Attesting for Meaningful Use in 2014 Clinical Quality Measures Customer Help Guide

Transcription

1 Attesting for Meaningful Use in 2014 Clinical Quality Measures Customer Help Guide

2 TABLE OF CONTENTS PURPOSE OF THIS DOCUMENT... 4 ATTESTING FOR CQMS... 4 NOTE: USE OF CLINICAL FINDINGS FROM THE 2014 CQM LIST TEMPLATE... 4 CARECLOUD S 2014 CLINICAL QUALITY MEASURES... 5 CMS165V2 - CONTROLLING HIGH BLOOD PRESSURE... 5 CMS156V2 - USE OF HIGH- RISK MEDICATIONS IN THE ELDERLY... 5 CMS138V2 - PREVENTATIVE CARE AND SCREENING: TOBACCO USE: SCREENING AND CESSATION INTERVENTION... 6 CMS166V3 - USE OF IMAGING STUDIES FOR LOW BACK PAIN... 7 CMS2V3 - PREVENTATIVE CARE AND SCREENING: SCREENING FOR CLINICAL DEPRESSION AND FOLLOW- UP PLAN... 7 CMS68V3 - DOCUMENTATION OF CURRENT MEDICATIONS IN THE MEDICAL RECORD... 8 CMS69V2 - PREVENTATIVE CARE AND SCREENING: BODY MASS INDEX (BMI) SCREENING AND FOLLOW- UP... 9 CMS50V2 - CLOSING THE REFERRAL LOOP: RECEIPT OF SPECIALIST REPORT CMS90V3 - FUNCTIONAL STATUS ASSESSMENT OF COMPLEX CHRONIC CONDITIONS CMS146V2 - APPROPRIATE TESTING FOR CHILDREN WITH PHARYNGITIS CMS155V2 - WEIGHT ASSESSMENT & COUNSELING FOR NUTRITION AND PHYSICAL ACTIVITY FOR CHILDREN & ADOLESCENTS CMS153V2 - CHLAMYDIA SCREENING FOR WOMEN CMS126V2 - USE OF APPROPRIATE MEDICATIONS FOR ASTHMA CMS117V2 - CHILDHOOD IMMUNIZATION STATUS CMS154V2 - APPROPRIATE TREATMENT FOR CHILDREN WITH UPPER RESPIRATORY INFECTION (URI) CMS136V3 - ADHD: FOLLOW- UP CARE FOR CHILDREN PRESCRIBED ATTENTION- DEFICIT/ HYPERACTIVITY DISORDER (ADHD) MEDICATION CMS75V2 - CHILDREN WHO HAVE DENTAL DECAY OR CAVITIES CMS125V2 - BREAST CANCER SCREENING CMS169V2 - BIPOLAR DISORDER AND MAJOR DEPRESSION: APPRAISAL FOR ALCOHOL OR CHEMICAL SUBSTANCE USE CMS148V2 - HEMOGLOBIN A1C TEST FOR PEDIATRIC PATIENTS CMS74V3 - PRIMARY CARIES PREVENTION INTERVENTION AS OFFERED BY PRIMARY CARE PROVIDERS, INCLUDING DENTISTS CMS137V2 - INITIATION AND ENGAGEMENT OF ALCOHOL AND OTHER DRUG DEPENDENCE TREATMENT CMS122V2 - DIABETES HEMOGLOBIN A1C POOR CONTROL CMS140V2 - BREAST CANCER: HORMONAL THERAPY FOR STAGE IC- IIIC ESTROGEN RECEPTOR/PROGESTERONE RECEPTOR (ER/PR) POSITIVE BREAST CANCER CMS147V2 - PREVENTIVE CARE AND SCREENING: INFLUENZA IMMUNIZATION CMS131V2 DIABETES: EYE EXAM

3 CMS123V2 DIABETES: FOOT EXAM CMS135V2 - HEART FAILURE (HF): ANGIOTENSIN- CONVERTING ENZYME (ACE) INHIBITOR OR ANGIOTENSIN RECEPTOR BLOCKER (ARB) THERAPY FOR LEFT SYSTOLIC DYSFUNCTION (LVSD) CMS144V2 - HEART FAILURE (HF): BETA- BLOCKER THERAPY FOR LEFT VENTRICULAR SYSTOLIC DYSFUNCTION (LVSD).. 28 CMS145V2 CORONARY ARTERY DISEASE (CAD): BETA- BLOCKER THERAPY- PRIOR MYOCARDIAL INFARCTION (MI) OR LEFT VENTRICULAR SYSTOLIC DYSFUNCTION (LVEF <40%) CMS164V2 ISCHEMIC VASCULAR DISEASE (IVD): USE OF ASPIRIN OR ANOTHER ANTITHROMBOTIC CMS182V3 ISCHEMIC VASCULAR DISEASE (IVD): COMPLETE LIPID PANEL AND LDL CONTROL CMS61V3 - CHOLESTEROL - FASTING LOW DENSITY LIPOPROTEIN (LDL- C) TEST PERFORMED CMS64V3 - RISK- STRATIFIED CHOLESTEROL - FASTING LOW DENSITY LIPOPROTEIN (LDL- C) CMS22V2 - SCREENING FOR HIGH BLOOD PRESSURE AND FOLLOW- UP DOCUMENTED CMS124V2 - CERVICAL CANCER SCREENING CMS130V2 - COLORECTAL CANCER SCREENING CMS56V2 - FUNCTIONAL STATUS ASSESSMENT FOR HIP REPLACEMENT CMS66V2 - FUNCTIONAL STATUS ASSESSMENT FOR KNEE REPLACEMENT CMS65V3 HYPERTENSION: IMPROVEMENT IN BLOOD PRESSURE CMS179V2 - ADE PREVENTION AND MONITORING: WARFARIN TIME IN THERAPEUTIC RANGE CMS128V2 - ANTI- DEPRESSANT MEDICATION MANAGEMENT CMS159V2 - DEPRESSION REMISSION AT TWELVE MONTHS CMS161V2 - ADULT MAJOR DEPRESSIVE DISORDER (MDD): SUICIDE RISK ASSESSMENT CMS160V2 - DEPRESSION UTILIZATION OF THE PHQ- 9 TOOL CMS82V2 - MATERNAL DEPRESSION SCREENING CMS149V2 - DEMENTIA: COGNITIVE ASSESSMENT CMS134V2 - DIABETES: URINE PROTEIN SCREENING CMS167V2 - DIABETIC RETINOPATHY: DOCUMENTATION OF PRESENCE OR ABSENCE OF MACULAR EDEMA AND LEVEL OF SEVERITY OF RETINOPATHY CMS163V2 - DIABETES: LOW DENSITY LIPOPROTEIN (LDL) MANAGEMENT CMS127V2 - PNEUMONIA VACCINATION STATUS FOR OLDER ADULTS CMS142V3 - DIABETIC RETINOPATHY: COMMUNICATION WITH THE PHYSICIAN MANAGING ONGOING DIABETES CARE CMS139V2 - FALLS: SCREENING FOR FUTURE FALL RISK CMS158V2 - PREGNANT WOMEN THAT HAD HBSAG TESTING CMS177V2 - CHILD AND ADOLESCENT MAJOR DEPRESSIVE DISORDER: SUICIDE RISK ASSESSMENT USING ORDER SETS FOR SPECIFIC CQM REQUIRED ORDERS CARECLOUD TEMPLATES CARECLOUD CHARTS CERTIFICATION ID NUMBER

4 Purpose of this Document The purpose of this document is to present CareCloud customers an overview of the requirements needed for Clinical Quality Measure (CQM) reporting. This document will also help guide customers in capturing and reporting this data using the CareCloud platform. Attesting for CQMs Eligible professionals attesting for Meaningful Use (MU) are required to report on 9 CQMs in order to demonstrate Meaningful Use. When selecting the CQMs to report, you must choose 3 out of the 6 key domains. Detailed information for all of the CQMs can be obtained on the CMS website. NOTE: To determine the measurement thresholds that you have achieved using the CareCloud system you will need to run the 2014 Clinical Quality Measures report in the CareCloud Analytics app (see Appendix). Note: Use of clinical findings from the 2014 CQM List template The 2014 CQM list template was created as a tool to house the findings that are needed to satisfy the various measures. Clients that know what CQM s they are planning to attest to can delete the groups from the template that do not apply to them. They may also use this template to merge the specific findings for the CQM s they are choosing to attest to into their own templates. 4

5 CareCloud s 2014 Clinical Quality Measures CMS165v2 - Controlling High Blood Pressure CQM Requirement: Percentage of patients years of age who had a diagnosis of hypertension and whose blood pressure was adequately controlled (<140/90mmHg) during the measurement period. To meet this requirement using CareCloud Charts: Record a hypertension diagnosis and capture the patient s blood pressure. Both are needed in order to accurately report this measure. CMS156v2 - Use of High- Risk Medications in the Elderly Domain: Patient Safety CQM Requirement: Percentage of patients 66 years of age and older who were ordered highrisk medications. Two rates are reported: a.) Percentage of patients who were ordered at least one high-risk medication, b.) Percentage of patients who were ordered at least two different high-risk medications. 5

6 To meet this requirement using CareCloud Charts: The patient s current medication list should be captured in the chart. CMS138v2 - Preventative Care and Screening: Tobacco Use: Screening and Cessation Intervention Domain: Population/Public Health CQM Requirement: Percentage of patients aged 18 years and older who were screened for tobacco use one or more times within 24 months AND who received cessation counseling intervention if identified as a tobacco user. To meet this requirement using CareCloud Charts: Assess and enter the patients smoking status via specific structured data elements found on the 2014 CQM Tobacco Use Screen- Intervene template in the CareCloud template folder. The findings listed in this template duplicate some of the findings from the 2014 MU Smoking Status template but also include a much larger range of findings including non-smoker findings and cessation interventions. 6

7 CMS166v3 - Use of Imaging Studies for Low Back Pain Domain: Efficient Use of Healthcare Resources CQM Requirement: Percentage of patients years of age with a diagnosis of low back pain who did NOT have an imaging study (plain X-ray, MRI, CT scan) within 28 days of the diagnosis. To meet this requirement using CareCloud Charts: Adding a low back pain diagnosis to the patient chart will initiate this measure. CMS2v3 - Preventative Care and Screening: Screening for Clinical Depression and Follow- Up Plan Domain: Population/Public Health CQM Requirement: Percentage of patients aged 12 years and older screened for clinical depression on the date of the encounter using an age appropriate standardized depression screening tool AND if positive, a follow-up plan is documented on the date of the positive screen. To meet this requirement using CareCloud Charts: Document an age appropriate depression screening tool and an associated follow up plan if the assessment is positive via the template named 2014 CQM List in the CareCloud template folder. 7

8 CMS68v3 - Documentation of Current Medications in the Medical Record Domain: Patient Safety CQM Requirement: Percentage of visits for patients aged 18 years and older for which the eligible professional attests to documenting a list of current medications using all immediate resources available on the date of the encounter. This list must include ALL known prescriptions, over-the-counters, herbals, and vitamin/mineral/dietary (nutritional) supplements AND must contain the medications' name, dosage, frequency and route of administration. To meet this requirement using CareCloud Charts: Document the patients complete medication list on the Chart. Also, in the Patient Summary select the checkbox item Reviewed on the Medications section or from the Medication List item that merges into encounter note templates. Clicking the reviewed checkbox with every medication list review will count towards the report for this measure. 8

9 CMS69v2 - Preventative Care and Screening: Body Mass Index (BMI) Screening and Follow- Up Domain: Population/Public Health CQM Requirement: Percentage of patients aged 18 years and older with a documented BMI during the encounter or during the previous six months AND when the BMI is outside of normal parameters, a follow-up plan is documented during the encounter or during the previous six months of the encounter. Normal parameters: Age 65 years and older BMI 23 and < 30. Age years BMI 18.5 and < 25. To meet this requirement using CareCloud Charts: Add the patient s height and weight via vital signs into the Chart. The BMI is auto-calculated from these data points. If the BMI is outside of normal parameters, the follow-up plan needs to be documented by adding one of the following CPT codes as an order via the A&P section of the note OR by documenting the follow up clinical finding on the 2014 CQM List template. 9

10 CMS50v2 - Closing the Referral Loop: Receipt of Specialist Report Domain: Care Coordination CQM Requirement: Percentage of patients with referrals, regardless of age, for which the referring provider receives a report from the provider to whom the patient was referred. To meet this requirement using CareCloud Charts: This measure can be met by capturing the receipt of the report with a structured data element using the findings from the 2014 CQM List template. 10

11 CMS90v3 - Functional Status Assessment of Complex Chronic Conditions Domain: Patient and Family Engagement CQM Requirement: Percentage of patients aged 65 years and older with heart failure who completed initial and follow-up patient-reported functional status assessments. To meet this requirement using CareCloud Charts: The functional status assessments can be captured by adding one of the following findings to your note. This is the entire list to choose from but only one of the findings is needed to populate the report. 11

12 CMS146v2 - Appropriate Testing for Children with Pharyngitis Domain: Efficient use of Healthcare Resources CQM Requirement: Percentage of children 2-18 years of age who were diagnosed with pharyngitis, ordered an antibiotic and received a group A streptococcus (strep) test for the episode. To meet this requirement using CareCloud Charts: Add a pharyngitis diagnosis to the patient along with one of the following Group A Strep tests and an appropriate antibiotic to meet this measure. 12

13 CMS155v2 - Weight Assessment and Counseling for Nutrition and Physical Activity for Children and Adolescents Domain: Population/Public Health CQM Requirement: Percentage of patients 3-17 years of age who had an outpatient visit with a Primary Care Physician (PCP) or Obstetrician/Gynecologist (OB/GYN) and who had evidence of the following during the measurement period: a.) height, weight, and body mass index (BMI) percentile documentation, b.) counseling for nutrition and c.) counseling for physical activity. To meet this requirement using CareCloud Charts: Record the patient s height and weight via vital signs. The BMI percentile is auto-calculated from these data points and plotted on the appropriate growth chart. If the BMI percentile is outside of normal parameters, then counseling needs to be performed using clinical findings from the 2014 CQM List template. You will need to choose at least one for nutrition counseling and one for physical activity. 13

14 CMS153v2 - Chlamydia Screening for Women Domain: Population/Public Health CQM Requirement: Percentage of women years of age who were identified as sexually active and who had at least one test for chlamydia during the measurement period. To meet this requirement using CareCloud Charts: The report will look for a diagnosis indicative of a sexually active woman as well as an order for a Chlamydia screening. One of the following Chlamydia tests can be used to meet this measure. 14

15 CMS126v2 - Use of Appropriate Medications for Asthma CQM Requirement: Percentage of patients 5-64 years of age who were identified as having persistent asthma and were appropriately prescribed medication during the measurement period. To meet this requirement using CareCloud Charts: Record specific mild, moderate or severe persistent asthma diagnosis along with appropriate asthma medications. CMS117v2 - Childhood Immunization Status Domain: Population/ Public Health CQM Requirement: Percentage of children 2 years of age who had four diphtheria, tetanus and acellular pertussis (DTaP); three polio (IPV), one measles, mumps and rubella (MMR); three H influenza type B (HiB); three hepatitis B (Hep B); one chicken pox (VZV); four pneumococcal conjugate (PCV); one hepatitis A (Hep A); two or three rotavirus (RV); and two influenza (flu) vaccines by their second birthday. To meet this requirement using CareCloud Charts: Record the specific Immunizations outlined above for patients within the age specifications via the Summary section of the chart. 15

16 CMS154v2 - Appropriate Treatment for Children with Upper Respiratory Infection (URI) Domain: Efficient Use of Healthcare Resources CQM Requirement: Percentage of children 3 months-18 years of age who were diagnosed with upper respiratory infection (URI) and were not dispensed an antibiotic prescription on or three days after the episode. To meet this requirement using CareCloud Charts: Record one of the following diagnosis codes when appropriate for children with URI upon exam. The purpose of this measure is to ensure that providers are NOT prescribing antibiotics for URI unless symptoms have been present for over 5-7 days. 16

17 CMS136v3 - ADHD: Follow- Up Care for Children Prescribed Attention- Deficit/ Hyperactivity Disorder (ADHD) Medication CQM Requirement: Percentage of children 6-12 years of age and newly dispensed a medication for attention-deficit/hyperactivity disorder (ADHD) that had appropriate follow-up care. Two rates are reported: a.) Percentage of children who had one follow-up visit with a practitioner with prescribing authority during the 30-day initiation phase, b.) percentage of children who remained on ADHD medication for at least 210 days and who, in addition to the visit in the Initiation Phase, has at least two additional follow-up visits with a practitioner within 270 days (9 months) after the Initiation Phase ended. To meet this requirement using CareCloud Charts: Record a diagnosis of ADHD and any new medication for patients within the age range. The follow up care is counted by looking at E&M codes used for follow-up services. CMS75v2 - Children Who Have Dental Decay or Cavities CQM Requirement: Percentage of children, age 0-20 years, who have had tooth decay or cavities during the measurement period. To meet this requirement using CareCloud Charts: Record appropriate diagnosis for dental decay or cavities if found on an exam. If a diagnosis is made, use one of the following CPT codes to populate the report with the correct evaluation procedure. 17

18 CMS125v2 - Breast Cancer Screening CQM Requirement: Percentage of women years of age who had a mammogram to screen for breast cancer. To meet this requirement using CareCloud Charts: If a mammogram has not been conducted in the last 12 months, order a mammogram via the A&P section of the note. You may also select the finding on the template named 2014 CQM List to document that the patient has stated that a mammogram has been performed in the last 12 months. 18

19 CMS169v2 - Bipolar Disorder and Major Depression: Appraisal for alcohol or chemical substance use CQM Requirement: Percentage of patients with depression or bipolar disorder with evidence of an initial assessment that includes an appraisal for alcohol or chemical substance use. To meet this requirement using CareCloud Charts: Record a new diagnosis of Bipolar disorder or Major Depression on the patient chart and conduct an initial alcohol or substance use assessment by selecting one of the findings on the template named 2014 CQM List to document that the initial assessment has been conducted. 19

20 CMS148v2 - Hemoglobin A1C Test for Pediatric Patients CQM Requirement: Percentage of patients 5-17 years of age with diabetes with an HbA1c test during the measurement period. To meet this requirement using CareCloud Charts: Record a diagnosis of diabetes then order and result a Hemoglobin A1C test for this population of patients. If you have a lab interface the lab results must be posted back to the patient chart. If you do not have a lab interface you will need to manually result the Hemoglobin A1C test by entering the lab in the Summary view of the chart or in the review results tasks associated with the lab order in the Inbox. The Hemoglobin A1C codes used in this measure are shown below. 20

21 CMS74v3 - Primary Caries Prevention Intervention as Offered by Primary Care Providers, including Dentists CQM Requirement: Percentage of children, age 0-20 years, who received a fluoride varnish application during the measurement period. To meet this requirement using CareCloud Charts: You will need to order a fluoride varnish application using the following CPT code via the A&P section of the note or you may select one of the findings on the template named 2014 CQM List to document that a fluoride varnish has been applied during the visit. 21

22 CMS137v2 - Initiation and Engagement of Alcohol and Other Drug Dependence Treatment CQM Requirement: Percentage of patients 13 years of age and older with a new episode of alcohol and other drug (AOD) dependence who received the following (the two rates are reported): a.) Percentage of patients who initiated treatment within 14 days of the diagnosis, b.) Percentage of patients who initiated treatment and who had two or more additional services with an AOD diagnosis within 30 days of the initiation visit. To meet this requirement using CareCloud Charts: Record a diagnosis of Alcohol or Drug Dependence then use the findings for CMS137 on the 2014 CQM List template to capture the appropriate follow-up needed for this measure. 22

23 CMS122v2 - Diabetes Hemoglobin A1c Poor Control CQM Requirement: Percentage of patients years of age with diabetes who had hemoglobin A1c > 9.0% during the measurement period. To meet this requirement using CareCloud Charts: Record a diagnosis of diabetes and on the patient chart then order and result a Hemoglobin A1C test. The result of the Hemoglobin A1C will need to be greater than 9.0% to qualify for this measure. If you have a lab interface the lab results must be posted back to the patient chart. If you do not have a lab interface you will need to manually result the Hemoglobin A1C test by entering the lab in the Summary view of the chart or in the review results tasks associated with the lab order in the Inbox. 23

24 CMS140v2 - Breast Cancer: Hormonal Therapy for Stage IC- IIIC Estrogen Receptor/Progesterone Receptor (ER/PR) Positive Breast Cancer CQM Requirement: Percentage of female patients aged 18 years and older with Stage IC through IIIC, ER or PR positive breast cancer who were prescribed tamoxifen or aromatase inhibitor (AI) during the 12-month reporting period. To meet this requirement using CareCloud Charts: Record a diagnosis of Breast Cancer on the patient chart and specify the appropriate TNM staging and estrogen/progesterone status for the breast cancer using the findings associated with CMS140 on the 2014 CQM List template. If appropriate, order the tamoxifen or aromatase inhibitor medication via the A&P section of the note or document it through the Summary view of the Chart. 24

25 CMS147v2 - Preventive Care and Screening: Influenza Immunization Domain: Population/Public Health CQM Requirement: Percentage of patients aged 6 months and older seen for a visit between October 1 and March 31 who received an influenza immunization OR who reported previous receipt of an influenza immunization. To meet this requirement using CareCloud Charts: Record an Office Visit E&M code during the months of October and March and record an influenza immunization in the Summary view of the patient chart. 25

26 CMS131v2 Diabetes: Eye Exam CQM Requirement: Percentage of patients years of age with diabetes who had a retinal or dilated eye exam by an eye care professional during the measurement period or a negative retinal exam (no evidence of retinopathy) in the 12 months prior to the measurement period. (Note: The eye exam must be performed by an ophthalmologist or optometrist.) To meet this requirement using CareCloud Charts: Record a diagnosis of diabetes and using the findings associated with CMS131 on the 2014 CQM List template to record the type(s) of exam performed on the patient. 26

27 CMS123v2 Diabetes: Foot Exam CQM Requirement: Percentage of patients aged years of age with diabetes who had a foot exam during the measurement period. To meet this requirement using CareCloud Charts: Record a diagnosis of Diabetes and use the findings associated with CMS123 on the 2014 CQM List template to record the type(s) of exam performed on the patient. CMS135v2 - Heart Failure (HF): Angiotensin- Converting Enzyme (ACE) Inhibitor or Angiotensin Receptor Blocker (ARB) Therapy for Left Systolic Dysfunction (LVSD) CQM Requirement: Percentage of patients aged 18 years and older with a diagnosis of heart failure (HF) with a current or prior left ventricular ejection fraction (LVEF) < 40% who were prescribed ACE inhibitor or ARB therapy either within a 12 month period when seen in the outpatient setting OR at each hospital discharge. 27

28 To meet this requirement using CareCloud Charts: Record a diagnosis of heart failure and record the percent of Ejection Fraction using the finding on the template named 2014 CQM List. If the ejection fraction is <40% the patient will need ACE inhibitor or ARB therapy prescribed in order to populate this measure. CMS144v2 - Heart Failure (HF): Beta- Blocker Therapy for Left Ventricular Systolic Dysfunction (LVSD) CQM Requirement: Percentage of patients aged 18 years and older with a diagnosis of heart failure (HF) with a current or prior left ventricular ejection fraction (LVEF) < 40% who were prescribed beta-blocker therapy either within a 12 month period when seen in the outpatient setting OR at each hospital discharge. 28

29 To meet this requirement using CareCloud Charts: Record a diagnosis of heart failure and record the percent of Ejection Fraction using the finding on the template named 2014 CQM List. If the ejection fraction is <40% the patient will need beta blocker therapy prescribed in order to populate this measure (see screen shot above with CMS144v2 measure). CMS145v2 Coronary Artery Disease (CAD): Beta- Blocker Therapy- Prior Myocardial Infarction (MI) or Left Ventricular Systolic Dysfunction (LVEF <40%) CQM Requirement: Percentage of patients aged 18 years and older with a diagnosis of coronary artery disease seen within a 12 month period who also have a prior MI or a current or prior LVEF <40% who were prescribed beta-blocker therapy. To meet this requirement using CareCloud Charts: Record a diagnosis of CAD with prior MI and a prescription of a Beta Blocker therapy. Or, if the patient has a diagnosis of CAD with no prior MI, record the percent of Ejection Fraction using the finding on the template named

30 CQM List. If the ejection fraction is <40% the patient will need to have a beta blocker prescribed in order to populate this measure (see screen shot above with CMS145v2 measure). CMS164v2 Ischemic Vascular Disease (IVD): Use of Aspirin or Another Antithrombotic CQM Requirement: Percentage of patients 18 years of age and older who were discharged alive for acute myocardial infarction (AMI), coronary artery bypass graft (CABG) or percutaneous coronary interventions (PCI) in the 12 months prior to the measurement period, or who had an active diagnosis of ischemic vascular disease (IVD) during the measurement period, and who had documentation of use of aspirin or another antithrombotic during the measurement period. To meet this requirement using CareCloud Charts: Record a diagnosis of IVD along with a medication of aspirin or another antithrombotic. The patient can also qualify for the measure if 30

31 they are discharged from the hospital with an acute MI, CABG or PCI. If the patient does have an acute MI, CABG or PCI, the ICD-9 and CPT codes indicative of the diagnosis and procedures need to be billed or put on the encounter note in CareCloud along with a medication of aspirin or another antithrombotic. CMS182v3 Ischemic Vascular Disease (IVD): Complete Lipid Panel and LDL Control CQM Requirement: Percentage of patients 18 years of age and older who were discharged alive for acute myocardial infarction (AMI), coronary artery bypass graft (CABG) or percutaneous coronary interventions (PCI) in the 12 months prior to the measurement period, or who had an active diagnosis of ischemic vascular disease (IVD) during the measurement period, and who had a complete lipid profile performed during the measurement period and whose LDL-C was adequately controlled (< 100 mg/dl). To meet this requirement using CareCloud Charts: Record a diagnosis of IVD along with a lab order and result for a complete lipid profile. The patient can also qualify for the measure if they are discharged from the hospital with an acute MI, CABG or PCI. If the patient does have an acute MI, CABG or PCI, the ICD-9 and CPT codes indicative of the diagnosis and procedures need to be billed or put on the encounter note in CareCloud along with a lab order and result for a complete lipid profile. The result of the complete lipid profile will need to be in the system as structured data. If you have a lab interface the lab results must be posted back to the patient chart. If you do not have a lab interface you will need to manually result the complete lipid profile by entering the lab in the Summary view of the chart or in the review results tasks associated with the lab order in the Inbox. This measure is looking for LDL-C to be in control and <100 mg/dl. 31

32 CMS61v3 - Preventative Care and Screening: Cholesterol - Fasting Low Density Lipoprotein (LDL- C) Test Performed CQM Requirement: Percentage of patients aged 20 through 79 years whose CHD (coronary heart disease) risk factors have been assessed and a fasting LDL-C test has been performed. To meet this requirement using CareCloud Charts: Record a diagnosis of a CHD (coronary heart disease) or a diagnosis of a CHD risk equivalent then order and result a complete lipid profile in the patient chart. The result of the complete lipid profile will need to be in the system as structured data. If you have a lab interface the lab results must be posted back to the patient chart. If you do not have a lab interface you will need to manually result the complete lipid profile by entering the lab in the Summary view of the Chart or in the review results tasks associated with the lab order in the Inbox. 32

33 CMS64v3 - Preventative Care and Screening: Risk- Stratified Cholesterol - Fasting Low Density Lipoprotein (LDL- C) CQM Requirement: Percentage of patients aged 20 through 79 years who had a fasting LDL- C test performed and whose risk-stratified fasting LDL-C is at or below the recommended LDL-C goal. (This is a two-part measure that is paired with CMS61. If the fasting LDL-C results are documented this measure CMS64 should also be reported.) To meet this requirement using CareCloud Charts: Record a diagnosis of a CHD (coronary heart disease) or a diagnosis of a CHD risk equivalent then order and result a complete lipid profile in the patient chart. The result of the complete lipid profile will need to be in the system as structured data. If you have a lab interface the lab results must be posted back to the patient chart. If you do not have a lab interface you will need to manually result the complete lipid profile by entering the lab in the Summary view of the Chart or in the review results tasks associated with the lab order in the Inbox. The measure will be looking specifically for LDL-C results that indicate good control. 33

34 CMS22v2 - Preventative Care and Screening: Screening for High Blood Pressure and Follow- Up Documented Domain: Population/Public Health CQM Requirement: Percentage of patients aged 18 years and older seen during the reporting period who were screened for high blood pressure AND a recommended follow-up plan is documented based on the current blood pressure (BP) reading as indicated. To meet this requirement using CareCloud Charts: Record the blood pressure of the patient. If the patient s blood pressure is above the current hypertension standards you will then need to recommend lifestyle modifications using the findings associated with CMS22 on the 2014 CQM List template or order a referral to Alternative/Primary Care Provider. 34

35 CMS124v2 - Cervical Cancer Screening CQM Requirement: Percentage of women years of age, who received one or more Pap tests to screen for cervical cancer. To meet this requirement using CareCloud Charts: Record an order and result of a Pap test as structured data in the patient chart. If you have a lab interface the lab results must be posted back to the patient chart. If you do not have a lab interface you will need to manually result the Pap test by entering the lab in the Summary view of the Chart or in the review results task associated with the lab order in the Inbox. 35

36 CMS130v2 - Colorectal Cancer Screening CQM Requirement: Percentage of adults years of age who had appropriate screening for colorectal cancer. To meet this requirement using CareCloud Charts: Record an order for a Fecal Occult Blood, Colonoscopy or Flexible Sigmoidoscopy. The Fecal Occult Blood test will need to be resulted as structured data in the patient chart. If you have a lab interface the lab results must be posted back to the patient chart. If you do not have a lab interface you will need to manually result the Fecal Occult Blood test by entering the lab in the Summary view of the Chart or in the review results task associated with the lab order in the Inbox. 36

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38 CMS56v2 - Functional Status Assessment for Hip Replacement Domain: Patient and Family Engagement CQM Requirement: Percentage of patients aged 18 years and older with primary total hip arthroplasty (THA) who completed baseline and follow-up (patient-reported) functional status assessments. To meet this requirement using CareCloud Charts: For patients who have had a primary total hip arthroplasty (THA) the CPT codes indicative of the procedure need to be billed or put on the encounter note in CareCloud along with a recording a finding that a Functional Status Assessment has been conducted via the template named 2014 CQM List. 38

39 CMS66v2 - Functional Status Assessment for Knee Replacement Domain: Patient and Family Engagement CQM Requirement: Percentage of patients aged 18 years and older with primary total knee arthroplasty (TKA) who completed baseline and follow-up (patient-reported) functional status assessments. To meet this requirement using CareCloud Charts: For patients who have had a primary total knee arthroplasty (TKA) the CPT codes indicative of the procedure need to be billed or put on the encounter note in CareCloud along with a recording a finding that a Functional Status Assessment has been conducted via the template named 2014 CQM List. CMS65v3 Hypertension: Improvement in Blood Pressure CQM Requirement: Percentage of patients aged years of age with a diagnosis of hypertension whose blood pressure improved during the measurement period. 39

40 To meet this requirement using CareCloud Charts: Record a diagnosis of hypertension and a blood pressure on the patient. Ensure that the patient has a follow-up blood pressure during the measurement period. If the follow-up blood pressure is at least 10 mmhg less than the baseline systolic blood pressure it is considered an improvement in blood pressure. CMS179v2 - ADE Prevention and Monitoring: Warfarin Time in Therapeutic Range Domain: Patient Safety CQM Requirement: Average percentage of time in which patients aged 18 and older with atrial fibrillation who are on chronic warfarin therapy have International Normalized Ratio (INR) test results within the therapeutic range (i.e., TTR) during the measurement period. To meet this requirement using CareCloud Charts: Record a diagnosis of atrial fibrillation as well as order and result an INR test for the patient. The result of the INR will need to be in the system as structured data. If you have a lab interface the lab results must be posted back to the patient chart. If you do not have a lab interface you will need to manually result the INR test by entering the lab in the Summary view of the Chart or in the review results task associated with the lab order in the Inbox. The measurement is looking for patients who stay in the therapeutic range with their INR. CMS128v2 - Anti- depressant Medication Management CQM Requirement: Percentage of patients 18 years of age and older who were diagnosed with major depression and treated with antidepressant medication, and who remained on antidepressant medication treatment. To meet this requirement using CareCloud Charts: Record a diagnosis of major depression from the Encounter note via the A&P section and record an order for antidepressant medication. 40

41 CMS159v2 - Depression Remission at Twelve Months CQM Requirement: Adult patients age 18 and older with major depression or dysthymia and an initial PHQ-9 score > 9 who demonstrate remission at twelve months defined as PHQ-9 score less than 5. This measure applies to both patients with newly diagnosed and existing depression whose current PHQ-9 score indicates a need for treatment To meet this requirement using CareCloud Charts: Record a diagnosis of major depression and use the finding associated with CMS159 on the 2014 CQM List template to record the PHQ-9 finding and enter the score for the assessment in the value field of the details view of the finding. 41

42 CMS161v2 - Adult Major Depressive Disorder (MDD): Suicide Risk Assessment CQM Requirement: Percentage of patients aged 18 years and older with a diagnosis of major depressive disorder (MDD) with a suicide risk assessment completed during the visit in which a new diagnosis or recurrent episode was identified To meet this requirement using CareCloud Charts: Record a diagnosis of major depression and use the finding associated with CMS161 on the 2014 CQM List template to record the suicide assessment has been performed. 42

43 CMS160v2 - Depression Utilization of the PHQ- 9 Tool CQM Requirement: Adult patients age 18 and older with the diagnosis of major depression or dysthymia who have a PHQ-9 tool administered at least once during a 4-month period in which there was a qualifying visit. To meet this requirement using CareCloud Charts: Record a diagnosis of major depression and use the finding associated with CMS159/160 on the 2014 CQM List template to record the PHQ-9 finding. You may record the score for the assessment in the value field for the finding. 43

44 CMS82v1 - Maternal depression screening Domain: Population/Public Health CQM Requirement: The percentage of children who turned 6 months of age during the measurement year, who had a face-to-face visit between the clinician and the child during child s first 6 months, and who had a maternal depression screening for the mother at least once between 0 and 6 months of life. To meet this requirement using CareCloud Charts: Record the finding associated with CMS82 on the 2014 CQM List template to record Post Partum depression care for this measure. 44

45 CMS149v2 - Dementia: Cognitive Assessment CQM Requirement: Percentage of patients, regardless of age, with a diagnosis of dementia for whom an assessment of cognition is performed and the results reviewed at least once within a 12 month period To meet this requirement using CareCloud Charts: Record a diagnosis of dementia and use the finding associated with CMS149 on the 2014 CQM List template to record a cognitive assessment. 45

46 CMS134v2 - Diabetes: Urine Protein Screening CQM Requirement: The percentage of patients years of age with diabetes who had a nephropathy screening test or evidence of nephropathy during the measurement period. To meet this requirement using CareCloud Charts: Record a diagnosis of diabetes AND either (a) an additional diagnosis of: Hypertensive Chronic Kidney disease, Glomerulonephritis and Nephrotic Syndrome, Diabetic Nephropathy or Proteinuria OR (b) a Procedure of Kidney Transplant, Vascular Access for Dialysis, Dialysis Services, Dialysis Education, ESRD Monthly Outpatient Services or Other Services Related to Dialysis OR (c) order a Microalbumin Test or Macroalbumin Test. For the education portion of the requirement use the findings associated with CMS134 on the 2014 CQM List template to record findings associated with education. 46

47 CMS167v2 - Diabetic Retinopathy: Documentation of Presence or Absence of Macular Edema and Level of Severity of Retinopathy CQM Requirement: Percentage of patients aged 18 years and older with a diagnosis of diabetic retinopathy who had a dilated macular or fundus exam performed which included documentation of the level of severity of retinopathy and the presence or absence of macular edema during one or more office visits within 12 months To meet this requirement using CareCloud Charts: Record a diagnosis of diabetic retinopathy and use the finding associated with CMS167 on the 2014 CQM List template to record a macular exam was performed as well as level of severity of retinopathy or presence/absence of macular edema. Note: Findings include level of severity of retinopathy (e.g., mild nonproliferative, moderate nonproliferative, severe nonproliferative, very severe nonproliferative, proliferative) AND the presence or absence of macular edema. CMS163v2 - Diabetes: Low Density Lipoprotein (LDL) Management CQM Requirement: Percentage of patients years of age with diabetes whose LDL-C was adequately controlled (<100 mg/dl) during the measurement period. To meet this requirement using CareCloud Charts: Record a diagnosis of diabetes via the A&P section of the note. You will also need to order and result a LDL-C on the patient s chart. Lab results can be imported via a standard lab interface (such as with Quest or LabCorp) or 47

48 entered via manual lab entry via the Summary view of the Chart or the review results task in the Inbox. Both an order and a result are needed to accurately report this objective CMS127v2 - Pneumonia Vaccination Status for Older Adults CQM Requirement: Percentage of patients 65 years of age and older who have ever received a pneumococcal vaccine. To meet this requirement using CareCloud Charts: Record a pneumococcal vaccination (immunization) in the Chart Summary or document a history of the patient receiving a pneumococcal vaccination by selecting the finding on the template named 2014 CQM List under CMS

49 CMS142v3 - Diabetic Retinopathy: Communication with the Physician Managing Ongoing Diabetes Care CQM Requirement: Percentage of patients aged 18 years and older with a diagnosis of diabetic retinopathy who had a dilated macular or fundus exam performed with documented communication to the physician who manages the ongoing care of the patient with diabetes mellitus regarding the findings of the macular or fundus exam at least once within 12 months 49

50 To meet this requirement using CareCloud Charts: Record a diagnosis of diabetic retinopathy and a macular exam along with communication to the patients physician managing the patients diabetes (this measure should be met by Ophthalmologists and communicated to primary providers). Note: Findings include level of severity of retinopathy (e.g., mild nonproliferative, moderate nonproliferative, severe nonproliferative, very severe nonproliferative, proliferative) AND the presence or absence of macular edema. Communication can include documentation of the findings in the medical record. CMS139v2 - Falls: Screening for Future Fall Risk Domain: Patient Safety CQM Requirement: Percentage of patients 65 years of age and older who were screened for future fall risk during the measurement period. To meet this requirement using CareCloud Charts: Record the finding for assessment of a fall risk from the template named 2014 CQM List under the group named CMS

51 CMS158v2 - Pregnant women that had HBsAg testing Domain: Clinical Process Effectiveness CQM Requirement: This measure identifies pregnant women who had a HBsAg (hepatitis B) test during their pregnancy. To meet this requirement using CareCloud Charts: Record an order and result for a HBsAg (Hepatitis B) lab test < or = 280 days prior to recording a procedure of a delivery for a female patient. Lab results can be imported via a standard lab interface (such as with Quest or LabCorp) or entered via manual lab entry via the Summary view of the Chart or the review results task in the Inbox. Both an order and a result are needed to accurately report this objective 51

52 CMS177v2 - Child and Adolescent Major Depressive Disorder: Suicide Risk Assessment Domain: Patient Safety CQM Requirement: Percentage of patient visits for those patients aged 6 through 17 years with a diagnosis of major depressive disorder with an assessment for suicide risk To meet this requirement using CareCloud Charts: Record a diagnosis of major depression via the A&P section of the note and record a suicide assessment via the template named 2014 CQM List. 52

53 Appendix Using Order Sets for Specific CQM Required Orders You may want to build order sets for the Clinical Quality Measures that you are planning to attest to. This will help to save order entry time while ensuring you are ordering the correct test for the requirement. CareCloud Templates CareCloud has also published templates to assist with specific data capture requirements for Core, Menu and Clinical Quality Measure reporting. The following templates are in the CareCloud folder and are available to merge into existing templates for your practice MU 2 Smoking Status (only) 2014 CQM Diabetes Foot and Eye Exam 2014 CQM Tobacco Use: Screening and Cessation Intervention (includes smoking status) 2014 CQM List 53

54 Reporting for Meaningful Use CQMs The CareCloud Analytics app provides all reports associated with Meaningful Use: The 2014 Clinical Quality Measures report lists the CQMs. This report can be found within the Analytics app under the Clinical tab Meaningful Use. CareCloud Charts Certification ID Number CareCloud Charts v2.1 is certified as a 2014 Edition Complete Ambulatory EHR. The 2014 Edition Certificate Number is: The CMS EHR Certification ID is: A014E01MYQ3PEAX. 54