Stage 2 Eligible Professional Meaningful Use Core and Menu Measures. User Manual/Guide for Attestation using encompass 3.0

Stage 2 Eligible Professional Meaningful Use Core and Menu Measures User Manual/Guide for Attestation using encompass 3.0 Prepared By: Arête Healthcare Services, LLC Document Version: V1.0 9/02/2015

Eligible Professional Core Objectives, Measures, and Exclusions & Eligible Professional Meaningful Use Menu Set Measures Issued by Centers for Medicare & Medicaid Services (CMS) in October 2012 and November 2014* And How Eligible Provider/s (EPs) Attest to Them In the Use of the Electronic Health Record (EHR) Using encompass 3.0 There are 17 Meaningful Use Core Measures that must be passed, unless you, the Eligible Professional (EP) fall into a category that excludes you/your practice from a measure. There are six Meaningful Use Menu Set Measures, of which you, the EP, must meet at least three. The following information provided in this manual instructs you/your practice on how to pass/ avoid failing, and/or how you/your practice might be excluded from the following measures. For the full document/requirements, and/or for further definitions of these rulings, please visit: http://www.cms.gov/regulations-and- Guidance/Legislation/EHRIncentivePrograms/Downloads/Stage2_MeaningfulUseSpecSheet_TableCont ents_eps.pdf Disclaimer: It is the responsibility of the provider to perform the necessary actions that are described below in order to build attestation numbers that will pass each measure. User Manual/Guide for Attestation using encompass 3.0 v1.0 2

Contents Core Measure 1 of 17: Computerized Provider Order Entry (CPOE) for Medication, Laboratory, and Radiology Orders... 4 Measure 1: Medication... 4 Measure 2: Radiology... 5 Measure 3: Laboratory... 5 Core Measure 2 of 17: Generate and Transmit Permissible Prescriptions Electronically (erx)... 6 Core Measure 3 of 17: Record Demographics... 7 Core Measure 4 of 17: Record Vital Signs... 8 Core Measure 5 of 17: Record Smoking Status... 9 Core Measure 6 of 17: Clinical Decision Support Rule... 10 Core Measure 7 of 17: Patient Electronic Access... 11 Measure 1: Patient Access... 11 Measure 2: View, Download Transmit (VDT)... 12 Core Measure 8 of 17: Clinical Summaries... 13 Core Measure 9 of 17: Protect Electronic Health Information... 14 Core Measure 10 of 17: Clinical Lab-Test Results... 14 Core Measure 11 of 17: Patient Lists... 16 Core Measure 12 of 17: Preventive Care... 16 Core Measure 13 of 17: Patient-Specific Education Resources... 18 Core Measure 14 of 17: Medication Reconciliation... 19 Core Measure 15 of 17: Summary of Care... 20 Measure A:... 21 Measure B:... 22 Core Measure 16 of 17: Immunization Registries Data Submission... 23 Core Measure 17 of 17: Use Secure Electronic Messaging... 24 Menu Measure 1 of 6: Syndromic Surveillance Data Submission*... 26 Menu Measure 2 of 6: Electronic Notes*... 27 Menu Measure 3 of 6: Imaging Results... 28 Menu Measure 4 of 6: Family Health History... 29 Menu Measure 5 of 6: Report Cancer Cases*... 29 Menu Measure 6 of 6: Report Specific Cases*... 30 Quick Guide for encompass 3.0 MU Measures... 31 *designates Menu Measure issued in November, 2014 User Manual/Guide for Attestation using encompass 3.0 v1.0 3

Core Measure 1 of 17: Computerized Provider Order Entry (CPOE) for Medication, Laboratory, and Radiology Orders Objective: 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 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. Exclusion: Any EP who writes fewer than 100 medication, radiology, or laboratory orders during the EHR reporting period. Measure 1: Medication Stage 2 60% Numerator The number of medication orders in the denominator recorded using CPOE Number of medication orders created by an EP during the EHR reporting period Stage 1 30% Numerator The number of patients in the denominator that have at least one medication order entered using CPOE Alternative Numerator (Effective 2013-Onward): Number of medication orders in the denominator recorded using CPOE Number of unique patients with at least one medication in their medication list seen by the EP during the EHR reporting period Alternative (Effective 2013-Onward): Number of medication orders created by an EP during the EHR reporting period Measure Criteria: The number of medication orders created during the reporting period. 1. Click Add from the medications section toolbar in the patient s chart. 2. The Chart Cart will pop up with the patient's name. If ChartCart is already open, click on the Rx tab. 3. Find and add medication. 4. Review your medications in ScriptPad and sign them. Any unsigned medication(s) increase(s) the denominator only. The medication order must be signed to count towards the numerator for Stage 2 Meaningful Use. The addition of active or stopped medication(s) in patients' records will not count toward this measure. User Manual/Guide for Attestation using encompass 3.0 v1.0 4

Measure 2: Radiology Stage 2 30% Numerator The number of radiology orders in the denominator recorded using CPOE Stage 1 N/A Number of radiology orders created by an EP during the EHR reporting period Measure Criteria: The number of radiology orders created during the reporting period. 1. Click Create -> Order from the toolbar on the patient's chart. 2. The Chart Cart will pop up with the patient's name. 3. Find and add the radiology order. 4. Review your orders in ScriptPad and sign them. If ChartCart is already open, click on the Ords tab. Radiology orders will display as. Any unsigned order(s) increase(s) the denominator only. The radiology order must be signed to count towards the numerator for Stage 2 Meaningful Use. Measure 3: Laboratory Stage 2 30% Numerator The number of laboratory orders in the denominator recorded using CPOE Stage 1 N/A Number of laboratory orders created by an EP during the EHR reporting period Measure Criteria: The number of laboratory orders created during the reporting period. 1. Click Create -> Order from the toolbar on the patient's chart. 2. The Chart Cart will pop up with the patient's name. 3. Find and add the laboratory order. 4. Review your orders in ScriptPad and sign them. If ChartCart is already open, click on the Ords tab. Laboratory orders will display as. Any unsigned order(s) increase(s) the denominator only. The radiology order must be signed to count towards the numerator for Stage 2 Meaningful Use. User Manual/Guide for Attestation using encompass 3.0 v1.0 5

Core Measure 2 of 17: Generate and Transmit Permissible Prescriptions Electronically (erx) Objective: Generate and transmit permissible prescriptions electronically (erx). Measure: More than 50 percent of all permissible prescriptions, or all prescriptions, written by the EP are queried for a drug formulary and transmitted electronically using CEHRT. Exclusion: Any EP who: (1) Writes fewer than 100 permissible prescriptions during the EHR reporting period. (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. Stage 2 50% Numerator The number of prescriptions in the denominator generated, queried for a drug formulary and transmitted electronically using CEHRT. Number of prescriptions written for drugs requiring a prescription in order to be dispensed other than controlled substances during the EHR reporting period; or Number of prescriptions written for drugs requiring a prescription in order to be dispensed during the EHR reporting period. Stage 1 40% Numerator The number of prescriptions in the denominator transmitted electronically. Number of prescriptions written for drugs requiring a prescription in order to be dispensed other than controlled substances during the EHR reporting period. Select the Transmit option in ScriptPad for each medication prescription. Controlled substances are included in the denominator for Stage 2 but not for Stage 1. User Manual/Guide for Attestation using encompass 3.0 v1.0 6

Core Measure 3 of 17: Record Demographics Objective: Record the following demographics: preferred language, sex, race, ethnicity, date of birth. Measure Criteria: More than 80 percent of all unique patients seen by the EP have demographics recorded as structured data. Exclusion: No exclusion. Stage 2 80% Numerator The number of patients in the denominator who have all the elements of demographics (or a specific notation if the patient declined to provide one or more elements or if recording an element is contrary to state law) recorded as structured data. Stage 1 50% Numerator Same as Stage 2. Same as Stage 2. Number of unique patients seen by the EP during the EHR reporting period. The patient s chart must contain the information below: preferred language sex race ethnicity date of birth 1. Click on the Patient Image -> Edit from the patient's chart to open the Patient Details editor. 2. Enter in the information. 3. Click Save. If Patient Details editor is already open, select the Demographics tab. Race can have multiple values for patients of mixed racial background. Multiple selections can be made by holding down the control (Ctrl) key on your keyboard while clicking. Demographics can be recorded before, during, or even after the reporting period. Some demographic elements may come from a billing system and must be set there, typically sex/gender and date of birth. User Manual/Guide for Attestation using encompass 3.0 v1.0 7

Core Measure 4 of 17: Record Vital Signs Objective: Record and chart changes in the following vital signs: height/length and weight (no age limit); blood pressure (ages 3 and over); calculate and display body mass index (BMI); and plot and display growth charts for patients 0-20 years, including BMI. Measure: More than 80 percent of all unique patients seen by the EP have blood pressure (for patients age 3 and over only) and/or height and weight (for all ages) recorded as structured data. Exclusion: Any EP who: (1) Sees no patients 3 years or older is excluded from recording blood pressure. (2) 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. (3) Believes that height/length and weight are relevant to their scope of practice, but blood pressure is not, is excluded from recording blood pressure. (4) 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. Stage 2 80% Numerator Number of patients in the denominator who have at least one entry of their height/length and weight (all ages) and/or blood pressure (ages 3 and over) recorded as structured data. Number of unique patients seen by the EP during the EHR reporting period. Stage 1 50% Numerator If height/length, weight, and blood pressure (all) within scope of practice (Optional 2013; Required effective 2014). Number of unique patients seen by the EP during the EHR reporting period. 1. Click Add from the vitals section toolbar in the patient s chart to open the Vitals editor. 2. Enter the information in the Vitals editor. 3. Click Save. If you meet exclusion (3) or (4) you must attest to the exclusion and attest to the remaining parts of either measure. User Manual/Guide for Attestation using encompass 3.0 v1.0 8

Core Measure 5 of 17: Record Smoking Status Objective: Record smoking status for patients 13 years and older. (Age determined on date of visit) Measure: More than 80 percent of all unique patients 13 years or older seen by the EP have smoking status recorded as structured data. Exclusion: Any EP that neither sees nor admits any patients 13 years or older. Stage 2 80% Numerator The number of patients in the denominator with smoking status recorded as structured data. Stage 1 50% Numerator Same as Stage 2. Same as Stage 2. Number of unique patients age 13 or older seen by the EP during the EHR reporting period. 1. Click on the Conditionals section just below the Create button on the patient s chart to open the Patient Details editor. 2. Select a Smoking Status using the drop-down box. 3. Click Save. If Patient Details editor is already open, select the Conditionals tab. Selecting a rate is optional, but does not qualify for meeting this measure. Smoking status can be recorded before, during, or even after the reporting period. User Manual/Guide for Attestation using encompass 3.0 v1.0 9

Core Measure 6 of 17: Clinical Decision Support Rule Objective: 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. If none of the CQMs are applicable to an EP's scope of practice, the EP should implement CDS interventions that he or she believes will to drive improvements in the delivery of care for the high-priority health conditions relevant to their patient population. Measure 2: The EP has enabled and implemented the functionality for drug-drug and drug-allergy interaction checks for the entire EHR reporting period. Drug-drug and drug-allergy interaction alerts are separate from the 5 clinical decision support interventions and do not count towards the 5 required for this first measure. Exclusion: For the second measure, any EP who writes fewer than 100 medication orders during the EHR reporting period. This measure is not reportable within encompass. To attest to this measure simply ensure that there are at least 5 rules present in the system during the entire reporting period. Thi 1. Click Dashboard -> Admin Panel. 2. Click Decision Support Rules. 3. Click Create New Rule. 4. Click the User Types for the rule for which it will trigger. 5. Enter a Title. (E.G. Hypertensive Patient ) 6. Enter the General Content. 7. Select Conditions. (E.G. Problem -> ICD10 -> I10 for Hypertension.) 8. Click Save. CDS rules may also be created directly from a patient s chart in applicable sections such as Medical History or Medications where the menu item New CDS Rule appears. User Manual/Guide for Attestation using encompass 3.0 v1.0 10

Core Measure 7 of 17: Patient Electronic Access Objective: Provide patients with the ability to view online, download and transmit their health information within four 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) online access to their health information, with the ability to view, download, and transmit to a third party. Business days are defined as Monday through Friday excluding federal or state holidays on which the EP or their respective administrative staffs are unavailable. Measure 2: More than 5 percent of all 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. 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. Measure 1: Patient Access Stage 2 50% Numerator The number of patients in the denominator who have timely (within 4 business days after the information is available to the EP) online access to their health information to view, download, and transmit to a third party. Stage 1 50% Numerator Same as Stage 2. Same as Stage 2. Number of unique patients seen by the EP during the EHR reporting period. User Manual/Guide for Attestation using encompass 3.0 v1.0 11

1. Click the Patient Image -> Generate Portal Pin from the patient s chart. PINs expire after 72 hours. This measure looks for patients to be given access to ClickMyDoctor.com, the patient portal connected to encompass EHR. It is recommended that a pin is created at every patient encounter and provided to the patient regardless of request. Measure 2: View, Download Transmit (VDT) Stage 2 5% Numerator The number of unique patients (or their authorized representatives) in the denominator who have viewed online, downloaded, or transmitted to a third party the patient's health information. Stage 1 5% Numerator Same as Stage 2. Same as Stage 2. Number of unique patients seen by the EP during the EHR reporting period. 1. Create a portal pin for each patient from Measure 1 above. 2. The remaining steps must be taken by the patient: 1. Patient creates a portal account. 2. Patient links portal account to health record using pin. 3. Patient views health record in the portal. ClickMyDoctor.com portal accounts are global to all encompass practices, however, connecting to a health record requires the patient to log into the practice-specific portal. E.G. https://<practice acronym>.clickmydoctor.com. This address will appear on the printed portal pin document created by encompass. User Manual/Guide for Attestation using encompass 3.0 v1.0 12

Core Measure 8 of 17: Clinical Summaries Objective: Provide clinical summaries for patients for each office visit. Measure: Clinical summaries provided to patients or patient-authorized representatives within one business day for more than 50 percent of office visits. Exclusion: Any EP who has no office visits during the EHR reporting period. Stage 2 50% Numerator Number of office visits in the denominator where the patient or a patientauthorized representative is provided a clinical summary of their visit within one (1) business day. Number of office visits conducted by the EP during the EHR reporting period. Stage 1 50% Numerator The number of office visits in the denominator for which the patient is provided a clinical summary within three business days. Number of office visits conducted by the EP during the EHR reporting period. Measure Criteria: This measure is based on the number of visits during the reporting period. I.E. The denominator will increase for every visit documented with a progress note. Meeting this measure requires that the patient be provided a Clinical Summary, or Visit Summary, within one business day of the date of service: 1. Progress notes must be signed to count in the denominator. 1. Credit will be applied to the provider who is the signer of the note. 2. Visit summaries may be printed, faxed or sent to the patient portal within 1 business day of the date of service for credit. 1. This action may be performed prior to signing the progress note although this is not recommended. The EHR will prompt when each note is signed to export. It is recommended to accept this option each time in order to meet this measure. Un-signing a progress note that has been sent to the portal previously will not affect meeting this measure, however, the progress note will remain on the portal in its original state until it is re-signed and re-transmitted. User Manual/Guide for Attestation using encompass 3.0 v1.0 13

Core Measure 9 of 17: Protect Electronic Health Information Objective: 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 requirement under 45 CFR 164.308(a) (1), including addressing the encryption/security of data stored in CEHRT in accordance with requirements under 45 CFR 164.312 (a)(2)(iv) and 45 CFR 164.306(d)(3), and implement security updates as necessary and correct identified security deficiencies as part of the provider's risk management process for EPs. Exclusion: No exclusion. This measure is not reportable within encompass. To attest to this measure simply ensure that there are at least 5 rules present in the system during the entire reporting period. Thi Conducting a security risk analysis is the responsibility of the practice and must be must be conducted according to CMS guidelines. Use of encompass EHR does not include this service or any expenses resulting from its completion. Core Measure 10 of 17: Clinical Lab-Test Results Objective: Incorporate clinical lab-test results into Certified EHR Technology (CEHRT) as structured data. Measure: More than 55 percent of all clinical lab test results ordered by the EP during the EHR reporting period whose results are either in a positive/negative or numerical format are incorporated in Certified EHR Technology as structured data. Exclusion: Any EP who orders no lab tests where results are either in a positive/negative affirmation or numeric format during the EHR reporting period. User Manual/Guide for Attestation using encompass 3.0 v1.0 14

Stage 2 55% Numerator Number of lab test results which are expressed in a positive or negative affirmation or as a numeric result which are incorporated in CEHRT as structured data. Stage 1 50% Numerator Same as Stage 2. Same as Stage 2. Number of lab tests ordered during the EHR reporting period by the EP whose results are expressed in a positive or negative affirmation or as a number. 1. Create Laboratory Orders using CPOE (see Measure 1). 2. Receive or create the resulting report in the EHR. 1. Results can be received electronically from the laboratory or HIE. 2. Results can be uploaded. 3. Results can be added as custom using the Add button on the Laboratory section toolbar. 3. Add discrete values to the result if the result was uploaded or is custom. This step is not necessary for electronic results. 1. Click Disc. Values in the result viewer. 2. Enter values as appropriate. 3. Click Save 4. Click Orders in the results viewer. 5. Click on any orders whose result appears within the report. Signed orders that have not been attached to a result will appear in the Pending Items section of the Archives in the patient s chart. CMS Guide: How to attest to Measure 19: Protect Electronic Health Information https://www.cms.gov/regulations-and- Guidance/Legislation/EHRIncentivePrograms/downloads/Stage2_EPCore_9_ProtectElectronicHealthInfo.pdf User Manual/Guide for Attestation using encompass 3.0 v1.0 15

Core Measure 11 of 17: Patient Lists Objective: Generate lists of patients by specific conditions to use for quality improvement, reduction of disparities, research, or outreach. Measure: Generate at least one report listing patients of the EP with a specific condition. Exclusion: No exclusion. This measure is not reportable within encompass. To attest to this measure simply ensure that there are at least 5 rules present in the system during the entire reporting period. Thi Each EHR reporting period should be identified with a different report. Reports generated in past EHR reporting periods cannot be used to satisfy this measure in the current EHR reporting period. 1. Click Dashboard -> Reports. 2. Click Patient Reminder Lists. 3. Fill in the fields with desired criteria. 4. After filling out fields, select your Output Format from the drop-down box at the top of the screen. 5. Click Run Report. If your intent is to use automated reminders, you must select the CSV format. The report will be added to the reporting queue. Some reports may take a long time to run depending on the conditions of the report, patient volume, and other queued reports. The report will appear in the Result Box in the main reporting window during the process and will display links to view/download when complete. Core Measure 12 of 17: Preventive Care Objective: Use clinically relevant information to identify patients who should receive reminders for preventive/follow-up care and send these patients the reminders, per patient preference. Measure: More than 10 percent of all unique patients who had 2 or more office visits with the EP within the 24 months before the beginning of the EHR reporting period were sent a reminder, per patient preference when available. User Manual/Guide for Attestation using encompass 3.0 v1.0 16

Exclusion: Any EP who has had no office visits in the 24 months before the EHR reporting period. Stage 2 10% Numerator Number of patients in the denominator who were sent a reminder per patient preference when available during the EHR reporting period. Number of unique patients who have had two or more office visits with the EP in the 24 months prior to the beginning of the EHR reporting period. Stage 1 10% Numerator The number of patients in the denominator who were sent the appropriate reminder during the reporting period. Number of unique patients 65 years old or older or 5 years old or younger. Patient reminders can be entered manually or using a patient list report. Using the patient list report option in combination with an automated communication system (E.G. Televox) can greatly improve efficiency on meeting this measure. 1. Manual Entry: 1. Click Create -> Template Note -> Reminder in the patient chart. 2. Enter the Date/Time, Description, and Content for the reminder. 3. Click Save. 2. Patient List Entry 1. Create a Patient List using instructions from Measure 11 above. 2. Remove any patients who should not receive the reminder. 3. Using the list, communicate with patient regarding the reminder. 4. Click Dashboard -> Reports. 5. Click Import Reminders. 6. Click Select File and browse to the patient list CSV file. 7. Enter the Reminder Title, or Description. 8. Enter the Reminder Text. 9. Click Process Reminders. CSV format is required for this option. Automated systems can be used to complete this step. Reminders should be sent using the preferred communication medium only when it is known by the provider. This is limited to the type of communication (phone, mail, secure messaging, etc.) and does not extend to other constraints like time of day. Patients may decline to provide their preferred communication medium in which case the provider may select the communication medium. A patient may also to decline reminders. User Manual/Guide for Attestation using encompass 3.0 v1.0 17

Core Measure 13 of 17: Patient-Specific Education Resources Objective: Use clinically relevant information from the Certified EHR Technology to identify patientspecific education resources and provide those resources to the patient. Measure: Patient-specific education resources identified by the Certified EHR Technology 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. Exclusion: Any EP who has no office visits during the EHR reporting period. Stage 2 10% Numerator Number of patients in the denominator who were provided patient-specific education resources identified by the Certified EHR Technology. Number of unique patients with office visits seen by the EP during the EHR reporting period. Stage 1 10% Numerator Number of patients in the denominator who are provided patient education specific resources. Number of unique patients seen by the EP during the EHR reporting period. 1. Create education resources. 1. Click Dashboard -> Admin Panel. 2. Click Patient Education. 3. Click Create Resource. 4. Enter a Title which will appear for selecting the education resource within the EHR. 5. Select the codes which will trigger the education resource. 6. Enter a URL for an existing web page or enter custom content in the supplied markup area. 2. Provide education resources to patient by performing any of the following actions: 1. Click on the icons to the right of problems, medications, or laboratory values where they appear for printing or to send to the patient portal. 2. When adding a vaccination select the VIS provided to the patient. 3. Click the Export icon on the top right of the patient chart to open the Summary Export window. 1. Select the to Patient tab. 2. Click on the education resources desired for the patient. 3. Click Send to Portal. Custom content is recommended over URL linking since independent sites may update over time and change the content of the page you are linking to. If using the URL method, it is recommended that you periodically review the pages supplied. 4. Select education resources to be sent to the portal when signing progress notes. (same as 2.3 above) User Manual/Guide for Attestation using encompass 3.0 v1.0 18

Core Measure 14 of 17: Medication Reconciliation Objective: 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 patients is transitioned into the care of the EP. Exclusion: Any EP who was not the recipient of any transitions of care during the EHR reporting period. Stage 2 50% Numerator The number of transitions of care in the denominator where medication reconciliation was performed. Number of transitions of care during the EHR reporting period for which the EP was the receiving party of the transition. Stage 1 50% Numerator The number of transitions of care in the denominator where medication reconciliation was performed. Number of transitions of care during the EHR reporting period for which the EP or eligible hospital's or CAH's inpatient or emergency department (POS21 or 23) was the receiving party of the transition. This measure is based on the number of Transfers of Care where the EP is the receiving provider. This includes any CCDA documents received or any visit where Transfer of Care Incoming is checked. This measures has 2 unique workflows within encompass. 1. Receive a CCDA record via Direct. 1. View message within Owner Triage by clicking on the Direct Incoming icon on the system toolbar. 2. Attach the CCDA document to a patient. 3. View the CCDA document within the patient s chart. 4. Click Apply within the CCDA viewer. 2. Click Transfer of Care Incoming in the Quality of Care section of a progress note. 1. Click Medication Reconciliation in the Quality of Care section of a progress note. - OR - 2. Click PBM -> Rx Graph on the Medications section toolbar, then click Med Reconciliation Completed in the Rx Graph window. RECOMMENDATION: Click PBM -> Rx Graph to review each patient s medication history during each visit. User Manual/Guide for Attestation using encompass 3.0 v1.0 19

Core Measure 15 of 17: Summary of Care Objective: 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: EPs must satisfy both of the following measures in order to meet the objective: Measure 1: o The EP who transitions or refers their patient to another setting of care or provider of Measure 2: care provides a summary of care record for more than 50 percent of transitions of care and referrals. o The EP who transitions or refers their patient to another setting of care or provider of care provides a summary of care record for more than 10 percent of such transitions and referrals either (a) electronically transmitted using CEHRT to a recipient or (b) where the recipient receives the summary of care record via exchange facilitated by an organization that is a NwHIN Exchange participant or in a manner that is consistent with the governance mechanism ONC establishes for the NwHIN. Measure 3: An EP must satisfy one of the following criteria: o Exchange a summary of care with a provider or third party who has different CERHT (and different vendor) as the sending provider as part of the 10% threshold for measure #2, allowing the provider to meet the criteria for measure #3 with the CMS Designated Test EHR (for EPs the measure at 495.6(j)(14)(ii)(C)(1) with a recipient who has EHR technology that was developed by designed by a different EHR technology developer than the sender's EHR technology certified to 45 CFR 170.314(b)(2). - OR - o If unable to exchange summary of care documents with recipients using a different CEHRT in common practice, retain documentation on circumstances and attest Yes to meeting measure 3 if using a certified EHR which meets the standards required to send a CCDA ( 170.202). NwHIN = Nationwide Health Information Network 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. User Manual/Guide for Attestation using encompass 3.0 v1.0 20

Measure A: Stage 2 50% Numerator The number of transitions of care and referrals in the denominator where a summary of care record was provided. The number of transitions of care and referrals during the EHR reporting period for which the EP was the transferring or referring provider. Stage 1 50% Numerator The number of transitions of care and referrals in the denominator where a summary of care record was provided. Number of transitions of care and referrals during the EHR reporting period for which the EP was the transferring or referring provider. There are two workflows for this measure. 1. Progress Note Transition of Care 1. Click Transition of Care Outgoing in the Quality of Care section. This will cause the visit to count in the denominator. 2. To meet the numerator for this measure complete 1 of the following actions: 2. Referrals 1. Click the print icon on top of the patient chart and print or fax the SoC OR 2. Click the export icon on top of the patient chart and complete 1 of the following actions: 1. Transmit to provider OR 2. Download OR 3. Send to Portal with Export Summary of Care selected 1. Click Create -> Referral in the patient chart. 2. The Chart Cart will pop up with the patient's name. 3. Find a referral type and add it. 4. Open ScriptPad. 5. Click Attach SoC. NOTE: Credit for referrals can also be granted following any of the actions described in the Progress Note workflow step 2 above. If ChartCart is already open, click on the Refs tab. User Manual/Guide for Attestation using encompass 3.0 v1.0 21

Measure B: Stage 2 10% Numerator 1. The number of transitions of care and referrals in the denominator where a summary of care record was electronically transmitted using CEHRT to a recipient. 2. The number of transitions of care and referrals in the denominator where the recipient receives the summary of care record via exchange facilitated by an organization that is a NwHIN Exchange participant. The number of transitions of care and referrals during the EHR reporting period for which the EP was the transferring or referring provider. Stage 1 N/A Numerator N/A N/A encompass EHR is partnered with SureScripts for DIRECT accounts and uses the domain ehrdirectmail.com for users. Users should verify whether the providers they refer to regularly have an enabled DIRECT account and make available such lists to Arête trainers to assist in bringing new providers up-to-speed on this new technology. Follow the instructions for Measure A above to create a Transition of Care or Referral. B.1 - To meet Measure B.1 the SoC must be sent to the The Transmit option is only available when the receiving provider has a valid DIRECT account. receiving provider using the Transmit option. Print, fax, and send to portal will NOT count for B.1. B.2 This measure is the same as B.1 with the exception that the SoC must be sent to a recipient using a different EHR. Per updated CMS documentation this measure is now a Yes/No attestation that can be met as follows: The EP attests YES to one of the two criteria: 1. Exchange a summary of care with a provider or third party who has different CEHRT (and different vendor) as the sending provider as part of the 10% threshold for measure #2, allowing the provider to meet the criteria for measure #3 without the CMS Designated Test EHR" (for Eps the measure at 495.6(j)(14)(ii)(C)(1) with a recipient who has EHR technology that was developed designed by a different EHR technology developer than the sender's EHR technology certified to 45 CFR 170.314(b)(2). - OR 2. If unable to exchange summary of care documents with recipients using a different CEHRT in common practice, retain documentation on circumstances and attest Yes to meeting measure 3 if using a certified EHR which meets the standards required to send a CCDA ( 170.202). User Manual/Guide for Attestation using encompass 3.0 v1.0 22

Core Measure 16 of 17: Immunization Registries Data Submission Objective: Capability to submit electronic data to immunization registries or immunization information systems except where prohibited, and in accordance with applicable law and practice. Measure: Successful ongoing submission of electronic immunization data from CEHRT to an immunization registry or immunization information system for the entire EHR reporting period. Exclusion: Any EP that meets one or more of the following criteria may be excluded from this objective: (1) the EP 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) the EP 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) the EP operates in a jurisdiction where no immunization registry or immunization information system provides information timely on [sic] capability to receive immunization data; or (4) the EP operates in a jurisdiction for which no immunization registry or immunization information system that is capable of accepting the specific standards required by the CEHRT at the start of their EHR reporting period can enroll additional EPs. This measure is not reportable within encompass. To attest to this measure simply ensure that there are at least 5 rules present in the system during the entire reporting period. Thi Each location in encompass must be configured for an immunization registry to enable immunization submission. This is done in the Manage Locations Admin Panel. Note that a unique facility code should be obtained for each location. Additional costs, subscriptions and/or memberships may be required to enable registration depending on the connected registry. 1. Click Add on the procedure history toolbar in the patient chart. 2. The Chart Cart will pop up with the patient's name. 3. Find and immunization by procedure code and click the editor icon. User Manual/Guide for Attestation using encompass 3.0 v1.0 23

4. Click Performed in the Procedure editor. 5. Complete all fields related to the immunization medication, including Location, NDC and VIS information. 6. Click Submit electronically to <selected registry> in the editor. 7. Click Save. If ChartCart is already open, click on the Procs tab. Immunizations are automatically detected based on procedure codes. The Procedure editor will display immunization-specific fields when one is selected. Core Measure 17 of 17: Use Secure Electronic Messaging Objective: Use secure electronic messaging to communicate with patients on relevant health information. Measure: A secure message was sent using the electronic messaging function of CEHRT by more than 5 percent of unique patients (or their authorized representatives) seen by the EP during the EHR reporting period. Exclusion: Any 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. Stage 2 5% Numerator The number of patients or patient-authorized representatives in the denominator who send a secure electronic message to the EP that is received using the electronic messaging function of CEHRT during the EHR reporting period. Stage 1 N/A Numerator N/A Number of unique patients seen by the EP during the EHR reporting period. N/A User Manual/Guide for Attestation using encompass 3.0 v1.0 24

This measure requires administrative setup within encompass, but can only be achieved through patient usage. 1. Set up Secure Messaging in encompass. 1. Click Dashboard -> Admin Panel. 2. Click Portal Settings. 3. Click Add. 4. Enter the name or description that will appear in the compose window within the portal under Display As. 5. Select the Recipient. 6. Repeat steps 3-5 as required. 7. Click Save. 2. Patient action required. 1. Follow the steps described in Core Measure 7 above to allow patient access. The same recipient can receive messages for multiple names and it is not required that a provider must receive their own messages even if their name appears as an option under Display As. User Manual/Guide for Attestation using encompass 3.0 v1.0 25

Menu Measure 1 of 6: Syndromic Surveillance Data Submission* Objective: Capability to submit electronic syndromic surveillance data to public health agencies except where prohibited, and in accordance with applicable law and practice. Measure: Successful ongoing submission of electronic syndromic surveillance data from CEHRT to a public health agency for the entire EHR reporting period. Exclusion: Any EP that meets one or more of the following criteria may be excluded from this objective: (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; (3) the EP operates in a jurisdiction for which no public health agency provides information timely on capability to receive syndromic surveillance data; or (4) the EP operates in a jurisdiction for which no public health agency that is capable of accepting the specific standards required by CEHRT at the start of their EHR reporting period can enroll additional EPs. This measure is not reportable within encompass. To attest to this measure simply ensure that there are at least 5 rules present in the system during the entire reporting period. Thi Using encompass 3.0 to Build Provider Numbers for Attestation: encompass 3.0 is not currently linked with any active registries to meet this measure. User Manual/Guide for Attestation using encompass 3.0 v1.0 26

Menu Measure 2 of 6: Electronic Notes* Objective: Record electronic notes in patient records. Measure: Enter at least one electronic progress note created, edited and signed by an EP for more than 30 percent of unique patients with at least one office visit during the EP reporting period. The text of the electronic note must be text searchable and may contain drawings and other content. Exclusion: Any EP who has no office visits during the EHR reporting period. Stage 2 30% Numerator The number of unique patients in the denominator who have at least one electronic progress note from an eligible professional recorded as text searchable data. Stage 1 N/A Numerator N/A Number of unique patients with at least one office visit during the EHR reporting period for EPs during the HER reporting period. N/A 1. Click Create->Progress Note->Progress Note for Today OR Progress Note for Date. 2. Click Save & Sign. Any note found will count in the denominator, but only signed notes count for the numerator. 3. Any Progress Notes not signed will appear to the left of the chart, under Archives. User Manual/Guide for Attestation using encompass 3.0 v1.0 27

Menu Measure 3 of 6: Imaging Results Objective: Imaging results consisting of the image itself and any explanation or other accompanying information are accessible through CEHRT. Measure: More than 10 percent of all tests whose result is one or more images ordered by the EP during the EHR reporting period are accessible through CEHRT. Exclusion: Any EP who orders less than 100 tests whose result is an image during the EHR reporting period; or any EP who has no access to electronic imaging results at the start of the EHR period. Stage 2 10% Numerator The number of results in the denominator that are accessible through CEHRT. Stage 1 N/A Numerator N/A Number of tests whose result is one or more images ordered by the EP during the EHR reporting period. N/A There are three ways in which a provider can choose to select/flag imaging results: 1. From the EHR homepage when you first log in; or, by clicking on Dashboard -> Home within the EHR. 1. Click on a patient s results under the Results column. 2. Click on the drop-down box and select Radiology report*imaging Result. 2. From the Archives, under which electronically received results will be pending after being transmitted inbound from a lab interface. The interface automatically marks inbound imaging results. 1. Open the results by either: 1. Click once on the results from the Archives OR 2. Double-click on results from the Archives. 2. Close box by clicking the x in the upper left of the document. 3. From the Archives, under which uploaded results (images provided by the practice and uploaded) will be pending under the name given to the result when entered in the Description field of the Patient Details box. 1. Select Radiology report*imaging Result after clicking on the Document Code field. 2. Select Save. If the patient s chart is open, the screen will not reflect an electronically received result. If you are waiting for a result, please refresh/close and reopen the patient s chart. User Manual/Guide for Attestation using encompass 3.0 v1.0 28

Menu Measure 4 of 6: Family Health History Objective: Record patient family health history as structured data. Measure: More than 20 percent of all unique patients seen by the EP during the EHR reporting period have a structured data entry for one or more first-degree relatives. Exclusion: Any EP who has no office visits during the EHR reporting period. Stage 2 20% Numerator The number of patients in the denominator with a structured data entry for one or more first-degree relatives. Stage 1 N/A Numerator N/A The number of unique patients seen by the EP during the EHR reporting period. N/A 1. Click the Add button from the Family History section of the EHR. 2. Select the first-degree relation(s) (First degree blood relative, child, daughter, son, parent, father, mother, sibling, brother, sister) from the Relation drop-down box. 3. Click Save. Menu Measure 5 of 6: Report Cancer Cases* Objective: Capability to identify and report cancer cases to a public health center registry, except where prohibited, and in accordance with applicable law and practice. Measure: Successful ongoing submission of cancer case information from CEHRT to a public health central cancer registry for the entire EHR reporting period. Exclusion: Any EP that meets at least 1 of the following criteria may be excluded from this objective: (1) The EP does not diagnose or directly treat cancer; (2) The EP operates in a jurisdiction for which no public health agency is capable of receiving electronic cancer case information in the specific standards required for CEHRT at the beginning of their EHR reporting period; (3) The EP operates in a jurisdiction where no PHA provides information timely on capability to receive electronic cancer case information: or User Manual/Guide for Attestation using encompass 3.0 v1.0 29

(4) The EP operates in a jurisdiction for which no public health agency that is capable of receiving electronic cancer case information in the specific standards required for CEHRT at the beginning of their EHR reporting period can enroll additional EPs. This measure is not reportable within encompass. To attest to this measure simply ensure that there are at least 5 rules present in the system during the entire reporting period. Thi Menu Measure 6 of 6: Report Specific Cases* Objective: Capability to identify and report specific cases to a specialized registry (other than a cancer registry), except where prohibited, and in accordance with applicable law and practice. Measure: Successful ongoing submission of specific case information from CEHRT to a specialized registry for the entire EHR reporting period. Exclusion: Any EP that meets at least 1 of the following criteria may be excluded from this objective: (1) The EP does not diagnose or directly treat any disease associated with a specialized registry sponsored by a national specialty society for which the EP is eligible, or the public health agencies in their jurisdiction; (2) The EP operates in a jurisdiction for which no specialized registry sponsored by a public health agency or by a national specialty society for which the EP is eligible is capable of receiving electronic specific case information in the specific standards required by CEHRT at the beginning of their EHR reporting period; (3) The EP operates in a jurisdiction where no public health agency or national specialty society for which the EP is eligible provides information timely on capability to receive information into their specialized registries; or (4) The EP operates in a jurisdiction for which no specialized registry sponsored by a public health agency or by a national specialty society for which the EP is eligible that is capable of receiving electronic specific case information in the specific standards required by CEHRT at the beginning of their EHR reporting period can enroll additional EPs. This measure is not reportable within encompass. To attest to this measure simply ensure that there are at least 5 rules present in the system during the entire reporting period. Thi User Manual/Guide for Attestation using encompass 3.0 v1.0 30