Modified Stage Two Meaningful Use with Final Rule Quick Reference Guide

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1 Modified Stage Two Meaningful Use with Final Rule Quick Reference Guide To qualify for Stage 1 or 2, a provider must meet: 10 objectives, Including 2 consolidated public health measures Reporting on Clinical Quality Measures: Beginning in 2014, the reporting of CQMs changed for all providers. All EPs will report using the new 2014 criteria regardless of whether they are participating in Stage 1 or Stage 2. In 2014 and beyond, EPs will report on 9 CQMs from a list of 64. There is also a new requirement that the quality measures selected must cover at least 3 of the 6 available National Quality Strategy (NQS) domains. The 6 NQS domains are: 1. Patient and Family Engagement 2. Patient Safety 3. Care Coordination 4. Population/Public Health 5. Efficient Use of Healthcare Resources 6. Clinical Process/Effectiveness For an EHR reporting period in 2015, and for providers demonstrating meaningful use for the first time in 2016, the final rule is that providers may Attest to any continuous 90-day period of CQM data during the calendar year through the Medicare EHR Incentive Program registration and attestation site; or Electronically report CQM data using the established methods for electronic reporting. For 2016 and subsequent years, providers beyond their first year of meaningful use may attest to one full calendar year of CQM data or they may electronically report their CQM data using the established methods for electronic reporting.

2 CORE OBJECTIVES CORE 1 NEW #3 - Computerized Provider Order Entry (CPOE) An EP, through a combination of meeting the thresholds Alternate Measure 1: For Stage 1 providers in 2015, more and exclusions (or both), must satisfy all three measures than 30 percent of all unique patients with at least one for this objective. medication in their medication list seen by the EP during Measure 1: More than 60 percent of medication orders the EHR reporting period have at least one medication created by the EP during the EHR reporting period are order entered using CPOE; or more than 30 percent of recorded using computerized provider order entry. medication orders created by the EP during the EHR Exclusion: Any EP who writes fewer than 100 medication reporting period are recorded using computerized orders during the EHR reporting period. provider order entry. Measure 2: More than 30 percent of laboratory orders Alternate Exclusion for Measure 2: Providers scheduled created by the EP during the EHR reporting period are to be in Stage 1 in 2015 may claim an exclusion for recorded using computerized provider order entry. measure 2 (laboratory orders) of the Stage 2 CPOE Exclusion: Any EP who writes fewer than 100 laboratory objective for an EHR reporting period in 2015; and, orders during the EHR reporting period. providers scheduled to be in Stage 1 in 2016 may claim an Measure 3: More than 30 percent of radiology orders exclusion for measure 2 (laboratory orders) of the Stage 2 created by the EP during the EHR reporting period are CPOE objective for an EHR reporting period in recorded using computerized provider order entry. Alternate Exclusion for Measure 3: Providers scheduled Exclusion: Any EP who writes fewer than 100 radiology to be in Stage 1 in 2015 may claim an exclusion for orders during the EHR reporting period. measure 3 (radiology orders) of the Stage 2 CPOE objective for an EHR reporting period in 2015; and, providers scheduled to be in Stage 1 in 2016 may claim an exclusion for measure 3 (radiology orders) of the Stage 2 CPOE objective for an EHR reporting period in CORE 2 NEW #4 - Generate and Transmit Prescriptions Electronically NOTE: Combined with measure to Implement drug formulary checks EP Measure: More than 50 percent of permissible prescriptions written by the EP are queried for a drug formulary and transmitted electronically using CEHRT. Exclusions: Any EP who - Writes fewer than 100 permissible prescriptions during the EHR reporting period; or Does not have a pharmacy within his or her organization and there are no pharmacies that accept electronic prescriptions within 10 miles of the EP's practice location at the start of his or her EHR reporting period. - Alternate EP Measure: For Stage 1 providers in 2015, more than 40 percent of all permissible prescriptions written by the EP are transmitted electronically using CEHRT **Pending specifications from CMS- All prescriptions written during the reporting period will be counted. - Eligible prescriptions will exclude controlled substances from the count. - Problem List Entries must be present (either problem list or an indication of no problem) - Formulary panel must be activated (box UNCHECKED in user preferences to allow formulary panel to populate) CORE 3 - Record Patient Demographics - NULL More than 80% of all unique patients seen by the EP have demographics recorded as structured data. CORE 4 - Record and Chart Changes in Vital Signs - NULL More than 80% of all unique patients seen by the EP during the EHR reporting period have blood pressure (for patients age 3 and over only) and height and weight (for all ages) recorded as structured data. CORE 5 - Smoking Status for Patients 13 years of age and older - NULL More than 80% of patients 13 years and older has smoking status recorded.

3 In order for EPs to meet the objective they must satisfy both of the following measures: Measure 1: Implement five clinical decision support interventions related to four or more clinical quality measures at a relevant point in patient care for the entire EHR reporting period. Absent four clinical quality measures related to an EP s scope of practice or patient population, the clinical decision support interventions must be related to high priority health conditions. Measure 2: The EP has enabled and implemented the functionality for drug-drug and drug allergy interaction checks for the entire EHR reporting period. Exclusion: For the second measure, any EP who writes fewer than 100 medication orders during the EHR reporting period. EP Measure 1: More than 50 percent of all unique patients seen by the EP during the EHR reporting period are provided timely access to view online, download, and transmit to a third party their health information subject to the EP's discretion to withhold certain information. EP Measure 2: For an EHR reporting period in 2015 and 2016, at least one patient seen by the EP during the EHR reporting period (or patient-authorized representative) views, downloads or transmits to a third party his or her health information during the EHR reporting period. For an EHR reporting period in 2017, more than 5% of unique patients seen by the EP during the EHR reporting period (or his or her authorized representatives) view, download or transmit to a third party their health information during the EHR reporting period. Exclusions: Any EP who: a. Neither orders nor creates any of the information listed for inclusion as part of the measures; or b. Conducts 50 percent or more of his or her patient encounters in a county that does not have 50 percent or more of its housing units with 4Mbps broadband availability according to the latest information available from the FCC on the first day of the EHR reporting period. CORE 6 - y/n - NEW#2 - Clinical Decision Support CORE 7 NEW #8 - Patient Electronic Access (VDT) For an EHR reporting period in 2015 only, an EP who is scheduled to participate in Stage 1 in 2015 may satisfy the following in place of measure 1: Alternate Objective and Measure: Objective: Implement one clinical decision support rule relevant to specialty or high clinical priority along with the ability to track compliance with that rule. Measure: Implement one clinical decision support rule. Alternate Exclusion: Providers may claim exclusion for the second measure if for an EHR reporting period in 2015 they were scheduled to demonstrate Stage 1, which does not have an equivalent measure. - Patient must have at least one encounter during the reporting period to be counted - Use of Secure Chart (MicroMD patient portal) required - CCR/CCD/CDA must be published to Portal, with patient accessing and either viewing, downloading, or transmitting to a third party - Portal updates on Desktop Navigator will be relevant `-CIN Direct Mail required to transmit CORE 8 - Provide Patient with Clinical Summary for Each Visit - NULL More than 50% of patients are given a Clinical Summary (Patient Care Plan) within one business day CORE 9 - y/n - NEW #1 - Protect Patient Health Information Measure: Conduct or review a security risk analysis in Practice should conduct or review security risk analysis accordance with the requirements in 45 CFR and implement security updates as necessary to correct (a)(1), including addressing the security (to identified deficiencies include encryption) of ephi created or maintained in CEHRT in accordance with requirements under 45 CFR While MicroMD EMR is only a part of the required

4 (a)(2)(iv) and 45 CFR (d)(3), and implement security updates as necessary and correct identified security deficiencies as part of the EP s risk management process. More than 55% of all clinical lab tests ordered by the EP during the HER reporting period whose results are either +/- or numerical format are incorporated in CEHRT as structured data. CORE 10 - Include Lab Test Results in HER - NULL security risk analysis, it is important to note that all software security requirements have been demonstrated successfully during the certification process. It is recommended that each practice would validate that each of the items are reviewed for proper setup in their practice: - Authentication: Verifying that the person seeking access to the electronic health information is the one authorized to do so. - Access Control: An ability to create, activate and deactivate users as well as to assign access levels within the software - Emergency Access: An ability to allow certain users to Break the Glass and obtain access to charts that they would be otherwise restricted from seeing. - Automatic Log-Off: An automatic function that will terminate an electronic session that has been inactive for a pre-determined amount of time. - Audit Log: An ability to produce audit logs of access to patient health information. - Integrity and Encryption: An ability to encrypt data based on specified standards with assurance that the data has not been altered in the process CORE 11 - y/n - Generate Lists of Patients by a specific condition - NULL Successful generation of one list of patients by a specific condition to use for quality improvement, reduction in disparities, research, and/or outreach. CORE 12 - Send reminders to patients for preventative and follow-up care - NULL Use EHR to send reminders to more than 10% of all unique patients who have had 2 or more office visits with the EP within the 24 months before the beginning of the EHR reporting period, per patient preference. EP Measure: Patient specific education resources identified by CEHRT are provided to patients for more than 10 percent of all unique patients with office visits seen by the EP during the EHR reporting period. Exclusion: Any EP who has no office visits during the EHR reporting period. CORE 13 NEW #6 - Patient Specific Education Alternate Exclusion: Provider may claim exclusion for the measure of the Stage 2 Patient Specific Education objective if for an EHR reporting period in 2015 they were scheduled to demonstrate Stage 1 but did not intend to select the Stage 1 Patient Specific Education menu objective. - Patient must have an encounter during the reporting period to be counted. - Can print educational material from within encounter or from chart, as long as patient had an office visit during the reporting period.

5 CORE 14 NEW #7 - Medication Reconciliation Between Care Settings Measure: The EP performs medication reconciliation for more than 50 percent of transitions of care in which the patient is transitioned into the care of the EP. Exclusion: Any EP who was not the recipient of any transitions of care during the EHR reporting period. Alternate Exclusion: Provider may claim an exclusion for the measure of the Stage 2 Medication Reconciliation objective if for an EHR reporting period in 2015 they were scheduled to demonstrate Stage 1 but did not intend to select the Stage 1 Medication Reconciliation menu objective. - Use of Transition of Care IN is relevant. - Use of Import CCR/CCD on Transition of Care In to import data into chart is relevant (Medications, Problem List, and Allergies) CORE 15 NEW #5 - Health Information Exchange ***Pending rule specifications from CMS -:Combined with the following measures: Maintain an up-to-date Problem list, Maintain an up-to-date Medication list, Maintain an up-to-date Allergy list Measure: The EP that transitions or refers their patient to another setting of care or provider of care must (1) use CEHRT to create a summary of care record; and (2) electronically transmit such summary to a receiving provider for more than 10 percent of transitions of care and referrals. Exclusion: Any EP who transfers a patient to another setting or refers a patient to another provider less than 100 times during the EHR reporting period. Alternate Exclusion: Provider may claim an exclusion for the Stage 2 measure that requires the electronic transmission of a summary of care document if for an EHR reporting period in 2015, they were scheduled to demonstrate Stage 1, which does not have an equivalent measure. - Patient must have at least one completed encounter during reporting period. - In MicroMD EMR, Transition of Care OUT will be used to satisfy measure. A Transition of Care (OUT) may be created on the desktop or in patient s Workflow Communicator. Additionally, Referrals Orders allow users a link to Transition of Care from within the order. - Requires use of Mail Messaging within the EMR. Surescripts CIN will have relevance CORE 16 - Immunization Registry See Public Health Proposal below CORE 17 NEW #9 - Secure Electronic Messaging Measure: For an EHR reporting period in 2015, the Alternate Exclusion: An EP may claim an exclusion for the capability for patients to send and receive a secure measure if for an EHR reporting period in 2015 they were electronic message with the EP was fully enabled during scheduled to demonstrate Stage 1, which does not have the EHR reporting period. an equivalent measure. For an EHR reporting period in 2016, for at least 1 patient seen by the EP during the EHR reporting period, a secure message was sent using the electronic messaging - Patient Portal (MicroMD Secure Chart) will be required function of CEHRT to the patient (or the patientauthorized representative), or in response to a secure message sent by the patient (or the patient-authorized representative) during the EHR reporting period. For an EHR reporting period in 2017, for more than 5 percent of unique patients seen by the EP during the EHR reporting period, a secure message was sent using the electronic messaging function of CEHRT to the patient (or

6 the patient-authorized representative), or in response to a secure message sent by the patient (or the patientauthorized Exclusion: Any EP who has no office visits during the EHR reporting period, or any EP who conducts 50 percent or more of his or her patient encounters in a county that does not have 50 percent or more of its housing units with 4Mbps broadband availability according to the latest information available from the FCC on the first day of the EHR reporting period. NEW #10 - PUBLIC HEALTH OBJECTIVE An EP scheduled to be in Stage 2 in 2015 must meet 2 measures. Measure Option 1 Immunization Registry Reporting: The EP is in active engagement with a public health agency to submit immunization data. Exclusions: Any EP meeting one or more of the following criteria may be excluded from the immunization registry reporting measure if the EP-- Does not administer any immunizations to any of the populations for which data is collected by its jurisdiction's immunization registry or immunization information system during the EHR reporting period; Operates in a jurisdiction for which no immunization registry or immunization information system is capable of accepting the specific standards required to meet the CEHRT definition at the start of the EHR reporting period; or Operates in a jurisdiction where no immunization registry or immunization information system has declared readiness to receive immunization data from the EP at the start of the EHR reporting period Measure Option 2 Syndromic Surveillance Reporting: The EP is in active engagement with a public health agency to submit syndromic surveillance data. Exclusion for EPs: Any EP meeting one or more of the following criteria may be excluded from the syndromic surveillance reporting measure if the EP: Is not in a category of providers from which ambulatory syndromic surveillance data is collected by their jurisdiction's syndromic surveillance system; Operates in a jurisdiction for which no public health agency is capable of receiving electronic syndromic surveillance data from EPs in the specific standards required to meet the CEHRT definition at the start of the EHR reporting period; or Alternate Specification: An EP scheduled to be in Stage 1 in 2015 may meet 1 measure. **Pending rule specifications from CMS PUBLIC HEALTH REPORTING OBJECTIVES WITH MULTIPLE OPTIONS. MUST SHOW ACTIVE ENGAGEMENT BY ONE OF THE FOLLOWING: COMPLETED REGISTRATION TO SUBMIT DATA -WITHIN 60 DAYS AFTER START OF REPORTING PERIOD TESTING AND VALIDATION -THE EP IS IN THE PROCESS OF TESTING AND VALIDATION OF THE ELECTRONIC SUBMISSION OF DATA. PROVIDERS MUST RESPOND TO REQUESTS FROM THE PHA OR, WHERE APPLICABLE, THE CDR WITHIN 30 DAYS; FAILURE TO RESPOND TWICE WITHIN AN EHR REPORTING PERIOD WOULD RESULT IN THAT PROVIDER NOT MEETING THE MEASURE. PRODUCTION STAGE-THE EP HAS COMPLETED TESTING AND VALIDATION OF THE ELECTRONIC SUBMISSION AND IS ELECTRONICALLY SUBMITTING PRODUCTION DATA TO THE PHA OR CDR

7 Operates in a jurisdiction where no public health agency has declared readiness to receive syndromic surveillance data from EPs at the start of the EHR reporting period. Measure Option 3 Specialized Registry Reporting: The EP is in active engagement to submit data to a specialized registry. Exclusions: Any EP meeting at least one of the following criteria may be excluded from the specialized registry reporting measure if the EP-- Does not diagnose or treat any disease or condition associated with, or collect relevant data that is collected by, a specialized registry in their jurisdiction during the EHR reporting period; Operates in a jurisdiction for which no specialized registry is capable of accepting electronic registry transactions in the specific standards required to meet the CEHRT definition at the start of the EHR reporting period; or Operates in a jurisdiction where no specialized registry for which the EP is eligible has declared readiness to receive electronic registry transactions at the beginning of the EHR reporting period. MENU OBJECTIVES MENU 2 - Record electronic progress notes in patient record - NULL Enter at least one electronic progress note created, edited and signed by an EP for more than 30% of unique patients with at least one office visit during the EHR reporting period. The text of the electronic note must be text searchable and may contain drawings and other content. MENU 3 - Imaging Results accessible through CEHRT - NULL More than 10% of all tests whose result is one or more images ordered by the EP during the EHR reporting period are accessible through CEHRT. MENU 4 - Record family health history as structured data - NULL More than 20% of all unique patients seen by the EP during the EHR reporting period have a structured data entry for one or more first-degree relatives. MENU 5 - Capability to identify and report cancer cases to a public health central cancer registry Successful ongoing transmission of cancer case Currently not supported by MicroMD information. NOW INCLUDED IN PUBLIC HEALTH OBJECTIVE MENU 6 - Capability to identify and report specific cases to a specialized registry (other than a cancer registry) Successful ongoing transmission of data to a specialized registry NOW INCLUDED IN PUBLIC HEALTH OBJECTIVE

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9 EHR Reporting Period Starting in 2015, the EHR reporting period for all providers will be based on the calendar year. In 2015 only, the EHR reporting period for all providers will be any continuous 90-day period. EPs may select an EHR reporting period of any continuous 90 day period from January 1, 2015 through December 31, In 2016 In 2016, the EHR reporting period for a payment adjustment year for EPs who are new participants is any continuous 90- day period in New participants who successfully demonstrate meaningful use for this period and satisfy all other program requirements will avoid the payment adjustment in CY 2017 if the EP successfully attests by October 1, 2016, and will avoid the payment adjustment in CY 2018 if the EP successfully attests by February 28, In 2016, the EHR reporting period for a payment adjustment year for EPs who are returning participants is the full Returning participants who successfully demonstrate meaningful use for this period and satisfy all other program requirements will avoid the payment adjustment in CY 2018 if the EP successfully attests by February 28, In 2017 In 2017, the EHR reporting period for a payment adjustment year for EPs who are new participants is any continuous 90- day period in New participants who successfully demonstrate meaningful use for this period and satisfy all other program requirements will avoid the payment adjustment in CY 2018 if the EP successfully attests by October 1, 2017 Payment Adjustments & Attestation Deadlines For an EHR reporting period in 2015, all Medicare providers must attest by February 29, Despite the change to a 90-day EHR reporting period in 2015, providers will not be able to attest to meaningful use for an EHR reporting period in 2015 prior to January 4, In CY 2015, the EHR reporting period for a payment adjustment year for EPs who have not successfully demonstrated meaningful use in a prior year (new participants) is any continuous 90-day period in calendar year (CY) New participants who successfully demonstrate meaningful use for this period and satisfy all other program requirements will avoid the payment adjustments in CYs 2016 and 2017 if the EP successfully attests by February 29, In CY 2015, the EHR reporting period for a payment adjustment year for EPs who have successfully demonstrated meaningful use in a prior year (returning participants) is any continuous 90-day period in CY Returning participants who successfully demonstrate meaningful use for this period and satisfy all other program requirements will avoid the payment adjustment in CY 2017 if the EP successfully attests by February 29,

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