Objective: Provide patients the ability to view online, download, and transmit their health information within 4 business days of the information being available to the EP. CMS Documentation: Date updated: February 4, 2016 https://www.cms.gov/regulations-and- Guidance/Legislation/EHRIncentivePrograms/Downloads/2016EP_8PatientElectronicAccessObjective.pdf PCM Workflow: Make sure that patients have access to patient Portal, or have been sent an invitation to join Patient Portal within 4 days of their visit AND have an encounter with an associated diagnosis for each of their visits and that the fields for current problem list, current medication list, and current medication allergy list are not blank and include the most recent information for each patient visit. Provide patients with Patient Portal access and information and encourage them to log into Patient Portal to view and access their information. I. Initial Setup Verify that PCM providers are registered with a Direct address a. A direct address is necessary for sending TOC Summary electronically via the Direct network. Please see the Direct Messaging document for more information. Verify that a direct address exists for the Referring providers; this is setup in the Referring Table, under the Phone tab. Review this entire document and become familiar with the required CMS information for this measure and how to record all of the necessary information in PCM. Review all of the PCM users and ensure all of the information is completely entered for each one Note: this is required for populating the Care Team Members in the CDA documents 1. Log in as the PCM ADMIN user 2. Review/Edit each user and make sure that the following information is completely updated o User Type: Providers; Attending, Primary Care, Consultant or Other T users; Resident, Nurse Practitioner, Physician Assistant or Other Other users; Nurse, Medical Assistant or Other o User Name, address and phone number the following fields filled in: First name Last Name Address, City, State, Zip Phone 1 Ver. 04-15-16
II. Creating Encounters An encounter AND an associated diagnosis must be entered prior to generating CCD documents The following options are available for creating an encounter, this will add the patient to the denominator: o When the patient is checked in for an Appointment (appt. type must be set to create a superbill) o Using the %Diagnosis% place holder in text documents to select an encounter diagnosis (there will be an option to create an encounter, if one does not already exist) o Using the $ Charge Entry Screen, New Charge Ticket Option The following options are available for adding a final diagnosis to the encounter; o Using the %Diagnosis% place holder in text documents to select the encounter diagnosis o While in pen or text document edit mode, from the Patient Data menu, using the Final Diagnosis table to select the encounter diagnosis o Using the Charge Entry screen to select the encounter diagnosis (there is no need to actually send the charges) T user Appointment Providers In order to correctly update the Diagnosis List in the Encounter log, the following applies; If the T-User will be selecting the final diagnosis for the visit, the Resp. Provider (Billing Prov.) must to be the signer for the document. If the Resp. Provider (Billing Prov.) is not the signer for the document (T-User is the signer) or documents are not being attached on the day of the visit (due to outside transcription, or other reasons), the Charge Entry Screen will have to be used to enter the Final Diagnosis. III. Required Information Prior to Generating CCDs All of the CMS required information (below) must be present for the Numerator to populate: o Allergies, Problems and Meds o Demographics: Patient name, Sex, Date of birth, Race & Ethnicity and Preferred language The following Table of Contents shows the information contained in the Summary by default, if the information is not recorded prior to regenerating the summary Data Not Recorded will be displayed in the corresponding section of the Summary. Medications Immunizations Allergies and Adverse Reactions Procedures Problem List Test Results Vital Signs Social History Care Plan Cognitive and Functional Status Chief Complaint and Reason for Visit Reason for Referral 2 Ver. 04-15-16
If an encounter and diagnosis is not available, you will not be prompted about missing data; the fields in the Summary of Care will display No Encounters, Not Applicable Data Not Recorded will be displayed in the Summary; specifically indicating the data is missing or left blank. If the patient was asked and an entry is recorded; the Summary of Care will display either No Known Drug Allergies, No Known Problems, No Medications Taken ; specifically indicating the patient was asked and this entry was made. IV. CMS Data Requirements for Patient Electronic Access https://www.cms.gov/ehealth/downloads/webinar_ehealth_november5_stage2exchange.pdf Patient Access Patient name Provider s name and office contact information Current and past problem list Procedures Laboratory test results Current medication list and medication history Current medication allergy list and medication allergy history Vital signs (height, weight, blood pressure, BMI growth charts) Smoking status Demographic Information (preferred language, sex, race, ethnicity, date of birth) Care plan field(s), including goals and instructions Any known care team members including the primary care provider (PCP) of record V. Excluding Tables from FHR Per CMS documentation, the provider may; Withhold any information provider determines could cause possible harm. https://www.cms.gov/ehealth/downloads/webinar_ehealth_november5_stage2exchange.pdf There is an option in Patient Data Tables to exclude certain tables from FHR, this option excludes tables from listing information on the Summary, the heading must still show, but will have Data Excluded from Formal Health Record. Note: if the tables are excluded, as long as the information has been entered in the system and the data exists at the time of generating the Summary, the CDA will count towards MU. The following tables can be excluded; o Allergies o Medications o Problem List o Encounter Log o Misc. Orders and Advice- excludes the Plan of Care section o Vital Signs table-vitals/social History (Smoking Status) are stored in the same table o if the Vital Signs table is excluded, the user generating the Clinical Summary will get a prompt with options to exclude Vitals and/or Social History (smoking) o Diagnostic test results- Diagnostic Test/ Reason for Referral are stored in the same table o if the Diagnostic Test Results table is excluded, the user generating the Clinical Summary will get a prompt with options to exclude Diagnostic tests and/or Reason for Referrals 3 Ver. 04-15-16
Note: The prompting for Vital Signs and Diagnostic Test Results as described above only happens when doing an individual Clinical Summary export and not when using Export CCDA for all Patients batch option When using the Export CCDA for all Patients batch option; if the Diagnostic Test Results are excluded, only diagnostic tests will be excluded and not the reason for referral. If the Vital Signs are excluded only, the Vital Signs will be excluded and not the Social History VI. Recording Information in PCM To ensure the CCD Documents contain all of the required information, make sure that all of that data is entered correctly in the appropriate places. 1. Recording Patient Demographics: Use the Patient Data Editor; make sure all of the required information shown below is entered for each patient, if the patient has declined to provide some information that must be documented by using the Declined to Specify options. Patient name, Sex, Date of birth Race & Ethnicity Preferred language 2. Recording Smoking Status: Use the Vital Signs Patient Data Table 3. Recording Medication Allergies: Use the Allergies Pane; make sure that the allergy Type is Drug Allergy. 4. Recording Medications: Use the Meds Pane 5. Recording Problems: Use the Diagnosis/Past Hx Pane 6. Recording Procedures: Use the Procedures Pane 7. Recording Vital Signs: Use the Vital Signs Patient Data Table, at a minimum, a patient s height/length, weight, and blood pressure must be recorded 8. Recording Laboratory Tests and Values/Results: Use the HL7 Interface to electronically receive and incorporate clinical laboratory tests values/results OR manually enter values/results data into the HL7 Table Patient Data Table 9. Recording Immunizations: Use the IMM Log Patient Data Table 10. Recording Orders (Populating the Care Plan Section): Use Treatment Plans/Order Entry for all orders; For more information on this, please see section Populating the CARE PLAN section of the CDA 11. Recording Encounter Diagnosis: Use one of the following options to record the encounter diagnosis for each visit; a. Use the %Diagnosis% place holder in text documents to select the encounter diagnosis b. While in pen or text document edit mode, go to the Patient Data menu and choose Final Diagnosis to select the encounter diagnosis 4 Ver. 04-15-16
c. Use the Charge Entry screen to select the encounter diagnosis (there is no need to actually send the charges) 12. Recording Functional and Cognitive Status: Use the Functional Status system Patient Data table, the table comes pre-loaded with Cognitive or Functional choices. 13. Recording Referrals: Use the Treatment Plan Item Type called REFERRAL for all patient referrals VII. Populating the CARE PLAN section on the CDA Note: All Treatment Plan Items Types that are applied will populate in the CARE PLAN Section of the Summary A. Use the Item comment to enter comments related to the test or referral, such as the planned appointment date or laterality for the procedure. B. All Treatment Plan Item Types that are set to create an entry in the Req Log will display Pending/Scheduled in the Summary if a result is not yet available at the time of generating the Summary, except for: INSTRUCTIONS, REFERRAL and REMINDER Types C. Treatment Plan Item Type INSTRUCTIONS with an Item Description starting with GOAL will be grouped at the very top of the CARE PLAN section o Use the Item Comment to add personalized patient instructions D. The Item Description for Treatment Plan Item Type REMINDER will populate in the CARE PLAN o Use the Item Comment to add personalized patient instructions 5 Ver. 04-15-16
E. For Item Type REFERRAL- the provider s name, address and phone (from the Referring Table) will appear in the CARE PLAN o Use the Item Comment to add a REASON FOR REFERRAL, OR other personalized patient information such as type of referral or appointment date o The REASON FOR REFERRAL section will contain the notes entered in the Item Comment F. For EDUCATION Item Descriptions, the Item Type has to be REMINDER 1. Double click on the EDUCATION Item Description to choose from the available Education Guidelines 6 Ver. 04-15-16
2. The Item Description Changes to the Title that was chosen in the above step (The database field for the Item description is still Education ) : G. Any future scheduled Appointments will show in the Summary, the information will contain the provider s name, address date and time of the appointment as well as the date the appointment was entered VIII. Populating the INSTRUCTIONS section of the Summary NOTE: The INSTRUCTIONS section is NOT displayed for the Summary of Care/ Transition of Care/Referral type of summary, as that only applies for Instructions given for the particular visit; Summaries on check- out. A. The Item Type INSTRUCTIONS appears under the INSTRUCTIONS section of the Summary o Item Description can be anything you like to populate the INSTRUCTIONS section of the CDA, use the Item Comment to add personalized patient information. o The information will populate just as it appears in the Treatment Plan. o If you wish to display Clinical Instructions make sure to add that in the Item Description. 7 Ver. 04-15-16
IX. Patient Data Tables Related to Applied Orders A. Misc. Orders and Advice Patient Data Table will display information for applied Treatment Plan items except for: o Types that are set to create a Req Log entry o MEDRECON and CHARGE types B. Manual Entries can also be made to the Misc. Orders and Advice Patient Data Table o These entries will be displayed under the Care Plan of the Summary o The default ORDER TYPE (Item Type) is INSTRUCTIONS o you can type anything in the ORDER DESCRIPTION and ORDER COMMENT C. Diag Test Results Patient Data Table will display information for applied Treatment Plan items types that are set to create a Req Log Entry, except for; o MEDRECON and CHARGE types X. PCM Workflow Verify that an encounter and diagnosis encounter exists for each patient visit and that the fields for current problem list, current medication list, and current medication allergy list are not blank and include the most recent information for each patient visit. If any of this information is missing, MU credit will not be given. a. PCM Workflow /Measure 1 All patients from the denominator count who have access to patient Portal, or who have been sent an invitation with the 4 days of the visit AND have an encounter with an associated diagnosis within the reporting period will be added to the numerator. 8 Ver. 04-15-16
Patient opt-out option The Opt Out option should ONLY be used when the patient actually opts-out, this option is not to be used as quick way to increase the numerator or to replace the requirement for providing electronic access for each patient, remember that CMS randomly audits and the proper documentation must exist. The opt-out option only applies to Measure 1, because Measure 2 requires that the patient actually logs in to View, Download or Transmit. The Preferred Method for Receiving Communication cannot be set to e-mail In the Registration packet, we recommend information about Patient Electronic Access/Patient Portal is included for each patient and that a copy of information is filed in the chart, for audit protection. 1. In the Patient Data Editor, right click on the email address field and choose the opt-out option. 2. The patient s GlobalID@practiceacctnumoptout.com will automatically be entered as their e-mail address; this entry will serve as an indicator of the patient opting out. 3. Click on the Send PP Email Invite button. 4. As long as the rest of the required criteria for this objective is met the patient will be added to the numerator After clicking on the Send PP Email Invite button, in PCM you will get email sent successfully, but an email is not actually sent anywhere; the database will just be updated as if the patient was invited. o After sending the PP Invite, the Date Invited gets updated in the database for each patient. If a patient is re-invited,, a warning message comes up, because the re-invite may remove the patient out of the MU eligibility (each time the patient is invited the Date Invited gets updated to today s date) This workflow serves as indication of the effort being made to provide the patient with the information and that an invite for Patient Electronic Access was attempted. To get a list of patients who have opted out and have been invited a) You can log into Patient Portal as an ADMIN user and search for all of the patients who have opted out by searching for optout. b) Or you can create a Patient Control Report, for a List of patients with email containing optout 9 Ver. 04-15-16
b. PCM Workflow /Measure 2 All patients from the denominator count who log into their Patient Portal account and use the Clinical Summaries options to either share, view or download their summary within the reporting period will be added to the numerator: o o o Provide all patients with instructions on how log into Patient Portal and use these options (share, view or download); at the very least, the patient should be using the View Summary option. When the patient uses either one of these options, the Clinical Summary will be generated in real time. If data is not currently available it will have Data not Recorded in the Clinical Summary where the information is missing. XI. Patient Access of Clinical Summaries using Patient Portal The patient will receive an email notice whenever there is new activity in their account. The Patient can log into their Patient Portal account and use the Clinical Summaries options: Share Summary- Allows the patient to share their Clinical Summary with other Providers View Summary- Displays a complete summary including all DOS Download Summary- this option will download a zip copy to the user s C:\Users\Username\Downloads folder, the CCD summary can saved and extracted When the patient performs either one of these options: MU Table will be populated with these events; Summary Viewed, Summary Downloaded, Summary Transmitted, etc Patient is then added to the numerator. XII. Patient Instructions for Accessing Clinical Summaries on Patient Portal Below, find instructions for your patients on how to use the Patient Portal. We have provided a copy of these instructions on our website under this measure for you to hand out to your patients. 1. After a visit with your doctor, you will receive an email notification when your visit s Clinical Summary becomes available in your chart for access 2. Following the email link you can log in to your Patient Portal Account 3. Once logged into your Patient Portal Account; Click on the Clinical Summaries link under Options 10 Ver. 04-15-16
4. Click on view Summary 5. A file showing a complete Clinical Summary for all dates of service will open 6. When you finished reviewing your information, Click on the browser s back button to go back to the previous screen 7. You may also download or share your Clinical Summary with other provider s within the Direct Messaging Network XIII. Authorized Patient Representative for Accessing Patient Information on Patient Portal Use the Guarantor fields in the Patient Data Editor to add an authorized patient representative who has access to the patient s Patient Portal account. To remove an authorized representative, open the patient s guarantor screen and Clear the selected guarantor. The patient s Patient Portal account will have an alert notifying the patient that another person (including the name) can act in their behalf and that there is an option for the patient to remove this person s access. When the patient clicks on that, the guarantor is immediately removed from their account and will no longer have access. An authorized representative can be a parent, guardian or a care taker, etc An authorized patient representative can log into Patient Portal and view, download and transmit on the patient s behalf. The authorized representative may or may not be an actual patient, but an account is required in order to be invited for Patient Portal Access If the patient representative is a patient as well, when the authorized patient representative logs in there will be options for accessing both accounts; the representative s own OR the other patient s account. 11 Ver. 04-15-16
If the patient representative does not have a chart in PCM, there will be an alert on the top reminding them that they are acting on another person s behalf. The Audit Trail in Patient Portal logs actions done by both the patient or the authorized representative. XIV. Patient Instructions for Sharing Clinical Summaries through Patient Portal We have provided a copy of these instructions on our website under this measure for you to hand out to your patients. 1. After a visit with your doctor, you will receive an email notification when your visit s Clinical Summary becomes available in your chart for access 2. Following the email link you can log in to your Patient Portal Account 3. Once logged into your Patient Portal Account; Click on the Clinical Summaries link under Options 4. Click on Share Summary 5. Click on Accept 6. Click on the tab Add doctor to my network. 7. In the Search Box, type the doctor s last name and click on Search. 8. Once you find the doctor you want to share your information with, select the row. 9. Next, choose how often to transmit: This time only OR whenever your information changes Note: If you choose This Time Only, the frequency is shown as 1 and this doctor is not added to tab My 12 Ver. 04-15-16
Network of doctors. Note: If you choose Whenever it changes the frequency will show as recurring and the doctor will be added to the my Network of doctors tab. 10. Click on Save to continue 11. A confirmation message will now appear. To continue with sharing your information click on Continue, OR otherwise cancel. transmitted via Direct Messaging. 12. After clicking on Continue the file is electronically XV. Patient Authorization for recurring transmission of Clinical Summaries There is a check box in the Patient Data Editor indicating that the patient has recurring electronic transmissions of Clinical Summaries to other providers. This box is checked by default. IMPORTANT: EACH PATIENT SHOULD BE PROVIDED WITH A CONSENT FORM which allows them to opt out of this type of sharing. If the patient choses to opt out, make sure to un-check the appropriate check box field. If the patient opts out of Clinical Summary transmissions, please note that this option only applies to recurring and will not impact a one-time sending of Clinical Summary. XVI. Managing My Network of Doctors We have provided a copy of these instructions on our website under this measure for you to hand out to your patients. 1. If you choose the option to share your 13 Ver. 04-15-16
information with a doctor whenever the information changes, the doctor will appear in this screen. a. To remove a doctor from this list- Click on the red X b. To leave a doctor on the list and disable Transmissions- Uncheck the Enable Transmissions checkbox XVII. Patient Audit Trail This log will record actions related to the Patient Portal when viewing, downloading and sharing Clinical Summaries: DISCLAIMER: Please note that it is ultimately your responsibility to verify and understand the requirements of Meaningful Use. Any information provided by Prime Clinical Systems is provided as a courtesy to help this process along the way. The information outlined in this summary is, to the best of our knowledge, accurate; however, we encourage you to do your due diligence in verifying this information directly from CMS. The number for the CMS hotline is 888-734-6433. 14 Ver. 04-15-16