The following table lists all the Stage 2 objectives with the CMS descriptions and a link to the official CMS tip sheet. Each link displays the CMS document that lists the description, requirements, exclusions, and other details for the objective.
Official CMS Stage 2 guide for details about the objectives, the requirements, and associated payments and adjustments
http://www.cms.gov/Regulations-and-Guidance/
Legislation/EHRIncentivePrograms/Downloads/
Stage2_Guide_EPs_9_23_13.pdf Stage 2 Toolkit - a collection of various Stage 2
tip sheets
http://www.cms.gov/Regulations-and-Guidance/
Legislation/EHRIncentivePrograms/Downloads/
Stage2_Toolkit_EHR_0313.pdf Changes between Stage 1 and Stage 2
Objectives orders into the medical record per state, local, and professional
Stage 2 objectives Introduction - General Information and Resources
Core #4 - Vital Signs
Record and chart changes in the following vital signs:
• height/length and weight (no age limit)
• blood pressure (ages 3 and over) • calculate and display body mass
index (BMI)
• plot and display growth charts for patients 0-20 years, including BMI
Record smoking status for patients 13 years old or older.
Provide patients the ability to view online, download, and transmit their health information within four business days of the information being available to the EP. created or maintained by the certified EHR technology through the
Core #10 - Incorporate clinical lab test results into
http://www.cms.gov/Regulations-and-Objective Description CMS tip sheet
Introduction - General Information and Resources Stage 2 objectives and provide those resources to the patient.
The EP who receives a patient from another setting of care or provider or care, or believes an encounter is relevant should perform medication
The EP who transitions his/her patient to another setting of care or provider of care, or who refers his/her patient to another provider of care should provide a summary care record for each transition of care or referral.
Capability to submit electronic data to immunization registries or
Registration Introduction - General Information and Resources
Registration
All EPs must register via the https://ehrincentives.cms.gov/hitech/login.action webpage prior to their first attestation. Refer to the CMS user guides for more information.
Menu #3 - Imaging Results
Imaging results consisting of the image itself and any explanation or other accompanying information are
Record patient family health history as structured data.
Capability to identify and report cancer cases to a public health central cancer registry, except where prohibited, and in accordance with applicable law and practice. specific cases to a specialized registry (other than a cancer registry), except where prohibited, and in accordance
Medicare Attestation - Registration User Guide http://www.cms.gov/Regulations-and-Guidance/
Legislation/EHRIncentivePrograms/Downloads/
EHRMedicareEP_RegistrationUserGuide.pdf Medicaid Attestation - Registration User Guide http://www.cms.gov/Regulations-and-Guidance/
Legislation/EHRIncentivePrograms/Downloads/
Introduction - General Information and Resources Registration
2. Click the Combination of 2011 & 2014 edition button.
Figure 1. Certified Health IT Product List
3. Click the Ambulatory Practice Type button.
Figure 2. Certified Health IT Product List
4. In the Search for field, enter the name of your EHR and click the Search button.
Attestation Introduction - General Information and Resources
5. Locate the correct version of the product from the displayed list and click the Add to cart button.
Figure 3. Certified Health IT Product List
6. Click the Get CMS EHR Certification ID button.
Attestation
For more information on the attestation process and CMS documents that aid the process, refer to the following links provided by CMS. At this time, CMS has not release an official attestation guide for Stage 2. When it is available, McKesson BPS will make it available online. McKesson
encourages all providers to regularly review the http://www.cms.gov/Regulations-and-Guidance/
Legislation/EHRIncentivePrograms website for the latest information.
You can find registration and attestation information at http://www.cms.gov/Regulations-and-Guidance/Legislation/EHRIncentivePrograms/RegistrationandAttestation.html.
Other useful resource links
The following table includes links to other useful information about Meaningful Use.
Description Location
Data Sharing for Stage 2 with Details of
Introduction - General Information and Resources Contact us
Contact us
For all questions and concerns related to Meaningful Use, both general and/or product-related, contact our dedicated Meaningful Use Strategic team.
This mailbox is intended for non-critical issues and QA only; all messages will be answered within 48 hours.
For critical issues, contact the Technical Support team by phone or create a new case online.
Phone
+1 (855) 368-8326 (Enterprise) +1 (855) 463-8326 (Independent) +1 (855) 827-8326 (VAR)
5am−5pm Pacific Time, Monday through Friday
Web
https://support.practicepartner.com
Consulting services
McKesson offers a variety of consulting services for Meaningful Use. For more information, contact your sales representative.
FAQs
https://www.cms.gov/Regulations-and-Guidance/Legislation/EHRIncentivePrograms/
downloads/faqsremediatedandrevised.pdf
Description Location
Contact us Introduction - General Information and Resources
Preface - Clinical Encounters
The Clinical Encounters feature allows users to record details for each provider encounter with patients. A clinical encounter is generally defined as an event where some kind of patient contact with a provider occurs. The EHR Performance Metrics Report uses clinical encounters as a basis for the Meaningful Use calculations. Careful generation and recording of clinical encounters, particularly those of the Office Visit, Office Visit Prev Care, Prenatal Visit, and Telemedicine Visit types, are necessary for accurate Meaningful Use reports.
NOTE: Clinical Encounters have been designed in Practice Partner solely to mine data for Meaningful Use reports. They are NOT related in any way to billing functions or electronic encounter forms.
The basis for most Meaningful Use metrics is the count of “unique patients.” Unique patients are defined as follows:
“A unique patient means that even if a patient is seen multiple times during the EHR reporting period they are only counted once."
For example, if a provider has one patient with two encounters of the Office Visit type, another patient with one such encounter, and a third patient with three such encounters, the EHR Performance Metrics Report will reflect three unique patients.
Patient Records and Appointment Scheduler will automatically create clinical encounter records based on the presence of Type of Visit (TOV) codes, status codes, and/or the .ENC Dot code.
Users can also manually add, edit, or delete clinical encounters.
Transition of Care is defined as a clear change in the setting of care. The following table describes transition types.
A single clinical encounter can be designated as both inbound and outbound if necessary.
Transition type Description
Inbound A transition of care is inbound when a patient
enters a provider’s care from a different setting (for example, the provider sees a patient after an ER visit the previous day).
Outbound A transition of care is outbound when a patient
is referred or transferred to another setting of care (for example, the patient is sent to a specialist by his primary care physician).
Neither A transition of care is neither inbound or
outbound when the patient neither enters from another setting of care nor is transitioned to another setting (for example, the patient comes in for an annual physical appointment).
Configuration of Appointment Scheduling Preface - Clinical Encounters
Configuration of Appointment Scheduling
The Appointment Scheduler will create clinical encounters based on the TOV code associated with the appointment and the status code entered when the patient checks in for his/her appointment.
The setup for generation of clinical encounters in Total Practice Partner through the schedule is different than Medisoft Clinical and Lytec MD.
The configuration mentioned below for Practice Partner holds true even if a different practice management system is used for scheduling appointments (for example, Horizon Practice Plus or GE Centricity) as long as the appointments along with the TOV codes and status codes are available in the EHR (for example, inbound scheduling interface).
The trigger for creation of the clinical encounter is always the check-in function, which in turn, enters the appropriate status code in the Status column of the schedule.
For Practice Partner
System administrators can alter the PPart.ini file to specify which status codes will create clinical encounters at the time of check-in. All status codes entered on the line item shown below will generate a clinical encounter. The system ships with a set of the standard status codes (that come as default with the application) entered on this line. Users must modify these settings to include the codes for which their organization wants clinical encounters created. The default status code settings in the PPart.ini file are: StatusCodes=DI,IN,LA,RM1,RM2,UR,WVC.
These default TOV and status codes must be updated to match the TOV and status codes you use in your EHR. The default values are provided for reference only and are not meant to reflect the values you might use in your system.
The TOV Codes setting in the PPart.ini file specified whether a TOV code will create encounters along with indicating whether the transition of care is Outbound (O), Inbound (I), or Neither (N), and whether the clinical encounter is relevant for clinical reconciliation (Y or N).
In the example AC:I:N, an appointment is created for a single patient with the TOV code AC, a clinical encounter is created for the patient denoting that the transition of care was inbound (I) and it will not be relevant for medication reconciliation (N).
To change the ppart.ini file settings:
1. Open the ppart.ini file in a text editor such as Notepad or WordPad.
2. Locate the [ClinEncounters] section.
3. To add a new TOV code to the TOVCodes= list, enter the new TOV code with no space after the comma. The TOV code must be followed immediately by a colon, then followed
Preface - Clinical Encounters For Practice Partner
When a clinical encounter is generated with a Neither transition of care value (for example, BCB:N:Y), both the Inbound and Outbound check boxes on the Clinical Encounter screen will be clear.
Figure 1. Clinical Encounter Edit screen
When a clinical encounter is designated to be Relevant for Clinical Reconciliation (for example, BCB:N:Y), the Med Rec button in the Current Medications section of the application turns red to remind the user to perform the appropriate task.
Figure 2. Med Rec button
The EHR Performance Metrics report only measures the “Med Rec” actions performed on visits designated as inbound transitions of care for meeting Menu Objective #7.
Performing allergy reconciliation (“All Rec”) and/or problem reconciliation (“Prob Rec”) are not necessary to meet this objective successfully.
4. To add a new status code to the StatusCodes= list, enter the new status code with no space after the comma (for example, DI,IN).
5. Save the file when you are finished.
See the PPart.ini file topic in Patient Records Help for more information.
NOTE: Add the status code of OUT to the StatusCodes= entry. Failure to do so can rarely result in clinical encounters being improperly deleted when a patient is checked out.
Configuration of Patient Records Preface - Clinical Encounters
Configuration of Patient Records
Users can use the .ENC Dot code to create clinical encounters from notes when a note is permanently saved, or when a note is loaded into Patient Records via Text Data Loader.
The note created for the clinical encounter will include the practice and provider who created the encounter, the date/time the encounter was created, the type of encounter (Office Visit, Transfer of Care, Letter, and so on), whether the transfer of care was inbound (I) or outbound (O), or not recorded (blank), and whether the encounter is relevant to clinical reconciliation (Y or N).
Users can include multiple .ENC Dot codes in one note. This will result in the creation of multiple clinical encounter records.
The system will not create a clinical encounter record from a Dot code if a matching clinical encounter exists for the patient (for example, the patient, date, practice, and encounter type [Office Visit, Transfer of Care, or Letter] are the same).
If necessary, users can modify the clinical encounter after it has been created using Clinical Encounter maintenance.
If any Dot code values are blank when the note is saved, the following will be specified for the clinical encounter:
Provider: If there is a current provider, the current provider will be specified as the provider for the clinical encounter.
Practice: The current practice will be specified as the practice for the clinical encounter.
Type: The type will be specified as Office Visit, Office Visit Prev. Med, Prenatal Visit, or Telemedicine Visit, unless the note is a letter in which case the type will be Letter.
Example of the .ENC Dot code:
.ENC: provider : practice : date : time: type : transfer of care : relevant for medication reconciliation
For example:
.ENC: ABC: 1 : 09/15/13 : 10:00 am : Office Visit : I : Y
Access levels
In order to use the Clinical Encounters screen, the user need access to do so. This is done in the Access Levels section > Records tab > Clinical Encounters Maintenance.
Preface - Clinical Encounters Clinical Encounters screen
Clinical Encounters screen
The Clinical Encounters screen lists the clinical encounters that have been added for the current patient. Users can use this screen to add new clinical encounters for the current patient or change or delete existing clinical encounters for the patient.
To open the Clinical Encounters screen when the patient chart is open:
1. Open the Patient Chart for the patient for whom you want to add, edit, or delete clinical encounters.
2. Select Show > Clinical Encounters. The Clinical Encounters screen appears.
To open the Clinical Encounters screen from the Patient Demographic screen:
1. Open the Patient screen for the patient for whom you want to add, edit, or delete clinical encounters.
2. On the Dates tab, click the Clin. Encounters button. The Clinical Encounters screen appears.
Fields and buttons on the Clinical Encounters screen
The following table describes the fields and buttons on the Clinical Encounters screen.
Field/button Description
Search Encounters area This area allows you to search for a patient's clinical encounters by date, type, practice, provider, and the encounter’s relevancy to medication reconciliation.
When you are finished entering all your search criteria, click the Search button. Clinical encounters matching all the criteria you entered are displayed in the Clinical
Encounters list that includes the date, clinical encounter number, encounter type, practice, provider, and Transfer of Care (inbound, outbound, or neither).
Start Date/End Date If you wish to search by date, enter the beginning and ending dates to specify the period that the search is to cover. To search for a single date, enter the same date in both fields.
The start date is defaulted to one year prior to the current date and the end date is defaulted to the current date.
Fields and buttons on the Clinical Encounters screen Preface - Clinical Encounters
Encounter Type If you wish to search by encounter type, select the encounter type from the drop-down list.
You can use List Maintenance to edit or add to the list of encounter types (ENCOUNTER LIST) that will be available from the drop-down list.
Practice If you wish to search by practice, enter the
practice ID in this field, or click the drop-down arrow and select the practice from the Practice Select screen.
Provider If you wish to search by provider, enter the
provider ID in this field, or click the drop-down arrow and select the provider from the Provider Select screen.
Sort by Select this check box to view only clinical
encounters that are relevant to medication reconciliation.
Clinical Encounters List This lists the clinical encounters that have been added for the selected patient.
Close button Click this button to close the screen.
New button Click this button to add a new clinical
encounter for the patient. The Clinical Encounter New screen appears.
See the Adding a clinical encounter topic in Patient Records Help for more information.
Edit button Click this button to edit the currently-selected
clinical encounter. The Clinical Encounter Edit screen appears.
See the Editing a clinical encounter topic in Patient Records Help for more information.
Delete button Click this button to delete the
currently-selected clinical encounter for the patient. A confirmation message appears. Click the OK button.
Field/button Description
Preface - Clinical Encounters Clinical Encounter New and Edit screen
Clinical Encounter New and Edit screen
The Clinical Encounter screen is used when adding or editing clinical encounters for a patient. You can use this screen to add new clinical encounters from the patient demographic screen, or edit existing clinical encounters.
To open the Clinical Encounter <New> or <Edit> screen:
1. Open the Clinical Encounters screen.
2. Click New to add a new clinical encounter or click Edit to edit the currently-selected clinical encounter. The Clinical Encounter New screen or Clinical Encounter Edit screen appears.
Fields and buttons on the Clinical Encounter screen
The following table describes the fields and buttons on the Clinical Encounter screen.
Field/button Description
Encounter Number This field displays the assigned encounter number on the Clinical Encounter Edit screen.
When a new clinical encounter is created, Patient Records automatically assigns the new encounter a number. The numbers assigned are in sequential order for all patients. For example, if the last encounter added was 100, the new encounter will be number 101.
The number will not be displayed for the encounter until after it has been added. The Clinical Encounter New screen will display Not Yet Assigned.
Date These fields reflect the current date and time.
Type Select the encounter type from the drop-down
list.
Provider This field reflects the current provider. To
change the current provider, enter the provider ID in this field or click the drop-down arrow and select the provider from the Provider Select screen.
Practice This field reflects the current practice. To
change the current practice, enter the practice ID in this field or click the drop-down arrow and select the practice from the Practice Select screen.
Transition of Care
Transition of Care Type Select a transition of care option. You can select Inbound and/or Outbound.
Fields and buttons on the Clinical Encounter screen Preface - Clinical Encounters
Inbound Select this check box if the patient is being
received by the provider from another healthcare organization or setting.
Outbound Select this check box if the patient is being
transferred out of your organization to another healthcare organization or setting.
Summary of Care Record provided for Care Coordination Physically
Select this check box if you provided a physical copy of the summary of care record for care coordination (that is, the Chart Summary report or the medical summary record [CCR, CCD, or CCDA]).
Summary of Care Record provided for Care Coordination Electronically
Select this check box if you sent the summary of care record provided for care coordination electronically (that is, the Chart Summary report or the medical summary record [CCR, CCD, or CCDA]).
Provided to Patient
Electronic Clinical Summary Select this check box if you sent the clinical summary electronically to the patient (that is,
Electronic Clinical Summary Select this check box if you sent the clinical summary electronically to the patient (that is,