Stage 1: Meaningful Use Manual

Promoting Meaningful Use in Your Practice

March 15, 2011

Dear BayCare Connect Participating Physicians and Practices, We hope you find this manual helpful for your practices in achieving Meaningful Use. Thanks to Chris Eakes, Manager, EMR Technical Liaison, and Alex Rennick, Systems Analyst, for assisting me in preparing this manual. We appreciate the information and feedback provided to us by the eClinicalWorks team. If you have questions or need assistance, please contact us.

Sincerely,

Patrick Cimino, MD, MPH Medical Director BayCare Health System O-(727) 467.4032 | M - (727) 253.6825 | F - (727) 467.4626 Patrick.Cimino@baycare.org

BayCare.org/EMRConnect BayCare Health System is a leading community-based health system in the Tampa Bay area. Composed of a network of 10 not-for-profit hospitals, outpatient facilities and services such as imaging, lab, behavioral health and home health care, BayCare provides expert medical care throughout a patients lifetime. With more than 214 locations throughout the Tampa Bay area, BayCare connects patients to a complete range of preventive, diagnostic and treatment services for any health care need. The extraordinary health care professionals across the BayCare network seek to advance the health of their patients and their communities by setting the standard for compassionate care that respects the dignity of every individual. BayCare Connect is BayCares initiative to promote EMR implementation in affiliated physician practices.

Introduction
What Is Meaningful Use?
Meaningful Use is the term coined by the Centers for Medicare and Medicaid Services EHR Incentive Program to promote the use of EHR by Eligible Professionals (EP) to:  Improve  the quality of care, efficiencies and safety in treating patients  R  educe health disparities Engage  patients and families Improve  care coordination Improve  population and public health Guarantee  adequate privacy and security protection of PHI Identifying  the settings that need to be in place Identifying  where data needs to be recorded Meeting  multiple measures within one workflow Evaluating  reporting on the local (practice) level as well as across the BayCare eCW community This manual is intended to provide Eligible Professionals using the eClinicalWorks EMR, promoted by BayCare, minimal information on achieving Meaningful Use. It is by no means all-inclusive and assumes some proficiency with the eCW EMR. In general, the manual includes only one straightforward means to achieve Meaningful Use, while there may be others appropriate for your practice. eClinicalWorks has detailed information on Meaningful Use on their support portal at http://support.eclinicalworks.com. You will need your User Name and Password to access this. Particularly helpful is the Meaningful Use Training Scenarios Guide. On the support portal go to the main toolbar to Documents > Meaningful Use (on the lower toolbar) > Step 2. Further Meaningful Use tracking and reporting tools are available through eCWs Meaningful Use, Adoption, Quality (MAQ) Dashboards in Version 9.
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BayCares Commitment to EHR

BayCare has made a huge commitment to inpatient EHR through the BEACON project. BayCare Connect is BayCares commitment to promoting EHR in physician practices, facilitating implementation, communication and interoperability, quality initiatives and therefore Meaningful Use. This Meaningful Use manual is provided by BayCare Connect to give guidance on meeting Meaningful Use with the eClinicalWorks (eCW) EHR by: Identifying  the feature(s) which cover each measure

BayCare Connect is providing these materials to assist our physicians with the attainment of Meaningful Use. While every effort has been made to assure the accuracy of the materials within, please recognize that none of the information contained herein constitutes legal or clinical advice and that the final responsibility for achievement of this aim remains the responsibility of the participating provider(s). The Meaningful Use process is in evolution so changes will need to be made to this Manual.

Score Card
What Are the Measures? Fifteen  Core Measures (C) Five  Menu Measures out of a menu of 10 (M) Within  one Core Measure: Six Clinical Quality Measures -T  hree Core CQMs (CQM-C) or Alternate Core CQMs (CQM-A) -T  hree Additional Set CQMs (CQM) TOTAL: 25 Measures How do I start? The registration process is open as of January 3, 2011, for the Medicare Incentive. The Medicare and Medicaid Registration Manuals are available online* To register, an Eligible Professional will need National  Provider Identifier (NPI)

 National Plan and Provider Enumeration System (NPPES) User ID and Password  Payee Tax Identification Number (if you are reassigning your benefits)  Payee National Provider Identifier If you need an NPI, go to the following CMS link: https://nppes.cms.hhs.gov/NPPES/Welcome.do Highlights of the 2011 incentives include the following:  The Eligible Professional is required to attest on any 90 days for 2011.  Reporting for 2011 is by attestation. The Attestation process will be available in April 2011. In 2012 reporting directly to CMS will be required. The Index of the 2011 Meaningful Use Measures is a separate document attached to this manual. The Index Measures are catalogued with letters and numbers for

* https://www.cms.gov/EHRIncentivePrograms/20_RegistrationandAttestation.asp
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reference purposes. They are specific to this manual and intended to make it easier to keep track of the measures. Refer to this while reviewing the manual. Related Measures are covered together, so it is helpful to refer to the Index. Meaningful Use requires that a lot of information in the electronic record be reportable. It is important that reportable information be entered in structured or discrete data, like a pick list. This usually means it is flagged for reporting by being placed in a certain format or field, e.g. a cell in a table. Generally free text is not discrete or structured so is not reportable. It may be used but should be limited to areas where reporting is not crucial. When data is referred to as discrete or structured, it means that it is reportable. eClinicalWorks has developed the MAQ Dashboard to track compliance with the key Meaningful Use Measures that require structured data and have to meet a threshold. The following section describes workflows where multiple measures can be met.

These workflows are color coded in the Manual, the Index and the checklist to facilitate reference between the documents. The Index is straight from CMS describing the Measures. The checklist is to help the practices select the measures where there are choices.

Following are workflow topics where multiple measures are met in a single workflow.

Demographics Vitals Medication-related Measures Smoking Status and Cessation

By fully addressing these topics, one can achieve 15 Meaningful Use Measures, and at least two CQM Additional Set Measures. The remainder of the manual will give information on the other Measures. Ready? Lets begin our Meaningful Use journey.

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Demographics

Demographics

More than 50% of all unique patients seen by the EP have demographics recorded as structured data Date of birth Gender Race Ethnicity Preferred language

Information must be recorded as structured data

Race: American Indian or Alaska Native Asian Black or African American White .. Unreported/Refused to Report Ethnicity: Hispanic or Latino Not Hispanic or Latino Refused to Report Preferred Language: Creole English Spanish Other Race and ethnicity are government requirements as listed on the left.

Measures Met: C.1.

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Demographics (continued)
C.1. Record Demographics Threshold: 50% The Patient Information (demographic) is recorded in the Info screen of patient chart and can be accessed from a variety of areas in the chart. The Gender and Date of Birth are on the first page and are set by default as mandatory. Further demographic information can be accessed by clicking the Additional Info button in the lower left of the Patient Information, which brings up a second screen with more fields. Race, Ethnicity and Language fields may be made Mandatory Fields when the Additional Info screen is accessed. From the main Toolbar go to Patients > Configure Demographics Mandatory Fields and check the appropriate boxes for these fields. The MAQ reports will track this measure. Numerator: Unique patients with language, gender, race, ethnicity and date of birth ALL recorded as structured data Denominator: Total unique patients seen during the reporting period

The Additional Info screen has fields to record Race, Ethnicity and Language. A practice should deal with capturing this information through front office workflow.

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Vitals

Vitals

Record and chart changes in vital signs: Height Weight Blood pressure Calculate and display BMI  Plot and display growth charts for children ages 2-20 including BMI

C.2. More than 50% of all unique patients seen by the EP have vitals recorded as structured data. BMI-calculated Growth Chart plotted for children ages 2-20 including BMI

Hypertension: Blood pressure measurement (adult or pediatric practices, depending on practice scope)

CQM.C.1. Percentage of patient visits for patients age 18 and older with a diagnosis of hypertension who have been seen for at least two office visits, with blood pressure (BP) recorded CQM.C.2. Percentage of patients age 18 and older with a calculated BMI in the past six months or during the current visit documented in the medical record AND if the most recent BMI is outside parameters, a follow-up plan is documented

Adult weight screening and followup (adult or pediatric, depending on practice scope)

Weight assessment and counseling for children and adolescents (adult or pediatric practices, depending on practice scope)

CQM.A.1. Percentage of patients age 2-17 who had an outpatient visit with a Primary Care Physician (PCP) or OB/GYN who had evidence of BMI percentile documentation, counseling for nutrition and counseling for physical activity during the measurement year

Measures potentially met: C.2. CQM.C.1. CQM.C.2. CQM.A.1.

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Vitals (continued)
C.2. Record and chart changes in vitals Threshold: 50% To configure the Vitals to be captured, do the following: Toolbar  EMR > Misc. Configuration Options > Configure Categories Under  Configure Categories use drop menu to go to Vitals Choose  provider(s) on right and be sure that BP, Ht, Wt and BMI checked with other vitals practice monitors. Click Apply then OK. A

B You can configure Vitals and Vitals Ranges by going to the following: Toolbar  EMR > Vitals > Configure Vitals (A) Toolbar  EMR > Vitals > Configure Vitals Range (B) The ranges need to be set in the Configure Vitals Ranges. For adult BMI, CQM.C.2., these are specified in NQF 0421 and PQRI 128 as follows: Parameters: Age 65 and older BMI > 30 or < 22; age 18-64 BMI > 25 or < 18.5

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Vitals (continued)
If out of parameter, a follow-up plan needs to be documented. One option would be having an Order Set to include such things as dietary counseling or referring to PCP if a specialist. CQM.A.1.For the age 2-17 population, a BMI percentile must be documented. A growth chart is populated in eCW as long as the height and weight are recorded and configured in Vitals as above. Counseling for Nutrition and Physical Activity then needs to be documented. This is on a yearly basis. This could be achieved through an Order Set, Preventive Medicine category, CDSS, Alerts and Education Material in the treatment window. It should be recorded in structured data. A professional could also choose two additional set clinical quality measures by adequately capturing blood pressure, CQM-7., blood pressure management in diabetes and CQM-27., blood pressure management with ischemic vascular disease (IVD). Version 9 has several new features in the Vitals that should make some capturing easier.  In A, there is a check box to have the height brought forward after a certain age.  The Growth Charts can be referenced to either the Centers for Disease Control (CDC), which is the default, or the World Health Organization (WHO), by checking the box shown in A. The MAQ reports will track measure C.2. Numerator: Unique patients with height, weight, BP recorded as structured data with BMI, including growth chart plot for children 2-20 years Denominator: All unique patients seen during the reporting period

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Medication-related Measures

Medication-related Measures

Use CPOE for medications orders directly entered by any licensed health care professional

C.3. More than 30% unique patients with at least one medication in their medication list seen by the EP have at least one medication order entered using CPOE C.4. The EP has enabled this functionality for the entire EHR reporting period.

Implement drug-drug and drugallergy interaction checks

Generate and transmit permissible prescriptions electronically (eRx)

C.5. More than 40% of all permissible prescriptions written by the EP are transmitted electronically using certified EHR technology C.6. More than 80% 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 C.7. More than 80% 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 M.1. The EP has enabled this functionality and has access to at least one internal or external drug formulary for the entire EHR reporting period

Maintain active medication list

Maintain active medication allergy list

Implement drug formulary checks

Measures potentially met: C.3. C.4. C.5. C.6. C.7. M.1.

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Medication-related Measures (continued)

C.3. Use Computerized Physician Order Entry for Medication Orders Threshold: 30% CPOE of medications is a basic function of the EMR through the Classic Treatment Window, eCliniSense, Telephone/Web Encounter and properly structured Templates and Order Sets. This has a threshold of 30%. If there is one medication in the current medications list during the reporting for a patient seen, then for the patient to count at least one medication order should be recorded during the reporting period. The MAQ reports will track this measure Numerator: Unique patients with at least one medication in their medication list with a computer entered medication order Denominator: Total unique patients seen during the reporting period with at least one medication in their medication list C.4. Implement drug-drug and drugallergy interaction checks Following is a description of enabling this feature in versions PRIOR TO Version 9. Version 9 has this feature enabled as default and this setting is not present. Therefore if a Provider is on Version 9 for the reporting period, this measure is met. While not a Meaningful Use requirement, the Allergies or Interactions buttons may indicate a potential concern. To address any concerns there is a note section at the bottom of the window giving the Provider the opportunity to acknowledge the warning and state why a decision is made to use a drug with a time stamp documentation. C.5. Generate and transmit permissible prescriptions electronically (eRx) Threshold: 40% The following is a brief outline of the steps a physician must complete to successfully eprescribe.  Providers participating with BayCare Connect will have their setup facilitated File > Settings > My Settings > User Settings

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Medication-related Measures (continued)

with Surescripts and in eClinicalWorks for eprescribing.  eClinicalWorks will set up the appropriate area pharmacy databases.  The practice needs to establish a workflow to capture the patients pharmacies in the Patient Information (Info) > Additional Info screen which is typically done by the front office. Multiple pharmacies can be loaded including a primary pharmacy and mail order pharmacy.  The provider can now order prescriptions through the Treatment window or other prescribing windows. Once a prescription is complete, the provider should click the Send button choosing the ePrescibe Rx option. Faxing does NOT constitute eprescribing. Electronically received refills may be sent electronically after the reconciliation and approval processes are complete. If there are problems with a pharmacy receiving electronic prescriptions and refills, Surescripts may be contacted online at Surescripts.com/Support. MAQ reports track this. The denominator is the total prescriptions: printed, faxed or eprescribed excluding controlled substances. The numerator is the eprescribed prescriptions. Numerator: Permissible prescriptions transmitted electronically Denominator: Total permissible prescriptions during reporting period C.6. Maintain Active Medication List Threshold: 80% Medication entry is a basic EMR function. Providers must be sure to address and update medications at each visit. The Medication Verified box should be checked at each visit. This is important to confirm medications were checked even if there are none. This feature is also important to the Menu measure M.7., medication reconciliation with transition of care.

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Medication-related Measures (continued)

The MAQ reports track this measure. Numerator: All the unique patients seen during the reporting period with the Medication Verified box checked whether they have medications or not Denominator: All unique patients seen during the reporting period C.7. Maintain Active Medication Allergy List Threshold: 80% Medication Allergies must be documented in a structured fashion in the Allergy section of the EMR. The Allergies Verified box should be checked each visit when allergies are confirmed or added. If there are no allergies, then clicking either NKDA or Allergies Verified boxes will check both.

The MAQ reports track this measure. Numerator: All the unique patients seen during the reporting period with the Allergies Verified box checked whether they have allergies or not Denominator: All unique patients seen during the reporting period M.1. Implement Drug Formulary Checks This measure requires that at least one formulary check must be set up. See C.5. above for Provider registration information for eprescribing. Rx Eligibility may be set as a job to run on a daily basis for the upcoming visits, like insurance eligibility, and be performed automatically. Following is a manual process for performing Rx Eligibility.

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Medication-related Measures (continued)

The front office will need to check Rx Eligibility and set the formularies up when checking patients in. At  the bottom of the Appointment window, click the Rx Eligibility button. On  the Rx Eligibility screen, click the Check Rx Eligibility button. Highlight  the desired plan and click the Set Formulary button at the bottom of the window. The  insurance Web site will need to be in the Update Insurance Window File > Insurance, click on the appropriate insurance, > Address tab. Then add the insurance Web site in the appropriate field.

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Smoking-related Measures
Smoking-related Measures

Record smoking status for patients age 13 or older

C.8. More than 50% unique patients age 13 years seen by EP have smoking status recorded as structured data

Preventive care and screening measure pair: a. Tobacco use assessment b. Tobacco-cessation intervention

CQM.C.3. Percentage of patients age 18 and older: a. who have been seen for at least two office visits who were queried about tobacco use one or more times within 24 months b. identified as tobacco users within the past 24 months and have been seen for at least two office visits, who received cessation intervention

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

CQM-1. Percentage of patients age 18 and older who were current smokers or tobacco users, who were seen by a practitioner during the measurement year and who received advice to quit smoking or tobacco use or whose practitioner recommended or discussed smoking or tobacco use cessation medications, methods or strategies

Measures potentially met: C.8. CQM.C.3. CQM-1.

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Smoking-related Measures (continued)

C.8. Smoking Status As Structured Data Threshold: 50% Within eCW, a provider can capture Smoking Status as structured data in whatever part of the record the practice chooses for their work flow, e.g. HPI, PMH, SH. The status must be captured as structured data, and it must be mapped for reporting purposes. The Tobacco Control Smart Form is one means of capturing Smoking Status as structured data. Either way the structured data MUST be mapped for reporting to be done. The mappings are done through the Toolbar Community > Mappings > Smart Forms for the Tobacco Control Smart Form Community > Mappings > Structured Data for custom smoking status capture. You may work with eCW to be sure this mapping is appropriately completed. The MAQ dashboard will be the reporting mechanism. The three Smoking-related Measures are closely linked, and two are required. It makes sense to create a workflow to accomplish all three. This is a big difference for many specialists. If you consider the health effects of smoking, this broad effort has potential for great medical merit. The following is an example of how to structure up to three Measures as simply as possible.  Click OK and click on the Details section by the Item and then the custom button.  Click Add and add the following. - Name: Do you smoke? - Type: Structured - Click Mandatory - Click Customize Structured Text and Add yes and then no  Add a child - Name: Do you want to quit?
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This is an example of capturing Smoking Status through structured data.  Find the Item to record smoking, typically in the Social History. You can also create a New Item. If the smoking item already exists, open Item by clicking on it and be sure structured box is checked.

Smoking-related Measures (continued)

- Type: Structured - Trigger: yes - Click Mandatory  Add a child to the child above - Name: Do you want to try medication? - Type: Structured - Trigger: yes - Click Mandatory The structured data needs to be mapped in the Community heading on the tool bar. To facilitate counseling being documented, education material supplied, medication offered and referral to a Smoking Cessation program, following is an example of an Order Set. It is triggered and linked to the diagnosis for Nondependent tobacco use disorder, 305.1. It also includes a linkage to a Smoking Cessation intervention code for reporting and reminding, Measure 211-CM.

The Structured Data will be input as follows

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Smoking-related Measures (continued)

In summary: To  complete C.8. record the smoking status. To  complete CQM.C.3. provide the CDC sheet, or other education material about quitting, on the Order Set and charge a counseling code. To  complete CQM-1. offer meds and use the Order Set for that. If everything is mapped correctly, C.8. will be reported in the MAQ reports. Numerator: All the unique patients age 13 or older with smoking status recorded as structure data Denominator: All unique patients age 13 or older seen during reporting period These CQM measures have no threshold to measure. They should be reportable based on the above discussion about structured data. Patient Portal. It specifies a threshold of 50% of patients who request an electronic copy of their health information must be provided it within three business days. eClinicalWorks has developed a new Portal called 100 Million Patients. Following is a brief description of the steps to web enable a patient. This is typically a front office task.  Go to Patient Info screen, click on Options button at bottom and select Web Enable. Complete the Patient Username and E-mail which is required. Password will be set by default and emailed to the patient. Version 9 has an alert for Front Office to Web enable and capture e-mail when an appointment is scheduled, under the Alert Meaningful Use tab.  On the left Admin band, go to Patient Portal Settings, under Synchronize, click Run and set a schedule for the desired items including Update Web Enabled Patient data to Web Portal. This setting is a one-time administrative setting.  Patient will receive an e-mail on how to log onto the Portal and access their information. Tracking this is a function of the eCW MAQ dashboard. The denominator will be the patients who go to the portal and check a Request Record box. If properly set up, all the patients will be provided
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Engaging Patients and Families in Their Health Care Measures

These Measures are intended to enhance patient access to their health information. C.9. Providing an Electronic Copy of Health Information Threshold: 50% This Measure will best be met through the

Engaging Patients and Families (continued)

electronic access to and a copy of their health information (if desired) so it will meet 100%. C.10. Providing Clinical Summaries Threshold 50% The Visit Summary can be printed from two places. Resource  Schedule, right click on the appointment and click on Print Visit Summary option. Progress  Note, click on button next to Print at bottom of Progress Note, then click on Print Visit Summary option. Give patient the Summary, which may include the next appointment. Patients may also access this Summary through the Patient Portal if set up to publish. The MAQ reports track this measure. Numerator: Office visits with printed or published clinical summaries Denominator: All office visits during reporting period

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Remaining Core Measures

C.11. Maintain an up-to-date problem list of current and active diagnoses Threshold: 80% Maintaining an Active or Current Problem List is a basic feature of the EMR. Following are highlights of this feature. The expectation is 80% compliance so it is important to address this Measure. Be  sure Chronic Problem ICDs are set up to default to the Problem List. - Billing on toolbar > ICD > ICD Codes -F  ind code in question, highlight and click Update. Be sure Chronic box is checked. Adding  or Removing a Problem at a Visit -I n Assessment window, click on Problem List box. Problems can be added or removed as appropriate If no Problems exist, click the No known problems box to get credit for confirming this. - In the Overview Tab, go to Problem List, click the ellipsis, then Add or Remove as appropriate. Version 9 has a reminder in the Dashboard if this has not been addressed with a problem or No known problems checked. The MAQ reports track this measure. Numerator: All unique patients seen with at least one problem noted or No known problems checked Denominator: All unique patients during reporting period C.12. Implement one clinical decision making rule with ability to track rule eCW has over 40 Clinical Decision Making Support System (CDSS) Alerts as well as the ability to create custom and patientspecific Alerts. This Measure can be met by setting one of these CDSS Alerts. There are reports that can be run measuring compliance. These can be tied to the Meaningful Use Clinical Quality Measures or PQRI. For more information on other Alerts, refer to eCW Manuals. To review the CDSS Measures, EMR > CDSS > Measures Definitions. When a Provider decides to use a CDSS Adding  or Removing a Problem from the Dashboard Measure, go to the list and enable only the desired CDSS Measure.

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Remaining Core Measures (continued)

EMR > CDSS > Measures Configuration The Provider should only enable those the practice is interested in monitoring. This will require the appropriate Security Settings. Again only one is required for Stage 1 of Meaningful Use. Under the Smoking Related Measures above, CDSS is used to facilitate this by linking the Order Set to the Measure code 211-CM. C.13. Report ambulatory clinical quality measures to CMS or the states This Core Measure includes reporting on three out of six Core and Alternate Clinical Quality Measures and three out of 38 Additional Clinical Quality Measures. This Measure only requires reporting, not achieving, a specific threshold of a standard. eClinicalWorks has created the Meaningful Use Adoption, Quality (MAQ) dashboard to gather this information for reporting. The MAQ dashboard is available in the Version 9 upgrade. eCW is certified for MAQ reporting on a number of measures including the Core and Alternate Clinical Quality Measures, CQM.C.1., CQM.C.2., CQM.C.3., CQM.A.1., CQM.A.2., and CQM.A.3., as well as three diabetes measures: CQM-2., CQM-3., and CQM-4. The PQRI feature is capable of capturing many of the Meaningful Use Measures and the Registry can report on them. Many of the Clinical Quality Measures have PQRI measures. C.14. Improve Care Coordination This Measure has no threshold but at least one of several eCW features will need to be enabled to meet Stage 1 Meaningful Use.  eClinicalWorks eHX - The eHX feature is provided to the BayCare eClinicalWorks Community by BayCare Connect.  eClinicalWorks P2P (Provider to Provider). P2P is set up through eClinicalWorks but is included by BayCare Connect as a feature for the BayCare Connect Community. Participants receive information from BayCare Connect when these features are enabled. C.15. Ensure Adequate Privacy and Security Protections for Personal Health Information This Measure deals with compliance with HIPAA and Security Rules. It merits attention not only for Meaningful Use, but also to adequately protect Protected Health Information (PHI) and avoid potential onerous government sanctions. The Meaningful Use Training Scenarios
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Remaining Core Measures (continued)

Guide covers this area in detail. It would be useful to comply with these regulations to have written practice policies and procedures and a mechanism for ensuring that they are being followed. Following are the requirements as described in the regulations referenced in the Meaningful Use Measure, 45 CFR 164.308 (a)(1) and brief references to eCW features to assure adherence to same. Risk  analysis Risk  management -C  onfigure P.S.A.C. categories to protect confidential information like HIV - Set Security Attributes  By user  By attribute  By role This will vary by practice but should limit staff access to only those areas they need to do their job. The more this is clarified and adhered to the easier it will be to remain in compliance. - Configure Provider Rx Security - Configure Authentication Settings Sanction  policy for those who violate the access policies Information  system activity review. Review logs on a regular basis to assure the inappropriate accessing of information is not occurring. Written Policies and Procedures with documented audits and checklists can facilitate the adherence to this Measure and reveal risks hopefully before they can cause damage to a practice.

Remaining Menu Measures

M.2. Incorporate clinical lab test results into certified EHR technology as structured data Threshold: 40% Providers who adopt eCW will have BayCare labs and diagnostic results interfaced as structured data. Some practices either based on volume or their willingness to pay for the interface may already have LabCorp and Quest data coming over as structured data. BayCare is working with LabCorp and Quest to provide an interface to all participating providers in 2011. The MAQ reports track this measure. Numerator: Number of clinical lab tests with results reported as structured data Denominator: All electronic labs marked as received *It is very important for in house labs to be marked as received
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Remaining Menu Measures (continued)

M.3. Generate lists of patients by specific conditions to use for quality improvement, reduction of disparities, research or outreach This Measure only requires that the Eligible Professional generate at least one report listing patients with a specific condition. This can be readily achieved through the Registry reporting or Patient Recall. M.4. Send reminders to patients per patient preference for preventive/follow up care Threshold: 20% This Measure requires that more than 20% of all unique patients age 65 or older or age 5 years or younger are sent an appropriate reminder during the EHR reporting period. An EP needs to decide what is important to his or her practice. This is geared toward preventive or follow-up care. An influenza vaccination reminder or a reminder to schedule a follow-up visit are good examples. eClinicalWorks has the capacity to send messages to patients: Through  Letters in the Patient Recall section of the Registry Band or the HUB. Letters to be sent will have a category box that reminder can be selected for reporting purposes. Letters are probably
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the most straightforward approach to meet this measure.

 Through e-mail if Web-enabled to use the Patient Portal, under Send eMsg  Through a telephone of preference in eMessenger which may include a text message

The MAQ reports track this measure. Numerator: Number of unique patients in selected age range who were sent a reminder

Remaining Menu Measures (continued)

Denominator: Number of unique patients in selected age range during the reporting period M.5. Provide patients with timely electronic access to their health information (including lab results, problem list, medication lists, medication allergies) within four business days of the information being available to the EP Threshold: 10% This Measure can be met with eClinicalWorks through the new Portal called 100 Million Patients. The patients need to be Web-enabled and they will have access to meet this measure. Refer to Measure C.9. The MAQ reports track this measure. Numerator: Number unique patients web enabled Denominator: Total number unique patients during the reporting period M.6. Use certified EHR technology to identify patient-specific education resources and provide those resources to the patient if appropriate Threshold: 10% This Measure can be accomplished through a variety of means with patientspecific education materials either printed or published to the Patient Portal. Printing can be accomplished through the Education button on the Treatment window or through an Order Set. The MAQ reports track this measure. Numerator: Number of unique patients who received patient-specific education materials Denominator: Number of unique patients seen during the reporting period M.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 Threshold: 50% This measure requires two steps to be recorded:  When the appointment is made, the front office needs to check the Transition of Care box below the Reason field, e.g. hospital follow-up.  When the medications are reviewed in the Current Medication screen, the provider must check the Medication Verified box as discussed in C.6.

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Remaining Menu Measures (continued)

referral providers must be P2P enabled) accessed through the drop down on the T by the jelly bean, Send eCW P2P Referral/ Consult. In the Referral (Outgoing) window, the Provider needs to click the Attachments button at the bottom and then click either the Attach Medical Summary box or the Attach CCR/CCD box. Continuity of Care Record (CCR) and Continuity of Care Document (CCD) are standard indices of summary patient demographics and medical information that can be shared between providers; for example, The MAQ reports track this measure. Numerator: Number of patient visits with Transition of Care and Medication Verified boxes checked Denominator: Number of patient visits with Transition of Care box checked M.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 of care record for each transition of care or referral Threshold: 50% This measure is associated with outgoing referrals. It may be accessed through the Treatment window Outgoing Referral button or through P2P (referring and
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problems, medications and allergies. If associated with a Progress Note that will appear as an attachment and will suffice as a summary of care.

The referral can then be faxed or sent through the P2P function.

Remaining Menu Measures (continued)

The MAQ reports track this measure. Numerator: Outgoing referrals with a summary of care record attached Denominator: Total Outgoing referrals during the reporting period Meaningful Use requires that an Eligible Professional perform either M.9. or M.10. M.9. Capability to submit electronic data to immunization registries or Immunization Information Systems and actual submission in accordance with applicable law and practice This Measure requires that the Eligible Professional complete at least one test of certified EHR technologys capacity to submit electronic data to immunization registries and follow up submission if the test is successful (unless none of the immunization registries to which the EP submits such information have the capacity to receive the information electronically). This only requires a test submission. eCW has these uploads programmed but they will need to be set up by eCW; Florida Shots is capable of this. M.10. Capability to submit electronic syndromic surveillance data to public health agencies and actual submission in accordance with applicable law and practice This Measure requires that the Eligible Professional complete at least one test of certified EHR technologys capacity to provide electronic syndromic surveillance data to public health agencies and followup submission if the test is successful (unless none of the public health agencies to which an EP submits such information have the capacity to receive the information electronically). The capacity to perform this Measure needs to be further defined by eCW. State agencies must be capable of accepting the reporting. As of March 2011 Florida was in the initial planning stages for this and it is not clear when this will be available.

:: 27

Notes:

28 ::

BC110477-0311