Meaningful Use Hello Health v7 Guide for Eligible Professionals. Stage 1

Meaningful Use Hello Health v7 Guide for Eligible Professionals Stage 1

Table of Contents Introduction 3 Meaningful Use 3 Terminology 5 Computerized Provider Order Entry (CPOE) for Medication Orders [Core] 6 Implement Drug-Drug and Drug-Allergy Interaction Checks [Core] 9 Maintain an Up-to-Date Problem List of Current and Active Diagnoses [Core] 11 Generate and Transmit Permissible Prescriptions Electronically (erx) [Core] 14 Maintain Active Medication List [Core] 18 Medication Allergy List [Core] 21 Record Demographics [Core] 24 Record Vital Signs [Core] 27 Record Smoking Status [Core] 30 Clinical Decision Support Rule [Core] 33 Patient Electronic Access (VDT) [Core] 36 Clinical Summaries [Core] 39 Protect Electronic Health Information [Core] 43 Drug Formulary Checks [Menu] 45 Clinical Lab Test Results [Menu] 48 Patient Lists [Menu] 50 Patient Reminders [Menu] 53 Patient-Specific Education Resources [Menu] 58 Medication Reconciliation [Menu] 62 Transition of Care Summary [Menu] 67 Immunization Registries Data Submission [Menu] 73 Syndromic Surveillance Data Submission [Menu] 75

Hello Health Meaningful Use Guide for Eligible Professionals Stage 1 3 Introduction Meaningful Use The Medicare and Medicaid EHR Incentive Programs provide a financial incentive for achieving "Meaningful Use", which is the use of certified EHR technology to reach health and efficiency goals. This section provides an overview of the Stage 1 of EHR Meaningful Use Core and Menu Objectives for Eligible Professionals (EPs), as outlined by CMS, which are intended to set a baseline for electronic data capture and information sharing. For Stage 1, eligible professionals must report on the following: 1. All 13 of the core measures; 2. 5 out of 9 of the menu measures; at least 1 public health measure must be selected; 3. 9 out of 64 of the CQMs covering at least 3 National Quality Strategy domains. The Meaningful Use objectives are grouped into five patient-driven domains that relate to health outcomes policy priorities. As depicted below, each core and menu objective is aligned with one of the following domains: D1 - Improve Quality, Safety, Efficiency - Computerized Provider Order Entry for Medication Orders (core) - Drug Interaction Checks (core) - Maintain Problem List (core) - E-Prescribing (core) - Active Medication List (core) - Medication Allergy List (core) - Record Demographics (core) - Record Vital Signs (core) - Record Smoking Status (core) - Clinical Decision Support (core) - Drug Formulary Checks (menu) - Clinical Lab Test Results (menu) - Patient List (menu) - Patient Reminders (menu)

Hello Health Meaningful Use Guide for Eligible Professionals Stage 1 4 D2 - Engage Patients and Families - Electronic Copy of Health Information (core) - Clinical Summaries (core) - Patient Electronic Access (core) - Patient-Specific Education Resources (menu) D3 - Improve Care Coordination - Medication Reconciliation (menu) - Transition of Care Summary (menu) D4 - Improve Public and Population Health - Immunization Registries Data Submission (menu) - Syndromic Surveillance Data Submission (menu) D5 - Ensure Privacy and Security for Personal Health Information - Protect Electronic Health Information (core) For more details, see the CMS attestation worksheet http://www.cms.gov/regulations-and- Guidance/Legislation/EHRIncentivePrograms/Downloads/EP_Attestation_Stage1Worksheet_2014Edition.pdf

Hello Health Meaningful Use Guide for Eligible Professionals Stage 1 5 Terminology Patient Seen Denominator often refers to "all unique patients seen by the EP during the EHR reporting period" For Hello Health, Patient Seen means patients: o o o o o With at least one appointment for the reporting period (date range); For any visit type (office, home, phone, IM or video); If visit status is NOT Cancel, nor No show: Regardless of visit documentation status (whether or not visit is Finished (signed)); Unique patient, that is, if a patient is seen by a provider more than once during the EHR reporting period, then it is for purposes of measurement that the patient is only counted once in the denominator for the measure.

Hello Health Meaningful Use Guide for Eligible Professionals Stage 1 6 Computerized Provider Order Entry (CPOE) for Medication Orders [Core] Overview Objective Use computerized provider order entry (CPOE) for medication orders directly entered by any licensed healthcare professional who can enter orders into the medical record per state, as per local and professional guidelines. Attestation Requirements Measure More than 30 percent of all unique patients with at least one medication in their medication list seen by the EP have at least one medication order entered using CPOE. Optional alternative: More than 30 percent of medication orders created by the EP during the EHR reporting period are recorded using CPOE. Numerator / Denominator / Exclusion Denominator Number of unique patients with at least one medication in their medication list seen by the EP during the EHR reporting period. Numerator Number of patients in the denominator that have at least one medication order entered using CPOE. Exclusion EPs who write fewer than 100 prescriptions during the EHR reporting period would be excluded from this requirement. EPs must enter the number of prescriptions written during the EHR reporting period in the Exclusion box to attest to exclusion from this requirement. Optional Numerator / Denominator Denominator Number of medication orders created by the EP during the EHR reporting period. Numerator Number of medication orders in the denominator entered using CPOE.

Hello Health Meaningful Use Guide for Eligible Professionals Stage 1 7 How to Meet the MU Attestation Using Hello Health You can document prescriptions (medication orders) in a visit s documentation, under the Current Medications subsection in the EHR, or the Prescriptions section: 1. Click Add new; 2. Select or search for a medication in the pop-up window by entering the name of the medication or the RxNorm code (not shown). Enter the required information for your prescription; 3. Click Prepare Rx; 4. Click either Save Prescription or Send erx.

Hello Health Meaningful Use Guide for Eligible Professionals Stage 1 8 Numerator and Denominator explained for Hello Health Denominator Patients seen with at least 1 medication documented either in the Current Medications or Past Medications section. Numerator Patients seen with at least 1 prescription (medication order), Rx or erx, documented either in the Current Medications or Past Medications section. Alternate Measure Denominator Number of prescriptions (Rx or erx) created in the reporting period. Numerator Number of prescriptions (Rx or erx) created in the reporting period. Hints, Tips and Additional Information A medication order can only be documented into Hello Health if the Rx or erx is created in Hello Health. Therefore, for the alternate measure, the score in the Hello Health Meaningful Use Report will always be 100%. It is the provider s responsibility, if some prescriptions are created outside Hello Health, to keep track of them and to adjust the denominator in the attestation form; Electronic transmittal of the prescription is not a requirement for meeting the measure of this objective. However, a separate objective addresses the electronic transmission of prescriptions. For more details, see CMS information http://www.cms.gov/regulations-andguidance/legislation/ehrincentiveprograms/downloads/1_cpoe_for_medication_orders.pdf

Hello Health Meaningful Use Guide for Eligible Professionals Stage 1 9 Implement Drug-Drug and Drug-Allergy Interaction Checks [Core] Overview Objective Implement drug-drug and drug-allergy interaction checks. Attestation Requirements Measure The EP has enabled this functionality for the entire EHR reporting period. Yes / No Eligible professionals (EPs) must attest (Yes) to having enabled drug-drug and drug-allergy interaction checks for the length of the reporting period to meet this measure. How to Meet the MU Attestation Using Hello Health Hello Health comes with the ability to automatically check for potentially adverse drug-drug or drug-allergy interactions. This functionality is turned on as a default setting. When adding a medication, you will be alerted if there are potential interactions. To view a description of the interactions, click View Interactions.

Hello Health Meaningful Use Guide for Eligible Professionals Stage 1 10 Numerator and Denominator Explained for Hello Health Not applicable. Hints, Tips and Additional Information This functionality must be turned on for the entire reporting period. If unsure whether you have this feature turned on, ask the Customer Experience Team. For more details, see CMS information http://www.cms.gov/regulations-and- Guidance/Legislation/EHRIncentivePrograms/downloads/2_Drug_Interaction_ChecksEP.pdf

Hello Health Meaningful Use Guide for Eligible Professionals Stage 1 11 Maintain an Up-to-Date Problem List of Current and Active Diagnoses [Core] Overview Objective Maintain an up-to-date problem list of current and active diagnoses. Attestation Requirements Measure More than 80 percent of all unique patients seen by the EP have at least one entry or an indication that no problems are known for the patient recorded as structured data. Numerator / Denominator Denominator Number of unique patients seen by the EP during the EHR reporting period. Numerator Number of patients in the denominator who have at least one entry or an indication that no problems are known for the patient recorded as structured data in their problem list. How to Meet the MU Attestation Using Hello Health To view and access a patient problem list and problem list history, go to the EHR section under Medical Conditions.

Hello Health Meaningful Use Guide for Eligible Professionals Stage 1 12 To add a medical condition: 1. Under the Medical Conditions section, click Add new; 2. Enter a medical condition and complete relevant information; 3. Click Save. If the patient does not have any known conditions, you can select No known conditions option from the drop-down menu. If the patient does not know and you do not have the information, select Do not know: Note that whenever documenting a diagnosis in the visit documentation once the visit is finished, the diagnosis is added to the problem list in the EHR. Numerator and Denominator Explained for Hello Health Denominator Patients seen. Numerator Patients seen with at least 1 medical condition documented in the Medical Conditions section, or for whom No known conditions or Do not know is selected.

Hello Health Meaningful Use Guide for Eligible Professionals Stage 1 13 Hints, Tips and Additional Information For patients with no current or active diagnoses, an entry must still be made to the problem list indicating that no problems are known. It is acceptable to select No known conditions or Do not know from the drop-down menu, but you cannot leave the default No information; An EP is not required to update the problem list at every contact with the patient. The measure ensures the EP has a problem list for patients seen during the EHR reporting period, and that at least one piece of information is presented to the EP. The EP can then use their judgment in deciding what further probing or updating may be required given the clinical circumstances. For more details, see CMS information http://www.cms.gov/regulations-and- Guidance/Legislation/EHRIncentivePrograms/downloads/3_Maintain_Problem_ListEP.pdf

Hello Health Meaningful Use Guide for Eligible Professionals Stage 1 14 Generate and Transmit Permissible Prescriptions Electronically (erx) [Core] Overview Objective Generate and transmit permissible prescriptions electronically (erx). Attestation Requirements Measure More than 40 percent of all permissible prescriptions written by the EP are transmitted electronically using certified EHR technology. Numerator / Denominator / Exclusions Denominator Number of prescriptions written for drugs requiring a prescription in order to be dispensed other than controlled substances during the EHR reporting period. Numerator Number of prescriptions in the denominator generated and transmitted electronically. Exclusions EPs who write fewer than 100 prescriptions during the EHR reporting period would be excluded from this requirement. EPs must enter the number of prescriptions written during the EHR reporting period in the Exclusion box to attest to exclusion from this requirement. EPs who do not have a pharmacy within their organization and for whom there are no pharmacies that accept electronic prescriptions within 10 miles of their practice location, at the start of their EHR reporting period, would be excluded from this requirement.

Hello Health Meaningful Use Guide for Eligible Professionals Stage 1 15 How to Meet the MU Attestation Using Hello Health To create and send an electronic prescription, a few options are available: From the visit documentation, you can create a prescription (medication order) by adding it from the Care plan section: In the patient record, in the Current Medications subsection of the EHR or in the Prescriptions section; Note that if not in the patient record, you can still create and send electronic prescriptions from the erx dashboard (tab). If you are already in the patient record, select either Add new medication in the EHR or the Prescriptions subsection in the patient record. If you are not in the patient record, click the erx tab at the top of the screen. o Search and select a patient, then click Create Rx. In the pop-up window, search and select the required medication (not shown).

Hello Health Meaningful Use Guide for Eligible Professionals Stage 1 16 1. Enter in the prescription information; 2. Click Prepare Rx; 3. Verify and choose the correct pharmacy; 4. Click Send erx.

Hello Health Meaningful Use Guide for Eligible Professionals Stage 1 17 Numerator and Denominator Explained for Hello Health Denominator All prescriptions (medication orders) created, Rx and erx, in the reporting period (except prescriptions for controlled substance). Numerator All electronically sent prescriptions (erx) in the reporting period. Hints, Tips and Additional Information Instances where patients specifically request a paper prescription may not be excluded from the denominator of this measure. The denominator includes all prescriptions written by the EP during the EHR reporting period. For more details, see CMS information http://www.cms.gov/regulations-and-guidance/legislation/ehrincentiveprograms/downloads/4_eprescribing.pdf

Hello Health Meaningful Use Guide for Eligible Professionals Stage 1 18 Maintain Active Medication List [Core] Overview Objective Maintain active medication list. More than 80 percent of all unique patients seen by the EP have at least one entry (or an indication that the patient is not currently prescribed any medication) recorded as structured data. Attestation Requirements Numerator / Denominator Denominator Number of unique patients seen by the EP during the EHR reporting period. Numerator Number of patients in the denominator who have a medication (or an indication that the patient is not currently prescribed any medication) recorded as structured data.

Hello Health Meaningful Use Guide for Eligible Professionals Stage 1 19 How to Meet the MU Attestation Using Hello Health In the EHR, you can record, change and access the patient medication list.

Hello Health Meaningful Use Guide for Eligible Professionals Stage 1 20 1. Under the Current Medications section, click Add new. Search and select the appropriate medication in the pop-up window; 2. Fill in the medication information; 3. Click Save. If the patient does not take any medication, you can select No from the drop-down menu. If the patient does not know and you do not have the information, select Do not know. Numerator and Denominator Explained for Hello Health Denominator Patients seen. Numerator Patients seen with at least 1 medication, either Rx or erx, documented either in the Current Medications or Past Medications section, or for whom No known condition or Do not know is selected under Current Medications. Hints, Tips and Additional Information If information is documented in the Past medications section, make sure to also complete Current medications; o For patients with no active medications, an entry must still be made to the Current Medications list indicating that there are no current medications. It is acceptable to select No or Do not know from the Current Medications drop-down menu but you cannot leave the default No information option; An EP is not required to update this list at every contact with the patient. The EP can use his or her clinical judgment to decide when additional updating is required. For more details, see CMS information http://www.cms.gov/regulations-and- Guidance/Legislation/EHRIncentivePrograms/downloads/5_Active_Medication_List.pdf

Hello Health Meaningful Use Guide for Eligible Professionals Stage 1 21 Medication Allergy List [Core] Overview Objective Maintain active medication allergy list. Attestation Requirements Measure More than 80 percent of all unique patients seen by the EP have at least one entry (or an indication that the patient has no known medication allergies) recorded as structured data. Numerator / Denominator Denominator Number of unique patients seen by the EP during the EHR reporting period. Numerator Number of unique patients in the denominator who have at least one entry (or an indication that the patient has no known medication allergies) recorded as structured data in their medication allergy list.

Hello Health Meaningful Use Guide for Eligible Professionals Stage 1 22 How to Meet the MU Attestation Using Hello Health In the EHR, you can record, change and access the patient s medication allergy list and medication allergy list history: 1. To add a drug allergy, under the Drug Allergies section, click Add new; 2. Enter the name of the drug and the severity of the reaction and the type of the reaction (optional). Click Add. If the patient does not have any drug allergies, you can select No known drug allergies from the dropdown menu. If the patient does not know and you do not have the information, select Do not know.

Hello Health Meaningful Use Guide for Eligible Professionals Stage 1 23 Numerator and Denominator Explained for Hello Health Denominator Patients seen. Numerator Patients seen with at least 1 drug allergy documented in the Drug Allergies section or for whom No known drug allergies or Do not know is selected. Hints, Tips and Additional Information Info must be present in the Drug Allergies section; documenting Other allergies is not enough; For patients with no active medication (drug) allergies, an entry must still be made to the drug allergy list indicating that there are no drug allergies. It is acceptable to select No known drug allergies or Do not know from the drop-down menu but you cannot leave the default No information option; An EP is not required to update this list at every contact with the patient. The measure ensures that the EP has not ignored having a medication allergy list for patients seen during the EHR reporting period and that at least one piece of information on medication allergies is presented to the EP. The EP can then use their judgment in deciding what further probing or updating may be required given the clinical circumstances at hand. For more details, see CMS information http://www.cms.gov/regulations-and- Guidance/Legislation/EHRIncentivePrograms/downloads/6_Medication_Allergy_List.pdf

Hello Health Meaningful Use Guide for Eligible Professionals Stage 1 24 Record Demographics [Core] Overview Objective Record all of the following demographics: (A) Preferred language; (B) Gender; (C) Race; (D) Ethnicity; (E) Date of birth. Attestation Requirements Measure More than 50 percent of all unique patients seen by the EP have demographics recorded as structured data. Numerator / Denominator Denominator Number of unique patients seen by the EP during the EHR reporting period. Numerator Number of patients in the denominator who have all the elements of demographics (or a specific exclusion if the patient declined to provide one or more elements or if recording an element is contrary to state law) recorded as structured data.

Hello Health Meaningful Use Guide for Eligible Professionals Stage 1 25 How to Meet the MU Attestation Using Hello Health In the Demographics section, you can record, change and access patient demographics under the Basic Information subsection: 1. Click Basic Information; 2. Enter the patient s date of birth, gender, ethnicity, race and preferred language. If the patient chooses not to specify or does not know the information, make sure to select the Declined to specify option; 3. Click Save. Numerator and Denominator Explained for Hello Health Denominator Patients seen. Numerator Patients seen with all of the following demographic fields documented: (A) Preferred language; (B) Gender; (C) Race; (D) Ethnicity; (E) Date of birth.

Hello Health Meaningful Use Guide for Eligible Professionals Stage 1 26 Hints, Tips and Additional Information If a patient declines to provide all or part of the demographic information, or if capturing a patient s ethnicity or race is prohibited by state law, such a notation entered as structured data would count as an entry for purposes of meeting the measure. In regards to patients who do not know their ethnicity, EPs should treat these patients the same way as patients who decline to provide race or ethnicity: by identifying, in the patient record, that the patient declined to provide this information; EPs are not required to communicate with the patient in his or her preferred language in order to meet the measure of this objective; Please note that race and ethnicity codes in Hello Health follow current federal standards published by the Office of Management and Budget: http://www.whitehouse.gov/omb/inforeg_statpolicy/#dr For more details, see CMS information http://www.cms.gov/regulations-and- Guidance/Legislation/EHRIncentivePrograms/downloads/7_Record_Demographics.pdf

Hello Health Meaningful Use Guide for Eligible Professionals Stage 1 27 Record Vital Signs [Core] Overview Objective Record and chart changes in the following vital signs: (A) Height; (B) Weight; (C) Blood pressure; (D) Calculate and display body mass index (BMI); (E) Plot and display growth charts for children 0-20 years, including BMI. Attestation Requirements Measure More than 50 percent of all unique patients seen by the EP during the EHR reporting period have blood pressure (for patients age 3 and over only) and height and weight (for all ages) recorded as structured data. Numerator / Denominator / Exclusion Denominator Number of unique patients (age 3 or over for blood pressure) seen by the EP during the EHR reporting period. Numerator Number of patients in the denominator who have at least one entry of their height, weight and blood pressure (age 3 and over) recorded as structured data. Exclusion Any EP who: 1. Does not see patients 3 years or older is excluded from recording blood pressure; 2. Believes that all three vital signs of height, weight, and blood pressure have no relevance to their scope of practice is excluded from recording them; 3. Believes that height and weight are relevant to their scope of practice, but blood pressure is not, are excluded from recording blood pressure.

Hello Health Meaningful Use Guide for Eligible Professionals Stage 1 28 How to Meet the MU Attestation Using Hello Health Vitals can be documented in the visit documentation: You can also record, change and access patient vitals directly in the Vitals section: 1. Click Add Vitals at the top-right hand corner of the screen; 2. Fill in the height, weight and blood pressure; 3. Click Save.

Hello Health Meaningful Use Guide for Eligible Professionals Stage 1 29 Numerator and Denominator Explained for Hello Health All Vitals in Scope Denominator Patients seen. Numerator Patients seen 3 years old or older who have at least one entry of their height, weight and blood pressure recorded; Patients seen less than 3 years old who have at least one entry of their length and weight recorded. If Height and Weight are Out of Scope (Only Blood Pressure within Scope) Denominator Patients seen 3 years old or older. Numerator Patients seen 3 years old or older who have at least one entry of their blood pressure recorded. If Blood Pressure is Out of Scope (Only Height and Weight within Scope) Denominator Patients seen. Numerator Patients seen who have at least one entry of their height/length and weight recorded. Hints, Tips and Additional Information The only information required to be input by the provider is the height, weight, and blood pressure of the patient. The certified EHR technology will calculate BMI and the growth chart if applicable to the patient based on age; Height, weight, and blood pressure do not have to be updated by the EP at every patient encounter. The EP can make the determination based on the patient s individual circumstances as to whether height, weight, and blood pressure need to be updated. For more details, see CMS information http://www.cms.gov/regulations-and- Guidance/Legislation/EHRIncentivePrograms/downloads/8_Record_Vital_Signs.pdf

Hello Health Meaningful Use Guide for Eligible Professionals Stage 1 30 Record Smoking Status [Core] Overview Objective Record smoking status for patients 13 years old or older. Attestation Requirements Measure More than 50 percent of all unique patients 13 years old or older seen by the EP have smoking status recorded as structured data. Numerator / Denominator / Exclusion Denominator Number of unique patients age 13 or older seen by the EP during the EHR reporting period. Numerator Number of patients in the denominator with smoking status recorded as structured data. Exclusion An EP who sees no patients 13 years or older would be excluded from this requirement. EPs must enter 0 in the Exclusion box to attest to exclusion from this requirement.

Hello Health Meaningful Use Guide for Eligible Professionals Stage 1 31 How to Meet the MU Attestation Using Hello Health From the EHR section, you can record, change and access the patient s smoking status. 1. In the EHR section, scroll down to the Social History section until you see the Smoking Status subsection; You can also document the Smoking Status through the EHR Summary in the visit documentation. 2. Select a status from the drop-down menu. If the status is unknown, make sure to specify Unknown if ever smoked. Numerator and Denominator Explained for Hello Health Denominator Patients seen age 13 years old or older. Numerator Patients seen age 13 years old or older with smoking status recorded as structured data.

Hello Health Meaningful Use Guide for Eligible Professionals Stage 1 32 Hints, Tips and Additional Information You must select one of the options in the drop-down menu to qualify for Meaningful Use. You can also add free text, but free text alone is not enough; The date when the smoking status is documented is not important; This is a check of the medical record for patients 13 years old or older. If this information is already available in the medical record through certified EHR technology, an inquiry does not need to be made every time a provider sees a patient 13 years old or older. The frequency of updating this information is left to the provider and guidance is already provided from several sources in the medical community. For more details, see CMS information http://www.cms.gov/regulations-and- Guidance/Legislation/EHRIncentivePrograms/downloads/9_Record_Smoking_Status.pdf

Hello Health Meaningful Use Guide for Eligible Professionals Stage 1 33 Clinical Decision Support Rule [Core] Overview Objective Implement one clinical decision support rule relevant to specialty or high clinical priority along with the ability to track compliance with that rule. Attestation Requirements Measure Implement one clinical decision support rule. Exclusion No exclusion. Yes / No Eligible professionals (EPs) must attest (Yes) to having implemented one clinical decision support rule for the length of the reporting period to meet the measure.

Hello Health Meaningful Use Guide for Eligible Professionals Stage 1 34 How to Meet the MU Attestation Using Hello Health Hello Health has the ability to program clinical decision support that can trigger on-screen notifications, for providers, that appear at the top of the patient record (see the image below) when providers encounter patients with or without certain clinical conditions. You should implement the rules (reminders) that make sense for your practice. Some system reminders are predefined, which you can either enable or disable, but you can also create your own clinical decision reminders. In the Admin section, you can create and/or enable Clinical Decision Reminders: 1. At the top-right hand corner of the screen, click on Admin. Then, under the Settings tab, click on Clinical Decision Reminders; 2. Select the applicable checkbox to activate the reminders or click the pencil icon and choose Edit to modify a reminder (system rules cannot be edited); 3. You can also click Add new to add new clinical decision support reminders relevant for your practice. Complete the relevant fields and click Save; Reminder: To create a rule, you must first create a query in the Advanced Search section.

Hello Health Meaningful Use Guide for Eligible Professionals Stage 1 35 4. Click Save. Numerator and Denominator Explained for Hello Health Not applicable. Hints, Tips and Additional Information This functionality must be turned on for the entire reporting period. If unsure whether you have this feature turned on, ask the Customer Experience Team; CMS will not issue additional guidance on the selection of appropriate clinical decision support rules for Stage 1 Meaningful Use. This determination is best left to the EP taking into account their workflow, patient population, and quality improvement efforts; Drug-drug and drug-allergy interaction alerts cannot be used to meet the Meaningful Use objective for implementing one clinical decision support rule. EPs must implement one clinical decision support rule in addition to drug-drug and drug-allergy interaction checks. Hello Health allows creating reminders for non-clinical notifications. For Meaningful Use attestation, at least one of the rules you have enabled must be clinically relevant for patient health and/or patient safety. For more details, see CMS information http://www.cms.gov/regulations-and- Guidance/Legislation/EHRIncentivePrograms/downloads/11_Clinical_Decision_Support_Rule.pdf

Hello Health Meaningful Use Guide for Eligible Professionals Stage 1 36 Patient Electronic Access (VDT) [Core] Overview Objective Provide patients the ability to view online, download and transmit their health information within four business days of the information being available to the EP. Attestation Requirements Measure 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. Numerator / Denominator / Exclusion Denominator Number of unique patients seen by the EP during the EHR reporting period. Numerator 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. Exclusion Any EP who neither orders nor creates any of the information listed for inclusion, except for Patient name and Provider's name and office contact information.

Hello Health Meaningful Use Guide for Eligible Professionals Stage 1 37 How to Meet the MU Attestation Using Hello Health Once patients have access to the patient portal (PortalConnect) and have an active membership plan, they are able to view, download or transmit their health information. Patients (or authorized representatives) can automatically access PortalConnect once they have created an account at a self check-in kiosk; or, you can send account activation instructions directly to patients from Hello Health. You can tell a patient has access to PortalConnect if the picture border is green and/or if the PHR Access information in the PortalConnect subsection indicates: This patient has access to PortalConnect: You can send the activation key directly to the patient from the PortalConnect section of the patient record menu. 1. Under Account Settings, click Send Account Activation Instructions or Send to patient;

Hello Health Meaningful Use Guide for Eligible Professionals Stage 1 38 2. Enter the email address and click Send by email. Numerator and Denominator Explained for Hello Health Denominator Patients seen. Numerator Patients (*) who had access to their health information in PortalConnect in the 4 business days following their visit (i.e. patient had or has had a membership plan and had access to PortalConnect). (*) Whether the patient or a representative with authorized PortalConnect access such as a patient s guardian. Hints, Tips and Additional Information The information must be made available online unless the provider believes that substantial harm may arise from disclosing particular health information in this manner; To meet this measure more easily, encourage your patients to register to PortalConnect for a trial period and to access PortalConnect at least once for them to see the value of being subscribed to a membership plan. For more details, see CMS information http://www.cms.gov/regulations-and- Guidance/Legislation/EHRIncentivePrograms/Downloads/11_Patient_Electronic_Access-.pdf

Hello Health Meaningful Use Guide for Eligible Professionals Stage 1 39 Clinical Summaries [Core] Overview Objective Provide clinical summaries for patients for each office visit. Attestation Requirements Measure Clinical summaries provided to patients for more than 50 percent of all office visits within 3 business days. Numerator / Denominator / Exclusion Denominator Number of office visits by the EP during the EHR reporting period. Numerator Number of office visits in the denominator for which the patient is provided a clinical summary within 3 business days. Exclusion EPs who have no office visits during the EHR reporting period would be excluded from this requirement. EPs must enter 0 in the Exclusion box to attest to exclusion from this requirement.

Hello Health Meaningful Use Guide for Eligible Professionals Stage 1 40 How to Meet the MU Attestation Using Hello Health From the menu icon in the visit documentation, select Export Clinical Summary or, in the Patient record menu, under the Export / Import subsection, you can export a clinical summary for the patient to view: 1. Follow the prompts in the pop-up window: a. In the Purpose field, select Patient Request; b. Modify, if relevant, the delay in which you provide the summary to the patient following the patient visit; c. Enter a Reason; the reason is optional and only used to document export audits (visible to the provider only, not to the patient); d. Select the sections you wish to include (by default, all are selected); e. Select the visit to export; f. Specify if you want to view as HTML or PDF and if you want to download the XML; g. Click the Export button.

Hello Health Meaningful Use Guide for Eligible Professionals Stage 1 41 Numerator and Denominator Explained for Hello Health Denominator Number of office visits (*) during the reporting period. Numerator Number of office visits (*) in the denominator for which: Patient (or representative) had access to their health information in PortalConnect in the 3 days following their visit (i.e. patient had or has had a membership plan and had access to PortalConnect); or A clinical summary was exported within 3 business days with Patient request selected as the purpose. (*) Excluding visits with a Cancelled or No show status.

Hello Health Meaningful Use Guide for Eligible Professionals Stage 1 42 Hints, Tips and Additional Information The clinical summary can be provided through a patient portal, secure email, electronic media such as CD or USB fob, or printed copy. If the EP chooses an electronic media, they would be required to provide the patient a paper copy upon request; If an EP believes that substantial harm may arise from the disclosure of particular information, an EP may choose to withhold that particular information from the clinical summary; Providers should not charge patients a fee to provide a clinical summary to a patient without PortalConnect access; When a patient visit lasts several days and the patient is seen by multiple EPs, a single clinical summary at the end of the visit can be used to meet the Meaningful Use objective for Provide clinical summaries for patients after each office visit; Make sure to document the information when a patient office visit is cancelled or when the patient does not show up for a visit so that the denominator calculated in Hello Health correctly reflects actual office visits; To meet this measure more easily, encourage your patients to register to PortalConnect and to access PortalConnect at least once for them to see the value of being subscribed to a membership plan. For more details, see CMS information http://www.cms.gov/regulations-and- Guidance/Legislation/EHRIncentivePrograms/downloads/13_Clinical_Summaries.pdf

Hello Health Meaningful Use Guide for Eligible Professionals Stage 1 43 Protect Electronic Health Information [Core] Overview Objective Protect electronic health information created or maintained by the certified EHR technology through the implementation of appropriate technical capabilities. Attestation Requirements Measure 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. Yes / No Eligible professionals (EPs) must attest (Yes) to having conducted or reviewed a security risk analysis in accordance with the requirements under 45 CFR 164.308(a)(1) and implemented security updates as necessary and corrected identified security deficiencies prior to or during the EHR reporting period to meet this measure. How to Meet the MU Attestation Using Hello Health Hello Health is compliant with the MU security measures D1 to D8: Auditable events and tamper-resistance; Audit reports; Amendments; Automatic log-off; Emergency access; End-user device encryption; Integrity; Authentication, access control, and authorization.

Hello Health Meaningful Use Guide for Eligible Professionals Stage 1 44 Hints, Tips and Additional Information EPs must conduct or review a security risk analysis of certified EHR technology and implement updates as necessary at least once prior to the end of the EHR reporting period and attest to that conduct or review. The testing could occur prior to the beginning of the first EHR reporting period. However, a new review would have to occur for each subsequent reporting period; A security update would be required if any security deficiencies were identified during the risk analysis. A security update could be updated software for certified EHR technology to be implemented as soon as available, changes in workflow processes or storage methods, or any other necessary corrective action that needs to take place in order to eliminate the security deficiency or deficiencies identified in the risk analysis. For more details, see CMS information http://www.cms.gov/regulations-and- Guidance/Legislation/EHRIncentivePrograms/downloads/15_Core_ProtectElectronicHealthInformation.pd f

Hello Health Meaningful Use Guide for Eligible Professionals Stage 1 45 Drug Formulary Checks [Menu] Overview Objective Implement drug formulary checks. Attestation Requirements Measure The EP has enabled this functionality and has access to at least one internal or external formulary for the entire EHR reporting period. Exclusion Any EP who writes fewer than 100 prescriptions during the EHR reporting period. Yes / No Eligible professionals (EPs) must attest (Yes) to having enabled this functionality and having had access to at least one internal or external formulary for the entire EHR reporting period to meet this measure. An EP who writes fewer than 100 prescriptions during the EHR reporting period can be excluded from this objective and associated measure. EPs must enter 0 in the Exclusion box to attest to exclusion from this requirement. How to Meet the MU Attestation Using Hello Health This functionality is already active by default within Hello Health. When drug formulary is enabled, the Drug formulary information is located above the prescription info and you can click on View coverage for details.

Hello Health Meaningful Use Guide for Eligible Professionals Stage 1 46 If you click View coverage, the Patient Eligibility screen will be displayed.

Hello Health Meaningful Use Guide for Eligible Professionals Stage 1 47 Numerator and Denominator Explained for Hello Health Not applicable. Hints, Tips and Additional Information The default setting when implementing Hello Health is to enable formulary check with electronic prescribing. If you are unsure this feature is turned on for your practice, contact the Customer Experience Team; At a minimum, an EP must have at least one formulary that can be queried. This may be an internally developed formulary or an external formulary. The formularies should be relevant for patient care during the prescribing process. For more details, see CMS information http://www.cms.gov/regulations-and- Guidance/Legislation/EHRIncentivePrograms/downloads/1_Drug_Formulary_Checks.pdf

Hello Health Meaningful Use Guide for Eligible Professionals Stage 1 48 Clinical Lab Test Results [Menu] Overview Objective Incorporate clinical lab test results into EHR as structured data. Attestation Requirements Measure More than 40 percent of all clinical lab test results ordered by the EP during the EHR reporting period for which results are either in a positive/negative or numerical format are incorporated in certified EHR technology as structured data. Numerator / Denominator / Exclusion Denominator Number of lab tests ordered during the EHR reporting period by the EP for which results are expressed in a positive or negative affirmation or as a number. Numerator Number of lab test results for which results are expressed in a positive or negative affirmation or as a number, which is incorporated as structured data. Exclusion If an EP orders no lab tests for which results are either in a positive/negative or numeric format during the EHR reporting period, they would be excluded from this requirement. EPs must select No next to the appropriate exclusion, then click the Apply button in order to attest to the exclusion.

Hello Health Meaningful Use Guide for Eligible Professionals Stage 1 49 How to Meet the MU Attestation Using Hello Health The Labs section must be enabled in the platform and orders must be sent out electronically. Please contact the Customer Experience Team to enable this functionality. Numerator and Denominator Explained for Hello Health Denominator Number of lab tests ordered during the EHR reporting period for which results are expressed in a positive or negative affirmation or as a number. Numerator Number of lab test results received in Hello Health that are expressed in a positive or negative affirmation or as a number incorporated as structured data. Hints, Tips and Additional Information All lab results received through Hello Health, expressed in a positive or negative affirmation or as a number, are incorporated as structured data; If you order labs (paper requisition or other) for which lab results are not received through the Hello Health lab feature, you must adjust the denominator for your Meaningful Use attestation. For more details, see CMS information http://www.cms.gov/regulations-and- Guidance/Legislation/EHRIncentivePrograms/downloads/2_Clinical_Lab_Test_Results.pdf

Hello Health Meaningful Use Guide for Eligible Professionals Stage 1 50 Patient Lists [Menu] Overview Objective Generate lists of patients by specific conditions to use for quality improvement, reduction of disparities, research, or outreach. Attestation Requirements Measure Generate at least one report listing patients of the EP with a specific condition. Yes / No Eligible professionals (EPs) must attest (Yes) to having generated at least one report listing patients of the EP with a specific condition to meet this measure.

Hello Health Meaningful Use Guide for Eligible Professionals Stage 1 51 How to Meet the MU Attestation Using Hello Health Hello Health features advanced search tools which enable providers to search within their patient panel for patients who have a given condition reported in the patient EHR. 1. Go to the patient Panel; 2. Select the Advanced Search option; 3. Enter the criteria for your search; 4. Click Search (you may also save your query for later use); 5. Results are shown as a patient list, showing only patients that have or have had the precise medical condition reported in their EHR. Numerator and Denominator Explained for Hello Health Not applicable.

Hello Health Meaningful Use Guide for Eligible Professionals Stage 1 52 Hints, Tips and Additional Information This objective does not dictate the report(s) that must be generated. An EP is best positioned to determine which reports are most useful to their care efforts; The report generated could cover every patient whose records are maintained using certified EHR technology or a subset of those patients at the discretion of the EP; Queries may be saved for future use. For more details, see CMS information http://www.cms.gov/regulations-and- Guidance/Legislation/EHRIncentivePrograms/downloads/3_Patient_Lists.pdf

Hello Health Meaningful Use Guide for Eligible Professionals Stage 1 53 Patient Reminders [Menu] Overview Objective Send reminders to patients per patient preference for preventive/follow-up care. Attestation Requirements Measure More than 20 percent of all patients 65 years old or older or 5 years old or younger were sent an appropriate reminder during the EHR reporting period. Numerator / Denominator / Exclusion Denominator Number of unique patients 65 years old or older or 5 years old or younger. Numerator Number of patients in the denominator who were sent the appropriate reminder. Exclusion If an EP has no patients 65 years old or older or 5 years old or younger with records maintained using certified EHR technology, the EP is excluded from this requirement. EPs must select No next to the appropriate exclusion, then click the Apply button in order to attest to the exclusion.

Hello Health Meaningful Use Guide for Eligible Professionals Stage 1 54 How to Meet the MU Attestation Using Hello Health Patients can be selected from the patient panel by performing an Advanced Search. From the resulting patient listing, click the Actions menu and select Create patient reminder. Enter the required information and click Create.

Hello Health Meaningful Use Guide for Eligible Professionals Stage 1 55 The new task is created and available from the task list. Click on the main patient Reminder task to see subtasks for all patients. You can also create a Patient reminder task for one patient at a time.

Hello Health Meaningful Use Guide for Eligible Professionals Stage 1 56 To indicate that a reminder was sent to the patient, complete the task by editing it or by selecting Complete Task in the pencil icon menu: Numerator and Denominator Explained for Hello Health Denominator Number of active unique patients 65 years old or older or 5 years old or younger (whether or not the patient has had a visit during the reporting period). Numerator Number of patients in the denominator with at least 1 patient reminder task completed in the reporting period (regardless of the task creation date). Hints, Tips and Additional Information This measure is based on your active panel. If there are patients in your panel who are no longer under your care, be sure to contact the Customer Experience Team so that the status of these patients is accurately changed to inactive; EPs meet the aspect of per patient preference of this objective if they are accommodating reasonable requests in accordance with the HIPAA Privacy Rule, as specified at 45 CFR 164.522(b), which is the guidance established for accommodating patient requests; EP has the discretion to determine the frequency, means of transmission, and form of the reminder; When you click on the task, the patient list for whom you have created the reminder opens. Clicking the blue pencil icon to the right hand side of the patient list enables the provider to send a secure message to that patient; You can also send secure messages to all patients at once from the panel. Run the same query used to create the Patient Reminder task, click the Actions menu and select Send message;

Hello Health Meaningful Use Guide for Eligible Professionals Stage 1 57 For more details, see CMS information http://www.cms.gov/regulations-and- Guidance/Legislation/EHRIncentivePrograms/downloads/4_Patient_Reminders.pdf

Hello Health Meaningful Use Guide for Eligible Professionals Stage 1 58 Patient-Specific Education Resources [Menu] Overview Objective Use certified EHR technology to identify patient-specific education resources and provide those resources to the patient if appropriate. Attestation Requirements Measure More than 10 percent of all unique patients seen by the EP are provided patient-specific education resources. Numerator / Denominator Denominator Number of unique patients seen by the EP during the EHR reporting period. Numerator Number of patients in the denominator who are provided patient-specific education resources.

Hello Health Meaningful Use Guide for Eligible Professionals Stage 1 59 How to Meet the MU Attestation Using Hello Health The Patient Education section of the patient record makes it possible for you to send patient education to your patients. The system automatically generates a list of topics that could be of interest to each patient based on the medications, conditions and labs ordered through the patient s chart. Hello Health is using MedlinePlus as a source of educational material, and you can also create your own Patient Education suggestions with educational material of your choice. In the patient record, select the Patient Education section, then click Select & Send Content. Select the relevant patient education information and click Next.

Hello Health Meaningful Use Guide for Eligible Professionals Stage 1 60 Add a message for the patient and click Send. The message will be sent by secure message to the patient. Numerator and Denominator Explained for Hello Health Denominator Patients seen. Numerator Patients seen who are provided patient education-specific resources including VIS content sent upon documentation of an immunization (regardless of date content was sent). Hints, Tips and Additional Information When sending a patient VIS upon documentation of a vaccine in Hello Health, this counts as relevant patient education; For patients who are not online, if you print the content for them (whether your own or MedlinePlus), you can still use the Patient Education section to document that you have provided them with the information, as if they were online patients. Also, if you give patients educational material coming from other sources about a topic that is listed by the system but that is not covered by MedlinePlus (gray topic in the Patient Education Selector dialog), Hello Health will record this information as having been sent to them; In addition to the Medline education material that is automatically available in Hello Health, you can also create your own patient education suggestions. Go to the Admin section and access the Patient Education subsection under Settings.

Hello Health Meaningful Use Guide for Eligible Professionals Stage 1 61 Refer to the Hello Health version 7 video for more information. For more details, see CMS information http://www.cms.gov/regulations-and-guidance/legislation/ehrincentiveprograms/downloads/6_patient- Specific_Education_Resources.pdf

Hello Health Meaningful Use Guide for Eligible Professionals Stage 1 62 Medication Reconciliation [Menu] Overview Objective The EP who receives a patient from another setting of care or provider of care or believes an encounter is relevant should perform medication reconciliation. Attestation Requirements Measure The EP performs medication reconciliation for more than 50 percent of transitions of care in which the patient is transitioned into the care of the EP. Numerator / Denominator / Exclusion Denominator Number of transitions of care during the EHR reporting period for which the EP was the receiving party of the transition. Numerator Number of transitions of care in the denominator where medication reconciliation was performed. Exclusion If an EP was not on the receiving end of any transition of care during the EHR reporting period, they would be excluded from this requirement. EPs must select No next to the appropriate exclusion, then click the Apply button in order to attest to the exclusion.

Hello Health Meaningful Use Guide for Eligible Professionals Stage 1 63 How to Meet the MU Attestation Using Hello Health From the Export / Import subsection, you can import a Summary Care Record from which you will then be able to launch a clinical reconciliation. If you have a Direct messaging account with Hello Health, you can also receive summaries of care for transitioned patients in your secure messages. Click Summary Care Record and select the file to import and open:

Hello Health Meaningful Use Guide for Eligible Professionals Stage 1 64 1. Specify the purpose of the import (in this case, it is for Patient referral); 2. Enter the Referrer information; 3. Ensure that the Reconcile now checkbox is selected; 4. Click Import. During reconciliation, data to reconcile is grouped by Medications, Allergies and Problems; 1. There is the option to import all data; this is particularly useful when a new patient transitions into the provider s care; 2. There is the option to add and remove entries individually using the +/- buttons; 3. You can click Expand All or click an individual item in one of the lists to see more details about the item; 4. When you have completed the reconciliation for all 3 sections, click Save. You can also receive a summary of care through Direct messaging, in a secure message. If a clinical document is attached to a secure message, the Clinical Document indication tells you that this file can be imported and reconciled. Click the file name or select Import Clinical Document in the pencil icon menu. Note that when importing from the Messages tab, you will need to select the patient name.

Hello Health Meaningful Use Guide for Eligible Professionals Stage 1 65 To help you keep track of imported summaries of care and patient referrals, you can link an import to a patient visit. For an imported summary of care, in the Audits section, use the pencil icon menu and choose Link to Visit. Numerator and Denominator Explained for Hello Health Denominator Number of imported summaries of care in the reporting period for which the selected purpose is Patient Referral, whether summary of care was received through Direct messaging (in your secure messages) or you have imported the file directly in the patient record. Numerator Number of imported summaries of care in the reporting period for which the selected purpose is Patient Referral and for which the provider accessed the Clinical Reconciliation dialog.