Providers Guide to Meaningful Use

Transcription

1 Updated: 5/16/2011

2 Table of Contents 1. Purpose of this Guide Meaningful Use: A Summary Overview Eligibility Requirements for Professionals Registering for the Incentives Guidance on the Meaningful Use Attestation Process IMS Meaningful Use Report Meaningful Use Core Requirements CR01: CPOE for Medication Orders CR02 - Drug Interaction Checks CR03 Transmit Permissible Prescriptions Electronically CR04 - Record Demographics CR05 - Maintain Problem List CR06 - Active Medication List CR07 - Medication Allergy List CR08 - Record Vital Signs CR09 Record Smoking Status CR10 - Clinical Decision Support Rule CR11 - Clinical Quality Measures (CQMs) CR12 - Electronic Copy of Health Information CR13 - Clinical Summaries CR14 - Electronic Exchange of Clinical Information CR15 - Protect Electronic Health Information Meaningful Use Menu Requirements MN01 - Drug Formulary Checks MN02 - Clinical Lab Test Results MN03 - Patient Lists MN04 -Patient Reminders MN05 - Patient Electronic Access MN06 - Patient-specific Education Resources MN07 - Medication Reconciliation MN08 - Transition of Care Summary MN09 - Immunization Registries Data Submission MN10 - Syndromic Surveillance Data Submission Summary IMS Core and Menu Set Requirements Checklist Referenced and Additional Resources

3 1. Purpose of this Guide The Centers for Medicare and Medicaid Services (CMS) make a vast library of Meaningful Use resources available to eligible providers on their website. A Providers Guide to Meaningful Use pulls from these resources with a specific focus on the eligible professional and includes: A Summary Overview of Meaningful Use Eligibility Requirements for Professionals Registering for the Incentives Guidance on the Meaningful Use Attestation Process Instruction for the IMS Meaningful Use Report Detailed Core and Menu Requirements with IMS Related Function Summary IMS Core and Menu Requirement Checklist Since the primary focus of this guide is intended for the eligible professional, information pertaining to hospital requirements has been largely excluded. For further clarification or additional guidance on any of the material covered herein, the CMS website should be referenced. ( Source: ) Important Dates for Eligible Professionals January 1, 2011 Reporting year begins for eligible professionals. January 3, 2011 Registration for the Medicare EHR Incentive Program begins. January 3, 2011 For Medicaid providers, states may launch their programs if they so choose. April 2011 Attestation for the Medicare EHR Incentive Program begins. May 2011 EHR Incentive Payments expected to begin. October 1, 2011 Last day for eligible professionals to begin their 90-day reporting period for calendar year 2011 for the Medicare EHR Incentive Program. December 31, 2011 Reporting year ends for eligible professionals. February 29, 2012 Last day for eligible professionals to register and attest to receive an Incentive Payment for calendar year (CY) Last year to initiate participation in the Medicare EHR Incentive Program 2015 Medicare payment adjustments begin for eligible professionals that are not Meaningful Users of EHR technology 2016 Last year to receive a Medicare EHR Incentive Payment 2016 Last year to initiate participation in the Medicaid EHR Incentive Program 2021 Last year to receive a Medicaid EHR Incentive Payment 3

4 2. Meaningful Use: A Summary Overview What is Meaningful Use? Meaningful Use was introduced as part of the American Recovery and Reinvestment Act of 2009 (ARRA2009) with a focus on improving health care through the use of health information technology. ARRA2009 specifies three main components of Meaningful Use: The use of a certified EHR in a meaningful manner, such as e-prescribing The use of certified EHR technology for electronic exchange of health information to improve quality of health care The use of certified EHR technology to submit clinic quality and other measures Why EHR and Why Now? For the purposes of the Medicare and Medicaid Incentive Programs, eligible professionals, eligible hospitals and critical access hospitals (CAHs) must use certified EHR technology. Certified EHR technology gives assurance to purchasers and other users that an EHR system or module offers the necessary technological capability, functionality, and security to help them meet the meaningful use criteria. Certification also helps providers and patients be confident that the electronic health IT products and systems they use are secure, can maintain data confidentially, and can work with other systems to share information. IMS is designed to provide this confidence. The Medicare EHR Incentive Program The Medicare EHR Incentive Program will provide incentive payments to eligible professionals, eligible hospitals, and CAHs that demonstrate meaningful use of certified EHR technology. Participation can begin as early as Eligible professionals can receive up to $44,000 over five years under the Medicare EHR Incentive Program. There's an additional incentive for eligible professionals who provide services in a Health Professional Shortage Area (HSPA). To get the maximum incentive payment, Medicare eligible professionals must begin participation by Important! For 2015 and later, Medicare eligible professionals, eligible hospitals, and CAHs that do not successfully demonstrate meaningful use will have a payment adjustment in their Medicare reimbursement. The Medicaid EHR Incentive Program The Medicaid EHR Incentive Program will provide incentive payments to eligible professionals, eligible hospitals, and CAHs as they adopt, implement, upgrade, or demonstrate meaningful use of certified EHR technology in their first year of participation and demonstrate meaningful use for up to five remaining participation years. The Medicaid EHR Incentive Program is voluntarily offered by individual states and territories and may begin as early as 2011, depending on the state. Eligible professionals can receive up to $63,750 over the six years that they choose to participate in the program. There are no payment adjustments under the Medicaid EHR Incentive Program. 4

5 What are the Criteria for Meaningful Use? Providers Guide to Meaningful Use Meaningful Use will be implemented over the course of the next five years. Stage 1 (2011 and 2012) sets the baseline for electronic data capture and information sharing. Stage 2 (expected to be implemented in 2013) and Stage 3 (expected to be implemented in 2015) will continue to expand on this baseline and be developed through future rule making. How To Meet Meaningful Use Requirements? To qualify for incentive payments, meaningful use requirements must be met in the following ways: Medicare EHR Incentive Program: Eligible professionals, eligible hospitals, and critical access hospitals (CAHs) must successfully demonstrate meaningful use of certified electronic health record technology every year they participate in the program. Medicaid EHR Incentive Program: Eligible professionals and eligible hospitals may qualify for incentive payments if they adopt, implement, upgrade or demonstrate meaningful use in their first year of participation. They must successfully demonstrate meaningful use for subsequent participation years. Adopted: Acquired and installed certified EHR technology. (For example, can show evidence of installation.) Implemented: Began using certified EHR technology. (For example, provide staff training or data entry of patient demographic information into EHR.) Upgraded: Expanded existing technology to meet certification requirements. (For example, upgrade to certified EHR technology or add new functionality to meet the definition of certified EHR technology.) What are the requirements for Stage 1 of Meaningful Use (2011 and 2012)? For eligible professionals, there are a total of 25 meaningful use objectives. To qualify for an incentive payment, 20 of these 25 objectives must be met. There are 15 required core objectives. The remaining 5 objectives may be chosen from the list of 10 menu set objectives. Details of each Core and Menu requirement are provided later in this guide. What are "Clinical Quality Measures"? (Source: ) Quality measures are tools that help CMS measure or quantify healthcare processes, outcomes, patient perceptions, and organizational structure and/or systems that are associated with the ability to provide high-quality health care and/or that relate to one or more quality goals for health care. These goals include: effective, safe, efficient, patientcentered, equitable, and timely care. To demonstrate meaningful use in this area successfully, eligible professionals are required also to report discipline specific clinical quality measures. Eligible professionals must report on 6 total clinical quality measures: 3 required core measures (substituting alternate core measures where necessary) and 3 additional measures (selected from a set of 38 clinical quality measures). CMS accepts PRQI quality measures data extracted from a qualified EHR product for a limited subset of PQRI quality measures. IMS provides a PQRI reporting utility for this purpose and a separate instructional guide is available. In addition to PQRI, other quality measures pertaining to the eligible professional include the use of an EHR, End Stage Renal Disease, and erx usage. For additional information about Clinical Quality Measure requirements, please see: 5

6 Guide for Reading the EHR Incentive Program EP Measures ( Overview of Electronic Specifications for Clinical Quality Measures ( Zip File with Core CQM Specifications ( ns.zip) Zip File with Supplemental CQM Specifications ( Physician Quality Reporting System Information (Formerly PQRI) ( 6

7 3. Eligibility Requirements for Professionals (Source: ) Eligibility Requirements for Professionals Incentive payments for eligible professionals are based on individual practitioners. If you are part of a practice, each eligible professional may qualify for an incentive payment if each eligible professional successfully demonstrates meaningful use of certified EHR technology. Each eligible professional is only eligible for one incentive payment per year, regardless of how many practices or locations at which he or she provide services. Hospital-based eligible professionals are not eligible for incentive payments. An eligible professional is considered hospital-based if 90% or more of his or her services are performed in a hospital inpatient (Place Of Service code 21) or emergency room (Place Of Service code 23) setting. Who is an Eligible Professional under the Medicare EHR Incentive Program? In addition to the requirements above, Medicare eligible professionals must have Medicare Part B allowed charges and must be enrolled in an approved status for Provider Enrollment, Chain and Ownership System (PECOS). Eligible professionals under the Medicare EHR Incentive Program include: Doctor of medicine or osteopathy Doctor of dental surgery or dental medicine Doctor of podiatry Doctor of optometry Chiropractor Who is an Eligible Professional under the Medicaid EHR Incentive Program? Eligible professionals under the Medicaid EHR Incentive Program include: Physicians (primarily doctors of medicine and doctors of osteopathy) Nurse practitioner Certified nurse-midwife Dentist Physician assistant who furnishes services in a Federally Qualified Health Center or Rural Health Clinic that is led by a physician assistant. To qualify for an incentive payment under the Medicaid EHR Incentive Program, an eligible professional must meet one of the following criteria: Have a minimum 30% Medicaid patient volume* Have a minimum 20% Medicaid patient volume, and is a pediatrician* Practice predominantly in a Federally Qualified Health Center or Rural Health Center and have a minimum 30% patient volume attributable to needy individuals * Children's Health Insurance Program (CHIP) patients do not count toward the Medicaid patient volume criteria. Eligible for Both Programs? Professionals eligible for both the Medicare and Medicaid EHR Incentive Programs must choose which incentive program they wish to participate in when they register. Before 2015, an eligible professional may switch programs 7

8 only once after the first incentive payment is initiated. Most eligible professionals will maximize their incentive payments by participating in the Medicaid EHR Incentive Program. 8

9 4. Registering for the Incentives (Source: Medicare EHR Incentive Program Registration opened on January 3, 2011, so all eligible professionals may now register at any time. Medicaid Registration is also open in the following states: As of January 3, 2011 Alaska Iowa Kentucky Louisiana Michigan Mississippi North Carolina Oklahoma South Carolina Tennessee Texas As of April 1, 2011 Alabama As of April 4, 2011 California Missouri Other states likely will launch their Medicaid EHR Incentive Programs during the spring and summer of Steps to Registration (NOTE: At this time, eligible providers must complete the registration process personally. In May 2011, CMS plans to implement functionality that will allow an eligible professional to designate a third party to register and attest on his or her behalf. 1. Gather the following required information ahead of time and have available at time of registration a. National Provider Identifier (NPI). (To locate your NPI number, visit: b. National Plan and Provider Enumeration System (NPPES) User ID and Password. a) If NPPES is unknown, contact the PECOS Help Desk at (866) or online at b) If NPPES is required, gather the information below and request via 1. Type 2 NPI 2. Taxpayer ID Number 3. Address from IRS Form CP-575. (A copy will also need to be mailed in) c. Payee Tax Identification Number (if you are reassigning your benefits). d. Payee National Provider Identifier (NPI) (if you are reassigning your benefits). 2. Eligible professional should determine EHR incentive programs to register for. Once decided, eligible professional should read the appropriate CMS Registration User Guide for Eligible Professionals for Medicare, Medicaid, or both. a. Medicare Guide b. Medicaid Guide 3. Once a clear understanding of what is required has been attained, eligible professionals should now follow the instructions within the appropriate guide(s) to complete the registration process. 9

10 4. Medicare Registration: Specific notes regarding Steps within EHRMedicareEP_RegistrationUserGuide.pdf (NOTE: While on the website, click Help at the top of the screen if there are any questions.) a. Step 1 Enter into browser and follow guide b. Step 2 Login via NPPES number c. Step 3 Click the Registration tab d. Step 4 Click on Register in the action column at the bottom to proceed. Other options for Resubmit, Modify, Cancel, and Reactivate will be available at next login. e. Step 5 Click Start Registration f. Step 6 a) Select Medicare and click Apply b) Select appropriate Eligible Professional Type c) Select Yes for Do you have a certified EHR? a. If you do not already have the EHR Certification Number, do the following: 1) Go to 2) Select Practice Type as Ambulatory Practice Type 3) In the center search option, set Select search type to be Vendor Name and enter Meditab in the Search for field. Click Search 4) In the next window, click on the Add to Cart link at the end of the CCHIT row in the table 5) Click the Get CMS EHR Certification ID button 6) The CMS EHR Certification ID is what is to be entered when prompted b. Complete the required information for the certified EHR c. Click Save And Continue g. Step 7 Follow guide in relation to assigning payments. h. Step 8 a) Review information for accuracy. This should match what is in NPPES. If a change is made here, be sure to make the same change in NPPES. A change here DOES NOT update NPPES. b) Enter your valid address and then repeat once more for confirmation. c) Click Save and Continue i. Step 9 Verify all Topics are checked as Completed. If not, click Modify Registration and provide required information. Once all are checked Completed, click Begin Submission. j. Step 10 Verify Registration Information is correct. If not correct, click Previous Page to make changes. Once the information is correct, click Submit. k. Step 11 Read the Disclaimer and click Agree to proceed or Disagree to be redirected back to the Registration Instructions Page. From here, Modify may be clicked as Action to restart. l. Step 12 At this point, a Submission Receipt is received and should be printed as a confirmation record. If successful, the receipt will read Successful Submission. If it was not successful, it will read Failed Submission and the eligible professional should read the instructions on the screen and make appropriate corrections. m. Step 13 Click the Status tab to view the registration summary. For detailed information, click Select in the Action column. Click ADDITIONAL INFORMATION for, the registration status reason, Fiscal Intermediary (FI)/ Carrier/Medicare Administrative Contractor (MAC) and validations performed on registration. 5. Medicaid Registration: Specific notes regarding Steps within EHRMedicaidEP_RegistrationUserGuide.pdf (NOTE: While on the website, click Help at the top of the screen if there are any questions.) a. Step 1 Enter into browser and follow guide b. Step 2 Login via NPPES number c. Step 3 Click the Registration tab 10

11 d. Step 4 Click on Register in the action column at the bottom to proceed. Other options for Resubmit, Modify, Cancel, and Reactivate will be available at next login. e. Step 5 Click Start Registration f. Step 6 a) Select Medicaid and click Apply b) Select the appropriate Medicaid State/Territory c) Select appropriate Eligible Professional Type d) Select Yes for Do you have a certified EHR? a. If you do not already have the EHR Certification Number, do the following: 1) Go to 2) Select Practice Type as Ambulatory Practice Type 3) In the center search option, set Select search type to be Vendor Name and enter Meditab in the Search for field. Click Search 4) In the next window, click on the Add to Cart link at the end of the CCHIT row in the table 5) Click the Get CMS EHR Certification ID button 6) The CMS EHR Certification ID is what is to be entered when prompted b. Complete the required information for the certified EHR c. Click Save And Continue g. Step 7 Follow guide in relation to assigning payments. h. Step 8 a) Review information for accuracy. This should match what is in NPPES. If a change is made here, be sure to make the same change in NPPES. A change here DOES NOT update NPPES. b) Enter your valid address and then repeat once more for confirmation. c) Click Save and Continue i. Step 9 Verify all Topics are checked as Completed. If not, click Modify Registration and provide required information. Once all are checked Completed, click Begin Submission. j. Step 10 Verify Registration Information is correct. If not correct, click Previous Page to make changes. Once the information is correct, click Submit. k. Step 11 Read the Disclaimer and click Agree to proceed or Disagree to be redirected back to the Registration Instructions Page. From here, Modify may be clicked as Action to restart. l. Step 12 At this point, a Submission Receipt is received and should be printed as a confirmation record. a) If successful, the receipt will read Successful Submission. As stated, wait 24 hours and then return and click the link associated with You can find your state here to complete the Medicaid registration. (NOTE: Visit for state specific launch and website information) b) If it was not successful, it will read Failed Submission and the eligible professional should read the instructions on the screen and make appropriate corrections. m. Step 13 Click the Status tab to view the registration summary. For detailed information, click Select in the Action column. Click ADDITIONAL INFORMATION for, the registration status reason, Fiscal Intermediary (FI)/ Carrier/Medicare Administrative Contractor (MAC) and validations performed on registration. For either of the EHR Incentive Program Registrations, if there are questions, the eligible provider should consult the CMS Frequently Asked Questions resource at If the answer cannot be found, there is an Ask a Question tab from which a question may be submitted online for answer. There is also a Contact Us link that provides phone number and web link information for assistance with both Medicare and Medicaid. 11

12 5. Guidance on the Meaningful Use Attestation Process (Source: Attestation for the Medicare Electronic Health Record (EHR) Incentive Program opened April 18 th. What do I need to do to receive my Medicare EHR incentive payment? Successfully register ( for the Medicare EHR Incentive Program; Meet meaningful use ( criteria using certified EHR technology; and Successfully attest, using CMS' Web-based system, that you have met meaningful use criteria using certified EHR technology. How will I attest for the Medicare and Medicaid Incentive Programs? Medicare eligible professionals, eligible hospitals and critical access hospitals will have to demonstrate meaningful use through CMS' web-based Registration and Attestation System ( In the Medicare & Medicaid EHR Incentive Program Registration and Attestation System, providers will fill in numerators and denominators for the meaningful use objectives and clinical quality measures, indicate if they qualify for exclusions to specific objectives, and legally attest that they have successfully demonstrated meaningful use. A complete EHR system will provide a report of the numerators, denominators and other information. Then you will need to enter that data into our online Attestation System. Providers will qualify for a Medicare EHR incentive payment upon completing a successful online submission through the Attestation System immediately after you submit your results you will see a summary of your attestation, and whether or not it was successful. The Attestation System for the Medicare EHR Incentive Program will open on April 18, For the Medicaid EHR Incentive Program, providers will follow a similar process using their state's Attestation System. Check here to see states' scheduled launch dates for their Medicaid EHR Incentive Programs: When can I attest? To attest for the Medicare EHR Incentive Program in your first year of participation, you will need to have met meaningful use for a consecutive 90-day reporting period. If your initial attestation fails, you can select a different 90- day reporting period that may partially overlap with a previously reported 90-day period and attest again. To attest for the Medicare EHR Incentive Program in subsequent years, you will need to have met meaningful use for a full year. Please note the reporting period for eligible professionals must fall within the calendar year. April 18, 2011, is the earliest an eligible professional, eligible hospital or critical access hospital can attest that they have demonstrated meaningful use of certified EHR technology under the Medicare EHR Incentive Program. Under the Medicaid EHR Incentive Program, providers can attest that they have adopted, implemented or upgraded certified EHR technology in their first year of participation to receive an incentive payment. Medicaid EHR Incentive Program participants should check with their state to find out when they can begin participation. What can I do now to prepare for attestation? Visit the CMS Registration page and get registered for the EHR Incentive Programs right now. If you haven't previously registered, you can complete the registration and attestation process at the same time. Register here: 12

13 Review the CMS Attestation User Guide, which provides step-by-step instructions for login and completing attestation. Attestation User Guide: Finally, you can enter your information in the CMS Meaningful Use Attestation Calculator prior to submitting your attestation to see if you would be able to meet all of the necessary measures to successfully demonstrate meaningful use and qualify for an EHR incentive payment. MU Attestation Calculator: What will I need to login to the Attestation System? If you are an eligible professional, you'll need: Your Type 1 National Provider Identifier (NPI) The same user ID and password you used to register What is the CMS EHR Certification Number? During attestation, CMS requires each eligible professional, eligible hospital and critical access hospital to provide a CMS EHR Certification ID or Number that identifies the certified EHR technology being used to demonstrate meaningful use. This unique CMS EHR Certification ID or Number can be obtained by entering the certified EHR technology product information at the Certified Health IT Product List (CHPL) on the ONC website: NOTE: The ONC CHPL Product Number issued to your vendor for each certified technology is different than the CMS EHR Certification ID. Only a CMS EHR Certification ID obtained through the CHPL will be accepted at attestation. Eligible professionals, eligible hospitals and critical access hospitals can obtain a CMS EHR Certification ID or Number by following these steps: 1) Go to the ONC CHPL website: 2) Select your practice type by selecting the Ambulatory or Inpatient buttons. 3) Search for EHR Products by browsing all products, searching by product name or searching by criteria met. 4) Add product(s) to your cart to determine if your product(s) meet 100% of the CMS required criteria. 5) Request a CMS EHR Certification ID for CMS attestation. NOTE: The "Get CMS EHR Certification ID" button will not be activated until the products in your cart meet 100% of the CMS required criteria. If the EHR product(s) do not meet 100% of the CMS required criteria to demonstrate Meaningful Use, a CMS EHR Certification ID will not be issued. 6) The CMS EHR Certification ID contains 15 alphanumeric characters. I'm an Eligible Professional (EP). Can I designate a third party to register and/or attest on my behalf? In April 2011, CMS implemented functionality that allows an EP to designate a third party to register and attest on his or her behalf. To do so, users working on behalf of an EP must have an Identity and Access Management System (I&A) web user account (User ID/Password), and be associated to the EP's NPI. If you are working on behalf of an EP(s), and do not have an I&A web user account, please visit I&A Security Check 13

14 ( to create one. States will not necessarily offer the same functionality for attestation in the Medicaid EHR Incentive Program. Check with your State to see what functionality will be offered. When will I get paid? Incentive payments for the Medicare EHR Incentive Program will be made approximately four to six weeks after an eligible professional, eligible hospital or critical access hospital meets the program requirements and successfully attests they have demonstrated meaningful use of certified EHR technology. CMS expects that Medicare incentive payments will begin in May Payments will be held for eligible professionals until the eligible professional meets the $24,000 threshold in allowed charges. Medicaid incentives will be paid by the states and are expected also to begin in States are required to issue incentive payments within 45 days of providers successfully attesting to having adopted, implemented or upgraded certified EHR technology during their first year of participation in the Medicaid EHR Incentive Program. Launch date for the Medicaid EHR Incentive Program varies by state, so the earliest date attestation can begin also varies by state. Several states have disbursed incentive payments as early as April How will I get paid? Payments to Medicare providers will be made to the taxpayer identification number (TIN) you selected at the time you registered for the Medicare EHR Incentive Program. CMS will deposit payment in the first bank account on file. It will appear on your bank statement as "EHR Incentive Payment". If you receive payments for Medicare services via electronic funds transfer, you will receive your Medicare EHR Incentive Program payment the same way. If you currently receive Medicare payments by paper check, you will also receive your first Medicare EHR Incentive Program payment by paper check. IMPORTANT: Medicare Administrative Contractors (MACs), carriers and fiscal intermediaries will not be making these payments. CMS has contracted with a Payment File Development Contractor to make these payments. Have questions about your EHR incentive payment or other related needs? DON'T: Call your MAC/carrier/fiscal intermediary with questions DO: Call the EHR Information Center TTY users should call Hours of Operation: 7:30 a.m. 6:30 p.m. (Central Time) Monday through Friday, except federal holidays Why the payment amount may be less than you thought: The Medicare & Medicaid EHR Incentive Program Registration and Attestation System contains a Status tab at the top which will contain the amount of the incentive payment, the amount of tax or nontax offsets applied, and the remittance advice reason code containing the reason for any reduction. For those receiving paper checks, there will be a tear-off pay stub which identifies offsets made to the incentive payment. Where you can find more information about the offsets: For more information about tax offsets, call the Internal Revenue Service (IRS) at For more information about non tax offsets, call the Department of the Treasury, Financial Management Service (FMS) at

15 Will CMS conduct audits? Any provider attesting to receive an EHR incentive payment for either the Medicare EHR Incentive Program or the Medicaid EHR Incentive Program potentially may be subject to an audit. Here's what you need to know to make sure you're prepared: Overview of the CMS EHR Incentive Programs Audits All providers attesting to receive an EHR incentive payment for either Medicare or Medicaid EHR Incentive Programs should retain ALL relevant supporting documentation (in either paper or electronic format used in the completion of the Attestation Module responses). Documentation to support the attestation should be retained for six years post-attestation. Documentation to support payment calculations (such as cost report data) should continue to follow the current documentation retention processes. CMS, and its contractors, will perform audits on Medicare and dually-eligible (Medicare and Medicaid) providers. States, and their contractors, will perform audits on Medicaid providers. CMS and states will also manage appeals processes. Preparing for an Audit To ensure you are prepared for a potential audit, save the supporting electronic or paper documentation that support your attestation. Also save the documentation to support your Clinical Quality Measures (CQMs). Hospitals should also maintain documentation to support their payment calculations. Upon audit, the documentation will be used to validate that the provided accurately attested and submitted CQMs, as well as to verify that the incentive payment was accurate. Details of the Audits There are numerous pre-payment edit checks built into the EHR Incentive Programs' systems to detect inaccuracies in eligibility, reporting and payment. Post-payment audits will also be completed during the course of the EHR Incentive Programs. If, based on an audit, a provider is found to not be eligible for an EHR incentive payment, the payment will be recouped. CMS will be implementing an appeals process for eligible professionals, eligible hospitals and critical access hospitals that participate in the Medicare EHR Incentive Program. More information about this process will be posted to the CMS Web site soon. States will implement appeals processes for the Medicaid EHR Incentive Program. For more information about these appeals, please contact your State Medicaid Agency. 15

16 6. IMS Meaningful Use Report IMS has a Meaningful Use Report (MU) incorporated into the program design that allows the user to access real-time meaningful use data for the Core and Menu Set criteria. The results obtained through the use of this report will be used during the Attestation portion of the Meaningful Use reporting. Throughout the reporting period, this report will help eligible professionals assess performance in relation to all Core and selected Menu Requirements. For those Requirements that have not yet qualified as Objective Achieved, information pertaining to the CMS requirements and related IMS function for each Core and Menu requirement can be found in the sections that follow. Access to the Meaningful Use Report is provided via the Reports menu. 16

17 Meaningful Use Report Layout A The top panel (A) of the Meaningful Use Report contains filters and settings to control the data that is returned: Report Date Range Set the From and To fields to designate the date range in which to search for the data. For 2011, a 90-day reporting period is required. For 2012 and beyond, the reporting period will be a calendar year. Filters The Office filter allows the user to filter the report based on one or more offices. Similarly, the Provider filter allows to filter the report based on one or more Providers. To set the Office filter, click the Set Office icon to the right of the Office field. Within the Select Office window (B), choose the appropriate office(s) from the left panel and click the center arrow to select. Click Ok. To set the Provider filter, click the Set Provider icon and select appropriate Provider(s) in a similar fashion (C). B C 17

18 Group By Select the Office check box if the data returned should be divided into separate groups of data for each office. Select the Provider check box if the data returned is to separate into group of data for each Provider. NOTE: If both boxes are checked, a separate group of data will be returned for each office and provider combination. Show Selecting Core Set will return Meaningful Use results for the 15 Core Requirements. Selecting Menu Set will return results for the 10 Menu Requirements. If both are selected, results from all Core and Menu Requirements will be returned. Retrieve Once the Report Date Range, Filters, Group By and Show have been set, clicking Retrieve will produce the Meaningful Use Report in the bottom panel (D). D The bottom panel of the Meaningful Use Report displays the results of the filtered data retrieved. The green bar is used to group the Core and Menu Requirements and also provides label information as to what information follows. ID This indicates which Core or Menu Requirement is being reported. Objective For Meaningful Use, the Objective is what CMS requires of the eligible provider to qualify for the incentive. This is a general definition of the requirement. Measures The Measures define the specific criteria that must be met in order to achieve the Objective. TR (Total Records) For percentage based Requirements, TR displays the total number of records added within the date range specified, that apply to that Objective. OA (Objective Achieved) OA displays the specific number of records within the Total Records population that met all criteria set by the Measures. % - Displays the percentage of records that achieved the objective (OA). For each percentage based Objective, this is calculated by dividing the Numerator by the Denominator as defined by each Core or Menu requirement. A green background means the Measure has been satisfied to qualify. Red indicates the required qualification percentage has not yet been met. 18

19 IMS Option Click the icon to open a Help window that displays the Objective, Measure, and Help text for the Objective. Additional text in this column pertains to relevant function within IMS specific to this Objective and may be further explanation and/or instruction to the provider. Note This field may be used to record additional information related to the Objective. The bottom panel is an active window, and additional functionality exists within the panel itself. By right-clicking on any Objective line, an action menu appears as highlighted below. View Objective Achieved Records This list presents all of the patients from the Total Records population that met the requirements of the Objective. View Objective NOT Achieved Records This list presents all of the patients from the Total Records population that DO NOT meet the requirements of the Objective. View Chart - Displays a graphical representation of the criterion data. An image with explanation is on the following page. Below is an example of output for View Objective Achieved Records. In the output window, use the checkbox next to each patient name to select for actions such as label creation, sending an , printing, faxing or exporting. Action buttons are found along the bottom of the window: Set Reminder Used to set reminders for a selected patient. (NOTE: Cannot select multiple patients) Label Used to select and print specific label types for all selected patients. Used to send a Letter Template to selected patients via (if database configured for use). Print Used to print a Letter Template and Address Label for selected patients. Fax Allows to fax Letter Templates to selected patients (NOTE: fax number must be in patient master) Export Exports the entire list of patients to one of several file formats for print or distribution. Export to HL7 Exports the entire list of patients to an HL7 file for distribution. Print List Prints the entire list of patients. Close Exits the output window 19

20 As mentioned previously, there is a View Chart option available within the right-click menu in the bottom panel. Selecting this option will produce a graphical chart similar to the one shown below. The chart provides a visual representation of the data shown in the panel. The top left hand corner of the chart will display the % of Total Records that have qualified as Objective Achieved. Also at the top of the graph is a label that corresponds to the Objective data being displayed in the chart. If desired, the user may click on Chart in the top right hand corner to select from a number of different display options such as bar, line, pie, or grid style graphs. The chart may also be printed. To print, right-click on the chart and select Print Chart. As new Objectives with percentage based measures are selected, the chart will update with the corresponding data. If the chart is no longer required or desired for viewing, right-click on any Objective and choose Hide Chart. Along the bottom of the Meaningful Report window, a Key is present to explain the column headings for TR, OA, and %. There are also several other icons as seen below. View Guideline This button is not yet functional, but will be used for a future feature. Set Parameter When clicked, presents the following to set Objective required parameters such as Letter and Reminder Categories and selection of specific Visit Note questions to be measured against. An option to select appropriate smoking habit status is also defined here. o Reminder, Letter and Smoking Parameters are covered in detail within the corresponding Core or Menu Requirement in the next section of this guide. 20

21 o Exclude Visit Type allows flexibility in the office so that specific Visit Types (phone calls, refill requests, etc) that are not considered provider visits can be excluded from the reporting process. Multiple Visit Types may be selected, but the selections will apply to all EP s within the database. To select, click the select icon (A) within the Parameter window. Select one or more Visit Types (B) from the Select Visit Type window and click Ok (C). The selected Visit Types (D) will now be excluded as a qualified unique visit for the Core and Menu Requirements that specify this need. Click Ok (E) to save changes. A B D C E Print Prints a copy of the entire report based on filtering options set at time of retrieval. Close Exits the Meaningful Use Report. 21

22 7. Meaningful Use Core Requirements CR01: CPOE for Medication Orders Providers Guide to Meaningful Use Objective: Use computerized provider order entry (CPOE) for medication orders directly entered by any licensed healthcare professional who can enter orders into the medical record per state, local and professional guidelines. Measure: More than 30 percent of all unique patients with at least one medication in their medication list seen by the EP have at least one medication order entered using CPOE. Exclusion: Any EP who writes fewer than 100 prescriptions during the EHR reporting period. Definition of Terms Computerized Provider Order Entry (CPOE) CPOE entails the provider s use of computer assistance to directly enter medication orders from a computer or mobile device. The order is also documented or captured in a digital, structured, and computable format for use in improving safety and organization. Unique Patient If a patient is seen by an EP more than once during the EHR reporting period, then for purposes of measurement that patient is only counted once in the denominator for the measure. All the measures relying on the term unique patient relate to what is contained in the patient s medical record. Not all of this information will need to be updated or even be needed by the provider at every patient encounter. This is especially true for patients whose encounter frequency is such that they would see the same provider multiple times in the same EHR reporting period. Attestation Requirements DENOMINATOR: Number of unique patients with at least one medication in their medication list seen by the EP during the EHR reporting period. NUMERATOR: The number of patients in the denominator that have at least one medication order entered using CPOE. EXCLUSION: EPs who write fewer than 100 prescriptions during the EHR reporting period would be excluded from this requirement. EPs must enter the number of prescriptions written during the EHR reporting period in the Exclusion box to attest to exclusion from this requirement. The resulting percentage (Numerator Denominator) must be more than 30 percent in order for an EP to meet this measure. 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. Any licensed healthcare professionals can enter orders into the medical record for purposes of including the order in the numerator for the objective of CPOE if they can enter the order per state, local and professional guidelines. The order must be entered by someone who could exercise clinical judgment in the case that the entry generates any alerts about possible interactions or other clinical decision support aides. This necessitates that the CPOE occurs when the order first becomes part of the patient s medical record and before any action can be taken on the order. Electronic transmittal of the medication order to the pharmacy, laboratory, or diagnostic imaging center is not a requirement for meeting the measure of this objective. However, a separate objective (EPCMU 22

23 Related IMS Function Providers Guide to Meaningful Use 04) addresses the electronic transmittal of prescriptions and is a requirement for EPs to meet Meaningful Use. 1) Current Medications within the Visit Note must include at least one medication. 2) Patient must have been prescribed a medication from within IMS during the reporting period. Chart history should show that a prescription was given to the patient on the specific date. (NOTE: Prescription does not have to be sent electronically to meet this requirement) 23

24 CR02 - Drug Interaction Checks Providers Guide to Meaningful Use Objective: Implement drug-drug and drug-allergy interaction checks. Measure: The EP has enabled this functionality for the entire EHR reporting period. Exclusion: No exclusion. Attestation Requirements YES / NO Eligible professionals (EPs) must attest YES to having enabled drug-drug and drug-allergy interaction checks for the length of the reporting period to meet this measure. Related IMS Function User Parameters for Prescription set to Yes for: Patient Allergy Check Required o Cross Sensitive Allergy Check o Inactive ingredient based Allergy Check Drug Drug Interaction Check Required o Medium Severity Interaction Check o Low Severity Interaction Check Drug Validation (NOTE: If this is not set to yes, interactions will not be checked) 24

25 CR03 Transmit Permissible Prescriptions Electronically Objective: Generate and transmit permissible prescriptions electronically. Measure: More than 40 percent of all permissible prescriptions written by the EP are transmitted electronically using certified EHR technology Exclusion: Any EP who writes fewer than 100 prescriptions during the EHR reporting period. Definition of Terms Permissible Prescriptions- The concept of only permissible prescriptions refers to the current restrictions placed by the Department of Justice on electronic prescribing for Schedule II-V controlled substances. (Schedule II-V substance list: ). Any prescription not subject to these restrictions would be permissible. Prescription The authorization by an EP to a pharmacist to dispense a drug that the pharmacist would not dispense to the patient without such authorization. Attestation Requirements DENOMINATOR: Number of prescriptions written for drugs requiring a prescription in order to be dispensed other than controlled substances during the EHR reporting period. NUMERATOR: Number of prescriptions in the denominator generated and transmitted electronically. EXCLUSION: EPs who write fewer than 100 prescriptions during the EHR reporting period would be excluded from this requirement. EPs must enter the number of prescriptions written during the EHR reporting period in the Exclusion box to attest to exclusion from this requirement. The resulting percentage (Numerator Denominator) must be more than 40 percent in order for an EP to meet this measure. 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. 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. Although the Department of Justice recently published an Interim Final Rule that allows the electronic prescribing of controlled substances, these recent guidelines could not be incorporated into the Medicare and Medicaid EHR Incentive Programs. 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, EPs cannot receive incentive payments for e-prescribing under both the Medicare Improvements for Patients and Providers Act of 2008 (MIPPA) and the Medicare EHR Incentive Program for the same year. However, EPs can receive payments from both the MIPPA E-Prescribing Incentive Program and the Medicaid EHR Incentive Program for the same year. Providers can use intermediary networks that convert information from the certified EHR into a computer-based fax in order to meet this measure as long as the EP generates an electronic prescription and transmits it electronically using the standards of certified EHR technology to the intermediary 25

26 network, and this results in the prescription being filled without the need for the provider to communicate the prescription in an alternative manner. 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 Certified EHR Technology. For more information, refer to ONC s FAQ at 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 constructively 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. Related IMS Function Prescriptions should be sent by the EP to pharmacy electronically when prescribed. Currently, this means a client must be registered for and submitting prescriptions through either New Crop or Surescripts. 26

27 CR04 - Record Demographics Objective: Record all of the following demographics: (A) Preferred language; (B) Gender; (C) Race; (D) Ethnicity; (E) Date of birth Measure: More than 50 percent of all unique patients seen by the EP have demographics recorded as structured data. Exclusion: No exclusion. Definition of Terms Preferred Language The language by which the patient prefers to communicate. Unique Patient If a patient is seen by an EP more than once during the EHR reporting period, then for purposes of measurement that patient is only counted once in the denominator for the measure. All the measures relying on the term unique patient relate to what is contained in the patient s medical record. Not all of this information will need to be updated or even be needed by the provider at every patient encounter. This is especially true for patients whose encounter frequency is such that they would see the same provider multiple times in the same EHR reporting period. Attestation Requirements DENOMINATOR: Number of unique patients seen by the EP during the EHR reporting period. NUMERATOR: Number of patients in the denominator who have all the elements of demographics (or a specific exclusion if the patient declined to provide one or more elements or if recording an element is contrary to state law) recorded as structured data. The resulting percentage (Numerator Denominator) must be more than 50 percent in order for an EP to meet this measure. Additional Information 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. 27

28 Related IMS Function Patient demographics are created for every patient in IMS. Date of Birth (DOB) and Gender are required fields. EP should verify that Race, Ethnicity, and Language have been captured or documented as Patient declined. 28

29 CR05 - Maintain Problem List Objective: Maintain an up-to-date problem list of current and active diagnoses. Measure: More than 80 percent of all unique patients seen by the EP have at least one entry or an indication that no problems are known for the patient recorded as structured data. Exclusion: No exclusion. Definition of Terms Problem List A list of current and active diagnoses as well as past diagnoses relevant to the current care of the patient. Unique Patient If a patient is seen by an EP more than once during the EHR reporting period, then for purposes of measurement that patient is only counted once in the denominator for the measure. All the measures relying on the term unique patient relate to what is contained in the patient s medical record. Not all of this information will need to be updated or even be needed by the provider at every patient encounter. This is especially true for patients whose encounter frequency is such that they would see the same provider multiple times in the same EHR reporting period. Up-to-date The term up-to-date means the list is populated with the most recent diagnosis known by the EP. This knowledge could be ascertained from previous records, transfer of information from other providers, diagnosis by the EP, or querying the patient. Attestation Requirements DENOMINATOR: Number of unique patients seen by the EP during the EHR reporting period. NUMERATOR: Number of patients in the denominator who have at least one entry or an indication that no problems are known for the patient recorded as structured data in their problem list. The resulting percentage (Numerator Denominator) must be more than 80 percent in order for an EP to meet this measure. Additional Information The Medicare and Medicaid EHR Incentive Programs do not specify the use of ICD-9 or SNOMED- CT in meeting the measure for this objective. However, the Office of the National Coordinator for Health Information Technology (ONC) has adopted ICD-9 or SNOMED-CT for the entry of structured data for this measure and made this a requirement for EHR technology to be certified. Therefore, EPs will need to maintain an up-to-date problem list of current and active diagnoses using ICD-9 or SNOMED-CT as a basis for the entry of structured data into certified EHR technology in order to meet the measure for this objective. For patients with no current or active diagnoses, an entry must still be made to the problem list indicating that no problems are known. An EP is not required to update the problem list at every contact with the patient. The measure ensures the EP has a problem list for patients seen during the EHR reporting period, and that at least one piece of information is presented to the EP. The EP can then use their judgment in deciding what further probing or updating may be required given the clinical circumstances. The initial diagnosis can be recorded in lay terms and later converted to standard structured data or can be initially entered using standard structured data. 29

30 Related IMS Function Patient Diagnosis must either: a) Be entered within the Visit Note (A) for the specific encounter and be visible within the Active Diagnosis tab in the Diagnosis Visit Note Template and also within Chart View on the Dx tab (C). Or b) Be entered within the Visit Note for the specific encounter and recorded with the Mark as No Known Problem button (B) if the patient does not have any current problems. A B C 30

31 CR06 - Active Medication List Objective: Maintain active medication list. Measure: More than 80 percent of all unique patients seen by the EP have at least one entry (or an indication that the patient is not currently prescribed any medication) recorded as structured data. Exclusion: No exclusion. Definition of Terms Active Medication List A list of medications that a given patient is currently taking. Unique Patient If a patient is seen by an EP more than once during the EHR reporting period, then for purposes of measurement that patient is only counted once in the denominator for the measure. All the measures relying on the term unique patient relate to what is contained in the patient s medical record. Not all of this information will need to be updated or even be needed by the provider at every patient encounter. This is especially true for patients whose encounter frequency is such that they would see the same provider multiple times in the same EHR reporting period. Attestation Requirements DENOMINATOR: Number of unique patients seen by the EP during the EHR reporting period. NUMERATOR: Number of patients in the denominator who have a medication (or an indication that the patient is not currently prescribed any medication) recorded as structured data. The resulting percentage (Numerator Denominator) must be more than 80 percent in order for an EP to meet this measure. Additional Information For patients with no active medications, an entry must still be made to the active medication list indicating that there are no active medications. An EP is not required to update this list at every contact with the patient. The EP can then use his or her clinical judgment to decide when additional updating is required. Related IMS Function Current Medications within the Visit Note should include the following: a) A list of all active medications that the patient is currently taking Or b) It must be documented that the Patient is not taking any medication. 31

32 CR07 - Medication Allergy List Providers Guide to Meaningful Use Objective: Maintain active medication allergy list. Measure: More than 80 percent of all unique patients seen by the EP have at least one entry (or an indication that the patient has no known medication allergies) recorded as structured data. Exclusion: No exclusion. Definition of Terms Active Medication Allergy List A list of medications to which a given patient has known allergies. Allergy An exaggerated immune response or reaction to substances that are generally not harmful. Unique Patient If a patient is seen by an EP more than once during the EHR reporting period, then for purposes of measurement that patient is only counted once in the denominator for the measure. All the measures relying on the term unique patient relate to what is contained in the patient s medical record. Not all of this information will need to be updated or even be needed by the provider at every patient encounter. This is especially true for patients whose encounter frequency is such that they would see the same provider multiple times in the same EHR reporting period. Attestation Requirements DENOMINATOR: Number of unique patients seen by the EP during the EHR reporting period. NUMERATOR: Number of unique patients in the denominator who have at least one entry (or an indication that the patient has no known medication allergies) recorded as structured data in their medication allergy list. The resulting percentage (Numerator Denominator) must be more than 80 percent to meet this measure. Additional Information For patients with no active medication allergies, an entry must still be made to the active medication allergy list indicating that there are no active medication allergies. An EP is not required to update this list at every contact with the patient. The measure ensures that the EP has not ignored having a medication allergy list for patients seen during the EHR reporting period and that at least one piece of information on medication allergies is presented to the EP. The EP can then use their judgment in deciding what further probing or updating may be required given the clinical circumstances at hand. 32

33 Related IMS Function Drug Allergy within the Visit Note should include the following: a) A list of all known drugs that patient is allergic to (A) Or b) It must be specifically documented that patient has No Known Drug Allergies (B) A B 33

34 CR08 - Record Vital Signs Objective: Record and chart changes in the following vital signs: (A) Height; (B) Weight; (C) Blood pressure; (D) Calculate and display body mass index (BMI); (E) Plot and display growth charts for children 2-20 years, including BMI Measure: For more than 50 percent of all unique patients age 2 and over seen by the EP, height, weight, and blood pressure are recorded as structured data. Exclusion: Any EP who either see no patients 2 years or older, or who believes that all three vital signs of height, weight, and blood pressure of their patients have no relevance to their scope of practice. Definition of Terms Unique Patient If a patient is seen by an EP more than once during the EHR reporting period, then for purposes of measurement that patient is only counted once in the denominator for the measure. All the measures relying on the term unique patient relate to what is contained in the patient s medical record. Not all of this information will need to be updated or even be needed by the provider at every patient encounter. This is especially true for patients whose encounter frequency is such that they would see the same provider multiple times in the same EHR reporting period. Attestation Requirements DENOMINATOR: Number of unique patients age 2 or over seen by the EP during the EHR reporting period. NUMERATOR: Number of patients in the denominator who have at least one entry of their height, weight and blood pressure are recorded as structured data. EXCLUSION: An EP who sees no patients 2 years or older would be excluded from this requirement. Additionally, an EP who believes that all three vital signs of height, weight, and blood pressure have no relevance to their scope of practice would be excluded from this requirement. EPs must select NO next to the appropriate exclusion, then click the APPLY button in order to attest to the exclusion. The resulting percentage (Numerator Denominator) must be more than 50 percent in order for an EP to meet this measure. 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 only information required to be input by the provider is the height, weight, and blood pressure of the patient. The certified EHR technology will calculate BMI and growth chart if applicable, 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. Height, weight, and blood pressure can get into the patient s medical record as structured data in a number of ways. Some examples include entry by the EP, entry by someone on the EP s staff, transfer of information from another provider or entered directly by the patient through a portal or other means. 34

35 Related IMS Function Vital Signs must be completed for a minimum of Height, Weight and Blood Pressure. If any one or more of the elements are missing, the requirement will not be met. 35

36 CR09 Record Smoking Status Providers Guide to Meaningful Use Objective: Record smoking status for patients 13 years old or older. Measure: More than 50 percent of all unique patients 13 years old or older seen by the EP have smoking status recorded as structured data. Exclusion: Any EP who sees no patients 13 years or older. Definition of Terms Unique Patient If a patient is seen by an EP more than once during the EHR reporting period, then for purposes of measurement that patient is only counted once in the denominator for the measure. All the measures relying on the term unique patient relate to what is contained in the patient s medical record. Not all of this information will need to be updated or even be needed by the provider at every patient encounter. This is especially true for patients whose encounter frequency is such that they would see the same provider multiple times in the same EHR reporting period. Attestation Requirements DENOMINATOR: Number of unique patients age 13 or older seen by EP during EHR reporting period. NUMERATOR: Number of patients in the denominator with smoking status recorded as structured data. EXCLUSION: An EP who sees no patients 13 years or older would be excluded from this requirement. EPs must enter 0 in the Exclusion box to attest to exclusion from this requirement. The resulting percentage (Numerator Denominator) must be more than 50 percent in order for an EP to meet this measure. 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. Related IMS Function 1. Within the Meaningful Use Report window, ensure that the EP has defined the appropriate Social History value to be recorded as capturing this data. a) Open the Meaningful Use Report window b) Click on the Set Parameter button in bottom left c) Within the Parameter window, click on Click here to set smoking option 36

37 d) Within the Select from Social History window, check the box next to the Question (A) that relates to patient smoking history. (NOTE: If a question does not exist or does not adequately meet these requirements, it may be necessary to customize the Social History visit note template prior to associating in this window.) e) Once the proper Question has been checked, click the Select button to save the setting A B f) Click OK to exit the Parameter window 37

38 2. For all patients over 13 years of age, Social History within the Visit Note should include the following: a) Smoking Status recorded as positive within the Question selected in Parameter Or b) Smoking Status recorded as negative within the Question selected in Parameter 38

39 CR10 - Clinical Decision Support Rule Providers Guide to Meaningful Use Objective: Implement one clinical decision support rule relevant to specialty or high clinical priority along with the ability to track compliance with that rule. Measure: Implement one clinical decision support rule. Exclusion: No exclusion. Definition of Terms Clinical Decision Support (CDS) HIT functionality that builds upon the foundation of an EHR to provide persons involved in care processes with general and person-specific information, intelligently filtered and organized, at appropriate times, to enhance health and health care. Attestation Requirements YES / NO Eligible professionals (EPs) must attest YES to having implemented one clinical decision support rule for the length of the reporting period to meet the measure. Additional Information CMS will not issue additional guidance on the selection of appropriate clinical decision support rules for Stage 1 Meaningful Use. This determination is best left to the EP taking into account their workflow, patient population, and quality improvement efforts. Drug-drug and drug-allergy interaction alerts cannot be used to meet the meaningful use objective for implementing one clinical decision support rule. EPs must implement one clinical decision support rule in addition to drug-drug and drug-allergy interaction checks. Related IMS Function Within IMS, there are a number of features available that qualify as clinical decision support rules. Essentially, this means that based on findings during a patient visit, IMS will offer diagnostic or treatment options to the provider. The link with functionality within IMS can be configured to assist EP s by providing reference information and other tools to support decisions within clinical workflow. Proper use of alerts and reminders qualify as CDS rules. Incorporating clinical guidelines or protocols into IMS workflow would also qualify. Defining appropriate Health Maintenance rules for specific patient populations is another option. EP s may use order sets to improve CPOE. The use of reports and dashboards to aid in clinical decision support would also qualify. Within IMS, the Visit Note dashboard is customizable to allow the EP to be presented with patient specific data pertinent to decision making and care. As mentioned above, it is up to the EP to determine which CDS rules to incorporate into their clinical setting. 39

40 CR11 - Clinical Quality Measures (CQMs) Objective: Report ambulatory clinical quality measures to CMS. Measure: Successfully report to CMS ambulatory clinical quality measures selected by CMS in the manner specified by CMS. Exclusion: No exclusion. Attestation Requirements YES / NO Eligible professionals (EPs) must attest YES to reporting to CMS ambulatory clinical quality measures selected by CMS in the manner specified by CMS to meet the measure. 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. Attesting to the measure of this objective indicates that the EP will submit complete ambulatory clinical quality measure information as required during the attestation process. During attestation, EPs will also attest to the numerators, denominators, and exclusions for individual ambulatory clinical quality measures. For requirements and electronic specifications related to individual ambulatory clinical quality measures, EPs should refer to: In the Downloads section accessible from the link above, detailed information regarding specific clinical measures that meet this requirement are outlined. EPs should download and refer to the materials provided in order to determine which measures are relevant to their specialty. Related IMS Function IMS provides a PQRI/NQF reporting tool for tracking of quality measures. This tool allows each EP to define clinical quality measures relevant to their specialty for reporting. Please view the recently conducted PQRI webinars for additional information on how to configure PQRI reporting within IMS. Additionally, a PQRI Help guide is available. The PQRI reporting tool is accessible from the Reports menu as shown below: 40

41 CR12 - Electronic Copy of Health Information Objective: Provide patients with an electronic copy of their health information (including diagnostic test results, problem list, medication lists, medication allergies) upon request. Measure: More than 50 percent of all patients who request an electronic copy of their health information are provided it within 3 business days. Exclusion: Any EP that has no requests from patients or their agents for an electronic copy of patient health information during the EHR reporting period. Definition of Terms Business Days Business days are defined as Monday through Friday excluding federal or state holidays on which the EP or their respective administrative staffs are unavailable. Diagnostic Test Results All data needed to diagnose and treat disease. Examples include, but are not limited to, blood tests, microbiology, urinalysis, pathology tests, radiology, cardiac imaging, nuclear medicine tests, and pulmonary function tests. Attestation Requirements DENOMINATOR: Number of patients of the EP who request an electronic copy of their electronic health information four business days prior to the end of the EHR reporting period. NUMERATOR: Number of patients in the denominator who receive an electronic copy of their electronic health information within three business days. EXCLUSION: An EP who has no requests from patients or their agents for an electronic copy of patient health information during the EHR reporting period would be excluded from this requirement. EPs must enter 0 in the Exclusion box to attest to exclusion from this requirement. The resulting percentage (Numerator Denominator) must be more than 50 percent in order to meet this measure. 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. When responding to patient requests for information, the EP should accommodate patient requests in accordance with the HIPAA Privacy Rule, as specified at 45 CFR , Access of individuals to protected health information. HIPAA contains requirements for providing patients copies of their health information. Information that must be provided electronically is limited to that information that exists electronically in or is accessible from the certified EHR technology and is maintained by or on behalf of the EP. At a minimum, this would include the elements listed in the ONC final rule at 45 CFR (f) for EPs and 45 CFR (d) for eligible hospitals and CAHs as required for EHR technology to become certified. An EP may withhold information from the electronic copy of a patient s health information in accordance with the HIPAA Privacy Rule, as specified at 45 CFR An EP should provide a patient with all of the health information they have available electronically, subject to withholding as described in the HIPAA Privacy Rule, as specified at in 45 CFR Form and format should be human readable and comply with the HIPAA Privacy Rule, as specified at 45 CFR (c). The media could be any electronic form such as patient portal, PHR, CD, USB fob, etc. EPs are expected to make reasonable accommodations for patient preference as outlined in 45 CFR (b). 41

42 The charging of fees for this information is governed by the HIPAA Privacy Rule at 45 CFR (c)(4) (which only permits HIPAA covered entities to charge an individual a reasonable, costbased fee for a copy of the individual s health information). If provision of the copy involves the mailing of physical electronic media, then it would need to be mailed by at least the third business day following the request of the patient or their agents. Third-Party Requests: Only specific third-party requests for information are included in the denominator. Providing the copy to a family member or patient s authorized representative consistent with federal and state law may substitute for a disclosure of the information to the patient and count in the numerator. A request from the same would count in the denominator. All other third-party requests are not included in the numerator or the denominator. Related IMS Function Reminder Category Creation EP shall create a Reminder Category specific to this purpose. Reminder Category shall contain all Reminder Tasks that inform staff that patient requires a copy of their health information in electronic format (CD, USB drive, portal, etc). (NOTE: For Meaningful Use, only one category will be reported on, so it is important that ONLY health information request related reminders are stored within this category.) 1) Click the Reminder icon or access via Activities > Reminder 2) Click the Setup (A) option in the center of the left panel 3) Click the Add (B) button to define a Reminder Category for this purpose a. Enter a Description such as MU Patient Info Request (C) b. Set a priority for this category if desired c. Leave Type set as General d. Leave Assign To set to None. Assignment will be at Task level e. Leave Remind set to None 4) Click Save (D) A C B D 42

43 Reminder Task Creation 1) Select the Task tab (A) at the top of the Reminder Setup window 2) Click Add (B) to define a health information request related reminder (ex: copy of chart, med list request, problem list, etc) a. Enter a Description such as Med List Request or Chart Request (C) b. Set Category to the Reminder Category created just created c. Set Priority in relation to the other health information requests d. If desired, select user(s) or group(s) to assign the task to upon creation in the Assign To field. i. Click the icon to the right of the Assign To field ii. Leave Create set to One task for selected group. This means that if one user completes the task, it will mark as complete for all. iii. Select individual users or groups from the list. (NOTE: If groups are not present, they have not yet been created on the Group tab). iv. Once all necessary personnel are selected, click Ok e. Do not click the Reminder Repeat Setup icon as these will be patient initiated requests f. Click the Reminder Alert/Action Setup g. In the Alert section, select the areas within IMS that you want an alert to appear reminding the user to complete the task h. If a Reminder Letter has been created for use with this specific health information request, select from the list as a Default Letter. i. Click Ok j. Set a Seq No if desired k. If the Provider will want to be able to quickly assign this Reminder Task while in the course of creating a Visit Note, check the box in Q column to add to the Quick Reminders list l. Do not click the M column m. Do not Link as this is a request for information and not a request for clinical action 3) Click Save (D) 4) If additional Reminder Tasks are needed, repeat Step 2 Otherwise, click Close (E) A C B D E 43

44 Setting Parameter in Meaningful Use Report Providers Guide to Meaningful Use 1) Within the Meaningful Use Report window, ensure that the EP has defined the appropriate Reminder Category for health information requests. a. Open the Meaningful Use Report window b. Click on the Set Parameter button in bottom left c. Within the Parameter window, click on the pull-down menu button for Reminder Category for CR12 d. From the list, select the appropriate Reminder Category that pertains to health information requests e. Once the proper category has been selected, click OK to exit the Parameter window Health Information Reminder Sample Flow 1) Create a health information Reminder request for patient by pressing CTRL-F2 2) Select a Reminder Task created in Reminder Task Creation and the defaults for Category, Assign To and Alerts should already be set 3) Due Date should be set to the date the patient requested the information. This will trigger the 3 day period in which the information must be provided to the patient within. 4) If a specific note is needed to advise the User or Group what the patient requires, add to the Note box 5) Select the appropriate Patient 6) Click Save 7) Close out of the Reminder Task window 8) As one of the Users assigned or a member of a Group assigned to the Reminder Task, they will now see the Reminder in their My Tasks > Reminder list. (TIP: Filter by Category and/or Task below left panel to shorten a lengthy list.) 9) The User will take action on the Reminder as requested by right-clicking on the Task name. 10) Once completed, the User may right-click and choose Set Done or click the box next to the Reminder and click Set Done below the list 11) In the Meaningful Use Report window, the OA column (objective achieved) will increase by one and the TR column (total records) will also increase by one. The increase is due to the fact that the Reminder in the Sample Flow was created and completed on the same day. As long as a Reminder Task is completed within 3 business days of creation, this objective will be achieved. If a Reminder Task takes longer than 3 business days to complete, the objective will not be achieved. Again, the 3 days are triggered based on Due Date, so be sure to set this as the date of patient request. 44

45 CR13 - Clinical Summaries Objective: Provide clinical summaries for patients for each office visit. Measure: Clinical summaries provided to patients for more than 50 percent of all office visits within 3 business days. Exclusion: Any EP who has no office visits during the EHR reporting period. Definition of Terms Clinical Summary An after-visit summary that provides a patient with relevant and actionable information and instructions containing the patient name, provider s office contact information, date and location of visit, an updated medication list, updated vitals, reason(s) for visit, procedures and other instructions based on clinical discussions that took place during the office visit, any updates to a problem list, immunizations or medications administered during visit, summary of topics covered/considered during visit, time and location of next appointment/testing if scheduled, or a recommended appointment time if not scheduled, list of other appointments and tests that the patient needs to schedule with contact information, recommended patient decision aids, laboratory and other diagnostic test orders, test/laboratory results (if received before 24 hours after visit), and symptoms. Office Visit Office visits include separate, billable encounters that result from evaluation and management services provided to the patient and include: (1) Concurrent care or transfer of care visits, (2) Consultant visits, or (3) Prolonged Physician Service without Direct (Face-To-Face) Patient Contact (tele-health). A consultant visit occurs when a provider is asked to render an expert opinion/service for a specific condition or problem by a referring provider. Attestation Requirements DENOMINATOR: Number of unique patients seen by the EP for an office visit during the EHR reporting period. NUMERATOR: Number of patients in the denominator who are provided a clinical summary of their visit within three business days. EXCLUSION: EPs who have no office visits during the EHR reporting period would be excluded from this requirement. EPs must enter 0 in the Exclusion box to attest to exclusion from this requirement. The resulting percentage (Numerator Denominator) must be more than 50 percent in order for an EP to meet this measure. 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 certified EHR technology. The clinical summary can be provided through a PHR, patient portal on the web site, secure , 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. 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 should not charge patients a fee to provide this information. When a patient visit lasts several days and the patient is seen by multiple EPs, a single clinical summary at the end of the visit can be used to meet the meaningful use objective for provide clinical summaries for patients after each office visit. 45

46 Related IMS Function 1. EP shall create a Document Sub-Category that will contain all clinical summary letter options. Document Sub- Category can be named CR13 Clinical Summaries within IMS for ease of identification. (NOTE: For Meaningful Use, only one sub-category will be reported on, so it is important that ONLY clinical summary letters are stored within this sub-category. It is equally important that ALL are stored within this subcategory. Letters not assigned to this sub-category will not be factored into the objective requirements.) 2. Within the Meaningful Use Report window, ensure that the EP has defined Letter Category for CR13. a) Open the Meaningful Use Report window b) Click on the Set Parameter button in bottom left c) Within the Parameter window, click on the pull-down menu button for Letter Category for CR13 d) From the list, select the pre-defined Document Category that pertains to clinical summary letters. (NOTE: Only one category may be selected as indicated in step 1 above.) e) Once the proper category has been selected, click OK to exit the Parameter window The above should be set for all clients as the functionality is available within IMS by default. For other methods such as patient portal or secure , the clinical summary letter will still be generated first and the method of transmission to the patient will be the only variance. 46

47 CR14 - Electronic Exchange of Clinical Information Objective: Capability to exchange key clinical information (for example, problem list, medication list, medication allergies, and diagnostic test results), among providers of care and patient authorized entities electronically. Measure: Performed at least one test of certified EHR technology s capacity to electronically exchange key clinical information. Exclusion: No exclusion. Definition of Terms Diagnostic Test Results All data needed to diagnose and treat disease. Examples include, but are not limited to, blood tests, microbiology, urinalysis, pathology tests, radiology, cardiac imaging, nuclear medicine tests, and pulmonary function tests. Different Legal Entities A separate legal entity is an entity that has its own separate legal existence. Indications that two entities are legally separate would include (1) they are each separately incorporated; (2) they have separate Boards of Directors; and (3) neither entity is owned or controlled by the other. Distinct Certified EHR Technology Each instance of certified EHR technology must be able to be certified and operate independently from all the others in order to be distinct. Separate instances of certified EHR technology that must link to a common database in order to gain certification would not be considered distinct. However, instances of certified EHR technology that link to a common, uncertified system or component would be considered distinct. Instances of certified EHR technology can be from the same vendor and still be considered distinct. Exchange Clinical information must be sent between different legal entities with distinct certified EHR technology and not between organizations that share a certified EHR technology. Distinct certified EHR technologies are those that can achieve certification and operate independently of other certified EHR technologies. The exchange of information requires that the eligible professional must use the standards of certified EHR technology as specified by the Office of the National Coordinator for Health IT, not the capabilities of uncertified or other vendor-specific alternative methods for exchanging clinical information. Patient Authorized Entities Any individual or organization to which the patient has granted access to their clinical information. Examples would include an insurance company that covers the patient, an entity facilitating health information exchange among providers, or a personal health record vendor identified by the patient. A patient would have to affirmatively grant access to these entities. Attestation Requirements YES / NO Eligible professionals (EPs) must attest YES to having performed at least one test of certified EHR technology s capacity to electronically exchange key clinical information during the EHR reporting period to meet this measure. Additional Information The test of electronic exchange of key clinical information must involve the transfer of information to another provider of care with distinct certified EHR technology or other system capable of receiving the information. Simulated transfers of information are not acceptable to satisfy this objective. The transmission of actual patient information is not required for the purposes of a test. The use of test information about a fictional patient that would be identical in form to what would be sent about an actual patient would satisfy this objective. 47

48 When the clinical information is available in a structured format it should be transferred in a structured format. However, if the information is unavailable in a structured format, the transmission of unstructured data is permissible. EPs can use their clinical judgment to identify what clinical information is considered key clinical information for purposes of exchanging clinical information about a patient at a particular time with other providers of care. A minimum set of information is identified in the HIT Standards and Criteria rule at 45 CFR (i), and is generally outlined in this objective as: problem list, medication list, medication allergies, and diagnostic test results. An EP s determination of key clinical information could include some or all of this information, as well as information not included here. An EP should test their ability to send the minimum information set in the HIT Standards and Criteria rule at 45 CFR (i). If the EP continues to exchange information beyond the initial test, then the provider may decide what information should be exchanged on a case-by-case basis. EPs must test their ability to electronically exchange key clinical information at least once prior to the end of the EHR reporting period. Testing may also occur prior to the beginning of the EHR reporting period. Every payment year requires its own, unique test. If multiple EPs are using the same certified EHR technology in a shared physical setting, testing would only have to occur once for a given certified EHR technology. An unsuccessful test of electronic exchange of key clinical information will be considered valid for meeting the measure of this objective. Related IMS Function IMS provides functionality for the Import and Export of Continuity of Care Documents (CCD). The Export (CCD) utility provides options for exporting Payer, Diagnosis, Allergy, Vitals, Medication/Rx, Lab Results, Immunization, Procedures, Family History, and Social History information. The file is created in XML format to share with other authorized entities. The Import (CCR) utility allows the EP to import patient information from XML files and then assign to the appropriate patient for view as a Document. A separate guide for this utility is available. 48

49 CR15 - Protect Electronic Health Information Objective: Protect electronic health information created or maintained by the certified EHR technology 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) and implement security updates as necessary and correct identified security deficiencies as part of its risk management process. Exclusion: No exclusion. Definition of Terms Appropriate Technical Capabilities A technical capability would be appropriate if it protected the electronic health information created or maintained by the certified EHR technology. All of these capabilities could be part of the certified EHR technology or outside systems and programs that support the privacy and security of certified EHR technology. Attestation Requirements YES / NO Eligible professionals (EPs) must attest YES to having conducted or reviewed a security risk analysis in accordance with the requirements under 45 CFR (a)(1) and implemented security updates as necessary and corrected identified security deficiencies prior to or during the EHR reporting period to meet this measure. Additional Information EPs must conduct or review a security risk analysis of certified EHR technology 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. A security update would be required if any security deficiencies were identified during the risk analysis. A security update could be updated software for certified EHR technology to be implemented as soon as available, changes in workflow processes or storage methods, or any other necessary corrective action that needs to take place to eliminate the security deficiency or deficiencies identified in the risk analysis. Related IMS Function IMS Security Features and Clinic Expectations Within IMS, the Security feature manages access to patient data at a User and Group level. Users are provided access via Username/Password. IMS provides parameters within the utility to increase the security of such access by requiring: 1) minimum characters for password, 2) case sensitivity, 3) enforced alpha-numeric passwords, 4) lockouts after number of failed login attempts, 5) password resets every set number of days and 6) historically unique passwords. Through the use of Grouping and Grants, users can be further limited to the activities and data within IMS that they are capable of accessing. In addition, IMS has a Lock Session feature for use when a user must step away from the terminal in order to protect patient data. IMS also provides an Audit Log utility. This utility allows the EP to determine when specific patient related data elements were accessed or modified within the database and by which specific user. The security within the EHR depends a great deal on the security practices within the clinic setting. Please refer to for other EP requirements outside of the EHR such as defining security management processes, assigning a security official, limiting personnel and information access, providing security awareness training, handling security incidents, establishing contingency plans, and periodically evaluating security policies and procedures. 49

50 Security Lock Session Screen 50

51 Audit Log 51

52 8. Meaningful Use Menu Requirements MN01 - Drug Formulary Checks Providers Guide to Meaningful Use Objective: Implement drug formulary checks. Measure: The EP has enabled this functionality and has access to at least one internal or external formulary for the entire EHR reporting period. Exclusion: Any EP who writes fewer than 100 prescriptions during the EHR reporting period. Attestation Requirements YES / NO / EXCLUSION Eligible professionals (EPs) must attest YES to having enabled this functionality and having had access to at least one internal or external formulary for the entire EHR reporting period to meet this measure. An EP who writes fewer than 100 prescriptions during the EHR reporting period can be excluded from this objective and associated measure. EPs must enter 0 in the Exclusion box to attest to exclusion from the requirement. Additional Information At a minimum an EP must have at least one formulary that can be queried. This may be an internally developed formulary or an external formulary. The formularies should be relevant for patient care during the prescribing process. Related IMS Function Formulary Setup To ensure Formulary checks are in use within IMS, the following setup is required (image on next page): 1. Within IMS, select Setup from the application menu (A) 2. Choose Prescription from the left panel (B) 3. Within Prescription, select Formulary (C). Each formulary will be associated with one or more Insurance Carriers or Plans. When creating, make sure that the drug associations made are applicable to Plans. If they do not apply to all, a separate formulary will be needed. 4. Enter details of the Formulary (D) a. Enter a meaningful Description for the Formulary b. If desired, enter a Note that further describes the formulary c. Enter the specific Drugs or Drug Groups relevant to the formulary i. Type: specify whether a specific drug or drug group ii. iii. Drug/Drug Group: search for and list the related drug or drug group Rule: specify if drug or drug group is: a) Not Covered Plan to be associated will not cover the med b) Prior Auth Req Plan requires prior authorization before prescribing c) Sp Instructions Med requires special instructions when prescribing. Special Instructions should be entered in the Note field for this drug. iv. Note: Used to enter Special Instructions v. Select Alternate Drug(s): If a drug is not covered by the Plan, this option creates a list of alternate drugs that the provider will be presented with on conflict during the prescription creation phase. d. Click the Insurance icon in top right corner to enter formula related Carrier or Plan(s). 5. Save the Formulary (E) 52

53 A B E D C Formulary Usage (Test Formulary Setup) 1. Select a Test patient and set the patient Insurance to match a Plan selected in the Formulary setup 2. Create a Prescription for a med selected in the Formulary setup 3. When Save is clicked, the user will be prompted with Formulary information as specified in Formulary Setup 53

54 MN02 - Clinical Lab Test Results Providers Guide to Meaningful Use Objective: Incorporate clinical lab test results into EHR as structured data. Measure: More than 40 percent of all clinical lab test 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. Exclusion: An EP who orders no lab tests whose results are either in a positive/negative or numeric format during the EHR reporting period. Attestation Requirements 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. NUMERATOR: Number of lab test results whose results are expressed in a positive or negative affirmation or as a number which are incorporated as structured data. EXCLUSION: If an EP orders no lab tests whose results are either in a positive/negative or numeric format during the EHR reporting period they would be excluded from this requirement. EPs must select NO next to the appropriate exclusion, then click the APPLY button in order to attest to the exclusion. The resulting percentage (Numerator Denominator) must be more than 40 percent in order for an EP to meet this measure. 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. 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. Related IMS Function Although incorporation of an HL7 interface with compatible lab companies will help to ensure the successful input of the required Lab Result data, it is not required. Essentially, the EP should ensure that any Labs defined within IMS have results entered as structured data. Linking a faxed results page to a Lab Order will not qualify for this requirement. The EP or a staff member must associate the returned results to the order by entering the values manually. 54

55 MN03 - 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. Definition of Terms Specific Conditions - Those conditions listed in the active patient problem list. Attestation Requirements YES / NO 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. Additional Information This objective does not dictate the report(s) which must be generated. 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 or a subset of those patients at the discretion of the EP. The report generated is required to include only patients whose records are maintained using certified EHR technology. Related IMS Function Patient Special Search Within IMS, the Patient Special Search feature allows real-time generation of patient lists by specific conditions. The Patient Special Search is found within the Utilities menu. 55

56 Within the Patient Special Search window, set the desired search criteria within the left panel (A). When criteria has been selected, click on Search (B) to query the database. Results will appear in the panel to the right (C). Administrative options such as Reminders, Label printing, Faxing or ing letters, Exporting or Printing the list are available in the bottom portion of the right panel (D). C A B D EMR Reports IMS also provides specific EMR reports that will also generate the conditions requested. Access to the reports is obtained by: 1. Click on Reports from Application Menu (A) 2. Select EMR from list (B) 3. Click the + sign next to Visit Note (C) Several related reports (D) are listed in the image on the next page, including: Patient Visit Summary by Diagnosis This report generates a summary list of patients grouped by Office and desired diagnosis range. The list does not specify visit date or provider seen. Visit Note by Diagnosis - This report will generate a list of patients grouped by Office and then Provider for the desired diagnosis range as filtered by date, office, and/or Provider. Details of report include visit date, time of visit, related case info and place of service. Patient Visit Detail by Diagnosis This report will generate a list of patients grouped by Office and desired diagnosis range. The list specifies visit date, provider seen, case info and reason for visit. 56

57 B A C D 57

58 MN04 -Patient Reminders Objective: Send reminders to patients per patient preference for preventive/follow-up care. Measure: More than 20 percent of all patients 65 years or older or 5 years old or younger were sent an appropriate reminder during the EHR reporting period. Exclusion: An EP who has no patients 65 years old or older or 5 years old or younger with records maintained using certified EHR technology. Definition of Terms Unique Patient If a patient is seen by an EP more than once during the EHR reporting period, then for purposes of measurement that patient is only counted once in the denominator for the measure. All the measures relying on the term unique patient relate to what is contained in the patient s medical record. Not all of this information will need to be updated or even be needed by the provider at every patient encounter. This is especially true for patients whose encounter frequency is such that they would see the same provider multiple times in the same EHR reporting period. Attestation Requirements DENOMINATOR: Number of unique patients 65 years old or older or 5 years older or younger. NUMERATOR: Number of patients in the denominator who were sent the appropriate reminder. EXCLUSION: If an EP has no patients 65 years old or older or 5 years old or younger with records maintained using certified EHR technology that EP is excluded from this requirement. EPs must select NO next to the appropriate exclusion, then click the APPLY button in order to attest to the exclusion. The resulting percentage (Numerator Denominator) must be more than 20 percent in order for an EP to meet this measure. 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. EPs meet the aspect of per patient preference of this objective if they are accommodating reasonable requests in accordance with the HIPAA Privacy Rule, as specified at 45 CFR (b), which is the guidance established for accommodating patient requests. EP has the discretion to determine the frequency, means of transmission, and form of the reminder limited only by the requirements the HIPAA Privacy Rule, as specified at 45 CFR (b), and any other applicable federal, state or local regulations that apply to them. Related IMS Function MN04 - Meaningful Use Report Setup 1. EP shall create a Document Sub-Category specific to this purpose that will contain all Patient Reminder letters that apply to the preventative/follow-up needs associated with patients 5 and under or 65 and older. Document Sub-Category can be aptly named MN04 Patient Preventative Reminder Letters within IMS for ease of identification. (NOTE: For Meaningful Use, only one sub-category will be reported on, so it is important that ONLY letters meeting requirements for this measure are stored within this sub-category. It is equally important that ALL relevant letters are stored within this sub-category. If the letters are not assigned to this sub-category, they will not be factored into the objective requirements.) 58

59 2. Within the Meaningful Use Report window, ensure that the EP has defined the appropriate Letter sub-category for Patient Preventative Reminder letters. a. Open the Meaningful Use Report window b. Click on the Set Parameter button in bottom left c. Within the Parameter window, click on the pull-down menu button for Letter Category for MN04 d. From the list, select the pre-defined Document Sub-Category that pertains to Patient Preventative Reminder letters. (NOTE: Only one sub-category may be selected as indicated in step 1 above.) e. Once the proper category has been selected, click OK to exit the Parameter window The above should be set for all clients as the functionality is available within IMS by default. 59

60 Letter Focus Letters to be generated from Scheduler, CheckIn, or Patient Special Search should be created as Scheduler type letters and assigned to the MN04 Patient Preventative Reminder Letters subcategory. Letters to be generated from within a Visit Note or at Checkout should be created as Visit Note type letters and assigned to the MN04 Patient Preventative Reminder Letters sub-category. Letters to be generated from Health Maintenance or Reminders should be created as Reminder/Note type letters and assigned to the MN04 Patient Preventative Reminder Letters sub-category. 60

61 MN05 - Patient Electronic Access Providers Guide to Meaningful Use Objective: 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. Measure: At least 10 percent of all unique patients seen by the EP are provided timely (available to the patient within four business days of being updated in the certified EHR technology) electronic access to their health information subject to the EP s discretion to withhold certain information. Exclusion: Any EP that neither orders nor creates lab tests or information that would be contained in the problem list, medication list, medication allergy list (or other information as listed at 45 CFR (g)) during the EHR reporting period. Definition of Terms Business Days Business days are defined as Monday through Friday excluding federal or state holidays on which the EP or their respective administrative staffs are unavailable. Unique Patient If a patient is seen by an EP more than once during the EHR reporting period, then for purposes of measurement that patient is only counted once in the denominator for the measure. All the measures relying on the term unique patient relate to what is contained in the patient s medical record. Not all of this information will need to be updated or even be needed by the provider at every patient encounter. This is especially true for patients whose encounter frequency is such that they would see the same provider multiple times in the same EHR reporting period. Attestation Requirements DENOMINATOR: Number of unique patients seen by the EP during the EHR reporting period. NUMERATOR: Number of patients in the denominator who have timely (available to the patient within four business days of being updated in the certified EHR technology) electronic access to their health information online. EXCLUSION: If an EP neither orders nor creates lab tests or information that would be contained in the problem list, medication list, medication allergy list (or other information as listed at 45 CFR (g)) during the EHR reporting period, they would be excluded from this requirement. EPs must select NO next to the appropriate exclusion, then click the APPLY button in order to attest to the exclusion. The resulting percentage (Numerator Denominator) must be at least 10 percent in order for an EP to meet this measure. Additional Information Online electronic access through either a patient portal or personal health record (PHR) will satisfy the measure of this objective. An EP may decide that electronic access to a portal or PHR is not the best forum to communicate results. Within the confines of laws governing patient access to their medical records, we would defer to EP s judgment as to whether to hold information back in anticipation of an actual encounter between the provider and the patient. Information that must be provided electronically is limited to that information that exists electronically in or is accessible from the certified EHR technology and is maintained by or on behalf of the EP. At a minimum, certified EHR technology makes available lab test results, problem list, medication list, and medication allergy list. An EP may withhold information from the electronic copy of a patient s health information in accordance with the HIPAA Privacy Rule, as specified at 45 CFR

62 The objective and measure focus on the availability of access and the timeliness of data, not utilization. The EP is not responsible for ensuring that 10 percent request access or have the means to access, only that 10 percent of all unique patients seen by the EP could access the information if they so desired. Related IMS Function IMS Patient Portal is designed to meet these requirements. If the EP is not using Patient Portal, this Menu Requirement is not an available option. For those EP s who are using the Patient Portal, be sure to create a login to the portal for each patient. This will ensure that access is afforded to the patient even if they choose not to use that access. Creating and providing the account information to the patient will satisfy this requirement. 1) Within Patient Master, click on Other Options (A) and then select Portal Login (B) to create user login for portal. A B 62

63 2) Define a User ID (A) for the patient and enter a valid address for the patient (B). Click Next (C). A B C 3) Select an appropriate letter to generate for the patient (A) and a label if desired (B). Click OK (C). This will activate the login and the patient shall be provided with the proper login criteria. A B C 63

64 MN06 - Patient-specific Education Resources Objective: Use certified EHR technology to identify patient-specific education resources and provide those resources to the patient if appropriate. Measure: More than 10 percent of all unique patients seen by the EP are provided patient-specific education resources. Exclusion: No exclusion. Definition of Terms Patient-Specific Education Resources Resources identified through logic built into certified EHR technology which evaluates information about the patient and suggests education resources that would be of value to the patient. Unique Patient If a patient is seen by an EP more than once during the EHR reporting period, then for purposes of measurement that patient is only counted once in the denominator for the measure. All the measures relying on the term unique patient relate to what is contained in the patient s medical record. Not all of this information will need to be updated or even be needed by the provider at every patient encounter. This is especially true for patients whose encounter frequency is such that they would see the same provider multiple times in the same EHR reporting period. Attestation Requirements DENOMINATOR: Number of unique patients seen by the EP during the EHR reporting period. NUMERATOR: Number of patients in the denominator who are provided patient-specific education resources. The resulting percentage (Numerator Denominator) must be more than 10 percent in order for an EP to meet this measure. Additional Information Certified EHR technology is certified to use either the patient s problem list, medication list, or laboratory test results to identify the patient-specific educational resources. These or additional elements can be used in the identification of educational resources that are specific to the patients needs. 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 in a manner where the technology suggests patient-specific educational resources based on the information stored in the certified EHR technology. The provider can make a final decision on whether the education resource is useful and relevant to a specific patient. Related IMS Function EP s who are using the Micromedix companion in conjunction with IMS Link with functionality will meet this requirement. With Link with technology, care plan information is presented when relevant diagnosis, lab, prescription, examination findings or procedures are encountered during a patient visit. 64

65 MN07 - Medication Reconciliation Providers Guide to Meaningful Use 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 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: An EP who was not the recipient of any transitions of care during the EHR reporting period. Definition of Terms Medication Reconciliation - The process of identifying the most accurate list of all medications that the patient is taking, including name, dosage, frequency, and route, by comparing the medical record to an external list of medications obtained from a patient, hospital, or other provider. Relevant Encounter An encounter during which the EP performs a medication reconciliation due to new medication or long gaps in time between patient encounters or for other reasons determined appropriate by the EP. Essentially an encounter is relevant if the EP judges it to be so. (Note: Relevant encounters are not included in the numerator and denominator of the measure for this objective.) Transition of Care The movement of a patient from one setting of care (hospital, ambulatory primary care practice, ambulatory specialty care practice, long-term care, home health, rehabilitation facility) to another. Attestation Requirements DENOMINATOR: Number of transitions of care during the EHR reporting period for which the EP was the receiving party of the transition. NUMERATOR: Number of transitions of care in the denominator where medication reconciliation was performed. EXCLUSION: If an EP was not on the receiving end of any transition of care during the EHR reporting period they would be excluded from this requirement. EPs must select NO next to the appropriate exclusion, then click the APPLY button in order to attest to the exclusion. The resulting percentage (Numerator Denominator) must be more than 50 percent in order for an EP to meet this measure. Additional Information Only patients whose records are maintained using certified EHR technology should 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 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. Related IMS Function To comply with the Medication Reconciliation requirements, EP must ensure that the referring provider is recorded within the Case associated with the transitioning patient. EP must also ensure that the status of the patient s current medication is recorded within IMS. Although not specifically stated that current medications must be recorded on the 65

66 first visit, it is highly recommended that the EP do this to ensure the information is in the chart and so that compliance is achieved. 1) Properly recorded referring physician is shown in the Case image below: 2) Properly recorded Current Medications are shown in the image below: 66

67 MN08 - Transition of Care Summary Providers Guide to Meaningful Use 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: 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. Exclusion: An EP who neither transfers a patient to another setting nor refers a patient to another provider during the EHR reporting period. Definition of Terms Transition of Care The movement of a patient from one setting of care (hospital, ambulatory primary care practice, ambulatory specialty care practice, long-term care, home health, rehabilitation facility) to another. Attestation Requirements DENOMINATOR: Number of transitions of care and referrals during the EHR reporting period for which the EP was the transferring or referring provider. NUMERATOR: Number of transitions of care and referrals in the denominator where a summary of care record was provided. EXCLUSION: If an EP does not transfer a patient to another setting or refer a patient to another provider during the EHR reporting period then they would be excluded from this requirement. EPs must select NO next to the appropriate exclusion, then click the APPLY button in order to attest to the exclusion. The resulting percentage (Numerator Denominator) must be more than 50 percent in order for an EP to meet this measure. Additional Information Only patients whose records are maintained using certified EHR technology should be included in the denominator for transitions of care. The transferring party must provide the summary care record to the receiving party. 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 be expected to do so. 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 should not be included in the denominator for transitions of care. 67

68 Related IMS Function IMS provides a Referral Tracking utility for this purpose. Within the Referral Tracking utility, the printing or faxing of a letter or form signifies that a Transition of Care Record has been provided for that patient. Generally, a patient will be referred during the course of the office visit and documented as such within the Visit Note. Alternatively, a patient may be added to the Referral Tracking utility manually via the Add option within the Referral Tracking utility. Once the patient is on the list, the EP must ensure that one of the following actions occurs: a) Select the patient from the Referral Tracking list (A). Choose either Letter or Form as transmit option (B). If Form is selected, first Fill Form (C) and click OK from the Forms to be Filled window. Click Fax (D) and complete the fax transmission process until Fax sent successfully message is received. C A B D b) Select the proper patient (A) and Print (B) the Letter via the associated print process. Once the print process is complete, right-click the patient and select Followup (C). Within the Follow-up window, select Type as Fax/Sent (D) and enter a Note (E) that letter was printed. Click Save and Close (F). C A D E F B 68