PBSI-EHR Off the Charts Meaningful Use in 2016 The Patient Engagement Stage Please note that this document is intended to supplement the information available on the CMS website for Meaningful Use for 2016 see links below. PBSI will advise and assist, but the responsibility to understand and comply with the Meaningful use requirements, as they apply to the Eligible Provider, ultimately rests with attesting eligible provider and staff. Recommendations for 2016 On November 1, 2016 as a part of the CMS Hospital Outpatient Prospective Payment Changes for 2017 final rule, the reporting period of 2016 and 2017 for Medicare and Medicaid has been changed to 90 days for all providers. Contact PBSI to order your DIRECT email account for transmitting your Summary of Care. (see page 3 ). Please note many providers would have qualified for an exception for this measure in the 90 day period in 2015 that no longer will for the full year in 2016. Actively engage patients with your Patient Portal Determine your stage by provider for 2016. Please note that all providers must run stage 2 reports. Providers that were scheduled for stage 1 in 2016 are eligible for several exclusions where stage 2 measures that do not have an equivalent stage 1 measure or were not required under stage 1. o Providers attesting for Stage 2 in 2016. Previously attested 2 years for Stage 1 o Providers attesting for Stage 1 in 2016: 1st Year of attestation 2nd Year of attestation Medicaid providers who attested in 2015 for Adopt, Implement, Upgrade If you have not already done so, please begin running your Provider Calculation / Meaningful Use report on a regular schedule. All providers should run the 10 - Stage 2 measures, however, Stage 1 providers are eligible for a few exclusions. We suggest that you run them every week. PBSI will not be monitoring your reports but will be happy to discuss or assist with any issues you have or identify. Familiarize yourself with the information available on the CMS website There is a new page on the CMS EHR Incentive Program for 2016 requirements: https://www.cms.gov/regulations-and-guidance/legislation/ehrincentiveprograms/2016programrequirements.html This is a What You Need to Know for 2016 Tipsheet: https://www.cms.gov/regulations-and-guidance/legislation/ehrincentiveprograms/downloads/2016_epwhatyouneedtoknowfor2016.pdf The stage 2 worksheet is available at: (Note this has not yet been updated for 2016.) https://www.cms.gov/regulations-and-guidance/legislation/ehrincentiveprograms/downloads/2015_epattestationworksheet.pdf Page 1 of 7
Meaningful Use for 2016 - Stage 2 PBSI Measure # PBSI Measure Description Target How To Core Measures that carried over from stage 1 or are new for stage 2 26 Permissible E-Rx 50% - increased from 40% stage 1 21 CPOE for Medication Orders 60% - modified in stage 2 More than 50 percent of all permissible prescriptions, or all prescriptions, written by the EP are queried for a drug formulary and transmitted electronically using CEHRT. Exclusion 1: Any EP who writes fewer than 100 permissible prescriptions during the EHR More than 60 percent of medication, 30 percent of laboratory, and 30 percent of radiology orders created by the EP during the EHR reporting period are recorded using CPOE (computerized provider order entry). Use E-prescribing for all of your prescriptions where the system will allow it. The software will not allow a controlled drug to be sent electronically and will not attempt an electronic script if the pharmacy indicates that it does not accept electronic prescriptions. Additionally, the drug formulary must be checked in order for the measure to be met. Each script contains the transaction ID of the formulary inquiry in order to verify compliance. All prescriptions must be entered thru the Prescription entry screen in your EHR. 22 CPOE for Radiology Orders 30% - new for stage 2 Exclusion available for stage 1 23 CPOE for Laboratory Orders 30% - new for stage 2 Exclusion available for stage 1 All orders for Radiology tests must be entered into the PBSI system with an order category that identifies the orders as Radiology. All orders for Laboratory tests must be entered into the PBSI system with an order category that identifies the orders as Lab. Page 2 of 7
20 Patient Education 10% - same as stage 1 Menu Measures that are now Required Core Measures Patient-specific education resources identified by Certified EHR Technology are provided to patients for more than 10 percent of all unique patients with office visits seen by the EP during the EHR reporting period. Provide a patient specific education based on EHR recommendation for a diagnosis - found in the Patient Ed section of the superbill. Must be provided once for the patient before, during, or after the measurement period. 30 Meds Reconciliation 50% - same as stage 1 The EP who performs medication reconciliation for more than 50 percent of transitions of care in which the patient is transitioned into the care of the EP. For all new patients: When the ENCOUNTER is added, check the Transfer Of Care checkbox on the General tab. From Current Meds display, compare the current meds on file with the new meds list from the patient or inbound resource. Click on the UPD next to Medication Reconciliation when completed. 32 Summary of Care - 'B' 10% of transfers must be send electronically thru DIRECT messaging unless provider qualifies for an exclusion. EXCLUSION: Any EP who transfers a patient to another setting or refers a patient to another provider less than 100 times during the EHR reporting period. The EP who transitions or refers their patient to another setting of care or provider of care provides a summary of care record for more than 10 percent of such transitions and referrals either (a) electronically transmitted using CEHRT to a recipient or (b) where the recipient receives the summary of care record via exchange facilitated by an organization that is a NwHIN Exchange participant or in a manner that is consistent with the governance mechanism ONC establishes for the NwHIN. Required for stage 1 and stage 2 for 2016. When the EP transfers a patient to another provider or setting: Create an order for the referral or activity such as speech therapy, etc. Check the transfer of Care indicator Use the PRINT CHART/CCD button to: o Generate a CCDA and use Send Email to use your DIRECT email account if your recipient has a DIRECT email address To Monitor the order SENT status: o Use Order Management to view any referral orders that may need a Summary of Care sent. NOTE: PBSI-EHR is Certified for DIRECT messaging but must use a 3rd party accredited HISP with whom we have partnered. Clients will need to acquire our Direct Services solution and purchase your DIRECT addresses in order to participate in the DIRECT messaging network. Page 3 of 7
27 VDT - Timely Access 'A' 50% - increased from 10% in stage 1 Portal Measures This measure with a 50% target is requirement of all providers regardless of stage. More than 50 percent of all unique patients seen by the EP during the EHR reporting period are provided timely (available to the patient within 4 business days after the information is available to the EP) online access to their health information, with the ability to view, download, and transmit to a third party. To activate a patient for Patient Portal access: Record the patient s EMAIL address, update it, and click on WEB ENABLE to send an activation code to the patient and activate their web account. Record the patient s communication preference by clicking on PREFERENCE to the right of email. 28 VDT - Timely Access 'B' Reduced to 1 patient in the Final Rule More than 5 percent of all unique patients seen by the EP during the EHR reporting period (or their authorized representatives) view, download, or transmit to a third party their health information. Only 1 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. Patient needs to sign in to the Portal and click on "View My Health Summary" 36 Secure Electronic Messaging Reduced to 1 patient for 2016 and changed to measure messages sent from the provider. See EHR Patient Portal.pdf 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. Page 4 of 7
Required Measures that are not part of Provider Calculations CDSS Rules Protect Electronic Patient Health Information 5 CDSS rules need to be setup for the entire reporting period Implement five clinical decision support interventions related to four or more clinical quality measures at a relevant point in patient care for the entire EHR reporting period. Absent four clinical quality measures related to an EP s scope of practice or patient population, the clinical decision support interventions must be related to highpriority health conditions. 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. Rules are setup via the patient list application and a red CDSS alert box will display on the encounter, vitals, and superbill panel. Clicking on the red alert box displays the rule and care suggestions. When provider enters the diagnosis, the CDSS panel will pop up. Make sure that your HIPAA procedures are in place and that you have a completed a full security risk assessment and continue to work on any deficiencies. There is a new version of the spreadsheet that is an interactive tool that can be downloaded from: http://www.healthit.gov/providers-professionals/security-risk-assessmenttool This is a tip sheet: https://www.cms.gov/regulations-and- Guidance/Legislation/EHRIncentivePrograms/Downloads/2016_SecurityRiskA nalysis.pdf Immunization Registry If you perform immunizations, you need to sign up with your state s public health registry to register your intent to submit within the first 60 days of the reporting period. Immunizations must be entered via the HMI or Immunization screen and the Prescription entry screen. You just enter the data as required by your state, such as Mfg, Lot Number, Expiration date, Injection site, and Mother s maiden name.. You should be at some point in the onboarding process with your state immunization organization. Syndromic Surveillance Everyone needs to sign up with your state s public health registry to submit Syndromic Surveillance. At this time, they are focused on hospitals and urgent care facilitates, but everyone need to register their intent to submit within the first 60 days of the reporting period. Page 5 of 7
Specialized Registry (Cancer Registry) In 2016, providers may again simply claim an alternate exclusion. This may be required for 2017 and the deadline to register may be Feb. 28, 2017. FAQ 13657: The eligible professional (EP) is not required to make an exhaustive search of all potential registries. Instead, they must do a few steps to meet due diligence in determining if there is a registry available for them, or if they meet the exclusion criteria. 1 An EP should check with their State* to determine if there is an available specialized registry maintained by a public health agency. (If you treat cancer or are otherwise required to report cancer patient information to your state registry, please contact us to discuss.) 2 An EP should check with any specialty society with which they are affiliated to determine if the society maintains a specialized registry and for which they have made a public declaration of readiness to receive data for meaningful use no later than the first day of the provider s EHR reporting period. If the EP determines no registries are available, they may exclude from the measure. Page 6 of 7
Measures that are eliminated from the reporting requirements by the Final Rule since they are "Redundant, Duplicated, or Topped out". It is critical to continue to capture this information as it is required throughout other measures and exchanges. 19 Demographics 24 Vital Signs 25 Smoking Status 29 Clinical Summary 31 Summary of Care - 'A' 33 Patient Reminders 34 Lab Results Incorporated 35 Electronic Notes 37 Imaging 38 Family Health History Patient List Page 7 of 7