Meaningful Use Simple Guide

Transcription

1 Meaningful Use Simple Guide

2 CORE Measures 1. CPOE for Medication Orders 2. Drug Interaction Checks * 3. Maintain Problem & Diagnosis List 4. eprescribing (erx) escripts 5. Active Medication List 6. Active Allergy List 7. Record Demographics 8. Record Vital Signs 9. Record Smoking Status 10. Report Clinical Quality Measures (CQMs) to CMS/States * 11. Clinical Decision Support Rule * 12. Electronic Copy of Patient s Health Information (CCR) 13. Clinical Summaries per visit 14. Electronic Exchange of Clinical Information * 15. Protect Electronic Health Information * * Doctor can attest to these items 2 P a g e

3 ADDITIONAL Measures (Must Pick 5) 1) Implement drug formulary checks. 2) Incorporate clinical lab-test results into EHR as structured data. 3) Generate patient lists by specific conditions to use for quality improvement, reduction of disparities, research, or outreach. 4) Send patient reminders per patient preference for preventive/follow-up care. 5) Provide patients with timely electronic access to their health information (including lab results, problem list, medication lists, and allergies) within 4 business days of the information being available to the EP. 6) Use certified EHR technology to identify patient-specific education resources and provide those resources to the patient if appropriate. 7) 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. 8) The EP who transitions their patient to another setting of care or provider of care or refers their patient to another provider of care should provide summary care record for each transition of care or referral. *9)Capability to submit electronic data to immunization registries or immunization information systems and actual submission according to applicable law and practice. *10)Capability to submit electronic syndromic surveillance data to public health agencies and actual submission according to applicable law and practice. * Most States do not have this capability yet, so it might be a freebie. 3 P a g e

4 More Details on CQM s 3 core measures (substitute the alternate core measures if necessary) and 3 additional measures Core Measures include: Adult Weight Screening and Follow-Up - (NQF 0421 / PQRI 128) Preventative Care and Screening Measure Pair (includes a. and b. shown below) (NQF 0028) Tobacco Use Assessment *0028(a) Tobacco Cessation Intervention *0028(b) Hypertension: Blood Pressure Measurement (NQF 0013) Alternative Core Measures: Note: It is required that eligible providers substitute one Alternative Core Measure for every Core Measure where the denominator is 0. Weight Assessment and Counseling for Children and Adolescents (NQF 0024) Preventive Care and Screening: Influenza Immunization for Patients 50 Years Old (NQF 0041 / PQRI 110) Childhood immunization Status (NQF 0038) Additional Quality Measures Note: It is required that eligible providers also select 3 additional CQMs from the list of 38 shown below (this excludes the core and alternate core measures). It is acceptable to have a '0' denominator provided the EP does not have an applicable population. (NQF 0001) Asthma Assessment (NQF 0002) Appropriate Testing for Children with Pharyngitis (NQF 0004) Initiation and Engagement of Alcohol and Other Drug Dependence Treatment: (a) Initiation, (b) Engagement (NQF 0012) Prenatal Care: Screening for Human Immunodeficiency Virus (HIV) (NQF 0014) Prenatal Care: Anti-D Immune Globulin (NQF 0018) Controlling High Blood Pressure (NQF 0027) Smoking and Tobacco Use Cessation, Medical assistance: a. Advising Smokers and Tobacco Users to Quit, b. Discussing Smoking and Tobacco Use Cessation Medications, c. Discussing Smoking and Tobacco Use Cessation Strategies (NQF 0031) Breast Cancer Screening (NQF 0032) Cervical Cancer Screening (NQF 0033) Chlamydia Screening for Women (NQF 0034) Colorectal Cancer Screening (NQF 0036) Use of Appropriate Medications for Asthma (NQF 0043) Pneumonia Vaccination Status for Older Adults (NQF 0047) Asthma Pharmacologic Therapy (NQF 0052) Low Back Pain: Use of Imaging Studies 4 P a g e

5 (NQF 0055) Diabetes: Eye Exam (NQF 0056) Diabetes: Foot Exam (NQF 0059) Diabetes: HbA1c Poor Control (NQF 0061) Diabetes: Blood Pressure Management (NQF 0062) Diabetes: Urine Screening (NQF 0064) Diabetes: LDL Management & Control (NQF 0067) Coronary Artery Disease (CAD): Oral Antiplatelet Therapy Prescribed for Patients with CAD (NQF 0068) Ischemic Vascular Disease (IVD): Use of Aspirin or another Antithrombotic (NQF 0070) Coronary Artery Disease (CAD): Beta-Blocker Therapy for CAD Patients with Prior Myocardial Infarction (MI) (NQF 0073) Ischemic Vascular Disease (IVD): Blood Pressure Management (NQF 0074) Coronary Artery Disease (CAD): Drug Therapy for Lowering LDL-Cholesterol (NQF 0075) Ischemic Vascular Disease (IVD): Complete Lipid Panel and LDL Control (NQF 0081) Heart Failure (HF) : Angiotensin-Converting Enzyme (ACE) Inhibitor or Angiotensin Receptor Blocker (ARB) Therapy for Left Ventricular Systolic Dysfunction (LVSD) (NQF 0083) Heart Failure (HF): Beta-Blocker Therapy for Left Ventricular Systolic Dysfunction (LVSD) (NQF 0084) Heart Failure (HF) : Warfarin Therapy Patients with Atrial Fibrillation (NQF 0086) Primary Open Angle Glaucoma (POAG): Optic Nerve Evaluation (NQF 0088) Diabetic Retinopathy: Documentation of Presence or Absence of Macular Edema and Level of Severity of Retinopathy (NQF 0089) Diabetic Retinopathy: Communication with the Physician Managing Ongoing Diabetes Care (NQF 0105) Anti-depressant medication management: (a) Effective Acute Phase Treatment, (b) Effective Continuation Phase Treatment (NQF 0385) Oncology Colon Cancer: Chemotherapy for Stage III Colon Cancer Patients (NQF 0387) Oncology Breast Cancer: Hormonal Therapy for Stage IC-IIIC Estrogen Receptor/Progesterone Receptor (ER/PR) Positive Breast Cancer (NQF 0389) Prostate Cancer: Avoidance of Overuse of Bone Scan for Staging Low Risk Prostate Cancer Patients (NQF 0575) Diabetes: HbA1c Control (<8%) 5 P a g e

6 (1) CPOE for Medication Orders Use computerized provider order entry for medication orders directly entered by any licensed healthcare professional who can enter orders into the medical record. All orders from PowerSoft MD s escripts features should count as computer order entry. Additionally, you or staff can enter medication for assigning to other staff and send later, or even for dissemination to the patient in office! To do this, open escripts. At the compose page, select the medication and dosing information you want for the patient, and save the Rx. This will place the order into the pending area for the patient. You can also go to the review page and mark the prescription as approved, and leave for staff. This will add the medication to a staff review list. When you close escripts, if you have not transmitted or printed any prescriptions, the system will also ask if you left any medications for review. Selecting yes will add the SOAP note to a list for further review. You can also do this manually from the tools option at the top of the SOAP note by selecting Add Note to SOAP Note Review List. To see what items have been marked for prescription review, at the top menu of the SOAP note screen, click find and then Open Visit Records items marked for review will say escript pending. 6 Page Click Here to Return to CORE Measures

7 (2) Drug Interaction Checks Implement drug-drug and drug-allergy interaction checks. The Eligible professionals must enabled this functionality for the entire EHR reporting period. Eligible professionals (EPs) must attest YES to having enabled drug-drug and drugallergy interaction checks for the length of the reporting period to meet this measure. Drug interaction checks for other drugs, allergies, and other criteria are enabled by default in the PowerSoft MD electronic prescribing system. You can check that all drug interaction checks for drugs and allergies will be displayed by opening escripts, and clicking on the admin tab, and then the Adjust Individual Drug and Allergy Interaction Display Link to make sure no interactions are listed as set to be ignored. 7 P a g e

8 (3) Problem List Maintain an up-to-date problem list of current and active diagnoses. 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. This requirement can be tracked from the PowerSoftMD Meaningful Use Menu and the Patient s Meaningful Use Panel From the EMR Patient Profile screen click on the Med Prob List tab. You can also open this list from the patient s SOAP Note screen by using the Medical Problems button. 2. Learn how to update and use the problem list from our web video at: 8 Page Click Here to Return to CORE Measures

9 (4) eprescribing (erx) escripts Generate and transmit permissible prescriptions electronically (erx). More than 40 percent of all permissible prescriptions written by the Eligible professionals (EPs) are transmitted electronically using certified EHR technology. Any EP who writes fewer than 100 prescriptions during the EHR reporting period is exempt from this requirement. The concept of only permissible prescriptions refers to the current restrictions established by the Department of Justice on electronic prescribing for controlled substances in Schedule II-V. (The substances in Schedule II-V can be found at Any prescription not subject to these restrictions would be permissible. You will need to be signed up for escripts service to complete this criteria. Sign up for escripts can be done on our website at Prescriptions can be sent electronically from the SOAP notes or message center notes screens. From the Primary menu click on the icon for the screen you will prescribe from, then click on escripts at the top of the screen. 9 P a g e

10 (5) Active Medication List 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. This requirement can be tracked from the PowerSoftMD Meaningful Use Menu and the Patient s Meaningful Use Panel From the Patient s Profile Screen, select the Meds tab. If the patient isn t on any Medications this can be listed in the Yellow Meds Window otherwise you can use the Meds Regimen button to see the Medications that are currently taking. The medication regimen is updated automatically from the escripts screen. 10 P a g e Click Here to Return to CORE Measures

11 (6) Active Allergy List 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. This requirement can be tracked from the PowerSoftMD Meaningful Use Menu and the Patient s Meaningful Use Panel From the Patient s SOAP Note screen on the left hand side you can check Allergies None or click on the Allergy Display Box below Allergies and enter all known medication allergies. 2. Additionally you can use the top toolbar escripts option to define Allergies, which will automatically synchronize both the escripts Window allergy list as well as the SOAP Note Allergy display. 11 P a g e Click Here to Return to CORE Measures

12 (7) Record Demographics Measurement Criteria Record all of the following demographics: (A) Preferred language, (B) Gender (Sex), (C) Race, (D) Ethnicity, (E) Date of birth More than 50 percent of all unique patients seen by the EP have demographics recorded as structured data. This requirement can be tracked from the PowerSoftMD Meaningful Use Menu and the Patient s Meaningful Use Panel Use the patient s General Screen and fill in the following fields: (B) Sex (C) Race (E) Birthdate 2. From the General Screen use the top toolbar Tools option, then select Additional Demographics and fill in the following fields: (A) Preferred Language (D) Ethnicity Note: You can set a Patient Add screen Default to be prompted for this extra screen after you add each new Patient. 12 P a g e Click Here to Return to CORE Measures

13 (8) Record Vital Signs Measurement Criteria 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 2-20 years, including BMI Measure For more than 50 percent of all unique patients age 2 and over seen by the EP, height, weight, and blood pressure are recorded as structured data. This requirement can be tracked from the PowerSoftMD Meaningful Use Menu and the Patient s Meaningful Use Panel From the EMR Patient Profile screen click on the Vital Signs tab. This will open the Vital Signs window for the patient. You can fill in the data fields typically during an office visit. When you click the Save button the vital signs are added as a new entry to their vital signs records and the BMI is automatically calculated and displayed. (A) Height (B) Weight (C) Blood Pressure (D) BMI 2. From the Top of the Vital Signs Window select the View Graphs toolbar option, then select Growth Charts. 13 P a g e Click Here to Return to CORE Measures

14 (9) Record Smoking Status 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. Exclusion Any EP who sees no patients 13 years or older. This requirement can be tracked from the PowerSoftMD Meaningful Use Menu and the Patient s Meaningful Use Panel From the Patient s SOAP Note screen on the left hand side you can check Yes or No for Tobacco usage. 2. Additionally you can define custom Habit Definitions that further break down data by using the Soc/Fam History button on the Soap Note Screen. 14 P a g e Click Here to Return to CORE Measures

15 (10) Report Clinical Quality Measures to CMS/States MeasureRecord 3 core measures (substitute the alternate core measures if necessary) and 3 additional measures Core Measures Include: Adult Weight Screening and Follow-Up Preventative Care and Screening Measure Pair which includes Tobacco Use Assessment and Tobacco Cessation Intervention Hypertension: Blood Pressure Measurement Note: It is required that eligible providers substitute one Alternative Core Measure for every Core Measure where the denominator is 0. Alternative Core Measures: Weight Assessment and Counseling for Children and Adolescents Preventive Care and Screening: Influenza Immunization for Patients 50 Years Old Childhood immunization Status 1) Adult Weight Screening and Follow-Up: From the SOAP note, click the View Vital Signs button and enter the patient s weight, along with any other relevant vital signs. Note: PowerSoft keeps a history of vital signs in this window, as well as Body Mass Index (BMI). 15 P a g e Click Here to Return to CORE Measures

16 (11) Clinical Decision Support Rule (CDS) Measure - Implement one clinical decision support rule relevant to specialty or high clinical priority along with the ability to track compliance with that rule. Notes: This rule must be conditional. CMS advises that the rule matches on the Clinical Quality Measures (CQM). Allergies, order sets and pick lists DO NOT count. The data must come from a patient s problem list, medication list, demographics and laboratory results. Examples: If patient has not had a certain test in X months and patient is over the age of Y, then the system should notify the provider that they need this certain test. Q. What are some examples of valid meaningful use CDS rules for eligible professionals (physician practice setting)? o For diabetic patients, an alert which allows the physician to order a hemoglobin A1c test if there is no hemoglobin A1c result in the past six months. o For a patient with a history of ischemic vascular disease without contraindications for aspirin use, and who does not have aspirin on his medication list, an alert which asks the provider if the patient is currently taking aspirin and if not, allows the provider to order it. o For women age with no mammogram in the past year, an alert and/or an order set to facilitate ordering of this diagnostic study. FAQ: NIST info: The Tester validates that these rules are based on data elements in a patient s problem list, medication list, demographics and laboratory test results. The Tester validates that the notifications and care suggestions verified in the Implement Rules test: -are generated and indicated to the user in real-time -are based on one or more clinical decision support rules that use data elements in a patient s problem list, medication list, demographics and laboratory results -are displayed as described by the Vendor 16 P a g e

17 (12) Electronic Copy of Patient s Health Information Measure Provide patients with an electronic copy of their health information (including diagnostic test results, problem list, medication lists, medication allergies) upon request. More than 50 percent of all patients who request an electronic copy of their health information are provided it within 3 business days. This requirement can be tracked from the PowerSoftMD Meaningful Use Menu and the Patient s Meaningful Use Panel P a g e

18 (13) Clinical Summaries Provide clinical summaries for patients for each office visit. Clinical summaries provided to patients for more than 50 percent of all office visits within 3 business days. Any Eligible Professional who has no office visits during the EHR reporting period is exempt from this requirement. A clinical summary is an after-visit summary that provides a patient with relevant and actionable information and instructions containing the patient name, provider s office contact information, date and location of visit, an updated medication list, updated vitals, reason(s) for visit, procedures and other instructions based on clinical discussions that took place during the office visit, any updates to a problem list, immunizations or medications administered during visit, summary of topics covered/considered during visit, time and location of next appointment/testing if scheduled, or a recommended appointment time if not scheduled, list of other appointments and tests that the patient needs to schedule with contact information, recommended patient decision aids, laboratory and other diagnostic test orders, test/laboratory results (if received before 24 hours after visit), and symptoms. Office visits include separate, billable encounters that result from evaluation and management services provided to the patient and include: (1) Concurrent care or transfer of care visits, (2) Consultant visits, or (3) Prolonged Physician Service without Direct (Face-To-Face) Patient Contact (tele-health). A consultant visit occurs when a provider is asked to render an expert opinion/service for a specific condition or problem by a referring provider P a g e

19 (14) Electronic Exchange of Health Information Objective Capability to exchange key clinical information (for example, problem list, medication list, medication allergies, and diagnostic test results), among providers of care and patient authorized entities electronically. Measure Performed at least one test of certified EHR technology s capacity to electronically exchange key clinical information. Attestation Requirements - Eligible professionals (EPs) must attest YES to having performed at least one test of certified EHR technology s capacity to electronically exchange key clinical information prior to the end of the EHR reporting period to meet this measure

20 (15) Protect Electronic Health Information Objective Protect electronic health information created or maintained by the certified EHR technology through the implementation of appropriate technical capabilities Measure Conduct or review a security risk analysis in accordance with the requirements under 45 CFR (a)(1)* and implement security updates as necessary and correct identified security deficiencies as part of its risk management process. Attestation Requirements Eligible professionals (EPs) must attest YES to having conducted or reviewed a security risk analysis in accordance with the requirements under 45 CFR (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. *Additional Note: 45 CFR (a)(1) is the Administrative Safeguards section of the HIPAA Security Rule.