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Bridge to Meaningful Use: Stage 2 Our Bridge to Meaningful Use connects the various measurements of the EHR Incentives to their respective counterparts in the EHR system. By utilizing the software and the guidance of TSI Healthcare s industry experts, are one step closer to obtaining their share of the EHR Incentives. Ce Measure Set # Objective 1 Computerized Physician Order Entry Use computerized provider der entry (CPOE) f medication, labaty and radiology ders directly entered by any licensed healthcare professional who can enter ders into the medical recd per state, local and professional guidelines. Me than 60% of medication, 30% of radiology ders created by the EP during the EHR repting period are recded using CPOE. Write fewer than 100 radiology ders eprescribing Generate and transmit permissible prescriptions electronically (erx). Me than 50% of all permissible prescriptions, all prescriptions, written by the EP are transmitted electronically using certified EHR technology and Are queried f a drug fmulary and transmitted electronically. Me than 80% of all unique patients seen by the EP have demographics recded as structured data. Writes fewer than 100 meds No pharmacies accepting erx within 10 miles Me than 80% of all unique patients seen by the EP have blood pressure (f patients age 3 and over only) Sees no pts 3+ BP is not relevant and/ height and weight (f all ages) recded as structured data. HT/WT are not relevant 2 3 4 Recd Demographics Recd all of the following demographics: preferred language, sex, race, ethnicity, date of birth. Recd Vital Signs Recd 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/display growth charts f patients 0 20 years, including BMI. Exclusion Write fewer than 100 meds Write fewer than 100 lab ders 30% of labaty, and Location Orders Module Lab Diagnostic Orders Change from 30% New New 40% EPM Pt. Demographics Temp. Vital Signs Combined Vital Signs 50% 50%, and Split into two measures 50%, and Split into two measures

# Objective Exclusion Location Change from 5 Recd Smoking Me than 80% of all unique patients 13 Sees no pts 13+ Recd smoking status f patients years old older seen by the EP have Social Histy 50% 13 years old older smoking status recded as structured data. 6 Clinical Decision Suppt Use clinical decision suppt to improve perfmance on highpriity health conditions. 7 Patient Electronic Access Provide patients the ability to view online, download and transmit their health infmation within four business days of the infmation being available to the EP. 8 Clinical Summaries Provide clinical summaries f patients f each office visit. Implement 5 clinical decision suppt interventions related to 4 me clinical quality measures at a relevant point in patient care f the entire EHR repting period. The EP has enabled and implemented the functionality f drug drug and drug allergy interaction checks f the entire EHR repting period. Me than 50% of all unique patients seen by the EP during the EHR repting period are provided timely (available to the patient within 4 business days after the infmation is available to the EP) online access to their health infmation. Me than 5% of all unique patients seen by the EP during the EHR repting period ( their authized representatives) view, download, transmit to a third party their health infmation. Clinical summaries provided to patients patient authized representatives within 1 business day f me than 50% of all office visits. Writes fewer than 100 meds 50%+ of encounters are in a county with 50%+ housing units have less than 3Mbps internet Sees no office visits Protocols Patient Ptal Patient Ptal Plan Check out 1 rule, and Added CMQ association Combined 10%, and Menu to Ce New 3 days to 1 day

# Objective Exclusion Location Change from 9 Protect Electronic Health Conduct review a security risk analysis in Security & Risk Infmation accdance with the requirements under 45 Analysis perfmed No change Protect electronic health CFR 164.308(a) (1), including addressing the by client infmation created maintained encryption/security of data sted in CEHRT by the certified EHR technology in accdance with requirements under 45 through the implementation of CFR 164.312 (a)(2)(iv) and 45 CFR appropriate technical capabilities. 164.306(d)(3), and implement security updates as necessary and crect identified security deficiencies as part of the provider's risk management process f EPs. 10 Clinical Lab Test Results Incpate Clinical Lab Test Results into EHR as structured data. 11 Patient Lists Generate lists of patients by specific conditions to use f quality improvement, reduction of disparities, research, outreach. 12 Patient Reminders Use clinically relevant infmation to identify patients who should receive reminders f preventive/follow up care and send these patients the reminders, per patient preference. Me than 55% of all clinical lab tests results dered by the EP during the EHR repting period whose results are either in a positive/negative numerical fmat are incpated in Certified EHR Technology as structured data. Generate at least one rept listing patients of the EP with a specific condition. Me than 10% of all unique patients who have had 2 me office visits with the EP within the 24 months befe the beginning of the EHR repting period were sent a reminder, per patient preference when available. Orders no labs with pos/neg numerical results No office visits in 24 months befe EHR repting period Orders Module Lab Standard Rept Writer Population Health 40% Moved to Ce Menu to Ce. Decreased to 10%, and Cannot include existing appointments

# Objective Exclusion Location Change from 13 Patient Education Resources Me than 10% of all unique patients seen Sees no office visits Use clinically relevant infmation by the EP during the repting period are Various s Menu to Ce from Certified EHR Technology to provided patient specific education identify patient specific education resources identified using certified EHR resources and provide those technology. resources to the patient. 14 Meds Reconciliation The EP who receives a patient from another setting provider of care believes an encounter is relevant should perfm meds reconciliation. 15 Summary of Care The EP who transitions their patient to another setting of care provider of care refers their patient to another provider of care should provide summary care recd f each transition of care referral. The EP perfms medication reconciliation f me than 50% of transitions of care in which the patient is transitioned into the care of the EP. The EP who transitions refers their patient to another setting of care provider of care provides a summary of care recd f me than 50% of transitions of care and referrals. The EP who transitions refers their patient to another setting of care provider of care provides a summary of care recd f me than 10% of such transitions and referrals either (a) electronically transmitted using CEHRT to a recipient (b) where the recipient receives the summary of care recd via Health Infmation Exchange. Conducts one me successful electronic exchanges of a summary of care document, as part of which is counted in previous measure with a recipient who has EHR technology that was developed designed by a different EHR technology developer than the sender's EHR technology. OR Conducts one me successful tests with the CMS designated test EHR during the EHR repting period. Did not receive transitions of care Transfers refers less than 100 patients during repting period Transfers refers less than 100 patients during repting period Transfers refers less than 100 patients during repting period Home Referral Document EHR EHR Menu to Ce Menu to Ce

# Objective Exclusion 16 Immunization Registries Data Submission Capability to submit electronic data to immunization registries immunization infmation systems except where prohibited, and in accdance with applicable law and practice. Successful ongoing submission of electronic immunization data from certified EHR to an immunization registry immunization infmation system f the entire EHR repting period. 17 Use Secure Electronic Messaging Use secure electronic messaging to communicate with patients on relevant health infmation. A secure message was sent using the electronic messaging function of CEHRT by me than 5% of unique patients ( their authized representatives) seen by the EP during the EHR repting period. Does not administer immunizations Registry incapable of accepting data registry Sees no visits 50%+ of encounters are in a county with 50%+ housing units have less than 3Mbps internet Location Immunization Registry Patient Ptal Change from Menu to Ce Our OurHands On Hands OnApproach Approach Analysis Regulaty Analysis Education Evaluation & Regulaty Education Goal Setting Evaluation & Goal Setting Training Recurring System Training Sessions Recurring System Training Sessions Personalized Personalized Selection Selection OutreachOutreach Assisted Program Registration Assisted Program Registration Continued Benchmarking Continued Benchmarking&&Review Review Repting Repting Assisted Submission to CMS Assisted Submission to CMS

Menu Measure Set Must select 3 of 6 objectives # Objective Exclusion Location Change from 1 Syndromic Surveillance Data Submission Capability to submit electronic syndromic surveillance data to public health agencies except where prohibited, and in accdance with applicable law and practice. 2 Electronic Notes Recd electronic notes in patient recds. 3 Imaging Results Imaging results consisting of the image itself and any explanation other accompanying infmation are accessible through CEHRT. 4 Family Health Histy Recd patient family health histy as structured data. Successful ongoing submission of electronic syndromic surveillance data from CEHRT to a public health agency f the entire EHR repting period. Enter at least one electronic progress note created, edited and signed by an EP f me than 30 percent of unique patients with at least one office visit during the EHR repting period. The text of the electronic note must be text searchable and may contain drawings and other content. Me than 10 percent of all tests whose result is one me images dered by the EP during the EHR repting period are accessible through CEHRT. Me than 20 percent of all unique patients seen by the EP during the EHR repting period have a structured data entry f one me first degree relatives. Does not collect syndromic surveillance data Agency incapable of accepting data agency Writes fewer than 100 radiology ders Have no access to electronic imaging results at start of repting period Sees no office visits Public Health Registry OV Note Document Various s Radiology Family Histy No Change # Objective Exclusion Location Change from

# Objective Exclusion Location 5 Rept Cancer Cases Capability to identify and rept cancer cases to a public health central cancer registry, except where prohibited, and in accdance with applicable law and practice. Successful ongoing submission of cancer case infmation from CEHRT to a public health central cancer registry f the entire EHR repting period. Does not diagnose treat cancer Agency incapable of accepting data agency Public Health Registry 6 Rept Specific Cases Capability to identify and rept specific cases to a specialized registry (other than a cancer registry), except where prohibited, and in accdance with applicable law and practice. Successful ongoing submission of specific case infmation from CEHRT to a specialized registry f the entire EHR repting period. Does not diagnose treat disease associated with specialty registry Agency incapable of accepting data agency Specialty Registry Change from