Capture and Record Vital Signs Configuration Guide

MU Core 4 Capture and Record Vital Signs This guide will provide instructions on how to configure the necessary setup and preferences to enable Enterprise EHR 11.4.1 to report on MU Core 4 Measure: Record and chart changes in the following vital signs: height/weight (no age limit), blood pressure (ages 3+); calculate and display BMI; and plot and display growth charts for patients 0-20 years, including BMI. Final Rule Requirements More than 80% of all unique patients seen by the EP durin g the EHR reporting period have blood pressures (for patients age 3 and over only) heights or lengths, and weights (for all ages) recorded as structured data. Core Objective: Menu Objective: Numerator: The numerator includes the number of patients counted in the denominator who have at least one entry of their height/length and weight (all ages) and blood pressure (ages 3 and over) recorded as structured data. Denominator: The number of unique patients seen by the eligible provider (EP) during the reporting period. Exclusions: Any EP who sees no patients 3 years or older is excluded from recording blood pressure. Any EP who believes that all 3 vital signs of height/length, weight, and blood pressure have no relevance to their scope of practice is excluded from recording them. Ant EP who believes that height/length and weight are relevant to their scope of practice, but blood pressure is not, is excluded from recording blood pressure. Any EP who believes that blood pressure is relevant to their scope of practice, but height/length and weight are not, is excluded from recording hei ght/length and weight. Copyright 2013 Allscripts Healthcare, LLC. 2

Objective is shared across Eligible Professionals: Yes: No: Objective must be recorded during the reporting period: Yes: No: Click on Preferences in left hand column, and Choose HMP in Preferenc e drop down box. Prerequisites Requires: Base Functionality Vital Signs Availability: v11.2: Configuration Steps Review HMP Vitals Unit Preference: This preference sets the default for the default measure of units when viewing vital signs from HMP Clinical Desktop Component. Select user can override of you want to allow user to change his/her setting. Set this to the appropriate value (US or Metric). 1. Go to TWAdmin Preferences Select HMP 2. Select HMP Vitals unit preference and review Value, change if appropriate. Click Save. Copyright 2013 Allscripts Healthcare, LLC. 3

Review Vital Signs Default Preferences 1. Go to TWAdmin Preferences Select Results 1. Allscripts delivers the following Vital Signs Panels for each of the below preferences. Review delivered values and update if appropriate. Default Vitals < 10 years old Default Vitals 3 year old and younger Default Vitals Female 10 years old or older Default Vitals Male 10 years or older Copyright 2013 Allscripts Healthcare, LLC. 4

Review Vitals Pick list Preference: This preference sets the value for the user of which vital sign option he/she has access to (what appears under the Vital Sign heart in the Clinical Toolbar). Allscripts delivers TW Vital Sign set this value appropriately at the Enterprise, organization or user level. 1. Go to TWAdmin Preferences Select Results. 2. Select Vitals Pick list and review value. Click Save. Review Height Not Documented, Weight Not Documented, and BP Not Documented Preferences: Height Not Documented indicates that the patient s height is not documented, and places an alert in the patient's Encounter Summary. Height information is a Meaningful Use (MU) requirement. Weight Not Documented indicates that the patient's weight is not documented in the patient's chart and places this alert in the Encounter Clinical Summary. Weight information is a Meaningful Use (MU) requirement. BP Not Documented determines when an alert is displayed in the patient's Encounter Clinical Summary if a blood pressure reading for patients age 3 and older is not documented. Documenting blood pressure in patients age 3 and older is a Meaningful Use (MU) 2 requirement. It is best practice to set these fields to "Show in my Alerts" for users whose role documents the vital signs and "Show in other alerts" for users who do not document vital signs. It is recommended to allow the user to override these preferences, but it is Copyright 2013 Allscripts Healthcare, LLC. 5

at the discretion of the organization to review if you want to let users modify this setting. 1. Go to TWAdmin Preferences Select Alerts. 2. Select one of the above preferences and review values. To set at the user level, change Ent/Org/User Settings drop down to User Pick organization search for user. Review Vital Sign Reference Range: Copyright 2013 Allscripts Healthcare, LLC. 6

Using the via SSMT RID-Reference Ranges Content Category, you can set reference range values for each vital sign. Allscripts has delivered a value set that you can update appropriately for your organization. Only users familiar and trained to use SSMT should follow this step. 1. Login to SSMT w/appropriate credentials 2. Pick RID- Reference Range 3. Select Headers in Extracted Data 4. Click Extract Data 5. Click in the extracted text 6. Click ctrl and a buttons to copy all text 7. Click ctrl and s buttons to select all text 8. Open excel 9. Format excel as General 10. Paste text into excel 11. Make modifications as necessary in excel for reference ranges 12. Copy appropriate rows and paste back into SSMT (after deleting text in window) 13. Click Load Data Review Clinical Desktop Configuration to include Vitals Component Consider customizing existing clinical desktop views and adding vital signs as its own component. 1. Select TWAdmin Work Def Admin Workspace Definitions 2. Choose appropriate Clinical Desktop View 3. Click Add/Edit Desktop 4. Select group where you want to add Vitals 5. Click HMP 6. Click Add Selected Copyright 2013 Allscripts Healthcare, LLC. 7

1. Deselect any views that you organization may not be using. 2. Select Apply. Assign LOINC codes to any client defined vital signs: If your organization has created any of your own vital signs for height, weight, or blood pressure, you will need the result to the appropriate LOINC Code. 1. TWAdmin Dictionary Search for vital signs that your organization created 2. Select icon next to LOINC to search for a LOINC Code For Height, review one of the following codes to use: 3137-7, 3138-5, 8302-2 8306-3, 8307-1, 8308-9 For Weight, review one of the following codes to use:18833-4, 29463-7, 3141-9, 3142-7 8350-1,8351-9 Copyright 2013 Allscripts Healthcare, LLC. 9

For Blood Pressure, review one of the following codes to use: 8480-6, 8488-5, 8453-3, 8454-1, 8462-4, 8461-6, 8459-0, 8460-8 1. Search by code or name 2. Select Code 3. Click Ok Workflow Considerations Ensure that appropriate staff documents vital signs that have clinical relevance in the provider s scope of practice Vital signs will need to be documented discretely, using the vital signs feature (the heart icon in the patient toolbar or vital signs flow sheet or another flow sheet that your organization has built for capturing vital signs) To facilitate the capture and ensure accuracy of vital sign data, consider implementing device integration (ex. Welch Allyn devices). This would automatically Copyright 2013 Allscripts Healthcare, LLC. 10

record the data, and pass it to the EHR. (Device integration is not required for MU Reporting.) How EEHR Calculates the MU2 Report Report A: Height, Weight, and Blood Pressure Numerator For each unique patient in the denominator, the system will count once any patient with the following at the end of the reporting period: Recorded height AND: Recorded weight AND: Recorded blood pressure for those patients that are 3 years old at the beginning of the reporting period Denominator The system will count once each unique patient seen by the provider during the reporting period. Report B: Blood Pressure Only Numerator For each unique patient in the denominator the system will count once any patient with the following at the end of the reporting period: Recorded blood pressure for those patients that are 3 years old at th e beginning of the reporting period Denominator Number of unique patients who were 3 YO at the beginning of the reporting period, seen by the EP during the reporting period Copyright 2013 Allscripts Healthcare, LLC. 11

Report C: Height and Weight Numerator For each unique patient in the denominator the system will count once any patient with the following at the end of the reporting period: Recorded height AND: Recorded weight Denominator Number of unique patients seen by the EP during the reporting period Recorded height AND: Recorded weight Exclusions Any EP who believes that blood pressure is relevant to their scope of practice, but height/length and weight are not, is excluded from recording height/length and weight. The EP should use only Report B: Blood Pressure for reporting. Any EP who sees no patients 3 years or older is excluded from recording blood pressure. The EP should use only the Reporting C: Height & Weight Report for reporting. Any EP who believes that height/length and weight are relevant to their scope of practice, but blood pressure is not, is excluded from rec ording blood pressure. The EP should use only the Reporting C: Height & Weight Report for reporting. Any EP who believes that all 3 vital signs of height/length, weight, and blood pressure have no relevance to their scope of practice is excluded from rec ording them. The EP will not use any of the reports. Indicators Copyright 2013 Allscripts Healthcare, LLC. 12

When the numerator divided by denominator greater than 80% When the numerator divided by denominator is between 70% and 80% When the numerator divided by denominator is 70% or belo w Report Calculation Flow Diagram Reporting Considerations Copyright 2013 Allscripts Healthcare, LLC. 13

Please note that the changes from Stage 1 for this measure apply to the patient's age required for capturing blood pressure (from 2 years old to 3 years old) and the new exclusions (listed in the reporting section). In the Allscripts Reporting Portal for Stage 2, there will now be 3 different reports for the end user to choose, based upon the new exclusions that were added (listed in the reporting section). The measure s threshold that was set takes into consideration those patients that may refuse to have their height, weight or blood pressure taken. These patients will not be included in the numerator by default. As a way to record this refusal, you can consider adding a vital sign result called Comment or Patient Refused Weight (with a pick list value of yes ). These and any user created entries should be associated to one of the valid LOINC codes above. Copyright 2013 Allscripts Healthcare, LLC. 14