Table of Contents General Info & Meaningful Use Report....4-7 Measures..........8-62 Objective 1: Protect Electronic Health Information 8 Conduct or Review a security risk analysis Objective 2: Clinical Decision Support........9-12 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. Measure 2: The EP has enabled and implemented the functionality for drug- drug and drug- allergy interaction checks for the entire EHR reporting period Objective 3: Computerized Physician Order Entry... 13-19 Use computerized physician 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 3.1 Medications...... 13-14 Measure : More than 60% (Numerator / Denominator) of medication orders created by the EP during the EHR reporting period are recorded using CPOE. 3.2 Laboratory.... 15-16 Measure: More than 30% (Numerator/Denominator) laboratory medication orders created by the EP during the EHR reporting period are recorded using CPOE. 3.3 Radiology. 17-19 Measure: 30% (Numerator/Denominator) of radiology orders medication orders created by the EP during the EHR reporting period are recorded using CPOE. Alternate Exclusion for Measure 3: Providers scheduled to be in Stage 1 in 2016 may claim exclusion for measure 3 (radiology orders) of the Stage 2 CPOE objective for an EHR reporting period in 2016 1
Objective 4: Electronic Prescribing... 20-21 Generate and transmit permissible prescriptions electronically (erx) Measure: More than 50% of all permissible prescriptions, or all prescriptions, written by the EP are queried for a drug formulary and transmitted electronically using Certified EHR Technology Objective 5: Health Information Exchange..... 22-29 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 of care record for each transition of care or referral Measure: The EP that transitions or refers their patient to another setting of care or provider of care must (1) use CEHRT to create a summary of care record; and (2) electronically transmit such summary to a receiving provider for more than 10% of transitions of care and referrals. Objective 6: Patient Specific Education..........30-34 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 Certified EHR Technology seen by the EP during the EHR reporting period. Objective 7: Medication Reconciliation.....34-39 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 performs medication reconciliation for more than 50% of transitions of care in which the patient is transitioned into the care of the EP Objective 8: Patient Electronic Access (VDT).... 39-51 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. Provider Portal Setup......40-43 8.1 Patient Electronic Access......43-48 More than 50% 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 transmitted to a third party 2
8.2 View Download Transmit...48-51 For an EHR reporting period in 2016, at least 1 (one) patient seen by the EP during the EHR reporting period (or their authorized representatives) view, download, or transmit to a third party their health information during the EHR reporting period Objective 9: Secure Messaging...52-56 Use secure electronic messaging to communicate with patients on relevant health information Measure: For an EHR reporting period in 2016, 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) during the EHR reporting period Objective 10: Public Health Reporting... 57-62 Capability to submit electronic data to immunization registries or Immunization Information Systems except where prohibited and in accordance with applicable law and practice. 10.1 Immunization Registry Reporting Measure : The EP is in active engagement with a public health agency to submit immunization data 10.2 Measure Syndromic Surveillance Reporting: The EP is in active engagement with a public health agency to submit Syndromic surveillance data 3
Eligible professionals must report on the following: 1. All 10 of the measures (If you claim an exclusion on a measure it counts as having met that objective) 2. Stage 1 and 2 will use the same 10 measures. Stage 1 exclusions and measures are listed throughout the document in purple. 3. 9 out of the 64 clinical quality measures (CQM s) covering at least 3 National Quality Strategy domains 2016 Reporting Period for all returning participants: For Modified Stage 2, the reporting period is a full calendar year (January 1 to December 31, 2016) For first- time participants in 2016, the EHR reporting period is any continuous 90- day period between January 1 and December 31, 2016 You must use a qualified eprescribing system to meet CPOE, drug formulary checking, and to generate and transmit permissible prescriptions electronically, even if you decide not to use Practice Director s preferred eprescribing portal. *Important Note: Practice Director s Meaningful Use Report is will only take into account information entered into the EHR. Since certain objectives require you to include data not necessarily captured in the certified EHR the Practice Director system generated values per the Meaningful Use Report may not necessarily be the values that you should be attesting to. For any patients whose records are not maintained using certified EHR (i.e. in another non- - - certified EHR or a paper chart) but who meet the denominator criteria you will need to add that value to the denominator calculated from Practice Director s Meaningful Use Report and that would be your true denominator value that you would attest to. For any Measure objective where it states seen by the EP : To indicate that a patient was seen by the EP the patient must have a completed, completed non- - - billable, or invoiced exam with a date of service within the reporting period, and where the exam s provider is the respective provider With the integration of Practice Director s e- - - Prescribing portal any medications, prescriptions and allergies you enter into the portal will automatically be pulled in to and available for view in Practice Director. Any diagnoses you enter in Practice Director will automatically be pulled into and viewable in Practice Director s e- - - Prescribing portal. If you choose to not enroll in Practice Director s e- - - Prescribing portal through Practice Director there will be no communication between your chosen eprescribing system, which means the following: 1. You will have to manually calculate the numbers and percentages for the measures that 4
require the use of a qualified eprescribing system, because the information will not be reportable with Practice Director 2. You will have to do double- - - entry into both Practice Director and your chosen eprescribing system as you will have to enter in the patient medications and drug prescriptions into both systems To run the Meaningful Use report: Go to the EHR Options Menu > Meaningful Use> Meaningful Use Report The Meaningful Use Reporting Periods dialog will open From this dialog you can do the following: 1. Select Add to create a new report for a desired date range, provider, and stage 2. Select a Saved Report to View, Edit, or Delete 5
Add: The Select Reporting Period dialog will open The current year will be defaulted as the date range but you can specify a date range by clicking on the calendar icon Provider Select the desired provider from the drop down Start Click on the calendar icon to select a start date for the desired reporting period End Click on the calendar icon to select an end date for the desired reporting period Stage The default is 2016 Modified Stage 2 (All Stages of MU will use 2016 Modified Stage 2 for attestation in 2016) The previous Stage 1, Stage 2, and 2015 Modified Stage 2 Reports are still available to view Select OK to view the report 6
1. The header displays whether you are looking at a 2016 Modified Stage 2, 2015 Modified Stage 2, Stage 1 or Stage 2 Report 2. Period displays the period you are running the report for 3. Provider displays the provider you are running the report for 4. System displays the system calculated numerator and denominator, Calculated displays the system calculated percentage, Required displays the percentage required to meet the measure 5. Selecting Save will save your date range on the Meaningful Use window. Once Save is selected you will be returned to the Meaningful Use dialog 6. View Report will launch the printable version in another dialog. You can select the printer icon in the upper left corner to print or the disc icon in the upper left to save to your computer. ***We recommend saving the report that you attest with to your computer*** Select a saved report to view and/or print: Double click on the desired report or by selecting and then selecting View Report The saved MU report will open Each time you view the report or the printable report the values are automatically recalculated so the Meaningful Use Report is always live time. 7
Objective 1: Protect Patient Health Information Protect electronic health information created or maintained by the certified EHR technology 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), 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: None Attestation Format: Yes/No Eligible professionals (EPs) must attest YES to conducting or reviewing a security risk analysis and implementing security updates as needed to meet this measure. Instructions: Print off the Security Risk Analysis worksheet available on the Client Documentation website. http://www.practicedirector.com/pdf/meaningful_use_security_risk_analysis_w orksh eet.pdf Fill out and keep on file. If you had done this in a previous Stage of MU, review your saved Security Risk Analysis worksheet and update if necessary. Sign an date the date of review Additional Information: In order to become certified software, Practice Director must contain all of the features required to protect your electronic health information. Practice Director EHR 5.1 received ONC- - - ATCB certification as a complete EHR by the Drummond Group on August 27, 0215 as it does contain all of the necessary security features https://www.cms.gov/regulations- and- Guidance/Legislation/EHRIncentivePrograms/Downloads/2016EP_1ProtectPatientHealthInfoObjective.p df 8
Objective 2: Clinical Decision Support 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 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 Exclusion for Measure 2: Any EP who writes fewer than 100 medication orders during the EHR reporting period. Attestation Format: Yes/No EP s must attest YES to implementing five clinical decision support interventions and enabling and implementing functionality for drug- - - drug and drug- - - allergy interaction to meet this measure. Instructions Measure 1 Clinical Decision Support To set up interventions to trigger and who you want them to trigger to (Provider, Clinical Staff, or Lab Technician). They all work the same: Go to Administration>General Administration>Clinical Decision Support You can set individual or combination filters Individual filters will trigger whenever one of these areas is used to calculate or look at intervention it will trigger intervention 1. Individual filters Select individual filters by checking box Problem List Diagnosis Codes from EHR Medication List From Dr First ERX Allergy List From Dr First ERX Demographic Information such as age from demographics Lab Test- - - When results are imported Vital Signs From EHR 9
2. Combination filters Add combination filters by selecting Add and then selecting a combination of filters These are the same as Individual filters but they will only trigger if all areas indicated within combination are included Click OK when completed Interventions will trigger when EHR is saved, Patient Demo saved, ERX syncs down from Dr First, or Lab Results Imported Once the interventions are set, they will begin to trigger you will see this indicated in the lower right corner of PD 10
Interventions will display when the exam is saved in any status (Draft, Completed, Completed Non- - - Billable, Invoiced) Click on the interventions indicator to see details on what action the system is recommending The Clinical Support Interventions dialog will open On the left side of the screen you will see patient names and the intervention When you click on the patient name the right side will display details about this intervention 1. Intervention Description will always be the same 2. Conclusion will tell you what is wrong and what is missing 3. Analytic Comments show you exactly what you entered for the specific patient exam number, value entered and what it is looking for, patient age and if it meets requirement. 4. Data elements Used shows you which filters were used to find this 5. Reference 6. Info Button will show you education 7. You can save or print 11
Interventions are not cleared until the appropriate action is taken care of in the system, such as adding the appropriate diagnosis in the EHR. Once the change is saved the intervention will clear and display as implemented in the Clinical Decision support history. Instructions Measure 2 Drug- Drug and Drug- Allergy Interaction: This measure is satisfied when using a certified E- Prescribe system (Dr First) Additional Information: If there are limited CQM s are applicable to an EP s scope of practice, the EP should implement CDS interventions that he or she believes will drive improvements in the delivery of care for the high priority health conditions relevant to their patient population. Drug- - - Drug and Drug- - - Allergy interaction alerts cannot be used to meet this objective, and do not count towards the 5 required for this first measure. https://www.cms.gov/regulations- and- Guidance/Legislation/EHRIncentivePrograms/Downloads/2016EP_2ClinicalDecisionSupportObje ctive.pdf 12
Core Objective 3: Computerized Provider Order Entry Use computerized physician 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: An EP, through a combination of meeting the thresholds and exclusions (or both) must satisfy all three measures for this objective. More than 60% (Numerator / Denominator) of medication, More than 30% (Numerator/Denominator) laboratory, and 30% (Numerator/Denominator) 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. Attestation Format: Numerator/Denominator/Threshold/Exclusion 3.1 Medications Numerator: The number of orders in the denominator recorded using CPOE PD: Entry of each current medication and or each prescription into Dr First. The prescription needs to be signed or signed and sent (as long as it syncs back to PD, it will count. See instructions below Denominator: Number of medication orders created by the EP during the EHR Reporting period. PD: The same as Numerator Threshold: The resulting percentage must be more than 60% in order for an EP to meet this measure PD: Currently this will always be 100% as PD only counts CPOE Exclusion: Any EP who writes fewer than 100 medication orders during the EHR reporting period Instructions: To enter in a drug prescription or medication into Practice Director s e- Prescribing portal: Be logged in as a provider If you are not in the EHR module already go to the EHR Options> E- Prescribing 13
Verify the patient that is displayed is the patient you are intending to create and send a drug prescription for If not click the spyglass to search for the correct patient. Click the Launch E- - - Prescribing button If you are already in the EHR module and have a patient selected you can just click the Launch E- - - Prescribing button Create and transmit the drug prescription or add a medication to the patient (for detailed instructions once in Practice Director s e- Prescribing portal please read the Practice Director e- Prescribing portal documentation) http://www.practicedirector.com/pdf/pd- - - eprescribing- - - Portal- - - Training- - - Guide.pdf 14
3.2 Laboratory Numerator: The number of orders in the denominator recorded using CPOE PD: All lab orders entered using CPOE. See Instructions below Denominator: Number of laboratory orders created by the EP during the EHR Reporting period. PD: All lab orders entered during the reporting period Threshold: The resulting percentage must be more than 30% in order for an EP to meet this measure PD: Currently this will always be 100% as PD only counts CPOE 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 exclusion for measure 2 (laboratory orders) of the Stage 2 CPOE objective for an EHR Reporting period in 2016 Instructions: To enter in a laboratory order into Practice Director: 1. Go to the Menu, select EHR Options>Optometry>Laboratory Order Entry 2. Verify the patient that is displayed is the patient you are intending to create a laboratory order for If not click the spyglass to search for the correct patient 3. Select Add to add a new order 15
4. Click on the Spyglass to select the Radiology procedure 5. You can change the order date if needed 6. Instructions are required 7. Select Save You will return to the Laboratory Order Entry dialog Your saved order will display From here you can: Repeat above steps for any additional lab orders Or Select the Order and then select Edit to edit the order Or Select the Order and then select Delete to delete the order Select Close when completed 16
3.3 Radiology Numerator: The number of orders in the denominator recorded using CPOE PD: All Radiology Orders entered using CPOE. See instructions below Denominator: Number of radiology orders created by the EP during the EHR Reporting period. PD: All Radiology orders entered during the reporting period. Threshold: The resulting percentage must be more than 30% in order for an EP to meet this measure PD: Currently this will always be 100% as PD only counts CPOE 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 exclusion for measure 3 (radiology orders) of the Stage 2 CPOE objective for an EHR reporting period in 2016 Instructions: To enter in a Radiology order into Practice Director: 1. Go to the Menu, select EHR Options>Other Specialty>Radiology/Imaging Order Entry 2. Verify the patient that is displayed is the patient you are intending to create a radiology order for 3. If not click the spyglass to search for the correct patient 4. Click the Add button to add a new order 17
5. Click on the Spyglass to select the Lab procedure 6. You can change the order date if needed 7. Instructions are required 8. Indication is required 9. Select Save You will return to the Radiology/Imaging Order Entry dialog Your saved order will display From here you can: Repeat above steps for any additional lab orders Or Select the Order and then select Edit to edit the order Or Select the Order and then select Delete to delete the order Select Close when completed 18
Additional Information: The provider is permitted, but not required, to limit the measure of this objective to those patients whose records are maintained using certified EHR technology (CEHRT) Any licensed healthcare professionals can enter orders into the medical record for purposes of including the order in the numerator for the objective of CPOE if they can enter the order per state, local, and professional guidelines. The order must be entered by someone who could exercise clinical judgment in the case that the entry generates any alerts about possible interactions or other clinical decision support aides. Electronic transmittal of the medication order is not a requirement for meeting the measure of this objective CPOE is the entry of the order into the patient s EHR that uses a specific function of CEHRT. It is not how that order is filled or otherwise carried out https://www.cms.gov/regulations- and- Guidance/Legislation/EHRIncentivePrograms/Downloads/2016EP_3CPOEObjective.pdf 19
Objective 4 Electronic Prescribing erx Generate and transmit permissible prescriptions electronically (erx) Measure: More than 50% of all permissible prescriptions, or all prescriptions, written by the EP are queried for a drug formulary and transmitted electronically using Certified EHR Technology 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 Attestation Format: Denominator/Numerator/Threshold/Exclusion Numerator: Number of prescriptions in the denominator generated, queried for a drug formulary and transmitted electronically using Certified EHR Technology PD: Entry of prescriptions within Dr First that are signed and sent will count in this measure. Each prescription entered, signed, and sent, not just the first one per patient. Pending prescriptions or prescriptions that are only signed will not count in the numerator. See instructions below Note: Prescriptions for scheduled drugs (controlled substances) do NOT count in either numerator or denominator of this measure since they cannot be sent electronically Denominator: 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 PD: Entry of prescriptions within Dr First that are signed, or signed/sent will count for this measure. Pending prescriptions will not affect count Threshold: The resulting percentage must be more than 50% in order for an EP to meet this measure. Instructions: To enter a drug prescription into Practice Director s e- - - Prescribing portal: 1. Be logged in as a provider 2. If you are not in the EHR module already go to the EHR Options> E- - - Prescribing 3. Verify the patient that is displayed is the patient you are intending to create and send a drug prescription for 4. If not click the spyglass to search for the correct patient. 5. Click the Launch E- - - Prescribing button 6. If you are already in the EHR module and have a patient selected you can just click the Launch E- Prescribing button 20
Create and transmit the drug prescription (for detailed instructions once in Practice Director s e- - - Prescribing portal please read the Practice Director e- - - Prescribing portal documentation) http://www.practicedirector.com/pdf/pd- - - eprescribing- - - Portal- - - Training- - - Guide.pdf *Note: Any prescription transmitted electronically through a different e- - - prescribing system will not be automatically calculated or tracked. They will need to be manually tracked for attestation. Additional Information: The provider is permitted, but not required, to limit the measure of this objective to those patients whose records are maintained using certified EHR technology (CEHRT) Instances where patients specifically request a paper prescription may NOT be excluded from the denominator https://www.cms.gov/regulations- and- Guidance/Legislation/EHRIncentivePrograms/Downloads/2016EP_4ePrescribingObjective.pdf 21
Objective 5 Health Information Exchange 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 of care record for each transition of care or referral Measure Summary of Care Provided and Transition of care: The EP who transitions or refers their patient to another setting of care or provider of care must (1) use CEHRT to create a summary of care record and (2) electronically transmit such a summary to a receiving provider for more than 10% of transitions of care and referrals Summary of Care Record A summary of care record must include the following elements: 1. Patient name 2. Referring or transitioning provider's name and office contact information (EP only) 3. Procedures 4. Encounter diagnosis 5. Immunizations 6. Laboratory test results 7. Vital signs (height, weight, blood pressure, BMI) 8. Smoking status 9. Functional status, including activities of daily living, cognitive and disability status 10. Demographic information (preferred language, sex, race, ethnicity, date of birth) 11. Care plan field, including goals and instructions 12. Care team including the primary care provider of record and any additional known care team members beyond the referring or transitioning provider and the receiving provider 13. Reason for referral 14. Current problem list (EPs may also include historical problems at their discretion) 15. Current medication list * 16. Current medication allergy list * *Note: An EP must verify that the fields for current problem list, current medication list, and current medication allergy list are not blank and include the most recent information known by the EP as of the time of generating the summary of care document. Attestation Format: Numerator/Denominator/Threshold/Exclusion Numerator: The number of transitions of care and referrals in the denominator where a summary of record was created using CEHRT and exchanged electronically 22
PD: Patients who were referred through a transition of care out of the provider s care to another provider who also had a Summary of Care report generated and sent electronically. NOTE: only valid CCDAs can be sent electronically. (Send electronically using Portal and then EHR Options>TOC>Save CCDA>Care Document check sent electronically). See instructions below Denominator: Number of transitions of care and referrals during the EHR reporting period for which the EP was the transferring or referring provider. PD: Patients who were referred through a transition of care out of the provider s care to another provider. Threshold: The percentage must be more than 10% in order for an EP to meet this measure. Exclusion: Any EP who transfers a patient to another setting or refers a patient to another provider less than a 100 times during the EHR reporting period Instructions To Provide a Summary of Care: Go to EHR Options select Transition of Care The Transition of Care dialog will open 1. Use the spyglass to select your desired patient if they are not already displaying 23
2. Click on the arrow next to Save, Select Save as C- CDA You will receive the following message To create a valid CCDA, the Problems List must be coded with SNOMED- - - CT. Would you like to convert the Problems List to SNOMED- - - CT before saving the CCDA? Select Yes A new dialog will open and show you the ICD- 9 code and the corresponding SNOMED- CT code. You can check the Remember this association box to have it remember this grouping. Select OK. The system will repeat this process until all ICD- 9 have been matched to SNOMED- CT The Save C- CDA dialog will open; select the destination for where you want to save your C- CDA. Select Save 24
The View screen will open To transmit electronically: 1. Select Care Document Tab 2. Select the patient you wish to transfer (only patients with Sent status can be transferred) (Optional) When the Tab opens Click on the file name header to put the patient s in alphabetical order to make it easier to find desired patient. 3. Select Transfer TOC button 25
The Transfer Transition of Care using Direct Transfer dialog will open 1. Click on the Spyglass in the from field to select the provider that is sending. A dialog will open showing you Providers with their Direct Email Address. Select the provider and then click OK 2. Click on the Spyglass in the To field to select the provider you are sending to. A Provider Directory dialog will open you can use any criteria or any combination of criteria to locate a Providers Direct email address. In this example I searched by Portal ID and 3 results were returned. Select the desired provider and then click OK 26
3. Enter a Subject for the message. IMPORTANT Protected Health Information (PHI) under HIPAA must not be included in a message s subject line 4. You can add a message to your email 5. The CCDA will already be attached, select Add Attachment if you want to send anything else such as EHR Report or Images 6. Select Send Message to Send 27
You will receive a message notifying you that the message has been successfully sent When you view the Care Documents tab the Electronic Copy will now have a checkmark in it so show Electronically Sent Completing the above steps will increase your numerator 28
Additional Information: Only patients whose records are maintained using certified EHR technology should be included in the denominator for this measure This exchange may occur before, during or after the EHR reporting period but must take place no earlier than the start of the same calendar year as the EHR reporting period and no later than the date of attestation in order to count in the numerator. Apart from the three fields noted as required (i.e., current problem list, current medication list, and current medication allergy list), in circumstances where there is no information available to populate one or more of the fields listed (because the EP does not record such information or because there is no information to record), the EP may leave the field(s) blank and still meet the objective and its associated measure. The referring provider must have reasonable certainty of receipt by the receiving provider to count the action toward the measure. The exchange must comply with the privacy and security protocols for ephi under HIPAA. In cases where the providers share access to an EHR, a transition or referral may still count toward the measure if the referring provider creates the summary of care document using CEHRT and sends the summary of care document electronically. If a provider chooses to include such transitions to providers where access to the EHR is shared, they must do so universally for all patient and all transitions or referrals https://www.cms.gov/regulations- and- Guidance/Legislation/EHRIncentivePrograms/Downloads/2016EP_5HealthInformationExchange Objective.pdf 29
Core Objective 6: 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 Certified EHR Technology are provided to patients for more than 10% 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. Attestation Format: Numerator/Denominator/Threshold/Exclusion Numerator: Number of patients in the denominator who were provided patient- specific education resources identified by the Certified EHR Technology PD: This numerator will populate when a patient has been given some piece of education within the system (EHR Options>Patient Education>either info button or other entered education with the date provided within the reporting period). See instructions below Denominator: Number of unique patients with office visits seen by the EP during the EHR reporting period PD: Unique patient seen in the period. Patient has an exam saved as completed, completed non- billable, or invoiced in the system during the reporting period. Threshold: The resulting percentage must be more that 10% in order for an EP to meet this measure Instructions: To identify and provide patient- specific education resources: Go to the EHR menu >Patient Education OR Click on the Patient Education button in the Final section of the EHR after you have saved the EHR 30
When the Patient Education window opens if the desired patient is not displaying click on the spyglass to select the desired patient 1. You will see a list of all diagnoses, medication, and lab results that the patient is associated with in the Patient Condition column located to the left side. You will also see this image for Info Button this indicates that additional information is available from Medline Plus. Click on the Info Button to see the details available 2. Condition Type shows whether the condition is a Lab Result, Diagnostic, or Medication 3. Education Resource this field stays blank until you click on the Info Button. Once the Info button has been selected the wording Info Button will populate in the field 4. Provided Allows you to check to indicate that you shared this information with your patient, by showing on screen, printing, or emailing. 5. Date Provided Once provided box is checked this field will populate with todays date. You can double click on the date to adjust it to the correct date Viewing Info Button 1. Click on the Info Button 31
2. Medline Plus window will open, from here you can: A. Click on the link and show your patient the information and print it for them from the linked website B. Click Launch System Viewer to print the content of this screen. It will open in your browser and you can print as you normally would from the Internet 32
Once you have shared the data with the patient you can close the window you will be returned to the Patient Education Window The Education Resource field will now be filled in with Info button Check the Provided field and then adjust the date if needed by double clicking in the date field Select Save in the lower right corner to finish Additional Information: Unique patients with office visits means that to count in the denominator a patient must be seen by the EP for one or more office visits during the EHR reporting period, but if a patient is seen by the EP more than once during the EHR reporting period, the patient only counts once in the denominator. The EP must use elements within certified EHR technology (CEHRT) to identify educational resources specific to patients' needs. Certified EHR technology is certified to use the patient's problem list, medication list, or laboratory test results to identify the patient- specific educational resources. The EP may use these elements or may use additional elements within CEHRT to identify educational resources specific to patients' needs. The EP can then provide these educational resources to patients in a useful format for the patient (such as, electronic copy, printed copy, electronic link to source materials, through a patient portal or PHR). The education resources or materials do not have to be stored within or generated by the CEHRT. There is no universal transitive effect policy in place for this objective and measure. It may vary based on the resources and materials provided and the timing of that provision. If an action is clearly attributable to a single provider, it may only count in the numerator for that provider. However, if the action is not attributable to a single provider, it may be counted in the numerator for all providers sharing the CEHRT who have the patient in their denominator for the EHR reporting period. The action may occur before, during or after the EHR reporting period but must take place no earlier than the start of the same calendar year as the EHR reporting period and no later than the date of attestation in order to count in the numerator. A provider may use an alternate calculation for an EHR reporting period in 2016 if that calculation is part of their CEHRT. 33
https://www.cms.gov/regulations- and- Guidance/Legislation/EHRIncentivePrograms/Downloads/2015EP_6PatientSpecificEducationObj ective.pdf Objective 7: 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 performs medication reconciliation for more than 50% of transitions of care in which the patient is transitioned into the care of the EP Exclusion: An EP who was not the recipient of any transitions of care during the EHR reporting period. Attestation Format: Numerator/Denominator/Threshold/Exclusion Numerator: Number of transitions of care in the denominator where medication reconciliation was performed PD: Patients within the denominator (had a Transition of Care into the provider s care) who had a medication reconciliation performed during the transition. (EHR Options>TOC>Import>Medication Reconciliation performed for manual and on screen reconciliation performed when an electronic summary of care was received). See instructions below Denominator: Number of transitions of care during the EHR reporting period for which the EP was the receiving party of the transition PD: All patients that had either a manual or an electronic summary of care imported into PD during the reporting period. (EHR Options>TOC>import). Threshold: The resulting percentage must be more than 50% in order for an EP to meet this measure. Instructions: To indicate the patient was received from another setting of care or provider: Select EHR Options Menu> Transition of Care 34
When the Transition of Care dialog opens use the spyglass to select the desired patient if they are not displaying Select Import The Transition of Care Type dialog will open You can select to Import the Transition of Care from a CCDA or to manually enter a received Transition of Care 1 Importing Transition of Care 2. Select Import Transition of Care button and Select OK 3. The import C- - - CDA dialog will open select the saved C- - - CDA File Select Open 35
4. The Import CCDA Reconciliation dialog will open. Go through each of the tabs, Problems, Medications, and Allergies and reconcile the data in each 4. The left side of the screen for each Tab displays the Active List (what is in your system currently) and Imported List (information that is being imported) 5. Select Auto Match at the bottom of the screen to let the system find matches 6. Highlight an item from Imported List and if there is a match in Active List it will highlight it also 7. Select Merge to merge the items to the Reconciled List 8. A dialog will pop up with both medications side by side; if they are the exact same and you want to continue select OK. If they don t match select Cancel and move them each independently 9. Once complete select OK 36
11. The medications will display on the right side as merged 12. Repeat for all Tabs (You will not be able to finish until all are reconciled) Add the selected Active and/or Imported from the patient s reconciled list (located at top and bottom of screen) Exclude the selected Active and/or imported from the patient s reconciled list (located at the top and bottom of screen) Merge entries from both lists to the patient s reconciled list 13. The Reconciliation Review dialogue will open 37
14. Select Submit when you are ready to finish You will be returned to TOC screen Select the red X in upper left corner to close Manually Receive Transition of Care 1. Select Manually enter a received Transition of Care 2. The Care Received Date will default to today, use the calendar to select another date if desired. 3. Check the Medication Reconciliation Performed Box if you have done this 4. Select OK To perform the medication reconciliation: You can perform the medication reconciliation by comparing medications that are reported by patient or other physician with your list if you are not using Practice Director s e- Prescribing portal. Additional Information: Only patients whose records are maintained using certified EHR technology must be included in the denominator for transitions of care. 38
In the case of reconciliation following transition of care, the receiving EP should conduct the medication reconciliation. The electronic exchange of information is not a requirement for medication reconciliation. The measure of this objective does not dictate what information must be included in medication reconciliation. Information included in the process of medication reconciliation is appropriately determined by the provider and patient. We define new patient as a patient never before seen by the provider. A provider may use an expanded definition of new patient for the denominator that includes a greater number of patients for whom the action may be relevant within their practice, such as inclusion of patients not seen in 2 years. https://www.cms.gov/regulations- and- Guidance/Legislation/EHRIncentivePrograms/Downloads/2016EP_7MedicationReconciliationOb jective.pdf Objective 8: Patient Electronic Access VDT 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 8.1 Electronic Access: More than 50% 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 8.2 View Download Transmit: For an EHR reporting period in 2016, at least 1 (one) patient seen by the EP during the EHR reporting period (or their authorized representatives) view, download, or transmit to a third party their health information during the EHR reporting period Exclusion: 8.1 : 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 8.2 : Conducts 50% or more of his or her patient encounters in a country that does not have 50% or more of its housing unites with 3Mbps broad band 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 39
Attestation Format: Numerator/Denomintaor/Threshold/Exclusion 8.1 Patient Electronic Access: 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 PD: Patients will count in this numerator if, within four days of a visit (saved EHR), they have registered within the patient portal and their registration has been linked to their file within PD (Patient menu>patient Portal Mgmt.). They do NOT have to actually view their information within the portal they just have to have access. See instructions below Denominator: Number of unique patients seen by the EP during the EHR Reporting period PD: Unique patients seen in the period. Patient has an exam saved as completed, completed non- - - billable, or invoiced in system during reporting period Threshold: The resulting percentage must be more than 50% in order for an EP to meet this measure Contact Practice Director Support to request Patient Portal Activation. Support will send you a provider link and a patient link once enabled One time Setup for each Provider in your Practice Create your Provider Portal account Select Patient Menu Select Patient Portal Select User Administration When the Patient Portal User Management Screen opens Select the Preferences Tab 1. Select Enable Portal Communications 2. Check the show in the Patient Portal checkbox for the Provider/s you want to display on Portal. In the NPI column make sure your Provider has a unique NPI, if they do not enter one in Provider Management before saving 3. Select Save 4. Select Close 40
You will receive confirmation when the data has successfully saved Launch your Provider Portal by going to your browser and entering your portal address Example Link https://test.only.com:8181/patientportal/?practicename= &usertype=provider Or From PD Select Patient Portal Select Launch Portal Register yourself as provider by selecting Register in right corner 41
When the Register New Account page opens add the following information User Name Password (must contain upper and lowercase letters and a number or symbol) Confirm Password NPI number Email Address (If you do not enter an email address the office will have to verify your account in Practice Director Confirm Email Direct Email Address Confirm Email Select your name from the provider list Select Register once completed 42
Instructions for 8.1 At some point during the patient visit you may register the patient or have them register themselves for Patient Portal Access. We recommend doing this with them in the office to ensure that they complete the steps. Once the exam is saved, as Completed or Completed Non- Billable the information will be available to Patient on the portal Go to your Patient Portal Link: Example https://test.only.com:8181/patientportal/?practicename= &usertype Have the Patient Select Register in the right corner 43
The Register New Account page will open Have the patient fill in the required Fields: User Name Password (Must contain upper, lowercase, and numeric value) Confirm Password First Name Last Name Birthdate Gender Zip Home or Cell Phone Email is optional (If you are over 18 years of age your email must be unique). If you use email the patient will receive an email with a link that they must select to activate. If you do not use email the office will need to verify the patient. Select your Provider Select Register 44
The user will receive a confirmation that the account has been created. If email was not specified they will see this confirmation 45
If user used email address they will see this confirmation And they will receive an activation email The user does not have to click on the link to activate the account in order to satisfy this measure, however they must activate before they can access their information. In order for the MU numerator count to increase, the staff must import the newly registered patient into PD in order to link the Portal Account and Practice Director Account. This must be done within 4 days of the patient DOS To link the accounts: Select Patient Menu Select Patient Portal Select User Administration 46
When the Patient Portal User Management screen opens 1. Select the User Management Tab 2. Select the desired patient from the left side of the screen 3. If there is a matching patient in the system the patient will display to the right of the screen 4. Select Link The Import New Patient dialog will open 1. The left side will display portal information 2. The right side will display PD information. You are also able to edit any information on the right by selecting the field and then typing. Note this will update the portal also 3. You can select Sync on the PD information side to override the current Demographic information with what the patient entered on the portal 47
4. If you do not wish to Sync you can select OK to link the Portal and PD account. Or once you have selected to Sync the Portal information to the PD you can select OK You will receive a message that the patient has been successfully imported 8.2: Numerator: The number of unique patients (or their authorized representatives) in the denominator that have viewed online, downloaded, or transmitted to a third party the patient s health information PD: Patients will count in this numerator if they have actually viewed their health information (CCDA) through the patient portal. So, if a patient has registered as a user for the portal, their account has been linked to their PD account and they have actually viewed the CCDA information in the portal, they will count. See instructions below Denominator: Number of unique patient seen by the EP during the EHR reporting period 48
PD: Unique patients see in the period. Patient has an exam saved as completed, completed non- - - billable, or invoiced in system during reporting period Threshold: The resulting percentage must be more than 1 (one) patient in order for an EP to meet this measure Instructions for 8.2: At some point during the patient visit you may register the patient or have them register themselves for Patient Portal Access. We recommend doing this with them in the office to ensure that they complete the steps. Once the exam is saved as Completed or Completed Non- - - Billable the information will be available to Patient on the portal Use the directions on pages 43-48 if you have not already registered and linked your patient. If you have already done this for 8.1 you do not need to have them register and linked again. Patient Access to Portal The patient can now access their information from the portal and must View, Download, or Transmit the information Have your patient go to the Patient Portal Link: Example https://test.only.com:8181/patientportal/?practicename= &usertype Have the user log on with their user name and password Once logged in they will select Patient Health Information 49
The patient Consolidated CCDA will display on the screen. All the patient has to do is view this page in order for it to increase the numerator The patient may also choose to Download or Transfer the CCDA Additional Information: In order to meet this objective, the following information must be made available to patients electronically within 4 business days of the information being made available to the EP: o Patient name o Provider's name and office contact information o Current and past problem list o Procedures o Laboratory test results o Current medication list and medication history o Current medication allergy list and medication allergy history o Vital signs (height, weight, blood pressure, BMI, growth charts) o Smoking status o Demographic information (preferred language, sex, race, ethnicity, date of birth) o Care plan field(s), including goals and instructions 50
o Any known care team members including the primary care provider (PCP) of record An EP can make available additional information and still align with the objective. In circumstances where there is no information available to populate one or more of the fields previously listed, either because the EP can be excluded from recording such information (for example, vital signs) or because there is no information to record (for example, no medication allergies or laboratory tests), the EP may have an indication that the information is not available and still meet the objective and its associated measure. The patient must be able to access this information on demand, such as through a patient portal or personal health record (PHR) or by other online electronic means. We note that while a covered entity may be able to fully satisfy a patient's request for information through VDT, the measure does not replace the covered entity's responsibilities to meet the broader requirements under HIPAA to provide an individual, upon request, with access to PHI in a designated record set. Providers should also be aware that while meaningful use is limited to the capabilities of CEHRT to provide online access there may be patients who cannot access their EHRs electronically because of a disability. Providers who are covered by civil rights laws must provide individuals with disabilities equal access to information and appropriate auxiliary aids and services as provided in the applicable statutes and regulations. For Measure 1, patient health information needs to be made available to each patient for view, download, and transmit within 4 business days of the information being available to the provider for each and every time that information is generated whether the patient has been "enrolled" for three months or for three years. A patient who has multiple encounters during the EHR reporting period, or even in subsequent EHR reporting periods in future years, needs to be provided access for each encounter where they are seen by the EP. If a patient elects to "opt out" of participation, that patient must still be included in the denominator If a patient elects to opt out of participation, the provider may count that patient in the numerator if the patient is provided all of the necessary information to subsequently access their information, obtain access through a patient- authorized representative, or otherwise opt back- in without further follow up action required by the provider. For Measure 2, the patient action may occur before, during or after the EHR reporting period but must take place no earlier than the start of the same calendar year as the EHR reporting period and no later than the date of attestation in order to count in the numerator. https://www.cms.gov/regulations- and- Guidance/Legislation/EHRIncentivePrograms/Downloads/2016EP_8PatientElectronicAccessObje ctive.pdf 51
Objective 9 Secure Messaging Use secure electronic messaging to communicate with patients on relevant health information Measure: For an EHR reporting period in 2016, 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) during the EHR reporting period. Exclusion: Any EP who has no office visits during the EHR reporting period, or any EP who conducts 50% or more of his or her patient encounters in a county that does not have 50% or more of its housing units with 4Mbps broadband availability according to the latest information available from the FCC on the first day of the EHR reporting period. Attestation Format: Yes/No/Exclusion Numerator: The number of patients in the denominator for whom a secure electronic message is sent to the patient (or patient- authorized representative), or in response to a secure message sent by the patient (or patient- authorized representative) Denominator: Number of unique patient seen by the EP during the EHR reporting period If you have not setup your provider portal yet, see pages 40-43 Provider Portal Activation Instructions for Logging into Provider Portal 1. Launch your Provider Portal by going to your browser and entering your portal address Or From PD Select Patient Portal Select Launch Portal 2. Select Log in, from the upper right corner 3. Enter your User Name and Password 52
Instructions for Sending and Receiving Messages 1. Once logged in you will be on the Secure Messaging screen 2. Patient Names that are available to message will display to the left side of the screen. Select the patient that you wish to message 3. In the field at the bottom of the screen enter your message to the patient 4. Select Send once completed 53
5. The sent message will display on the screen with the date and time sent, the provider that sent the message, and the message 6. When the patient responds, the message will display at the top of the list Selecting a Patient displays all communication with that patient and allows you to send new messages 54
Directions for Patient to send message: Have your patient log on with their user name and password 1. Once logged in the patient will be on the Secure Messaging screen 2. Providers that are available to message will display to the left side of the screen 3. Messages that have been received and sent will display on right side of the screen with the most recent message on top 4. Enter message that you want to send 5. Select Send 55
Additional Information: The thresholds for this measure increase over time between 2015 through 2017 to allow providers to work incrementally toward a high goal. This is consistent with our past policy in the program to establish incremental change from basic to advanced use and increased thresholds over time. The measure thresholds for this objective are fully enabled for 2015, at least one patient for 2016, and a threshold of 5 percent for 2017 to build toward the Stage 3 threshold. Provider initiated action and interactions with a patient- authorized representative, are acceptable for the measure and are included in the numerator. A patient- initiated message would only count toward the numerator if the provider responds to the patient The action for the numerator must occur within the calendar year but may occur before, during, or after the EHR reporting period if that period is less than one full calendar year. https://www.cms.gov/regulations- and- Guidance/Legislation/EHRIncentivePrograms/Downloads/2016EP_9SecureElectronicMessaging Objective.pdf 56
Objective 10 Public Health Reporting Capability to submit electronic data to immunization registries or Immunization Information Systems except where prohibited and in accordance with applicable law and practice. 10.1 Immunization Registry Reporting 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 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 CEHRT at the start of their EHR reporting period can enroll additional EPs. Attestation Format: Yes/No/Exclusion The EP must attest YES to meeting one of the following criteria under the umbrella of ongoing submission. Ongoing submission was already achieved for an EHR reporting period in a prior year and continues throughout the current EHR reporting period using either the current standard at 45 CFR 170.314(f)(1) and (f)(2) or the standards included in the 2011 Edition EHR certification Immunization Registries Data Submission 56criteria adopted by ONC during the prior EHR reporting period when ongoing submission was achieved. Registration with the PHA or other body to whom the information is being submitted of intent to initiate ongoing submission was made by the deadline (within 60 days of the start of the EHR reporting period) and ongoing submission was achieved. 57
Registration of intent to initiate ongoing submission was made by the deadline and the EP or hospital is still engaged in testing and validation of ongoing electronic submission. Registration of intent to initiate ongoing submission was made by the deadline and the EP or hospital is awaiting invitation to begin testing and validation Instructions: To record immunizations for a patient 1. If you want to submit optional information from Patient Demographics go to Patient Demographics, select the Public Health Reporting Tab, select the desired patient using the spyglass, select Edit to add information. Select Save once completed. If you don t want to include this information skip to step 2 2. Go to EHR Options> Optometry>. Immunization 3. If your intended patient is not already selected, search for them by clicking on the spyglass 4. Click Add 58
5. The Add Immunization dialog will open The required fields are Action, Administered Date, and Vaccine Name Fill in all of the remaining fields as needed, click OK You will then see it added to the immunization list where you can add, edit, delete, or export the immunization listed 59
To submit immunization information: 1. Generate an HL7 filed by selecting one or more immunizations from the list in the Immunization dialog 2. Click Export 3. When the Save dialog opens, Save as will be filled in with the file name 4. Select the Directory where you want to save the file to 5. Select the specific folder you want to save the file to 6. File Format will default to All Files 7. Select Save 60
8. You will upload the file as directed by the immunization registry or immunization information system Additional Information: Providers who have previously registered, tested, or begun ongoing submission of data to registry do not need to restart the process beginning at active engagement option 1. The provider may simply attest to the active engagement option, which most closely reflects their current status. In order to meet this objective an EP would need to meet two of the total number of measures available to them An exclusion for a measure does not count toward the total of two measures. If an EP excludes from a measure, they must meet or exclude from the remaining measures in order to meet the objective. If the EP qualified 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 reaming measure available to them. If no measures are available, the EP can meet the objective by meeting the requirements for exclusion from all three measures For Measure 1, an exclusion does not apply if an entity designated by the immunization registry or immunization information system can receive electronic immunization data submissions. For example, if the immunization registry cannot accept the data directly or in the standards required by CEHRT, but if it has designated a Health Information Exchange to do so on their behalf and the Health Information Exchange is capable of accepting the information in the standards required by CEHRT, the provider could not claim the second exclusion. For Measure 2, an exclusion does not apply if an entity designated by public health agency can receive electronic syndromic surveillance data submissions. For example, if the public health agency cannot accept the data directly or in the standards required by CEHRT, but if it has designated a Health Information Exchange to do so on their behalf and the Health Information Exchange is capable of accepting the information in the 61