Description
Record patient family history as structured data.
Objective
More than 20% of unique patients seen by the provider during the reporting period must have family history for first degree relatives recorded as structured data.
Performance metric
Denominator
Count of unique patients with clinical encounters of type Office Visit, Office Visit Prev. Med., Prenatal Visit, or Telemedicine Visit.
Numerator
Portion of the denominator where at least one entry exists in the grid section of the Family History tab.
Exclusion
An EP who does not have any patient visits during the EHR reporting period.
Note
Although CMS only requires family history documented for first degree relatives to meet this objective, McKesson recommends as best practice that family history also be recorded for maternal and paternal aunts, uncles, grandparents, and grandchildren.
Configuration Chapter 21 - Menu Objective 4 - Family History as Structured
Configuration
Special Features: note view vs. grid view
The EHR can be configured to display the grid view or note view on the Family History chart tab.
This setting is location on the Special Features screen - Records 5 tab.
Figure 129. Special Features screen - Records 5 tab
The Family History View field has a drop-down menu that allows you to choose the Grid or Note option. When the system is upgraded to the 2014 certified version of the EHR, the default setting is
Chapter 21 - Menu Objective 4 - Family History as Structured Data Note template edits
Steps for adding and editing access levels have not changed since previous versions of the product. Follow the same process as before.
Note template edits
If workflow involves recording family history via notes, a new Dot code, .FH, may be used to record structured family history data in the grid section of the Family History tab.
Basic format for Dot code statement:
.FH: <<Family Member>>: <<Name of Problem>>: <<SNOMED Code>>: <<Age Affected>>:
<<Status>>
For example:
.FH: Mother: Coronary Heart Disease: 53741008: 45: Living The SNOMED code, age affected, and status fields are optional.
Consider building these statements with picklists for the Relative and Condition fields to simplify the process for end users. The picklist for the Condition field could include the top 10-20 chronic problems most pertinent to the EP’s specialty and practice.
For example:
.FH: <<Relative...>>: <<Top25Prob...>>: <<SNOMED Code>> <<*>>: <<Age Affected>>
<<*>>: <<Living>> <<Deceased>>
Consider adding <<PUSH>> labels if desired. For more information, see the PUSH and ENTER Label Markers topic in the online help.
End user workflow
Recording family history data in the Family History grid
When the upgrade to the 2014 certified version of the EHR is completed, the grid section of the Family History tab will be blank for all patients, even if a previously recorded family history note exists. The grid must be populated by the operator. This is a manual process.
To record family history data in the Family History grid:
1. Open a patient chart and select the Family History chart tab. The Family History screen appears.
Recording family history data in the Family History grid Chapter 21 - Menu Objective 4 - Family History as Structured
NOTE: Steps 2, 3, and 4 have not changed since previous versions of the product.
Figure 130. Family History screen
2. Refer to the following table for your next step.
3. If the patient does not have any prior family history recorded as a note, the system prompts you to create a new note and the Family History template automatically loads.
4. Enter details of the patient’s family history using the QuickText and picklists on the template.
Click the Save button.
If the default view is set to... Then...
Note the family history note displays.
Grid skip to step 5.
Chapter 21 - Menu Objective 4 - Family History as Structured Data Recording family history data in the Family History grid
5. To access the Grid view, click the Family History chart tab again and click the Grid button the Note screen.
Figure 131. Family History screen
6. If the patient is an adopted child, select the Adopted check box.
7. To add a new entry to the grid, double-click the Add a Family Member row, or highlight the Add a Family Member row and click the New button. The Family Member New screen appears.
Figure 132. Family Member New screen
8. Select an entry from the Family Member drop-down list.
9. Select Alive or Deceased from the Status drop-down list and enter the person’s date of birth and name, if known.
10. Click the No Sig Med History button if appropriate, then click OK to save.
Recording family history data in the Family History grid Chapter 21 - Menu Objective 4 - Family History as Structured
11. To add a new problem for the selected family member, click the Add a Problem button. The Family History Problem New screen appears.
Figure 133. Family History Problem New screen
12. Enter a problem name in the Problem field and click the Lookup button. The Diagnosis Code Select screen appears.
Chapter 21 - Menu Objective 4 - Family History as Structured Data Recording family history data in the Family History grid
13. Select the appropriate problem from the list and click the OK button. The Family History Problem New screen reappears.
Figure 135. Family History Problem New screen
14. Enter information in the following fields, as appropriate.
- Active/Inactive - Age Affected - Date Last - Date Resolved - Note
15. Click the Save and Add New button to add a second problem for the same family member.
16. When you have added all problems for the family member, click the OK button to save.
17. Repeat steps 6-16 to add problems for all other family members.
Recording family history data in the Family History grid Chapter 21 - Menu Objective 4 - Family History as Structured
18. To add significant negative history, double-click the No Family History of row, or highlight the No Family History of row and click the New button. The Negative Family History New screen appears.
Figure 136. Family History screen
Figure 137. Negative Family History New screen
19. Enter a problem name in the Problem field and click the Lookup button. The Diagnosis Code Select screen appears.
20. Select the appropriate diagnosis and click the OK button.
Chapter 21 - Menu Objective 4 - Family History as Structured Data Recording family history data in a progress note
22. When all problems have been added to the grid, click the Close button.
Figure 138. Family History screen
Recording family history data in a progress note
Family history may be captured as discrete data and exported to the Family History grid using the .FH Dot code in progress notes. The Dot code statement is in the following format:
.FH: <<Relative...>>: <<Top25Prob...>>: <<SNOMED Code>> <<*>>: <<Age Affected>>
<<*>>: <<Living>> <<Deceased>> <<PUSH>>
For example:
.FH: Mother: Coronary Heart Disease: 53741008: 50: Living <<PUSH>>
You may use <<PUSH>> label markers if workflow demands it.
End user notes
As long as at least one family history note is recorded, you can toggle between the Note view and Grid view.
This objective can be met successfully if the grid has any one of the following:
• at least one entry for at least one family member
• at least one entry in the Negative Family History section • Adopted check box selected
The presence or absence of a family history note does not affect the performance metric for this objective.
The grid will be blank for all patients at the time of the upgrade to the 2014 certified version of the EHR. McKesson recommends that administrative personnel implement a process where the staff is trained to populate the grid for each patient as part of visit triage.
End user notes Chapter 21 - Menu Objective 4 - Family History as Structured
Chapter 22 - Menu Objectives 5 and 6 - Cancer Registry and Specialized Disease Registry
Objectives
Menu objective 5
Identify and report cancer cases to central cancer registry.
Menu objective 6
Identify and report specific cases to a specialized registry.
The Office of the National Coordinator for Health Information Technology (ONC) does not require an EHR to meet these objectives to be a 2014 certified system.
The 2014 certified version of the EHR currently does not have the capability to meet these two objectives; therefore, providers must choose three of the four remaining menu objectives.
Objectives Chapter 22 - Menu Objectives 5 and 6 - Cancer Registry and
Chapter 23 - EHR Performance Metrics Report
This chapter provides step-by-step instructions on how to set up and run the EHR Performance Metrics report for meaningful use. The EHR Performance Metrics report was created to help eligible professionals (EPs) with their responses to particular measures required to qualify for meaningful use incentive payments.
Configuring the EHR Performance Metrics report
After the version 11.0 upgrade is completed, it is necessary to confirm the configuration settings in PRUtils for accurate data capture by the EHR Performance Metrics report.
Access levels
Operators who run the EHR Performance Metrics report must have appropriate access to do so.
Access Levels > Reports > Records Reports > EHR Performance Metrics Report
PPart.ini settings
The EHR Performance Metrics report tool provides you the option to run the report for Stage 1 or Stage 2 objectives. Based on the selection, the scree displays the appropriate objectives. You can set a default value, which will determine the set of objectives that display when the tool is
accessed.
The DefaultObjectivesList= setting in the PPart.ini file allows you to specify whether Stage 1 or Stage 2 will be selected by default.
Figure 139. DefaultObjectivesList= setting
Running and printing the EHR Performance Metrics report
To run the EHR Performance Metrics report:
The EHR Performance Metrics report tool is located in the client folder. You can run it from a workstation or from the application server.
1. Go to C:\Program Files\McKesson\Practice
Partner\PMSI.Reports.PerformanceMetrics.exe. The EHR Performance Metrics Sign In screen appears.
Running and printing the EHR Performance Metrics report Chapter 23 - EHR Performance Metrics Report
McKesson recommends that you create a desktop shortcut for the report for easy access in the future.
Figure 140. EHR Performance Metrics Sign In screen
2. Enter the EHR user ID and password and click the OK button. The EHR Performance Metrics Report screen appears.
Chapter 23 - EHR Performance Metrics Report Running and printing the EHR Performance Metrics report
McKesson recommends using the option if you have multiple clinics under the same organization to aid in tracking and troubleshooting (for example, cardiology clinic, internal medicine clinic, and so on).
- Select the Specific Provider option to run the report for one specific provider.
4. Enter the date range for the report.
5. In the Meaningful Use Performance Objectives field, select whether you want Stage 1 or Stage 2 meaningful use performance objectives to be displayed on this screen. If you select Stage 2, the Stage 2 objectives with associated check boxes display.
Figure 142. EHR Performance Metrics Report screen - Stage 2
6. In the Report Options section of the screen, select the appropriate check boxes for the objectives to be included in the report. Use the Check All and Uncheck All buttons to select or clear all check boxes.
7. Select the Print to File option if you want a .pdf file version of the generated report.
The system prompts you to save the report in a desired destination folder with an appropriate file name. Navigate to the location where you want to save the report. McKesson recommends that you create a dedicated folder in a shared location where all reports can be saved.
Consider creating subfolders for each practice and/or provider, so that reports can be accessed easily in the future.
Running and printing the EHR Performance Metrics report Chapter 23 - EHR Performance Metrics Report
The default name for the report is EHR Performance Metrics Report mmddyyyy_hhmmss, where mmddyyyy is the date and hhmmss is the time stamp.
Figure 143. Directory Path for Export Files screen
8. Click the Run Report button to generate the EHR Performance Metrics report. When the report has been generated, it displays in the Report Viewer.
9. To print the report from the Report Viewer, click the Print button on the toolbar. The Print screen appears.
NOTE: Run this report often and at regular intervals, ideally at least once a week, to make sure that all providers are meeting the different objectives. The earlier any gaps are detected, the earlier they can be investigated and fixed to ensure that providers are able to attest successfully. Do not wait until the end of the reporting period to first run the EHR Performance Metrics report.
Chapter 23 - EHR Performance Metrics Report EHR Performance Metrics report example
EHR Performance Metrics report example
Figure 144. EHR Performance Metrics report
Information on the EHR Performance Metrics report
The following table lists the numerator and denominator line items for each objective displayed on the EHR Performance Metrics report and how they are calculated. This is a useful tool in gap analysis and for identifying solutions to objectives that are not being met above the required thresholds.
2014 Stage 2Objectives Chapter 23 - EHR Performance Metrics Report
Definitions for terms used in the following table:
2014 Stage 2Objectives
Term Definition
Ratio The ratio is the percentage of the objective that
was achieved. The ratio value on the report is the numerator value divided by the
denominator value expressed as a percentage.
For some measurements, if the denominator value is zero, the ratio is displayed as N/A.
Note that CMS required all ratios to be “more than” the thresholds listed. For example, if the threshold listed for a particular objective is 50%, the EP must strive to have the numerator/denominator value > 50%.
Unique patients A unique patient means that even if a patient is seen multiple times during the EHR reporting period, he/she is counted only once in the calculation of the metrics.
Report Element Description
Core Objective #1 - CPOE for Medication Orders (Threshold 60%)
1. Medication Orders Placed Using CPOE Number of medication orders placed using CPOE
The number of orders in the denominator recorded by a licensed operator (one who has the Operator is licensed to enter Orders check box selected on the Patient Records tab or the This Operator IS the Provider check box selected on the General tab in Operator Maintenance).
This value is used as the numerator.
Number of medication orders placed Total number of medication orders created by the provider (recorded in the Current and Historical tabs) during the reporting period.
This value is used as the denominator.