Objective
Use Computerized Provider Order Entry (CPOE) for medication, laboratory, and radiology orders directly entered by any licensed healthcare professional who can enter orders into the medical record per state, local, and professional guidelines. More than 60% of medication, 30% of laboratory, and 30% of radiology orders created by the EP during the EHR reporting period are recorded using CPOE.
Description
To meet Core Objective 1, providers must enter medications in the Rx/Medications tab of patient chart and enter laboratory and radiology orders in the Order Entry tab.
Performance metric
Measure 1: Medication Orders Denominator
Number of medication orders created by the EP during the EHR reporting period. (Number of medications in the Current and Historical tabs associated with the EP’s provider ID within the reporting period. Outside medications and ON NO MEDS entries will not be counted.)
Numerator
Portion of denominator where medications were entered by a licensed operator - one who has the Operator is licensed to enter orders check box selected on the Patient Records tab in Operator Maintenance or the This Operator IS the Provider check box on the General tab in Operator Maintenance.
Ratio
The resulting percentage must be more than 60%.
Exclusion
Any EP who writes fewer than 100 medication orders during the EHR reporting period.
Measure 2: Radiology Orders Denominator
Number of radiology orders created by the EP during the EHR reporting period. (Number of orders with type Radiology in the Order Entry module associated with the EP’s provider ID within the reporting period.)
Configuration Chapter 1 - Core Objective 1 - Computerized Physician Order
Numerator
Portion of denominator recorded by a licensed operator - one who has the Operator is licensed to enter orders check box selected on the Patient Records tab in Operator Maintenance or the This Operator IS the Provider check box on the General tab in Operator Maintenance.)
Ratio
The resulting percentage must be more than 30%.
Exclusion
Any EP who writes fewer than 100 radiology orders during the EHR reporting period.
Measure 3: Laboratory Orders Denominator
Number of laboratory orders created by the EP during the EHR reporting period. (Number of orders with type Laboratory in the Order Entry module associated with the EP’s provider ID within the reporting period.)
Numerator
Portion of denominator recorded by a licensed operator - one who has the Operator is licensed to enter orders check box selected on the Patient Records tab in Operator Maintenance or the This Operator IS the Provider check box on the General tab in Operator Maintenance.)
Ratio
The resulting percentage must be more than 30%.
Exclusion
Any EP who writes fewer than 100 laboratory orders during the EHR reporting period.
Notes
If a provider wishes to claim exclusion for medication orders, he/she may be asked to enter the total number of prescriptions issued during the reporting period at the time of attestation. A provider can use the Prescription Output Log report available in the EHR to determine this. For more
information, see the Prescription Output Log Report topic in the online help.
If a provider wishes to claim exclusion for the lab and/or radiology orders, he/she may be asked to enter the total number of such orders issued during the reporting period at the time of attestation. A provider may use the Order Analysis report available in the EHR to determine this. This report can be run for the desired provider, date range, and order type. For more information, see the Order Analysis Report topic in the online help.
Configuration
Chapter 1 - Core Objective 1 - Computerized Physician Order Entry (CPOE) Configuration
- Access Levels > Orders > New Orders
• All admin personnel who edit order names to assign appropriate order types need access to do so.
- Access Levels > Orders > Order Names - Access Levels > Orders > Order Types
• All admin personnel who edit Operator Maintenance need access to do so.
- Access Levels > General > Operators (under the Maintenance/Setup section) Steps to add and edit access levels have not changed since previous versions of the product.
Follows the same steps as before.
Operator Maintenance
Complete the following steps for all operators who are licensed to enter medications, lab, and radiology orders on behalf of the EP.
1. Select Maintenance > Setup > Operators.
2. Enter your password.
3. Select the appropriate operator from the list and click the Edit button. The Operator Maintenance Edit screen appears.
Figure 3. Operator Maintenance Edit screen 4. Select the Patient Records tab.
5. Select the Operator is not a full, signing Provider, but may self-enter an Rx or Order option.
6. Select the Operator is licensed to enter orders check box.
7. Click the OK button.
8. Repeat steps 3-7 for all appropriate operators.
Configuration Chapter 1 - Core Objective 1 - Computerized Physician Order
McKesson recommends that all operators be assigned a sign-on provider on the General tab as best practice.
Complete the following steps for all providers who prescribe medications and place lab and radiology orders.
1. Select Maintenance > Setup > Operators.
2. Enter your password.
3. Select the appropriate operator from the list and click the Edit button. The Operator Maintenance Edit screen appears.
Figure 4. Operator Maintenance Edit screen
4. On the General tab, enter the operator’s provider ID in the Sign-on Provider field.
5. Select the This Operator IS the above Provider check box and click the OK button.
6. Repeat steps 3-5 for all appropriate providers.
Assign order type values to order names
Laboratory and radiology order names must be assigned the appropriate order type to properly identify them for the performance metrics.
To assign an order type to an order name:
Chapter 1 - Core Objective 1 - Computerized Physician Order Entry (CPOE) Configuration
2. Select an order name that is a laboratory or radiology order and click the Edit button. The Order Name Edit screen appears.
Figure 5. Order Name Edit screen - Order Type Laboratory
Figure 6. Order Name Edit screen - Order Type Radiology
3. From the Order Type drop-down list, select Laboratory for lab orders and Radiology for radiology orders (single orders and hidden sets).
4. For lab orders that have structured results, select the Order is for lab test with structured results check box. This is required for the Structured Lab Results objective.
Configuration notes Chapter 1 - Core Objective 1 - Computerized Physician Order
5. Click the OK button.
6. Repeat steps 2-5 for all laboratory and radiology order names.
Note template edits
Lab and radiology orders also may be placed using .OR Dot codes and/or Enter labels in notes.
Prescriptions may be issued using the .RX Dot code and/or Enter labels in notes.
Consider editing the appropriate note templates with the required Dot code statements and/or Enter labels either directly or embedded within QuickText.
Examples:
.OR: CBC <<PUSH>>
<<Enter|Orders>>
<<Enter|Medications>>
McKesson does not recommend prescribing medications using the .RX Dot code.
For more information on the Push and Enter label markers, see the Push and Enter Label Markers topic in the online help.
Configuration notes
Although not required to meet this objective, if you wish to link Rx templates to order names for therapeutic medications (not vaccines) delivered in-house (for example, Vit B12 Injection, Albuterol treatments, joint injections) in an attempt to increment the numerator for the metric, complete the required configuration steps in Associating a Prescription Template to an order under the Order Entry Overview section in the online Help.
Chapter 1 - Core Objective 1 - Computerized Physician Order Entry (CPOE) End user workflow training
End user workflow training
To enter prescriptions in the Rx/Medications section:
1. Open patient chart and select the Rx/Medications tab.
2. Click the New button. The Prescription New screen appears.
Figure 7. Prescription New screen
3. In the Rx Template Code field, enter the name of the medication to be prescribed and click the Lookup button.
4. Select the desired preparation of the medication from the Rx Template list and click the OK button.
End user workflow training Chapter 1 - Core Objective 1 - Computerized Physician Order
5. Enter/change values in the fields as desired and click the OK button. The system adds the medication to the Current tab on the Rx/Medications screen.
Figure 8. Rx/Medications screen
To enter lab and radiology orders in the Order Entry section:
1. Click the Orders icon on the toolbar. The New Order screen appears.
Chapter 1 - Core Objective 1 - Computerized Physician Order Entry (CPOE) End user notes
2. Enter the facility, processor, urgency, diagnosis, and other details at the top of the screen as needed.
3. Use the Order Tree to select laboratory and/or radiology orders, or use the Lookup button to search for orders by name. All lab and radiology orders may be placed on this screen to meet this objective successfully.
4. Click the OK button to place the selected orders. The system appends the orders to the Orders tab in the patient’s chart.
Figure 10. Orders screen
End user notes
• Per CMS rules: “Any licensed healthcare professionals and credentialed medical assistants can enter orders into the medical record for purposes of including the order in the numerator for the objective of CPOE if they can originate the order per state, local, and professional guidelines. Credentialing for a medical assistant must come from an organization other than the organization employing the medical assistant.”
• It is permissible to create duplicate medication, lab, and radiology orders.
• Drug warnings WILL display for .RX Dot codes in notes.
• Drug warnings WILL NOT display for .RX Dot codes contained in notes processed by the Text Data Loader.
• If you are editing a prescription template linked to an order and you attempt to modify the Rx Template Code value, the system displays a warning and prevents you from making the change.
End user notes Chapter 1 - Core Objective 1 - Computerized Physician Order