Medisoft Clinical and Lytec MD EHR Meaningful Use Stage 2 Guide Configuration and End User Training 2014 and Beyond

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Produced in Cork, Ireland

 

 

Business Performance Services

August 2014

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Medisoft Clinical and Lytec MD

EHR Meaningful Use Stage 2 Guide

Configuration and End User Training

2014 and Beyond

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Copyright notice

Copyright notice

Copyright © 2014 McKesson Corporation and/or one of its subsidiaries. All Rights Reserved.

Use of this documentation and related software is governed by a license agreement. This documentation and related software contain confidential, proprietary, and trade secret information of McKesson Corporation and/or one of its subsidiaries, and is protected under United States and international copyright and other intellectual property laws. Use, disclosure, reproduction, modification, distribution, or storage in a retrieval system in any form or by any means is prohibited without the prior express written permission of McKesson Corporation and/or one of its subsidiaries. This documentation and related software is subject to change without notice.

Publication date

August 2014

Product

Medisoft Clinical and Lytec MD

Corporate address

McKesson Corporation 5995 Windward Parkway Alpharetta, GA 30005

Trademarks

Medisoft Clinical and Lytec MD®are registered trademarks of McKesson Corporation and/ or one of its subsidiaries. All other product and company names may be trademarks or registered trademarks of their respective companies.

Revision history

Date Page (s) Description

08/01/2014 161 Updated the Performance metric section. 08/25/2014 161 Updated chapter 20.

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Table of Contents

Table of Contents

Introduction - General Information and Resources . . . 1

Meaningful Use Stage 2 requirements . . . 1

Reporting periods and payment adjustments . . . 1

Stage 2 overview guides . . . 2

Stage 2 objectives. . . 3

Registration . . . 6

Attestation . . . 8

Other useful resource links . . . 8

Contact us . . . 9

Preface - Clinical Encounters . . . 11

Configuration of Appointment Scheduling . . . 12

For Practice Partner . . . 12

Configuration of Patient Records. . . 14

Access levels . . . 14

Clinical Encounters screen . . . 15

Fields and buttons on the Clinical Encounters screen . . . 15

Clinical Encounter New and Edit screen . . . 17

Fields and buttons on the Clinical Encounter screen . . . 17

Chapter 1 - Core Objective 1 - Computerized Physician Order Entry (CPOE) . . . 21

Objective . . . 21

Description . . . 21

Performance metric. . . 21

Configuration. . . 22

Configuration notes . . . 26

End user workflow training . . . 27

End user notes . . . 29

Chapter 2 - Core Objective 2- E-Prescribing and Use of Formulary Data . . . 31

Objective . . . 31

Description . . . 31

Performance metric. . . 31

Notes . . . 31

Configuration for e-Prescribing . . . 32

Configuration notes . . . 32

End user workflow for e-Prescribing . . . 32

New prescriptions and renewals (from the patient’s chart). . . 32

Responding to electronic refill requests . . . 33

End user notes . . . 33

Configuration for formulary implementation . . . 34

ePrescribing Configuration utility setup . . . 34

Patient demographics . . . 34

End user workflow for formulary checks . . . 35

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Table of Contents

Chapter 3 - Core Objective 3 - Demographics. . . 37

Objective . . . 37

Description . . . 37

Performance metric. . . 37

Configuration. . . 37

End user training . . . 39

End user notes . . . 39

Chapter 4 - Core Objective 4 - Vital Signs . . . 41

Objective . . . 41

Description . . . 41

Performance metric. . . 41

Configuration. . . 42

End user training . . . 43

End user notes . . . 43

Chapter 5 - Core Objective 5 – Smoking Status . . . 45

Objective . . . 45

Description . . . 45

Performance metric. . . 45

Configuration. . . 45

End user training . . . 47

End user training notes . . . 47

Chapter 6 - Core Objective 6 – Clinical Decision Support Rule . . . 49

Objective . . . 49

Measure 1 . . . 49

Measure 2 . . . 49

Notes. . . 49

Configuration. . . 50

Measure 1: Clinical decision support interventions. . . 50

Measure 2: Drug-drug and drug-allergy interaction checks . . . 52

End user training . . . 53

Measure 1: Clinical decision support interventions . . . 53

Measure 2: Drug-drug and drug-allergy interaction checks . . . 54

End user notes . . . 54

Chapter 7 - Core Objective 7 - Patient Electronic Access . . . 55

Objective . . . 55

Description . . . 55

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Table of Contents

End user training for RelayHealth. . . 58

End user notes . . . 59

Measure 2: Patient has viewed/downloaded/transmitted health information . . . . 59

Access levels . . . 59

Web View Audit Trail . . . 60

Obtaining and saving a RelayHealth certificate . . . 60

RelayHealth Login Metrics . . . 61

End user training for Web View (for patients) . . . 62

End user training for RelayHealth (for patients) . . . 64

End user notes . . . 65

Chapter 8 - Core Objective 8 - Clinical Summary . . . 67

Objective . . . 67 Description . . . 67 Performance metric. . . 67 Configuration. . . 67 Access levels . . . 67 System configuration. . . 68 Configuration notes . . . 70

End user training . . . 71

End user notes . . . 74

Chapter 9 - Core Objective 9 - Security & Risk Analysis . . . 77

Objective . . . 77

Description . . . 77

Performance metric. . . 77

Exclusions . . . 77

Notes. . . 77

Security measures recommendations in the EHR application. . . 79

Access control/authentication in Practice Partner . . . 79

Chart access control and emergency access . . . 80

Auto-park and log-off features. . . 81

Operator Audit Trail report . . . 82

System security events . . . 85

Notes. . . 86

Chapter 10 - Core Objective 10 – Structured Lab Results . . . 87

Description . . . 87

Objective . . . 87

Performance metric. . . 87

Configuration. . . 87

Configuration notes . . . 88

End user workflow . . . 89

End user notes . . . 90

Chapter 11 - Core Objective 11 – Generate Patient List by Problem . . . 91

Objective . . . 91

Description . . . 91

Performance metric. . . 91

Patient Inquiry . . . 92

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Table of Contents

Running a Patient Inquiry report . . . 92

Notes. . . 95

Patient registries . . . 96

Configuration. . . 96

Access levels . . . 96

Setting up a new patient registry . . . 96

Note template edits. . . 97

End user training . . . 98

End user notes . . . 98

Chapter 12 - Core Objective 12 - Generate Patient Reminders . . . 99

Objective . . . 99 Description . . . 99 Performance metric. . . 99 Configuration. . . 99 PRUtils . . . 99 Access levels . . . 100 Configuration notes . . . 100

End user training . . . 101

Patient Demographics. . . 101

Patient Inquiry . . . 102

Batch Communication . . . 102

Setting up batch communication jobs . . . 102

Running a Batch Communication Job . . . 105

End user notes . . . 106

Chapter 13 - Core Objective 13 - Provide Patient-Specific Education . . . 107

Objective . . . 107

Description . . . 107

Performance metric. . . 107

Notes. . . 107

Configuration. . . 108

End user training . . . 111

End user notes . . . 114

Chapter 14 - Core Objective 14 - Medication Reconciliation . . . 115

Objective . . . 115

Description . . . 115

Performance metric. . . 115

Configuration. . . 115

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Table of Contents Measure 3. . . 124 Important notes . . . 124 Configuration. . . 125 Access levels . . . 125 PPart.ini edits . . . 125

Setting up a direct message account with RelayHealth and acquiring direct mes-sage addresses . . . 126

Direct exchange via RelayHealth (external systems) . . . 127

Entry of direct addresses . . . 128

End user training . . . 131

Measure 1: Generate Summary of Care Record . . . 131

End user notes . . . 136

Measure 2: Sending an electronic summary of care via direct message . . . 136

Measure 3: Exchange an electronic summary of care with a provider with a differ-ent EHR or with a CMS test EHR . . . 140

Chapter 16 - Core Objective 16 - Submit Vaccine Data to State Immunization Registries .

143

Objective . . . 143 Description . . . 143 Exclusion. . . 143 Note . . . 143 Performance metric. . . 143 Configuration. . . 143

Health Maintenance names . . . 143

Editing the Immunization report . . . 144

Note template edits. . . 145

End user training . . . 146

Entering immunization information in Health Maintenance. . . 146

Entering immunization information in a note. . . 147

Creating the .hl7 file for submission to the state registry . . . 147

Chapter 17 - Core Objective 17 - Secure Message from Patient . . . 149

Objective . . . 149 Description . . . 149 Performance metric. . . 149 Exclusions. . . 149 Important notes. . . 149 Configuration. . . 150 Provider Maintenance. . . 150 Access levels . . . 150

Web View Audit Trail . . . 151

Obtaining and saving a RelayHealth certificate . . . 151

RelayHealth Secure Messaging Metrics. . . 152

End user training (for patients) . . . 153

Notes . . . 153

Chapter 18 - Menu Objective 1 - Submit Electronic Syndromic Surveillance Data to Public

Health Agencies . . . 155

Objective . . . 155

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Table of Contents

Performance metric. . . 155

Exclusion. . . 155

Configuration. . . 155

End user training . . . 156

Notes. . . 156

Submission to local/state health agency . . . 157

Chapter 19 - Menu Objective 2 - Electronic Notes . . . 159

Description . . . 159

Objective . . . 159

Performance metric. . . 159

Note. . . 159

Configuration. . . 159

End user workflow. . . 159

End user notes . . . 160

Chapter 20 - Menu Objective 3 - Images and Imaging Results Accessible through CEHRT

161

Description . . . 161 Objective . . . 161 Performance metric. . . 161 Configuration. . . 161 Access levels . . . 161 PPart.ini edits . . . 162

Setting up external systems . . . 162

Zoom configuration . . . 165

Configuration notes . . . 165

End user workflow. . . 166

End user notes . . . 168

Chapter 21 - Menu Objective 4 - Family History as Structured Data. . . 169

Description . . . 169

Objective . . . 169

Performance metric. . . 169

Note. . . 169

Configuration. . . 170

Special Features: note view vs. grid view. . . 170

Access levels . . . 170

Note template edits. . . 171

End user workflow. . . 171

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Table of Contents

PPart.ini settings. . . 181

Running and printing the EHR Performance Metrics report . . . 181

EHR Performance Metrics report example . . . 185

Information on the EHR Performance Metrics report . . . 185

2014 Stage 2Objectives . . . 186

“Drill-down” patient information on the EHR Performance Metrics report . . . 195

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List of Figures

List of Figures

Figure 1 Certified Health IT Product List . . . 7

Figure 2 Certified Health IT Product List . . . 7

Figure 3 Certified Health IT Product List . . . 8

Figure 1 Clinical Encounter Edit screen . . . 13

Figure 2 Med Rec button . . . 13

Figure 3 Operator Maintenance Edit screen . . . 23

Figure 4 Operator Maintenance Edit screen . . . 24

Figure 5 Order Name Edit screen - Order Type Laboratory . . . 25

Figure 6 Order Name Edit screen - Order Type Radiology . . . 25

Figure 7 Prescription New screen . . . 27

Figure 8 Rx/Medications screen . . . 28

Figure 9 New Order screen . . . 28

Figure 10 Orders screen . . . 29

Figure 11 Prescription screen . . . 33

Figure 12 ePrescribing Configuration Utility screen . . . 34

Figure 13 Select Rx Template screen . . . 35

Figure 14 Prescription New screen . . . 36

Figure 15 Patient New screen . . . 39

Figure 16 Vital Signs New screen . . . 47

Figure 17 Health Maintenance Template Edit screen . . . 50

Figure 18 HM Procedure Rules Edit screen . . . 51

Figure 19 Prescription Defaults screen . . . 52

Figure 20 Health Maintenance prompt message. . . 53

Figure 21 Health Maintenance Summary screen . . . 54

Figure 22 Special Features screen - General tab . . . 57

Figure 23 Patient Edit screen - Configuration tab . . . 58

Figure 24 Patient Edit screen . . . 59

Figure 25 Web View Audit Trail Report screen . . . 60

Figure 26 RelayHealth Login Metrics screen. . . 61

Figure 27 Download My Health Information button . . . 62

Figure 28 How do you want the PHI document delivered? screen . . . 62

Figure 29 Download my Health Information screen . . . 63

Figure 30 CCDA file. . . 63

Figure 31 Health Records button. . . 64

Figure 32 Import/Export Health Data link . . . 64

Figure 33 Download My Data button . . . 65

Figure 34 Text Results Chart Sections screen . . . 69

Figure 35 External Systems screen. . . 69

Figure 36 Clinical Summaries to RelayHealth screen . . . 70

Figure 37 Patient Clinical Summary Report screen. . . . 71

Figure 38 Clinical Encounter Not Found screen . . . 72

Figure 39 Render to file screen . . . 73

Figure 40 Export Medical Summary screen . . . 73

Figure 41 Clinical Encounter New screen . . . 75

Figure 42 Operator Maintenance Edit screen . . . 79

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List of Figures

Figure 44 Access Level Configuration Edit screen . . . 80

Figure 45 Break-the-Glass Security screen. . . 81

Figure 46 Electronic Security screen. . . 82

Figure 47 Electronic Security screen. . . 83

Figure 48 Reports menu . . . 84

Figure 49 Operator Audit Trail Report screen . . . 84

Figure 50 Electronic Security screen. . . 86

Figure 51 Order Name Edit screen . . . 88

Figure 52 Order New screen . . . 89

Figure 53 Laboratory Data Table screen. . . 89

Figure 54 Patient Inquiry New Report screen . . . 92

Figure 55 Enter The Problem Name screen . . . 93

Figure 56 Operator screen . . . 93

Figure 57 Select Provider screen . . . 93

Figure 58 Patient Inquiry New Report screen . . . 94

Figure 59 Enter File Name screen. . . 94

Figure 60 Registry Maintenance screen . . . 97

Figure 61 Patient Edit screen . . . 101

Figure 62 Batch Communication Select screen . . . 102

Figure 63 Batch Communication Detail New screen . . . 103

Figure 64 Letter Template Select screen . . . 104

Figure 65 Batch Communication Select screen . . . 105

Figure 66 Job Summary screen . . . 105

Figure 67 Batch Communication Recipients screen . . . 106

Figure 68 Clinical Encounter Edit screen . . . 108

Figure 69 External Systems screen. . . 109

Figure 70 New External System screen . . . 109

Figure 71 Pat Ed button. . . 111

Figure 72 Patient Education module . . . 111

Figure 73 Problems/Procedures screen . . . 112

Figure 74 Select the Patient Ed... screen - OK button. . . 112

Figure 75 Select the Patient Ed... screen - Cancel button. . . 113

Figure 76 Problems/Procedures screen . . . 113

Figure 77 Rx/Medications screen . . . 117

Figure 78 Medication Reconciliation Detail screen . . . . 118

Figure 79 Clinical Encounter New screen . . . 118

Figure 80 Medication Reconciliation Detail screen . . . . 119

Figure 81 Medication Reconciliation History screen . . . 120

Figure 82 Medication Reconciliation History screen . . . 121

Figure 83 New Message screen . . . 125

Figure 84 DirectActivated= setting. . . 126

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List of Figures

Figure 96 Save As screen . . . 134

Figure 97 Export Medical Summary Detail Selection screen . . . 135

Figure 98 Clinical Encounter Edit screen . . . 136

Figure 99 New Message screen . . . 137

Figure 100 Select Destination screen . . . 137

Figure 101 Select Destination screen . . . 138

Figure 102 New Message screen . . . 138

Figure 103 Attachments screen. . . 139

Figure 104 Select Attachment screen . . . 139

Figure 105 Attachments screen. . . 140

Figure 106 New Message screen . . . 140

Figure 107 New Message screen . . . 141

Figure 108 Health Maintenance Procedure Name Edit screen . . . 144

Figure 109 Immunizations Selection screen . . . 145

Figure 110 Health Maintenance Procedure New screen. . . 146

Figure 111 PPConnect - Immunization Registry Import screen . . . 147

Figure 112 PPConnect - Immunization Registry Export screen . . . 148

Figure 113 Provider Maintenance Edit screen . . . . 150

Figure 114 Web View Audit Trail Report screen . . . 151

Figure 115 RelayHealth Secure Messaging Metrics screen . . . 152

Figure 116 Report Syndromic Surveillance screen . . . 156

Figure 117 NoteTypesRadiology= setting . . . 162

Figure 118 NoteTypesRadiology= setting . . . 162

Figure 119 New External System screen . . . 163

Figure 120 Operator Maintenance Edit screen . . . . 163

Figure 121 Edit External System screen . . . 164

Figure 122 New External System User screen . . . 164

Figure 123 Operator Select screen . . . 164

Figure 124 New External System User screen . . . 165

Figure 125 Practice Partner Zoom screen. . . 166

Figure 126 View menu. . . 167

Figure 127 Select Note screen . . . 167

Figure 128 Radiology screen. . . 168

Figure 129 Special Features screen - Records 5 tab . . . 170

Figure 130 Family History screen . . . 172

Figure 131 Family History screen . . . 173

Figure 132 Family Member New screen . . . 173

Figure 133 Family History Problem New screen . . . 174

Figure 134 Diagnosis Code Select screen . . . 174

Figure 135 Family History Problem New screen . . . 175

Figure 136 Family History screen . . . 176

Figure 137 Negative Family History New screen . . . 176

Figure 138 Family History screen . . . 177

Figure 139 DefaultObjectivesList= setting . . . 181

Figure 140 EHR Performance Metrics Sign In screen. . . 182

Figure 141 EHR Performance Metrics Report screen . . . 182

Figure 142 EHR Performance Metrics Report screen - Stage 2 . . . 183

Figure 143 Directory Path for Export Files screen. . . 184

Figure 144 EHR Performance Metrics report . . . . 185

Figure 145 EHR Performance Metrics report . . . . 195

Figure 146 EHR Performance Metrics report . . . . 196

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List of Figures

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Introduction - General Information and

Resources

This section provides general information and resources for Meaningful Use.

Meaningful Use Stage 2 requirements

This section provides the general requirements for the first year of Meaningful Use Stage 2, in 2014 and beyond as specified by CMS. Along with the descriptions, several valuable resources are included in the form of links to various CMS tip sheets. These links ensure that you always have the latest information released by CMS pertaining to the various objectives and timelines.

IMPORTANT: All eligible providers (EPs) MUST upgrade to a 2014 certified version of their EHR

to meet Stage 2 requirements for Meaningful Use in 2014. 

All Practice Partner customers must upgrade to v11 of the product to meet this requirement. All Medisoft Clinical customers must upgrade to v19 SP1 of the product to meet this requirement. All Lytec MD customers must upgrade to v2014 SP1 of the product to meet this requirement. EPS will not be able to attest for Stage 2 Meaningful Use with any versions of the EHRs other than the ones listed above.

Reporting periods and payment adjustments

• All EPs who have attested for Stage 1 Meaningful Use for at least two years must move on to Stage 2 in 2014.

• All EPs will be attesting for a period of three months (or 90 days) in 2014.

• EPs attesting through Medicare must do so for a three-month period aligned with one of the fiscal quarters of 2014 (for example, January March 31 or April June 30 or July

1-September 30 or October 1-December 31).

• EPs attesting through Medicaid may do so for any 90-day reporting period throughout the year. They do not have to align their reporting period with a fiscal quarter.

• All EPs will be required to attest for a full calendar year in 2015 and 2016.

• EPs participating in the Medicare incentive program are required to attest every consecutive year, once they start attesting for Meaningful Use.

- If they “skip” a year, they move on to the next phase the following year. For example, if an EP attests in 2012 for the first time (Stage 1 Year 1) but skips attestation in 2013 (which would otherwise have been Stage 1 Year 2), the EP still must move on to Stage 2 Year 1 in 2014. The EP will incur payment adjustments in 2015 for non-attestation in 2013 (in addition to not qualifying for the 2013 incentive monies).

• EPs who can only participate in the Medicaid EHR Incentive Program (for example, mid-level providers like nurse practitioners) and/or those who do not bill Medicare at all (for example, pediatricians) are not subject to these payment adjustments listed above. Medicaid Incentive policy is different in two respects.

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Stage 2 overview guides Introduction - General Information and Resources

- Second, Medicaid providers are not required to participate in consecutive years of the Medicaid EHR Incentive Program. Thus, unlike Medicare providers, Medicaid providers who skip years of participation will resume their Meaningful Use progression where they left off. For example, if a Medicaid EP skips 2014 (which would otherwise be Stage 1 Year 2) and also skips 2015 but comes back to the Medicaid program in 2016, the EP would be required to demonstrate Stage 1 Year 2 in 2016 as if the EP had never left the Medicaid program for those two years.

• EPs who are eligible to participate in either Medicare or Medicaid incentive programs but choose to go through Medicaid will be subject to the Medicare payment adjustments if they choose to skip a year. For example, if a family practitioner, who attested through Medicaid for the first time in 2012 (Stage 1 Year 1) skips attestation in 2013 (what would otherwise be Stage 1 Year 2), he/she will incur Medicare payment adjustment in 2015 because the EP is

considered to be “Medicare-eligible.”

- However, the EP will not be subject to any Medicaid adjustments for non-attestation in 2013.

- The EP can continue in the Medicaid program and can demonstrate Stage 1 Year 2 in 2015 (or later).

For more information on basic eligibility and payment schedules and adjustments, refer to the following tip sheets.

Stage 2 overview guides

The following table provides links to Stage 2 overview guides.

Tip sheet Location

Medicare EHR Incentive Program - Overview, Payment Schedules, General Rules and Regulations

https://www.cms.gov/Regulations-and-Guidance/ Legislation/EHRIncentivePrograms/Downloads/ MLN_MedicareEHRProgram_TipSheet_EP.pdf

Medicaid EHR Incentive Program - Overview, Payment Schedules, General Rules and Regulations

https://www.cms.gov/Regulations-and-Guidance/ Legislation/EHRIncentivePrograms/Downloads/ MLN_MedicaidEHRProgram_TipSheet_EP.pdf

Payment Adjustment and Hardship Exception Rules http://www.cms.gov/Regulations-and-Guidance/Legislation/EHRIncentivePrograms/ Downloads/ PaymentAdj_HardshipExcepTipSheetforEP.p df

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Introduction - General Information and Resources Stage 2 objectives

Stage 2 objectives

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

http://www.cms.gov/Regulations-and-Guidance/ Legislation/EHRIncentivePrograms/Downloads/ Stage1vsStage2CompTablesforEP.pdf

Overview guide Location

Objective Description CMS tip sheet

Core #1 - CPOE

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. http://www.cms.gov/Regulations-and-Guidance/Legislation/ EHRIncentivePrograms/downloads/ Stage2_EPCore_1_CPOE_Medicatio nOrders.pdf Core #2 - Electronic Prescribing

Generate and transmit permissible prescriptions electronically (eRx).

http://www.cms.gov/Regulations-and-Guidance/Legislation/ EHRIncentivePrograms/downloads/ Stage2_EPCore_2_ePrescribing.pdf Core #3 - Record the Demographic s

Record the following demographics: • preferred language • sex • race • ethnicity • date of birth http://www.cms.gov/Regulations-and-Guidance/Legislation/ EHRIncentivePrograms/downloads/ Stage2_EPCore_3_RecordingDemogr aphics.pdf

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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

http://www.cms.gov/Regulations-and-Guidance/Legislation/ EHRIncentivePrograms/downloads/ Stage2_EPCore_4_RecordVitalSigns. pdf Core # 5 - Smoking Status

Record smoking status for patients 13 years old or older.

http://www.cms.gov/Regulations-and-Guidance/Legislation/ EHRIncentivePrograms/downloads/ Stage2_EPCore_5_RecordSmokingSt atus.pdf Core #6 - Clinical Decision Support Rule

Use clinical decision support to improve performance on high-priority health conditions. http://www.cms.gov/Regulations-and-Guidance/Legislation/ EHRIncentivePrograms/downloads/ Stage2_EPCore_6_ClinicalDecisionS upport.pdf Core # 7 - Patient Portal

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. http://www.cms.gov/Regulations-and-Guidance/Legislation/ EHRIncentivePrograms/downloads/ Stage2_EPCore_7_PatientElectronic Access.pdf Core #8 - Clinical Summary

Provide clinical summaries for patients for each office visit.

http://www.cms.gov/Regulations-and-Guidance/Legislation/ EHRIncentivePrograms/downloads/ Stage2_EPCore_8_ClinicalSummarie s.pdf Core #9 - Security & Risks Analysis

Protect electronic health information created or maintained by the certified EHR technology through the

implementation of appropriate technical capabilities. http://www.cms.gov/Regulations-and-Guidance/Legislation/ EHRIncentivePrograms/downloads/ Stage2_EPCore_9_ProtectElectronic HealthInfo.pdf

Core #10 - Incorporate clinical lab test results into

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Introduction - General Information and Resources Stage 2 objectives

Core #12 - Patient Reminders

Use clinically relevant information to identify patients who should receive reminders for preventive/follow-up care and send these patients the

reminders, per patient preference.

http://www.cms.gov/Regulations-and-Guidance/Legislation/ EHRIncentivePrograms/downloads/ Stage2_EPCore_12_PreventiveCare. pdf Core #13 - Patient Education

Use clinically relevant information from certified EHR technology to identify patient-specific education resources and provide those resources to the patient. http://www.cms.gov/Regulations-and-Guidance/Legislation/ EHRIncentivePrograms/downloads/ Stage2_EPCore_13_PatientSpecificE dRes.pdf Core #14 - Medication Reconciliatio n

The EP who receives a patient from another setting of care or provider or care, or believes an encounter is relevant should perform medication reconciliation. http://www.cms.gov/Regulations-and-Guidance/Legislation/ EHRIncentivePrograms/downloads/ Stage2_EPCore_14_MedicationReco nciliation.pdf Core #15 - Summary of Care Record

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.

http://www.cms.gov/Regulations-and-Guidance/Legislation/ EHRIncentivePrograms/downloads/ Stage2_EPCore_15_SummaryCare.p df Core #16 - Immunization Data Submission to State Registry

Capability to submit electronic data to immunization registries or

immunization information systems except where prohibited, and in accordance with applicable law and practice. http://www.cms.gov/Regulations-and-Guidance/Legislation/ EHRIncentivePrograms/downloads/ Stage2_EPCore_16_ImmunizationRe gistriesDataSubmission.pdf Core #17 - Secure Electronic Messaging

Use secure electronic messaging to communicate with patients on relevant health information. http://www.cms.gov/Regulations-and-Guidance/Legislation/ EHRIncentivePrograms/downloads/ Stage2_EPCore_17_UseSecureElectr onicMessaging.pdf Menu #1 - Syndromic Surveillance Data Submission

Capability to submit electronic syndromic surveillance data to public health agencies except where prohibited, and in accordance with applicable law and practice.

http://www.cms.gov/Regulations-and-Guidance/Legislation/ EHRIncentivePrograms/downloads/ Stage2_EPMenu_1_SyndromicSurveil lanceDataSub.pdf Menu #2 - Record Electronic Notes

Record electronic notes in patient records. http://www.cms.gov/Regulations-and-Guidance/Legislation/ EHRIncentivePrograms/downloads/ Stage2_EPMenu_2_ElectronicNotes. pdf

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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 accessible through CEHRT.

http://www.cms.gov/Regulations-and-Guidance/Legislation/ EHRIncentivePrograms/downloads/ Stage2_EPMenu_3_ImagingResults.p df Menu #4 - Family History as Structured Data

Record patient family health history as structured data. http://www.cms.gov/Regulations-and-Guidance/Legislation/ EHRIncentivePrograms/downloads/ Stage2_EPMenu_4_FamilyHealthHist ory.pdf Menu #5 - Identify and Report Cancer Cases to Central Cancer Registry

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. http://www.cms.gov/Regulations-and-Guidance/Legislation/ EHRIncentivePrograms/downloads/ Stage2_EPMenu_5_ReportCancerCa ses.pdf Menu #6 - Identify and Report Specific Cases to a Specialized Registry

Capability to identify and report specific cases to a specialized registry (other than a cancer registry), except where prohibited, and in accordance with applicable law and practice.

http://www.cms.gov/Regulations-and-Guidance/Legislation/

EHRIncentivePrograms/downloads/ Stage2_EPMenu_6_ReportSpecificCa ses.pdf

Objective Description CMS tip sheet

User guide Location

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/

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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

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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

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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.

E-mail

PPSMeaningfuluse@mckesson.com

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

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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).

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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

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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

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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.

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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.

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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.

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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.

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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, exported a clinical summary via CCR/CCD/ CCDA or an HIE).

The system automatically selects this check box when you send the Patient Clinical Summary report to the patient as a Web View message.

Paper Clinical Summary Select this check box if you provided the printed clinical summary to the patient (that is, the Patient Clinical Summary report).

Use the .CS Dot code to select this check box when working in a progress note. For

procedural steps, see the .CS code in the Dot

Code topic in the online help.

Patient-Specific Education Materials Select this check box if patient education handouts or other educational materials were printed or e-mailed to the patient using the

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Preface - Clinical Encounters Fields and buttons on the Clinical Encounter screen

Relevant for Clinical Reconciliation Select this check box if the clinical encounter is relevant for medication reconciliation. If you select this check box, you must link the clinical encounter to a medication reconciliation record.

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Chapter 1 - Core Objective 1 - Computerized

Physician Order Entry (CPOE)

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.)

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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

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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.

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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.

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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

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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

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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.

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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:

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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

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Chapter 2 - Core Objective 2- E-Prescribing and

Use of Formulary Data

Objective

More than 50% of all permissible prescriptions written by the eligible provider (EP) are queried for a drug formulary and transmitted electronically to the pharmacy using certified EHR technology.

Description

Providers must transmit permissible medications (new prescriptions and renewals) electronically. Electronic refill requests received from Surescripts will count in the denominator of the

performance metric. Surescripts or InfoScan formulary data always will be available when prescribing, as long as it has been downloaded successfully and is current.

Performance metric

Denominator

The number of prescriptions issued by a provider during the reporting period, for which

transmission is permissible. This includes all such prescriptions faxed, printed, and transmitted (excludes prescriptions marked as “do not print” or “sample given”) AND all electronic refill requests received by that provider.

Numerator

Portion of the prescriptions in the denominator that were transmitted electronically AND the number of electronic refill requests that were transmitted back to the pharmacy electronically.

Ratio

The resulting percentage should be more than 50%.

Exclusions

• Any provider who prescribes a total of fewer than 100 medications during the reporting period. • Any provider who does not have a pharmacy within his/her organization and there are no

pharmacies that accept electronic prescriptions within 10 miles of the provider’s practice location at the start of his/her EHR reporting period.

Notes

If a provider wishes to claim exclusion, 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.

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 http://www.deadiversion.usdoj.gov/schedules/ orangebook/e_cs_sched.pdf.

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Configuration for e-Prescribing Chapter 2 - Core Objective 2- E-Prescribing and Use of Formulary

Any prescription not subject to these restrictions is considered permissible.

Configuration for e-Prescribing

All users who need to transmit prescriptions must have appropriate access to do so.

Access Levels > Records tab > Rx/Medications

Access Levels > Records tab > Print from Rx/Medications

Steps to access and edit access levels have not changed since previous versions of the product. Follow the same steps as before.

Configuration notes

None.

End user workflow for e-Prescribing

New prescriptions and renewals (from the patient’s chart)

In the 2014 certified version of the product, a prescription now is required to have an NDC associated with it.

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Chapter 2 - Core Objective 2- E-Prescribing and Use of Formulary Data Responding to electronic refill requests

The end user workflows for electronically transmitting new prescriptions and renewals have not changed from previous versions. Providers may e-Prescribe using their existing workflows.

Figure 11. Prescription screen

Responding to electronic refill requests

The end user workflows for appropriately responding to electronic refill requests has not changed from previous versions. Providers may respond to electronic refill requests using their existing workflow.

End user notes

No specific actions need to be taken by the end users when prescribing “non-permissible” medications. The system automatically calculates the number of permissible prescriptions written to determine the denominator for this objective (controlled substances like morphine and

Oxycontin are NOT counted).

As long as electronic refill requests from Surescripts are responded to correctly and in a timely manner (always reply to the Surescripts request message within 48 hours of receipt), it will count toward the numerator of the metric for this objective.

A provider can choose to Approve, Change, or Deny a refill request and successfully help increment the numerator for the metric.

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Configuration for formulary implementation Chapter 2 - Core Objective 2- E-Prescribing and Use of Formulary

Configuration for formulary implementation

ePrescribing Configuration utility setup

Once a provider has successfully enrolled in Surescripts for e-Prescribing, he/she will have access to the Surescripts formulary.

Formulary updates are set up for automatic downloads on a weekly basis.You may have to modify the formulary download schedule to avoid conflict with other automated services.

In some environments, you may have to direct the download through a proxy server. To access the e-Prescribing formulary download settings in Patient Records, launch the ePrescribing Configuration utility.

To launch the ePrescribing Configuration utility:

1. In the PPart folder, double-click ePrescriptionConfiguration.exe. The ePrescribing Configuration Utility screen appears.

Figure 12. ePrescribing Configuration Utility screen

2. Enter the Days and Time information as desired to set the time and day of the automatic download each week. All users must be out of the system when this takes place for successful installation of the updates.

Figure

Updating...

References

  1. https://www.cms.gov/Regulations-and-Guidance/Legislation/EHRIncentivePrograms/Downloads/
  2. https://www.cms.gov/Regulations-and-Guidance/Legislation/EHRIncentivePrograms/Downloads/
  3. http://www.cms.gov/Regulations-and-Guidance/Legislation/EHRIncentivePrograms/
  4. Downloads/PaymentAdj_HardshipExcepTipSheetforEP.p
  5. https://www.federalregister.gov/articles/2012/10/23/2012-25975/medicare-and-medicaid-
  6. http://www.cms.gov/Regulations-and-Guidance/Legislation/EHRIncentivePrograms/Downloads/
  7. http://www.cms.gov/Regulations-and-Guidance/Legislation/EHRIncentivePrograms/Downloads/
  8. http://www.cms.gov/Regulations-and-Guidance/Legislation/EHRIncentivePrograms/Downloads/
  9. http://www.cms.gov/Regulations-and-Guidance/Legislation/EHRIncentivePrograms/Downloads/
  10. http://www.cms.gov/Regulations-and-Guidance/Legislation/
  11. EHRIncentivePrograms/downloads/Stage2_EPCore_1_CPOE_Medicatio
  12. http://www.cms.gov/Regulations-and-Guidance/Legislation/
  13. EHRIncentivePrograms/downloads/Stage2_EPCore_2_ePrescribing.pdf
  14. http://www.cms.gov/Regulations-and-Guidance/Legislation/
  15. EHRIncentivePrograms/downloads/Stage2_EPCore_3_RecordingDemogr
  16. http://www.cms.gov/Regulations-and-Guidance/Legislation/
  17. EHRIncentivePrograms/downloads/Stage2_EPCore_4_RecordVitalSigns.
  18. http://www.cms.gov/Regulations-and-Guidance/Legislation/
  19. EHRIncentivePrograms/downloads/Stage2_EPCore_5_RecordSmokingSt
  20. http://www.cms.gov/Regulations-and-Guidance/Legislation/
  21. EHRIncentivePrograms/downloads/Stage2_EPCore_6_ClinicalDecisionS
  22. http://www.cms.gov/Regulations-and-Guidance/Legislation/
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  24. http://www.cms.gov/Regulations-and-Guidance/Legislation/
  25. EHRIncentivePrograms/downloads/Stage2_EPCore_8_ClinicalSummarie
  26. http://www.cms.gov/Regulations-and-Guidance/Legislation/
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  30. http://www.cms.gov/Regulations-and-Guidance/Legislation/