Meaningful Use - Core Measure 5 Record Smoking Status Configuration Guide
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1 Enterprise EHR Meaningful Use - Core Measure 5 Record Smoking Status Configuration Guide Last Updated: October 26, 2013 Copyright 2013 Allscripts Healthcare, LLC.
2 MU Core 5 Record Smoking Status This guide will provide instructions on how to configure the necessary setup and preferences to enable Enterprise EHR to work for Core Measure 5: Record smoking status for patients 13 years old or older Final Rule Requirements More than 80% of all unique patients 13 years old or older seen by the eligible professional (EP) have smoking status recorded as structured data. Core Objective: Menu: Numerator: The number of patients in the denominator with smoking status recorded as structured data. Denominator: The number of unique patients age 13 or older seen by the eligible professional (EP) during the EHR reporting period. Exclusion: Any eligible professional (EP) who does not see patients 13 years or older Objective is shared across Eligible Professionals: Yes: No: Objective must be recorded during the reporting period: Yes: No: Prerequisites Requires: Core EHR - Base Availability: v11.2: Enhanced with v11.4.1: Complete Problem Conversion as part of 11.4/ Upgrade As part of the upgrade to 11.4 or , you will be performing a problem conversion. As you are working through the conversion and Problem Mapping Tool (PMT), you will want to ensure that all of the previous smoking status problems are also being converted. Configuration Steps 1. Review Smoking Status for Patients 13 and Older is Not Documented Preference: The Smoking Status preference determines if the application will indicate that a smoking status for patients 13 and older is not documented in the patient's chart and place an alert in Copyright 2013 Allscripts Healthcare, LLC. 2
3 the Encounter Clinical Summary. It is best practice to set to Show in My Alerts to ensure smoking is captured when missing. Navigate to TWAdminPreferencesAlerts 2. Create Favorite Lists to capture smoking status Favorites are used to configure master level and personal favorites lists of frequently used items for organizations and users. Favorites are used in the pages and workspaces of functional areas throughout Allscripts Enterprise EHR. Favorites are used to make search and selection of frequently used items more efficient. You can set up lists of favorites for the master database, specialties, and users within a specific area. Ensure users have smoking problems set as Quick List items in their Social History favorites Users can also set this up on their own favorites through the Add Clinical Item (ACI) dialog. Favorite list setup is optional for reporting this objective. Navigate to Physician Admin Base Social Hx Favorites or through the SSMT category Favorites: Patient Hx-Social Hx to build favorites if they do not exist today Copyright 2013 Allscripts Healthcare, LLC. 3
4 3. Understanding how problems are identified as a smoking status : The Problem dictionary contains a comprehensive list of entries that you can add to a patient's problem lists. The Problem dictionary entries are delivered by Allscripts. The dictionary includes entries for active, past medical, past surgical, social, and family history diagnoses, symptoms, physical findings, and procedures. Customers can inactivate the entries. The dictionary i ncludes entries from Medcin and IMO. Any smoking status term that is associated with a SNOMED code listed below can be used to meet the measure. Synonyms can be created in the problem dictionary with different description for existing terms that have required SNOMED code. The following are SNOMED Codes identified by CMS as appropriate Smoking Statuses. If a problem in the problem dictionary is assigned to one the below SNOMED codes, it will be counted for this MU measure. SNOMED Code: (current every day smoker) SNOMED Code: (current some day smoker) Copyright 2013 Allscripts Healthcare, LLC. 4
5 SNOMED Code: (smoker, current status unknown) SNOMED Code: (former smoker) SNOMED Code: (never a Smoker) SNOMED Code: (unknown if ever smoked) SNOMED Code: (heavy tobacco smoker) SNOMED Code: (light tobacco smoker) 4. Reviewing Smoking Status terms in the Smoking Status MU Alert: The Problem dictionary contains a comprehensive list of entries that you can add The frequently used smoking status problems can be added to the Smoking Status in Not Documented MU alert in Encounter Summary for the end user to quickly document a smoking status for the patient. Allscripts will be delivering which Problems appear in the Smoking Status Alert Copyright 2013 Allscripts Healthcare, LLC. 5
6 If there are other problems you would like as options to include, or remove, from the Smoking Status Alert: o o o Navigate to the Problem Dictionary Search for the Problem (the smoking term) Select or unselect the Show in Smoking Status MU Alert checkbox Copyright 2013 Allscripts Healthcare, LLC. 6
7 Workflow Considerations We do not recommend the use of the Deny action to document smoking status/tobacco us. To meet MU requirements, we must map denied smoking to one of the above CDC terms. Unfortunately, denied smoking could mean either former smoker or never smoker. You will need to direct your users to choose one of the specified smoking terms. How EEHR Calculates the MU2 Report Numerator For each patient in the denominator, where one of the following SNOMED codes documented as Social History o SNOMED Code: (current every day smoker) o SNOMED Code: (current some day smoker) o SNOMED Code: (smoker, current status unknown) o SNOMED Code: (former smoker) o SNOMED Code: (never a smoker) o SNOMED Code: (unknown if ever smoked) o SNOMED Code: (heavy tobacco smoker) o SNOMED Code: (light tobacco smoker) AND: Problem is NOT Entered in Error or Unverified Denominator: For each unique patient the system will count once any patient that was at least age 13 at the time of the encounter Exclusion: Any eligible professional (EP) who does not see patients 13 years or old er Indicators When the numerator divided by denominator is greater than 80%. When the numerator divided by denominator is between 70% and 80%. When the numerator divided by denominator is below 70%. Copyright 2013 Allscripts Healthcare, LLC. 7
8 Report Calculation Flow Diagram Reporting Considerations Per CMS, smoking statuses includes any form of tobacco that is smoked, but not all tobacco use. Secondhand smoke is not considered for this measure. CMS does not specify who records the status and how often it needs to be cap tured for any patient. The presence of smoking status for the patient during the reporting period is sufficient to meet the measure. The status can be recorded before the reporting period begins. CMS has added two new smoking status descriptions that are not included in Stage 1 o Light tobacco smoker = fewer than 10 cigarettes per day or equivalent quantity of cigar or pipe smoke Copyright 2013 Allscripts Healthcare, LLC. 8
9 o Heavy tobacco smoker = greater than 10 cigarettes per day or equivalent quantity of cigar or pipe smoke Additional Information Following is a list of reference documents, and where you can find them in the system. Certified Workflows: ClientConnect >Toolbox > Product Documentation > Allscripts Enterprise EHR > Certified Workflows o Chart Review Basic (F1) and Detail (F2) Documents o Intake Process: Detailed (E2) Document o Resolving Clinical Alerts Document Application Design and Behavior Resource (ADBR): ClientConnect > Toolbox > Product Documentation > Allscripts Enterprise EHR > Pick your version > Manual Guides > Application Design and Behavior Resource (ensure you save it to your PC) Problem Mapping Tool Documentation: ClientConnect > Toolbox > Product Documentation > Allscripts Enterprise EHR > 11.4 > Manual/Guides > Allscripts Enterprise EHR 11.x Problem Mapping Tool User Guide Enterprise EHR Set Problem Value Enhancement: Available with GA Copyright 2013 Allscripts Healthcare, LLC. 9
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