configuring axium for meaningful use
DESCRIPTION
Meaningful USE (MU) List of measures that dictate how to use an EHR Goal is to get Providers to use EHRs meaningfully Complete and accurate information Better access to information Patient Empowerment An Overall Improvement in Patient CareTRANSCRIPT
CONFIGURING AXIUM FOR MEANINGFUL USELauralynn Mealing, axiUm ConsultantPaul Delicana, Business Analyst
MEANINGFUL USE (MU)
• List of measures that dictate how to use an EHR
• Goal is to get Providers to use EHRs meaningfully– Complete and accurate information– Better access to information– Patient Empowerment
• An Overall Improvement in Patient Care
MU INCENTIVE PROGRAMS
• Medicare EHR Incentive Program– Total maximum incentive amount of $24,000
• Medicaid EHR Incentive Program– Total maximum incentive amount of $63,750– Last year to receive incentive payments is 2021– State Run 6 Year program (non-continuous)– Last year to Join the program is in 2016– Last year to receive Incentive Payments is in 2021
MEDICAID INCENTIVE PROGRAMYear Requirement for Incentive Payment Incentive Reporting Period
1 Adopt, Implement or Upgrade (AIU) $21,250 N/A
2 STAGE 1 Meaningful Use $8,500 90 Days
3 STAGE 2 Meaningful Use $8,500 Full Year
4 STAGE 2 Meaningful Use $8,500 Full Year
5 STAGE 3 Meaningful Use $8,500 Full Year
6 STAGE 3 Meaningful Use $8,500 Full Year
Total Incentive of $63,750 over 6 years PER Provider
BEFORE YEAR 1
• Register to an Incentive Program– Can only register for one incentive program
• Eligibility Requirements1. Must be a Dentist2. More than 10% of Dentist’s appointments in a non-hospital
setting 3. More than 30% of Dentist’s appointments with Medicaid
Patients• Medicaid Patient Volume Requirement
MEDICAID PATIENT VOLUME• 90 day period in the previous Year• Three ways to calculate– # of appointments the Providers had– # of appointment the Providers had and Start-Checked– # of appointments in the entire clinic
• Group Registration– Can use as a proxy for the Providers Patient volume– Only if it is appropriate for the EP
AXIUM CERTIFICATION• axiUm CE Certification – Valid for axiUm 5.3 CE
• What is a Certified EHR ?– Guarantee that the EHR has the functionality to support
the measures of MU– Certified EHR(EHR Functionality) ≠ Meaningful Use
(Reporting)
AXIUM 5.3 CE
MEDICAID INCENTIVE PROGRAMYear Requirement for Incentive
PaymentIncentive Reporting Period
1 (2013) Adopt, Implement or Upgrade (AIU)
$21,250 N/A
2 (2014) STAGE 1 Meaningful Use $8,500 90 Days
• Once a provider has registered for an EHR Incentive program they are referred to as an “Eligible Professional” an EP• Eligible to receive Incentive payments if they meet the
requirements for the incentive year
MU DASHBOARD
CORE/MENU MEASURE OVERVIEW
MEANINGFUL USE CRITERIA• List of measures that dictate how to use an EHR
• Three Types of Measures1. Core Measures
• The threshold for all these measure have to be met
2. Menu Measures• Threshold for only SOME of there measures have to be met
3. Clinical Quality Measures (CQMs)• No Threshold has to be met
MEANINGFUL USE CRITERIA
• The Core/Menu Measures change at each stages– Stage 1 to 3 gets progressively more difficult– CQMs stay the same
• Stage 1 Meaningful Use Measures– 14 Core Measures– 5 out of 10 Menu Measures (7 to choose from)– 9 out of 64 CQM (15 to choose from)
STAGE 1 CORE MEASURES
Measure # Description aixUm areaCORE 1 CPOE for Medication orders eRxCORE 2 Drug Interaction Checks eRxCORE 3 Maintain Problem List eRxCORE 4 e-Prescribing eRxCORE 5 Active Medication List eRxCORE 6 Active Medication Allergies List eRxCORE 7 Record Demographics Patient Card
STAGE 1 CORE MEASURES
Measure # Description aixUm areaCORE 8 Record Vitals EHR FormCORE 9 Record Smoking Status Alerts TabCORE 10 Clinical Quality Measures * VariesCORE 11 Clinical Decision Support CDS interventionCORE 12 Electronic Copy of Information EHR
CORE 13 Clinical SummariesPatient Attachment
CORE 14 Protect Electronic Information axiUm
STAGE 1 MENU MEASURES
Implemented MENU Measures
MENU 1 Drug Formulary Checks eRx
MENU 3 Patient Lists Infomanager
MENU 4 Patient Reminders Contact Notes
MENU 5 Patient Electronic Access Patient Card
MENU 6 Patient-specific Education Resources EHR
MENU 7 Medication Reconciliation EHR
MENU 9 Immunization Registries EHR (Excluded)
RECORD DEMOGRAPHICSCORE 7 (OF 14)
• MEASURE– More than 50% of patients seen have
demographics recorded• Preferred language/Gender/Race/Ethnicity/DOB
• ATTESTATION– Percentage must be more than 50%
PATIENT CARD, PERSONAL TAB (CORE 7/14)
PATIENT CARD, PERSONAL TAB (CORE 7/14)
PATIENT ELECTRONIC ACCESSMENU 5 (OF 10)
• MEASURE– At least 10% patients provided timely electronic access to health information
• Available within 4 business days of being updated• Patient Access
• ATTESTATION– Percentage must be more than 10%– Exclusion
1. Provider does not need information contained in the problem list, medication lists and medication allergy lists
MU DASHBOARD (MENU 5/10)
CLINICAL DECISION SUPPORT (CDS)CORE 11 (OF 14)
• MEASURE– Implement one clinical decision support rule – EHR functionality that gives a provider general and person-
specific information, intelligently filtered and organized, at appropriate times, to enhance health and health care.
• ATTESTATION– Yes/No
CLINICAL DECISION SUPPORT (CDS)CORE 11 (OF 14)
CLINICAL DECISION SUPPORT (CDS)CORE 11 (OF 14)
CLINICAL DECISION SUPPORT (CDS)CORE 11 (OF 14)
MU DASHBOARD (MENU 5/10)
DRUG FORMULARY CHECKSMENU 1 OF (10)
• MEASURE– The EP has enabled and access to at least one formulary
• ATTESTATION– Yes/No– Exclusion
1. EP Writes Fewer than 100 prescriptions
ERX (MENU 1/10)
MU DASHBOARD (MENU 1/10)
DRUG INTERACTION CHECKS CORE 2 (OF 14)
• MEASURE– Drug – drug & drug – allergy interaction checks are
enabled for entire reporting period– Use eRx
• ATTESTATION– Yes/No
ERX (CORE 2/14)
MU DASHBOARD (CORE 2/14)
CPOE FOR MEDICATION ORDERSCORE 1 (OF 14)
• MEASURE– More than 30% all unique patients have at least 1 medication
order CPOE (Computerized Provider Order Entry) entered – ALTERNATIVE MEASURE
• More than 30% all prescriptions created by the EP were recorded using CPOE
• ATTESTATION• Percentage must be more than 30%• Exclusion
1. EP Writes Fewer than 100 prescriptions
MU DASHBOARD (CORE 1/14)
MU DASHBOARD (CORE 1/14)
E-PRESCRIBING (ERX) CORE 4 (OF 14)
• MEASURE– More than 40% permissible prescriptions written are transmitted
electronically (eRx)• Permissible prescriptions are prescriptions written (NOT for controlled substances)
• ATTESTATION– Percentage must be more than 40%– Exclusion
1. Fewer than 100 prescriptions written2. No Pharmacy within 10 miles accepts eRx prescriptions
MU DASHBOARD (CORE 4/14)
ACTIVE MEDICATION LIST CORE 5 (OF 14)
• MEASURE– More than 80% patients have at least one active
medication (or indication that no medication is currently prescribed)
• ATTESTATION– Percentage must be more than 80%
EHR, CURRENT MEDICATIONS LIST
In axiUm EHR, Medications tab
In axiUm eRx, Medications section
MU DASHBOARD (CORE 5/14)
MAINTAIN MEDICALPROBLEM LISTS CORE 3 (OF 14)
• MEASURE– More than 80% all patients have at least 1 entry or
indication that no medical problems in their problem lists
• ATTESTATION– Percentage must be more than 80%
EHR & ERX PROBLEMS LIST (CORE 3/14)
In axiUm EHR, Alerts tab
In axiUm eRx, Patient Problems section
RECORD SMOKING STATUS CORE 9 (OF 14)
• MEASURE– More than 50% of patients 13 years old or older
have smoking status recorded• ATTESTATION– Percentage more than 50% – Exclusion• No patients 13 years or older seen
EHR, FORMS (CORE 9/14)
In axiUm EHR tab, Update/Review Medical Alerts
MU DASHBOARD (CORE 9/14)
MEDICATION ALLERGY LIST CORE 6 (OF 14)
• MEASURE– More than 80% patients have at least one entry in
their medication allergy list or an indication of no medication allergy
• ATTESTATION– Percentage must be more than 80%
EHR, ALERTS TAB In axiUm eRx, Allergies section
In axiUm EHR, Alerts tab (display from entry in eRx)
MU DASHBOARD (CORE 6 OF 14)
RECORD VITAL SIGNS CORE 8 (OF 14)
• MEASURE– More than 50% of patients have blood pressure (for patients age 3 and
over only) and height and weight (for all ages) recorded as structured data.• Plot and Display Growth Charts 2-20 years old, including BMI
• ATTESTATION– Percentage must be more than 50%– Exclusion:
1. No patients 3 years or older seen2. Patient vitals have no relevance3. Blood pressure is not relevant 4. Height and weight are not relevant
EHR, FORMS, MED HIST (CORE 8/14)
Question/Header Answer Type Reference Code
Height and Weight Assessment: - -
Feet: Number PT_STD_HT1
Inches: Number PT_STD_HT2
Height (Inches): Calculated (EPR_GET_HEIGHT_MDH_F) PT_STD_HT
Weight (Lbs): Number PT_STD_WT
BMI: Calculated (EPR_CALC_BMI_STD) PT_STD_BMI
Is BMI reading over 25? Yes/No MDH_BMI
Blood Pressure: - -
Systolic Blood Pressure (mmHg) Number MDH_SBP
Diastolic Blood Pressure (mmHg) Number MDH_DBP
Pulse (BPM): Number PULSE
In axiUm Maintenance, EHR tab, EPR Forms
MEDICAL HISTORY IN EHR
In axiUm EHR, Forms, Medical History Form tab
MU DASHBOARD (CORE 8/14)
PATIENT LISTSMENU 3 (OF 10)
• MEASURE– Generate at least one report listing patients with a
specific condition • ATTESTATION– Yes/No
MU DASHBOARD (MENU 3/10)
PROTECT ELECTRONIC INFORMATION CORE 14 (OF 14)
• MEASURE– Conduct or review a security risk analysis,
implement security updates and correct identified security deficiencies
• ATTESTATION– Yes/No
MU DASHBOARD (CORE 14/14)
• MEASURE– Submit at least one electronic data test to immunization
registries and follow up submission if the test is successful • ATTESTATION
– Yes/No– Exclusion
• Immunizations not performed• No immunization registry electronic receipt capacity
MU DASHBOARD (MENU 9/10)
PATIENT SPECIFIC EDUCATIONMENU 6 (OF 10)
• MEASURE– More than 10% patients provided patient-specific
education resources • ATTESTATION–Percentage more than 10%
SUGGESTED AXIUM INPUT(MENU
6/10)
MU DASHBOARD (MENU 6/10)
ELECTRONIC COPY OF HEALTH INFO CORE 12 (OF 14)
• MEASURE– More than 50% patients requesting electronic copy of
health information provided it within 3 business days • ATTESTATION– Percentage more than 50%– Exclusion
• No patient requests
AXIUM INPUT IN EHR (CORE 12/14)
MU DASHBOARD (CORE 12/14)
CLINICAL SUMMARIES(CORE 13/14)
• MEASURE– Provided a clinical summary to patients, within 3
business days, for more than 50% of all office visits• ATTESTATION– Percentage more than 50% – Exclusion
• No office visits
AXIUM OUTPUT FOR CLINICAL SUMMARY (CORE 13/14)
SAMPLE CLINICAL SUMMARY(CORE 13/14)
SAMPLE CLINICAL SUMMARY(CORE 13/14)
CLINICAL SUMMARY – TECHNICAL DETAILS
• http://wiki.siframework.org/file/view/Companion_Guide_to_CCDA_for_MU2_r0.docx/390200714/Companion_Guide_to_CCDA_for_MU2_r0.docx
• Relevant Information in:– Table 3: MU2 Data Requirements (pg. 23 – 25)
MU DASHBOARD (CORE 13/14)
CLINICAL QUALITY MEASURES (CQMs) (CORE 10/14)
• MEASURE– Report on 9 CQMs (15 to choose from) – From at least 3 different domains
• Workflows– Some will overlap with the workflows of the
Core/Menu measures– Others are dental related measures
MU DASHBOARD (CORE 10/14)
REC ONLINE ATTESTATION
QUESTIONS/COMMENTS?
THANK YOU