Evident is dedicated to making your attestation for Meaningful Use as seamless as possible. To assist our customers with implementation of the software required to meet Stage 2, 2015 requirements, Evident has created the guideline below. Each practice/clinic should contact their Evident Sales Account Manager to receive their Meaningful Use requirements matrix as well as fill out and return the Meaningful Use Eligible Professionals (EP) questionnaire as a prerequisite to their attestation effort. Below is a list of items that will need to be implemented at each practice/clinic prior to the start of your attestation period: Implement the Updated Platform of Medical Practice EHR (Thrive Provider EHR) Clinical Monitoring InfoButton Clinical Vocabulary Patient Education Documents Patient Portal with Secure Messaging CCD, Patient Summary Subscription Direct Messaging with Direct Address Discrete Element Lab Interface with Micro may be needed Medication Management Electronic File Management 3 rd Party PACS with URL interface may be needed 2 Public Health interfaces may be needed In addition to the above, each practice/clinic will also need to do the following: Review disk storage requirements as additional disk space may be necessary. Convert to Rule Based Security (Must Implement before loading Version 19). Load Version 19 (V19). Contact your Evident Sales Account Manager for a system analysis and final preparation review. Once completed, individual situations will be opened for education on each objective. A representative will review all setup that is required as well as answer any questions regarding the objectives. Revision Date: 08/26/2016 1
GUIDELINES FOR IMPLEMENTATION Clinical Quality Measures (CQMs): Continuing in 2016, there is no longer a separate objective for reporting Eligible Professional Clinical Quality Measures as a part of Meaningful Use. It is important to note, however that eligible professionals will still be required to report on clinical quality measures in order to achieve Meaningful Use. Applications needed for Clinical Quality Measures: Thrive Provider EHR *Please note, as CMS further defines their interpretation of how to use the certified technology to satisfy Meaningful Use by publishing Frequently Asked Questions, updates and /or changes will be made. Also, as CMS further defines electronic submission, Evident will update our Meaningful Use FAQs accordingly. Set-Up for objective: LOINC codes should be attached to all lab items and their reference ranges. In particular, this setup needs to be completed for the lab tests Strep, Fecal Occult Blood, HbA1c, and HBsAg. Pathway to Attach LOINC Code to Item: Base Menu > Master Selection > Business Office Tables > Table Maintenance > Control > Materials Management: Item Master > Search for and doubleclick on item > Page 3 > Under Misc Codes section, attach the appropriate LOINC code by typing it in or by using the binoculars icon lookup > Save. Pathway to View Reference Ranges for Lab Item: Base Menu > Charge Tables and Inventory > Enter Item Number or use Item or Service Search > Enter > Order Entry Results Format > View Reference Range(s) listed. Pathway to Attach LOINC Code to Reference Ranges: Base Menu > Master Selection > Business Office Tables > Table Maintenance > Control > Lab Control Information: Reference Range Table > Search for and double-click on the reference range > Attach the appropriate LOINC code by typing it in or by using the magnifying glass lookup. SNOMED-CT codes should be attached to all education documents used for Clinical Quality Measures. Pathway: Base Menu > Master Selection > Business Office Tables > Table Maintenance > Clinical > Patient Education Maintenance: Document Maintenance > Search for and double-click on document > Add Code > Add SNOMED code by typing it in the SNOMED field or by selecting the binoculars icon lookup > Save. Review setup required for each data element listed in the Data Element Key to Quality Measures document. Required setup for these data elements are listed in the following measures. Revision Date: 08/26/2016 2
How to achieve Objective: This objective is achieved by charting electronically, posting charges and running the Quality Measures report. Review Data Collected for Quality Measures document for required data elements to meet each Quality measure. Review Data Element Key to Quality Measures document for where to input information in the system for each data element. Review the Quality Measures Calculations Detail document for details on how the initial population, denominator, numerator, and any exclusions or exceptions are calculated for each measure. Create a report filter for each EP. Pathway to create an EP-specific filter for the Quality Measures report: Base Menu > Other Applications and Functions > Word Processing > Ad Hoc Report > Clinic CQM Report > Select filter icon next to facility dropdown > Add > New > Edit filter for the facility > Select (Filter Title) to enter desired filter name (i.e. John Smith MD) > Add an item to this filter > Physician Number > Under May be any of the following values, select Configure Values > Enter 6-digit physician number > Enter > Back arrow twice > Save > Back arrow > Select created filter from list > Back arrow. Run the Clinic CQM Report: Path to run report: Base Menu > Other Applications and Functions > Word Processing > Ad Hoc Report > Clinic CQM Report > Select correct facility from the dropdown field and enter the desired date range > Select the appropriate filter to run the report for each Eligible Professional > Config > Double-click on each quality measure that should be included in the report > After selecting all desired measures, select Back Arrow. To view Numerator, Denominator, Exclusion and Exception totals: Select Totals. To electronically generate a QRDAI file: Select XML zip > Select OK. *Note: This file will be saved to your C drive under the title qrda_yyyymmdd.zip unless a different title is specified on this screen prior to saving. To electronically generate a QRDAIII file: Select Totals > Select XML file > Select OK. *Note: Please retain the copy of the report that you use for attestation for auditing purposes. Revision Date: 08/26/2016 3
Computerized Provider Order Entry (must meet 3 measures): Use computerized provider order entry (CPOE) for medication, laboratory and radiology orders directly entered by any licensed healthcare professional who can enter orders into the medical record per state, local and professional guidelines. Measure: More than 60 percent of medication, 30 percent of laboratory, and 30 percent of radiology orders created by the EP during the EHR reporting period are recorded using CPOE. Applications needed to meet Objective: Thrive Provider EHR Set-Up for Objective: Setup tables for Prescription Entry are found via the path: Clinic Base Menu > Master Selection > Business Office Tables > Table Maintenance > Clinical. All tables are under the header "Prescription Entry". Setup of pharmacy items (like immunizations) orderable via CPOE is found via the path: Clinic Base Menu > Master Selection > Business Office Tables > Table Maintenance > Control > Item Master > search and select item > Pharmacy Info > Page 1 > Chart cart Selectable must be unchecked. Setup to make lab or radiology items orderable via CPOE is found via the path: Clinic Base Menu > Master Selection > Business Office Tables > Table Maintenance > Item Master > search and select item > Order Entry Info > Page 3 tab > Ancillary Procedure must be checked. How to achieve Objective: For Medications: This objective is met by: 1. Entering new prescriptions and/or renewing prescriptions through prescription writer. 2. Ordering medications to be administered in the clinic via Updated Order Entry. For Laboratory: This objective is met by ordering labs items via Updated Order Entry. For Radiology: This objective is met by ordering radiology items via Updated Order Entry. Measure 1 (Medications): DENOMINATOR: Number of medication orders created by the EP during the EHR reporting period. Medication orders placed NUMERATOR: The number of orders in the denominator recorded using CPOE. Medication orders that have been placed using prescription writer and/or Updated Order Entry. Exclusion: Any EP who writes fewer than 100 medication orders during the EHR reporting period. Revision Date: 08/26/2016 4
Measure 2 (Laboratory): DENOMINATOR: Number of laboratory orders created by the EP during the EHR reporting period. Laboratory orders placed NUMERATOR: The number of orders in the denominator recorded using CPOE. Number of laboratory orders placed that have been recorded using Updated Order Entry. Exclusion: Any EP who writes fewer than 100 laboratory orders during the EHR reporting period. Alternate Exclusion for Measure 2: Providers scheduled to be in Stage 1 in 2016 may claim an exclusion for measure 2 (laboratory orders) of the Stage 2 CPOE objective for an EHR reporting period in 2016. Measure 3 (Radiology): DENOMINATOR: Number of radiology orders created by the EP during the EHR reporting period. Radiology orders placed NUMERATOR: The number of orders in the denominator recorded using CPOE. Number of radiology orders placed that have been recorded using Updated Order Entry. Exclusion: Any EP who writes fewer than 100 radiology orders during the EHR reporting period. Alternate Exclusion for Measure 3: Providers scheduled to be in Stage 1 in 2016 may claim an exclusion for measure 3 (radiology orders) of the Stage 2 CPOE objective for an EHR reporting period in 2016. Electronic Prescribing (erx) Generate and transmit permissible prescriptions electronically. Measure: More than 50 percent of all permissible prescriptions written by the EP are queried for a drug formulary and transmitted electronically using CEHRT. Applications needed to meet Objective: Thrive Provider EHR Set-Up for Objective: Setup tables for Prescription Entry are found via the path: Base Menu > Master Selection > Business Office Tables > Table Maintenance > Clinical. All tables are under the header "Prescription Entry". Clinical Monitoring Revision Date: 08/26/2016 5
Control Table- Use E-Scribe must be checked. Discontinue Reasons Doses Frequencies Modifiers Pharmacies Routes Units Zip Codes Indications Physicians using E-scribe must have an SPI number generated and loaded in the physician security table (Table Maintenance > Control > Physician Security > Select Physician > Page 3 > E-scribe Data). How to achieve Objective: When creating new prescriptions, the prescription must be marked as either Dispense as Written or Generic Substitution Permitted, and the Delivery Method on the prescription must be marked as Electronic and then processed. All new prescriptions created are queried for a drug formulary. DENOMINATOR: Number of permissible prescriptions written for drugs requiring a prescription in order to be dispensed during the EHR reporting period. New, changed or refilled prescriptions that were written during the reporting period. NUMERATOR: The number of prescriptions in the denominator generated, queried for a drug formulary, and transmitted electronically using CEHRT. Number of prescriptions in the denominator that were processed and transmitted as electronic prescriptions (and queried for a drug formulary automatically). Exclusion: Any EP who: (1) Writes fewer than 100 permissible prescriptions during the EHR reporting period; or (2) Does not have a pharmacy within their organization and there are no pharmacies that accept electronic prescriptions within 10 miles of the EP's practice location at the start of his/her EHR reporting period. Revision Date: 08/26/2016 6
Clinical Decision Support Rule (Must meet 2 measures) Use clinical decision support to improve performance on high-priority health conditions Measure 1: Implement five clinical decision support interventions related to four or more clinical quality measures at a relevant point in patient care for the entire EHR reporting period. Absent four clinical quality measures related to an EP s scope of practice or patient population, the clinical decision support interventions must be related to high-priority health conditions. Measure 2: The EP has enabled and implemented the functionality for drug-drug and drug-allergy interaction checks for the entire EHR reporting period. Applications needed to meet Objective: Thrive Provider EHR Clinical Monitoring InfoButton Clinical Vocabulary Set-Up for Measure 1: Clinical Decision and the rules must be activated from the following path (Note: To be able to configure and enable CDS Alerts, you must be set up in the System Administrator Group): Clinic Base Menu > Master Selection > Business Office Tables > Table Maintenance > Clinical > CDS Alert Configuration. The following types of alerts can be activated for a user: Problem list and laboratory tests - Comprehensive Diabetes Care Triggered when a diagnosis of diabetes is added through Physician Problem List for patient and no record of a recent HbA1c order exists in patient's Order Chronology. Medication list - Use of appropriate medications for Asthma Triggered when patient has a diagnosis of asthma added through Physician Problem List without any asthma medication therapy ordered through Prescription Entry. Laboratory tests and values - Colorectal Cancer Screening Triggered when patient's Order Chronology displays no record of a recent colorectal cancer screening performed (Fecal Occult Blood test in the past year, Flexible Sigmoidoscopy in the past 4 years, Colonoscopy in the past 9 years). Vital Signs Blood Pressure Assessment Triggered when a patient s blood pressure assessment has not been documented. Revision Date: 08/26/2016 7
Demographics - Tobacco Use Screening and Cessation Intervention Triggered when patient's smoking status demographics field indicates use of tobacco products and there is no education documentation that tobacco cessation counseling was performed at least once within the last 2 years. Problem list - Treatment for Children with Upper Respiratory Infection Triggered when diagnosis of Upper Respiratory Infection is added through Physician Problem List for patient. Vital signs - Weight Assessment Triggered when patient does not have height or weight recorded in Vital Signs template. Laboratory tests and values - Prenatal screening for HBV Triggered when a diagnosis of pregnant is added through Physician Problem List for patient and no record of HBV infection screening displays in patient's Order Chronology. Medication list - Medication Review Triggered when some home meds have been updated through Medication Reconciliation, but discharge medication reconciliation has not been performed. Vital signs - Body Mass Index Screening and Follow-up Triggered when patient does not have height or weight recorded within the past six months through Vital Signs template. Demographics - Date of Birth not addressed Triggered when patient's date of birth has not been entered through their demographics. Problem list and laboratory tests - Appropriate Testing for Pharyngitis Triggered when a diagnosis of pharyngitis is added through Physician Problem List for a patient who is between 2-18 years and who does not have a positive Streptococcus screening lab test ordered through Order Chronology. Laboratory tests and values - Incomplete Clinical Result Triggered when the patient has at least one laboratory test since last visit that is incomplete in Order Chronology. Medication allergy list - Allergy List not addressed Triggered if the patient's allergy list has not been addressed. *Note: Once an alert has been activated, it cannot be deactivated. Revision Date: 08/26/2016 8
Auditing: For each CDS Alert, the system will track when changes are made to the alerts. (Pathway: Table Maintenance > Clinical > CDS Alert Configuration > Choose Alert > Status History) Set-Up for Measure 2: Clinical Monitoring must be set up. Table Maintenance > Clinical tab > Prescription Entry: Clinical Monitoring The following CM Options will need to be checked under General Settings: Use Clinical Monitoring (The site will decide which Interaction Filtering options will be used.) Allergy Checking Drug Interaction Checking The site will be responsible for deciding whether or not Overrides will be required by the facility. Auditing: For each Clinical Monitoring category, the system will track when the alerts are activated/inactivated (Table Maintenance > Clinical > Under Prescription Entry: Clinical Monitoring > General Settings > View Audit). How to achieve Objective: This objective is met with real time alerting of the system based on a CDS alert and configurations and clinical monitoring options that are set up above. Evident has provided a default set of rules to be used (5 of the above) that meet the CMS criteria. The EHR must also have the ability to offer diagnostic or therapeutic reference information based on Problems, Medications, Medication Allergies, Laboratory Tests/Values, and Vital Signs and a combination option. This will be achieved with the use of the InfoButton. Drug-Drug, Drug-Allergy must be used in addition to the 5 CDS alerts to meet this objective. For auditing purposes, retain a copy of all alerts activated and the status history/view audit to show alerts were on for the entire reporting period for auditing purposes. *Note: If clinical monitoring was turned on prior to loading V19, a screenshot of the Clinical Monitoring Audit screen should be saved along with documentation/screenshot of when the V19 release was received. Evident can assist with this information. Exclusion: For the second measure, any EP who writes fewer than 100 medication orders during the EHR reporting period. Revision Date: 08/26/2016 9
Patient Electronic Access (View, Download Transmit) (must meet 2 measures) 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. Measure 1: More than 50 percent of all unique patients seen by the EP during the EHR reporting period are provided timely (available to the patient within 4 business days after the information is available to the EP) access to view online, download and transmit to a third party their health information subject to the EP s discretion to withhold certain information. Measure 2 for EHR reporting period in 2016: At least one patient seen by the EP during the EHR reporting period (or their authorized representatives) views, downloads or transmits to a third party their health information. Measure 2 for EHR reporting period in 2017: More than 5 percent of unique patients seen by the EP during the EHR reporting period (or their authorized representatives) view, download or transmit to a third party their health information. Applications needed to meet Objective: Patient Portal CCD Patient Summary Subscription Direct Messaging Addresses with Direct Address Thrive Provider EHR Set-Up for Objective: Measure 1: Set up Release of Information tables via Medical Records. Create requestor Code for Request Cd for Patient request. Create Purpose Code for Purpose Cd for Patient Possesses Info to Access Portal. Update ROI Control Table with Requestor Type and Purpose Code in the appropriate fields. The Release of Information Control Record needs to be setup prior to the beginning of the attestation period. In addition, the Control Record should not be changed during the attestation period as this could affect statistics for this measure. Create a custom Patient Education Document to provide the patient all of the necessary instructions and information needed to view, download, or transmit their information. This document must be attached to the ROI code for "Patient Possesses Info to Access Portal" that is set up in the ROI Control Table in the clinic facility. Revision Date: 08/26/2016 10
Pathway to create the document: First must be logged in to the hospital facility and in the Nursing Administration department. > Hospital Base Menu > Print Reports > Patient Education Maintenance > Create a New Document > Type in a Category > Enter > Type additional categories or enter through to Name1 field > Enter title of document > Enter > Enter additional titles or enter through the remaining fields > Select a, b, c, d, or e for desired document type > Edit > Y > Enter instructions in Word document > Save/Exit from Evident tab. Pathway to add ROI code: First must be logged in to the clinic facility. > Base Menu > Master Selection > Business Office Tables > Table Maintenance > Clinical > Patient Education Maintenance: Document Maintenance > Search for and double-click on document > Add Code > Enter ROI code for "Patient Possesses Info to Access Portal" in the ROI field (type exactly as it appears in the ROI Control Table) > Save. *Note: that this option will only assist with meeting Measure 1. The patient must still access their Patient Portal to view, download, or transmit their information to meet Measure 2. How to achieve Objective: Measure 1: The patient must be discharged from the Tracking Board and must have a discharge code entered in for the patient to pull to the statistics report. This measure can be met in one of three ways: Enter the patient s valid email address in the Email field in Person Profile prior to the visit being created. Patient s visit must be discharged. Once the patient is discharged they will be sent an introductory email to create a login name and user password. They will then be able to view their patient/clinical summary (or CCD) on the Patient Portal. After the patient has a login name and user password the Patient Portal can be accessed via http://www.thrivepatientportal.com. The authorized representative entered in the Census Visit screen will also have access to the Patient Portal, giving the authorized representative access to the clinical information for the patient (visit they were the authorized representative on). The site should verify the authorized representative on each visit created. Assist the patient with creating a login for Patient Portal and accessing their information. Pathway: Base Menu > Profile Listing > Select Patient > Select Visit > Patient Charting > Patient Portal > Fill out New User Registration and verify the information > Register > Enter security questions > Submit. Pathway: Tracking Board > Name > Select Patient > Select Visit > Health Information Resource > Patient Portal > Fill out New User Registration and verify the information> Register > Enter security questions > Submit. Revision Date: 08/26/2016 11
Provide the patient instructions on how to access the portal through an education document. Pathway: Base Menu > Profile Listing > Select Patient > Select Visit > Patient Charting > Narrative > Education > Search for and select document > View or Print > Select Document > Process NOTE: If Exclude from Portal is checked on a patient s account, the account will not display on the portal. That account will only count in the denominator. Measure 2: The patient or the patient's authorized representative will log in to the Patient Portal. They will choose a visit and either view, download or transmit their patient/clinical summary (or CCD). Measure 1: DENOMINATOR: Number of unique patients seen by the EP during the EHR reporting period. Unique patients discharged during the reporting period. NUMERATOR: The number of patients in the denominator who have access to view online, download and transmit their health information within 4 business days after the information is available to the EP. Unique patients who have been provided access within 4 business days to their health information. Measure 2: DENOMINATOR: Number of unique patients seen by the EP during the EHR reporting period. Unique patients discharged during the reporting period NUMERATOR: The number of unique patients (or their authorized representatives) in the denominator who have viewed online, downloaded, or transmitted to a third party their health information. Unique patients in the denominator who have done one of the following: Viewed Online Downloaded Transmitted CCD-Patient Summary to a 3 rd Party. Exclusion: Any EP who: (1) Neither orders nor creates any of the information listed for inclusion as part of both measures, except for "Patient name" and "Provider's name and office contact information, may exclude both measures. (2) Conducts 50 percent or more of his or her patient encounters in a county that does not have 50 percent or more of its housing units with 3Mbps broadband availability according to the latest information available from the FCC on the first day of the EHR reporting period may exclude only the second measure. Revision Date: 08/26/2016 12
Patient-Specific Education Use clinically relevant information from Certified EHR Technology to identify patient-specific education resources and provide those resources to the patient. Measure: Patient-specific education resources identified by CEHRT are provided to patients for more than 10 percent of all unique patients with office visits seen by the EP during the EHR reporting period. Applications needed to meet Objective: Patient Education Documents Info Button Thrive Provider EHR Set-Up for Objective: The patient must have a medication, problem, and/or a lab documented in their patient chart. How to achieve Objective: This objective will be met by the use of Patient Education Documents and Clinical Knowledge button. When an education document is given and saved, this will be recorded onto the patient's account. Patient Education documents must be linked to a patient's problem, lab test ordered on visit, or related to a medication the patient is on or have been given to count for this objective. Custom education documents can also be used to meet this objective if your custom document is tied to a lab test, problem via the classification code area (patient education maintenance) in table maintenance (clinical, update user defined documents). The above noted are the only documents that will count in the numerator for this measure. Measure Calculation: DENOMINATOR: Number of unique patients with office visits seen by the EP during the EHR reporting period Number of Unique patients seen by the EP during the reporting period. NUMERATOR: Number of patients in the denominator who were provided patient-specific education resources identified by the EHR technology Number of patients in the denominator what were provided one of the following patient education documents: Education based on Problem List Education based on Patient's Lab Test Education based on Patient Drug Information Exclusion: Any EP who has no office visits during the EHR reporting period. Revision Date: 08/26/2016 13
Medication Reconciliation The EP who receives a patient from another setting of care or provider of care or believes an encounter is relevant should perform medication reconciliation. Measure: The EP who performs medication reconciliation for more than 50 percent of transitions of care in which the patient is transitioned into the care of the EP. Applications needed to meet Objective: Medication Management Thrive Provider EHR Set-Up for Objective: Tables for Medication Reconciliation are found via the following path: Clinic Base Menu > Master Selection > Business Office Tables > Table Maintenance > Clinical > Under Medication Reconciliation > Destinations AND Clinic Base Menu > Master Selection > Business Office Tables > Table Maintenance > Clinical > Prescription Entry. The following need to be setup: Medication Reconciliation Destinations Discontinue Reasons Doses Routes Frequencies Modifiers Pharmacies Units Zip Codes All Pharmacy Medication items must have accurate and up-to-date NDC Numbers. Direct Messaging must be purchased in order to perform clinical reconciliation. If a provider would like each encounter to count toward medication reconciliation they can select the option via the following path: Base Menu > Master Selection > Business Office Tables > Table Maintenance > Control > Physicians > Select Physician > MU Tab > Select Include all encounters for medication reconciliation Revision Date: 08/26/2016 14
How to achieve Objective: This objective will be met by perform medication reconciliation and/or clinical reconciliation. Path for Medication Reconciliation: Tracking Board > Select Patient > Medication Reconciliation > Select Destination from dropdown > Select pending action for each medication > Select Reconcile. Path for Clinical Reconciliation (For TOC): Tracking Board > Select Patient > Health Information Resources > Import from Inbox > Select Patient Document from Inbox > Import > Select Allergies > Select allergies to import, keep, or remove > Select Review > Select Reconcile > Select Problem List > Select problems to import, keep, or remove > Select Review > Select Reconcile > Select Medication Reconciliation > Select medications to import, keep, or remove > Select Review > Select Reconcile. *Note: As soon as the Reconcile button is selected, an entry is created in the Med Rec History, and the numerator is met. Measure Calculation: DENOMINATOR: Number of transitions of care during the EHR reporting period for which the EP was the receiving party of the transition. Number of transitions of care during the reporting period where the EP was the receiving party of the transition. NUMERATOR: The number of transitions of care in the denominator where medication reconciliation was performed. Number of admissions and discharges in the denominator where medication reconciliation was performed (Reconcile). Exclusion: Any EP who was not the recipient of any transitions of care during the EHR reporting period. Health Information Exchange (Summary of Care) The EP who transitions their patient to another setting of care or provider of care or refers their patient to another provider of care should provide summary care record for each transition of care or referral. Measure: The EP who transitions or refers their patient to another setting of care or provider of care that uses CEHRT to create a summary of care record must electronically transmit the summary of care record to a recipient for more than 10% of such transitions and referrals. Revision Date: 08/26/2016 15
Applications needed to meet Objective: Thrive Provider EHR Electronic File Management Direct Messaging with Direct Address Clinical Vocabulary Clinical Monitoring Medication Management Set-Up: The patient must be discharged. SNOMED Codes must be added to the following to pull to the CCD: Lab Items (Reference Range Table) Rad/Respiratory Items/Procedures (Item Master) Micro Items (Infection Control) The patient must have a referral entered in their patient chart Path to enter referral: Select Visit > Once on Virtual Chart > Health History > New > Referral/Transition of Care > Select Provider > Select Appointment Date > Save. Set up the following in Release of Information System via Medical Records: Purpose code for complete summary of care has to be set up in Release of Information. Purpose code (created above) has to be entered in Release of Information Control Table: Purpose Cd for Complete Patient Summary Sent for Transfer/Referral field. Purpose code for incomplete summary of care has to be set up in Release of Information. Purpose code (created above) has to be entered in Release of Information Control Table: Purpose Cd for Incomplete Summary Sent for Transfer/Referral field. MU Due Date to reflect business days. Each facility will have to go through onboarding for Direct Messaging. In order to receive a Direct Messaging Address, an order must be placed with Evident and your system configured. Once this is done by Evident, your facility will receive an email to explain the onboarding process with Inpriva (our 3rd Party HISP). NOTE: Inpriva is a fully accredited DirectTrust HISP. As such, the exchange of Direct Messages must be to/from other DTAAP accredited HISPs. Revision Date: 08/26/2016 16
Inpriva will assign your facility a Direct Messaging Address. Once that address is received, it should be placed in the following location: Pathway: Base Menu > Master Selection > Business Office Tables > Table Maintenance > B.O. > Under Insurance select Clinic Table > Select a Clinic > Direct Address. The accepting provider that will be receiving the referral or summary of care can be pre-defined and set up in the following table: Base Menu > Master Selection > Business Office Tables > Table Maintenance > Business Office > Referring Physician. How to achieve Objective: When a patient is transferred to another facility, Problems, Medications, Medication Allergies must be entered on the patient s account in order to meet the objective. Referral/Transition of Care widget is accessed and recorded for your patient to be in the denominator. Submit to Provider is chosen. This creates a Release of Information (ROI) entry for the patient in the Release of Information Application. All Summary of Care documents used to meet this objective must include the following information (if known) upon sending. Patient Name Referring or Transitioning provider s name and office contact information Procedures Encounter Diagnosis Immunizations Laboratory Test Results Vital Signs (height, weight, blood pressure and BMI) Smoking Status Functional Status (including activities of daily living), Cognitive Status and Disability Status Demographic Information (preferred language, sex, race, ethnicity, and date of birth) Care Plan Field (including goals and instructions) Care Team (including primary care provider and record of any additional known care team members beyond referring and transitioning provider and receiving provider) Reason for Referral Revision Date: 08/26/2016 17
In circumstances where there is no information available to populate one or more of the fields listed (either because it is not known or EP can be excluded from recording such information), the fields may be left blank and still meet the objective and its associated measures. *Note: The provider to whom the referral is made or to whom the patient is transitioned must have either a different National Provider Identifier (NPI) OR hospital CMS Certification Number (CCN) AND must be sent a summary of care document to count in the numerator. Measure Calculation: DENOMINATOR: Number of transitions of care and referrals during the EHR reporting period for which the EP was the transferring or referring provider. Number of discharges where the transfer/referral widget was addressed or number of discharges where the follow up care question was addressed. NUMERATOR: Number of transitions of care and referrals in the denominator where a summary of care record was created using Certified EHR Technology and is exchanged electronically. Number of discharges where the following was done: Transfer/Referral Documented (see above) Physician Problem List Addressed via Problem List Application Medication List Addressed via Medication Reconciliation/Profile Medication Allergy List Addressed Transfer of Care/Referral Summary is chosen from the virtual chart Submit to Provider is chosen and sent to another provider through Direct Messaging. *Note: Inpriva is a fully accredited DirectTrust HISP. As such, the exchange of Direct Messages must be to/from other DTAAP accredited HISPs. Once your CCD-Transfer Summary/Referral is successfully sent, there is an indication of Success in the CCDA transmission log. The path to this log is found via the following path: Server Menu > Special Functions > Audit Log > EPHI Audit Logs> CCDA Transmission Log. Users of the EHR will have the ability to control what is sent in the CCD document electronically to a provider. This can be achieved by building the Patient Summary/CCD via Print Electronic Record, selecting edit and choosing the information you would like to include/exclude and save document. This will save a version of the document in Print Electronic Record and Electronic File Management with the changes that have been made to the document. The most recently edited version will be sent when electronically exchanging a document. Exclusion: Any EP who transfers a patient to another setting or refers a patient to another provider less than 100 times during the EHR reporting period is excluded from all three measures. Revision Date: 08/26/2016 18
Secure Electronic Messaging Use secure electronic messaging to communicate with patients on relevant health information. Measure for 2016 EHR Reporting Period: For at least 1 patient seen by the EP during the EHR reporting period, a secure message was sent using the electronic messaging function of CEHRT to the patient (or the patient authorized representative), or in response to a secure message sent by the patient (or the patient authorized representative). Measure for 2017 EHR Reporting Period: For more than 5 percent of unique patients seen by the EP during the EHR reporting period, a secure message was sent using the electronic messaging function of CEHRT to the patient (or the patient authorized representative), or in response to a secure message sent by the patient (or patient authorized representative). Applications needed to meet Objective: Thrive Provider EHR Patient Portal with Secure Messaging Set-Up for Objective: Patient must have a visit with the EP. Patient must have a Patient Portal login setup. Each provider number can only be attached to one UBL. EP may set up a folder on their Home Screen for Secure Messages. Pathway: Home Screen > New > Enter a Name and Description (example: Secure Messaging) > Under Select Options, select the green icon next to Task Type > Under Configure Items, Select Task Type > Secure Patient Message > Insert > OK > Select the back arrow to return to the Home Screen. How to achieve Objective: EP must send a new secure electronic message to the patient (or patient s authorized representative) or respond to a secure message sent by the patient (or patient s authorized representative). Pathway for EP to send a secure message to the patient: Tracking Board > Select Patient > Select Communication > Secure Messaging > Select Patient or Patient s Authorized Representative > Continue > Enter Subject and Message > Send. Pathway for patient to send a secure message to the provider: Internet Explorer > Type address www.thrivepatientportal.com > Log in with username and password > Message Center > Select the pencil in the upper right hand corner > Enter Subject and Message > Send. Revision Date: 08/26/2016 19
Measure Calculation: DENOMINATOR: Number of unique patients seen by the EP during the EHR reporting period Number of unique patients with a visit that is admitted and discharged during the reporting period. NUMERATOR: Number of Patients or patient-authorized representatives in the denominator who were sent a secure electronic message from the EP using the electronic messaging function of the CEHRT during the EHR reporting period. Number of patients or authorized representatives with visit in the denominator that were sent an electronic message from the EP during the reporting period. Exclusion: An EP who has no office visits during the EHR reporting period, or any EP who conducts 50 percent or more of his or her patient encounters in a county that does not have 50 percent or more of its housing units with 3Mbps broadband availability according to the latest information available from the FCC on the first day of the EHR reporting period. Protect Patient Health Information (Protect Electronic Health Record) Protect electronic health information created or maintained by the certified EHR technology (CEHRT) through the implementation of appropriate technical capabilities. Measure: Conduct or review a security risk analysis in accordance with the requirements under 45 CFR 164.308(a)(1) and implement security updates as necessary and correct identified security deficiencies as part of its risk management process. Applications needed to meet Objective: Assessment of current disk storage utilization with possible additional storage required How to achieve Objective: A review must be conducted each reporting period and any security updates and deficiencies that are identified should be included in the risk management process and implemented or corrected as dictated by that process. Review the guidance from the OCR regarding compliance with HIPAA Security Rule. This objective will be supported through installation and utilization of the following functionalities: Encryption Enabled by default for data in use. Cannot be disabled. EPs are recommended to keep a record of the date site installs V19 as that is the first date that Encryption is enabled by default. Revision Date: 08/26/2016 20
Run the Patient Audit Log report routinely in order to ensure the appropriateness of access to EPHI by authorized users. Document any changes made resulting from the review. Path: Clinic Base Menu > Other Applications and Functions > Word Processing > Ad Hoc Report > Report Dashboard > Add Report > Patient Audit Log. Allow Emergency Access to PHI Path to allow a physician Emergency Access to PHI: Special Functions > System Security > Physician Security > Emergency Access to PHI checkbox. Path to allow employee Emergency Access to PHI: Special Functions > System Security > Employee Security > Emergency Access to PHI set to Y. Attestation Requirements: YES /NO (EPs) must attest YES to having conducted or reviewed a security risk analysis in accordance with the requirements under 45 CFR 164.308(a)(1) and implemented security updates as necessary and corrected identified security deficiencies prior to or during the EHR reporting period to meet this measure. For more information on securing EPHI using V19, review the Security Objective & Measure Roadmap. TruBridge offers Security Risk Analysis (SRA) Services that are designed to assist sites in complying with the HIPAA Security Rule. For more information on this service, please contact your TruBridge Account Manager. Public Health Reporting (must meet two measures) The eligible professional is in active engagement with a Public Health Agency (PHA) to submit electronic public health data from certified EHR technology, except where prohibited and in accordance with applicable law and practice. CMS states that active engagement may be demonstrated by any of the following options: Completed registration to submit data The EP has registered to submit data with the PHA or, where applicable, the CDR to which the information is being submitted; registration was completed within 60 days after the start of the reporting period and not on the first day of the reporting period; and the EP is awaiting an invitation from the PHA or CDR to begin testing and validation. Testing and validation The EP is in the process of testing and validation of the electronic submission of data. Providers must respond to requests from the PHA or CDR within 30 days; failure to respond twice within an EHR reporting period would result in that provider not meeting the measure. Production The EP has completed testing and validation of the electronic submission and is electronically submitting production data to the PHA or CDA. Revision Date: 08/26/2016 21
EPs are required to choose from Measures 1 through 3 and are required to successfully attest to any combination of two measures. An exclusion for a measure does not count toward the total of two measures. In order to meet this objective, an EP would need to meet two of the total number of measures available to them. If the EP qualifies for multiple exclusions and the remaining number of measures available to the EP is less than two, the EP can meet the objective by meeting the one remaining measure available to them and claiming the applicable exclusions. If no measures remain available, the EP can meet the objective by claiming applicable exclusions for all measures. Please note: a minimum of a 90-day lead time is required for all interfaces. Measure 1: Immunization Registry Reporting The EP is in active engagement with a public health agency to submit immunization data. Applications needed to meet Measure: Immunization Interface Thrive Provider EHR Attestation Requirements: YES / NO / EXCLUSION A record of transmissions will need to be retained for auditing purposes. Set-Up for Measure: Interface must be setup. The Pharmacy department number and Clinic/Nursing department number need to be loaded as issuing departments for the immunization item. Pathway: Base Menu > Master Selection > Business Office Tables > Table Maintenance > Control > Materials Management: Item Master > Search for item > Double-click on item > Enter department number in Issuing Departments > Save. The correct NDC/Manufacturer needs to be loaded on the immunization item. Pathway: Base Menu > Master Selection > Business Office Tables > Table Maintenance > Control > Materials Management: Item Master > Search for item > Select item > Pharmacy Information > Selecting NDC from magnifying glass lookup will automatically load Manufacturer > Save. Each vaccine item must have the appropriate CDC common procedural term (CPT) code attached. Pathway: Base Menu > Master Selection > Business Office Tables > Table Maintenance > Control > Materials Management: Item Master > Search for item > Double-click on item > Enter CPT code in Default FC CPT Code field > Save. Revision Date: 08/26/2016 22
CPT code needs to be marked as an immunization and mapped to the appropriate CVX code. If a CPT code is currently referenced to an inactive CVX code, ensure that it is disassociated. For combination immunizations, individual CVX codes need to be added to the combo CVX code in the Immunization Table. Pathway: Base Menu > Business Office Tables > Business Office Table Maintenance > Diagnosis Codes > CPT Table Maintenance > Type in CPT Code > Enter > Type an uppercase A > Enter > Select Vaccine checkbox and associate CVX Code using magnifying glass lookup > Save. Any route that can be used in an immunization order must have an HL7 code attached. Pathway: Base Menu > Master Selection > Business Office Tables > Table Maintenance > Clinical > Pharmacy Control: Route Table > Double-click on route > Attach the appropriate HL7 code from the magnifying glass lookup > Save. Any unit that can be used in an immunization order must have a UCUM code attached. Pathway: Base Menu > Master Selection > Business Office Tables > Table Maintenance > Clinical > Pharmacy Control: Units Table > Double-click on unit > Attach the appropriate UCUM code from the binoculars lookup > Save. Any site that is approved for the administration of an immunization must have a Standard Site Code attached. Pathway: Base Menu > Master Selection > Business Office Tables > Table Maintenance > Clinical > Nursing: Site Options Table > Double-click on site > Attach the appropriate Standard Site Code from the magnifying glass lookup > Save. If site-specific omit reasons need to be added, they must be attached to Immunization Refusal Reason Codes. Refusal Reason Codes: 00 - Parental Decision 01 - Religious Exemption 02 - Other 03 - Patient Decision Pathway: Base Menu > Master Selection > Business Office Tables > Table Maintenance > Clinical > Nursing: Omit Reasons Table > New > Enter Description > Choose Immunization Refusal Reason Code > Save. If participating in the Vaccines for Children program, the VFC Status table must be loaded with the following codes: V00 V01 V02 V03 V04 VFC Eligibility not determined/unknown Not VFC eligible VFC Eligible Medicaid/Medicaid Managed Care VFC Eligible Uninsured VFC Eligible American Indian Alaskan Native Revision Date: 08/26/2016 23
V05 V06 V07 VFC Eligible Federally Qualified Health Center Patient (under insured) VFC Eligible State specific eligibility VFC Eligible Local-Specific eligibility Pathway: Base Menu > Master Selection > Business Office Tables > Table Maintenance > Clinical > Pharmacy Control: VFC Status Table > New > Type in VFC Status Code and Description > Save. How to achieve Measure: Order and administer immunizations through Thrive Provider EHR. Maintain an up-to-date Immunization Record by adding historical immunizations to the Immunization Record. *Note: To electronically submit, an interface is required. Please complete an Interface Request Form and contact your Evident Sales Account Manager to initiate the development for your facility. Evident s Interface department will need a minimum of a 90-day lead time to set up the interface for the selected registry. Evident s Interface department will contact you to implement an interface with ongoing submission achieved. Exclusions: Any EP that meets one or more of the following criteria may be excluded from this measure: (1) Does not administer any of the immunizations to any of the populations for which data is collected by their jurisdiction's immunization registry or immunization information system during the EHR reporting period; (2) Operates in a jurisdiction for which no immunization registry or immunization information system is capable of accepting the specific standards required for CEHRT at the start of their EHR reporting period; (3) Operates in a jurisdiction where no immunization registry or immunization information system provides information timely on capability to receive immunization data; or (4) Operates in a jurisdiction for which no immunization registry or immunization information system that is capable of accepting the specific standards required by CEHRT at the start of their EHR reporting period can enroll additional EPs. Revision Date: 08/26/2016 24
Measure 2: Syndromic Surveillance Reporting The EP is in active engagement with a public health agency to submit syndromic surveillance data. Applications needed to meet Measure: Syndromic Surveillance Interface Clinical Vocabulary Thrive Provider EHR Set-Up for Measure: Must enter chief complaint (confirm with Health Information Exchange on required format of submissions: free text vs coded chief complaints) *Note: To electronically submit, an interface is required. Please complete an Interface Request Form and contact your Evident Sales Account Manager to initiate the development for your facility. Evident s Interface department required a minimum of a 90-day lead time to set up the interface for the selected registry. If choosing this measure, Evident Interface department will contact you to implement an interface with ongoing submission achieved. How to achieve Measure: This measure is met by entering in required state-specific information on a patient account (such as chief complaint, working and final diagnosis) to be transmitted. Evident suggests making Chief Complaint a required field from Census. Chief Complaint and Working Diagnosis can be accessed via MISC dropdown from Visit Screen. To electronically submit, an interface is required. Please complete an Interface Request Form and contact your Evident Sales Account Manager to initiate the development for your facility. A record of transmissions will need to be retained for auditing purposes. Exclusion: Any EP that meets one or more of the following criteria may be excluded from this measure: (1) The EP is not in a category of providers that collect ambulatory syndromic surveillance information on their patients during the EHR reporting period; (2) The EP operates in a jurisdiction for which no public health agency is capable of receiving electronic syndromic surveillance data in the specific standards required by CEHRT at the start of their EHR reporting period; or (3) The EP operates in a jurisdiction for which no public health agency has declared readiness to receive syndromic surveillance data from EPs at the start of the EHR reporting period. Revision Date: 08/26/2016 25