Enterprise EHR Meaningful Use Stage 2- Cre Measure 10 Lab Results Cnfiguratin Guide Last Updated: Octber 26, 2013 Cpyright 2013 Allscripts Healthcare, LLC. www.allscripts.cm
MU Cre 10 Lab Results This guide will prvide instructins n hw t cnfigure the necessary setup t enable Enterprise EHR (EEHR) t wrk fr reprting MU Cre 10: Incrprate clinical lab test results int certified EHR technlgy as structured data. Final Rule Requirements Mre than 55% f all clinical lab test results rdered by the eligib le prfessinal (EP) during the EHR Reprting Perid (RP)whse results are expressed in a psitive/negative affirmatin r numerical frmat are incrprated in the certified EHR technlgy (CEHRT) as structured data. Cre Objective: Menu Objective: Numeratr: The number f lab test results whse results are expressed in a psitive r negative affirmatin r as a number and are incrprated as structured data. Denminatr: The number f lab tests rdered during the RP by the EP, whse results are expressed in a psitive r negative affirmatin r as a number. Exclusin: Any EP wh rders n lab tests whse results are either in a psitive/negative r numeric frmat during the EHR reprting perid. Objective is shared acrss Eligible Prfessinals: Yes: N: Objective must be recrded during the reprting perid: Yes: N: Prerequisites Requires: Results Functinality Availability: Prir t v11.2: AND Requires: Orders Functinality Availability: Prir t v11.2: Enhanced 11.4.1 Enhanced with: EHR Results Interface Availability: Prir t v11.2: Cpyright 2013 Allscripts Healthcare, LLC. 2
1. Implement Lab Orders & Lab Results: As part f this bjective, bth lab rders and lab results must be implemented. If yu have nt implemented any f these features and are lking fr implementatin assistance, please cntact yur Accunt Manager. Cnfiguratin Steps 1. Optinal: Assciate lab results t LOINC Cdes T prepare fr standard reprting, interperability and quality measures reprting, it is recmmended that all results have a LOINC cde assigned. Review btaining LOINC cdes frm yur lab vendr. This is an ptinal requirement fr Stage 2. SSMT Steps 1. T use SSMT, smene in yur rganizatin needs t be familiar with it, if nt either cntact yur Accunt Manager fr training r manually update in the Resultable Item Dictinary 2. SSMT Cntent Categry = RID- Resultable Item 3. Make mdificatins as necessary in excel fr LOINC Cde clumn. Cpyright 2013 Allscripts Healthcare, LLC. 3
Dictinary Steps 1. TWAdmin Dictinaries Resultable Item dictinary (RID). 2. Search fr apprpriate result. 3. Click n icn next t LOINC ID. 4. Search fr LOINC value, recmmended t search by cde. 5. Select cde. 6. Click Ok. 7. Click Save. 2. Review Lab Orders Classificatin Ensure all labratry rders are apprpriately classified under the Labratry classificatin in the Orderable Item Dictinary (OID). Yu can re-classify rders using drag/drp in the OID r yu can use SSMT cntent categry OID - Orderable Item and the Parent Class clumn. Dictinary Steps G t TWAdmin Dictinaries Resultable Item dictinary (RID). Cpyright 2013 Allscripts Healthcare, LLC. 4
Click n rderable item, that is placed in the rders hierarchy in the wrng parent class and drag it t the crrect parent classificatin. SSMT Steps Cntent Categry = OID- Orderable Item Cntent Categry Make mdificatins as necessary in excel fr Parent Class clumn 3. Identify and update any rders that shuld be excluded fr MU Reprtin g Available in 11.4.1, yu can identify any lab rders that shuld nt cunt as an rder fr any MU2 Reprts that use rders as part f the reprt s calculatin. Cpyright 2013 Allscripts Healthcare, LLC. 5
Dictinary Steps G t TWAdmin Dictinaries and chse Orderable Item in Dictinary drp dwn bx. At bttm f screen, use scrll n right search fr Behavir ptin. Click n arrws left f Behavir t expand windw. Check the D nt include fr MU Reprting checkbx. SSMT Steps Cntent Categry = OID- Orderable Item Make mdificatins as necessary in excel fr DNtIncludeFrMUReprting clumn Cpyright 2013 Allscripts Healthcare, LLC. 6
Wrkflw Cnsideratins Implementatin f a results interface will significantly help with the achievement f this meaningful use bjective. If yu need additinal assistance in implementing a results interface, please cntact yur Accunt Manager. Fr rders adptin, ensure that yur prviders can place an rder withut being frced t cmplete details unless abslutely necessary. This means t default all required fields t allw the prvider t save the rder and cntinue his/her wrkflw. We recmmend t nly require the prvider t cmplete the infrmatin when they are abslutely the nly ne that can answer the questin timely and crrectly (nt required fr MU2 reprting, but general recmmendatin). Ensure that the results are fllwing the verificatin prcess fr the rdering prvid er (r apprpriate staff member. Ensure that the Verify Results tasks, wrk lists, and Clinical Desktp views are apprpriately assigned t verifying users. Determine plicies and prcedures fr when results are received via paper and recrded discretely. Cnsider if retaining the paper is necessary. This includes reviewing the new feature in 11.4.1 that allws yu t attached dcuments t rders as Cpyright 2013 Allscripts Healthcare, LLC. 7
a result. In rder fr an attached dcument t cunt in the numeratr fr this reprt, the result values will need t be abstracted and entered as discrete result values. Encurage the use f CareGuides, Quicksets, and Order Grups fr yur prviders (nt required fr MU2 reprting, but general recmmendatin). Order Grups is a new feature with 11.4.1. It is the ability t create a grup f rderable items (acrss all rder classificatins: labs, imaging, referrals, etc.) that can be rdered by a prvider in ne click. In preparatin fr use f this feature (prir t yur upgrade), yu can review if there are any cmmnly gruped rders (that are nt specifically prblem based) in which yu can administratively setup this grupings by specialty. Ex. pre -p testing and prenatal screenings Encurage the use f specialty favrites and Quick -Lists created fr ad hc rdering wrkflws (nt required fr MU2 reprting). Encurage the use f rder interfaces in wrkflws where yu are receiving results fr the rders (nt required fr MU2 reprting, but general recmmendatin). Encurage the use f medical necessity checking fr understanding which tests are cvered by Medicare fr the assciated diagnsis (nt required fr MU2 reprting, but general recmmendatin). Encurage the use f batch editing when users need t make the same change t many rders. This is a new feature intrduced with 11.3 that allws users t edit similar fields acrss meds and nn-med rders, such as updating the t be dne date r pharmacy (nt required fr MU2 reprting, but general recmmendatin) Hw EEHR Calculates the MU2 Reprt Numeratr: The system will cunt any lab rder in the denminatr status that has an assciated result value (numeric, text, date/time, r picklist value) Cpyright 2013 Allscripts Healthcare, LLC. 8
Denminatr: Cunts each lab rder created by the EP during the RP AND: Order is in an resulted r cmpleted status AND: EP is listed as the Ordered By r Supervised By r Authrized By prvider AND: Order created date during the reprting perid (date is reflected by the Created Date) AND: Order is classified in the Labratry classificatin sectin f the OID Excludes any rder flagged as D nt include fr MU Reprting in the OID Will nt include rders created utside f EEHR in the fllwing instances Unslicited rders received as results Carbn Cpies f labs frm utside system, even if the EP is the rdering, authrizing, r supervising prvider (includes thse rders frm Native Integratin) Will include labs created by the Inbund Orders Interface nly if they required authrizatin (includes retrspective and prspective authrizatin) Orders Created by inbund rders interface. Ex. Reflex Orders cming frm the inbund rders interface If Recrd w/ Ordering flag is checked, the rder will be excluded This will include thse results that are entered via the ACI withut an rder already existing This will include thse rders yu entered as histry Exclusin: If the denminatr cunt is zer, the prvider will be excluded frm this bjective. Indicatrs When the numeratr divided by denminatr is greater than 55% When the numeratr divided by denminatr is between 45% and 55% Cpyright 2013 Allscripts Healthcare, LLC. 9
When the numeratr divided by denminatr is belw 45% Reprt Calculatin Flw Diagram Reprting Cnsideratins Unslicited results will nt cunt as part f the denminatr. The rder fr the result must be placed in the system (by a user r rders interface) and the result needs t be assciated with that rder. The riginating rder needs t be in the EEHR fr the system t be able t determine if the results are applicable fr the EP s reprt (ex. If there were hspital based labs). Scanned results will nt cunt in either the numeratr r the denminatr. If user scans in lab results and is attaching it as a result (new feature fr 11.4.1), the user will need t still enter at least ne result as structured as it needs t be stred discretely. Just attaching a result fr this lab des nt meet the spirit f the measure and will nt be included in the numeratr. Cpyright 2013 Allscripts Healthcare, LLC. 10
Althugh psitive/negative and numerical are specifically called ut in the meaningful use bjective, ur belief is that the intentin f the final rule is t capture and retain discrete clinical result data. Because we always stre data as received, the reprting fr this bjective is purpsely brad t capture this intent. Additinal Infrmatin Here is a list f reference dcuments, and where yu can find them : Certified Wrkflws: ClientCnnect > Tlbx > Prduct Dcumentatin > Allscripts Enterprise EHR > Certified Wrkflws. Ad Hc Dx Order: With/Withut Supervisin (H6a) Dcument Ad Hc Dx Order: Entering fr a Prvider (H6b) Dcument Quicksets (H10) Dcument Charging fr Orders (J3) Dcument Nn-Medicatin Order Prcessing (J6) Dcument Order Specimen/Data Cllectin (J10) Dcument CareGuides (H11) Dcument Entry f Paper Results (R1) Dcument In-Huse Testing (R2) Dcument Results Verificatin (R3) Dcument Results Cmmunicatin (R5) Dcument Appintment Check-Out (K3) Dcument Applicatin Design and Behavir Resurce (ADBR): ClientCnnect > Tlbx > Prduct Dcumentatin > Allscripts Enterprise EHR > Pick yur versin > Manual Guides > Applicatin Design and Behavir Resurce (ensure yu save it t yur PC). Jin Mnthly Order/Results Special Interest Grup n ClientCnnect Care Guide Dcumentatin ClientCnnect > Tlbx > Prduct Dcumentatin > Allscripts Enterprise EHR > 11.4 > Manual Guides. Cpyright 2013 Allscripts Healthcare, LLC. 11
Care Guide Administratin Guide Care Guide User Guide Enterprise EHR Care Guide Updates: https://clientcnnect.allscripts.cm/blgs/eehrcg Batch Clinical Item Edit Enhancement Dcumentatin ClientCnnect > Tlbx > Prduct Dcumentatin > Allscripts Enterprise EHR > 11.3 > Enhancement Supplements. Fr mre infrmatin frm CMS n this bjective, see: http://www.cms.gv/regulatins-and- Guidance/Legislatin/EHRIncentivePrgrams/dwnlads/Stage2_EPCre_10_Cl inicallabtestresults.pdf Cpyright 2013 Allscripts Healthcare, LLC. 12