaningful Use Training Scenarios Guide 223

224 Menu Set Objectives Workflow Recommendations Front Office - Rx eligibility can be checked from the Appointment window. For more information, refer to the section titled Checking Rx Eligibility and Setting Formularies from the Appointment Window on page 224. Mid Office - Follow the steps in one or more of the following sections as needed: To check the formulary for a specific medication from the Treatment window on the Progress Notes, follow the steps in the section titled Checking Formularies from the Treatment Window on page 225. To check prescription eligibility for patients from a Telephone Encounter, follow the steps in the section titled Viewing Rx Eligibility from Telephone Encounters on page 226. Additional Tips Additional setup and configuration may be necessary for your practice. For more information, refer to the Informed Prescribing Users Guide, which can be found at my.eclinicalworks.com. Checking Rx Eligibility and Setting Formularies from the Appointment Window Scenario: John Smith has come in for his appointment. You must now check his Rx eligibility while you check him in for his appointment. Workflow: 1. From the Resource Scheduling window, double-click on John Smith s appointment. The Appointment window opens. 2. Click the Rx Eligibility button. The Rx Eligibility window opens: Copyright eclinicalworks, LLC 2011, Meaningful Use Training Scenarios Guide 224

225 Menu Set Objectives 3. Click the Check Rx Eligibility button. The available insurance plans for John Smith display in the Rx Eligibility Lookup section. Note: If no match is found, or if there is a problem with the information returned from the insurers, an Errors button displays and an error message displays at the bottom of the window. Click the Errors buttons to view an Error Report. 4. Highlight a plan. The Rx Eligibility Details section is populated with John Smith s eligibility details for the selected insurance plan. Note: To set the formulary for this patient, click the Set Formulary button. This activates the formulary information, which displays whenever the Rx window is accessed. Checking Formularies from the Treatment Window Scenario: You want to prescribe Coumadin to John Smith. You must now check the formulary for Coumadin for John Smith to ensure that it is covered by his insurance. Workflow: 1. From John s Progress Notes, click the Treatment link The Treatment window opens. Copyright eclinicalworks, LLC 2011, Meaningful Use Training Scenarios Guide 225

226 Menu Set Objectives 2. Click the Formulary button: The designated website opens, where you can perform a formulary check. Viewing Rx Eligibility from Telephone Encounters Scenario: John Smith has requested a refill of his Coumadin prescription. You must now perform an Rx eligibility check on this medication to ensure that it is covered by his insurance. Workflow: 1. Click the T quick-launch button at the top-right of the eclinicalworks application. The Telephone/Web Encounters window opens. 2. Click on John Smith s telephone encounter. The Telephone Encounter window opens. 3. Click the Rx tab. The Rx options display. 4. Click the Rx Eligibility option: Copyright eclinicalworks, LLC 2011, Meaningful Use Training Scenarios Guide 226

227 Menu Set Objectives To perform an eligibility check whenever a prescription is sent from this Telephone Encounter, check the Perform Eligibility Check box. The Rx Eligibility window opens: Copyright eclinicalworks, LLC 2011, Meaningful Use Training Scenarios Guide 227

228 Menu Set Objectives Note: To view and make any necessary changes to this patient s demographic information, click the Demographic Info button at the bottom of the window. 5. Click the Check Rx Eligibility button. The available insurance plans for John Smith display in the Rx Eligibility Lookup section. Note: If no match is found, or if there is a problem with the information returned from the insurers, an Errors button displays and an error message displays at the bottom of the window. Click the Errors buttons to view an Error Report. 6. Highlight a plan. The Rx Eligibility Details section is populated with John Smith s eligibility details for the selected insurance plan. Note: To set the formulary for this patient, click the Set Formulary button. This activates the formulary information, which displays whenever the Rx window is accessed. Copyright eclinicalworks, LLC 2011, Meaningful Use Training Scenarios Guide 228

229 Menu Set Objectives (h): Incorporating Lab Test Results as Structured Data Stage 1 Objective Lab and Diagnostic Imaging test results must be recorded as structured data so that they can be easily looked up for analysis. Note: A Lab Interface add-on feature is available for eclinicalworks, but is not required to satisfy this measure. Stage 1 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. Denominator The number of lab tests ordered during the EHR reporting period by the eligible professional whose results are expressed in a positive or negative affirmation or as a number. Numerator The number of lab test results whose results are expressed in a positive or negative affirmation or as a number which are incorporated as structured data. Exclusions Eligible professionals are excluded from this measure if they do not order any lab tests whose results are either in a positive/negative or numeric format. eclinicalworks Calculations Denominator Lab tests are included in the denominator if the Result Date is within the reporting period. IMPTANT! Labs in the Microbiology category are excluded from this calculation. Any labs for which results are not entered into the yellow grid should be included in the Microbiology category so that they are excluded from calculations. IMPTANT! A lab is only considered to be ordered for your patient if you are listed as the Ordering Provider. Numerator Labs that are included in the denominator are also included in the numerator if: Results have been entered in the yellow row on the Lab Results window. AND The Received box has been checked on the Lab Results window. Copyright eclinicalworks, LLC 2011, Meaningful Use Training Scenarios Guide 229

230 Menu Set Objectives Exclusion Providers are excluded from this measure if they have not ordered any tests with results that are either in a positive/negative or numeric format during the reporting period. Action Recommendations Policy Recommendations: Mid Office - Providers must review lab test results that are assigned to them before the next appointment with the patient. eclinicalworks Setup Recommendations System Administration - Labs must be linked with the appropriate lab attributes for each lab company. For more information, refer to the section titled Associating Attribute Codes with Labs on page 230. Workflow Recommendations Mid Office - Perform one or more of the following actions as needed: To mark lab tests from the lab interface that have been assigned to you as received, refer to the section titled Marking Lab Test Results from the Interface as Received on page 231. To enter lab test results not received through a lab interface and mark them as received, refer to the section titled Recording Lab Test Results as Structured Data on page 232. Note: An enhancement is currently being developed for eclinicalworks to allow for easier entry of lab test results that have been received as a fax. Associating Attribute Codes with Labs Scenario: The WBC item for the CBC lab does not have an associated attribute code for LabCorp. You must now enter this attribute code. Workflow: 1. From the EMR menu, hover over the Labs, DI & Procedures option to open a drop-down list. 2. From the drop-down list, click the Labs option. The Labs window opens. 3. Highlight the CBC lab and click the Attribute Codes button at the bottom of the window. The CBC window opens: Copyright eclinicalworks, LLC 2011, Meaningful Use Training Scenarios Guide 230

231 Menu Set Objectives 4. Highlight the WBC item and click the AttrCode button. The Lab Codes window opens: 5. Enter the appropriate code in the Code column for the Labcorp row. 6. Click the OK button. The Lab Codes window closes and the attribute code for the WBC item is saved. For more information on lab codes, refer to the Electronic Medical Records Users Guide, which can be found at Marking Lab Test Results from the Interface as Received Scenario: John Smith s lab test results have been imported into the system through the lab interface. You must now open these results, view the information, and mark the results as received. Copyright eclinicalworks, LLC 2011, Meaningful Use Training Scenarios Guide 231

232 Menu Set Objectives Workflow: 1. From the Practice band in the navigation pane on the left side of the application, click the Labs/Imaging icon. Note: This window can also be accessed by clicking the L quick-launch button in the top-right corner of the application. Alternately, you can click the L quick-launch link to open a drop-down list, and then select an order type (Labs, Imaging, or Procedures). The Labs/Imaging window opens with the To be reviewed tab open by default: Note: You can search for specific orders and groups of orders on this window in many ways using the various filters and tabs. For more information on these filters and tabs, refer to the Labs section of the Electronic Medical Records Users Guide, which can be found at 2. Click John Smith s lab test results. Note: If this lab test result is not displayed here, change the information in the filters at the top of the window in order to find it. For more information on these filters, refer to the Electronic Medical Records Users Guide, which can be found at The Lab Results window opens. 3. Once all information here has been reviewed, check the Received radio button: Note: To review this lab and move on to the previous or next lab in the list in one step, click the Prev (R) or Next (R) button at the bottom of the window. 4. Click the OK button. John Smith s lab results are now marked as received and this includes John in the numerator for this measure. They can be viewed on his Progress Notes by clicking the purple link for this lab under the Lab Results heading. Recording Lab Test Results as Structured Data Scenario: John Smith s lab test results have been received. You must now enter this information into the system and mark it as received. Copyright eclinicalworks, LLC 2011, Meaningful Use Training Scenarios Guide 232

233 Menu Set Objectives Workflow: 1. From the Practice band in the navigation pane on the left side of the application, click the Labs/Imaging icon. Note: This window can also be accessed by clicking the L quick-launch button in the top-right corner of the application. Alternately, you can click the L quick-launch link to open a drop-down list, and then select an order type (labs, Imaging, or Procedures). The Labs/Imaging window opens with the To be reviewed tab open by default: Note: You can search for specific orders and groups of orders on this window in many ways using the various filters and tabs. For more information on these filters and tabs, refer to the Labs section of the Electronic Medical Records Users Guide, which can be found at 2. Click John Smith s lab test results. Note: If this lab test result is not displayed here, change the information in the filters at the top of the window in order to find it. For more information on these filters, refer to the Electronic Medical Records Users Guide, which can be found at The Lab Results window opens. 3. Enter or update all applicable information in the yellow rows in the Results section: Note: Only the information contained in these yellow rows is recorded in a structured manner, allowing for easy searching and reporting. Scanned or transmitted documents attached to lab results are not searchable or reportable. 4. Once all information here has been reviewed, check the Received radio button: Note: To review this lab and move on to the previous or next lab in the list in one step, click the Prev (R) or Next (R) button at the bottom of the window. 5. Click the OK button. Copyright eclinicalworks, LLC 2011, Meaningful Use Training Scenarios Guide 233

234 Menu Set Objectives John Smith s lab results are now marked as received and this includes John in the numerator for this measure. They can be viewed on his Progress Notes by clicking the purple link for this lab under the Lab Results heading (i): Generating Lists of Patients by Specific Conditions Stage 1 Objective Providers must be able to generate lists of patients using specific criteria for quality improvement, reduction of disparities, research, or outreach Stage 1 Measure Generate at least one report listing patients of the eligible professional with a specific condition. This objective is reported to CMS based on self-attestation. eclinicalworks Calculations eclinicalworks does not perform any calculations for this measure. Providers must generate at least one report listing their patients with a specific condition. This measure is reported through self-attestation. Action Recommendations Policy Recommendations: Mid Office - Providers must periodically run searches on the database to determine patients that need preventive or follow-up care. eclinicalworks Setup Recommendations All - All information must be entered into the system, not just scanned in as a form, in order to be able to generate accurate lists. Workflow Recommendations Mid Office - To create generate lists of patients that match certain criteria, refer to the section titled Generating a List of Patients on page 235. Additional Tips Lists of patients can also be generated from the Patient Recalls window. For more information on this window, refer to the Front Office Users Guide, which can be found at The Registry in the eclinicalworks application can be used to search your entire patient database, and then repeatedly narrow this search to return results on subsets of patients. Lists can be generated in the Registry using the following broad criteria: Demographics Vitals Labs/DI ICDs CPT * s Copyright eclinicalworks, LLC 2011, Meaningful Use Training Scenarios Guide 234

235 Menu Set Objectives Prescriptions Medical History Immunizations Encounters Structured Data Referrals The Registry also allows you to generate and save reports based on theses criteria. For more information, refer to the Electronic Medical Records Users Guide, which can be found at Generating a List of Patients Scenario: You must generate a list of all male patients aged 50 years or older who have not had a prostate exam in the past year in order to identify the patients that are in need of preventive care. Workflow: 1. From the Registry band in the left navigation pane, click the Registry icon. The Registry window opens with the Demographics tab displayed: Note: The various filters and tabs on this window can be used to create lists of patients based on a wide variety of criteria. For more information on these filters and tabs, refer to the Registry section of the Electronic Medical Records Users Guide, which can be found at 2. Enter 50 in the left-most Age Range field. 3. Select Male from the Sex drop-down list. 4. Click the Run New button. All male patients aged 50 or older are displayed in the middle pane. The formula used to calculate results (based on the filters you have set) is displayed in the bottom pane: 5. Click the Labs/DI tab. The Labs/DI options display: *. CPT only 2010 American Medical Association. All rights reserved. Copyright eclinicalworks, LLC 2011, Meaningful Use Training Scenarios Guide 235

236 Menu Set Objectives 6. To select a lab: a. Click the Sel button next to the Labs field. The Labs window opens. b. Highlight the Prostate exam and click the OK button. The Prostate exam is populated in the Labs field. c. Click the Cancel button. The Labs window closes. 7. Select a date one year before today s date from the left-most Results Date Range field. 8. Click the Run Subset (NOT) button. All patients in the existing list of results are filtered to include only patients that have not had a result for a Prostate exam entered into the system for the past year. Note: For more information on creating letters for these patients, refer to the section titled Creating Letters for Lists of Patients on page (d): Sending Reminders to Patients for Preventive and Follow-Up Care Stage 1 Objective Practices must send reminders to patients that may require preventive or follow-up care in order to remind them. The method of this reminder must be based on patient preference (e.g., letter, voice mail, , etc.). Stage 1 Measure More than 20% of all unique patients 65 years or older or 5 years old or younger must be sent an appropriate reminder during the EHR reporting period. Denominator The number of unique patients 65 years old or older or 5 years old or younger. Numerator The number of patients in the denominator who are sent the appropriate reminder. Copyright eclinicalworks, LLC 2011, Meaningful Use Training Scenarios Guide 236

237 Menu Set Objectives eclinicalworks Calculations Denominator Unique patients are included in the denominator if they: Are 5 years old or younger 65 years old or older AND Have ever had an appointment with you Have you listed as their PCP on the Patient Information window Have you listed as their Rendering Provider on the Patient Information window Numerator Patients in the denominator are included in the numerator if they are sent one of the following types of reminders: Letter using a template where Follow Ups, Health Maintenance, or Preventive Care has been selected from the Category drop-down list Voice/text message using a template where Health Maintenance has been selected from the Category drop-down list emessage from the Patient Portal with the Preventive/Follow-up care message box checked Exclusion Providers are excluded from this measure if they do not have any patients 5 years old or younger or 65 years old or older. Action Recommendations Policy Recommendations: Mid Office - Providers must periodically run searches on the database to determine patients that need preventive or follow-up care. eclinicalworks Setup Recommendations System Administration - Perform one or more of the following actions as required: Letter templates must be marked as Follow Up, Health Maintenance, or Preventive Care letters in order for a patient that is sent that letter to be included in the numerator for this measure. For more information, refer to the section titled Creating Letter Templates on page 238. To set up standardized text for emessages sent to patients on the Patient Portal, refer to the section titled Configuring emessages on the Patient Portal on page 239. Front Office - Patient communication settings must be configured. For more information, refer to the section titled Configuring Patient Communication Settings on page 240. Copyright eclinicalworks, LLC 2011, Meaningful Use Training Scenarios Guide 237

238 Menu Set Objectives Workflow Recommendations Mid Office - Perform one or more of the following actions as required: To filter registry queries by patients that have certain types of communication enabled, refer to the section titled Filtering Registry Queries by Reminder Type on page 241. To create letters for patients that match certain criteria, refer to the section titled Creating Letters for Lists of Patients on page 242. To create and send e-messages through the Patient Portal, refer to the section titled Sending emessages through the Patient Portal on page 243. To create and send a voice message using eclinicalmessenger, refer to the section titled Sending Voice Messages with eclinicalmessenger on page 244. Additional Tips The Patient Portal, as well as patients Portal accounts, can be customized in various ways to meet the needs of your practice and your patients. For more information on the various available features, refer to the Patient Portal Users Guide, which can be found at In order to use eclinicalmessenger, it must be enabled and configured for your practice. For more information on the various available features, refer to the eclinicalmessenger Users Guide, which can be found at Creating Letter Templates Scenario: Your usual follow up reminder letter template has not yet been configured. You must now specify that this letter template is a Follow-Up type of template. Workflow: 1. From the Registry band in the left navigation pane, click the Registry icon. The Registry window opens. 2. Click the More (...) button next to the Letter field at the bottom of the window. The Letter Templates window opens. 3. Highlight your follow up reminder letter template and click the Update button. The Update Letter Template window opens. 4. Select the Follow Ups option from the Category drop-down list: Copyright eclinicalworks, LLC 2011, Meaningful Use Training Scenarios Guide 238

239 Menu Set Objectives IMPTANT! Only templates with the Follow Ups, Health Maintenance, or Preventive Care option selected here can be used to include patients in the numerator for this measure. 5. Click the OK button. This letter template is now specified as a follow up letter. For more information on all other options for creating letter templates, refer to the Front Office Users Guide, which can be found at Configuring emessages on the Patient Portal Scenario: The automatic message sent to patients to notify them that they have an appointment coming up has not yet been configured. You must now configure this message. Workflow: 1. From the Admin band, click the Patient Portal Settings icon. The Patient Portal Settings window opens. 2. Click the Message Settings link in the left pane. The Text Settings options display in the right pane. 3. Enter the message you want to be sent to patients with upcoming appointments in the Appointment Reminders field: 4. Click the Save button at the bottom of the window. This message is now configured. Copyright eclinicalworks, LLC 2011, Meaningful Use Training Scenarios Guide 239

240 Menu Set Objectives There are many other messages and settings for how these messages are sent and their replies routed to staff members available. For more information on these other settings, refer to the Patient Portal Users Guide, which can be found at my.eclinicalworks.com. Configuring Patient Communication Settings Scenario: Jansen Smith s patient communication settings have not yet been configured. He would like to have all types of messages enabled for all types of reminders. He would also like to receive his messages in English in the evenings. You must now configure these settings. Note: eclinicalmessenger must be enabled (although it does not have to be used) to access this feature. Workflow: 1. From the Patient Lookup window, highlight Jansen Smith s name and click the speaker icon at the bottom of the window: The Patient Communication Settings window opens: 2. To enable voice message reminders for Jansen Smith, check the Enable Voice box. Copyright eclinicalworks, LLC 2011, Meaningful Use Training Scenarios Guide 240

241 Menu Set Objectives 3. To enable SMS text message reminders for Jansen Smith, check the Enable SMS box. 4. Select Jansen Smith s preferred contact number from the Preferred Phone # drop-down list. Note: This drop-down list is populated based on the phone numbers entered on Jansen Smith s Patient Information window. 5. Click the English radio button in the Preferred Language row. 6. Click the Evening radio button in the Preferred Time To Call row. 7. To enable letter reminders for Jansen Smith, check the Enable Letters box. 8. To enable reminders for Jansen Smith, check the Enable box. 9. To enable all types of reminders, check the Select All box in the Type of Reminders section. 10. Enter any miscellaneous notes concerning Jansen Smith s communication preferences in the Notes field. 11. Click the Save Settings button. Jansen Smith s communication settings are now configured. Filtering Registry Queries by Reminder Type Scenario: You want to view all patients that have letter reminders enabled in their communication settings. You must now create a registry query for these patients over the age of 65. Note: Patient communication settings must have been configured for all applicable patients in order to use this feature. For more information, refer to the section titled Configuring Patient Communication Settings on page 240. Workflow: 1. From the Registry band in the left navigation pane, click the Registry icon. The Registry window opens with the Demographics tab selected by default. 2. Enter 65 in the left-most Age Range field. 3. Enter 120 (or any other age higher than the oldest patient) in the right-most Age Range field. 4. Select the Preferred Method: Letter option from the Show drop-down list: Copyright eclinicalworks, LLC 2011, Meaningful Use Training Scenarios Guide 241

242 Menu Set Objectives 5. Click the Run New button. All patients over the age of 65 with letters enabled in their communication settings display. Creating Letters for Lists of Patients Scenario: You must send letters to all male patients over the age of 65 that do not have a prostate exam recorded in their history, reminding them to create an appointment. Note: Only letters using templates that have been specified as either Follow Up or Health Maintenance letters will include patients in the numerator. For more information on configuring letter template categories, refer to the section titled Creating Letter Templates on page 238. Workflow: 1. From the Registry, generate a list of all patients over the age of 65 that have not had a prostate exam recorded in their history For more information, refer to the section titled Generating a List of Patients on page Click the More (...) button next to the Letter field in the bottom-right corner of the window. The Letter Templates window opens: Copyright eclinicalworks, LLC 2011, Meaningful Use Training Scenarios Guide 242

243 Menu Set Objectives 3. Highlight a reminder letter template and click the OK button. 4. Click the Run Letter button. Note: To exclude specific patients from this letter run, uncheck the box(es) next to their name(s) before you click the Run Letter button. Microsoft Word opens with the letters for the selected patients displayed. 5. Print these letters as needed. Sending emessages through the Patient Portal Scenario: You want to send all patients over the age of 65 a health maintenance reminder e-message through the Patient Portal. You must now generate this list and send this message. Workflow: 1. From the Registry band in the left navigation pane, click the Registry icon. The Registry window opens with the Demographics tab selected by default. 2. Enter 65 in the left-most Age Range field. 3. Enter 120 (or any other age higher than the oldest patient) in the right-most Age Range field. 4. Click the Run New button. All patients that meet the selected criteria are displayed. 5. Click the Send emessage button at the bottom of the window. The Portal emsg window opens: Copyright eclinicalworks, LLC 2011, Meaningful Use Training Scenarios Guide 243

244 Menu Set Objectives 6. Enter a subject for this message in the Subject field. 7. Check the Preventive/Follow up care message box. IMPTANT! This box MUST be checked in order for these patients to be included in the numerator for this measure. 8. Type your message in the blank field here. Click the Load button to load a letter template. 9. Click the Send button. All patients returned with the registry query are now sent this e-message. Sending Voice Messages with eclinicalmessenger Scenario: John Smith s appointment is coming up. You must send him an appointment confirmation voice message using eclinicalmessenger Workflow: 1. From the provider's schedule or Resource Schedule, right-click on John Smith s appointment to open a drop-down list. 2. From the drop-down list, click the Send vmsg option: Copyright eclinicalworks, LLC 2011, Meaningful Use Training Scenarios Guide 244

245 Menu Set Objectives The vmsg Templates window opens: 3. Click the English language tab in the left pane. 4. Highlight the Appt: Confirmation vmsg template from the list in the left pane. The message text template displays in the right pane: Note: Use the vmsg Templates to stack templates and create one message from multiple templates. Clear any unwanted template information from the right pane before finalizing the message. Copyright eclinicalworks, LLC 2011, Meaningful Use Training Scenarios Guide 245

246 Menu Set Objectives Note: The keyword functionality is similar to the Letter Tags function. Each double-braced keyword inserts the corresponding patient-specific information into the voice message. For example, whenever the tag {{DOCTNAME}} appears in the message, the eclinicalmessenger system will insert the doctor s name. For more information, refer to the Letters chapter of the Electronic Medical Records Users Guide, which can be found at 5. Edit the message text, if necessary. The total number of words in the selected message template is displayed in the Word Count field at the bottom of the right pane. 6. To insert the vmsg Confirmation functionality, check the box in the lower-right corner. For more information about vmsg Confirmation, refer to the eclinicalmessenger Users Guide, which can be found at 7. Click the Spell Check button to check the spelling of the message text before sending. 8. To test the text conversion, click the Test Text-to-Speech (TTS) button. For more information about testing the Text-to-Speech functionality, refer to the eclinicalmessenger Users Guide, which can be found at 9. Click the Send vmsg button. The eclinicalmessenger message is sent and within minutes John Smith will receive the automated message. There are many other ways to send voice messages using eclinicalmessenger, as well as many options and settings that affect the way they are sent. For more information on these other options and settings, refer to the eclinicalmessenger Users Guide, which can be found at Copyright eclinicalworks, LLC 2011, Meaningful Use Training Scenarios Guide 246

247 Menu Set Objectives (g): Providing Timely Electronic Access to Health Information Stage 1 Objective Patients must be provided with timely electronic access to their health information (including lab results, problem list, medication lists, medication allergies) within four business days of the information being available to the eligible professional. Stage 1 Measure More than 10% of all unique patients seen by the eligible professional must be provided timely (available to the patient within four business days of being updated in the certified EHR technology) electronic access to their health information subject to the eligible professional s discretion to withhold certain information. Note: Some results and other sensitive information may best be communicated at a face-to-face encounter. From the CMS ruling: We agree that there may be situations where a provider may decide that electronic access of a portal or Personal Health Record is not the best forum to communicate results. Within the confines of laws governing patient access to their medical records, we would defer to EPs, eligible hospital or CAH s judgment as to whether to hold information back in anticipation of an actual encounter between the provider and the patient. Denominator The number of unique patients seen by the eligible professional during the EHR reporting period. Numerator The number of patients in the denominator who have timely (available to the patient within four business days of being updated in the certified EHR technology) electronic access to their health information online. Exclusions This measure is subject to the eligible professional s discretion to withhold certain sensitive information. eclinicalworks Calculations Denominator Unique patients are included in the denominator if: An appointment has been created for them during the reporting period from the Resource Scheduling, Provider Schedule, or Office Visits window AND NOT A visit type or visit code with the exclusion flag enabled has been selected for this appointment Note: Telephone encounters are not counted as appointments. Patients with only Telephone Encounters are not included in the denominator for this measure. Copyright eclinicalworks, LLC 2011, Meaningful Use Training Scenarios Guide 247

248 Menu Set Objectives Numerator Patients in the denominator are included in the numerator if they have been web-enabled from the Patient Information window on or before the appointment date, or within four business days (excluding national, but not state, holidays) of the appointment date. Action Recommendations Policy Recommendations: Mid Office - Providers should upload health information for patients within four days to the Patient Portal. eclinicalworks Setup Recommendations System Administration - Patients must be web-enabled in order to access the Patient Portal. For more information, refer to the section titled Web-Enabling a Patient on page 151. Workflow Recommendations System Administration - The synchronization schedule for health information must be configured before information is exchanged between the eclinicalworks application and the Patient Portal. For more information, refer to the section titled Scheduling the Synchronization of Health Information with the Patient Portal on page 155. Patients - Patients can access any information that has been uploaded to the Patient Portal through the Internet. For more information, refer to the section titled Accessing Health Information on the Patient Portal on page 158. Additional Tips The Patient Portal, as well as patients Portal accounts, can be customized in various ways to meet the needs of your practice and your patients. For more information on the various available features, refer to the Patient Portal Users Guide, which can be found at my.eclinicalworks.com (m): Providing Access to Patient-Specific Education Stage 1 Objective Use certified EHR technology to identify patient-specific education resources and provide them to patients. Stage 1 Measure More than 10% of all unique patients seen by the eligible professional must be provided patient-specific education resources. Denominator The number of unique patients seen by the eligible professional during the EHR reporting period. Copyright eclinicalworks, LLC 2011, Meaningful Use Training Scenarios Guide 248

249 Menu Set Objectives Numerator The number of patients in the denominator who are provided patient-specific education resources. Note: Patients are considered by the system to have been given education once the Print (or Publish to Portal) option is selected on the Treatment or Order Sets windows, as outlined in the sections below. eclinicalworks Calculations Denominator Unique patients are included in the denominator if: An appointment has been created for them during the reporting period from the Resource Scheduling, Provider Schedule, or Office Visits window AND NOT A visit type or visit code with the exclusion flag enabled has been selected for this appointment Note: Telephone encounters are not counted as appointments. Patients with only Telephone Encounters are not included in the denominator for this measure. Numerator Patients in the denominator are included in the numerator if one of the following options is selected from the Treatment section of the Progress Notes: Printing Rx education (Treatment window > Education drop-down list > Rx Education option > Print button) Printing patient education via Krames, Adam, or Healthwise (Treatment window > Education drop-down list > Patient Education option > Print button) Opening custom patient education (Treatment window > Education drop-down list > Custom Education option > Open button) Ordering patient education as a part of an Order Set (Order Set window > Patient Education section > open education by clicking the PDF icon) Publishing patient education via Krames, Adam, or Healthwise to the Patient Portal (Treatment window > Education drop-down list > Patient Education option > Publish to Portal check box) Action Recommendations Policy Recommendations: Mid Office - Providers must be instructed on how to generate and print patient education documents. Copyright eclinicalworks, LLC 2011, Meaningful Use Training Scenarios Guide 249

250 Menu Set Objectives eclinicalworks Setup Recommendations System Administration - Any additional patient education sites that the providers should be using that are not pre-loaded by eclinicalworks must be set up and saved as favorites on the Patient Education window. Also, any custom education must be saved on every computer s local drive in a known location so that it can be accessed from any workstation. Front Office - In order to view and print patient education uploaded to the Patient Portal, patients must first be web enabled. For more information, refer to the section titled Web-Enabling a Patient on page 151 Note: A list of available education vendors for eclinicalworks can be reviewed at Contact ecw Sales to subscribe to one of these services. Mid Office - In order to view and print patient education from Order Sets, they must first be properly configured. For more information, refer to the section titled Adding Patient Education to an Order Set on page 250. Workflow Recommendations Mid Office - Perform one or more of the following actions as needed: To upload patient education to the Patient Portal, refer to the section titled Uploading Patient Education to the Patient Portal on page 251. To provide education to patients from Order Sets, refer to the section titled Viewing and Printing Patient Education from Order Sets on page 252. To provide education to patients from the Progress Notes, refer to the section titled Viewing and Printing Patient Education from the Treatment Window on page 252. Additional Tips The Patient Portal, as well as patients Portal accounts, can be customized in various ways to meet the needs of your practice and your patients. For more information on the various available features, refer to the Patient Portal Users Guide, which can be found at my.eclinicalworks.com. Adding Patient Education to an Order Set Scenario: You are configuring an existing Smoking Cessation Order Set and would like to include some patient education. You must now attach the appropriate PDF and web reference education. Workflow: 1. From the EMR menu, click the Order Set Administration option. The Order Sets window opens. 2. Select the Smoking Cessation option from the Order Set drop-down list. The Smoking Cessation Order Set configuration displays. 3. In the Physician Education section, click the Add button next to the PDF heading: The Open window opens. Copyright eclinicalworks, LLC 2011, Meaningful Use Training Scenarios Guide 250

251 Menu Set Objectives 4. Navigate to a PDF file on your computer and click the OK button. The Open window closes and the selected file is displayed on the Order Sets window in the Physician Education section under the PDF heading. Note: To view this PDF now to ensure the correct PDF was selected, click the PDF icon to the left of a file and the selected PDF will open. 5. Click the Save button next to the PDF heading. The selected PDF is now associated with this Order Set. Uploading Patient Education to the Patient Portal Scenario: John Smith has just been diagnosed with Type 2 Diabetes. You must now upload education on this condition to the Patient Portal for him to access. Note: John Smith must be web enabled in order for him to be able to access education uploaded to the Patient Portal. For more information, refer to the section titled Web-Enabling a Patient on page 151. Workflow: 1. From John Smith s Progress Notes, click the Treatment link. The Treatment window opens. 2. Click the Education button to open a drop-down list. 3. Click the Patient Education option. The Patient Education window opens: Note: To use different sources for patient education, enter the web address for the education site in the Address field at the top of the window and click the Go button. Checking the Add to Favorites box saves this site as an option 4. Enter diabetes in the Search field. 5. Click the Go button next to the Search field. The available education that meets the search criteria displays in the Search Results section. 6. Click the Type 2 diabetes link. Education for Type 2 Diabetes displays on the Patient Education window. 7. Click the Publish to Portal button. This patient education information is now uploaded to the Patient Portal. Copyright eclinicalworks, LLC 2011, Meaningful Use Training Scenarios Guide 251

252 Menu Set Objectives Viewing and Printing Patient Education from Order Sets Scenario: Amy Smith is a heavy smoker and is interested in quitting. You must now provide her with relevant education. Note: To view and print education from an Order Set, it must first be properly configured. For more information on adding education to Order Sets, refer to the section titled Adding Patient Education to an Order Set on page 250. Workflow: 1. From Amy Smith s Progress Notes, click the OS tab in the Right Chart Panel. The OS options display. 2. Click the OS icon to the left of the Smoking Cessation option. The Order Sets window opens with the Smoking Cessation option selected. 3. In the Physician Education section, click the PDF icon to the left of a PDF: The selected document opens. Note: This patient is added to the numerator for this measure as soon as the PDF icon is clicked. 4. Review this information with the patient and click the Print icon to print it out for them. Viewing and Printing Patient Education from the Treatment Window Scenario: John Smith has just been diagnosed with Type 2 Diabetes. You must now provide him with education on this condition. Workflow: 1. From John Smith s Progress Notes, click the Treatment link. The Treatment window opens. 2. Click the Education button to open a drop-down list. 3. Click the Patient Education option. Note: To provide custom medication to a patient, click the Custom Medication option. Copyright eclinicalworks, LLC 2011, Meaningful Use Training Scenarios Guide 252

253 Menu Set Objectives Note: To provide prescription education to a patient, hover over the Rx Education option to open a new drop-down list and select English or Spanish. The Patient Education window opens: Note: To use different sources for patient education, enter the web address for the education site in the Address field at the top of the window and click the Go button. Checking the Add to Favorites box saves this site as an option 4. Enter diabetes in the Search field. 5. Click the Go button next to the Search field. The available education that meets the search criteria displays in the Search Results section. 6. Click the Type 2 diabetes link. Education for Type 2 Diabetes displays on the Patient Education window. Review this information with John Smith. 7. Click the Print button at the bottom of the window to print this information for John to take home. Note: This patient is not added to the numerator for this measure until the Print button is clicked for integrated education. For education materials stored on your local computer, patients are added to the numerator when the Custom button is clicked (j): Performing Medication Reconciliation at Relevant Encounters Stage 1 Objective Practices must be able to electronically reconcile (compare and merge) two or more medication lists into a single medication list that can be electronically displayed in real time. Stage 1 Measure The eligible professional must perform medication reconciliation for more than 50% of transitions of care in which the patient is transferred into the care of the eligible professional. Denominator The number of transitions of care during the EHR reporting period for which the eligible professional was the receiving party of the transition. Copyright eclinicalworks, LLC 2011, Meaningful Use Training Scenarios Guide 253

254 Menu Set Objectives Numerator The number of transitions of care in the denominator where medication reconciliation was performed. Note: Patients are only included in the numerator once the Medication Verified box is checked on the Current Medications window. For more information on this window, refer to the section titled Updating Patients Current Medications on page 183. Exclusions Eligible professionals are excluded from this measure if they were not on the receiving end of any transition of care during the EHR reporting period. eclinicalworks Calculations Denominator Unique patients are included in the denominator if: An appointment has been created for them during the reporting period with the Transition of Care box checked from the Resource Scheduling, Provider Schedule, or Office Visits window AND NOT A visit type or visit code with the exclusion flag enabled has been selected for this appointment Note: Telephone encounters are not counted as appointments. Patients with only Telephone Encounters are not included in the denominator for this measure. Numerator Patients in the denominator are included in the numerator if the Medication Verified box is checked in the Current Medications section of the Progress Notes. Exclusion Providers are excluded from this measure if they do not transfer any patients to another setting or refer any patients to another provider during the reporting period. Action Recommendations Policy Recommendations: Mid Office - Providers should verify with the patient and/or through external medication history checks (with the patient s consent) the medications that the patient is currently taking. eclinicalworks Setup Recommendations System Administration (Optional) - Providers can perform medication history checks through Surescripts. Your practice must have e-prescribing installed to perform this action. For more information, refer to the Informed Prescribing Users Guide, which can be found at Copyright eclinicalworks, LLC 2011, Meaningful Use Training Scenarios Guide 254

255 Menu Set Objectives Workflow Recommendations Front Office - Appointments involving a transition of care must be marked as such. For more information, refer to the section titled Marking an Appointment as a Transition of Care Encounter on page 255. Mid Office (Optional) - Perform one or more of the following actions as required: Clinical information can be exported from eclinicalworks as a Continuity of Care Document (CCD). For more information, refer to the section titled Exporting a Continuity of Care Document on page 201. Clinical information can be imported into eclinicalworks as a Continuity of Care Document (CCD). For more information, refer to the section titled Importing a Continuity of Care Document on page 202. Note: Once eclinicalworks P2P (Physician-to-Physician) has been certified, additional methods of importing and exporting clinical information will be available. For more information, refer to the eclinicalworks P2P Guide, which can be found at Mid Office (Required) - The Current Medications for all patients being referred from another provider must be updated with information received from the referring provider. For more information, refer to (d): Maintaining an Active Medications List on page 181. IMPTANT! The Medication Verified box MUST be checked after adding, updating, or removing all applicable medications in order for a patient to be included in the numerator. Marking an Appointment as a Transition of Care Encounter Scenario: Amy Smith has been referred to you by a different provider in your community. You must now mark this appointment as a transition of care encounter before Amy is checked in. Workflow: 1. From the Resource Scheduling window, open Amy s appointment. The Appointment window opens. 2. Check the Transition of Care box: Copyright eclinicalworks, LLC 2011, Meaningful Use Training Scenarios Guide 255

256 Menu Set Objectives 3. Click the OK button. This appointment is now marked as a transition of care encounter (i): Providing a Summary of Care for Each Transition of Care and Referral Stage 1 Objective Practices must electronically transmit patient summary records to other providers and organizations at each transition of care. Stage 1 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. Denominator The number of transitions of care and referrals during the EHR reporting period for which the eligible professional was the transferring or referring provider. Numerator The number of transitions of care and referrals in the denominator where a summary of care record was provided. Exclusions Eligible professionals are excluded from this measure if they do not transfer a patient to another setting or refer a patient to another provider during the EHR reporting period. Copyright eclinicalworks, LLC 2011, Meaningful Use Training Scenarios Guide 256

257 Menu Set Objectives eclinicalworks Calculations Denominator Referrals are included in the denominator if one of the following actions is performed on them during the reporting period: Printed in any manner Faxed in any manner Transmitted in any manner through the P2P Portal Note: Referrals are only counted for a provider if they are listed as the Referral From Provider on the referral. Numerator Referrals in the denominator are included in the numerator if one of the following actions is performed on them during the reporting period: Printed with attachments Faxed with attachments Transmitted through the P2P Portal with attachments Exclusion Providers are excluded from this measure if they do not transfer any patients to another setting or refer any patients to another provider during the reporting period. Action Recommendations Policy Recommendations: Mid Office - Providers should include a medical summary on all outgoing referrals. eclinicalworks Setup Recommendations System Administration - Perform the following actions as necessary: Medical summaries can be automatically attached to all outgoing referrals. For more information, refer to the section titled Automatically Attaching Medical Summaries to Outgoing Referrals on page 258. All applicable information must be entered into the system for Referring Providers in order to electronically transmit outgoing referrals. For more information on configuring referring provider information, refer to the System Administration Users Guide, which can be found at Workflow Recommendations Mid Office - If medical summaries are not automatically attached to all outgoing referrals at your practice, they must be attached manually in order to satisfy this measure. For more information, refer to the section titled Creating an Outgoing Referral with a Medical Summary on page 258. Additional Tips Additional setup and configuration may be required in order to use eclinicalworks P2P. For more information, refer to the eclinicalworks P2P Guide, which can be found at my.eclinicalworks.com. Copyright eclinicalworks, LLC 2011, Meaningful Use Training Scenarios Guide 257

258 Menu Set Objectives Automatically Attaching Medical Summaries to Outgoing Referrals Scenario: Currently, all providers must manually attach a medical summary to each outgoing referral in order to comply with this measure. You must now configure the system to automatically attach medical summaries to each outgoing referral. Workflow: 1. From the File menu, hover over the Settings option to open a drop-down list. 2. From the drop-down list, click the Practice Defaults option. The Practice Defaults window opens with the Front Office tab displayed by default. 3. Check the Attach Medical Summary by Default in Outgoing Referral box: 4. Click the OK button. Medical summaries are now attached to all outgoing referrals automatically. Creating an Outgoing Referral with a Medical Summary Scenario: You are referring Amy Smith to a specialist. You must now create and transmit an outgoing referral that includes a medical summary to the specialist. Copyright eclinicalworks, LLC 2011, Meaningful Use Training Scenarios Guide 258

259 Menu Set Objectives Workflow: 1. From the Progress Notes window, click the Treatment link. The Treatment window opens. 2. Click the Outgoing Referral button. The Referral (Outgoing) window opens: 3. To select the provider to whom you are referring John Smith: a. Click the More (...) button next to the Provider field. The Referring Physician Lookup window opens. b. Highlight the provider to whom you are referring and click the OK button. 4. To select the facility to which you are referring John Smith: a. Click the More (...) button next to the Facility To field. The Facility List window opens. b. Highlight the facility to which you are referring and click the OK button. 5. Enter any other information in the remaining fields as applicable. 6. Click the Attachments button. A confirmation window opens notifying you that this referral must be saved before anything can be attached to it. 7. Click the Yes button. Copyright eclinicalworks, LLC 2011, Meaningful Use Training Scenarios Guide 259

260 Menu Set Objectives The Attachments window opens with the Attach Medical Summary box checked by default: 8. Attach any other documents and click the OK button. The Attachments window closes. 9. Click the Send Referral button. The How would you like to send your referral? pane displays: Copyright eclinicalworks, LLC 2011, Meaningful Use Training Scenarios Guide 260

261 Menu Set Objectives 10. Click one of the following icons and follow all prompts to transmit this referral with the medical summary attached: Print with Attachments Fax with Attachments Send electronically via ecw P2P (k): Submitting Electronic Data to Immunization Registries Stage 1 Objective Practices must electronically transmit immunization information to immunization registries or Immunization Information Systems in accordance with applicable state law and practice. Stage 1 Measure Practices 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. Exclusions 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. eclinicalworks Calculations eclinicalworks does not perform any calculations for this measure. To satisfy this measure, users must perform at least one test of their ability to submit electronic data to immunization agencies and provide a follow-up submission if the test was successful (unless none of the immunization agencies to which you submit such information has the capacity to receive the information electronically). This measure is reported by self-attestation. Exclusion Providers that do not perform any immunizations during the reporting period are excluded from this measure. Action Recommendations Policy Recommendations: System Administration - Immunization information must be exported to state registries on a weekly basis, at a minimum. Mid Office - All immunization information must be entered into the system. Scanning in an immunization form does not allow for this information to be exported to state registries. eclinicalworks Setup Recommendations System Administration - The system must be configured to export immunization data to the registry for your state. This process differs by state. For more information, refer Copyright eclinicalworks, LLC 2011, Meaningful Use Training Scenarios Guide 261

262 Menu Set Objectives to the System Administration Users Guide, which can be found at my.eclinicalworks.com. Workflow Recommendations System Administration - Immunization information can be exported to your state s registry from the EMR menu. For more information, refer to the section titled Exporting Immunizations to State Registries on page 262. Exporting Immunizations to State Registries Scenario: You are performing your weekly maintenance activities. You must now export all immunization information from this past week to your state registry. Note: This scenario only applies to providers in states with Immunization Registries set up to receive electronic data. If no such registry exists in your state, then you may meet the Exclusion criteria for this measure (displayed above) and may be exempt from this measure. Workflow: 1. From the EMR menu, hover over the Immunization Registry option to open a drop-down list. 2. From the drop-down list, click the Export Immunizations option. The Export Immunization Details window opens, with the current date populated in both the From and To fields: 3. Select the day one week prior to today s date from the From drop-down calendar (in this case, 05/27/2010). 4. Check the Export All Pending Immunizations box. 5. Select the Ready to Export status from the Status drop-down list. 6. Click the OK button. All immunization information from the past week is transmitted to the state registry. Copyright eclinicalworks, LLC 2011, Meaningful Use Training Scenarios Guide 262