Sevocity v Improvement Activities User Reference Guide

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1 Sevocity v.12 User Reference Guide support@sevocity.com

2 Table of Contents Table of Contents...2 Product Support Services...2 About Sevocity v About This Guide...3 About Improvement Activities...3 Depression Screening...4 Diabetes Screening...5 Implementation of Fall Screening and Assessment Programs...6 Implementation of Medication Management Practice Improvements...7 Implementation of Use of Specialist Reports Back to Referring Clinician or Group to Close Referral Loop...8 Improved Practices that Disseminate Appropriate Self-Management Materials...9 Practice Improvements for Bilateral Exchange of Patient Information Use of Certified EHR to Capture Patient Reported Outcomes Use of Decision Support and Standardized Treatment Protocols Product Support Services Sevocity offers live US-based support and ongoing web-based training free of charge for all customers. For questions not answered in this guide or to schedule a personalized training session, please contact a Support Specialist at , support@sevocity.com, or via the Contact Us option under the Help menu in Sevocity. About Sevocity v.12 Sevocity v.12 is ONC 2015 Edition compliant and has been certified by an ONC-ACB in accordance with the applicable eligible certification criteria adopted by the Secretary of Health and Human Services. ONC Certified HIT is a registered trademark of HHS. Page 2 of 12

3 About This Guide About This Guide The User Reference Guide has been developed to help users identify tools and workflows in Sevocity to assist with the implementation of Improvement Activities at the practice. The information contained herein is based on the Medicare Access and CHIP Reauthorization Act of 2015 (MACRA) final rule. The activities are presented as defined by this rule and are subject to change. This guide is designed as a supplemental resource and is not a substitute for program eligibility and requirements. To view the entire list of Improvement Activities and for full program requirements, refer to CMS s Quality Payment Program website: About Improvement Activities Improvement Activities is one of the performance categories for Merit-based Incentive Payment System (MIPS) reporting. This category is designed to promote ongoing improvement and innovation to clinical activities. There are over 100 activities to choose from, focusing on areas such as population management, beneficiary engagement, and care coordination, and each activity is weighted with either a high or medium value. Page 3 of 12

4 Depression Screening Depression Screening Depression screening and follow-up plan: Regular engagement of MIPS eligible clinicians or groups in integrated prevention and treatment interventions, including depression screening and follow-up plan (refer to NQF #0418) for patients with cooccurring conditions of behavioral or mental health conditions. Behavioral and Mental Health Health Guidelines can be used to identify patients with co-occurring behavioral or mental health conditions. Creating a new Health Guideline Interventions for this guideline could include Flowsheet values or values from the Standard Flowsheets for Depression Screening (Adult or Pediatric), PHQ-2, or PHQ-9. PHQ-9 Score added as a Health Guideline intervention Page 4 of 12

5 Diabetes Screening Diabetes Screening Diabetes screening for people with schizophrenia or bipolar disease who are using antipsychotic medication. Behavioral and Mental Health Health Guidelines can be used to identify patients with schizophrenia or bipolar disease who are also using antipsychotic medication. Creating a new Health Guideline Interventions for this guideline could include Flowsheet values or orders for fasting plasma glucose or oral glucose tolerance tests. Fasting plasma glucose test added as a Health Guideline intervention Page 5 of 12

6 Implementation of Fall Screening and Assessment Programs Implementation of Fall Screening and Assessment Programs Implementation of fall screening and assessment programs to identify patients at risk for falls and address modifiable risk factors (e.g., Clinical decision support/prompts in the electronic health record that help manage the use of medications, such as benzodiazepines, that increase fall risk). Patient Safety and Practice Assessment Health Guidelines can be used to identify patients at risk for falls based on previous assessments or use of medication. Creating a new Health Guideline Interventions for this guideline could include Flowsheet values or values from the Standard Flowsheet for Fall Risk Screening, such as the Morse Fall Scale Score or Other fall risk assessment performed. Morse Fall Scale Score added as a Health Guideline intervention Page 6 of 12

7 Implementation of Medication Management Practice Improvements Implementation of Medication Management Practice Improvements Manage medications to maximize efficiency, effectiveness and safety that could include one or more of the following: Reconcile and coordinate medications and provide medication management across transitions of care settings and eligible clinicians or groups; Integrate a pharmacist into the care team; and/or Conduct periodic, structured medication reviews. Population Management Medications can be reconciled during a patient visit or when electronically incorporating a care summary into a patient chart as part of a transition of care. In an encounter, medications can be reviewed and reconciled from the Allergies/Meds Hx tab or the Medications tab. A clinical reconciliation for summaries of care received electronically can be performed from the C-CDA Reconciliation tool or from the Provider PDX Inbox. Medications being reconciled as part of a C-CDA clinical reconciliation Page 7 of 12

8 Implementation of Use of Specialist Reports Back to Referring Clinician or Group to Close Referral Loop Implementation of Use of Specialist Reports Back to Referring Clinician or Group to Close Referral Loop Performance of regular practices that include providing specialist reports back to the referring individual MIPS eligible clinician or group to close the referral loop or where the referring individual MIPS eligible clinician or group initiates regular inquiries to specialist for specialist reports which could be documented or noted in the EHR technology. Care Coordination Referral reports received from specialists or other providers can be documented in the Results section of the original referral. Documented results from referral report received Page 8 of 12

9 Improved Practices that Disseminate Appropriate Self-Management Materials Improved Practices that Disseminate Appropriate Self-Management Materials Provide self-management materials at an appropriate literacy level and in an appropriate language. Beneficiary Engagement The patient education features throughout Sevocity can be used to identify and provide appropriate self-management materials to patients. The Pt Ed button and Infobutton icon available at both chart and encounter levels--launch Medline Plus website resources with access to health information in multiple languages and easy-to-read formats. Infobutton resources in the patient chart MedlinePlus Connect resource result for Spanish-speaking patient Self-management materials can also be created or uploaded as Handouts, accessible from the Plan/Disposition tab in an encounter. Page 9 of 12

10 Practice Improvements for Bilateral Exchange of Patient Information Practice Improvements for Bilateral Exchange of Patient Information Ensure that there is bilateral exchange of necessary patient information to guide patient care, such as Open Notes, that could include one or more of the following: Participate in a Health Information Exchange if available; and/or Use structured referral notes Care Coordination Referral Notes and Continuity of Care Documents (CCDs) can be sent as structured C-CDA files to other providers or settings of care using Sevocity s integrated Direct messaging technology. Referrals can be sent electronically from the Referrals tab in the chart or from the Orders/Referrals tab in the encounter. Summaries of care can be sent electronically using the Send Clinical Summary feature in Chart Tools. Sending a clinical summary from Chart Tools Page 10 of 12

11 Use of Certified EHR to Capture Patient Reported Outcomes Use of Certified EHR to Capture Patient Reported Outcomes In support of improving patient access, performing additional activities that enable capture of patient reported outcomes (e.g., home blood pressure, blood glucose logs, food diaries, at-risk health factors such as tobacco or alcohol use, etc.) or patient activation measures through use of certified EHR technology, containing this data in a separate queue for clinician recognition and review. Beneficiary Engagement Patient-generated health data received in the Patient Portal Inbox can be stored to the patient chart. Storing patient-supplied health data to the patient chart Page 11 of 12

12 Use of Decision Support and Standardized Treatment Protocols Use of Decision Support and Standardized Treatment Protocols Use decision support and standardized treatment protocols to manage workflow in the team to meet patient needs. Patient Safety and Practice Assessment Health Guidelines can be used to create decision support protocols by selecting interventions to standardize treatment for identified populations. Health Guideline interventions for asthma management protocol Encounter templates can be used to apply standardized treatment protocols during a patient visit. Abdominal pain order set applied using a template Page 12 of 12

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