Meaningful Use Stage 1 Guide for 2013

Transcription

1 Meaningful Use Stage 1 Guide for 2013 Aprima PRM 2011 December 20, Aprima Medical Software. All rights reserved. Aprima is a registered trademark of Aprima Medical Software. All other trademarks are the property of their respective holders. Reference Number:

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3 Contents Introduction... 7 Using Aprima PRM 2011 for Meaningful Use... 7 PQRS and Meaningful Use... 7 Registration and Attestation... 8 Registration... 8 Attestation... 8 Supporting Documentation for Meaningful Use Attestation... 9 Reporting Configuration Race and Ethnicity Information Race Ethnicity Verify HCPCS Procedure Code Definitions User-Defined Diagnosis Codes Associate LOINC Codes with Lab Tests Used for Measures Associate CVX Codes with Types of Vaccine Used for Measures SNOMED Codes SNOMED Code for Discontinue Reason SNOMED Code for Diagnosis Code SNOMED Codes for Medical Problem SNOMED Code for Procedure Codes SNOMED Code for Questions SNOMED Code for KDB Answers Configure Education Forms Define the Patient Communication Type for Education Forms Associate Education Forms Required for Measures Enter Practice, Provider, Insurance Payer, and Patient Information Practice Information Provider Information Patient Information Patient Status for Test Patient Features Used for Meaningful Use Clinical Summaries Complete Chart Request Message Ref:

4 Create a Complete Chart Request Task Message Process a Complete Chart Request Task Message Preventative Follow Up Defining a Health Maintenance Rule for Reporting as Preventative Follow Up Messages for Preventive Follow Up Recording the Review of Transfer or Referral Patient s Medications Measure Charting Details Core Measures Core Measure 1: CPOE (Computerized Provider Order Entry) of Prescriptions Core Measure 2: Drug/Drug and Drug/Allergy Interaction Checks Core Measure 3: Up-to-Date Diagnoses List Core Measure 4: Electronic Prescribing (erx) Permissible Prescriptions Core Measure 5: Active Medication List Maintained Core Measure 6: Active Allergy List Maintained Core Measure 7: All Required Demographic Information Core Measure 8: All Required Vitals Core Measure 9: Smoking Status Core Measure 10: CMS Quality Measures Reported Core Measure 11: Clinical Decision Support Core Measure 12: Electronic Patient Health Information Core Measure 13: Patient Clinical Summary Core Measure 14: Electronic PHI Exchange Core Measure 15: Security Risk Analysis Menu Set Measures Menu Set Measure 1: Implement Drug Formulary Checks Menu Set Measure 2: Clinical Lab Test Results Menu Set Measure 3: Generate Patient Lists Menu Set Measure 4: Reminders for Preventive and Follow-Up Care Menu Set Measure 5: Electronic Access to Patient s Health Information Menu Set Measure 6: Education Resources Menu Set Measure 7: Medication Reconciliation Menu Set Measure 8: Summary of Care for Transitioning Patients Menu Set Measure 9: Immunization Registries or Immunization Information Systems.. 39 Menu Set Measure 10: Syndromic Surveillance Data Submission Ref:

5 Clinical Quality Measures Measure 0013 Hypertension: Blood Pressure Measurement Measure 0028 Preventive Care and Screening: Tobacco Use Assessment Measure 0028 Preventive Care and Screening: Tobacco Cessation Intervention Measure 0421 Adult Weight Screening and Follow-Up (Age 18 to 64) Measure 0024 Weight Assessment and Counseling for Children and Adolescents Measure 0038 Childhood Immunization Status Measure 0041 Preventive Care and Screening: Influenza Immunization for Patients > 50 Years Old Measure 0018 Controlling High Blood Pressure Measure 0027 Smoking and Tobacco Use Cessation Measure 0031 Breast Cancer Screening Measure 0032 Cervical Cancer Screening Measure 0034 Colorectal Cancer Screening Measure 0043 Pneumonia Vaccination Status for Older Adults Measure 0047 Asthma Pharmacologic Therapy Measure 0055 Diabetes: Eye Exam Measure 0056 Diabetes: Foot Exam Measure 0059 Diabetes: HbA1c Poor Control Measure 0061 Diabetes: Blood Pressure Management Measure 0062 Diabetes: Urine Screening Measure 0064 Diabetes: LDL Management & Control (LDL Test) Measure 0067 Coronary Artery Disease (CAD): Oral Antiplatelet Therapy Prescribed for Patients with CAD Measure 0575 Diabetes: HbA1c Control (<8%) Certification Test Process Reporting to an Immunization Registry Test Process Modify the Type of Vaccine to Include the CVX Code Create a Directory on the Server Activate the HL7 Partner for the Registry Chart a Vaccination for the Test Patient Copy the HL7 Message Locate the HL7 Message File Inactivate the HL7 Partner for the Registry Monitoring and Reports Ref:

6 Meaningful Use Dashboard Amount Allowed Summary Report Clinical Quality Reports ARRA Quality Measure Lipid Panel Values Meaningful Use Patient Volume for Meaningful Use Patients and BP Patients and Drug Patients and Lab Values Patients and Smoking Ref:

7 Introduction The Health Information Technology for Economic and Clinical Health (HITECH) Act, enacted as part of the American Recovery and Reinvestment Act (ARRA) of 2009, promotes the adoption and meaningful use of health information technology. One of its specific goals is to increase physician adoption of electronic health record (EHR) applications to 90 percent by To encourage physicians to adopt EHR software the HITECH and ARRA acts include incentive payments to physicians who demonstrate meaningful use of a certified EHR application over the next six years. The Department of Health and Human Services (HHS) definition of meaningful use expands over three stages: Stage I Data capturing and sharing Stage II Advanced clinical processes Stage III Improved outcomes To receive incentive payments for EHR adoption, physicians must demonstrate that they are using a certified EHR in the manner proscribed by HHS as meaningful use. You must use the application for 90 consecutive days during the reporting year and meet the Meaningful Use requirements to qualify for that incentive payment for the 2013 calendar year. Using Aprima PRM 2011 for Meaningful Use This guide provides a general introduction to using Aprima PRM 2011 for Meaningful Use Stage I reporting in the 2013 calendar year. In calendar year 2013, all participants submit using Stage 1 requirements, whether you are participating for the first time or have participated in the past. This document: Explains the features and functions that can be used to meet the meaningful use requirements. Gives general information about the meaningful use measures, and what must be done to meet the measures requirements. Describes the reports used for meaningful use monitoring and reporting. PQRS and Meaningful Use Please note that the Physician Quality Reporting System (PQRS) program and its incentive payments are distinct from the Health Information Technology for Economic and Clinical Health (HITECH) Act, which established incentive payments to physicians who demonstrate meaningful use of a certified EHR application. You can participate in both the PQRS program and the Meaningful Use program and receive payments from both. Ref:

8 Registration and Attestation You must register with the Centers for Medicare and Medicaid Services (CMS) in order to apply for the meaningful use incentive. You must have registered before you can attest to your use of the application. To register and to attest, you must have your NPI user ID and password. Your NPI user ID is not your NPI number. If you do not know your NPI user ID, you can call to get your NPI user ID and a temporary password. Please note that CMS only allows this information to be given to the doctor; they will not accept calls from or provide information to an administrative assistant or other staff member on your behalf. Registration You may register at any time, but you must have registered prior to attestation. Use the following procedure to register. 1. Browse to 2. Select the National Provider Identifier (NPI) link. 3. Select the Login link, and then go through the steps to create a new password. The password will be needed in step Browse to Guidance/Legislation/EHRIncentivePrograms/RegistrationandAttestation.html 5. Select the Registration User Guide for Eligible Professionals, and save it to your desktop. That is your step by step guide to the registration process at CMS. You will need to use your NPPES Login and Password you obtained in step 1 to login into the EHR incentive site and then you are almost done. 6. When prompted about your Meaningful Use EMR, enter Aprima s certification number: SVIWEAK 7. Print and save your Certificate. Attestation Once you have met the meaningful use requirements, you can attest to your use of the application. Use the following procedure to attest. 1. Print the Meaningful Use report and the other quality reports that show your use of the application. You will need information from these reports to enter your attestation data. 2. Browse to 3. Select the Continue button. 4. Log in using your NPI user ID and password. 5. Follow the attestation process of the website to enter your meaningful data from the Meaningful Use and other quality reports. 8 Ref:

9 Supporting Documentation for Meaningful Use Attestation The Centers for Medicare and Medicaid Services (CMS) has announced that they will audit between 5 and 10 percent of providers who attest for Meaning Use. This document can help you identify the documentation you need to create and keep in order to support your attestation in the event of an audit. This information is for guidance only. As the provider or practice, you are responsible for any Meaningful Use audit and its results, including any monies that must be returned to CMS in the case of a failed audit. CMS has provided the following information regarding the documentation needed to support attestation in the case of an audit. Additional information is available directly from CMS at: Guidance/Legislation/EHRIncentivePrograms/Downloads/EHR_SupportingDocumentation_A udits.pdf CMS will not make the risk profiles for audits public. All documentation to support attestation should be retained for at least six years following the attestation. The primary source document is the Meaningful Use report and the other quality reports that show your use of the application. You will need information from these reports to enter your attestation data, and you must retain them to support that attestation. If you request an exclusion for any measure, you must generate and retain the report for that measure showing a zero denominator for the measure. Depending on the measures on which you report, you may also need one or more dated screen shots showing the use of functionality or the completion of a test. For example: SIG Writer and drug-drug/drug-allergy interaction warning windows SIG Writer window showing drug formulary check information Health Maintenance Rule window with rules used for clinical decision support and the use of those rules in the Full Note Composer s HM Rule slider Reports window showing the filtering criteria for the Quality Report or the Patients by Diagnosis report used to generate a list of patients by condition (retain the actual report as well) The PHI exchange process is not required for The CMS announcement regarding this change is available from their website at Guidance/Legislation/EHRIncentivePrograms/Downloads/Stage1ChangesTipsheet.pdf Aprima recommends that you print the CMS announcement and keep it with your Meaningful Use attestation documents. If you conduct a test of the immunization registry reporting, then you need: Dated screen shot of the Interface Data Detail window confirming that the information was received by the vaccine registry. Test instructions, including capturing screen shots are in the Reporting to an Immunization Registry Test Process section of this document. Ref:

10 If the test was successful, then dated screen shots of the Interface Data Detail window showing submission during the reporting period. Evidence that the submission was generated from provider s system (e.g., identified by National Provider Identifier (NPI), CMS Certification Number (CCN), provider name, practice name, etc.). This information must be displayed in your Interface Data Detail window screen shot. Letter or from registry or public health agency confirming the receipt (or failure of receipt) of the submitted data, including the date of the submission, name of parties involved, and whether the test was successful. If you conduct a security risk analysis, then you need: A copy of the analysis report. Documentation of security updates implemented as a result of the analysis. Reporting Configuration There are a number of tasks that you must perform in the application to configure it for meaningful use reporting. Race and Ethnicity Information The Department of Health and Human Services (HHS) requires that a Medicare or Medicaid patient s race and ethnicity be identified and reported as part of the HITECH and ARRA meaningful use requirements for EHR adoption. Therefore, the application includes the Centers for Disease Control and Prevention s (CDC) full set of race and ethnicity names and ANSI codes. HHS has defined a subset of race and ethnicity identifiers that are most frequently used, including a Not Provided identifier that is acceptable for meaningful use purposes. The race and ethnicity identifiers in this subset are defined as active. All other race and ethnicity codes are inactive by default. All race and ethnicity identifiers that include a valid ANSI code are valid for meaningful use purposes. If you need a race or ethnicity identifier that is not active, simply search for inactive items, find the desired item, and activate it by unselecting the Inactive checkbox. If you have created and used user-define race or ethnicity options, you must associated them with a valid ANSI code. Race 1. List Editor ( ) Demographics Race 2. Search for and select the desired race, and select the Modify button. 3. Enter a valid ANSI Code. 10 Ref:

11 Ethnicity 1. List Editor ( ) Demographics Ethnicity 2. Search for and select the desired ethnicity, and select the Modify button. 3. Enter a valid ANSI Code. Verify HCPCS Procedure Code Definitions Some measures may be charted using HCPCS or CPT codes. HCPCS codes must be properly defined as the HCPCS code type, rather than as CPT code type. 1. List Editor ( ) Clinical Lab Template 2. Search for and select the desired procedure code, and select the Modify button. 3. In the Code Type field, select HCPCS. User-Defined Diagnosis Codes Some measures may be charted using ICD-9 codes that are for procedures, rather than for diagnoses. ICD-9 procedure codes are not included in the application. If you want to use these codes, you must create them as user-defined diagnosis codes. The codes are then charted in a patient visit note as a diagnosis code, even though they identify procedures. Ref:

12 1. List Editor icon ( ) Clinical Diagnosis Code 2. Select New from the List Editor window to display the Add Diagnosis Codes window. 3. Select the Add Custom Code radio button, and select OK. 4. Enter an ID, if desired. 5. Enter the appropriate ICD-9 Code. 6. For clinical Specificity, select the Complete radio button. 7. For Billing, select the Complete radio button. 8. Enter a Short Description for the code. This will distinguish your custom code from the actual ICD-9 code. 9. Enter the Long Description. It is recommended that you use the long description from the actual ICD-9 code. 10. Enter any Notes explaining the custom code, if desired. 11. In the SNOMED Concept ID field, select the appropriate SNOMED code. Associate LOINC Codes with Lab Tests Used for Measures The PQRS and meaningful use measures involving lab tests for which quantifiable results must be entered require that an appropriate LOINC code for the lab test be entered in the lab template used to record the test results. The LOINC code may be added to the lab test on the lab template after the results are received, but it is critical that LOINC code be entered prior to reporting for PQRS or Meaningful Use. An appropriate LOINC code must be entered in every lab template that may be used to record results for the test, whether the results are recorded manually or through a laboratory interface. If there are duplicate test items in a lab template, then an appropriate LOINC code must be entered for each of the test items. 12 Ref:

13 Please keep in mind that CMS makes changes to the PQRS measures and measure requirements each year, and that Meaningful Use measures are also subject to change. You should regularly verify that your lab templates contain the correct LOINC codes for current PQRS and Meaningful Use measures. Use the following procedure to add a LOINC code to a lab test in a lab template. 1. List Editor ( ) Clinical Lab Template 2. Search for and select the desired lab template, and select the Modify button. 3. Highlight the desired test entry in the list of test items. 4. In the Test Item area at the bottom of the window: a. Enter the LOINC Code for the selected test item. b. Select the Update button to update the selected test item. 5. Repeat step 4 for each test item used for a PQRS or Meaningful Use measure. 6. Select the OK button. 7. Repeat steps 2 through 6 for each lab template contain test items used for a PQRS or Meaningful Use measure. Ref:

14 Associate CVX Codes with Types of Vaccine Used for Measures Measures related to vaccinations require a CVX code associated with the type of vaccine. The CVX code is required for reporting and for submitting immunization records to registries. 1. List Editor ( ) Vaccines Types of Vaccine 2. Search for and select the desired type of vaccine, and select the Modify button. 3. Select the CVX Code used to submit immunization records to registries. SNOMED Codes SNOMED (Systematized Nomenclature of Medicine) codes are used to report on Meaningful Use measures, PQRS measures, and other government and non-government quality reporting programs. You may associate SNOMED codes with a number of different items in the database. Then, when providers chart diagnoses, procedures, and other items in patient visit notes, the associated SNOMED code is also recorded in the patient chart. The SNOMED code is then available for reporting on various programs. SNOMED Code for Discontinue Reason Discontinue reasons identify why a prescription has been discontinued for a patient. 1. List Editor ( ) Clinical Discontinue Reason 2. Search for and select the desired entry, and select the Modify button. 14 Ref:

15 3. In the SNOMED Concept ID field, select the appropriate SNOMED code. SNOMED Code for Diagnosis Code 1. List Editor ( ) Clinical Diagnosis Code 2. Search for and select the desired entry, and select the Modify button. 3. In the SNOMED Concept ID field, select the appropriate SNOMED code. SNOMED Codes for Medical Problem 1. List Editor ( ) Clinical Problem 2. Search for and select the desired entry, and select the Modify button. Ref:

16 3. In the SNOMED Concept ID field, select the appropriate SNOMED code. SNOMED Code for Procedure Codes 1. List Editor ( ) Clinical Procedure Code 2. Search for and select the desired entry, and select the Modify button. 3. Select the NDC/SNOMED tab. 4. In the SNOMED Concept ID field, select the appropriate SNOMED code. 16 Ref:

17 SNOMED Code for Questions You can associate SNOMED codes with history questions in the knowledge database. 1. List Editor ( ) KDB History Questions/Answers 2. Select the desired History Group. 3. Search for and select the desired Question entry, and select the Modify button. 4. In the SNOMED Concept ID field, select the appropriate SNOMED code. Ref:

18 SNOMED Code for KDB Answers You can associate SNOMED codes with history answers in the knowledge database. 1. List Editor ( ) KDB Problem 2. Select the desired History Group. 3. Search for and select the desired Question entry 4. Search for and select the desired Answer entry, and select the Modify button. 5. In the SNOMED Concept ID field, select the appropriate SNOMED code. Configure Education Forms Measures that require educating or counseling the patient can be fulfilled by providing one or more relevant patient education forms. To use education forms for meaningful use measures, you must first define the forms that are used for measures. This is done by defining the patient communication type on the form. You can associate education forms with age, gender, chief complaint, diagnosis, procedure, and/or observation item and results. Then when the specified conditions are met in a patient visit note, the application adds the associated education form to the Education Form slider so that the provider can easily give it to the patient. Define the Patient Communication Type for Education Forms Forms that will be used to satisfy a meaningful use requirement must have a patient communication type that associates the form with the education subject matter of the measure. 1. List Editor ( ) Clinical Education Form 2. Search for and select the desired education form, and select the Modify button. 18 Ref:

19 3. In the Patient Communication Type, select the type that is appropriate for the meaningful use measure education need addressed by this form. The patient communication types used for meaningful use measures are: Nutrition Overweight Physical Activity Underweight Smoking Cessation 4. Ignore the Related PQRI Measure field. This is no longer used. Associate Education Forms Required for Measures 1. List Editor ( ) Clinical Education Form Association 2. Select the New button. 3. Enter a Name for the set of education form associations. 4. Enter an ID or Notes if desired. Ref:

20 5. In the Patient Education Form field, search for and select the desired form. 6. Define the Demographic Factors for the education form. a. Define the age range by entering From and To ages and select the Units for the age (days, years, etc.). b. Select the Gender or genders. 7. If desired, enter the Recurrence period in which you want the form to be automatically available in the Education Form Slider. For example, Every 1 Years, or Every 6 Months. 8. Search for and select the item or items to which you want to associate the education form. You may associate the form with one or more: CC Symptom Diagnosis Procedure 9. In the Other Factors section, select the checkboxes for the additional factors related to the form. Smoker: If identified as a smoker in the patient history. Overweight: For patients between the ages of 18 and 65, Medicare defines overweight as having a BMI over 25. Underweight: For patients between the ages of 18 and 65, Medicare defines underweight as having a BMI under Define the Observation Items that the education form is associated with. a. Select the desired Observation Item. b. Select the operator for the Result. c. Enter the result Value. d. If an additional observation item is desired, select the radio button for And or Or and then repeat substeps a through c for the next observation item. 11. Repeat steps 5 through 10 for each education form. 20 Ref:

21 Enter Practice, Provider, Insurance Payer, and Patient Information The following information is required to calculate, monitor, and report on meaningful use compliance. Practice Information Practice information is entered in the Configure Practice Settings window. You must enter the following: Practice name Practice address, including state and ZIP code Service site addresses, including state and ZIP code Provider Information Provider information is entered in the Provider window. The following information must be entered in the provider record for each provider participating in the program. The provider s employer tax identification number (ETIN) and NPI numbers must be correctly entered in the Provider window s ID Values tab. The ETIN and NPI numbers must be entered through the system-defined claim format value types. If these IDs are entered through user- defined claim format value types, then the ID numbers will not report properly. First and last name Specialty Primary phone number NPI number ETIN number Patient Information Patient information is entered in the Patient and Account windows. The Department of Health and Human Services (HHS) requirements for meaningful use of health information technology includes the following demographic information. If you are participating in the meaningful use program, you should enter this information for all patients. First and last name Gender Date of birth Race Ref:

22 Ethnicity For both race and ethnicity, you may select the Not Provided option if the patient chooses not to provide specific information. If, however, you leave either of these fields empty, the patient will not meet the reporting requirements for any meaningful use measure that includes this demographic information. Language Patient Status for Test Patient The application includes a system-defined patient status for Test Patient. Use this patient status to identify patient records that are used for application testing or training, and are not actual patients. Patient records with this status are not included in meaningful use reporting and may be excluded from other reports that filter on patient status. Features Used for Meaningful Use The following features and functions have specific application to meaningful use measures and requirements. Your use of these features will depend on the measures on which you are reporting. Clinical Summaries Core Measure 13: Patient Clinical Summary requires that patients be provided with a clinical summary of each office visit within three days of the visit. The clinical summary must include diagnostic test results, problem list, medication list, and medication allergy list, and may include other information as appropriate. The continuity of care document (CCD) is by definition designated as clinical summary documents. Your administrative super user may have defined formatting models for document generation that are designed as a clinical summary document. When you generate a CCD or other designated clinical summary document for a specific patient visit within three days of that visit, the application records that you have met the clinical summary requirement for that visit. The clinical summary may be provided in paper or electronic format. A clinical summary that is provided in electronic format must be readable by people, not just by a computer application. 22 Ref:

23 Complete Chart Request Message Menu Set Measure 8: Summary of Care for Transitioning Patients is the percentage of patients to whom you provide a copy of their health information (including diagnostic test results, problem list, medication lists, medication allergies) within three business days of their request for this information. You can use a complete chart request message to enter, fulfill, and properly count these requests for the meaningful use measure. (Note: If you are using the optional Patient Portal, requests made through the portal are counted toward this measure.) A complete chart request message may be created as a task message or by selecting a complete chart print button from the toolbar of a patient-identifying window, such as Patient Demographics or Full Note Composer. Create a Complete Chart Request Task Message 1. Desktop New Message New Task Message 2. Select the Patient. 3. Select the Urgency level appropriate for the messages action. 4. In the Sub-Type field, select Complete Chart Print. 6. In the Due Date field, select a date no more than three business days from today. 7. In the Assign To field, select the user or users to receive the message. 8. Enter the text of the message in the Task field. Process a Complete Chart Request Task Message 1. Desktop Message Time Stamp or More Options icon ( ) Process Message 2. In the Message window, select the Print Patient Chart tab. The message displays the patient s name and the date the request was submitted. Ref:

24 3. The Chart Type field displays the complete chart definition requested by the user who created the request message. You may select another complete chart definition if desired. 4. Enter the Patient Record Disclosure information. a. In the Releasing Provider field, select the provider in your practice who is releasing the patient s information. The selected provider gets credit for core measure 12. If no provider is selected, then this release is credited to all providers in the practice. b. In the Reason field, select the Released to Patient reason. c. In the Recipient field, enter the patient s name. d. Select the Print Chart button. 5. In the Print window: a. Select the desired printer. This may be Microsoft XPS Document Writer, Adobe PDF, or other file-generation application or a physical printer. b. Select the OK button. c. If in substep a, you selected a file-generation application as the printer, browse to the location where the file is to be saved. 6. After the document has printed or the file saved, return to the Message window and select the Complete button. Preventative Follow Up Menu Set Measure 4: Reminders for Preventive and Follow-Up Care measures is the percentage of patients whom you remind of preventative care services. You can use clinical decision support rules to identify preventative care services, such as annual flu shots, mammograms, and PSA tests. (In the 2014 version, these are called.) The health maintenance rule must be flagged for preventative follow up, have an associated care team, and have recipients for messages regarding the rule in order for the rule to be used for reporting as preventive follow up. When a patient meets the criteria for the rule, a task message is sent to the defined recipient user so that a reminder can be sent to the patient. Once the user sends the reminder or contacts the patient, the user must complete the message in order for the reminder to be counted. The Meaningful Use report includes the number of patients meeting preventative follow up criteria and the number reminded, based on the completion of the health maintenance rule. Defining a Health Maintenance Rule for Reporting as Preventative Follow Up 1. List Editor ( ) Clinical Health Maintenance Rule 2. Search for and select the desired rule, and select the Modify button. 24 Ref:

25 3. Select the checkbox for Report as Preventative Followup. 4. Select the Care Team tab. 5. Select or verify the Care Team associated with the rule. 6. Select the Msg (message) Recipients for the rule. Messages for Preventive Follow Up When a patient meets the criteria for a health maintenance or clinical decision support rule that is used for preventative follow up, then a task message is sent to the defined recipient user so that a reminder can be sent to the patient. Once the user sends the reminder or otherwise contacts the patient, the user must complete the message in order for the reminder to be counted. The Meaningful Use report includes the number of patients meeting preventative follow up criteria and the number reminded, based on the completion of the health maintenance or clinical decision support rule. Recording the Review of Transfer or Referral Patient s Medications One of the HHS s meaningful use quality measures is whether you have reviewed the medications taken by a patient who has transferred to your care or who has been referred to you by another provider. In the visit note, you may indicate in the patient s medication history that this information has been reviewed. Ref:

26 1. Full Note Composer or other clinical note type window Hx tab 2. Select the Medication History category. 3. Select the Patient Has Been Seen By Another Provider checkbox. Measure Charting Details The following sections describe the charting or other tasks that must be performed for each meaningful use and quality measure. Meaningful use measures are based on your total patient population, not just Medicare patients. Meaningful use measures must be reported for individual providers. Reporting cannot be done for the practice as a whole. Each provider must report on: All the core measures, Any four measures from menu set measures 1 through 8, and Either menu set measure 9 or 10. If your state does not have an immunization registry and does not have an electronic repository for syndromic surveillance, you may qualify for an exemption for this part of the meaningful use requirements. Core Measures Core Measure 1: CPOE (Computerized Provider Order Entry) of Prescriptions More than 30 percent of unique patients with at least one medication in their medication list seen by the eligible provider or admitted to the eligible hospital s or CAH s inpatient or emergency department (POS 21 or 23) have at least one medication order entered using CPOE. 26 Ref:

27 To report on this measure, you must write the prescription through the SIG Writer window, and either print the prescription or submit it electronically through the Surescripts pharmacy clearinghouse. The prescription must be entered and submitted by an eligible health provider. Aprima PRM determines this by the user being listed as a provider. The prescription counts for the billing provider on the visit note, even if another provider enters and submits the prescription. To meet the measure s goal, you must print from the application or electronically prescribe at least one medication for more than 30 percent of your qualifying patients who have medications in their history during the reporting period. Core Measure 2: Drug/Drug and Drug/Allergy Interaction Checks Implement drug-drug and drug-allergy interaction checks. No data entry is required to report on this measure. However, the practice and individual providers must turn on drug-drug and drug-allergy screening. To meet the measure s goal, you must attest Yes that drug interaction checks are performed by the application and that you review the interaction information provided by the check. Core Measure 3: Up-to-Date Diagnoses List More than 80 percent of all unique patients seen by the eligible provider or admitted to the eligible hospital's or CAH's inpatient or emergency department (POS 21 or 23) have at least one entry or an indication that no problems are known for the patient recorded as structured data. To report on this measure, you must enter at least one diagnosis in the Dx tab of Full Note Composer or other clinical note type window, or have an entry in the Problem/Diagnosis History category of the Hx tab. If the patient has not been diagnosed with any particular problem or disease, then the problem entry in the Hx tab may be *Denies Any Medical Problems entry. To meet the measure s goal, you must properly enter a diagnosis for more than 80 percent of your qualifying patients seen during the reporting period. Core Measure 4: Electronic Prescribing (erx) Permissible Prescriptions More than 40 percent of all permissible prescriptions written by the eligible provider are transmitted electronically using certified EHR technology. Ref:

28 To report on this measure, you must write the prescription through the SIG Writer window, and submit the prescription electronically through the Surescripts pharmacy clearinghouse. Prescriptions sent through Surescripts to fax-only pharmacies meet the requirements for this measure. Prescriptions which are faxed to a pharmacy using a fax service do not meet the requirements for this measure. To meet the measure s goal, you must electronically prescribe more than 40 percent of the prescriptions written during the reporting period for qualifying patients. This measure applies only to prescriptions for medications which may be electronically prescribed; it does not apply to prescriptions for controlled substances. Prescriptions for controlled substances are not counted in the numerator or denominator for this measure. Complex prescriptions are not counted in the numerator because the application cannot submit them electronically, but are counted in the denominator for this measure because the medication is eligible for electronic prescribing. The denominator for this measure counts all new prescriptions written, whether printed or electronically submitted. The only exception to this is prescriptions for controlled substances which do not qualify for this measure, and so are not counted. The numerator counts all new prescriptions written and electronically submitted. The numerator only counts refilled prescriptions when initiated by the provider within Full Note Composer or other clinical note type window. Refilling the prescription in this way essentially sends a new prescription with prescription details to the pharmacy. Prescription refills processed through a refill message or electronic refill message are not counted in the numerator or denominator for this measure. Core Measure 5: Active Medication List Maintained More than 80 percent of all unique patients seen by the eligible provider or admitted to the eligible hospital s or CAH s inpatient or emergency department (POS 21 or 23) have at least one entry (or an indication that the patient is not currently prescribed any medication) recorded as structured data. To report on this measure, you must either: Enter prescriptions through the SIG Writer window and print or electronically submit the prescriptions, or Have a medication entry in the Medication History category of the on the Hx tab of Full Note Composer or other clinical note type window, or Select the Patient Takes No Medications checkbox in the Medication History category on the Hx tab of Full Note Composer or other clinical note type window. To meet the measure s goal, you must enter prescriptions or indicate no medications taken for more than 80 percent of your qualifying patients seen during the reporting period. 28 Ref:

29 Core Measure 6: Active Allergy List Maintained More than 80 percent of all unique patients seen by the eligible provider or admitted to the eligible hospital s or CAH s inpatient or emergency department (POS 21 or 23) have at least one entry (or an indication that the patient has no known medication allergies) recorded as structured data. To report on this measure, you must either enter allergy information in the Drug Allergy categories on the Hx tab of Full Note Composer or other clinical note type window, or select the No Known Allergies entry in the Drug Allergy category. Please note that food and environmental allergy information is not used for reporting purposes. Only drug allergy information is used for this purpose. To meet the measure s goal, you must enter drug allergy information or indicate no known drug allergies for more than 80 percent of your qualifying patients seen during the reporting period. Core Measure 7: All Required Demographic Information More than 50 percent of all unique patients seen by the eligible provider or admitted to the eligible hospital's or CAH's inpatient or emergency department (POS 21 or 23) have demographics recorded as structured data. To report on this measure, you must enter the patient s first and last name, date of birth, gender, language, race, and ethnicity in the Patient window. To meet the measure s goal, you must enter all the required demographics data for more than 50 percent of your qualifying patients seen during the reporting period. Note: If you are using a third-party practice management system and are entering patient information in that system, you must confirm that all the required demographic information is entered in the Aprima PRM Patient window. Some third-party practice management systems do not allow you to enter language, race, and ethnicity. Also, even if the third-party practice management systems does allow language, race, and ethnicity to be entered, the interface between your third-party practice management system and Aprima PRM may not include these items. In either of these cases, you will need to edit the patient record once it has been created in Aprima PRM. Core Measure 8: All Required Vitals More than 50 percent of all unique patients age 2 and over seen by the eligible provider or admitted to eligible hospital s or CAH s inpatient or emergency department (POS 21 or 23), height, weight and blood pressure are recorded as structured data. Ref:

30 To report on this measure, you must enter the patient s height, weight, and blood pressure in the Vitals tab of Full Note Composer or other clinical note type window. To meet the measure s goal, you must enter the required vitals data for more than 50 percent of your qualifying patients seen during the reporting period. Although the information is required per patient, not per visit, the height, weight and blood pressure information must be entered in at least one visit note during the reporting period. Core Measure 9: Smoking Status More than 50 percent of all unique patients 13 years old or older seen by the eligible provider or admitted to the eligible hospital s or CAH s inpatient or emergency department (POS 21 or 23) have smoking status recorded as structured data. To report on this measure, you must enter the patient s use or non-use of tobacco in the Hx tab, Social History category, in Full Note Composer or other clinical note type window. The tobacco history answer selected must be associated with a valid an appropriate SNOMED code in order to qualify. The following system-defined tobacco history answers are associated with the correct SNOMED codes. Current every day smoker Current some days smoker Former smoker Never smoker Smoker, current status unknown Unknown if ever smoked Heavy tobacco smoker Light tobacco smoker Has never smoked or chewed tobacco Currently uses smokeless tobacco To meet the measure s goal, you must enter the tobacco use information for more than 50 percent of your qualifying patients seen during the reporting period. Core Measure 10: CMS Quality Measures Reported Report ambulatory clinical quality measures to CMS. 30 Ref:

31 To meet this measure s goal, you must report on the required CMS clinical quality measures as explained in the Clinical Quality Measures section of this document. Then you attest Yes that you have properly reported the data for the CMS quality measures. It is recommend that you print the ARRA Quality Measure report, and keep the report with your meaningful use documentation. Core Measure 11: Clinical Decision Support Implement one clinical decision support rule relevant to specialty or high clinical priority along with the ability to track compliance with that rule. No data entry is required to report on this measure. You must create and activate relevant health maintenance rules for your practice or individual care teams. You need a rule that prompts the user to perform a specific procedure; for example, annual exam, based on the patient s medical history. To meet the measure s goal, you must attest Yes that you properly used health maintenance or clinical decision support rules for clinical decision support. It is recommended that you print a screen capture of your health maintenance or clinical decision support rule, and keep this with your meaningful use documentation. Core Measure 12: Electronic Patient Health Information More than 50 percent of all patients of the eligible provider or the inpatient or emergency departments of the eligible hospital or CAH (POS 21 or 23) who request an electronic copy of their health information are provided it within 3 business days. To report on this measure, you must generate a complete chart document for the patient. The generated document must contain the patient s diagnostic test results, problem list (diagnoses), medication list, and medication allergy list, and other information as appropriate. If you can generate the document immediately, then do so using the instructions below. If you cannot generate the document immediately, then you should create a complete chart request message, which starts the timing on the request. The recipient of the message must then generate an electronic file of a clinical summary document in human-readable form and give the file to the patient within the three business days of the request. Ref:

32 To generate the document immediately, you must a complete chart print button defined on either the Patient Demographics, Full Note Composer, One Page Summary, or Review Past Notes windows. Then: 1. Select the complete chart print button to print the document. 2. Enter the Patient Record Disclosure information: a. In the Releasing Provider field, select the provider in your practice who is releasing the patient s information. This is the provider who gets credits for core measure 12. If no provider is selected, then this release is credited to all providers in the practice. b. In the Reason field, select Released to Patient. c. In the Recipient field, enter the patient s name. 3. In the Print window, select a file-generation printer, such as Microsoft XPS Document Writer, or Adobe PDF, and select the location where the file is to be saved. 4. Copy the file to a CD or other device and give it to the patient. To create a task message from which to generate the document: 1. Create a complete chart request message for the patient. A complete chart request message may be created as a task message or by selecting a complete chart print button from the toolbar of a patient-identifying window, such as Patient Demographics or Full Note Composer. 2. The complete chart request message recipient must then generate the document and complete the message within three days. a. The Chart Type field displays the complete chart definition requested by the user who created the request message. You may select another complete chart definition if desired. b. Enter the Patient Record Disclosure information. In the Releasing Provider field, select the provider in your practice who is releasing the patient s information. This is the provider who gets credits for core measure 12. If no provider is selected, then this release is credited to all providers in the practice. In the Reason field, select Released to Patient. In the Recipient field, enter the patient s name. c. In the Print window, select a file-generation printer, such as Microsoft XPS Document Writer, or Adobe PDF, and select the location where the file is to be saved. d. After the file has saved, return to the Message window and select the Complete button. 3. Copy the file to a CD or other device and give it to the patient. 32 Ref:

33 If you are using patient self-service functionality through the Aprima Portal, which enables patients to access information through a secure website, then you may use the kiosk or portal to meet this requirement. To do this, you must select the Allow Patients to View Complete Chart option on the Portal Configuration tab of the Configure Practice Settings window. When you do this, you will select the document formatting template to be used for all clinical summaries made available to patients through the portal. Then when a patient selects the View Complete Medical Chart option from the Portal, the request and the satisfaction of request are recorded in the application at this time. To meet the measure s goal, you must generate clinical summary documents or make them available through the kiosk or Portal for more than 50 percent of your qualifying patients who request such a document during the reporting period. Core Measure 13: Patient Clinical Summary Clinical summaries provided to patients for more than 50 percent of all office visits within 3 business days. To report on this measure, you must generate a document using a document formatting template that is designated as a qualifying clinical summary, and either print it and give it to the patient or give the patient an electronic file of the clinical summary document within 3 business days (whether or not the patient requests this information). To qualify as a clinical summary, the document must include diagnostic test results, problem list (diagnoses), medication list, and medication allergy list, and may include other information as appropriate. There are several ways you can meet this measure s requirement. Print the visit checkout plan at the conclusion of the visit, and give the document or file to the patient. The system-defined Checkout Plan formatting model is defined as a clinical summary, and is the default checkout plan document. You can select another formatting model for the checkout plan on the User Settings window. Use the document generation functionality to print a summary document or generate of a file of the summary document within three days of the patient s visit, and give the document or file to the patient. If your practice is using the Aprima Portal, which enables patients to access information through a secure website, then you may use the portal to meet this requirement. To do this, you must select the Allow Patients to View Clinical Summary option on the Portal Configuration tab of the Configure Practice Settings window. When you do this, you will select the document formatting template to be used for all clinical summaries made available to patients through the portal. Then you must create a user ID and password for the patient. To meet the measure s goal, you must either print the summary or create a file of the summary and give it to patients or make the summary available to patients through the portal for more than 50 percent of your qualifying patients visits during the reporting period. Ref:

34 Core Measure 14: Electronic PHI Exchange Capability to exchange key clinical information (for example, problem list, medication list, medication allergies, and diagnostic test results), among providers of care and patient authorized entities electronically. The Centers for Medicare and Medicaid Services (CMS) have announced that in calendar year 2013 it is not necessary for providers to report on Core Measure 14: Electronic PHI Exchange. This applies to all providers reporting for Meaningful Use Stage 1 for this year. CMS determined that because the requirements of this measure were difficult to understand, they will replace it with a more robust requirement for electronic health information exchange as part of the Stage 2 measure which will take effect in The CMS announcement is available from their website at Aprima recommends that you print the CMS announcement and keep it with your Meaningful Use attestation documents. Core Measure 15: Security Risk Analysis Protect electronic health information created or maintained by the certified EHR technology through the implementation of appropriate technical capabilities. No data entry is required to report on this measure. To meet the measure s goal, you must attest Yes to having conducted or reviewed a security risk analysis in accordance with the requirements under 45 CFR (a)(1) and implemented security updates as necessary and corrected identified security deficiencies as part of its risk management process. Keep a copy of the security risk analysis report and documentation of security updates implemented as a result of the analysis with your meaningful use documentation. This may be needed in case of an audit. 34 Ref:

35 Menu Set Measures Menu Set Measure 1: Implement Drug Formulary Checks The eligible provider has enabled this functionality and has access to at least one internal or external formulary for the entire EHR reporting period. No data entry is required to report on this measure. Providers must be enrolled with Surescripts, and you must enable drug formulary downloads. To meet the measure s goal, you must attest Yes that the application makes formulary information available through the Surescripts pharmacy clearinghouse, and that you review the information available for patients. Menu Set Measure 2: Clinical Lab Test Results More than 40% of all clinical lab tests results ordered by the eligible provider or by an authorized provider of the eligible hospital or CAH for patients admitted to its inpatient or emergency department (POS 21 or 23) during the EHR reporting period whose results are either in a positive/negative or numerical format are incorporated in certified EHR technology as structured data. To report on this measure, you must order the desired lab test using the appropriate procedure code, and then either enter the test results or receive them through an interface and give them a status of Resulted or Approved. The test results not received through an interface must be entered as discrete, quantifiable data. Enter the results in the Patients Results window using a lab template enabling you to enter the result values in a positive/negative or numerical format. To meet the measure s goal, you must receive through an interface or properly enter lab test results for more than 40 percent of the clinical lab test ordered for qualifying patients seen during the reporting period. (Please note that simply attaching the scanned lab report does not meet this requirement.) Menu Set Measure 3: Generate Patient Lists Generate lists of patients by specific conditions to use for quality improvement, reduction of disparities, research, or outreach. Ref:

36 No data entry is required to report on this measure. However, you must enter problems or diagnoses in patients medical history or in patient visit notes in order to have the data needed for the report. To meet the measure s goal, you must attest Yes that you have generated at least one report listing the eligible provider s qualifying patients with a specific condition. This can be done using any system-defined or custom report that associates patients with a specific condition. System-defined reports that can be used for this include, but are not limited to, the Quality Report and the Patients by Diagnosis report. It is recommended that you print the report, and keep it with your meaningful use documentation. Menu Set Measure 4: Reminders for Preventive and Follow-Up Care More than 20% of all unique patients 65 years or older or 5 years old or younger were sent an appropriate reminder for preventive or follow-up care during the EHR reporting period. To report on this measure, you must create and activate relevant health maintenance rules, such as annual flu shots, vaccinations, mammograms, and PSA tests. These health maintenance or clinical decision support rules must be defined as preventative follow up. This is done by selecting the Report as Preventative Followup checkbox on the Health Maintenance Rule window. These health maintenance or clinical decision support rules must also have defined recipients of messages notifying users that the rule is due for a particular patient. Message recipients are defined by care team on the Health Maintenance Rule window s or Clinical Decision Support window s Care Team tab. When a patient meets the criteria for the rule, a message is sent to the defined recipient user so that a reminder can be sent to the patient. Once the user sends the reminder or contacts the patient, the user must complete the message in order for the reminder to be counted. The Meaningful Use report includes the number of patients meeting preventative follow up criteria and the number reminded, based on the completion of the health maintenance or clinical decision support rule. To meet the measure s goal, you must complete preventive follow-up messages for more than 20 percent of your qualifying patients seen during the reporting period. Important Note: Because of an issue within the application, recurring health maintenance rules that were created and run in 2012 and for which message were created and completed, are not being correctly counted when messages are created and completed in Therefore, to report on this measure for 2013, you must review your Meaningful Use Dashboard or report to determine if this has negatively affected you (that is, you have less than 20% for this measure). If are less than 20%, then you must create a new health maintenance rule or rules and create and complete the messages for those rules before December 31, Ref:

37 Menu Set Measure 5: Electronic Access to Patient s Health Information Provide patients with timely electronic access to their health information (including lab results, problem list, medication lists, and allergies) within 4 business days of the information being available to the EP. More than 10% of all unique patients seen by the eligible provider are 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 provider s discretion to withhold certain information. To report on this measure, you must provide patient self-service functionality through the Aprima Portal, which enables patients to access information through a secure website. To meet the measure s goal, you must create user IDs and passwords for more than 10 percent of your qualifying patients seen during the reporting period. Menu Set Measure 6: Education Resources More than 10% of all unique patients seen by the eligible provider or admitted to the eligible hospital s or CAH s inpatient or emergency department (POS 21 or 23) during the EHR reporting period are provided patient-specific education resources. To report on this measure, you must attach an appropriate educational form to the visit note and print it for the patient. This is done from the Education Form slider in Full Note Composer or other clinical note type window or during the checkout process. To meet the measure s goal, you must provide educational forms to more than 10 percent of your qualifying patients seen during the reporting period. Please note that the Patient Medication Summary report does not count as an education form, even though it appears in the Education Forms slider. Menu Set Measure 7: Medication Reconciliation The eligible provider, eligible hospital or CAH performs medication reconciliation for more than 50% of transitions of care in which the patient is transitioned into the care of the eligible provider or admitted to the eligible hospital s or CAH s inpatient or emergency department (POS 21 or 23). To report on this measure, you must first identify the patient as transitioning by selecting the Patient has been seen by another provider checkbox in the Medication History category of the Hx tab of Full Note Composer or other clinical note type window. Ref:

38 Then, you must perform the medication reconciliation. There are several ways that you can do this. You can reconcile that patient s medication history in the application with a document listing the patient s medication. You must then scan the document, and attach it to the visit note. You can download the patient s electronic medication history, import the electronic medication history, and reconcile that medication history with the medication history in your patient record. To download the medication history, providers must be enrolled with the Surescripts pharmacy clearinghouse. Downloading the electronic medication history may be done automatically for appointments scheduled in advance, or may be done on demand from the Appointment window, Patient Demographics window, or Full Note Composer or other clinical note type window. Importing and reconciling the electronic medication history and the medication history in the patient record is done from the Import Medication History window. Then in the Hx tab of the patient visit note window, select the checkbox for Medication History. This checkbox will be automatically selected if you made any changes while reconciling the electronic medication history. To meet the measure s goal, you must reconcile the medication history for more than 50 percent of the qualifying patients who transition into your care during the reporting period. Menu Set Measure 8: Summary of Care for Transitioning Patients The eligible provider, eligible hospital or CAH who transitions or refers their patient to another setting of care or provider of care provides a summary of care record for more than 50% of transitions of care and referrals. To report on this measure, you must first identify the patient as a transition-of-care patient. Then you must generate a clinical summary document for the visit or a continuity of care document (CCD) for the patient, and give the document or file to the receiving physician or medical services provider. To identify the patient as a transition-of-care patient, you must create a referral for the patient. You can do this either through the Patient/Provider Tracking window or the Referral Order dynamic procedure note. The clinical summary or CCD document that you generate must contain the patient s diagnostic test results, problem list (diagnoses), medication list, and medication allergy list, and may include other information as appropriate, for the transitioning patient. When you generate the document, you must enter the reason for creating the document as patient transfer or referral and enter the receiving physician or medical services provider as the recipient. 38 Ref:

39 To meet the measure s goal, you must generate clinical summary or CCD documents for more than 50 percent of your qualifying patients who are transitioned to or referred to another physician or medical services provider during the reporting period. Menu Set Measure 9: Immunization Registries or Immunization Information Systems Capability to submit electronic data to immunization registries or immunization information systems and actual submission according to applicable law and practice. No data entry is required to report on this measure. However, you must perform a test sending data to your local registry. To do this, you must first: 1. Contact your state or local immunization registry to determine whether they can accept HL7 immunization files, and if so, whether this requires an interface or if they have another means for receiving the files. If the agency does accept HL7 files, then continue to step 2. If the agency does not accept HL7 files, then you cannot use this measure as part of your meaningful use reporting. 2. Contact Support to set up the interface to the registry. See the Reporting to an Immunization Registry Test Process section below for instructions on performing this test after your registry interface is in place. Please note that this test only needs to be performed for one provider to be valid for the practice as a whole. It does not have to be done for each individual provider. After performing the test, you must attest Yes that you have generated at least one vaccination report, submitted it to an immunization registry or immunization information system, and verified that the submission was successful during the reporting period. If your test submission is successful, then you must submit actual patient information to the registry during the reporting period. Menu Set Measure 10: Syndromic Surveillance Data Submission Capability to submit electronic syndromic surveillance data to public health agencies and actual submission according to applicable law and practice. No data entry is required to report on this measure. However, you must enter problems or diagnoses in patients medical history or in patient visit notes in order to have the data needed for the report. To meet the measure s goal, you must attest Yes that you have generated at least one syndromic surveillance data report, submitted it to a public health agency, and verified that the submission was successful during the reporting period. Ref:

40 There are several steps that must be taken to be able to generate the reports and submit them to a public health agency. Please note that this test only needs to be performed for one provider to be valid for the practice as a whole. It does not have to be done for each individual provider. 1. Contact your state or local public health agency to determine whether they can accept HL7 syndromic surveillance files, and if so, whether this requires an interface or if they have another means for receiving the files. If the agency does accept HL7 syndromic surveillance files, then continue to step 2. If the agency does not accept HL7 syndromic surveillance files, then you cannot use this measure as part of your meaningful use reporting. 2. Activate the job schedules for the following jobs. If you have an HL7 interface for, such as for a lab interface or a device, then these job schedules may already be active. Interface Message Listener Interface Message Processor Interface Message Sender 3. Configure the ExportPatientDiagnosisData HL7 partner to define a folder in which the HL7 files will be created. 4. Generate the Export Patient Diagnosis Data report for the diagnosis of interest. This generates a file for each patient with the selected diagnosis, and stores the file in the folder specified in your ExportPatientDiagnosisData HL7 partner record. 5. Once the files are created, use the method specified by your public health agency to submit the files. Clinical Quality Measures The following sections describe the charting or other tasks that must be performed for each CMS clinical quality measure. These measures are endorsed by the National Quality Forum. They are sometimes referred to as ARRA quality measures. To fulfill the requirements of Meaningful Use Core Measure 10: CMS Quality Measures Reported, you must report on three of the core or alternate core measures. You must also report on three of the remaining measures. The core measures are 0013, 0028, and The alternate core measures are 0024, 0038, and These measures apply to all patients, not just Medicare patients. These measures do not have goals; that is, you do not have to perform the measure s procedure on a certain percentage of patients. You only have to report your percentage for each measure. Quality measures, like the meaningful use measures, must be reported for individual providers. Reporting cannot be done for the practice as a whole. 40 Ref:

41 Measure 0013 Hypertension: Blood Pressure Measurement Percentage of patient visits for patients aged 18 years and older with a diagnosis of hypertension who have been seen for at least 2 office visits, with blood pressure (BP) recorded. To report on this measure, you must enter the patient s blood pressure in the Vitals tab of a patient visit note window. You must document the visit using one of the following CPT encounter codes. Office outpatient visit: 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 visit: 99304, 99305, 99306, 99307, 99308, 99309, You must document patients with hypertension using one of the following ICD-9 diagnosis codes: 401.0, 401.1, 401.9, , , , , , , , , , , , , , , , , , , , , , , , or Measure 0028 Preventive Care and Screening: Tobacco Use Assessment Percentage of patients aged 18 years or older who have been seen for at least 2 office visits, who were queried about tobacco use one or more times within 24 months. Note that some specific encounter types require only one office visit. To report on this measure, you must enter the patient s use or non-use of tobacco in the Hx tab, Social History category, in the patient visit note. The tobacco use history answer must be associated with one a valid SNOMED code. You must document the visit using one of the following CPT encounter codes: Encounter Health and Behavior Assessment:96150, Encounter Occupational Therapy:97003, Encounter Office Visit:99201, 99202, 99203, 99204, 99205, 99212, 99213, 99214, Encounter Preventive Med Group Counseling:99411, Encounter Preventive Med Other Services:99420, Encounter Preventive Med Services 18 and Older:99385, 99386, 99387, 99395, 99396, Encounter Preventive Med-Individual counseling:99401, 99402, 99403, Ref:

42 Encounter Psychiatric & Psychologic:90801, 90802, 90804, 90805, 90806, 90807, 90808, 90809, 90810, 90811, 90812, 90813, 90814, 90815, 90845, Valid SNOMED codes for the history answer are: , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , Measure 0028 Preventive Care and Screening: Tobacco Cessation Intervention Percentage of patients aged 18 years and older identified as tobacco users within the past 24 months and have been seen for at least 2 office visits, who received cessation intervention. Note that some specific encounter types require only one office visit. To report on this measure, you must enter the patient s use of tobacco in the Hx tab, Social History category, in the patient visit note. When the patient is a tobacco user, then you must attach the appropriate smoking information educational form to the visit note and print it for the patient. You must document the visit using one of the following CPT encounter codes: Encounter Health and Behavior Assessment:96150, Encounter Occupational Therapy:97003, Encounter Office Visit:99201, 99202, 99203, 99204, 99205, 99212, 99213, 99214, Encounter Preventive Med Group Counseling:99411, Encounter Preventive Med Other Services:99420, Encounter Preventive Med Services 18 and Older:99385, 99386, 99387, 99395, 99396, Encounter Preventive Med-Individual counseling:99401, 99402, 99403, Encounter Psychiatric & Psychologic:90801, 90802, 90804, 90805, 90806, 90807, 90808, 90809, 90810, 90811, 90812, 90813, 90814, 90815, 90845, To document cessation counseling, use either a valid CPT or SNOMED code. CPT codes: or SNOMED codes: , , , , , , , , , , Ref:

43 To report the cessation medication, write the prescription through the SIG Writer print the prescription or send it electronically. Measure 0421 Adult Weight Screening and Follow-Up (Age 18 to 64) Percentage of patients aged 18 years of age and older with a calculated BMI in the past six months or during the current visit documented in the medical record AND if the most recent BMI is outside parameters, a follow-up plan is documented. Patients are excluded if they are pregnant, have a terminal illness, or if a physical exam was not done during the visit. You must record the patient body mass index (BMI) by recording height and weight in the Vitals tab of a patient visit note window. For patients who are less than 65: If the BMI is 18.5 to 24.99, then nothing further is needed. If the BMI is less than 18.5 or is 25 or greater, then you must define a follow-up plan. For patients who are 65 or older: If the BMI is 22 to 29.99, then nothing further is needed. If the BMI is less than 22 or is 30 or greater, then you must define a follow-up plan. You must document the visit using one of the following CPT encounter codes: 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, or When a follow-up plan is needed, you must document it with one of the following codes. CPT codes: 43644, 43645, 43770, 43771, 43772, 43773, 43774, 43842, 43843, 43845, 43846, 43847, 43848, 97804, 98961, 98962, or HCPCS: G8417, S9449, S9451, S9452, S9470 ICD-9 code: V65.3, V65.41 SNOMED: , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , Ref:

44 , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , Measure 0024 Weight Assessment and Counseling for Children and Adolescents The percentage of patients 2 17 years of age who had an outpatient visit with a PCP or OB/GYN and who had evidence of BMI percentile documentation, counseling for nutrition and counseling for physical activity during the measurement year. Patients who are pregnant are not included. This measure is reported separately for BMI, nutrition counseling, and physical activity counseling for each of the following age groups: 2 years to 16 years 2 years to 10 years 11 years to 16 years You must record the patient body mass index (BMI) by recording height and weight in the Vitals tab of a patient visit note window. You may also document nutrition and physical activity counseling. You must document the visit using one of the following CPT encounter codes: 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, or To document nutrition counseling, you may use the 97802, 97803, or CPT code or the V65.3 ICD-9 code. 44 Ref:

45 To document physical activity counseling, you may use the S9451 HCPCS code or the V65.41 ICD-9 code. Measure 0038 Childhood Immunization Status The percentage of children 2 years of age who had four diphtheria, tetanus and acellular pertussis (DTaP); three polio (IPV); one measles, mumps and rubella (MMR); two H influenza type B (HiB); three hepatitis B (Hep B), one chicken pox (VZV); four pneumococcal conjugate (PCV); two hepatitis A (Hep A); two or three rotavirus (RV); and two influenza (flu) vaccines by their second birthday. The measure calculates a rate for each vaccine and two separate combination rates. Patients who have a documented allergy to the vaccine or have been diagnosed with the disease are not included. To report on this measure, you must record the patient s vaccinations using the vaccine administration record. The antigen must be associated with the vaccine and type of vaccine used to chart the vaccination. You must document the visit using one of the following CPT encounter codes: 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, or Or you may use one of the following ICD-9 codes: V70.0, V70.3, V70.5, V70.6, V70.8, or V70.9. Measure 0041 Preventive Care and Screening: Influenza Immunization for Patients > 50 Years Old Percentage of patients aged 50 years and older who received an influenza immunization during the flu season (September through February). Patients who have a documented allergy to the vaccine. Patients may also be excluded if they decline the vaccine or if there is a patient, medical, or system reason for not giving the vaccine. To report on this measure, you must record the patient s vaccinations using the vaccine administration record. The antigen must be associated with the vaccine and type of vaccine used to chart the vaccination. You must document the visit using one of the following CPT encounter codes: Encounter Nursing Discharge:99315, Encounter Nursing Facility:99304, 99305, 99306, 99307, 99308, 99309, Ref:

46 Encounter Outpatient: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, Encounter Prev Med 40 and Older:99386, 99387, 99396, Encounter Prev Med Group Counseling:99411, Encounter Prev Med Other Services:99420, Encounter Prev Med-Individual counseling:99401, 99402, 99403, Please note that a correct CVX code is required on the type of vaccine that is associated with the vaccine used to fulfill this measure. Measure 0018 Controlling High Blood Pressure The percentage of patients years of age who had a diagnosis of hypertension and whose BP was adequately controlled during the measurement year. This measure excludes patients who are pregnant or have a diagnosis of end-stage renal disease (ESRD). To report on this measure, you must enter the patient s blood pressure in the Vitals tab of a patient visit note window. You must document the visit using one of the following CPT encounter codes: 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, or You must document patients with hypertension using one of the following ICD-9 diagnosis codes: 401, 401.0, 401.1, or Measure 0027 Smoking and Tobacco Use Cessation The percentage of patients 18 years of age and older who were current smokers or tobacco users, who were seen by a practitioner during the measurement year and who received advice to quit smoking or tobacco use or whose practitioner recommended or discussed smoking or tobacco use cessation medications, methods or strategies. To report on this measure, you must enter the patient s use or non-use of tobacco in the Hx tab, Social History category, in the patient visit note. 46 Ref:

47 You must document the visit using one of the following CPT encounter codes: 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, or To document cessation counseling, use either of these CPT codes: or Measure 0031 Breast Cancer Screening The percentage of women years of age who had a mammogram to screen for breast cancer. To report on this measure, you must perform a mammogram or order a mammogram and enter the results of the test. You must document the visit using one of the following CPT encounter codes: 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, or To document the test and its results, order the mammogram using one of the following codes. Enter the code on the SP tab if you performed the test. Enter the code on the SO tab if you are ordering the test. CPT: 76090, 76091, 76092, 77055, 77056, HCPCS: G0202, G0204, G0206 The test results must either be received through an interface or entered in the Patient Results window. The results must be given a status of Resulted or Approved. Measure 0032 Cervical Cancer Screening The percentage of women years of age who received one or more Pap tests to screen for cervical cancer. To report on this measure, you must perform a Pap test or order the Pap test and enter the results of the test. You must document the visit using one of the following CPT encounter codes: 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, or Ref:

48 To document the test and its results, order the using one of the following codes. Enter the code on the SP tab if you performed the test. Enter the code on the SO tab if you are ordering the test. CPT: 88141, 88142, 88143, 88147, 88148, 88150, 88152, 88153, 88154, 88155, 88164, 88165, 88166, 88167, 88174, HCPCS: G0123, G0124, G0141, G0143, G0144, G0145, G0147, G0148, P3000, P3001, Q0091 ICD-9-CM: 91.46, V72.32 The test results must either be received through an interface or entered in the Patient Results window. The results must be given a status of Resulted or Approved. Measure 0034 Colorectal Cancer Screening The percentage of adults years of age who had appropriate screening for colorectal cancer. The population for this measure includes all qualifying patients who have a patient visit in the measurement year or the previous year. Patients who have an active, inactive, or resolved diagnosis of colorectal cancer are excluded from this measure. To report on this measure, you must either perform the test or order the test and enter the results or enter the appropriate procedure code and modifier indicating why the test was not performed. You must document the visit using one of the following CPT encounter codes: CPT: 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, or ICD-9-CM: V70.0, V70.3, V70.5, V70.6, V70.8, V70.9 To document the test and its results, order one of the following tests using one of the identified codes. Enter the code on the SP tab if you performed the test. Enter the code on the SO tab if you are ordering the test. Colonoscopy CPT: 44388, 44389, 44390, 44391, 44392, 44393, 44394, 44397, 45355, 45378, 45379, 45380, 45381, 45382, 45383, 45384, 45385, 45386, 45387, 45391, HCPCS: G0105, G0121 ICD-9-CM: 45.22, 45.23, 45.25, 45.42, Ref:

49 Flexible Sigmoidoscopy CPT: 45330, 45331, 45332, 45333, 45334, 45335, 45337, 45338, 45339, 45340, 45341, 45342, HCPCS: G0104 ICD-9: FOBT CPT: 82270, HCPCS: G0328, G0394 ICD-9-CM: V76.51 Enter the screening results in the Patient Results window, and give them a status of Resulted or Approved. Measure 0043 Pneumonia Vaccination Status for Older Adults The percentage of patients 65 years of age and older who have ever received a pneumococcal vaccine. To report on this measure, you must record the patient s vaccinations using the vaccine administration record. The antigen must be associated with the vaccine and type of vaccine used to chart the vaccination. You must document the visit using one of the following CPT encounter codes: 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, or Or you may use one of these ICD-9 codes: V70.0, V70.3, V70.5, V70.6, V70.8, or V70.9. Measure 0047 Asthma Pharmacologic Therapy Percentage of patients aged 5 through 40 years with a diagnosis of mild, moderate, or severe persistent asthma who were prescribed either the preferred long term control medication (inhaled corticosteroid) or an acceptable alternative treatment. To report on this measure, you must write a prescription for a corticosteroid, inhaled or alternative asthma medication through the SIG Writer window or prescription refill message and print the prescription or send it electronically. You must document the visit using one of the following CPT encounter codes: 99201, 99202, 99203, 99204, 99205, 99212, 99213, 99214, 99215, 99241, 99242, 99243, 99244, or Ref:

50 Please note that a correct CVX code is required on the type of vaccine that is associated with the vaccine used to fulfill this measure. Measure 0055 Diabetes: Eye Exam The percentage of patients years of age with diabetes (type 1 or type 2) who had a retinal or dilated eye exam or a negative retinal exam (no evidence of retinopathy) by an eye care professional. To report on this measure, you must document the eye exam using one of the following CPT codes: 67028, 67030, 67031, 67036, 67038, 67039, 67040, 67041, 67042, 67043, 67101, 67105, 67107, 67108, 67110, 67112, 67113, 67121, 67141, 67145, 67208, 67210, 67218, 67220, 67221, 67227, 67228, 92002, 92004, 92012, 92014, 92018, 92019, 92225, 92226, 92230, 92235, 92240, 92250, or You must document the visit using one of the following CPT encounter codes: 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, or Or you may document the visit using one of the following ICD-9 codes: V70.0, V70.3, V70.5, V70.6, V70.8, or V70.9. Measure 0056 Diabetes: Foot Exam The percentage of patients aged years with diabetes (type 1 or type 2) who had a foot exam (visual inspection, sensory exam with monofilament, or pulse exam). To report on this measure, you must document the foot exam using either the 2028F or G0245 CPT code. You must document the visit using one of the following CPT encounter codes: 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, or Or you may document the visit using one of the following ICD-9 codes: V70.0, V70.3, V70.5, V70.6, V70.8, or V Ref:

51 Measure 0059 Diabetes: HbA1c Poor Control The percentage of patients years of age with diabetes (type 1 or type 2) who had HbA1c >9.0%. To report on this measure, you must perform an A1c test or order the test and either enter the test results or receive them through an interface and give them a status of Resulted or Approved. Document the test using CPT code or Enter the code on the SP tab if you performed the test. Enter the code on the SO tab if you are ordering the test. If the test was ordered, then either enter the test results or receive them through an interface and give them a status of Resulted or Approved. The A1c test results not received through an interface must be entered as discrete, quantifiable data. Enter the results in the Patients Results window using a lab template enabling you to enter the HGB A1c value. The lab template, whether for an interface or manual entry, must have an appropriate LOINC code entered for the A1c test item. If there are duplicate A1c test items in the template, then each must have the appropriate LOINC code. The LOINC code must be either , , or The LOINC code may be added to the lab template after the results are received. It is critical that LOINC code be entered prior to reporting for Meaningful Use. Use the following procedure to add a LOINC code to a lab template. 1. List Editor ( ) Clinical Lab Template 2. Search for and select the desired lab template, and select the Modify button. 3. Highlight the A1c entry in the list of test items. 4. In the Test Item area at the bottom of the window: a. Enter the LOINC Code for the A1c. b. Select the Update button to update the A1c test item. 5. Repeat step 4 for each A1c test item in the lab template. 6. Select the OK button. 7. Repeat steps 2 through 6 for each lab test containing an A1c test item. You must document the visit using one of the following CPT encounter codes: 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, or Or you may document the visit using one of the following ICD-9 codes: V70.0, V70.3, V70.5, V70.6, V70.8, or V70.9. Ref:

52 Measure 0061 Diabetes: Blood Pressure Management The percentage of patients years of age with diabetes (type 1 or type 2) who had BP <140/90 mmhg. To report on this measure, you must enter the patient s blood pressure in the Vitals tab of a patient visit note window. You must document the visit using one of the following CPT encounter codes: 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, or Or you may document the visit using one of the following ICD-9 codes: V70.0, V70.3, V70.5, V70.6, V70.8, or V70.9. Measure 0062 Diabetes: Urine Screening The percentage of patients years of age with diabetes (type 1 or type 2) who had a nephropathy screening test or evidence of nephropathy. To report on this measure, you must perform an nephropathy screening test, or order the test and enter the results, or enter a nephropathy diagnosis, or order a nephropathy-related procedure, or prescribe an angiotensin converting enzyme (ACE) inhibitor or an angiotensin receptor blocker (ARB). Document the nephropathy screening using CPT code 82042, 82043, 82044, or Enter the code on the SP tab if you performed the test. Enter the code on the SO tab if you are ordering the test. If the test was ordered, then either enter the test results or receive them through an interface and give them a status of Resulted or Approved. To report a nephropathy diagnosis, enter one of the following ICD-9 codes: 250.4, , , , , 403, 403.0, , , 403.1, , , 403.9, , , 404, 404.0, , , , , 404.1, , , , , 404.9, , , , , , , , 580, 580.0, 580.4, 580.8, , , 580.9, 581, 581.0, 581.1, 581.2, 581.3, 581.8, , , 581.9, 582, 582.0, 582.1, 582.2, 582.4, 582.8, , , 582.9, 583, 583.0, 583.1, 583.2, 583.4, 583.6, 583.7, 583.8, , , 583.9, 584, 584.5, 584.6, 584.7, 584.8, 584.9, 585, 585.1, 585.2, 585.3, 585.4, 585.5, 585.6, 585.9, 586, 587, 588, 588.0, 588.1, 588.8, , , 588.9, 753.0, 753.1, , , , , , , , , , 791.0, V42.0, V45.1, V45.11, V45.12, V56, V56.0, V56.1, V56.2, V56.3, V56.31, V56.32, or V Ref:

53 To order a nephropathy-related procedure, enter one of the following CPT codes on either the SP or SO tabs. If entered on the SO tab, then you must mark the order as Resulted. The valid CPT codes are: 36145, 36800, 36810, 36815, 36818, , 36831, 36832, 36833, 50300, 50320, 50340, 50360, 50365, 50370, 50380, 90920, 90921, 90924, 90925, 90935, 90937, 90940, 90945, 90947, 90957, 90958, 90959, 90960, 90961, 90962, 90965, 90966, 90969, 90970, 90989, 90993, 90997, 90999, or To report on this measure, you must write a prescription for an ACE inhibitor or ARB through the SIG Writer window or prescription refill message and print the prescription or send it electronically. You must document the visit using one of the following CPT encounter codes: 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, or Or you may document the visit using one of the following ICD-9 codes: V70.0, V70.3, V70.5, V70.6, V70.8, or V70.9. Measure 0064 Diabetes: LDL Management & Control (LDL Test) The percentage of patients years of age with diabetes (type 1 or type 2) who had LDL C <100mg/dL. To report on this measure, you must perform a lab test that includes LDL-C or order the test and enter the results. Document the test using CPT code 80061, 83700, 83701, 83704, or Enter the code on the SP tab if you performed the test. Enter the code on the SO tab if you are ordering the test. If the test was ordered, then either enter the test results or receive them through an interface and give them a status of Resulted or Approved. The test results not received through an interface must be entered as discrete, quantifiable data. Enter the results in the Patients Results window using a lab template enabling you to enter the LDL-C value. The lab template, whether for an interface or manual entry, must have an appropriate LOINC code entered for the LDL-C test item. If there are duplicate LDL-C test items in the template, then each must have the appropriate LOINC code. The LOINC code must be either , , , , , , , , or The LOINC code may be added to the lab template after the results are received. It is critical that LOINC code be entered prior to reporting for Meaningful Use. Use the following procedure to add a LOINC code to a lab template. 1. List Editor ( ) Clinical Lab Template 2. Search for and select the desired lab template, and select the Modify button. 3. Highlight the LDL-C entry in the list of test items. Ref:

54 4. In the Test Item area at the bottom of the window: a. Enter the LOINC Code for the LDL-C. b. Select the Update button to update the LDL-C test item. 5. Repeat step 4 for each LDL-C test item in the lab template. 6. Select the OK button. 7. Repeat steps 2 through 6 for each lab test containing an LDL-C test item. You must document the visit using one of the following CPT encounter codes: 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, or Or you may document the visit using one of the following ICD-9 codes: V70.0, V70.3, V70.5, V70.6, V70.8, or V70.9. Measure 0067 Coronary Artery Disease (CAD): Oral Antiplatelet Therapy Prescribed for Patients with CAD Percentage of patients aged 18 years and older with a diagnosis of CAD who were prescribed oral antiplatelet therapy. To report on this measure, you must write a prescription for oral antiplatelet therapy through the SIG Writer window or prescription refill message and print the prescription or send it electronically. You must document the visit using one of the following CPT encounter codes: Nursing Facility: :2010:99304, 99305, 99306, 99307, 99308, 99309, Outpatient: :2010:99201, 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, Measure 0575 Diabetes: HbA1c Control (<8%) The percentage of patients years of age with diabetes (type 1 or type 2) who had HbA1c <8.0%. To report on this measure, you must perform an A1c test or order the test and either enter the test results or receive them through an interface and give them a status of Resulted or Approved. Document the test using CPT code or Enter the code on the SP tab if you performed the test. Enter the code on the SO tab if you are ordering the test. 54 Ref:

55 If the test was ordered, then either enter the test results or receive them through an interface and give them a status of Resulted or Approved. The A1c test results not received through an interface must be entered as discrete, quantifiable data. Enter the results in the Patients Results window using a lab template enabling you to enter the HGB A1c value. The lab template, whether for an interface or manual entry, must have an appropriate LOINC code entered for the A1c test item. If there are duplicate A1c test items in the template, then each must have the appropriate LOINC code. The LOINC code must be either , , or The LOINC code may be added to the lab template after the results are received. It is critical that LOINC code be entered prior to reporting for Meaningful Use. Use the following procedure to add a LOINC code to a lab template. 1. List Editor ( ) Clinical Lab Template 2. Search for and select the desired lab template, and select the Modify button. 3. Highlight the A1c entry in the list of test items. 4. In the Test Item area at the bottom of the window: a. Enter the LOINC Code for the A1c. b. Select the Update button to update the A1c test item. 5. Repeat step 4 for each A1c test item in the lab template. 6. Select the OK button. 7. Repeat steps 2 through 6 for each lab test containing an A1c test item. You must document the visit using one of the following CPT encounter codes: 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, or Or you may document the visit using one of the following ICD-9 codes: V70.0, V70.3, V70.5, V70.6, V70.8, or V70.9. Certification Test Process Reporting to an Immunization Registry Test Process Use the following processes to test your ability to report information to an immunization registry. Please note that this test only needs to be performed for one provider to be valid for the practice as a whole. It does not have to be done for each individual provider. The test done has to been performed in each calendar year in order to report on this measure. Make screen prints of each part of this process, and retain them as part of your documentation for attestation. Ref:

56 To perform this process and attest for this measure, you must be registered with your state immunization registry. You must also know whether your state registry accepts an HL7 message through , or whether you must copy and paste the HL7 message into the registry s test system. Please note that this test uses the Hep-A vaccination. This vaccination is used for the test because it is one of the most commonly used vaccinations, and most customers have it on their vaccine administration record. If you do not, then you must modify the vaccine administration record to include it. If you prefer to use a different vaccination for the test, then make sure that you include the correct CVX code on the type of vaccine you want to use. Modify the Type of Vaccine to Include the CVX Code 1. List Editor ( ) Vaccines Type of Vaccine 2. Search for and select the HepA (Adult) entry, and select the Modify button. 3. In the CPT Code field, ensure that the code is selected. 4. In the CVX Code field, select Complete any other fields as needed. Create a Directory on the Server Create a directory on the server for your registry files. Make note of the directory path and name because it will be needed in some of the following tasks. Activate the HL7 Partner for the Registry You must active the HL7 partner record for the immunization registry to be used for the test. Once the HL7 partner record is activated, all vaccination information entered for patients will be sent to the registry. Therefore it is very important that you activate the HL7 partner immediately before entering the test vaccination information. Note: If the CIR Immunization Registry entry is active, you must inactivate this partner. 1. List Editor Interface Engine HL7 Partner 2. Select the Include Inactive Items checkbox, and select the Search button. 56 Ref:

57 3. Select the VXUV04 entry, and select the Modify button. 4. Deselect the Inactive checkbox in order to activate the partner record. 5. In the Send Msg Directory field, enter the path and directory name for registry files. (Created in the process above.) 6. Do not make any other changes. Chart a Vaccination for the Test Patient 1. Desktop Find Patient ( ) icon 2. Search for test patient Jane Zzdoe, and select the Name hyperlink. 3. In the Patient Demographics window, select New Full Note Composer 4. In the Visit Information window: a. Select the Billing and Rendering Providers for whom the test is being conducted. b. Select the Service Site for which the test is being conducted. c. Deselect the Require Superbill checkbox. d. Select the OK button. 5. In Full Note Composer, select the Dx tab. 6. Search for and select the V05.3 diagnosis code. 7. Select the SP tab. 8. Search for and select the procedure code for the HepA vaccination. 9. Select the Vaccinations ( ) icon. 10. In the Vaccination Record window: a. Enter the details for the HepA vaccination. Ref:

58 b. Select the OK button. 11. In Full Note Composer, select the OK button to save and close the note. 12. In the Visit Checkout window, select the Complete Note radio button, and select the OK button. The vaccination information will be sent to the registry the next time the Interface Message Processor job runs. The standard configuration is for the job to run once per minute. 13. Close the Patient Demographics window. Copy the HL7 Message Once you have entered the vaccination information and saved and closed the patient visit note, you must confirm that the information was received by the vaccine registry. 1. Desktop Interface Data Details 2. In the HL7 Partner field, enter VXUV Select the Logged Between field, press the F4 key to enter today s date. 4. In the And field, press the F4 key to enter today s date. This will search for only messages sent on the date of your test. 5. Select the Search button. 6. Confirm the HL7 message has been generated, and confirm the status of the transmission. 7. Select the VXUV04 link in the Partner column to access the message. 8. Press the PrtScrn key to take a screen shot of the Interface Data Center window. 9. Select the OK button to close the window. 10. Paste the screen print into a Microsoft Word document or other file, and save and print the document. Keep this document and others produced in the test in your meaningful use file. 58 Ref:

59 Locate the HL7 Message File 1. Go to the directory on the server that you created for your registry files. (Created in the task above.) 2. Double-click on the file to open the message. If you must select an application to open the file, use NotePad. 3. Press CTRL-A to select the entire contents of the message. 4. Press CTRL-C to copy the message. 5. Either: If you are submitting by , paste the message into an to your state registry. If your state registry has a test system, go to that test system and paste in the message. 6. When the state registry receives your message, they will notify you of the success or failure of your test. Inactivate the HL7 Partner for the Registry 1. List Editor Interface Engine HL7 Partner 2. Search for and select the VXUV04 entry, and select the Modify button. 3. Select the Inactive checkbox. Ref: