Meaningful Use for Eligible Providers. Session Three: The Menu Set

Meaningful Use for Eligible Providers Session Three: The Menu Set

Session Agenda The purpose of this training session is to assist an ARRA EHR Meaningful Use Funding Eligible Provider to understand how to meet each of the menu set requirements. An eligible provider must choose and meet five items from this menu set. For each Menu Set Requirement this training will: 1) Identify the requirement from the regulation and the required minimum threshold 2) Restate the requirement as a Yes / No statement for the eligible professional 3) Identify the specific areas or actions in Optum Physician EMR utilized to meet the requirement 4) Explain the documentation methodology for each requirement: Self Attestation Reporting

Provider Self Assessment Tool On Optum Physician EMR Help, near the same link you utilized to access this recording, there is a link to a document called the Self Assessment Tool. We encourage you to print this document and be prepared to record your self assessment or follow up action items after you have learned how to use Optum Physician EMR to meet each Meaningful Use Requirement. The Menu Set Items have M before the number:

The Requirements Menu Set Final Regulation

M 16 Drug Formulary Checks Menu Set The Requirement: Implement drug-formulary checks (generate at least one report for entire reporting period). Self Assessment Statement: My practice utilizes a Medicare Certified eprescribing application which presents me with formulary information when I am eprescribing if the patient is eligible and has a participating pharmacy benefit manager. Self Attestation Where and How? Prescription Writer > formulary information in medication search results and on screen formulary information to the right of where the provider enters the sig: "Formulary" at top right - if patient has information available.

M 16 Drug Formulary Checks Menu Set When a patient has formulary information available from their Pharmacy Benefit Manager (PBM) Optum Physician EMR will automatically gather this information during the nightly medication history check for a patient on the schedule. Self Attestation This information will appear in the prescription writer:

M 16 Drug Formulary Checks Menu Set Self Attestation These are the formulary symbols and what they each mean:

M 16 Drug Formulary Checks Menu Set Self Attestation If the patient walks into the office and is added to the schedule this information must be requested and will then be present in the same manner previously shown if the patient s PBM has information to share. To request the information simply select the Check Rx Eligibility button in the prescription writer:

M 17 Clinical Test Results Menu Set The Requirement: Incorporate clinical lab-test results into EHR as structured data (40% of all tests ordered with results in a positive /negative or numerical format). Self Assessment Statement: My practice enters Optum Physician EMR orders and either receives electronic lab results as structured data and links the results to the order or my practice manually enters key lab results via orders and completes the orders for at least 40% of entered orders. Where and How? (For Lab Type Orders / Results Only) 1. Medical Record > Clinical Tool Bar > Order Entry 2. Home Dashboard > Results; and / or 3. Clinical Today > Provider Quick Task > Results; and / or 4. Orders > Manual Data Entry and completion 5. And linking electronic results to orders

M 17 Clinical Test Results Menu Set First get ready to enter patient laboratory orders minimally for any test that will have a structured result (a number or a +/- result): Set up your favorites facilities with account numbers Set up your favorite tests and the defaults for each test Create order sets You can access Optum Physician EMR Help or Training Sessions if you need assistance with these set up areas Start to create and print lab orders for patients during their visits:

M 17 Clinical Test Results Menu Set Write your orders Choose Save and Print to get the order printed out. You can also add your signature electronically.

M 17 Clinical Test Results Menu Set Optum Physician EMR has the following examples of some of the interfaces currently available for activation by your practice: Contact a Optum Physician EMR Sales Executive to sign up for your first interface or if a desired interface is not listed. Subsequent add on of available interfaces can be done by sending a ToDo with your request to Optum Physician EMR Support.

M 17 Clinical Test Results Menu Set Once a results interface is activated the results can be viewed and committed to the patient s medical record via several different views. From the Home Dashboard > Clinical > Select the Results Link:

M 17 Clinical Test Results Menu Set Selecting a lab from the previous screen results in an actionable pop-up: The results in red are outside reference range set by facility. User can print, attach to a message, add a recall, sign (commit) the result to the chart, view the patient s record, or link ( ) the result to a previously entered order using the buttons across the bottom of the results screen.

M 17 Clinical Test Results Menu Set From Clinical Today on the Provider s Quick Tasks the Results can be accessed several ways: Results opens Tasks The arrow opens & closes the list Click on an item to get the pop up When a result is selected from the Quick Task or the Tasks Tab it will appear in a pop-up with all the same actions as previously described.

M 17 Clinical Test Results Menu Set If your practice does not receive electronic results you can enter results using manual data entry into a lab order. Create order using the Clinical Tool Bar, then access the order on the Orders > Health History Pane:

M 17 Clinical Test Results Menu Set When electronic results are received they should be linked to Open Orders. This action will resolve your open orders and allow you to know when a patient has not completed a clinical order. As noted earlier when you are viewing the result or on the orders screen there is an action to "Link to Result. Select this action and locate the corresponding order on the patient s list of open orders. Select the Link button and the link the open order is completed. START HERE>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>.

M 18 Patient List Menu Set The Requirement: Generate lists of patients by specific conditions (those on the problem list) to use for quality improvement, reduction of disparities, research, and outreach (generate at least one report with a list of patients with a specific condition). Self Attestation Self Assessment Statement: I have generated at least one report from Medical Reports or the Clinical Query Builder to use for quality improvement, reduction of disparities, research, and outreach. Where and How? Reporting > Other Medical Reports > Global Patient by Diagnosis Standard Report. Reporting > Medical Reports > Clinical Query Builder > Create, save, and run a query that identifies patients by identified problems that can be used for quality improvement or outreach. Per CMS 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.

M 18 Patient List Menu Set Self Attestation EASY: Select Generate and when it is complete collect it from the Published Reports Queue

M 18 Patient List Menu Set This new report tool, located under Medical Reports, enables you to create a combination of clinical queries based on patient demographics and clinical data from one location. You can use the reporting tool for creating simple queries to more complex queries using the criteria listed below: Diagnoses Results Medications Medication Class Patient Care Management Procedures Allergies Vitals Self Attestation Let s take a look at how the Query Builder works

M 18 Patient List Menu Set Video Clinical Query Builder

M 19 Patient Education Menu Set The Requirement: Use certified EHR to identify patient-specific education resources and provide to patient if appropriate (10% requirement). Self Assessment Statement: My practices uses Optum Physician EMR Krames Patient Education Resources, practice specific documents loaded into Optum Physician EMR Patient Education, or Patient Medication Education Handouts in the Prescription Writer to assist with educating our patients and copies of the handouts dispensed can be found in more than 10% of our patients records. Where and How? Medical Record > Clinical Tool Bar > Patient Education searched & printed for patient. Record of what was printed can be located in Patient Medical Record > Health History Pane > Correspondence, and Clinical Tool Bar > Prescription Writer > Medication Education Handouts printed.

M 19 Patient Education Menu Set Patient Medical Record > Clinical Tool Bar > Patient Education Complete the search fields and choose Search Remember when you search sometimes less entry will yield more results from which to choose. This is especially true if you are not sure of the spelling or title of exactly what you are trying to locate.

M 19 Patient Education Menu Set Health History Pane of patient s medical record stores a copy!

M 19 Patient Education Menu Set Clinical Tool Bar > Prescription Writer > Patient Teaching Handout:

M 20 Medication Reconciliation Menu Set The Requirement: The eligible provider who receives a patient from another setting of care or provider of care or believes an encounter is relevant should perform medication reconciliation (50% requirement). Self Assessment Statement: My practice has set up appointment type that identify appointments that are related to a transition or relevant for medication reconciliation. When patient's have relevant encounters or care transitions I review all available medication information in comparison to the patient's Medication List and update the list to ensure accuracy at least 50% of the time. Where and How? Patient Medical Record> Health History Pane>Medications: Actively manages and reviews this list during relevant or transition of care visits (defined by practice in appointment type set up or edited manually in encounter) and utilizes Mark Reviewed" button to document review or reviews medication list in patient progress note and uses the chart viewer link to medications to indicate "Mark Reviewed". Documenting no known medications qualifies. When appointment is a transition or relevant the user will be prompted on Medication HHP when Mark Reviewed is utilized to answer: "This visit is a transition in care. Was Medication Reconciliation done?"

M 20 Medication Reconciliation Menu Set Part One: (Measurement denominator will be how many appts have this indicated) Set up your appointment types to indicate which appointment types you consider to be related to a transition in care or relevant visit. Relevant is to be defined by your practice according to CMS. An example might be a patient who has not been seen by the practice in over a set period of time you determine. Part Two: (Measurement numerator will be how many appts have the above indication and have Mark Reviewed, Yes, Medication Reconciliation Completed during the corresponding encounter) Patient Medical Record > Health History Pane > Medications OR Chart Viewer > Medications: Actively manage and compare this list with other information available during relevant visits. Some other sources for information might be: 1) Medication Pane: PBM information displayed as History as of MM/DD/YYYY" link when patient has been scheduled for an appointment or the "Request Medication History" button; compare PBM list to Medication List, or 2) Medication Pane: Patient has a paper or scanned medication list; compare list to Medication List, or 3) CCD sent to practice: compare CCD provided to medication list. Then utilize "mark reviewed" button in Medication Health History Pane or on Med Pane of Chart viewer to document this comparison, answer the prompt Yes. NOTE: Med List Reviewed Check Box on History Section of Progress Note does not satisfy this requirement.

M 20 Medication Reconciliation Menu Set Appt Type = Transition of Care Clinical Today, Appt Type Displays And then on Med List Pane when either Mark Reviewed or Confirm No Known Meds is chosen the pop up to denote reconciliation completed presents.

M 21 Transition of Care Summary Menu Set The Requirement: The eligible provider 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 and referral (50% requirement). Self Assessment Statement: I print and send (mail or fax) a chart summary when I refer a patient to another provider or when care is transitioned. OR I send a CCD via the Provider Portal when I refer a patient to another provider or when care is transitioned. Separately, or together, I do this for at least 50% of my transitioned and referred patients. Where and How? After the creation of an outgoing referral with Transition in Care indicated, create a ToDo with Category: Interoffice, Type: EHR, Reason: Med Record Request- Provider. The required information can then separately be mailed, faxed, or sent via the Provider Portal to the provider being referred to. Close ToDo when actions are completed.

M 21 Transition of Care Summary Menu Set First create an outgoing referral: This can be done from Practice Management Or from Medical Record Clinical Tool Bar

M 21 Transition of Care Summary Menu Set Sample ToDo Use the Link Patient Data function to add pertinent information and select Send : Practice might print and mail, print and fax, or send via Provider Portal, but Remember to close the ToDo when the action is completed!

M 22 Immunizations Menu Set The Requirement: Self Attestation Capability to submit electronic data to immunization registries or Immunization Information Systems and actual submission in accordance with applicable law and practice (perform at least one test if the registry has the capability to receive electronically). NOTE: EP must complete one of Immunization or Syndromic Surveillance unless has an exception for both. Self Assessment Statement: I have submitted at least one immunization file electronically to my state. The provider needs to ascertain if their state will accept immunization registry data electronically. If electronically capable notify Optum Physician EMR via a ToDo of the need to generate test file ASAP. Please include a technical contact at the state and Optum Physician EMR will work to program and activate the Immunization "Save and Send" feature or the Immunization Export. Where and How? States with HL7 Interface: Clinical Tool Bar > Immunization Module > Utilize Save & Send Electronically button which will automatically batch and send data to state. States that accept a file (not HL7): Administration > Clinical > Immunization Export after documenting on HHP or Immunizations Module.

M 22 Immunizations Menu Set Self Attestation HL7 States: Clinical Tool Bar > Immunization Module > Utilize the Save & Send Electronically button once functionality is activated: The files are sent automatically in the background.

M 22 Immunizations Menu Set First document administration of the immunization either on the HHP > Immunization or Clinical Toolbar Immunization Module: Self Attestation Then at the interval required by your state access : Administration > Import/Export > Clinical > Immunization Export and create your file, download it to your local computer and upload it to your state as per their directions:

M 23 Public Health Surveillance Menu Set Self Attestation The Requirement: Capability to submit electronic syndromic surveillance data to public health agencies and actual transmission in accordance with applicable law and practice (perform at least one test unless public health agencies do not have the capacity to receive electronically). NOTE: Must complete one of Immunization or Syndromic Surveillance unless EP has an exception for both. Self Assessment Statement: My practice has run the syndromic surveillance report for <influenza or others> and can attest that at least one test has been completed and sent to my state s public health agency if they are able to receive. How and Where? Reporting > Medical Records > Medical Reports > Clinical Query Builder can be used to build a query in the format desired (and accepted by your DPH which is usually HL7 ADT format). Using the Clinical Query Builder was reviewed for M18, please build and save an appropriate query.

M 23 Public Health Surveillance Menu Set Additional information from CMS: Self Attestation http://www.cms.gov/ehrincentiveprograms/downloads/ep-mu-toc-core-and-menuset-objectives.pdf

M 24 Patient Reminders Menu Set The Requirement: Send appropriate reminders to patients per patient preference for preventative/follow up care during the 90 day reporting period for patients 65 and older or 5 years and younger (20% requirement). (Note must have patients in these age brackets.) Self Assessment Statement: My practice has activated the appropriate Care Management Rules for my patient population and actively enter and maintain data for patients 65 years or older and/or 5 years old or younger and we use the recall module or Patient Portal to send reminders to at least 20% of patients. May also use the Clinical Query Builder to generate recalls for Patient Care Management based reminders. Where and How? Use Recall application, Population Management to generate recalls, or the Clinical Query Builder to capture a list of patient's requiring pertinent reminders and generate recalls based on this list. Recall letters generated or Patient Portal messages regarding reminders will be logged in correspondence and contribute to meeting this requirement. Using the Clinical Query Builder was reviewed for M 18, please build and save an appropriate query.

M 24 Patient Reminders Menu Set Activate Care Management Rules that apply to patients who are over 65 years old, or who are 5 years old or younger, and actively use these rules to remind your patient population of needed actions. How to activate Care Management was reviewed in Session 2 for Core Requirement 13. This requirement is included to promote keeping your patient s care needs current; to do this it is required that you send the reminders, so you have to make the following a standard part of your practice workflow: 1) Set up the rule or define a process to set recall appointments, 2) Keep your Population Management information current, and 3) Use the recall module to set up and then send reminders to patients, 4) And/or use the Clinical Query Builder to generate lists for needed reminders to message via Patient Portal for enrolled patients, 5) Recall Letters, Appointment Reminder Letters, and Patient Portal emails created for 20% of appropriate age patients, logged on the Correspondence Pane, will satisfy this requirement. 6) Televox messages do not currently count.

M 25 Patient Access to Electronic Record Menu Set The Requirement: Provide patients with timely electronic access to their health information, including laboratory results, problem list, medication list, and medication allergies within four business days of the information being available to the eligible provider (10% requirement). Self Assessment Statement: My practice has activated the Patient Portal option to share data with patients (practice is able to set areas for inclusion to meet criteria). My practice has at least 10% of our patients who had visits in the 90 day reporting period registered to use Patient Portal. This option will make the data available immediately to all registered Patient Portal patients. Where and How? Administration > Set Up > Patient Portal > Health Record. Actively register patients to participate in Patient Portal.

M 25 Patient Access to Electronic Record Menu Set

M 25 Patient Access to Electronic Record Menu Set Optum Physician EMR Help has a Recorded Training Session on how to set up Patient Portal. Please access this session and start to enroll patient s in Patient Portal. This is available as part of your existing EHR subscription. There are no additional fees for this service.

Meaningful Use Dashboard You have an interactive dashboard available to you to monitor and assess your success with meeting each of the requirements. Here is an example of what it looks like:

Conclusion Session Three: Menu Set Requirements Meaningful Use for Eligible Providers Please remember to complete your Provider Self Assessment Tool and thank you for your time and attention!