Attesting for Meaningful Use Stage 2 in 2014 Customer Help Guide

Attesting for Meaningful Use Stage 2 in 2014 Customer Help Guide

Table of Contents PURPOSE OF THIS DOCUMENT 4 MEANINGFUL USE STAGE 2 OVERVIEW 4 ATTESTING FOR CORE OBJECTIVES 5 CORE OBJECTIVE #1: CPOE 7 CPOE FOR MEDICATIONS 7 CPOE FOR LABS 8 CPOE FOR RADIOLOGY/IMAGING 8 CORE OBJECTIVE #2: E-PRESCRIBING (ERX) 9 CORE OBJECTIVE #3: RECORD DEMOGRAPHICS 10 CORE OBJECTIVE #4: VITAL SIGNS 11 CORE OBJECTIVE #5: SMOKING STATUS 12 CORE OBJECTIVE #6: CLINICAL DECISION SUPPORT 13 CORE OBJECTIVE #7: PATIENT ELECTRONIC ACCESS 14 CORE OBJECTIVE #8: CLINICAL SUMMARIES 16 CORE OBJECTIVE #9: PROTECT HEALTH INFORMATION 17 CORE OBJECTIVE #10: CLINICAL LAB TEST RESULTS 18 2

CORE OBJECTIVE #11: LIST OF PATIENTS BY SPECIFIC CONDITIONS 19 CORE OBJECTIVE #12: SEND PATIENT REMINDERS 20 CORE OBJECTIVE #13: PATIENT EDUCATION RESOURCES 22 CORE OBJECTIVE #14: MEDICATION RECONCILIATION 24 CORE OBJECTIVE #15: TRANSITIONS OF CARE 25 CORE OBJECTIVE #16: SUBMIT DATA TO IMMUNIZATION REGISTRY 27 CORE OBJECTIVE #17: SECURE ELECTRONIC MESSAGING 28 ATTESTING FOR MENU OBJECTIVES 29 MENU OBJECTIVE #1: SUBMIT SYNDROMIC SURVEILLANCE DATA TO PUBLIC HEALTH REGISTRY 30 MENU OBJECTIVE #2: ELECTRONIC NOTES 30 MENU OBJECTIVE #3: IMAGING RESULTS 31 MENU OBJECTIVE #4: FAMILY HEALTH HISTORY 33 APPENDIX 34 REPORTING FOR MEANINGFUL USE STAGE 2 34 CARECLOUD CHARTS CERTIFICATION ID NUMBER 34 CARECLOUD TEMPLATES 34 3

Purpose of this Document The purpose of this document is to present CareCloud customers an overview of the requirements needed for Meaningful Use Stage 2 attestation. This document will also help guide customers in capturing and reporting this data using the CareCloud platform. Meaningful Use Stage 2 Overview Physicians who want to attest for Meaningful Use Stage 2 are required to report on 17 core objectives and 3 menu objectives plus 9 out of 64 Clinical Quality Measures (CQMs). 4

Attesting for Core Objectives The following section describes how you can use the CareCloud system to successfully attest for the 17 core objectives in Meaningful Use Stage 2. Note: To determine the measurement thresholds that you have achieved for the Core and Menu objectives, you will need to run the 2014 Stage 2 - Automated Measures report in the CareCloud Analytics app (see Appendix). Meaningful Use Stage 2 Required Core Objectives Core Objective 1. CPOE for Medication/Labs/Radiology Measurement Threshold > 60% of medication, > 30% of labs and radiology orders are recorded using CPOE 2. erx > 50% of all permissible prescriptions are transmitted electronically and compared to at least one drug formulary 3. Record Demographics > 80% of all unique patients have preferred language, gender, race, ethnicity and date of birth recorded 4. Vital Signs > 80% of all unique patients have height and weight recorded, patients 3 years old also need blood pressure recorded 5. Smoking Status > 80% of unique patients (> 13 years old) have smoking status recorded 6. Clinical Decision Support Implement 5 rules related to at least 4 Clinical Quality Measures; enable Drugdrug and Drug-allergy interaction checks for entire period 7. Patient Electronic Access > 50% of patients have online access to clinical data within 4 business days with the ability to view, download, and transmit to a third party; > 5% of patients view, download or transmit clinical data 5

8. Clinical Summaries Clinical summaries are provided to patients within 1 business day for > 50% of office visits 9. Protect Health Information Conduct or review security risk analysis 10. Clinical Lab Test Results > 55% of all clinical lab test orders are resulted as structured data and incorporated into the EHR 11. List of Patients by Specific Conditions Generate at least one report listing patients with a specific condition 12. Send Patient Reminders > 10% of patients with 2 or more office visits within the last 24 months are provided reminders 13. Patient Education Resources > 10% of patients with office visits are provided patient specific education resources 14. Medication Reconciliation > 50% of transitions of care must have medication reconciliation 15. Transition of Care Records Provide a summary of care for > 50% of transitions of care and referrals, > 10% of the total number of transitions or referrals are submitted electronically, perform at least one successful electronic exchange of a summary of care document with a different EHR technology vendor or with a CMS designated test EHR 16. Submit data to immunization registry Ongoing submission of electronic data to immunization registries 17. Secure Electronic Messaging > 5% of unique patients sent a secure message using the electronic messaging function 6

Core Objective #1: CPOE Stage 2 Requirement: > 60% of medication, > 30% of labs and radiology orders are recorded using CPOE. To meet this requirement using CareCloud Charts: For all CPOE items, you can initiate orders via the A&P section via the Encounter Note, or from the Simple A&P. CPOE for Medications To meet this requirement using CareCloud Charts: Order medications via the A&P section of the Encounter Note. On the Automated Measure Report: See calculation C1a. CPOE for Medications. 7

CPOE for Labs To meet this requirement using CareCloud Charts: Order labs via the A&P section of the Encounter Note. On the Automated Measure Report: See calculation C1b. CPOE for Labs. CPOE for Radiology/Imaging To meet this requirement using CareCloud Charts: Order Imaging Tests via the A&P section of the Encounter Note. 8

On the Automated Measure Report: See Calculation C1c. CPOE for Radiology/Imaging. Core Objective #2: e-prescribing (erx) Stage 2 Requirement: > 50% of all permissible prescriptions are transmitted electronically and compared to at least one drug formulary. To meet this requirement using CareCloud Charts: You can order medications via the A&P section of the note or through the Simple A&P. To meet this measure, you must check the formulary before sending the prescription. 9

Then you must choose to e-prescribe the medication. On the Automated Measure Report: See calculation C2. eprescribing (erx). Core Objective #3: Record Demographics Stage 2 Requirement: > 80% of all unique patients have preferred language, gender, race, ethnicity and date of birth recorded. To meet this requirement using CareCloud: Unique patients seen during the reporting period must have preferred language, gender, race, ethnicity and date of birth recorded as well as other standard demographics entered (e.g., Name, etc.). 10

On the Automated Measure Report: See calculation C3. Record Demographics. Core Objective #4: Vital Signs Stage 2 Requirement: > 80% of all unique patients have height and weight recorded, patients 3 years old also need blood pressure recorded. To meet this requirement using CareCloud Charts: Enter vital signs in the Patient Summary or the Encounter Note. 11

There are 3 possible reports for this measure. Choose the report that best reflects the needs of your practice for vital signs. On the Automated Measure Report: See calculation C4a. Vitals (All, All Ages). On the Automated Measure Report: See calculation C4b. Vitals (Height/Weight Only, All Ages). On the Automated Measure Report: See calculation C4c. BP Only (Age 3+). Core Objective #5: Smoking Status Stage 2 Requirement: > 80% of unique patients have (> 13 years old) have smoking status recorded. To meet this requirement using CareCloud Charts: Record smoking status in the Encounter Note using the CareCloud supplied 2014 MU Smoking Status template or through the History section of the Chart Patient Summary. You must select at least one status for each patient over the age of 13 to indicate if the patient is a smoker or non-smoker. 12

On the Automated Measure Report: See calculation C5. Smoking Status. Core Objective #6: Clinical Decision Support Stage 2 Requirement: Implement 5 rules related to at least 4 CQMs, enable Drug-drug and Drug-allergy interaction checks for entire period. To meet this requirement using CareCloud: Drug and Allergy Interaction checking is defaulted to on with Charts 2.0. To view this setting you can go to Settings > Business Entity >Charts 2.0. 13

Drug Contraindication: Clinical Alerts: Enable clinical decision support rules by assigning clinical alerts access to the different roles within the practice via Settings > Business Entity > Charts 2.0. On the Automated Measure Report: There is no entry on the Automated Measure Report for this measure. Core Objective #7: Patient Electronic Access Stage 2 Requirement: a.) > 50% of patients have online access to clinical data within 4 14

business days with the ability to view, download, and transmit to a third party. b.) > 5% of these patients must view, download or transmit clinical data. To meet this requirement using CareCloud Charts: There are two parts to this measure that need to be reported. a.) The provider needs to sign the note and invite the patient to the patient portal within 4 business days of the date of service. This can be done on either the Summary or Note view of the Chart. b.) > 5% of these patients must view, download or transmit clinical data. The patient must login to the portal via CareCloud Community and either view, download or transmit the Clinical Summary or Referral Summary. 15

On the Automated Measure Report: a.) See calculation C7a. Patient Electronic Access - Timely Access. b.) See calculation C7b. Patient Electronic Access - Electronic Copy of Information. Core Objective #8: Clinical Summaries Stage 2 Requirement: Clinical summaries are provided to patients within 1 business day for > 50% of office visits. To meet this requirement using CareCloud Charts: Click to view or print the Visit Summary from the Preview of the Note or from the Summary view of the chart. 16

On the Automated Measure Report: See calculation C8. Clinical Summaries. Core Objective #9: Protect Health Information Stage 2 Requirement: Conduct or review security risk analysis. You have to meet the same HIPAA requirements for protecting patient information in your EHR as you do for paper records. To do this, you must conduct a security review of your system and correct any problems that could make patient information vulnerable. To meet this requirement using CareCloud Charts: There is no measure to meet this requirement, however you must complete all required documentation. CareCloud has passed certification meeting all security requirements under 45 CFR 164.308 (a)(1), including the encryption/security of data, however you still have a responsibility to insure all other facets of your facility meet HIPAA requirements. On the Automated Measure Report: There is no entry on the Automated Measure Report for this measure. 17

Core Objective #10: Clinical Lab Test Results Stage 2 Requirement: > 55% of all clinical lab test orders are resulted as structured data and incorporated into the EHR. To meet this requirement using CareCloud Charts: Order labs via the A&P section of the note. Structured lab results can be imported via a standard lab interface (such as with Quest or LabCorp) or entered via manual lab entry via the Patient Summary screen. Both an order and a result are needed to accurately report this objective. On the Automated Measure Report: See calculation C10. Clinical Lab Test Results. 18

Core Objective #11: List of Patients by Specific Conditions Stage 2 Requirement: Generate at least one report listing patients with a specific condition. To meet this requirement using CareCloud: Navigate to the Clinical tab of the Analytics application and choose patient list. Complete the required fields and generate the report. On the Automated Measure Report: There is no entry on the Automated Measures Report for this measure. 19

Core Objective #12: Send Patient Reminders Stage 2 Requirement: > 10% of patients with 2 or more office visits within the last 24 months are provided reminders. To meet this requirement using CareCloud: There are a couple of ways you can achieve this objective. First, in the appointment app, you may create a patient recall (reminder) within the appointment details to satisfy this measure. Second, in the patient app you can go to the Lists section, select the Recalls button and enter the recall there. 20

On the Automated Measure Report: See calculation C12. Send Patient Reminders. 21

Core Objective #13: Patient Education Resources Stage 2 Requirement: > 10% of patients with office visits are provided patient specific education resources. To meet this requirement using CareCloud Charts: Clicking the Medline education link to obtain educational materials for problems, medications, labs, or allergies will populate the report for this objective. Or you can order patient education materials via CPOE. If patient education material is ordered, it needs to be fulfilled in order to count for this objective. 22

On the Automated Measure Report: See calculation C13. Patient Education Resources. 23

Core Objective #14: Medication Reconciliation Stage 2 Requirement: > 50% of transitions in care must have medication reconciliation. To meet this requirement using CareCloud Charts: This measure is a 2 step process. The steps can be done in any order but both must be complete to update the measure. First, you need to click the Reconciliation button in the Summary view of the chart to perform medication reconciliation. That will bring you to a screen where you are able to upload a file (from a CCDA) to reconcile the medications or you can make an electronic call to Surescripts to perform an electronic medication reconciliation. 24

Second, since this measure specifies that medication reconciliation is done for encounters that are transitions of care you must also be sure to mark the encounter as such for it to be counted in the measure. To do so, upon signing the note, you will need to designate the encounter as a Transition of Care. On the Automated Measure Report: See calculation C14. Medication Reconciliation. Core Objective #15: Summary of Care Stage 2 Requirement: Provide a summary of care for > 50% of transitions of care or referrals. 10% of these transitions or referrals must be submitted electronically to a recipient. The EP must perform at least one successful electronic exchange of a summary of care document with a different EHR technology vendor or with a CMS designated test EHR. (Note: Any provider who transitions patients less than 100 times during the EHR reporting period is excluded from this objective) 25

To meet this requirement using CareCloud Charts: To provide a Summary of Care requires 2 steps. First, add a referral order to the A&P section of the note and fulfill the order by printing or faxing. Second, print or export the Referral Summary for that patient from the Summary view of the Chart. When submitting the referral order electronically, you must have a unique email address for the provider who is receiving it. NOTE: This email address is used for DIRECT messaging and helps ensure security of clinical data. On the Automated Measure Report: For Summary of Care see calculation 15a. Summary of Care. On the Automated Measure Report: For submitting the referral electronically see calculation 15b. Summary of Care (Electronic). 26

Core Objective #16: Submit Data to Immunization Registry Stage 2 Requirement: Ongoing submission of electronic data to immunization registries. To meet this requirement using CareCloud Charts: Once your state registry is connected and configured the integration engine will do the work for you. However, we have added several new fields when ordering or entering a historic immunization. Immunization Registry Protection This gives you the ability to tell the registry if your patient has opted in or out of having immunization information protected by the registry. The none chosen option is the default, and will not affect the protection status of the patient. On the Automated Measure Report: There is no entry on the Automated Measure Report for this measure. 27

Core Objective #17: Secure Electronic Messaging Stage 2 Requirement: > 5% of unique patients send a secure message using the electronic messaging function via the Patient Portal. To meet this requirement using CareCloud Charts: Patients (or their proxy) must send the provider a message via the patient portal (CareCloud Community). This means patients (or the proxy) must be invited to the portal, create their portal account and then send a message. On the Automated Measure Report: See calculation C17. Secure Electronic Messaging. 28

Attesting for Menu Objectives The following section describes how you can use CareCloud Charts to successfully attest for key menu objectives in Meaningful Use Stage 2. Note: CareCloud Charts is certified for the first four Menu measures. Clients will need to choose 3 of these first 4 measures for attestation. Note: To determine measurement thresholds you have achieved with CareCloud, you need to run the 2014 Stage 2 - Automated Measures report from the CareCloud Analytics app (see Appendix). Meaningful Use Stage 2 Menu Objectives (must select 3) Menu Objective 1. Submit syndromic surveillance data to public health registry Measurement Threshold Ongoing Submission of electronic syndromic surveillance data to public health agencies 2. Electronic Notes > 30% of unique patients must have at least one electronic progress note created, edited and signed for at least one office visit 3. Imaging Results > 10% of all tests that yield an image must be accessible through an EHR 4. Family Health History > 20% of unique patients have family health history recorded for one or more first-degree relatives 29

Menu Objective #1: Submit syndromic surveillance data to public health registry Stage 2 Requirement: Ongoing Submission of electronic syndromic surveillance data to public health agencies. To meet this requirement using CareCloud Charts: Once your state registry is connected and configured the integration engine will do the work for you. You must still complete all appropriate documentation as required. On the Automated Measure Report: There is no entry on the Automated Measure Report for this measure. Menu Objective #2: Electronic Notes Stage 2 Requirement: > 30% of unique patients must have at least one electronic progress note created, edited and signed for at least one office visit. To meet this requirement using CareCloud Charts: The encounter must be signed and the PDF generated. Once you sign the note CareCloud will create the PDF and attach it to the patient s chart. On the Automated Measure Report: See calculation M2. Electronic Notes. 30

Menu Objective #3: Imaging Results Stage 2 Requirement: > 10% of all tests whose result is one or more images ordered by the EP must be accessible through an EHR (either by the image itself and/or any explanation or other accompanying information) (Note: Any EP who orders less than 100 imaging tests during the EHR reporting period; or who has no access to electronic imaging results at the start of the EHR reporting period are excluded from this measure).. To meet this requirement using CareCloud Charts: You must order an imaging study and then attach a image result document to the Imaging Order. First you can order the image test via the A&P portion of the note. Next, in the summary view of the chart in the imaging section, you need to add the image/document results of that test to the chart. To do so, click to add a new image. 31

Next, enter details about the image and attach the image/document to an existing image order in order to properly attest to this measure. On the Automated Measure Report: See calculation M3. Imaging Results. 32

Menu Objective #4: Family Health History Stage 2 Requirement: > 20% of unique patients have family health history recorded for one or more first-degree relatives. To meet this requirement using CareCloud Charts: You must enter Family History for a firstdegree relative, such as a Mother, Brother, etc. You can use the History button from the Patient Summary to meet this measure. On the Automated Measure Report: See calculation M4. Family Health History. 33

Appendix Reporting for Meaningful Use Stage 2 The CareCloud Analytics app provides all reports associated with Meaningful Use: The 2014 Stage 2 - Automated Measures report lists the measurement thresholds for core and menu objectives. This report can be found within the Analytics app under the Clinical tab Meaningful Use. The 2014 Clinical Quality Measures report lists the Clinical Quality Measures. This report can be found within the Analytics app under the Clinical tab Meaningful Use. CareCloud Charts Certification ID Number CareCloud Charts v2.1 is certified as a 2014 Edition Complete Ambulatory EHR. The 2014 Edition Certificate Number is: 12192013-2309-8. The CMS EHR Certification ID is: A014E01MYQ3PEAX. CareCloud Templates CareCloud has also published templates to assist with specific data capture requirements for Core, Menu and Clinical Quality Measure reporting. The following templates are in the CareCloud folder and are available to merge into existing templates for your practice. 2014 MU 2 Smoking Status (only) 2014 CQM Diabetes Foot and Eye Exam 2014 CQM Tobacco Use: Screening and Cessation Intervention (includes smoking status) 2014 CQM List 34