Meaningful Use Workflow - Stage 2

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1 [MEANINGFUL USE STAGE 2 REPORTING] P. 1 OF 97 Meaningful Use Workflow - Stage 2 Sevocity 11.4 is a Complete EHR, which is ONC 2014 Edition compliant and has been certified by the Certification Commission for Health Information Technology (CCHIT ), an ONC-ACB, in accordance with the applicable eligible provider certification criteria adopted by the Secretary of Health and Human Services. ONC HIT certification conferred by CCHIT does not represent an endorsement of the certified EHR technology by the U.S. Department of Health and Human Services. The ability to meet Meaningful Use Requirements is a clinic wide function. All staff from check in through all clinical functions and check out all play a role in meeting Meaningful Use Requirements. It is imperative that the clinic have the Patient Portal function activated. If you do not, or do not know, contact Sevocity Support to assist. The patients must be registered in Patient Portal within Sevocity before encounters can be sent to their Patient Portal. Front Office Objective 3 (Core): Record Demographics Objective Measure Exclusion Record the following demographics: preferred language, sex, race, ethnicity, and date of birth. More than 80 percent of all unique patients seen by the EP have demographics recorded as structured data. No exclusion. Numerator: The number of patients in the denominator who have all the elements of demographics (or a specific notation if the patient declined to provide one or more elements or if recording an element is contrary to state law) recorded as structured data. Denominator: Number of unique patients seen by the EP during the EHR reporting period with an office visit with any of the following encounter types: Procedure OB Initial Visit Multi-System/ Exam OB Follow Up Immunization OB Postpartum Urgent Care

2 [MEANINGFUL USE STAGE 2 REPORTING] P. 2 OF 97 In Sevocity: Demographics Chart > Demographics > Patient Info > Update > designate applicable demographic data Demographics Change Patient Info window showing Refused to answer options new for MU2 Core Objective 3. Patient Info pane displaying selections for demographics items required for MU2 Core Objective 3.

3 Additional Information USER CONFERENCE 2014 [MEANINGFUL USE STAGE 2 REPORTING] P. 3 OF 97 Race and ethnicity codes should follow current federal standards published by the Office of Management and Budget ( If a patient declines to provide all or part of the demographic information, or if capturing a patient s ethnicity or race is prohibited by state law, such a notation entered as structured data would count as an entry for purposes of meeting the measure. In regards to patients who do not know their ethnicity, EPs should treat these patients the same way as patients who decline to provide race or ethnicity identify in the patient record that the patient declined to provide this information. EPs are not required to communicate with the patient in his or her preferred language in order to meet the measure of this objective. The term gender in the Stage 1 objective is replaced with the term sex for Stage 2. In order to meet this objective and measure an EP must use the capabilities and standards of certified electronic health record technology (CEHRT) at 45 CFR (a) (3). Objective 7 (Core): Patient Electronic Access Objective 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. Measure Measure 1: More than 50 percent of all unique patients seen by the EP during the EHR reporting period are provided timely (available to the patient within 4 business days after the information is available to the EP) online access to their health information. Measure 2: More than 5 percent of all unique patients seen by the EP during the EHR reporting period (or their authorized representatives) view, download, or transmit to a third party their health information. Exclusion Any EP who: (1) Neither orders nor creates any of the information listed for inclusion as part of both measures, except for "Patient name" and "Provider's name and office contact information, may exclude both measures. (2) 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 3Mbps broadband availability according to the latest information available from the FCC on the

4 [MEANINGFUL USE STAGE 2 REPORTING] P. 4 OF 97 first day of the EHR reporting period may exclude only the second measure. Measure 1 Numerator: The number of patients in the denominator who have timely (within 4 business days after the information is available to the EP) online access to their health information. Denominator: Number of unique patients seen by the EP during the EHR reporting period. Measure 2 Numerator: The number of unique patients (or their authorized representatives) in the denominator who have viewed online, downloaded, or transmitted to a third party the patient's health information. Denominator: Number of unique patients seen by the EP during the EHR reporting period. Setup Requirements NOTE: In order to meet think measure your clinic/facility must have the patient portal activated. If you are not sure if this has been done for you please contact support. Chart > Demographics > Contacts > Alternate > Update >Add Alternate Contact Information > check off the Patient Portal Access checkbox > Click Save button.

5 [MEANINGFUL USE STAGE 2 REPORTING] P. 5 OF 97 Tools > Patient Portal > Add Patient / Add Alternate > Search for patient > Select Patient > click OK > click on Add to Portal checkbox > assign Login Name > assign (temporary) Password > enter a valid Address > Click OK. Additional Information The following information must be made available online: Patient name, provider's name and office contact information, current and past problem list, procedures, laboratory test results, current medication list and medication history, current medication allergy list and medication allergy history, vital signs (height, weight, blood pressure, BMI, growth charts), smoking status, demographic information (preferred language, sex, race, ethnicity, date of birth), care plan field(s), including goals and instructions, and any known care team members including the primary care provider (PCP) of record unless the information is not available in certified EHR technology (CEHRT), is restricted from disclosure due to any federal, state or local law regarding the privacy of a person s health information, including variations due to the age of the patient or the provider believes that substantial harm may arise from disclosing particular health information in this manner. Replaces the Stage 1 core objective for EPs of "Provide patients with an electronic copy of their health information (including diagnostic test results, problem list, medication lists, medication allergies) upon request" and the Stage 1 menu objective for EPs of "Provide patients with timely electronic access to their health information (including lab results, problem list, medication lists, and allergies) within 4 business days of the information being available to the EP." This objective aligns with the Fair Information Practice Principles (FIPPs), in affording baseline privacy protections to individuals. Both of the measures for this objective must be met using CEHRT.

6 [MEANINGFUL USE STAGE 2 REPORTING] P. 6 OF 97 Objective 9 (Core): Protect Electronic Health Information Objective Protect electronic health information created or maintained by the certified EHR technology (CEHRT) through the implementation of appropriate technical capabilities. Measure Conduct or review a security risk analysis in accordance with the requirements under 45 CFR (a) (1), including addressing the encryption/security of data stored in CEHRT in accordance with requirements under 45 CFR (a) (2) (iv) and 45 CFR (d) (3), and implement security updates as necessary and correct identified security deficiencies as part of the provider's risk management process for EPs. Exclusion No exclusion. Yes: Eligible professionals (EPs) must attest YES to conducting or reviewing a security risk analysis and implementing security updates as needed to meet this measure. No In Sevocity: Login, Administrative, No Activity Log Off, Log Reports, HIPAA disclosures, Latest Updates Login: Allows three attempts. If failed, then a lockout or wait period is imposed. Log In window displaying temporary lockout message.

7 [MEANINGFUL USE STAGE 2 REPORTING] P. 7 OF 97 Administrative: Sevocity Administrators have full access to administrative functionality including: application and data analysis and issue resolution; system backups and restorations; password administration; database management; auditing; and security. No Activity Logoff: Sevocity logs any user off after a period of no activity. The Security Administrator configures this. Log Reports: User activities are logged and available for reporting by Clinic/Security Administrators. HIPAA: All exported data is password protected. Latest Updates: Sevocity updates are performed each time a user launches Sevocity. Additional Information EPs must conduct or review a security risk analysis of CEHRT including addressing encryption/security of data, and implement updates as necessary at least once prior to the end of the EHR reporting period and attest to that conduct or review. The testing could occur prior to the beginning of the first EHR reporting period. However, a new review would have to occur for each subsequent reporting period. The parameters of the security risk analysis are defined 45 CFR (a) (1) which was created by the HIPAA Security Rule. Meaningful use does not impose new or expanded requirements on the HIPAA Security Rule nor does it require specific use of every certification and standard that is included in certification of EHR technology. More information on the HIPAA Security Rule can be found at In order to meet this objective and measure, an EP must use the capabilities and standards of CEHRT at 45 CFR (d) (4), (d) (2), (d) (3), (d) (7), (d) (1), (d) (5), (d) (6), (d) (8), and (d) (9).

8 [MEANINGFUL USE STAGE 2 REPORTING] P. 8 OF 97 Objective 12 (Core): Preventive Care Objective 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. Measure More than 10 percent 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 were sent a reminder, per patient preference when available. Exclusion Any EP who has had no office visits in the 24 months before the EHR reporting period. Numerator: Number of patients in the denominator who were sent a reminder per patient preference when available during the EHR reporting period. Denominator: Number of unique patients who have had two or more office visits with the EP in the 24 months prior to the beginning of the EHR reporting period. In Sevocity: Tools Tools > Patient Reminder > Select patient and Actual Method for this Reminder (to match patient s preferred method) and then Finalize (or Finalize and Route). In Sevocity: Past Encounters Chart > Past Encounters > view or amend Patient Reminder encounter notes.

9 [MEANINGFUL USE STAGE 2 REPORTING] P. 9 OF 97 Patient Reminder window with actual method drop-don selection matching Preference for Reminders value. Past Encounters tab with checkmark and comments indicating Patient Reminder was amended.

10 [MEANINGFUL USE STAGE 2 REPORTING] P. 10 OF 97 Setup Requirements NOTE: For reminders to be counted in the numerator, user must have set up and accommodated the patient s preferred communication medium. Chart > Demographics > Patient Info > Update > specify method of communication in Preference for Reminders drop-down. NOTE: Preference for Reminders field is distinct from Contact Preference field. Preference for Reminders drop-down, which includes Decline to Receive option. Additional Information The provider is permitted, but not required, to limit the measure of this objective to those patients whose records are maintained using certified EHR technology (CEHRT). EPs meet the aspect of per patient preference of this objective if they are accommodating known reasonable requests in accordance with the HIPAA Privacy Rule, as specified at 45 CFR (b), which is the guidance established for accommodating patient requests. An EP should use clinically relevant information stored within the CEHRT to identify patients who should receive reminders. To count for the measure, reminders for preventive/follow-up care must be for care that the patient is not already scheduled to receive. Reminders for referrals or to engage in certain activities are also included in this objective and measure.

11 [MEANINGFUL USE STAGE 2 REPORTING] P. 11 OF 97 Reminders must be sent using the preferred communication medium only when it is known by the provider. This is limited to the type of communication (phone, mail, secure messaging, etc.) and does not extend to other constraints like time of day. Patients may decline to provide their preferred communication medium in which case the provider may select the communication medium. A patient may also decline to receive reminders. In order to meet this objective and measure, an EP must use the capabilities and standards of CEHRT at 45 CFR (a)(14). Core Objective 17: Use Secure Electronic Messaging Objective Use secure electronic messaging to communicate with patients on relevant health information. Measure A secure message was sent using the electronic messaging function of CEHRT by more than 5 percent of unique patients (or their authorized representatives) seen by the EP during the EHR reporting period. 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 3Mbps broadband availability according to the latest information available from the FCC on the first day of the EHR reporting period. Numerator: The number of patients or patientauthorized representatives in the denominator who send a secure electronic message to the EP that is received using the electronic messaging function of CEHRT during the EHR reporting period. Denominator: Number of unique patients seen by the EP during the EHR reporting period.

12 [MEANINGFUL USE STAGE 2 REPORTING] P. 12 OF 97 Secure Message being sent by a patient from their Patient Portal site. Setup Requirements NOTE: o To access the Patient Portal, the clinic s Patient Portal account for the practice must first be set up. If your clinic s account has not yet been set up, please contact Sevocity Support. Each clinic user must be granted the correct privilege to access the Patient Portal. Tools > Security Administration > Add New User (or Add Existing User or Edit User) > (Patient Portal) select Can access portal inbox Additional Information An EP or staff member could decide that a follow-up telephone call or office visit is more appropriate to address the concerns raised in the electronic message. There is not an expectation that the EP must personally respond to electronic messages to the patient. In order to meet this objective and measure, an EP must use the capabilities and standards of CEHRT at 45 CFR (e) (3).

13 [MEANINGFUL USE STAGE 2 REPORTING] P. 13 OF 97 Clinical Staff Objective 1 (Core): CPOE for Medication, Laboratory and Radiology Orders (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. Measure Exclusion More than 60 percent of medication, 30 percent of laboratory, and 30 percent of radiology orders created by the EP during the EHR reporting period are recorded using CPOE. Any EP who writes fewer than 100 medication, radiology, or laboratory orders during the EHR reporting period. Numerator: The number of orders in the denominator recorded using CPOE. Denominator: Number of medication orders created by the EP during the EHR reporting period. Patient must be seen by the EP during the EHR reporting period with an office visit with any of the following encounter types: Procedure OB Initial Visit Multi-System/ Exam OB Follow Up Immunization OB Postpartum Urgent Care In Sevocity/Rcopia: Medications Encounter > Medications > Manage/Prescribe Meds > medication CPOE orders in Rcopia.

14 [MEANINGFUL USE STAGE 2 REPORTING] P. 14 OF 97 Measure 1: Medication Completed prescription displayed in Review Prescription pane in Rcopia. Sevocity Medications tab updated after medication ordered in Rcopia.

15 [MEANINGFUL USE STAGE 2 REPORTING] P. 15 OF 97 In Sevocity: Orders/Procedure Encounter > Orders/Procedure > Orders/Referrals > Add orders by category or CPT Master List Measure 2: Laboratory. Sevocity Orders/Procedure tab displaying both Radiology and Laboratory orders created using CPOE.

16 [MEANINGFUL USE STAGE 2 REPORTING] P. 16 OF 97 In Sevocity: Orders/Procedure Encounter > Orders/Procedure > Orders/Referrals > Add orders by category or CPT Master List Measure 3: Radiology Sevocity Orders/Procedure tab displaying both Radiology and Laboratory orders created using CPOE. Additional Information The provider is permitted, but not required, to limit the measure of this objective to those patients whose records are maintained using certified EHR technology (CEHRT). The CPOE function must be used to create the first record of the order that becomes part of the patient's medical record and before any action can be taken on the order to count in the numerator.

17 [MEANINGFUL USE STAGE 2 REPORTING] P. 17 OF 97 However, in some situations it may be impossible or inadvisable to wait to initiate an intervention until a record of the order has been created. For example, situations where an intervention is identified and immediately initiated by the provider, or initiated immediately after a verbal order by the ordering provider to a licensed healthcare professional under his/her direct supervision. Therefore in these situations, so long as the order is entered using CPOE by a licensed healthcare professional or certified medical assistant to create the first record of that order as it becomes part of the patient s medical record, these orders would count in the numerator of the CPOE measure. 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. Electronic transmittal of the medication order is not a requirement for meeting the measure of this objective. CPOE is the entry of the order into the patient's EHR that uses a specific function of CEHRT. It is not how that order is filled or otherwise carried out. Objective 2 (Core): e-prescribing (erx) (If clinical user is a provider agent) Objective Generate and transmit permissible prescriptions electronically (erx). Measure More than 50 percent of all permissible prescriptions, or all prescriptions, written by the EP are queried for a drug formulary and transmitted electronically using CEHRT. Exclusion Any EP who: 1) Writes fewer than 100 permissible prescriptions during the EHR reporting period. 2) Does not have a pharmacy within their organization and there are no pharmacies that accept electronic prescriptions within 10 miles of the EP's practice location at the start of his/her EHR reporting period.

18 [MEANINGFUL USE STAGE 2 REPORTING] P. 18 OF 97 Numerator: The number of prescriptions in the denominator generated, queried for a drug formulary and transmitted electronically using CEHRT. Denominator: Number of prescriptions written for drugs requiring a prescription in order to be dispensed other than controlled substances during the EHR reporting period; or Number of prescriptions written for drugs requiring a prescription in order to be dispensed during the EHR reporting period. Patient must be seen by the EP during the EHR reporting period with an office visit with any of the following encounter types: Procedure OB Initial Visit Multi-System/ Exam OB Follow Up Immunization OB Postpartum Urgent Care

19 In Sevocity/Rcopia: Medications USER CONFERENCE 2014 [MEANINGFUL USE STAGE 2 REPORTING] P. 19 OF 97 Encounter > Medications > Manage/Prescribe Meds > drug prescription in Rcopia. Rcopia Prescribe screen showing pharmacy, formulary, and erx signed and sent status message.

20 [MEANINGFUL USE STAGE 2 REPORTING] P. 20 OF 97 Updated Medications tab in Sevocity after erx signed and sent in Rcopia. Additional Information The provider is permitted, but not required, to limit the measure of this objective to those patients whose records are maintained using certified EHR technology (CEHRT). Authorizations for items such as durable medical equipment, or other items and services that may require EP authorization before the patient could receive them, are not included in the definition of prescriptions. These are excluded from the numerator and the denominator of the measure. Instances where patients specifically request a paper prescription may not be excluded from the denominator of this measure. The denominator includes all prescriptions written by the EP during the EHR reporting period. As electronic prescribing of controlled substances is now possible, providers can choose to include all prescriptions or only permissible prescriptions as long as the decision applies to all patients and for the entire EHR reporting period. The determination of whether a prescription is a ''permissible prescription'' for purposes of this measure should be made based on the guidelines for prescribing Schedule II-V controlled substances in effect on or before January 13, 2010.

21 [MEANINGFUL USE STAGE 2 REPORTING] P. 21 OF 97 An EP needs to use CEHRT as the sole means of creating the prescription, and when transmitting to an external pharmacy that is independent of the EP's organization such transmission must use standards adopted for EHR technology certification. EPs should include in the numerator and denominator both types of electronic transmissions (those within and outside the organization) for the measure of this objective. For purposes of counting prescriptions "generated and transmitted electronically," we consider the generation and transmission of prescriptions to occur concurrently if the prescriber and dispenser are the same person and/or are accessing the same record in an integrated EHR to creating an order in a system that is electronically transmitted to an internal pharmacy. Prescriptions transmitted electronically within an organization (the same legal entity) do not need to use the NCPDP standards. However, an EP's EHR must meet all applicable certification criteria and be certified as having the capability of meeting the external transmission requirements of (b). In addition, the EHR that is used to transmit prescriptions within the organization would need to be CEHRT. For more information, refer to ONC s FAQ at In order to meet this objective and measure, an EP must use the capabilities and standards of CEHRT at 45 CFR (b) (3) and 45 CFR (a) (10). Objective 4 (Core): Record Vital Signs Objective Measure Record and chart changes in the following vital signs: Height/length (no age limit); 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. More than 80% of all unique patients seen by the EP have blood pressure (for patients age 3 and over only) and/or height and weight (for all ages) recorded as structured data.

22 [MEANINGFUL USE STAGE 2 REPORTING] P. 22 OF 97 Exclusion Any EP who: 1) Sees no patients 3 years or older is excluded from recording blood pressure. 2) Believes that all 3 vital signs of height/length, weight, and blood pressure have no relevance to their scope of practice is excluded from recording them. 3) Believes that height/length and weight are relevant to their scope of practice, but blood pressure is not, is excluded from recording blood pressure. 4) Believes that blood pressure is relevant to their scope of practice, but height/length and weight are not, is excluded from recording height/length and weight. Numerator: Number of patients in the denominator who have at least one entry of their height/length and weight (all ages) and/or blood pressure (ages 3 and over) recorded as structured data. Denominator: Number of unique patients seen by the EP during the EHR reporting period with an office visit with any of the following encounter types: Procedure OB Initial Visit Multi-System/ Exam OB Follow Up Immunization OB Postpartum Urgent Care

23 [MEANINGFUL USE STAGE 2 REPORTING] P. 23 OF 97 In Sevocity: Vitals Encounter > Vitals > Encounter > Add/Retake Vitals > document Height/Length, Weight, (auto calculates BMI) and Blood Pressure. Vital Signs window- date defaults to match Encounter Date. NOTE: This screen might look different due to clinic setup preferences. To customize, go to Tools > Preferences > User (CLINIC) > (Clinic Settings) General > Configure Vitals.

24 [MEANINGFUL USE STAGE 2 REPORTING] P. 24 OF 97 Vitals tab display of structured data entries and link buttons to growth charts required for MU2 Core Objective 4. Additional Information The provider is permitted, but not required, to limit the measure of this objective to those patients whose records are maintained using certified EHR technology. If the EP meets exclusion (3) or exclusion (4) they must both attest to the exclusion and report the numerator and denominator for the remaining elements of the measure. The only information required to be inputted by the provider is the height and weight, and/or blood pressure of the patient. The certified EHR technology will calculate BMI and the growth chart if applicable to patient based on age. Height, weight, and blood pressure do not have to be updated by the EP at every patient encounter. The EP can make the determination based on the patient s individual circumstances as to whether height, weight, and blood pressure need to be updated. Vital sign information can be entered into the patient's medical record in a number of ways including: direct entry by the EP; entry by a designated individual from the EP s staff; data transfer from another provider electronically, through an HIE or through other methods; or data entered directly by the patient through a portal or other means. Some of these methods are more accurate than others, and it is up to the EP to determine the level of accuracy needed to care for their patient and how best to obtain this information. In order to meet this objective and measure, an EP must use the capabilities and standards of certified EHR technology (CEHRT) at 45 CFR (a) (4).

25 [MEANINGFUL USE STAGE 2 REPORTING] P. 25 OF 97 Core Objective 5: Record Smoking Status Objective Record smoking status for patients 13years old or older. Measure More than 80 percent of all unique patients 13 years old or older seen by the EP have smoking status recorded as structured data. Exclusion Any EP that neither sees nor admits any patients 13 years old or older. Numerator: Number of patients in the denominator with smoking status recorded as structured data. Denominator: Number of unique patients age 13 or older seen by the EP during the EHR reporting period with one of the following encounter types: Procedure OB Initial Visit Multi-System/ Exam OB Follow Up Immunization OB Postpartum Urgent Care In Sevocity: Past History Encounter > Past History > Structured >Social History > Smoking Status > select Smoking status from drop-down.

26 [MEANINGFUL USE STAGE 2 REPORTING] P. 26 OF 97 Available selections that satisfy Smoking status structured data attestation requirements. Setup Requirements NOTE: To have access to Smoking status in the Past History tab, user must have correct preferences assigned. Tools > Preferences > User (Provider s Name) > Encounter Customizations > Clinical Content > Begin Edit > Past History > Social History > add Smoking status.

27 [MEANINGFUL USE STAGE 2 REPORTING] P. 27 OF 97 Smoking status added to structured Social History using Clinical Content Tool Additional Information The provider is permitted, but not required, to limit the measure of this objective to those patients whose records are maintained using certified EHR technology. This is a check of the medical record for patients 13 years old or older. If this information is already in the medical record available through certified EHR technology, an inquiry does not need to be made every time a provider sees a patient 13 years old or older. The frequency of updating this information is left to the provider and guidance is provided already from several sources in the medical community. In order to meet this objective and measure, an EP must use the capabilities and standards of CEHRT at 45 CFR (a) (11). Objective 9 (Core): Protect Electronic Health Information Objective Protect electronic health information created or maintained by the certified EHR technology (CEHRT) through the implementation of appropriate technical capabilities.

28 [MEANINGFUL USE STAGE 2 REPORTING] P. 28 OF 97 Measure Conduct or review a security risk analysis in accordance with the requirements under 45 CFR (a) (1), including addressing the encryption/security of data stored in CEHRT in accordance with requirements under 45 CFR (a) (2) (iv) and 45 CFR (d) (3), and implement security updates as necessary and correct identified security deficiencies as part of the provider's risk management process for EPs. Exclusion No exclusion. Yes: Eligible professionals (EPs) must attest YES to conducting or reviewing a security risk analysis and implementing security updates as needed to meet this measure. No In Sevocity: Login, Administrative, No Activity Log Off, Log Reports, HIPAA disclosures, Latest Updates Login: Allows three attempts. If failed, then a lockout or wait period is imposed. Log In window displaying temporary lockout message. Administrative: Sevocity Administrators have full access to administrative functionality including: application and data analysis and issue resolution; system backups and restorations; password administration; database management; auditing; and security. No Activity Logoff: Sevocity logs any user off after a period of no activity. The Security Administrator configures this.

29 [MEANINGFUL USE STAGE 2 REPORTING] P. 29 OF 97 Log Reports: User activities are logged and available for reporting by Clinic/Security Administrators. HIPAA: All exported data is password protected. Latest Updates: Sevocity updates are performed each time a user launches Sevocity. Additional Information EPs must conduct or review a security risk analysis of CEHRT including addressing encryption/security of data, and implement updates as necessary at least once prior to the end of the EHR reporting period and attest to that conduct or review. The testing could occur prior to the beginning of the first EHR reporting period. However, a new review would have to occur for each subsequent reporting period. The parameters of the security risk analysis are defined 45 CFR (a) (1) which was created by the HIPAA Security Rule. Meaningful use does not impose new or expanded requirements on the HIPAA Security Rule nor does it require specific use of every certification and standard that is included in certification of EHR technology. More information on the HIPAA Security Rule can be found at In order to meet this objective and measure, an EP must use the capabilities and standards of CEHRT at 45 CFR (d) (4), (d) (2), (d) (3), (d) (7), (d) (1), (d) (5), (d) (6), (d) (8), and (d) (9). Objective 10 (Core): Clinical Lab Test Results into EHR as Structured Data Objective Measure Exclusion Incorporate clinical lab-test results EHR as structured data. More than 55 percent of all clinical lab tests results ordered by the EP during the EHR reporting period whose results are either in a positive/negative or numerical format are incorporated in Certified EHR Technology as structured data. Any EP who orders no lab tests where results are either in a positive/negative affirmation or numeric format during the EHR reporting period. Numerator: Number of lab test results which are expressed in a positive or negative affirmation or as a numeric result which are incorporated as structured data. Denominator: Number of lab tests ordered during the EHR reporting period by the EP whose results are expressed in a positive or negative affirmation or as a number.

30 Setup Requirements USER CONFERENCE 2014 [MEANINGFUL USE STAGE 2 REPORTING] P. 30 OF 97 An order must be created and lab results finalized before the encounters can be linked. See Core Objective 01, CPOE for Medication, Laboratory and Radiology Orders. In Sevocity: Chart Chart > Flowsheets/Labs > Scanned/E-Lab > Link Encounters > Add Link (ELab) link lab results to order encounter. Link Encounters button opens Encounter Links popup, which enables linking imported images to the original order.

31 [MEANINGFUL USE STAGE 2 REPORTING] P. 31 OF 97 Select Encounter that contains Order to link to encounter with the finalized lab results, and click OK button.

32 [MEANINGFUL USE STAGE 2 REPORTING] P. 32 OF 97 Select the E-Lab Encounter that contains the correlating Lab results to link to encounter with Order, click OK. Chart > Imported Documents > Link Encounters showing original order encounter (Enc A) and lab result encounter (Enc B) now linked.

33 [MEANINGFUL USE STAGE 2 REPORTING] P. 33 OF 97 Once the order and image results encounters are linked, an icon appears in the Imported Documents Link column. Additional Information The provider is permitted, but not required, to limit the measure of this objective to labs ordered for those patients whose records are maintained using certified EHR technology. The structured data for the numeric/quantitative test results may include positive or negative affirmations and/or numerical format that would include a reference range of numeric results and/or ratios. Structured data does not need to be electronically exchanged in order to qualify for the measure of this objective. The EP is not limited to only counting structured data received via electronic exchange, but may count in the numerator all structured data entered through manual entry through typing, option selecting, scanning, or other means. Lab results are not limited to any specific type of laboratory or to any specific type of lab test. The Medicare and Medicaid EHR Incentive Programs do not specify the use of code set standards in meeting the measure for this objective. However, the Office of the National Coordinator for Health Information Technology (ONC) has adopted Logical Observation Identifiers Names and Codes (LOINC ) version 2.27, when such codes were received within an electronic transaction from a laboratory, for the entry of structured data for this measure and made this a requirement for EHR technology to be certified. Provided the lab result is recorded as structured data and uses the standards above, there does not need to be an explicit linking between the lab result and the order placed by the physician in order to be counted in the numerator. In order to meet this objective and measure, an EP must use the capabilities and standards of CEHRT at 45 CFR (b) (5). Objective 4 (Menu): Family Health History Objective Record patient family health history as structured data. Measure More than 20 percent 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. Exclusion Any EP who has no office visits during the EHR reporting period. Numerator: The number of patients in the denominator with a structured data entry for one Denominator: Number of unique patients seen by the EP during the EHR reporting period.

34 [MEANINGFUL USE STAGE 2 REPORTING] P. 34 OF 97 or more first-degree relatives. In Sevocity: Past History Encounter > Past History > Structured > Family History > select structured item(s) with MU tag. Only items with the MU tag can be counted toward meeting the Menu 4 Family History Structured data measure. Setup Requirements NOTE: New Meaningful Use Family Health History structured nodes must be added on both the clinical and the user level. Additional Information This measure is a minimum and not a limitation on the health history that can be recorded. For patients who are asked about their family health history, but do not know their family history, it is acceptable for the provider to record the patient's family history as "unknown."

35 [MEANINGFUL USE STAGE 2 REPORTING] P. 35 OF 97 Standards require CEHRT to be able to use SNOMEDCT or the HL7 Pedigree standard to record a patient's family health history. Either a structured data entry of "unknown" or any structured data entry identified as part of the patient's family history and conforming to the standards of CEHRT at 45 CFR (a) (13) must be in the provider's CEHRT for the patient to count in the numerator. In order to meet this objective and measure, an EP must use the capabilities and standards of CEHRT at 45 CFR (a) (13). Provider Objective 1: CPOE for Medication, Laboratory and Radiology Orders (CPOE) Objective Measure Exclusion 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 percent of medication, 30 percent of laboratory, and 30 percent of radiology orders created by the EP during the EHR reporting period are recorded using CPOE. Any EP who writes fewer than 100 medication, radiology, or laboratory orders during the EHR reporting period. Numerator: The number of orders in the denominator recorded using CPOE. Denominator: Number of medication orders created by the EP during the EHR reporting period. Patient must be seen by the EP during the EHR reporting period with an office visit with any of the following encounter types: Procedure OB Initial Visit Multi-System/ Exam OB Follow Up Immunization OB Postpartum Urgent Care

36 In Sevocity/Rcopia: Medications USER CONFERENCE 2014 [MEANINGFUL USE STAGE 2 REPORTING] P. 36 OF 97 Encounter > Medications > Manage/Prescribe Meds > medication CPOE orders in Rcopia. Measure 1: Medication Completed prescription displayed in Review Prescription pane in Rcopia. Sevocity Medications tab updated after medication ordered in Rcopia.

37 [MEANINGFUL USE STAGE 2 REPORTING] P. 37 OF 97 In Sevocity: Orders/Procedure Encounter > Orders/Procedure > Orders/Referrals > Add orders by category or CPT Master List Measure 2: Laboratory Sevocity Orders/Procedure tab displaying both Radiology and Laboratory orders created using CPOE. In Sevocity: Orders/Procedure Encounter > Orders/Procedure > Orders/Referrals > Add orders by category or CPT Master List.

38 [MEANINGFUL USE STAGE 2 REPORTING] P. 38 OF 97 Measure 3: Radiology Sevocity Orders/Procedure tab displaying both Radiology and Laboratory orders created using CPOE Additional Information The provider is permitted, but not required, to limit the measure of this objective to those patients whose records are maintained using certified EHR technology (CEHRT). The CPOE function must be used to create the first record of the order that becomes part of the patient's medical record and before any action can be taken on the order to count in the numerator. However, in some situations it may be impossible or inadvisable to wait to initiate an intervention until a record of the order has been created. For example, situations where an intervention is identified and immediately initiated by the provider, or initiated immediately after a verbal order by the ordering provider to a licensed healthcare professional under his/her direct supervision. Therefore in these situations, so long as the order is entered using CPOE by a licensed healthcare professional or certified medical assistant to create the first record of that order as it becomes part of the patient s medical record, these orders would count in the numerator of the CPOE measure.

39 [MEANINGFUL USE STAGE 2 REPORTING] P. 39 OF 97 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. Electronic transmittal of the medication order is not a requirement for meeting the measure of this objective. CPOE is the entry of the order into the patient's EHR that uses a specific function of CEHRT. It is not how that order is filled or otherwise carried out. Objective 2 (Core): e-prescribing (erx) Objective Generate and transmit permissible prescriptions electronically (erx). Measure More than 50 percent of all permissible prescriptions, or all prescriptions, written by the EP are queried for a drug formulary and transmitted electronically using CEHRT. Exclusion Any EP who: 5) Writes fewer than 100 permissible prescriptions during the EHR reporting period. 6) Does not have a pharmacy within their organization and there are no pharmacies that accept electronic prescriptions within 10 miles of the EP's practice location at the start of his/her EHR reporting period. Numerator: The number of prescriptions in the denominator generated, queried for a drug formulary and transmitted electronically using CEHRT. Denominator: Number of prescriptions written for drugs requiring a prescription in order to be dispensed other than controlled substances during the EHR reporting period; or Number of prescriptions written for drugs requiring a prescription in order to be dispensed during the EHR reporting period. Patient must be seen by the EP during the EHR reporting period with an office visit with any of the following encounter types: Procedure OB Initial Visit Multi-System/ Exam OB Follow Up Immunization OB Postpartum Urgent Care

40 [MEANINGFUL USE STAGE 2 REPORTING] P. 40 OF 97 In Sevocity/Rcopia: Medications Encounter > Medications > Manage/Prescribe Meds > drug prescription in Rcopia Rcopia Prescribe screen showing pharmacy, formulary, and erx signed and sent status message.

41 [MEANINGFUL USE STAGE 2 REPORTING] P. 41 OF 97 Updated Medications tab in Sevocity after erx signed and sent in Rcopia. Additional Information The provider is permitted, but not required, to limit the measure of this objective to those patients whose records are maintained using certified EHR technology (CEHRT). Authorizations for items such as durable medical equipment, or other items and services that may require EP authorization before the patient could receive them, are not included in the definition of prescriptions. These are excluded from the numerator and the denominator of the measure. Instances where patients specifically request a paper prescription may not be excluded from the denominator of this measure. The denominator includes all prescriptions written by the EP during the EHR reporting period. As electronic prescribing of controlled substances is now possible, providers can choose to include all prescriptions or only permissible prescriptions as long as the decision applies to all patients and for the entire EHR reporting period. The determination of whether a prescription is a ''permissible prescription'' for purposes of this measure should be made based on the guidelines for prescribing Schedule II-V controlled substances in effect on or before January 13, An EP needs to use CEHRT as the sole means of creating the prescription, and when transmitting to an external pharmacy that is independent of the EP's organization such transmission must use standards adopted for EHR technology certification.

42 [MEANINGFUL USE STAGE 2 REPORTING] P. 42 OF 97 EPs should include in the numerator and denominator both types of electronic transmissions (those within and outside the organization) for the measure of this objective. For purposes of counting prescriptions "generated and transmitted electronically," we consider the generation and transmission of prescriptions to occur concurrently if the prescriber and dispenser are the same person and/or are accessing the same record in an integrated EHR to creating an order in a system that is electronically transmitted to an internal pharmacy. Prescriptions transmitted electronically within an organization (the same legal entity) do not need to use the NCPDP standards. However, an EP's EHR must meet all applicable certification criteria and be certified as having the capability of meeting the external transmission requirements of (b). In addition, the EHR that is used to transmit prescriptions within the organization would need to be CEHRT. For more information, refer to ONC s FAQ at In order to meet this objective and measure, an EP must use the capabilities and standards of CEHRT at 45 CFR (b) (3) and 45 CFR (a) (10). Objective 6 (Core): Clinical Decision Support Rule Objective Measure Use clinical decision support to improve performance on high-priority health conditions. 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 (if the provider cannot find) 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.

43 [MEANINGFUL USE STAGE 2 REPORTING] P. 43 OF 97 Measure 1 Yes: The EP implemented five clinical decision support interventions. No In Sevocity: Health Guidelines Chart > Health Guidelines/Disease Management > Retrieve or Custom (to customize a Health Guideline for a patient Measure 2 Yes: The EP has enabled and implemented the functionality for drug-drug and drug-allergy interaction checks for the entire EHR reporting period. No or Exclusion: Any EP who writes fewer than 100 medication orders during the EHR reporting period. In Sevocity/Rcopia: Medications Medications > Manage Prescribe/Meds > Manage Medications and Manage Allergies in Rcopia.

44 [MEANINGFUL USE STAGE 2 REPORTING] P. 44 OF 97 Guideline Summary pane showing Prostate cancer screening recommendation and identified interventions Setup Requirements NOTE: To enable clinical decision support interventions, users must have appropriate privilege. Tools > Security Administration > Add New User (or Add Existing User or Edit User) > (Clinical Decision Support) Can enable CDS interventions checkbox. NOTE: Users must also set up and implement health guidelines that pertain to their practice. Tools > Preferences > User (CLINIC) > Health Guidelines / Disease Management. Additional Information If none of the CQMs are applicable to an EP's scope of practice, the EP should implement CDS interventions that he or she believes will to drive improvements in the delivery of care for the high-priority health conditions relevant to their patient population. CMS will not issue additional guidance on the selection of appropriate clinical decision support rules for Stage 2 Meaningful Use. This determination is best left to the EP taking into account their workflow, patient population, and quality improvement efforts.

45 [MEANINGFUL USE STAGE 2 REPORTING] P. 45 OF 97 The need for inclusion of attributes for each CDS intervention also applies to drug-drug and drug-allergy interventions as well as interventions based on self-generated evidence. Drug-drug and drug-allergy interaction alerts are separate from the 5 clinical decision support interventions and do not count towards the 5 required for this first measure. In order to meet this objective and measure, an EP must use the capabilities and standards of CEHRT at 45 CFR (a) (8) and (a) (2). Objective 11 (Core): List of Patients by Specific Conditions Lists Objective Generate lists of patients by specific conditions to use for quality improvement, reduction of disparities, research, or outreach. Measure Generate at least one report listing patients of the EP with a specific condition. Exclusion No exclusion. In Sevocity: Reports Reports > Patient Lists Detailed > specify columns and report criteria to include in report Yes: Eligible professionals (EPs) must attest YES to having generated at least one report-listing patients of the EP with a specific condition to meet this measure. No

46 [MEANINGFUL USE STAGE 2 REPORTING] P. 46 OF 97 Patient List Detailed Reporting Tool options: checkboxes determine report columns and dropdowns specify criteria.

47 [MEANINGFUL USE STAGE 2 REPORTING] P. 47 OF 97 Patient List (Detailed) Report output matching customized format and report criteria specified in Reporting Tool. Additional Information: This objective does not dictate the report(s), which must be generated; therefore an EP or a member of the EP's staff could generate the list and meet this measure. An EP is best positioned to determine which reports are most useful to their care efforts. The report generated could cover every patient whose records are maintained using certified EHR technology (CEHRT) or a subset of those patients at the discretion of the EP. Each EHR reporting period should be identified with a different report. Reports generated in past EHR reporting periods cannot be used to satisfy this measure in the current EHR reporting period.

48 [MEANINGFUL USE STAGE 2 REPORTING] P. 48 OF 97 Core Objective 8: Clinical Summaries Objective Provide clinical summaries for patients for each office visit. Measure Clinical summaries provided to patients or patient-authorized representatives within one business day for more than 50 percent of office visits. Exclusion Any EP who has no office visits during the EHR reporting period. Numerator: Number of office visits in the denominator where the patient or a patientauthorized representative is provided a clinical summary of their visit within one (1) business day. Denominator: Number of office visits conducted by the EP during the EHR reporting period and with an office visit with any of the following coded and uncoded encounter types: Procedure OB Initial Visit Multi-System/ Exam OB Follow Up Immunization OB Postpartum Urgent Care In Sevocity: Plan/Disposition Encounter > Plan/Disposition/QM > Plan/Disposition > Print > Plan checkbox > select provider who saw patient from drop-down, and choose Print Preview, Print, or Export to Patient Portal. In Sevocity: Plan/Disposition Encounter > Plan/Disposition/QM > Plan/Disposition > ensure Clinical Summary provided to patient is checked.

49 [MEANINGFUL USE STAGE 2 REPORTING] P. 49 OF 97 Print Options popup window showing options and buttons that become active once Plan checkbox is clicked. NOTE: The Export to Patient Portal button stays grayed out if the patient has not been set up in the Patient Portal.

50 [MEANINGFUL USE STAGE 2 REPORTING] P. 50 OF 97 Plan/Disposition subtab showing Clinical Summary provided to patient checkbox selected. You can access the Clinical Summary functionality in a patient record as it suits your workflow. This includes when documenting the plan or disposition, coding, or finalizing the encounter. For the summary provided to the patient to be counted toward meeting the measure, designate the provider who saw the patient and document the summary was given to the patient. Ensure the summary provided to the patient was properly documented by verifying the Clinical Summary provided to patient checkbox is selected. This field is checked automatically upon previewing, printing, or exporting the summary. Additional Information The provider is permitted, but not required, to limit the measure of this objective to those patients whose records are maintained using certified EHR technology. The provision of the clinical summary is limited to the information contained within CEHRT. The clinical summary can be provided through a PHR, patient portal on the web site, secure e- mail, electronic media such as CD or USB fob, or printed copy. If the EP chooses an electronic media, they would be required to provide the patient a paper copy upon request. They may also default to providing paper copies, in which case an electronic form of the EP s choice would need to be provided upon request.

51 [MEANINGFUL USE STAGE 2 REPORTING] P. 51 OF 97 If an EP believes that substantial harm may arise from the disclosure of particular information, an EP may choose to withhold that particular information from the clinical summary. Providers may not charge patients a fee to provide this information. When a patient visit lasts several days or a patient is seen by multiple EPs, a single clinical summary at the end of the visit should be counted only once in both the numerator and denominator. In the event that a clinical summary is offered to and subsequently declined by the patient, that patient may still be included in the numerator of the measure. In circumstances where there is no information available to populate one or more of the fields previously listed, either because the EP can be excluded from recording such information (for example, vital signs) or because there is no information to record (for example, no medication allergies or laboratory tests), an indication that the information is not available in the clinical summary would meet the measure of this objective. Objective 9 (Core): Protect Electronic Health Information Objective Protect electronic health information created or maintained by the certified EHR technology (CEHRT) through the implementation of appropriate technical capabilities. Measure Conduct or review a security risk analysis in accordance with the requirements under 45 CFR (a) (1), including addressing the encryption/security of data stored in CEHRT in accordance with requirements under 45 CFR (a) (2) (iv) and 45 CFR (d) (3), and implement security updates as necessary and correct identified security deficiencies as part of the provider's risk management process for EPs. Exclusion No exclusion. Yes: Eligible professionals (EPs) must attest YES to conducting or reviewing a security risk analysis and implementing security updates as needed to meet this measure. No

52 [MEANINGFUL USE STAGE 2 REPORTING] P. 52 OF 97 In Sevocity: Login, Administrative, No Activity Log Off, Log Reports, HIPAA disclosures, Latest Updates Login: Allows three attempts. If failed, then a lockout or wait period is imposed. Log In window displaying temporary lockout message. Administrative: Sevocity Administrators have full access to administrative functionality including: application and data analysis and issue resolution; system backups and restorations; password administration; database management; auditing; and security. No Activity Logoff: Sevocity logs any user off after a period of no activity. The Security Administrator configures this. Log Reports: User activities are logged and available for reporting by Clinic/Security Administrators. HIPAA: All exported data is password protected. Latest Updates: Sevocity updates are performed each time a user launches Sevocity.

53 [MEANINGFUL USE STAGE 2 REPORTING] P. 53 OF 97 Additional Information EPs must conduct or review a security risk analysis of CEHRT including addressing encryption/security of data, and implement updates as necessary at least once prior to the end of the EHR reporting period and attest to that conduct or review. The testing could occur prior to the beginning of the first EHR reporting period. However, a new review would have to occur for each subsequent reporting period. The parameters of the security risk analysis are defined 45 CFR (a) (1) which was created by the HIPAA Security Rule. Meaningful use does not impose new or expanded requirements on the HIPAA Security Rule nor does it require specific use of every certification and standard that is included in certification of EHR technology. More information on the HIPAA Security Rule can be found at In order to meet this objective and measure, an EP must use the capabilities and standards of CEHRT at 45 CFR (d) (4), (d) (2), (d) (3), (d) (7), (d) (1), (d) (5), (d) (6), (d) (8), and (d) (9). Objective 10 (Core): Clinical Lab Test Results into EHR as Structured Data Objective Measure Exclusion Incorporate clinical lab-test results EHR as structured data. More than 55 percent of all clinical lab tests results ordered by the EP during the EHR reporting period whose results are either in a positive/negative or numerical format are incorporated in Certified EHR Technology as structured data. Any EP who orders no lab tests where results are either in a positive/negative affirmation or numeric format during the EHR reporting period. Numerator: Number of lab test results which are expressed in a positive or negative affirmation or as a numeric result which are incorporated as structured data. Denominator: Number of lab tests ordered during the EHR reporting period by the EP whose results are expressed in a positive or negative affirmation or as a number.

54 Setup Requirements USER CONFERENCE 2014 [MEANINGFUL USE STAGE 2 REPORTING] P. 54 OF 97 An order must be created and lab results finalized before the encounters can be linked. See Core Objective 01, CPOE for Medication, Laboratory and Radiology Orders. In Sevocity: Chart Chart > Flowsheets/Labs > Scanned/E-Lab > Link Encounters > Add Link (ELab) link lab results to order encounter. Link Encounters button opens Encounter Links popup, which enables linking imported images to the original order.

55 [MEANINGFUL USE STAGE 2 REPORTING] P. 55 OF 97 Select Encounter that contains Order to link to encounter with the finalized lab results, and click OK button.

56 [MEANINGFUL USE STAGE 2 REPORTING] P. 56 OF 97 Select the E-Lab Encounter that contains the correlating Lab results to link to encounter with Order, click OK.

57 [MEANINGFUL USE STAGE 2 REPORTING] P. 57 OF 97 Chart > Imported Documents > Link Encounters showing original order encounter (Enc A) and lab result encounter (Enc B) now linked. Once the order and image results encounters are linked, an icon appears in the Imported Documents Link column. Additional Information The provider is permitted, but not required, to limit the measure of this objective to labs ordered for those patients whose records are maintained using certified EHR technology. The structured data for the numeric/quantitative test results may include positive or negative affirmations and/or numerical format that would include a reference range of numeric results and/or ratios. Structured data does not need to be electronically exchanged in order to qualify for the measure of this objective. The EP is not limited to only counting structured data received via electronic exchange, but may count in the numerator all structured data entered through manual entry through typing, option selecting, scanning, or other means. Lab results are not limited to any specific type of laboratory or to any specific type of lab test. The Medicare and Medicaid EHR Incentive Programs do not specify the use of code set standards in meeting the measure for this objective. However, the Office of the National Coordinator for Health Information Technology (ONC) has adopted Logical Observation

58 [MEANINGFUL USE STAGE 2 REPORTING] P. 58 OF 97 Identifiers Names and Codes (LOINC ) version 2.27, when such codes were received within an electronic transaction from a laboratory, for the entry of structured data for this measure and made this a requirement for EHR technology to be certified. Provided the lab result is recorded as structured data and uses the standards above, there does not need to be an explicit linking between the lab result and the order placed by the physician in order to be counted in the numerator. In order to meet this objective and measure, an EP must use the capabilities and standards of CEHRT at 45 CFR (b) (5). Objective 13 (Core): Patient-Specific Education Resources Objective Use clinically relevant information from Certified EHR Technology to identify patientspecific education resources and provide those resources to the patient. Measure Patient-specific education resources identified by Certified EHR Technology 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. Numerator: Number of patients in the denominator who were provided patient-specific education resources identified by the EHR. Denominator: Number of unique patients with office visits seen by the EP during the EHR reporting period. Patient must be seen by the EP during the EHR reporting period with an office visit with any of the following encounter types: Procedure OB Initial Visit Multi-System/ Exam OB Follow Up Immunization OB Postpartum Urgent Care To meet the measure, you can access patient education resources via the following areas. In Sevocity: Labs Chart > Flowsheets/Labs > Scanned/E-Labs > select the lab and click the Pt Ed button. Encounter > Flowsheets/Labs > Scanned/E-Labs > select the lab and click the Pt Ed button.

59 Assessment Medications Immunizations USER CONFERENCE 2014 [MEANINGFUL USE STAGE 2 REPORTING] P. 59 OF 97 Chart > Medications/Assessments > select the assessment and click the Pt Ed button Encounter > Assessment > select the assessment and click the Pt Ed button. Chart > Medications/Assessments > click medication hyperlink to access patient education resource options. Encounter > Medications > click medication hyperlink to access patient education resource options. Encounter > Immunizations > Add > (Administration) click VIS button, select immunization publication, and then Preview or Print (activates Education provided button and inserts VIS Pub. Date). To ensure the patient visit is counted toward meeting the measure, document that the applicable resources identified by Sevocity were provided to the patient. In Sevocity: Plan/Disposition/QM Encounter > Plan/Disposition/QM > Plan/Disposition > click Handouts given to patient checkbox Scanned/E-Labs subtab on Encounter showing Pt Ed link and popup message RE: external lab test education resource.

60 [MEANINGFUL USE STAGE 2 REPORTING] P. 60 OF 97 Assessment tab on Encounter showing close-up of Pt Ed link to external diagnosis education resource. Medications tab on Encounter showing hyperlink popup options to external medication education resource.

61 [MEANINGFUL USE STAGE 2 REPORTING] P. 61 OF 97 VIS button on Add Immunization window opens popup to select Vaccine Information Statement education handout.

62 [MEANINGFUL USE STAGE 2 REPORTING] P. 62 OF 97 Plan/Disposition subtab on Encounter showing Handouts given to patient checkbox that must be selected. Note Display tab on Encounter showing comment added upon clicking Handouts given to patient checkbox.

63 Additional Information USER CONFERENCE 2014 [MEANINGFUL USE STAGE 2 REPORTING] P. 63 OF 97 Unique patients with office visits means that to count in the denominator a patient must be seen by the EP for one or more office visits during the EHR reporting period, but if a patient seen by the EP more than once during the EHR reporting period, the patient only counts once in the denominator. Education resources or materials do not have to be stored within or generated by the certified EHR. However, the provider should utilize certified EHR technology (CEHRT) in a manner where the technology suggests patient-specific educational resources based on the information stored in the CEHRT. The provider can make a final decision on whether the education resource is useful and relevant to a specific patient. While CEHRT must be used to identify patient-specific education resources, these resources or materials do not have to be stored within or generated by the CEHRT. Certified EHR technology is certified to use the patient's problem list, medication list, or laboratory test results to identify the patient-specific educational resources. The EP may use these elements or additional elements within CEHRT to identify educational resources specific to patients' needs. The EP can then provide these educational resources to patients in a useful format for the patient (such as, electronic copy, printed copy, electronic link to source materials, through a patient portal or PHR). If resources or topic area of resources are not identified by CEHRT and provided to the patient then it will not count in the numerator. The education resources will need to be provided prior to the calculation and subsequent attestation to meaningful use. In order to meet this objective and measure, an EP must use the capabilities and standards of CEHRT at 45 CFR (a) (15).

64 [MEANINGFUL USE STAGE 2 REPORTING] P. 64 OF 97 Objective 14 (Core): Medication Reconciliation Objective The EP who receives a patient from another setting of care or provider of care or believes an encounter is relevant should perform medication reconciliation. Measure The EP who 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. Numerator: The number of transitions of care in the denominator where medication reconciliation was performed. Denominator: Number of transitions of care during the EHR reporting period for which the EP was the receiving party of the transition. Patient must be seen by the EP during the EHR reporting period with an office visit with any of the following encounter types: Procedure OB Initial Visit Multi-System/ Exam OB Follow Up Immunization OB Postpartum Urgent Care

65 In Sevocity/Rcopia: Medications USER CONFERENCE 2014 [MEANINGFUL USE STAGE 2 REPORTING] P. 65 OF 97 Encounter > Medications > Manage/Prescribe Meds > Manage Meds-Add a Medication in Rcopia and Return to EMR > Ensure Medication Reconciliation Performed is checked in Sevocity In Sevocity: Coding Encounter > Coding > Ensure Encounter Related to Transition of Care into Clinic is checked Clicking Manage Meds menu link in Rcopia provides access to Add a Medication prescribed by another provider.

66 [MEANINGFUL USE STAGE 2 REPORTING] P. 66 OF 97 Activating Medication Reconciliation Performed checkbox for added medication(s) triggers inclusion in numerator.

67 [MEANINGFUL USE STAGE 2 REPORTING] P. 67 OF 97 Activating Encounter Related to Transition of Care into Clinic checkbox triggers inclusion in denominator. Additional Information Only patients whose records are maintained using certified EHR technology must be included in the denominator for transitions of care. In the case of reconciliation following transition of care, the receiving EP should conduct the medication reconciliation. The electronic exchange of information is not a requirement for medication reconciliation. The measure of this objective does not dictate what information must be included in medication reconciliation. Information included in the process of medication reconciliation is appropriately determined by the provider and patient. In order to meet this objective and measure the EP must use the capabilities and standards of CEHRT at 45 CFR (b) (4), (g) (1), and (g) (2).

68 [MEANINGFUL USE STAGE 2 REPORTING] P. 68 OF 97 Objective 15 (Menu): Summary of Care Objective The EP who transitions their patient to another setting of care or provider of care or refers their patient to another provider of care should provide summary care record for each transition of care or referral. Measure EPs must satisfy both of the following measures in order to meet the objective: Measure 1: The EP who transitions or refers their patient to another setting of care or provider of care provides a summary of care record for more than 50 percent of transitions of care and referrals. Measure 2: The EP who transitions or refers their patient to another setting of care or provider of care provides a summary of care record for more than 10 percent of such transitions and referrals either (a) electronically transmitted using CEHRT to a recipient or (b) where the recipient receives the summary of care record via exchange facilitated by an organization that is a NwHIN Exchange participant or in a manner that is consistent with the governance mechanism ONC establishes for the NwHIN. Measure 3: An EP must satisfy one of the following criteria: Conducts one or more successful electronic exchanges of a summary of care document, as part of which is counted in "measure 2" (for EPs the measure at 495.6(j) (14) (ii) (B) with a recipient who has EHR technology that was developed designed by a different EHR technology developer than the sender's EHR technology certified to 45 CFR (b) (2). Conducts one or more successful tests with the CMS designated test EHR during the EHR reporting period. 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 is excluded from all three measures. Setup Requirements NOTE: To set up recipient s contact information to send Summary of Care with referral: Tools > Preferences > User (CLINIC) > (Contacts List) Contact List > Begin Edit > Type (Professional) Add (or Change) > Add Secure for professional contact.

69 In Sevocity: Referrals USER CONFERENCE 2014 [MEANINGFUL USE STAGE 2 REPORTING] P. 69 OF 97 Chart > Referrals > Add > Ensure Summary of Care Record Provided checkbox is selected when adding referral request Measure 1 Numerator: The number of transitions of care and referrals in the denominator where a summary of care record was provided. Denominator: Number of transitions of care and referrals during the EHR reporting period for which the EP was the transferring or referring provider. Summary of Care Record Provided checkbox selected when adding referral request.

70 [MEANINGFUL USE STAGE 2 REPORTING] P. 70 OF 97 Measure 2 Numerator: The number of transitions of care and referrals in the denominator where a summary of care record was: a) electronically transmitted using CEHRT to a recipient or Denominator: Number of transitions of care and referrals during the EHR reporting period for which the EP was the transferring or referring provider. b) where the recipient receives the summary of care record via exchange facilitated by an organization that is a NwHIN Exchange participant or in a manner that is consistent with the governance mechanism ONC establishes for the nationwide health information network. The organization can be a third-party or the sender's own organization. Referral transmitted via PDX.

71 [MEANINGFUL USE STAGE 2 REPORTING] P. 71 OF 97 Summary of Care (C-CDA) received via PDX. Measure 3 Yes: Conducts one or more successful electronic exchanges of a summary of care document, as part of which is counted in "measure 2" (for EPs the measure at 495.6(j) (14) (ii) (B) with a recipient who has EHR technology that was developed designed by a different EHR technology developer than the sender's EHR technology certified to 45 CFR (b) (2). or Conducts one or more successful tests with the CMS designated test EHR during the EHR reporting period. No or 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 is excluded from all three measures.

72 [MEANINGFUL USE STAGE 2 REPORTING] P. 72 OF 97 Additional Information Only patients whose records are maintained using certified EHR technology must be included in the denominator for transitions of care. The EP that transfers or refers the patient to another setting of care or provider should provide the summary of care document. It is for this provider that has the most recent information on the patient that may be crucial to the provider to whom the patient is transferred or referred. The EP can send an electronic or paper copy of the summary care record directly to the next provider or can provide it to the patient to deliver to the next provider, if the patient can reasonably expected to do so and meet Measure 1. If the provider to whom the referral is made or to whom the patient is transitioned to has access to the medical record maintained by the referring provider then the summary of care record would not need to be provided, and that patient must not be included in the denominator for transitions of care. To count in the numerator of any measure, the EP must verify these three fields for current problem list, current medication list, and current medication allergy list are not blank and include the most recent information known by the EP or hospital as of the time of generating the summary of care document. To count in the numerator of measure 2, the summary of care record must be received by the provider to whom the sending provider is referring or transferring the patient. To count in the numerator of measure 2, one of the following three transmission approaches must be used: Use of the transport standard capability required for certification. As required by ONC to meet the CEHRT definition, every EP, eligible hospital, and CAH, must have EHR technology that is capable of electronically transmitting a summary care record for transitions of care and referrals according to the primary Direct Project specification (the Applicability Statement for Secure Health Transport). Thus, EPs, eligible hospitals, or CAHs that electronically transmit summary care records using their CEHRT s Direct capability (natively or combined with an intermediary) would be able to count all such electronic transmissions in their numerator. Use of the SOAP-based optional transport standard capability permitted for certification. As part of certification, ONC permits EHR technology developers to voluntarily seek certification for their EHR technology s capability to perform SOAP-based electronic transmissions. EHR technology developers who take this approach would enable their customers to also use this approach to meet the measure. Thus, EPs, eligible hospitals, or CAHs that electronically transmit summary care records using their CEHRT s SOAP-based capability (natively or combined with an intermediary) would be able to count all of those transmissions in their numerator.

73 [MEANINGFUL USE STAGE 2 REPORTING] P. 73 OF 97 Use of CEHRT to create a summary care record in accordance with the required standard (i.e., Consolidated CDA as specified in 45 CFR (b)(2)), and the electronic transmission is accomplished through the use of an ehealth Exchange participant who enables the electronic transmission of the summary care record to its intended recipient. Thus, EPs, eligible hospitals, or CAHs who create standardized summary care records using their CEHRT and then use an ehealth Exchange participant to electronically transmit the summary care record would be able to count all of those transmissions in their numerator. Objective 2 (Menu): Electronic Notes Objective Record electronic notes in patient records. Measure Enter at least one electronic progress note created, edited and signed by an EP for more than 30 percent 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 Exclusion No exclusion. Numerator: Number of unique patients with at least one office visit during the EHR reporting period for EPs during the EHR reporting period. Denominator: The number of unique patients in the denominator who have at least one electronic progress note from an eligible professional recorded as text searchable data. In Sevocity: Tools Tools > Progress Note > Select patient, add Summary and progress note, and then Finalize (or Finalize and Route) Optional: click on magnifying glass to open find text popup. In Sevocity: Past Encounters Chart > Past Encounters > (Get Next 5 Encounters) select progress note > Amend > Add and Save Amendments to progress note. Optional: click on magnifying glass to open find text popup. Additional Information Any EP as defined for the Medicare or Medicaid EHR Incentive Programs may author, edit, and provide an electronic signature for the electronic notes in order for them to be considered for this measure.

74 [MEANINGFUL USE STAGE 2 REPORTING] P. 74 OF 97 An EP or authorized provider may author, edit and sign the note in any manner including dictation, conversion of written notes to text searchable notes, direct entry into the EHR or any other method as long as the end result is a text searchable note that is the information that the EP or authorized provider wanted to note. Non-searchable notes do not qualify, but this does not mean that all of the content has to be character text. Drawings and other content can be included with searchable text notes under this measure. In order to meet this objective and measure, an EP must use the capabilities and standards of CEHRT at 45 CFR (a) (9). Objective 3 (Menu): Imaging Results Objective Imaging results consisting of the image itself and any explanation or other accompanying information are accessible through CEHRT. Measure More than 10 percent of all tests whose result is one or more images ordered by the EP during the EHR reporting period are accessible through CEHRT. Exclusion Any EP who orders less than 100 tests whose result is an image during the EHR reporting period; or any EP who has no access to electronic imaging results at the start of the EHR reporting period. Numerator: The number of results in the denominator that are accessible through CEHRT. Denominator: Number of tests whose result is one or more images ordered by the EP during the EHR reporting period.

75 Setup Requirements USER CONFERENCE 2014 [MEANINGFUL USE STAGE 2 REPORTING] P. 75 OF 97 An order must be created and image results imported before the encounters can be linked. See Core Objective 01, CPOE for Medication, Laboratory and Radiology Orders. In Sevocity: Chart Chart > Imported Documents > Link Encounters > link image results to order encounter. Link Encounters button opens Encounter Links popup, which enables linking imported images to the original order.

76 [MEANINGFUL USE STAGE 2 REPORTING] P. 76 OF 97 Select Encounter that contains Order to link to encounter with imported Image results, and click OK.

77 [MEANINGFUL USE STAGE 2 REPORTING] P. 77 OF 97 Select Encounter that contains imported Image results to link to encounter with Order. Encounter Links popup showing original order encounter (Enc A) and image result encounter (Enc B) now linked.

78 [MEANINGFUL USE STAGE 2 REPORTING] P. 78 OF 97 Once the order and image results encounters are linked, an icon appears in the Imported Documents Link column.

79 [MEANINGFUL USE STAGE 2 REPORTING] P. 79 OF 97 Clicking the Linked Encounter hyperlink or the imported file s Link icon opens the Linked Encounter summary. Additional Information There are no limitations on the resolution of the image. Storing the images natively in CEHRT is one way to make them accessible through CEHRT, but there are many other ways and native storage is not required by the objective and measure. Images and imaging results that are scanned into the CEHRT may be counted in the numerator of this measure. In order to meet this objective and measure, an EP must use the capabilities and standards of CEHRT at 45 CFR (a) (12).

80 [MEANINGFUL USE STAGE 2 REPORTING] P. 80 OF 97 Administrative Objective 11 (Core): Patient Lists Objective Generate lists of patients by specific conditions to use for quality improvement, reduction of disparities, research, or outreach. Measure Generate at least one report listing patients of the EP with a specific condition. Exclusion No exclusion. In Sevocity: Reports Reports > Patient Lists Detailed > specify columns and report criteria to include in report. Yes: Eligible professionals (EPs) must attest YES to having generated at least one report-listing patients of the EP with a specific condition to meet this measure. No

81 [MEANINGFUL USE STAGE 2 REPORTING] P. 81 OF 97 Patient List Detailed Reporting Tool options: checkboxes determine report columns and dropdowns specify criteria.

82 [MEANINGFUL USE STAGE 2 REPORTING] P. 82 OF 97 Patient List (Detailed) Report output matching customized format and report criteria specified in Reporting Tool. Additional Information This objective does not dictate the report(s), which must be generated; therefore an EP or a member of the EP's staff could generate the list and meet this measure. An EP is best positioned to determine which reports are most useful to their care efforts. The report generated could cover every patient whose records are maintained using certified EHR technology (CEHRT) or a subset of those patients at the discretion of the EP. Each EHR reporting period should be identified with a different report. Reports generated in past EHR reporting periods cannot be used to satisfy this measure in the current EHR reporting period. Objective (Core) 16: Immunization Registries Data Submission Objective Capability to submit electronic data to immunization registries or immunization information systems except where prohibited, and in accordance with applicable law and practice. Measure Successful ongoing submission of electronic immunization data from CEHRT to an immunization registry or immunization information system for the entire EHR reporting period.

83 [MEANINGFUL USE STAGE 2 REPORTING] P. 83 OF 97 Exclusion Any EP that meets one or more of the following criteria may be excluded from this objective: 1) the EP does not administer any of the immunizations to any of the populations for which data is collected by their jurisdiction's immunization registry or immunization information system during the EHR reporting period; 2) the EP operates in a jurisdiction for which no immunization registry or immunization information system is capable of accepting the specific standards required for CEHRT at the start of their EHR reporting period; 3) the EP operates in a jurisdiction where no immunization registry or immunization information system provides information timely on capability to receive immunization data; 4) the EP operates in a jurisdiction for which no immunization registry or immunization information system that is capable of accepting the specific standards required by CEHRT at the start of their EHR reporting period can enroll additional EPs. Yes: The EP must attest YES to meeting one of the following criteria under the umbrella of ongoing submission. Ongoing submission was already achieved for an EHR reporting period in a prior year and continues throughout the current EHR reporting period using either the current standard at 45 CFR (f) (1) and (f) (2) or the standards included in the 2011 Edition EHR certification criteria adopted by ONC during the prior EHR reporting period when ongoing submission was achieved. Registration with the PHA or other body to whom the information is being submitted of intent to initiate ongoing submission was made by the deadline (within 60 days of the start of the EHR reporting period) and ongoing submission was achieved. Registration of intent to initiate ongoing submission was made by the deadline and the EP or hospital is still engaged in testing and validation of ongoing electronic submission. Registration of intent to initiate ongoing submission was made by the deadline and the EP or hospital is awaiting invitation to begin testing and validation.

84 [MEANINGFUL USE STAGE 2 REPORTING] P. 84 OF 97 No or Exclusion: Any EP that meets one or more of the exclusion criteria listed above. In Sevocity: Immunizations/Growth Charts Chart > Immunizations > Child > Imm Reg Export > Select desired immunization(s) and Export (as HL7 output file for transmission to immunization registry). Chart > Immunizations > Adult > Imm Reg Export > Select desired immunization(s) and Export (as HL7 output file for transmission to immunization registry). Imm Reg Export button is available for patients who have had immunizations administered.

85 [MEANINGFUL USE STAGE 2 REPORTING] P. 85 OF 97 Navigate to a local or network folder and Save the file with a name that suits your clinic standards and workflow. Setup Requirements NOTE: This objective does not have a numerator or denominator-it is just Yes or No. To provide verification that your clinic meets this measure, obtain a letter or other form of confirmation from your state or Medicaid entity responsible for the registry. NOTE: Contact Sevocity Support to startup registry interface if your clinic hasn t yet done so. Additional Information In determining whether the PHA has the capacity, CMS anticipates developing a centralized repository for this information, including a deadline for the PHA to submit information. If the PHA fails to provide information to this centralized repository by the deadline, the provider could claim the exclusion. In the event, that we are unable to develop a centralized repository, providers will make the determination of PHA capacity by working directly with the PHA as is currently the case for Stage 1 of meaningful use. The second exclusion does not apply if an entity designated by the immunization registry or immunization information system can receive electronic immunization data submissions. For example, if the immunization registry cannot accept the data directly or in the standards required by CEHRT, but if it has designated a Health Information Exchange to do so on their behalf and the Health Information Exchange is capable of accepting the information in the standards required by CEHRT, the provider could not claim the second exclusion. In order to meet this objective and measure, an EP must use the capabilities and standards of CEHRT at 45 CFR (f) (1) and (f) (2). However, if EPs prior to CY 2014 have achieved

86 [MEANINGFUL USE STAGE 2 REPORTING] P. 86 OF 97 successful ongoing submission using EHR technology certified to the 2011 Edition EHR certification criteria (HL only), it is acceptable to continue this ongoing submission and meet the Stage 2 measure for as long as HL continues to be accepted by the immunizations information system or immunization registry. Objective 1 (Menu): Syndromic Surveillance Data Submission Objective Capability to submit electronic syndromic surveillance data to public health agencies except where prohibited, and in accordance with applicable law and practice. Measure Successful ongoing submission of electronic syndromic surveillance data from CEHRT to a public health agency for the entire EHR reporting period. Exclusion Any EP that meets one or more of the following criteria may be excluded from this objective: 1) the EP is not in a category of providers that collect ambulatory syndromic surveillance information on their patients during the EHR reporting period; 2) the EP operates in a jurisdiction for which no public health agency is capable of receiving electronic syndromic surveillance data in the specific standards required by CEHRT at the start of their EHR reporting period; 3) the EP operates in a jurisdiction where no public health agency provides information timely on capability to receive syndromic surveillance data; 4) the EP operates in a jurisdiction for which no public health agency that is capable of accepting the specific standards required by CEHRT at the start of their EHR reporting period can enroll additional EPs.

87 [MEANINGFUL USE STAGE 2 REPORTING] P. 87 OF 97 Yes: EPs must attest YES to successful ongoing submission of electronic syndromic surveillance data from CEHRT to a public health agency for the entire EHR reporting period. Ongoing submission was already achieved for an EHR reporting period in a prior year and continues throughout the current EHR reporting period. No or Exclusion: Any EP that meets one or more of the exclusion criteria above. Registration with the PHA or other body to whom the information is being submitted of intent to initiate ongoing submission was made by the deadline (within 60 days of the start of the EHR reporting period) and ongoing submission was achieved. Registration of intent to initiate ongoing submission was made by the deadline and the EP or hospital is still engaged in testing and validation of ongoing electronic submission. Registration of intent to initiate ongoing submission was made by the deadline and the EP or hospital is awaiting invitation to begin testing and validation.

88 In Sevocity: Urgent Care Encounters USER CONFERENCE 2014 [MEANINGFUL USE STAGE 2 REPORTING] P. 88 OF 97 Encounter (Urgent Care encounter type only) > Plan/Disposition/QM > Plan/Disposition > Syndromic Surveillance Data > Select message type-registration or Discharge-and Export (as HL7 output file for submission to district agency.) NOTE: The Syndromic Surveillance Data button is accessible from all Encounter tabs for the Urgent Care encounter type. First, select message type to export Syndromic Surveillance Data to a file in hl7 format. Next, save the exported file for submission of the data to your public health agency.

89 [MEANINGFUL USE STAGE 2 REPORTING] P. 89 OF 97 NOTE: The Urgent Care encounter type has new fields. Encounter > HPI > Admit Date Encounter > HPI > Admit Time Encounter > Plan/Disposition/QM > Plan/Disposition > > Discharge Date Encounter > Plan/Disposition/QM > Plan/Disposition > > Time Setup Requirements NOTE: To enable clinical decision support interventions, user must have appropriate privilege. Tools > Preferences > User (CLINIC) > (Clinic Settings) Headers/Locations > Add > Add Facility NPI. Additional Information In determining whether the PHA has the capacity, CMS anticipates developing a centralized repository for this information, including a deadline for the PHA to submit information. If the PHA fails to provide information to this centralized repository by the deadline, the provider could claim the exclusion. In the event, that we are unable to develop a centralized repository, providers will make the determination of PHA capacity by working directly with the PHA as is currently the case for Stage 1 of meaningful use. The second exclusion does not apply if an entity designated by public health agency can receive electronic syndromic surveillance data submissions. For example, if the public health agency cannot accept the data directly or in the standards required by CEHRT, but if it has designated a Health Information Exchange to do so on their behalf and the Health Information Exchange is capable of accepting the information in the standards required by CEHRT, the provider could not claim the second exclusion. If EPs prior to CY 2014 have achieved successful ongoing submission using EHR technology certified to the 2011 Edition EHR certification criteria (HL only), it is acceptable to continue this ongoing submission and meet the Stage 2 measure for as long as HL continues to be accepted by the PHA in that jurisdiction.

90 [MEANINGFUL USE STAGE 2 REPORTING] P. 90 OF 97 In order to meet this objective and measure, an EP must use the capabilities and standards of CEHRT at 45 CFR (f)(3) Objective 3 (Menu): Imaging Results Objective Imaging results consisting of the image itself and any explanation or other accompanying information are accessible through CEHRT. Measure More than 10 percent of all tests whose result is one or more images ordered by the EP during the EHR reporting period are accessible through CEHRT. Exclusion Any EP who orders less than 100 tests whose result is an image during the EHR reporting period; or any EP who has no access to electronic imaging results at the start of the EHR reporting period. Numerator: The number of results in the denominator that are accessible through CEHRT. Denominator: Number of tests whose result is one or more images ordered by the EP during the EHR reporting period. Setup Requirements An order must be created and image results imported before the encounters can be linked. See Core Objective 01, CPOE for Medication, Laboratory and Radiology Orders. In Sevocity: Chart Chart > Imported Documents > Link Encounters > link image results to order encounter

91 [MEANINGFUL USE STAGE 2 REPORTING] P. 91 OF 97 Link Encounters button opens Encounter Links popup, which enables linking imported images to the original order.

92 [MEANINGFUL USE STAGE 2 REPORTING] P. 92 OF 97 Select Encounter that contains Order to link to encounter with imported Image results, and click OK.

93 [MEANINGFUL USE STAGE 2 REPORTING] P. 93 OF 97 Select Encounter that contains imported Image results to link to encounter with Order. Encounter Links popup showing original order encounter (Enc A) and image result encounter (Enc B) now linked.

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