Evident is dedicated to making your transition to Meaningful Use as seamless as possible. In an effort to assist our customers with implementation of the software conducive to meeting Stage 2 requirements, Evident has created a general guideline. Each facility should have contacted their Account Manager to receive their matrix and should have filled out a questionnaire and returned it prior to moving forward with Meaningful Use. Below is a list of items each facility will need before proceeding with Meaningful Use: CPOE Pharmacy Clinical Monitoring Point of Care ChartLink Clinical Vocabulary Census Application Laboratory or a Discrete Element Lab Interface Order Entry Radiology Patient Portal CCD, Patient Summary Subscription DIRECT Messaging with 3rd party HISP provider Patient Education Document Medication Management Electronic File Management Additional Disk Space May be Needed (see Security Objective) Immunization Interface Electronic Reportable Laboratory Results Interface Syndromic Surveillance Interface Core Measures CQM Submission Interface ImageLink or 3rd party PACS with URL Interface Thrive Provider EHR or 3 rd party Ambulatory Interface Physician Documentation In addition to the above, each facility will also have to perform the following: Convert to Rule Based Security (Must Implement before loading Thrive Version 19) Load Thrive Version 19 (V19) Revision Date: 07/09/2015 1
Quality Measures: Beginning in 2013, there will no longer be a separate objective for reporting hospital clinical quality measures (CQMs) as a part of Meaningful Use. It is important to note, however that eligible hospitals will still be required to report on clinical quality measures in order to achieve Meaningful Use. Facilities beyond their first year of reporting will be required to electronically submit CQMs. Applications needed for Clinical Quality Measures: Core Measures and Clinical Quality Measures Submission Interface * As CMS further defines electronic submission, there will be a Frequently Asked Question Published. Set-Up for objective: For further information on this objective as well as set up for this objective, please review the Quality Measures Setup and Data Collected for Quality Measures and Quality Measures Roadmap documents. How to achieve Objective: This objective is achieved by running the Quality Measures report. Information on this report will be reflective of documentation that has been put in the system to calculate Quality Measures. Path to Quality Measures report: Hospital Base Menu > Other Applications and Functions > Indicator Measurement/Core Measures > Quality Measures. Please retain a copy of this report from attestation for auditing purposes Objectives, Measures and Set-Up Core Objectives: CPOE (must meet 3 measures): Measure 1: More than 60% of medication orders created by authorized providers of the eligible hospitals ED/IP during the reporting period are recorded using CPOE. Measure 2: More than 30% of Laboratory orders created by authorized providers of the eligible hospitals ED/IP during the reporting period are recorded using CPOE. Measure 3: More than 30% of Radiology orders created by authorized providers of the eligible hospitals ED/IP during the reporting period are recorded using CPOE. Applications needed to meet Objective: CPOE, Laboratory, Radiology and Pharmacy How to achieve Objective: This objective is met by placing orders through Computerized Physician Order Entry. CPOE entails the provider s use of computer assistance to directly enter orders from a computer or mobile device. The order is also documented or captured in a digital, structured, and computable format for use in improving safety and organization. Telephone and Verbal orders count for this objective. Measure 1: Medication: DENOMINATOR: Number of medication orders created by the EP or authorized providers in the eligible hospital's or CAH's inpatient or emergency department during the EHR reporting period. Medication Orders Placed Revision Date: 07/09/2015 2
NUMERATOR: The number of medication orders in the denominator recorded using CPOE. Medication Orders placed that have been recorded using CPOE. Measure 2: Radiology DENOMINATOR: Number of radiology orders created by the EP or authorized providers in the eligible hospital's or CAH's inpatient or emergency department during the EHR reporting period. Radiology Orders Placed NUMERATOR: The number of radiology orders in the denominator recorded using CPOE. Number of Radiology Orders Placed that have been recorded using CPOE. Measure 3: Laboratory DENOMINATOR: Number of laboratory orders created by the EP or authorized providers in the eligible hospital's or CAH's inpatient or emergency department during the EHR reporting period. Laboratory Orders Placed NUMERATOR: The number of laboratory orders in the denominator recorded using CPOE. In 2013, CMS is adding an optional alternate measure to the objective for CPOE. Number of Laboratory Orders Placed that have been recorded using CPOE. Record Demographics More than 80% of all unique patients have demographics recorded as structured data. Applications needed to meet Objective: Census Application Set-Up for Objective: Evident suggests making the below demographics required, or a census edit set up to ensure information is captured. Race and Ethnicity Tables must now be set up to convert the old value to the new value via the following paths: Path to Race and Ethnicity Tables: Hospital Base Menu > Master Selection > Business Office Tables > Table Maintenance > Patient Tab > Race and Ethnicity. The correct value code will have to be mapped to each code created in these tables. Please note: Patients that previously had H-Hispanic or N-Non Hispanic (or the word Hispanic/Non- Hispanic) in the ethnicity field of their demographics will now be converted as such in the ethnicity field. However, if your facility did not use H/N or Hispanic/Non-Hispanic in the ethnicity field, those patient accounts/profiles may have to be manually converted. Revision Date: 07/09/2015 3
How to achieve Objective: The following demographics are recorded on the patients profile/visit. Race Additional races can now be recorded for patients by selecting the + sign next to race. If there are additional races recorded on a patient the Race field will change to red and will read as Races. Ethnicity DOB This field is now table driven. Preferred Language There is now a hardcoded table for this entry. Sex Date and preliminary cause of death (within hospital)- this will show a tab of paper when expired within hospital discharge code is used. The Eligible Hospital or CAH can now audit demographic changes made to the above fields on the patient s account or Profile by running any of the following reports in Report Dashboard: MU Visit Audit Report MU Profile Audit Report MU Profile and Visit Audit Report DENOMINATOR: Number of unique patients admitted to the eligible hospitals or CAH s inpatient or emergency department during the EHR reporting period. Unique Patients admitted to ED/IP during reporting period. NUMERATOR: Number of patients in the denominator who have all the elements of demographics recorded as structured data. Unique patients in denominator that have the following documented on patients profile/visit: Race Ethnicity Date of Birth Sex Preferred Language Date and Preliminary cause of Death (within hospital). Record and Chart Changes in Vital Signs More than 80% of all unique patients admitted to the eligible hospital s IP/ED during the EHR reporting period have blood pressure (for patients age 3 and over only) and height/length and weight (for all ages) recorded as structured data. Revision Date: 07/09/2015 4
Applications needed to meet Objective: Point of Care Set-Up for Objective: It is recommended BMI is set-up to display on patient s virtual chart. It is recommended Height and Weight and BP be set up on Flow chart and /or Eform. It is recommended Growth Charts be set up on Virtual Chart Tab. How to achieve Objective: It is recommended Height, Weight and Blood Pressure be documented through Patient Documentation- Flow Chart or EForms. DENOMINATOR: Number of unique patients admitted to the hospital s IP/ED during the EHR reporting period. Unique Patients admitted to ED/IP during reporting period. NUMERATOR: Number of patients in the denominator who have blood pressure (ages 3 and over only) and height and weight (all ages) recorded as structured data. Unique patients who have the following documented via flow chart/eform/documentation: Blood Pressure (ages 3 and over) Height Weight Record Smoking Status for Patients 13 and Older More than 80% of all unique patients 13 years or older have smoking status recorded. Applications needed to meet Objective: Census and Point of Care Set-Up for Objective: Evident suggests smoking field to be required or a census edit be set up to ensure Smoking status is captured in Census. How to achieve Objective: Smoking Status can be captured via POC/Census/E-forms. Note: If using e-forms, ensure your drop-down options reflect choices in census. The Eligible Hospital or CAH can now audit smoking status changes made on the patient s account or Profile by running any of the following reports in Report Dashboard: MU Visit Audit Report MU Profile Audit Report MU Profile and Visit Audit Report DENOMINATOR: Number of unique patients age 13 or older admitted to the eligible hospital s inpatient or emergency department during the EHR reporting period. Unique Patients 13 and older admitted to ED/IP during reporting period. Revision Date: 07/09/2015 5
NUMERATOR: Number of patients in the denominator with smoking status recorded as structured data. Unique patients 13 and older with smoking status documented via census/flow chart/eform/documentation. Clinical Decision Support (must meet 2 measures): 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 eligible hospital or CAH s patient population, the clinical decision support interventions must be related to high-priority health conditions. It is suggested that one of the five clinical decision support interventions be related to improving healthcare efficiency. Measures 2: The eligible hospital or CAH has enabled the functionality for drug-drug and drug-allergy interaction checks for the entire EHR reporting period. Application needed to meet Objective: Point of Care, CPOE, Lab, Radiology, Pharmacy, Clinical Vocabulary and Clinical Monitoring and Infobutton. Set-Up for Objective: Clinical Decision and the rules must be activated from the following path: Hospital Base Menu > Master Selection > Business Office Tables > Table Maintenance > Clinical > CDS Alert Configuration. Drug-Drug, Drug-Allergy Clinical Monitoring options must be set up via Nursing, Pharmacy, and/or Chartlink. The following are clinical monitoring options that must also be Used: Allergy Checking Drug Interaction Checking The following types of alerts can be activated for a user (note: some of the below alerts are being programmed at this time): Please note: At least 4 must be chosen related to clinical quality measures for entire reporting period and one of the 5 is suggested it is related to improving healthcare efficiency. Lab Tests and Values Problem List Vital Signs (Blood Pressure) Medication List Vital Signs (Body Mass Index) Demographics (Date of Birth) Problem List, Demographics, Lab Tests Discharged on Antithrombotic Therapy Anticoagulation Therapy for Atrial Fibrillation/Flutter Thrombolytic Therapy Antithrombotic Therapy by End of Hospital Day 2 Revision Date: 07/09/2015 6
Discharged on Statin Medication Stroke Education Assessed for Rehabilitation Venous Thromboembolism Prophylaxis Venous Thromboembolism Patients with Anticoagulation Overlap Therapy Venous Thromboembolism Patients Receiving Unfractionated Heparin with Dosages/Platelet Count Monitoring by Protocol or Nomogram Venous Thromboembolism Discharge Instructions Home Management Plan of Care Document given to Patient/Caregiver How to achieve Objective: This objective is met with real time alerting of the system based on a CDS alert and configurations and clinical monitoring options that are set up above. Evident has provided a default set of rules to be used (5 of the above), that meet the CMS criteria. Override Reasons report and Clinical Monitoring reports are available to assist with tracking compliance from the Pharmacy Department. In addition to Override Reasons and Clinical Monitoring reports, the system will now track when each CDS alert was activated/ deactivated. This can be found by choosing the specific alert in CDS alert configuration (Table Maintenance) and choosing Status History. Drug- Drug, Drug-Allergy must be used in addition to the 5 CDS alerts to meet this objective. The system will now track when each clinical monitoring option is activated/deactivated. This can be found through the following paths: Table Maintenance, Control, Prescription Entry, Clinical Monitoring, View Audit. Table Maintenance, Control, Pharmacy Control, Clinical Monitoring, View Audit. Business Office Table Maintenance, Chartlink Tables, Chartlink Clinical Monitoring, View Audit. Nursing Administration, Print Reports, Clinical Monitoring, View Audit. The EHR must also have the ability to offer diagnostic or therapeutic reference information based on Problems, Medications, Medication Allergies, Laboratory tests/values, and Vital Signs and a combination option. This will be achieved with the use of the InfoButton. Please retain a copy of all alerts activated and the status history/view audit to show alerts were on for the entire reporting period for auditing purposes. View, Download, Transmit (must meet 2 Measures): Measure 1: More than 50% of all unique patients discharged from the IP/ED during the EHR reporting period have their information available online within 36 hours of discharge. It is Evident s interpretation that Measure 1 can be met once the patient possesses all information necessary in order to know how to log onto the portal to view their information. Revision Date: 07/09/2015 7
Access is defined as the following: When a patient possesses all of the necessary information needed to view, download, or transmit their information. This could include providing patients with instructions on how to access their health information, the website address they must visit for online access, a unique and registered username or password, instructions on how to create a login, or any other instructions, tools, or materials that patients need in order to view, download, or transmit their information. Measure 2: More than 5% of patients (or their authorized representatives)who are discharged from the inpatient or emergency department of an Eligible Hospital or CAH view, download, or transmit to a 3 rd party their information during the EHR reporting period. Applications needed to meet Objective: Patient Portal, CCD Patient Summary Subscription, Direct Messaging with 3rd party HISP provider Network Addresses, Point of Care, Pharmacy, Laboratory, and Radiology. Set-Up for Objective: Purpose code has to be created in Release of Information for Patient Possesses Info to Access Portal. (recommend creating code PIA) Purpose code (created above) has to be entered in Release of Information Control Table: Purpose Cd for Patient Possesses Info to Access Portal. Recommended code PIA ) How to achieve Objective: (Objective can be met in 1 of 4 ways currently) 1. This objective can be met by having a valid email address on the patient s registration visit screen (or their authorized provider) in the Census Application. Once the patient is then discharged, they will be sent an introductory email to create a login name and user password and their patient/clinical summary (or CCD) will then be available on the patient portal for them to view. The patient portal address will be the following: www.mymedicalencounters.com. The authorized representative entered in the census visit screen will also have access to the patient portal, giving the authorized representative access to the clinical information for the patient (visit they were the authorized rep on). The authorized representative should be verified each time a visit is created. 2. This objective can also be met by placing the patient portal launch onto the Point of Care Virtual Chart. The facility can follow this link and assist the patient in logging into the patient portal. Please note: This will only update the numerator of this objective if the launch is chosen previous to 36 hours after discharge (to meet Measure 1 of this objective). However this launch will stay on the virtual chart for the patient indefinitely so that the facility can instruct the patients how to log into their portal to also meet measure 2 of this objective. 3. This objective can also be met by giving the patient information regarding how to log onto the portal or education classes that will be conducted on how to log into the portal etc. Once this is done, Release of Information can be manually updated with PIA which is the code for Patient Possesses information regarding portal that was created above. 4. This objective can be met in the same way as number 3. However, this can now be an automatic process. A custom patient education document can be created and tied to the Release of Information Code (Usually PIA is used) that is found in the Patient Possesses Information regarding field in the Release of Information Control Table. Once that patient education document is given, this ROI entry will be created to update statistics. Revision Date: 07/09/2015 8
Users of the EHR will have the ability to control what is viewable to the patient on the patient portal. This can be achieved by building the Patient Summary/CCD via Print Electronic Record, selecting edit and choosing the information you would like to include/exclude and save document. This will save a version of the document in Print Electronic Record and Electronic File Management with the changes that have been made to the document. The most recently edited version will be what the patient (or authorized representative) sees when logged into the Patient Portal. Any unresolved problems, allergies, and/or immunizations from previous visits will appear on the patient summary (unless hidden via the edit option). Measure 1: DENOMINATOR: Number of unique patients discharged from an eligible hospital or CAH's inpatient or emergency department during the EHR reporting period. Unique patients discharged during the reporting period. Measure 1: NUMERATOR: The number of patients in the denominator whose information is available online within 36 hours of discharge. Unique patients who have been provided access within 36 hours of discharge via the following: Provided email address (patient or authorized provider) or Launch Portal from Virtual Chart or Provided education material and updated Release of Information Patient in Room Measure 2: DENOMINATOR: Number of unique patients discharged from an eligible hospital's or CAH's inpatient or emergency department) during the EHR reporting period. Unique patients discharged during reporting period. Measure 2: 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 discharge information (CCD) provided by the eligible hospital or CAH. Unique patients in denominator who have done one of the following with Discharge Information (CCD) provided by the hospital: Viewed Online Downloaded Transmitted CCD-Patient Summary to a 3 rd Party. Protect Electronic Health Record Conduct or review a security risk analysis in accordance with the requirements under 45 CFR 164.308(a)(1) and implement security updates as necessary and correct identified security deficiencies as part of its risk management process. This must be done prior to or during the reporting period Attestation. Additional Hardware needed: Due to the increased amount of data being kept for audit purposes, additional disk space may be needed. How to achieve Objective: This objective will be met by each site performing a security risk analysis. Evident recommends the following for meeting this objective. Revision Date: 07/09/2015 9
Review the guidance from the OCR regarding compliance with HIPAA Security Rule TruBridge offers Security Risk Analysis (SRA) Services that are designed to assist sites in complying with the HIPAA Security Rule. For more information on this service, please contact your TruBridge Account Manager. For further information on this objective as well as websites to assist with your risk analysis, please review the Security Objective & Measure Roadmap. Incorporate Clinical Lab Results into the EHR as Structured Data More than 55% of all clinical lab tests ordered whose results are either positive/negative or numerical are incorporated into the certified EHR as structured data. Applications needed to meet Objective: Lab Application or a Discrete Element Lab Interface with Micro and Clinical Vocabulary. Set Up for Objective: Laboratory items will be set up in accordance with Evident s standard format (when lab install takes place) to be recognized as structured data. Please contact Evident if you are unsure how to set up your lab items to meet this measure. How to meet Objective: Entering Laboratory results through the Evident system (or discrete element interface) in a positive/negative or numerical format will meet this objective. DENOMINATOR: Number of lab tests ordered during the EHR reporting period by authorized providers of the eligible hospital or CAH for patients admitted to an eligible hospital s or CAH s inpatient or emergency department whose results are expressed in a positive or negative affirmation or as a number. Number of lab tests ordered during reporting period that are formatted with positive/negative or number value. NUMERATOR: Number of lab test results whose results are expressed in a positive or negative affirmation or as a number which are incorporated as structured data. Number of lab tests that are resulted with positive/negative or number value (structured). Generate List of Patients by Specific Conditions Generate at least one report listing patients with a specific condition to use for quality improvement, reduction of disparities, research or outreach. - Attestation. Applications needed to meet Objective: Point of Care, Pharmacy, Clinical Vocabulary, Lab and Order Entry. How to meet Objective: This objective will be met by utilizing the Patient with Clinical Data option in Report Writer. This report is found in the following path: Hospital Base Menu > Other Applications and Functions > Word Processing > AdHoc > Report Dashboard > Add Report > Patients with Clinical Data. Revision Date: 07/09/2015 10
Please note: When searching for Problems, Medications, Allergies etc, a * can be used as a wild card before and after a string of letters to search. Example: if you are searching for Tylenol Q8H, you can use *Tylenol* and it will bring up all results that has the string of letters in it. Patient Education Resources More than 10% of all unique patients are provided patient-specific education resources. Applications need to meet Objective: Point of Care, Patient Education Documents and Infobutton. Set Up for Objective: LOINC codes will need to be set up on Laboratory items in order to utilize the Patient Lab Information Documents. How to meet Objective: This objective will be met by the use of Patient Education Documents and InfoButton. When an education document is given and saved, this will be recorded onto the patient s account. Patient Education by Problem List, Patient Lab Information Documents, and Patient Drug Information education documents will be used to meet this objective. Custom education documents can also be used to meet this objective if your custom document is tied to lab tests or problems via the classification code area (patient education maintenance) in table maintenance (clinical, update user defined documents). The above selections are the only education documents that will count in the numerator for this measure. DENOMINATOR: Number of unique patients admitted to the eligible hospitals or CAH s inpatient or emergency department during the EHR reporting period. Number of Unique patients admitted during the reporting period. NUMERATOR: Number of patients in the denominator who are provided patient education specific resources. Number of patients in denominator that were provided one of the following patient education documents: Education based on Problem List Education based on Patient s Lab Test Education based on Patient Drug Information Perform Medication Reconciliation at Relevant Encounters and Each Transition of Care Perform medication reconciliation on more than 50% of transitions of care. Applications needed to meet Objective: Medication Management. Set Up for Objective: The following will need to be set up under the Medication Management Tab in Table Maintenance (Table Maintenance, Clinical, Medication Management). Medication Reconciliation Destinations Revision Date: 07/09/2015 11
Discontinue Reasons Doses Routes Frequencies Modifiers Pharmacies Units Zip Codes All Pharmacy Medications have accurate and up-to-date NDC Numbers. How to meet Objective: This objective will be met with the use of Medication Reconciliation through the ChartLink, Pharmacy or Point of Care Applications. Admission and Discharge Reconciliations are strongly encouraged and are considered best practice. DENOMINATOR: Number of transitions of care during the EHR reporting period for which the eligible hospital s or CAH s inpatient or emergency department was the receiving party of the transition. Number of transitions of care during the reporting period where the hospital was the receiving party of the transition. NUMERATOR: Number of transitions of care (admissions and discharges) in the denominator where medication reconciliation was performed. Number of admissions and discharges of patients in the denominator where medication reconciliation was performed (Reconcile). Clinical Information Reconciliation can also be utilized in the EHR. This enables a user to electronically reconcile data that represent a patient s active medication, problem and medication allergies into one single list to review accuracy and upon a user s confirmation, automatically update the list. If a facility wishes to utilize this function, please contact Evident for further information. Summary of Care (Must meet 3 measures): Measure 1: The eligible hospital or CAH that transitions or refers their patient to another setting of care or provider of care provides a summary of care record for more than 50 percent of transitions of care and referrals. Measure 2: The eligible hospital or CAH that transitions or refers their patient to another setting of care or provider of care provides a summary of care record electronically for more than 10 percent of such transitions and referrals. Measure 3: The eligible hospital or CAH must satisfy one of the two following criteria: Conducts one or more successful electronic exchanges of a summary of care document, which is counted in "measure 2" with a recipient who has EHR technology that was designed by a different EHR technology developer than the sender's EHR technology. This exchange may be conducted outside of the EHR reporting period, but must take place no earlier than the start of the year and no later than the end of the EHR reporting year or the attestation date, whichever occurs first. If providers cannot exchange a Revision Date: 07/09/2015 12
summary of care document with recipients using different CEHRT in common practice, then they may retain documentation on their circumstances and attest yes to meeting measure 3 if they have and are using a certified EHR which meets the standards required to send a CCDA Attestation. Applications needed to meet Objective: Point of care, Lab, Radiology, Physician Documentation, Clinical Vocabulary, Direct Messaging with 3rd party HISP provider Network Address, Medication Management, Clinical Monitoring and Electronic File Management. Set Up for Measure 1: SNOMED Codes must be added to the following to pull to the CCD: Lab Items (Reference Range Table) Rad/Respiratory Items/Procedures (Item Master) Micro Items (Infection Control) Referral/Transition of Care Widget must be accessible via POC Flow Charts via the following path: Hospital Base Menu > Nursing Administration Department > Print Reports > Nursing Chart Masters (select Chart Type) > Discharge Summary/Instructions > Select existing or enter a new question. > Select Referral/Transfer of Care option under Flow sheet answer format. > Once question has been set up, pull to flowchart. Add CCD-Transfer/Referral Patient Summary to Virtual Chart Tab. This is the only CCD that will pull for Stage 2 Statistics for this measure. Purpose code for complete summary of care has to be set up in Release of Information. Purpose code (created above) has to be entered in Release of Information Control Table: Purpose Cd for Complete Patient Summary Sent for Transfer/Referral field. Purpose code for incomplete summary of care has to be set up in Release of Information. Purpose code (created above) has to be entered in Release of Information Control Table: Purpose Cd for Incomplete Summary Sent for Transfer/Referral field. Cognitive and Functional status can also be documented for the patient and pull to the CCD- Summary of Care/Transfer/Referral. This can be documented via the following paths: CW5 > HIST Icon > Cognitive and Functional Status or Physician Documentation Application How to meet Measure 1: This objective will primarily be met through Nursing. When a patient is transferred to another facility- problems (physician problem list), Medications, Medication Allergies must be entered on the patient s account in order to meet the objective. Referral/Transition of Care widget is accessed and recorded for your patient to be in the denominator. Transfer of Care/Referral Summary is chosen from the virtual chart. Print, or Submit to Provider is chosen. This creates a Release of Information (ROI) entry for the patient in the Release of Information Application. Revision Date: 07/09/2015 13
This objective can also be achieved through the Medical Records Department once Nursing has completed the Referral/Transition of Care widget via the following path: Hospital Base Menu > Medical Records > Print Electronic Record > Referral/Transition of Care Summary is chosen > Print, Copy to Portable Media, or Submit to Provider is chosen and Release of Information is updated. DENOMINATOR: Number of transitions of care and referrals during the EHR reporting period for which the eligible hospital s or CAH s inpatient or emergency department was the transferring or referring provider. Number of discharges where the transfer/referral widget was addressed or number of discharges where the follow up care question was addressed. The above can be addressed through the following: Set up Transfer/Referral Widget in Flow Chart or Eform Set Up Follow Up Care Question in Flow Chart of Eform Document in Referral/Transition widget in the HIST icon in CW5 NUMERATOR: Number of transitions of care and referrals in the denominator where a summary of care record was provided. Number of discharges where the following was done: Transfer/Referral Documented (see above) Physician Problem List Addressed via Problem List Application Medication List Addressed via Medication Reconciliation/Profile Medication Allergy List Addressed Transfer of Care/Referral Summary is chosen from the virtual chart or Transfer of Care/Referral Summary is chosen in Medical Records Print or Submit to Provider is chosen. Set Up for Measure 2: (in addition to set up for measure 1) Each facility will have to go through onboarding for Direct Messaging. (More information to follow). Once the Direct Messaging address has been obtained through the on-boarding process, that address will be listed in the following location: Hospital Base Menu > Master Selection > Business Office Tables > Table Maintenance > Control > Physicians > Physician 999999 (Evident Community Physician) > Page 5 > Direct Address. The accepting provider that will be receiving the referral or summary of care can be pre-defined and set up in the following table: Hospital Base Menu > Master Selection > Business Office Tables > Table Maintenance > Business Office > Referring Physician. Revision Date: 07/09/2015 14
How to Meet Measure 2: To meet measure 2, the summary of care document, specifically the referral/transitions summary (referral/transition of care summary) must be sent electronically via the above mentioned Submit to Provider option through direct messaging. It is suggested the referral/transitions summary be set up in the virtual chart. In order to receive a Direct Messaging Address an order must be placed with EvidentI and your system configured. Once this is done by Evident, your facility will receive an email to explain the onboarding process with Inpriva (our 3 rd Party Hisp). Inpriva will assign your facility a direct messaging address. Once that address is received it should be placed in the following location: Master Selection> Business Office Tables > Table Maintenance > Contro l> Physicians > 999999 Physician > Page 5 > Direct Messaging Address. In order to send information to another provider through direct messaging address, this can be chosen once submit to provider is chosen to electronically transmit the CCD-Transfer Summary/Referral. Please note: You can set up any providers that your facility wishes to send to via direct messaging in the Referring Provider table: Master Selection > Business Office Tables > Table Maintenance > Business Office > Referring Physician > Direct Address. Once your CCD-Transfer Summary/Referral is successfully sent, there is an indication of Success in the CCDA transmission log. The path to this log is found via the following path: Server Menu > Special Functions > Audit Log > CCDA Transmission Log. Users of the EHR will have the ability to control what is sent in the CCD document electronically to a provider. This can be achieved by building the Patient Summary/CCD via Print Electronic Record, selecting edit and choosing the information you would like to include/exclude and save document. This will save a version of the document in Print Electronic Record and Electronic File Management with the changes that have been made to the document. The most recently edited version will be sent when electronically exchanging a document. DENOMINATOR: Number of transitions of care and referrals during the EHR reporting period in which an Eligible Hospital or CAH s inpatient or emergency department was the transferring or referring provider. (same as Measure 1) Number of discharges where the transfer/referral widget was addressed or number of discharges where the follow up care question was addressed. The above can be addressed through the following: Set up Transfer/Referral Widget in Flow Chart or Eform. Set Up Follow Up Care Question in Flow Chart of Eform. Document in Referral/Transition widget in the HIST icon in CW5. NUMERATOR: Number of transitions of care and referrals in the denominator where a summary of care record was provided and electronically transmitted. Number of discharges where the following was done: Transfer/Referral Documented (see above) Physician Problem List Addressed via Problem List Application Medication List Addressed via Medication Reconciliation/Profile Revision Date: 07/09/2015 15
Medication Allergy List Addressed Transfer of Care/Referral Summary is chosen from the virtual chart or Transfer of Care/Referral Summary is chosen in Medical Records Submit to Provider is chosen and sent to another provider through Direct Messaging. Measure 3: (in addition to set up for measure 2) Information can be exchanged (through direct messaging) with another facility has been developed by another EHR vendor. Please keep all correspondence of sending to a facility that utilizes another vendor or utilizing the EHR randomizer. If providers cannot exchange a summary of care document with recipients using different CEHRT in common practice, then they may retain documentation on their circumstances and attest yes to meeting measure 3 if they have and are using a certified EHR which meets the standards required to send a CCDA. Capability to Submit Electronic Data to Immunization Registries Successful ongoing submission of electronic immunization data from Certified EHR Technology to an immunization registry or immunization information system for the entire EHR reporting period. The transmission of immunization information must use the standards at 45 CFR 170.302(k). Applications needed to meet Objective: Point of Care, Pharmacy, and Immunization Interface A record of transmissions will need to be retained for auditing purposes. To electronically submit, an interface is required. Please complete an Interface Request Form and contact your Account Manager to initiate the development for your facility. Capability to Submit Electronic Reportable Laboratory Results to Public Health Agencies Successful ongoing submission of electronic reportable laboratory results from Certified EHR Technology to a public health agency for the entire EHR reporting period. Applications needed to meet Objective: Reportable Laboratory Results Interface, Laboratory w/ Micro Analyzer OR w/ Discrete Reference Lab Interface w/micro OR a Discrete Element Lab Interface w/micro. Set Up for Objective: LOINC needs to be loaded on both the item and in the Reference Range Table for Laboratory items that a hospital is reporting. SNOMED needs to be loaded in the Reference Range Table for lab items that a hospital is reporting. Security Switch 109 is needed for employees to access the reportable option via Order Entry Maintenance Screen. Revision Date: 07/09/2015 16
Specimen Information prompt should be activated in page 5 of Item Master as Specimen Information is required on reportable lab items. How to meet Objective: This objective is met by locking onto the Order Entry Maintenance Screen of the Lab Item to report and choosing Reportable In order to transmit electronic laboratory results successfully, the user must associate a problem as well as enter in specimen information on the lab item to transmit. A record of transmissions will need to be retained for auditing purposes. To electronically submit, an interface is required. Please complete an Interface Request Form and contact your Account Manager to initiate the development for your facility. Capability to Submit Syndromic Surveillance to Public Health Agencies Successful ongoing submission of electronic syndromic surveillance data from Certified EHR Technology to a public health agency for the entire EHR reporting period. Applications needed to meet Objective: Syndromic Surveillance Interface and Clinical Vocabulary. How to meet Objective: This objective is met by entering in required state specific information on a patient account (such as chief complaint, working and final diagnosis) to be transmitted. Evident suggests making Chief Complaint a required field from Census. A record of transmissions will need to be retained for auditing purposes. To electronically submit, an interface is required. Please complete an Interface Request Form and contact your Account Manager to initiate the development for your facility. Electronic Medication Administration Record (emar) More than 10 percent of medication orders created by authorized providers of the eligible hospital's or CAH's inpatient or emergency department during the EHR reporting period for which all doses are tracked using emar. Hospital must automatically track medications from order to administration using assistive technologies in conjunction with an electronic medication administration record (emar). In combination with an assistive technology that provides automated information on the 5 rights, enable a user to electronically verify the following before administering medication(s): Right Patient The patient to whom the medication is to be administered matches the medication to be administered. Right Medication- The medication to be administered matches the medication ordered for the patient. Right Dose- The dose of the medication to be administered matches the dose of the medication ordered for the patient. Right Route- The route of the medication delivery matches the route specified in the medication order. Right Time- The time that the medication was ordered to be administered compared to the current time. Revision Date: 07/09/2015 17
Applications needed to meet Objective: Point of Care, Pharmacy and Medication Management. How to meet Objective: Medications for this objective can be placed via CPOE, Pharmacy, or Point of Care/Pharmacy. To document medications correctly the orders placed, will need to be given through the Medication Verification Application and all doses tracked using emar. DENOMINATOR: Number of medication orders created by authorized providers in the eligible hospital's or CAH's inpatient or emergency department during the EHR reporting period. Number of medications orders during the reporting period. NUMERATOR: The number of orders in the denominator for which all doses are tracked using emar. (Med Verify) Menu Objectives Must choose 3 of 6 Record Advanced Directive for Patients 65 Years and Older for Inpatients More than 50% of all unique Inpatients 65 years and older have an indication of advanced directive recorded. Applications needed to meet Objective: Census, Point of Care Set-Up for Objective: Evident suggests Advanced Directives is a required field or a census edit set up to ensure this information is captured in Census. How to meet Objective: This objective will be met by recording whether the patient (65 years or older) has an advance directive. DENOMINATOR: Number of unique patients age 65 or older admitted to an eligible hospital s or CAH s inpatient department during the EHR reporting period. Unique Patients 65 years older admitted (IP) during reporting period. NUMERATOR: Number of patients in the denominator with an indication of an advanced directive entered using structured data. Number of Inpatients admitted with Advanced directive addressed from Profile/Visit/Point of Care Flow Chart/Electronic Form Please note: This objective is for Inpatient type patients only. Therefore, filters will need to be set at the facility level to reflect this patient type when running the statistics report for this objective. Electronic Notes Enter at least one electronic progress note created, edited and signed by an authorized provider of the eligible hospital's or CAH's inpatient or emergency department for more than 30 percent of unique patients admitted to the eligible hospital or CAH's inpatient or emergency department during the EHR reporting period. The text of the electronic note must be text searchable and may contain drawings and other content. Revision Date: 07/09/2015 18
Applications needed to meet Objective: Physician Documentation Set-Up for Objective: Progress note must be indicated in Physician Document Title List, Documentation Note Title. How to meet Objective: This objective will be met by entering an electronic progress note via the Physician Documentation Application and signing the note electronically. DENOMINATOR: Number of unique patients admitted to an eligible hospital or CAH's inpatient or emergency department during the EHR reporting period. Number of unique patients admitted during reporting period. NUMERATOR: The number of unique patients in the denominator who have at least one electronic progress note from an authorized provider of the eligible hospital's or CAH's inpatient or emergency department recorded as text searchable data Number of Unique patients in denominator who have at least one progress note documented through physician documentation application. Imaging Results More than 10 percent of all tests whose result is one or more images ordered by an authorized provider of the eligible hospital or CAH for patients admitted to its inpatient or emergency department during the EHR reporting period are accessible through Certified EHR Technology. Please Note Accessible Through is further defined as the following: Either incorporation of the image and accompanying information into Certified EHR Technology or an indication in Certified EHR Technology that the image and accompanying information are available for a giving patient in another technology and a link to that image and accompanying information. Applications needed to meet Objective: Chartlink, Radiology ImageLink or 3 rd party PACS with URL Interface How to meet Objective: This objective is met by resulting the Radiology Order and populating with an image and accompanying information about that image. DENOMINATOR: Number of tests whose result is one or more images ordered by an authorized provider on behalf of the eligible hospital or CAH for patients admitted to its inpatient or emergency department during the EHR reporting period. Number of radiology tests that would have an image ordered by a provider, for patients admitted during the reporting period. Radiology Tests will need to have the following to fall into the denominator: Modality Type- Item master> Order Entry Information> Page 3 > Modality Type NUMERATOR: The number of results in the denominator that are accessible through Certified EHR Technology. Number of radiology tests in the denominator that have images accessible through Imagelink or a PACS URL interface. Revision Date: 07/09/2015 19
Family Health History More than 20 percent of all unique patients admitted to the eligible hospital or CAH's inpatient or emergency department during the EHR reporting period have a structured data entry for one or more firstdegree relatives. A first degree relative is a family member who shares about 50 percent of their genes with a particular individual in a family. First-degree relatives include parents, offspring, and siblings. Applications needed to meet Objective: Point of Care, Clinical Vocabulary How to meet Objective: Objective will be met by entering a known problem and selecting the relative it is associated with (unknown can also be entered) through the Health History icon, Problem List- Family Health History, or set up through Initial Interview. DENOMINATOR: Number of unique patients admitted to the eligible hospital or CAH's inpatient or emergency departments during the EHR reporting period. Number of unique patients admitted during the reporting period. NUMERATOR: The number of patients in the denominator with a structured data entry for one or more first-degree relatives. Number of unique patients in the denominator with Family Health History addressed (or unknown) via the following areas: Physician Problem List- Family Health History HIST Icon- Patient Family Health History Screen E-Prescribing More than 10 percent of hospital discharge medication orders for permissible prescriptions (for new, changed, and refilled prescriptions) are queried for a drug formulary and transmitted electronically using certified EHR technology. Applications needed to meet Objective: Medication Management Set-Up for Objective: The Prescription Entry sub-fields will need to be set up under the Medication Management Tab in Table Maintenance (Table Maintenance, Clinical, Medication Management, and Prescription Entry). They include the following: Clinical Monitoring Control Table Discontinue Reasons Doses Frequencies Modifiers Pharmacies Routes Units Zip Codes Revision Date: 07/09/2015 20
How to meet Objective: This objective will be met when launching the e-scribe application after discharge medication reconciliation has been performed and processed. DENOMINATOR: Number of new, changed, or refill prescriptions written for drugs requiring a prescription in order to be dispensed other than controlled substances for IP/ED patients discharged during the EHR reporting period. New, Changed or refilled Prescriptions that were written during the reporting period. NUMERATOR: The number of prescriptions in the denominator generated, queried for a drug formulary and transmitted electronically. Number of prescriptions in the denominator that were generated through electronic prescription application (and queried for a drug formulary- automatically) and transmitted electronically. Lab Results to Ambulatory Providers Hospital labs send structured electronic clinical lab results to the ordering provider for more than 20 percent of electronic lab orders received. Applications needed to meet Objective: Laboratory, Clinical Vocabulary, MP-EMR5 or Interface to 3 rd party ambulatory provider(s). Set-Up for Objective: Orders must be placed in the clinic using the Temp Orders function. How to meet Objective: This objective is met with the use of an ambulatory product (interface via 2.5.1) to the Hospital Thrive Laboratory application. DENOMINATOR: The number of electronic lab orders received. Number of electronic lab orders received from ambulatory providers NUMERATOR: The number of structured clinical lab results sent to the ordering provider. Number of lab orders in denominator for which structured electronic clinical lab Please note: This objective is for Ambulatory type patients (outpatients). Therefore, filters will need to be set at the facility level to reflect this patient type when running the statistics report for this objective. Statistics Reporting: Stage 2 statistics report will be utilized for those facilities who will be in stage 2 starting in Federal Fiscal Year 2014. This report contains all information that is required on percentage based objectives. It can be found through the following path: Hospital Base Menu > Other Applications and Functions > Word Processing > Ad Hoc > MU Stage 2 Statistics Report > Choose Objective > Enter in Date range (or choose from pre-defined date box) > Calculate > PDF. MU Stats Filters must be set up for the Emergency Method or Observation Services depending on the reporting method the facility will use (see below under Patient Types). Filters will need to be added by the system administrator for the patient types that are required by CMS that a facility wishes to report. Revision Date: 07/09/2015 21