CHCANYS NYS HCCN ecw Webinar 4

Transcription

1 CHCANYS NYS HCCN ecw Webinar 4 Meaningful Use Data Capture and Configuration Clinical Quality Measures for Stage 1 and 2 August 14, 2014 Stephanie Rose, Project Director Desiree Railine, HIT Implementation Specialist

2 Agenda 2014 CQM Requirements Adult Recommended CQMs Pediatric Recommended CQMs Resources 2

3 2014 Clinical Quality Measures Must report using the new 2014 criteria Must report on 9 out of 64 measures Recommended Core Quality Measures are encouraged but not required 9 for Adult 9 for Pediatrics Selected CQMs must cover at least 3 of the National Quality Strategy domains 2014 Clinical Quality Measures & Domains on CMS.Gov website: and Guidance/Legislation/EHRIncentivePrograms/2014_ClinicalQualityMeasures.html 2014 ecqm Library for Eligible Professionals CMS.GovWebsite: and Guidance/Legislation/EHRIncentivePrograms/eCQM_Library.html 3

4 Core Quality Measures Rationale CMS selected the recommended core set of CQMs for EPs based on analysis of several factors: Conditions that contribute to the morbidity and mortality of the most Medicare and Medicaid beneficiaries Conditions that represent national public health priorities Conditions that are common to health disparities Conditions that disproportionately drive healthcare costs and could improve with better quality measurement Measures that would enable CMS, States, and the provider community to measure quality of care in new dimensions, with a stronger focus on parsimonious measurement Measures that include patient and/or caregiver engagement 4

5 6 CQM Domains Patient and Family Engagement Patient Safety Care Coordination Population/Public Health Efficient Use of Healthcare Resources Clinical Process/Effectiveness 5

6 CMS Specification Sheets Details about what is included in the numerator and denominator can be found on the CMS Specification documents and are fairly complex. Recommend you download the zip file and review 6

7 ecw Quick Reference Guide Be sure to download the ecw Stage 2 ecqm Quick Reference guide June 2014 or later under Documentation and not the older document from the ecqms or MU Stage 2 folders on my.eclinicalworks.com. 7

8 ecw Guides Expand the CQM folder to see detailed information on some CQMs 8

9 Adult Recommended Core CQM 9

10 Core Adult CQM 10

11 Controlling High Blood Pressure (CMS 165) Percentage of patients between years of age Have one applicable office visit during reporting period: 99341, 99342, 99343, 99344, 99345, 99347, 99348, 99349, 99350, 99241, 99242, 99243, 99244, 99245, 99395, 99396, 99397, 99385, 99386, 99387, G0438, G0439 Diagnosis of Essential Hypertension 401.0, 401.1, or BP adequately controlled: Diastolic BP <90mmHG and Systolic BP <140mmHG Excludes ESRD and pregnant patients by active diagnosis 11

12 ecw Configuration EMR Vitals Vitals Configuration BP Consider making BP a mandatory field 12

13 Use of High Risk Medications in the Elderly (CMS 156) Percentage of patients 66 years or older Have one applicable office visit during reporting period: 99201, 99202, 99203, 99204, 99205, 99212, 99213, 99214, 99215, 99341, 99342, 99343, 99344, 99345, 99347, 99348, 99349, 99350, 99385, 99386, 99387, 99395, 99396, 99397, 99406, G0438, G0439 Two rates are reported: The percentage of patients who were ordered at least one high risk medication. The percentage of patients who were ordered at least two different high risk medications. 13

14 ecw Documentation Progress Note Treatment Add 14

15 ecw Documentation, cont d Telephone/Web Encounter Rx Tab Select Rx 15

16 ecw Documentation, cont d Telephone/Web Encounter Virtual Visit Tab Treatment Add 16

17 Preventive Care and Screening: Tobacco Use: Screening and Cessation Intervention (CMS 138) Percentage of patients 18 years and older One psychiatric visit 90791, 90792, 92002, 92004, 92012, 92014, 96150, 96152, 97003, 97004, 90832, 90834, 90837, 90845, 99201, 99202, 99203, 99204, 99205, 99212, 99213, 99214, OR two preventive care visits 99385, 99386, 99387, 99395, 99396, 99397, 99401, 99402, 99403, 99404, 99406, 99411, 99412, 99420, 99429, G0438, G0439 Need tobacco use assessment AND counseling intervention (if identified as a tobacco user) 17

18 ecw Documentation Part 1 Record the screening via Smart Form drop down field; OR Social History Tobacco Use Smoking Are you a: Additional Findings: Tobacco User Additional Findings: Tobacco Non User 18

19 ecw Documentation Part 1, cont d 19

20 ecw Documentation Part 2 If the patient has been identified as a tobacco user, documentation of counseling intervention has to be recorded as structured data. *Preventive Medicine Counseling * A complete listing of all of the questions can be found on the My eclinicalworks portal under the Meaningful Use Stage 2 documentation. 20

21 Exceptions Patient has to have a medical reason excepted. Information has be recorded as structured data Parent Question: Social History Tobacco Use Screening Not Performed Q: Reason; A: Medical reason or limited life expectancy Child Questions: Q: Type of medical reason; A: various options Q: Details; A: various options 21

22 Mapping Structured data must be mapped to community items in the Mapper Window. To access: Community Mappings Structured Data Use the filters to drill down to the items Choose/ highlight item Choose/ highlight item Click the Map button. Items will them turn blue. 22

23 Use of Imaging Studies for Low Back Pain (CMS 166) Percentage of patients years of age Had one office visit during reporting period: Assessment Codes: 721.3, , , , , , , 724.2, 724.3, 724.5, 724.6, , 738.5, 739.3, 739.4, 846.0, 846.1, 846.2, 846.3, 846.8, 846.9, Within 28 days of initial diagnosis, have NOT had: X ray of the lower spine MRI of the lower spine CT Scan of lower spine 23

24 Exclusions Dx for low back pain within 180 days of the diagnosis within the reporting period Dx for cancer any time during or before the reporting period Dx for trauma, IV drug abuse, or neurological impairment during or within one year before the reporting period 24

25 ecw Configuration One of the following LOINC codes must be linked to the x ray of the lower spine, the MRI or the lower spine, and the CT Scan of the lower spine. X ray of lower spine: , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , MRI of lower spine: , , , , , , , , , , , , , , , , , , , , , CT Scan of lower spine: , , , , , , , , , , , , , , , , ,

26 ecw Configuration cont d (ecw my.eclinicalworks.com Documentation): EMR Labs, DI & Procedures Diagnostic Imaging Attribute Codes Update LOINC (Help Hub documentation: option has been removed; and is no longer available) 26

27 ecw Configuration cont d EMR Labs, DI & Procedures Diagnostic Imaging Choose desired code Associate CPTs LOINC field, click on ellipsis button to open Associate LOINC window 27

28 ecw Configuration cont d 28

29 Preventive Care and Screening: Screening for Clinical Depression & Follow Up Plan (CMS 2) Percentage of patients 12 years and older Had a depression screening encounter: 90791, 90792, 90832, 90834, 90837, 90839, 92557, 92567, 92568, 92625, 92626, 96116, 96118, 96150, 96151, 97003, 99201, 99202, 99203, 99204, 99205, 99212, 99213, 99214, 99215, G0101, G0402, G0438, G0439, G0444 Active Dx of depression or bipolar: , , , 296.2, , , , , , , 296.3, , , , , , , 298.0, 300.4, , 309.0, 309.1, , 311, , , , , , , , Follow Up plan documented within one day after positive result Additional evaluation for depression Follow up for depression Suicide risk assessment Referral to specialist Depression medications ordered 29

30 Add Structured Questions All Structured questions need to be created in HPI Depression Screening Don t forget to map your questions!! 30

31 Documentation of Current Medications in the Medical Record (CMS 68) Percentage of visits for patients 18 years and older Applicable office visits: 90791, 90792, 90832, 90834, 90837, 90839, 90957, 90958, 90959, 90960, 90962, 90965, 90966, 92002, 92004, 92012, 92014, 92507, 92508, 92526, 92541, 92542, 92543, 92544, 92545, 92547, 92548, 92557, 92567, 92568, 92570, 92585, 92588, 92626, 96116, 96150, 96152, 97001, 97002, 97003, 97004, 97110, 97140, 97532, 97802, 97803, 97804, 98960, 98961, 98962, 99201, 99202, 99203, 99204, 99205, 99212, 99213, 99214, 99215, 99324, 99325, 99326, 99327, 99328, 99334, 99335, 99336, 99337, 99341, 99342, 99343, 99344, 99345, 99347, 99348, 99349, 99350, 99495, 99496, G0101, G0108, G0270, G0402, G0438, G0439 Need to document the name, dosage, frequency, and route of administration for: ALL known prescriptions Over the counters Herbals Vitamin/mineral/dietary (nutritional) supplements 31

32 Current Medication Window 32

33 Preventive Care and Screening: Body Mass Index (BMI) Screening and Follow Up (CMS 69) Patient 18 years or older At least one encounter during reporting period BMI calculated and documented during encounter; or within the past six months Follow up plan documented if outside of normal range 33

34 Configure Height to automatically carry forward Recommendation: 1. Move the vitals to the order you want them. 2. Configure Vitals to automatically carry forward the height from the previous visit for patients 21 and older. 3. Check the WHO Growth charts for

35 Configure Vital Ranges EMR/Vitals/Configure Vitals Range Range 1 (or next available) Age Sex both Enter 22 in Low column for BMI Enter in High column for BMI Range Sex both Enter 18.5 in Low column for BMI Enter in High column for BMI 37

36 Example: need to configure BMI Range so out of range BMI s trigger clinician 38

37 BMI Management Follow Up Care Plan One of the following will satisfy the measure Assessment of V65.3, V65.41 CPT Codes: 43644, 43645, 43770, 43771, 43772, 43773, 43774, 43842, 43843, 43845, 43846, 43847, 43848, 97804, 98960, 99078, G8417, G8418, S9449, S9451, S9452, S9470 Structured Data Community Mapping Preventive Medicine, Counseling, Care Goal Follow Up Plan (BMI management provided) or Provider to Provider Communication (Dietary consultation order provided) Local element must be the same type as the community (Boolean) If no local category or item you will need to create Visit type must be physical to get to preventive medicine Exclusions: current Dx of pregnancy *Check with coding staff about using CPT code may have billing impact 39

38 Example: BMI Management Care Plan not mapped to local item, need item added to map 40

39 Adult Weight Follow up: Mid Office Workflow Click on the Preventive Medicine Link in Progress Note window (visit type must be physical exam) Click on category Counseling and select either Care Goal Follow Up Plan or Provider to Provider Communication Click in the notes field for the item containing the structured data Select Yes from the value drop down list 41

40 Closing the Referral Loop: Receipt of Specialist Report (CMS 50) Percentage of patients with referrals, regardless of age, for which the referring provider receives a report from the provider to whom the patient was referred. 40

41 Referral has to be created during the visit by utilizing the Outgoing Referral button on the Treatment Window from within the progress note. 41

42 Referred to Provider needs to be recorded Status must be Consult Pending or Addressed to be counted in the denominator 42

43 Referral must be marked as Addressed during reporting period AND Either Received Date box is checked; OR Date is recorded via structured data 43

44 Functional Status Assessment for Complex Chronic Conditions (CMS 90) Patient is 65 years or older Applicable office visit codes: 99201, 92202, 92203, 99204, 99205, 99212, 99213, 99214, First office visit within 185 days of start of reporting period Second visit between days after first office visit Active Dx for heart failure , , , , , , , , , 428.0, 428.1, , , , , , , , , , , , , Had a functional status assessment within two weeks prior to, or during, the current encounter Exclusions: Dx of cancer or severe dementia in problem list 44

45 FSA Complex Continued Needs to be recorded in one of the following locations: Progress Note HPI Functional Status Assessment for Heart Failure Description OR Progress Note HPI Functional Status Assessment Description *Don t forget to map your structured data questions! 45

46 Pediatric Recommended Core CQM 46

47 Pediatric Core CQM 47

48 Appropriate Testing for Children with Pharyngitis (CMS 146) Percentage of children 2 18 years of age, who were diagnosed with pharyngitis, ordered an antibiotic and received a group A streptococcus (strep) test for the episode. 48

49 ecw Configuration LOINC Mapping for Strep Lab Attribute must have one of the following LOINC Codes , , , , , , , 626 2, , , , ,

50 Look up the Lab EMR Menu >Labs, DI s & Procedures >Labs 50

51 Search for Strep A tests Highlight the name to select Click on Attribute Code 51

52 Select the Strep A attribute Highlight the name to select Click on Update LOINC if no value appears or use the green arrow to update it if you need to make an edit 52

53 Search for the appropriate LOINC Enter one of the LOINC codes from the Quick Reference Guide Click OK to add the LOINC Code to the lab attribute The LOINC Code is added to the attribute Repeat for all Strep A tests 53

54 Weight Assessment and Counseling for Children and Adolescents (CMS 155) Percentage of patients 3 17 years of age who had an outpatient visit with a PCP or OB/GYN and had evidence of the following during the measurement period. Must have all 3: Height, weight and BMI Percentile documented Nutrition Counseling if out of range Physical Activity Counseling if out of range *Pregnant women are excluded (dx or visit type) 54

55 ecw Configuration Vitals Mapping Structured Data Mapping 55

56 Denominator Inclusion Patients in the age range of 3 17 during the reporting period Office visit determined by E&M Code of: 99341, 99342, 99343, 99344, 99345, 99347, 99348, 99349, 99350, 99201, 99202, 99203, 99204, 99205, 99212, 99213, 99214, 99215, 99391, 99392, 99393, 99394, 99381, 99382, 99383, 99384, 99411, 99412, 99401, 99402, 99403, *Note this means dentists will not have any patients in the denominator 56

57 Numerator Inclusion (3 Parts) 1. Height, weight and BMI recorded during the measurement period in Vitals 2. Had a nutrition counseling encounter (E&M Code of 97802, 97803, 97804) Or 2. Nutrition counseling structured data in Preventive Medicine AND 3. Physical Activity Counseling as structured data in Preventive Medicine 57

58 Exclusions Patients whose pregnancy does not end before the end of the reporting period. Progress Notes Assessment or Problem list has ICD9 Code of Pregnancy 58

59 Vital Mapping (Configuration) Example: Ht, Wt & BMI Percentile configured Find your vital name on the left Use the drop down arrow to select the ecw name to map Remember to change the vital order as needed when you add new vitals 59

60 Structured Data Mapping Community Menu Mapping Structured Data 60

61 Community Mapping Use the drop down arrows for Section, Category and Item to find the ecw standard item and highlight the item to map (if not blue) Use the drop down arrows on the right side to find your local item and Highlight it Click on the MAP button 61

62 Adding new Item Names The Add button will light up once you have the section, category and item created. Click on the Item Ellipsis button and Press New to add the Item Description. Then use the Add Arrow button to add the ecw name to your local. 62

63 Counseling for nutrition and physical activity Mid Office Workflow Click on the Preventive Medicine Link in Progress Note window (visit type must be physical exam) Click on category Counseling (or your local category name if different) and select Counseling for nutrition and counseling for physical activity Click in the notes field for both items containing the structured data Click Yes for both 63

64 Chlamydia Screening for Women (CMS 153) Percentage of women years of age who were identified as sexually active and who had at least one test for Chlamydia during the measurement period. NOTE: A CDSS Alert is available for this measure. CDSS requires that you complete the sexual history smart form or structured data to determine if sexually active and then the Chlamydia alert will appear. Recommend you turn both CDSS alerts on. 64

65 Sexually Active Community Mapping Sexual History Smart Form Mapped to Social History Had sex in past 12 months (yes/no) item determines if the patient is sexually active. The other questions determine risk but are not required for this measure calculation. 65

66 ecw Configuration LOINC Mapping for Chlamydia Test Lab Attribute must have one of the LOINC Codes from the Quick Reference Guide (Too many to list on a slide) Sample Chlamydia Screening: , , , , , , , , , , , , , , , , , , , , , , , , 66

67 Find and LOINC Chlamydia Labs Examples: *Disclaimer: HCNNY can not advise you of what is the correct LOINC code to use for each test. You will need to work with your lab vendor and clinical staff. 67

68 Workflow Complete Sexual History Smart Form at least once annually If sexually active and within the guidelines, Order Chlamydia test Review Lab, result Received box checked and Result entered in attribute. 68

69 Appropriate Medications for Asthma (CMS 126) Percentage of patients 5 64 years of age who were identified as having persistent asthma and were appropriately prescribed medication during the reporting period. 69

70 Documentation Identify Persistent Asthma: Asthma Smart Form, or Use one of the following ICD9 Codes in the Assessment or Problem List , , , , 496, , , , , , 492.0, 492.8, 518.1, Asthma Medication dispensed during the reporting period Progress Note, Treatment Telephone Encounter, Virtual Visit, Treatment Telephone/Web Encounter RX 70

71 Childhood Immunization Status (CMS 117) Percentage of children 2 years of age during the reporting period who had: Outpatient encounter with PCP or OB/GYN Vaccines by 2 nd birthday DTaP 4 IPV 3 MMR 1 HiB 3 HepB 3 VZV 1 PCV 4 Hep A 1 RV 2 or 3 Flu 2 71

72 LOINC Mapping Hepatitis A Antigen Test: , , , , , Hepatitis B Antigen Test: , Measles Antigen Test: , , , , , , , , , , , , Mumps Antigen Test: , , , , , , , , , , , , ,5249 8, , , , , Rubella Antigen Test: , , , , , , , , Varicella Zoster Antigen Test: , , , , , , , , , , , , , ,

73 CVX Code Mapping Immunizations should have CVX codes for the immunization registry submission and are mandatory in V10. Immunization CVX Code DTAP (4) 20, 50, 106, 110, 120, 130 IPV (3) 110, 130, 10 MMR (1) 03, 94 HiB (3) 48, 49, 50, 51, 120 VZV (1) 21, 94 Hep B (3) 08, 44, 51, 104, 110 PCV (4) 100, 133,33 Hep A (1) 83, 104 RV (2/3) 119,116 Flu () 111, 141,

74 Add/Update CVX Code EMR>Immunizations/Therapeutic Injections, Immunizations/Therapeutic Injections Highlight the immunization Click the green arrow next to New Select Update to add or change the CVX code 74

75 Add/Update CVX Code Use the SEL button to find the CVX Code Click OK 75

76 Appropriate Treatment for Children with Upper Respiratory Infection (URI) CMS 154 Percentage of Children 3 months 18 years of age who were diagnosed with upper respiratory infection (URI) and were not dispensed an antibiotic prescription on or within three days after the episode. Note: This measures not prescribing an unnecessary antibiotic since URIs are self regulating viral infections that cannot be treated by antibiotics. 76

77 Mapping/Configuration No mapping required Diagnosis/Assessment of Upper Respiratory Infection Antibiotic not Prescribed 77

78 ADHD: Follow Up Care for Children Prescribed ADD/ADHD Medication (CMS 136) Percentage of children 6 12 years of age and newly dispensed a medication for attention deficit/hyperactivity disorder (ADHD) who had appropriate follow up care. Two rates are reported. a. Percentage of children who had one follow up visit with a practitioner with prescribing authority during the 30 Day Initiation Phase. b. Percentage of children who remained on ADHD medication for at least 210 days and who, in addition to the visit in the Initiation Phase, had at least two additional follow up visits with a practitioner within 270 days (9 months) after the Initiation Phase ended. 78

79 Mapping No Mapping Required Calculation uses medications prescribed and encounters 79

80 Preventive Care and Screening: Screening for Clinical Depression and Follow Up Plan CMS 2 Also a UDS Measure! Percentage of patients aged 12 years and older screened for clinical depression on the date of the encounter using an age appropriate standardized depression screening tool AND if positive, a followup plan is documented on the date of the positive screen. 80

81 Structured Data Mapping Part 1 Structured Data Mapping: HPI > Depression Screening > Intervention > Q: Depression Screening findings; (Structured Data Type: Single Select) OR Smart Forms > PHQ2 > Document patient's responses to questionnaire Smart Forms > PHQ9 > Document patient's responses to questionnaire 81

82 Structured Data Mapping Part 2 AND HPI > Depression Screening > Intervention > Q: Additional Evaluation for Depression; A: Description; (Structured Data Type: Single Select) OR Q: Follow Up for Depression; A: Description; (Structured Data Type: Single Select) OR Q: Suicide Risk Assessment Performed; A: Date; (Structured Data Type: Date) Exclusion HPI>Depression Screening > Screening Not Performed Q: Reason:; A: Medical Reason or Patient Reason Child Questions: Type of medical reason; A: Various options Type of patient reason; A: Various options 82

83 ecw Community Mapping This ecw database does not have the Intervention items locally. They will need to first add the item Intervention, then add the 3 item names using the Add button, then map them one at a time. ecw EBO UDS will follow this logic. 83

84 Workflow Complete the PHQ2 (and PHQ9 if required) If the tool indicates they are positive for depression, complete the follow up plan in HPI Structured data If a PHQ2 was not performed for medical or patient reasons, complete the HPI Structured data for not performed to exclude. 84

85 Children who have dental decay or cavities Percentage of children ages 0 20, who have had tooth decay or cavities during the measurement period. 85

86 Mapping None 86

87 Questions 87

88 MAQ Dashboard CQM Configuration Reminder 88

89 MAQ Dashboard Welcome Page 89

90 MAQ Configuration Go to the Scorecard View Click on the Configuration Icon 90

91 Edit Stage and Program for Providers Select Provider(s) and click Edit Stage button Select Stage or Stage Select MU Program 91

92 Configure CQMs MAQ Dashboard All 64 ecqms have been released by ecw You need to configure the necessary measures that you want displayed on the MAQ Dashboard. Select at least nine (9) of the 64 approved ecqms up to a maximum of 20 measures. Selected CQMs must cover at least three (3) of the National Quality Strategy Domains. NOTE: Recommend you pick 20 that cover adult, pediatric, UDS and PCMH related items consider workflow impact 92

93 20 CQMS Example 93

94 Configure CQM Select the provider(s), then click on the CQMs 2014 button Select up to CQM s 94

95 CPCI CQM Reporting Option CPCI has received 2014 ONC HIT certification, and may be used to submit up to 24 CQMs for Meaningful Use. See the Azara website for more details: events/azara drvs rreceives 2014 onc hit certification 95

96 Pause for questions 96

97 NYS-HCCN Ask the Experts Forum 1. If you do not have an account, the link will take you to the login screen so you can create an account. 2. Choose the options for NYS-HCCN members only 3. You will need to wait for an from the CHCANYS system administrator approving your account before you ll be able to log in for the first time. 4. When you get a confirmation, return to this link to log in. Posting a Question 1. Click on a relevant category, e.g., Meaningful Use Data Capture for eclinical Works 2. Click the New Topic button in the top right, type a question (message body optional) and submit the form. a. The question will appear on the list of questions for your selected category. 97

98 We appreciate your feedback! Please take survey using the link below 98

99 About HCNNY HCNNY is a Health Center Controlled Network that provides support to member and non member health centers utilizing eclinicalworks. Please contact Stephanie Rose at srose@hcnny.org if you are interesting in utilizing our training services or obtaining more information about the benefits of becoming a HCNNY member. 99