meaningful use 2014 edition stage 2*

For additional information regarding PrognoCIS, please visit our Client Resource Center ( ).

Stage 1 2011 – 2013

(data capture/sharing)

Stage 2 2014 – 2015

(adv. clinical processes)

Stage 3 After 2016

(improved outcomes)

4010 Moorpark Avenue, Suite 222 San Jose, CA 95117

www.prognocis.com [email protected] *Revision January 2015 / Copyright 2014 – Bizmatics, Inc.

Meaningful Use 2014 Edition

Stage 2* PrognoCIS, v3b2

Access the Client Resource Center

Login as a valid user to your database

Click Resource Center icon ( )

Locating the Video

Scroll down to the Training Videos pane

Click the first thumbnail (upper left image) to access videos main page

If there are technical difficulties with playing the video, please contact Technical Support at (408) 873-3032. The Education Department cannot help with technical issues; only content.

Playing the Webinar Video

Playing the Webinar Video (cont’d)

Using the Video Library

Single-click Webinars under the Workflows directory, which lists sub-category modules in gray

Single-click the sub-category (EMR, Practice Management, Portals & Mobile Apps), which will

display in a gray background & list video titles on right

Select applicable icon* to play or download/save to your local pc/server for later playback

*Click to Play ( ) or

Download ( )

CMS Stage 2 Status http://www.cms.gov/Regulations-and-Guidance/Legislation/EHRIncentivePrograms/Stage_2.html

CMS MU Educational Resources http://www.cms.gov/Regulations-and-Guidance/Legislation/EHRIncentivePrograms/EducationalMaterials.html

Eligible Professional (EP) Eligibility

Completed at least two years of Stage 1 (either 2011 or 2014 edition)

Registered with CMS under the current Certification Number for PrognoCIS*

Medicare Reporting

For 2015, the reporting of Stage 2 is a 365-day requirement (Jan 1 – Dec 31, 2015)

As of February 2015, there is a proposal before Congress to reduce this requirement to 90 days

that is not yet approved.

Medicaid Reporting

EPs reporting under Medicaid program should verify 2015 rules with their state/intermediary

https://www.cms.gov/apps/files/statecontacts.pdf

*PrognoCIS V3 Certification No: #A014E01MAG3ZEAV

Participation Criteria for Providers http://www.cms.gov/Regulations-and-Guidance/Legislation/EHRIncentivePrograms/index.html

http://www.cms.gov/Regulations-and-Guidance/Legislation/EHRIncentivePrograms/Stage_2.html

Incentive Payment / Payment Adjustments http://www.cms.gov/Regulations-and-

Guidance/Legislation/EHRIncentivePrograms/Downloads/MLN_MedicareEHRProgram_TipSheet_EP.pdf

From 2015 forward, incentives are n/a for New

EPs; however, Payment Adjustments are applicable for those who don’t comply.

1. Use CPOE for entering medication, laboratory, & radiology orders 2. Generate & transmit permissible prescriptions electronically (eRx) 3. Record demographics: language, sex, race, ethnic group, & date of birth 4. Record vital signs [a-Ht/Wt for all ages, b-BP for 3 & over numerically) 5. Record smoking status for ages 13 & over w/SNOMED code per answer 6. USE CDS rules to improve high-priority health conditions performance 7. Provide patient’s access to view PHI electronically within 4 business days 8. Provide clinical summary for each office visit within 1 business day 9. Perform security risk analysis and prepare checklist of same 10. Incorporate lab test results into structured data of CEHRT 11. Generate at least one patient list per patient conditions 12. Send reminders for preventive/follow-up care not yet scheduled 13. Provide education resources indicated as relevant per CEHRT 14. Perform medication reconciliation on relevant transitions of care 15. Provide summary of care with all referrals to other care providers 16. Submit immunization data electronically to state registry 17. Communicate with patients using secure electronic messaging

Core Set Measures http://www.cms.gov/Regulations-and-Guidance/Legislation/EHRIncentivePrograms/Downloads/

Stage2_MeaningfulUseSpecSheet_TableContents_EPs.pdf

EP must be able to physically demonstrate compliance per audit requirements.

Some measures modified in 2014

Measures are modified from 2011

edition.

Core Set 1 % numerator

CPOE Medication, Laboratory, & Radiology Orders

Exclusion: Any EP who writes fewer than 100 orders for medication, radiology, or laboratory during the

reporting period.

• Denominator = total number of all orders created by the EP* during the reporting period • Numerator = total number of orders entered into structured data (CPOE)

• 60% - medication orders (both new and refill prescriptions) • 30% - lab orders • 30% - radiology orders

Notes: • *ALL ORDERS (i.e.: both internal and external) prescribed/ordered by the EP are to be

counted in the denominator. External orders are not counted in the numerator. • Status of the order must be A or O; method of transmission of the order is irrelevant

Modified from Stage 1

Medication Orders

Encounter TOC a Prescription CPOE a Refill / Rx

CPOE Rx or Refills • Method of transmission is not a factor (can be printed, eRx, or Fax) • Applicable to both new prescriptions and refills

Face Sheet Current Medications • Source = Ext Rx* (i.e.: Rx ordered within reporting period but not within PrognoCIS CPOE)

• *External Rx must be part of the Denominator • Rx Date must reflect the actual date when the

medication was ordered; not data-entry date.

Medication60%


Lab/Radiology Orders Lab/Rad 30% each

New measure

Encounter TOC Lab Order/Radiology Order • Status must = A (Approved) or O (Ordered) to be counted in the Numerator • Method of transmission is not a factor (can be printed, esend, or fax)

Internal orders – HL7 or Paper

Encounter TOC a Lab Order / Radiology Order

Entered status is excluded from

numerator

Encounter TOC Lab Results/Rad Results • External orders w/Ordering Doc = EP • Does not include external results created to review but not otherwise ordered

(i.e.: patient brings outside results for a second opinion but you are not the Ordering Doctor)

Lab/Radiology Orders - External

Encounter TOC a Lab Result / Radiology Result

• *External Tests must be part of the Denominator • Order Date must reflect the actual date when it

was ordered; not data-entry date • Ordering Doc must be the internal EP

e-Prescribing & Drug Formulary Core Set 2 50%

• Denominator = all prescriptions written* by the EP during the reporting period • Numerator = total prescriptions within the denominator that is queried for Formulary and also

transmitted electronically, and this must exceed 50%

Notes: • Both conditions must apply for the drug to count in Numerator. • Rx Eligibility (which includes Drug Formulary) is automatically enabled with eRx permissions. • EPCS is optional*. If used, CS Drugs will be included. If EPCS not implemented, they will not be

part of either Denominator or Numerator.

Exclusion: (a) Any EP who writes fewer than 100 permissible prescriptions during the 90-day reporting period; OR,

(b) if there is no in-house pharmacy nor an eRx pharmacy within 10 miles of the practice location.

*See Appendix E – MU Settings Provider tab


Prescription Formulary Prescription Formulary Info • Eligibility checks all Pharmacy Benefit Managers (PBM) who report to Surescripts automatically upon

Encounter Start (i.e.: marking an appointment as Arrived) • Each drug is validated against Eligibility as it is entered into the Prescription for Formulary status

Alternate Drugs per formulary

will auto-display

Prescription a Formulary Info icon

When Eligibility is found, details are saved

under .

Stage 1 MS-1

Prescription Eligibility Eligibility Found • The Eligibility button label will appear white ( ) • No manual intervention is required by the EP

Eligibility Error (Not Found) • The Eligibility button label will appear red ( ) • This occurs when the demographics match, but the patient has no benefits reported by any PBM • EP must verify/correct the data as applicable then come back to Eligibility and click retry button

Prescription Eligibility (cont’d)

Eligibility Unknown/Mismatch • The Eligibility button label will appear red ( ) • This occurs when the demographics do not match exactly or there are multiple PMBs reporting • EP must select the applicable option from the Eligibility Info and click ok button

E-Prescription

Prescription a eRx icon

Numerator • Pharmacy assigned to the applicable drug • eRx / EPCS indicator as per Drug Type • Prescription transmitted via eRx button

Stage 1 CS-4

Denominator=6 Numerator=2

Encounter TOC Prescription eRx • Status must = A (Approved) or O (Ordered) to be counted in the Numerator • Drug Type & Pharmacy Type must = eRx or EPCS as applicable for each drug/prescription

Note: If no pharmacy is selected, the drug may still count in the Denominator if applicable.

EPCS is eligible for Stage 2; however, it is not mandatory.

See Appendix E – MU Settings.

Indicates Pharmacy & Drug Types

Drug Type Status • eRx – regular drug with eRx pharmacy assigned • Not Signed – CS drug not yet authorized for EPCS • [blank] – regular drug with no pharmacy assigned • Signed – CS drug authorized for EPCS

Record Demographics

• Denominator = all unique patients seen by EP* during the reporting period • Numerator = patients who have all five required elements recorded in Patient Register

(unless prohibited by law as supported by proper notation), and must exceed 80%; e.g.: • Date of Birth • Gender • *Preferred Language • *Race • *Ethnic Group

Core Set 3 80%

*See Appendix C – Encounter Type Setup

Stage 1 CS-7


Note: • If these values are not entered at time of registration, an error will display at the time

for the registrar to update the details. This error can be overridden and hence the EP will be non-compliant..

Patient Register • auto-complete, pre-defined (non-customizable) lists per MU standards • System Code mapped to each value is linked to MU credit for each demographic field

Patient Register a Other Info (Note: If values are not entered, an alert* will occur upon Save.)

Reference Sites for Acceptable Values: http://www.loc.gov/standards/iso639-2/php/English_list.php

http://www.cdc.gov/phin/tools/PHINvads/index.html http://www.cdc.gov/phin/activities/vocabulary.html

Record Vital Signs Core Set 4 80%

• Denominator = all unique patients seen by EP* during the reporting period • Numerator = patients who have at least 1 entry of the respective vital signs and must

exceed 80% (except where exclusion applies), e.g.: • Height/Length and weight is required for all ages • Blood pressure is applicable only for age 3 and above and must be numerically recorded

as two distinct values for systolic and diastolic values.

*See Appendix C – Encounter Type Setup ^See Appendix E – MU Settings – Provider & Clinic tabs

Stage 1 CS-8


Encounter TOC Vitals Vital Signs Template • Weight, Height, and BP are data-entry fields by clinician • Blood Pressure must be entered as two separate, numeric fields *

Note: A single, fraction text field entry is no longer acceptable. • 2014 edition does not require Growth Chart nor BMI to be reported.

Encounter TOC a Vitals

Exclusions (see Appendix E): 1 – Any EP who believes all 3 vitals are not relevant to his/her scope of practice is excluded from this measure in its entirety. 2 – Any EP who sees no patients 3 & over are excluded from BP only. 3 – Any EP who believes Height and Weight are relevant but BP is not is excluded from recording BP only. 4 – Any EP who believes BP is relevant but Height and Weight are not is excluded from recording height/length & weight only.

BMI is required; however, is not necessary for attestation.

Record Smoking Status Core Set 5 80%

• Denominator = all unique patients over age of 13 seen by EP* during the reporting period • Numerator = number of patients whose smoking status is recorded as structured data as to

his/her level of smoking, which must exceed 80%.

Notes: • You must specify 1 out of 8 standard responses, each of which is mapped to an applicable

SNOMED-CT code. Yes/No is not an acceptable response. • The mapping of a valid SNOMED Code is requirement of ICSA certification.

Exclusion: Any EP who does not see nor admit any patient 13 y/o or above.


Stage 1 CS-9


Social History Social History Template Smoking Status • Smoking History (MU) element is pre-defined with 8 acceptable answers. • Yes/No is no longer acceptable (modified from stage 1). • The SNOMED Codes will not display on your Social History template nor progress note.

Face Sheet a Social History a Smoking Status

Clinical Decision Support Rules and Drug Interaction Validation

Core Set 6 Yes/No

• Attestation = Yes/No that you have implemented at least 5 rules as well as enabled Drug/Drug and Drug/Allergy Interaction validation checks within CEHRT.

Notes: • A minimum of 5 CDS must remain active during the reporting period and 4 of these

should reflect NQFs* or high-priority health conditions within your clinic. • If no NQF measures apply to your specialty, you can create your own CDS that are

relevant to your practice.

See Appendix A for list of certified CQMs


Creating Expressions

Trigger

Expression Type • EMR – locally-defined expressions*; Source of information must be entered by user • Medline Plus – automated expressions; Source is automatically provided via Web Service app

Conditions may be as basic or as specific as

needed.

Settings a Configuration a Workflow a Expressions (Based upon defined triggers + Roles defined in login.expression.applicable).

• 9 standard NQF measures have Expressions pre-defined. (Refer to complete list under Appendix A.)

• EP may elect to use 5 of these 9 or create local rules per specialty

Core Set 6a Yes/No

The Rule

Stage 1 CS-11

User Type Expression

Type Action

(optional)

Prescription a Interaction pop-up (as applicable)

Encounter Drug Interaction • System properties are available to assist you in managing your medication interactions

based on severity levels (but they do not have an impact on compliance)

Core Set 6b Yes/No

Exclusion: Any EP who writes fewer than 100 orders for medication during reporting period.

Severity Level Interaction allergy.druginteraction.severitylevel rx.drugdruginteraction.severitylevel

• 1 – Most severe • 2 – Moderately severe • 3 – Least severe

Stage 1 CS-2

Alerts do not need to display. Compliance is based upon having

the functionality enabled.

Patient Electronic Access to PHI

• Denominator = all unique patients seen by EP* during the reporting period • Numerator (Measure 1) = patients who are provided online access within 4 days after visit,

which must exceed 50%.

Exclusion: Any EP who neither orders nor creates information that would otherwise be contained within the online record.

Core Set 7a 50%

Stage 1 MS-5 (7a)

Note: • Compliance depends upon the patient having the access; not whether he/she uses it or not. As long as you issue the patient a User ID/Password, you are considered compliant for 7a.

*See Appendix C – Encounter Type Setup ^See Appendix D – Patient Portal Login User ID


Patient Electronic Access (cont’d)

• Denominator = all unique patients seen by EP* during the reporting period • Numerator (Measure 2) = patients or authorized representatives view, download, or

transmit Ambulatory Summary to a 3rd party, which must exceed 5%

Core Set 7b 5%


7b - New Measure

Exclusion: (a) Any EP who neither orders nor creates information that would otherwise be contained within the online record; OR, (b) any EP who conducts more than 50% encounters in a county where more than 50% housing units do not have 3Mbps broadband service available per FCC prior to the

reporting period beginning.

This functionality must be done by the patient or patient’s authorized

representative.

Note: • PrognoCIS Audit Trail captures the transactions that occur on the Patient Portal as executed under each patient’s login User ID when counting compliance for 7b.

Patient Portal – Ambulatory Summary

See Appendix D – Patient Portal Login

• Patient or Authorized Representative must actually log into the Patient Portal • Ambulatory Summary must be viewed (at a minimum), printed, downloaded, or transmitted by

the patient/authorized rep to be counted in the Numerator of 7b

Numerator 7b

Patient Register a

Numerator 7a

• Denominator = total number of Office Visits* by the EP during the reporting period • Numerator = total number of office visits for which the patient is provided a Clinical

Summary within 1 business day, which must exceed 50%.

Clinical Summary

Notes: • Clinical Summary format is hard-coded to CCD format and cannot be customized; however,

the EP can choose to suppress certain data before distributing it to the patient. • Patient may refuse to accept the clinical summary and still be counted in the numerator • This measure applies only to applicable Encounter Types*.


Core Set 8 50%

Stage 1 CS-13


Exclusion: Any EP who has no office visits during the reporting period.

Clinical Summary

Encounter TOC a Encounter Close a MU Summary

Patient may decline the summary and it will still count in the Numerator.

Clinical Summary (cont’d)

• Recreate – recompiles the system default as to data (i.e.: removes any edits you may have previously done)

• Edit – enables you to hide specific sections of the summary before distributing it to the patient or PA

• Portal – activates the summary on the portal for the patient to access via Logon User ID/Password provided

• Print – sends hard copy to printer in the office • Download – prompts for a password then saves the file to

your pc’s Download directory or path otherwise specified if local IE Browser/Settings allow. File is saved as a self-extracting .EXE file to give to the patient via external media (USB drive/CD-ROM).

Patient Preference dictates method of delivery

User must select an Action in order to receive Numerator credit.

Simply viewing this screen does not comply in itself.

Clinical Summary - Edit

Note: Even if all elements of a section are suppressed, the title of the section will still be visible; however, the data

will not be present on the patient’s copy. Edits can be reversed via the recreate button.

*Provider discretion dictates level of editing. All editing should occur prior to distributing to client by any method.

Suppress individual values within a section*

Suppress all elements within a

section*

Clinical Summary - Portal

*Some Patient Portal setup is required.

. You must click portal button (in EMR)

in order for the icon* to appear on the Past Visits page of Portal.

Clinical Summary - Download

^Patient will need the password assigned to decrypt the file.

• Encrypt – assign a password (alpha-numeric) of choice to encrypt the PHI file

• Save As – save the file to desired path Note: Most browsers auto-save to a Downloads directory.

• Distribute – the *.exe file can be copied to a USB-drive or burned to a CD-ROM to be given to the patient^

Exact process for file download may vary per

browser.

Protect Electronic Health Info Core Set 9 Yes/No

Home Page a Resource Center

Stage 1 CS-15

• Attestation = EPs must attest Yes to having conducted or reviewed a security risk analysis and implemented security updates as necessary and corrected identified security deficiencies prior to or during the reporting period.

Notes: • CEHRT technology is automatically compliant; however, users must also perform human

security reviews and risk analysis of their operations. • The security risk analysis must occur at least once prior to the end of the reporting period • EP must maintain physical proof (i.e.: a Journal/Operations Log) of compliance with these

requirements • A new EP Action status applies on ARRA Dashboard to indicate the human activity was also

executed before the green thumb-up can display.

http://www.hhs.gov/ocr/privacy/hipaa/administrative/securityrule/

Protect Electronic Health Info

At least once prior to end of each reporting period: Conduct a Security Risk Analysis*

Implement applicable security updates Implement an Employee Sanction Policy to ensure PHI compliance amongst all staff Perform a periodic system activity review

Technical organization/infrastructure Physical safeguards as to workflow, document storage, etc.

Download Security Risk Analysis

Checklist from Client Resource

Center.

2 components – i.e.: Human + EHR

Clinical Lab Test Results Core Set 10

55%

• Denominator = total number of lab tests ordered by the EP within the reporting period as part of structured data (HL7 e-Lab, Fax, or Paper Requisition).

• Numerator = total number of results entered into structured data for applicable tests (HL7 e-Lab or manual data entry), which must exceed 55%.

Exclusion: An EP who orders no lab tests whose results are either in a positive/negative or numeric format during the

EHR reporting period.

Notes: • Faxed results (even if attached as a Lab Result type) do not count in the numerator. • If there is no HL7 in place, results will have to be manually keyed by a user. • Status of the Lab Order must = O, R, or C. (Status E or A are not compliant); property

cpoe.labresults.forapproved should not be set to Y if MU is enabled.

Stage 1 MS-2


Encounter TOC a Lab Result

Clinical Lab Test Results (cont’d) • Lab test ordered through EMR (manually or via HL7 bi-directional interface) must have status = O

(Ordered), R (Results Received), or C (Completed) • Results must be entered to a test(s) ordered within the reporting period.

Workflow Adjustment: If you are not eligible for an HL7 interface,

you will have to manually enter these results as structured data because this measure is now mandatory.

Patient Lists by Conditions Core Set 11

Yes/No

• Attestation = EPs must attest Yes to have generated certain lists based on specific patient conditions. (The measure does not dictate which reports should be generated; that is at the EP’s discretion.)

Notes: • Standard reports used for certification are automatically available for users to print. • Additional custom reports can be added upon request per local needs. • A new EP Action status applies on ARRA Dashboard to indicate the human activity was also

executed before the green thumb-up can display.

See Appendix B – Dashboards and Reports

Stage 1 MS-3

Report a Meaningful Use a Patient Lists

Meaningful Use Reports – Patient Lists • User must generate at least one report classified as Patient-Lists • PrognoCIS Audit Trail will capture this activity; thus, each EP must generate at least one

Patient List under his/her own User ID for appropriate credit.

Patient-Lists

Preventive Care Reminders

• Denominator = total number of active patients (i.e.: those with at least 2 office visits* in past 24 months) prior to the beginning of the reporting period

• Numerator = total number of reminders sent via phone or email during the reporting period (for services due but not yet scheduled), which must exceed 10%.


Core Set 12 10%

Stage 1 MS-4

Exclusion: An EP who has had no office visits in the

24 months prior to reporting period.


Patient Reminders

Home Page a Patient Reminders

• MU-specific Reminders Follow-up, Health Maintenance, Vaccination Services due per Face Sheet or Encounter History but

patient has not yet scheduled an appointment • Specify stage (Stage 1 or Stage 2) • Specify reporting period date range • Click GO button

Core Set 13 10%

Patient-specific Education Resources

• Denominator = total number of unique patients with office visits seen by the EP* within the reporting period

• Numerator = total number of patients in the denominator who receive the CEHRT-identified education during or outside of the reporting period, which must exceed 10%.

Notes: • Individual check box for distribution method must be selected & click the OK button. • Medline Plus education associated to PHI does count and will auto-flow to Patient

Education from the respective screens if chosen. However, it must be printed or emailed from the resident screen first in order to apply in the numerator.

• Education manually added through the + button at Encounter level does not count. The material must be selected by the system as being relevant for the patient.


Stage 1 MS-6

Encounter TOC Education

Encounter TOC a Education a OK

Medline - printed or emailed from the individual pop-up on the appropriate screen via the Edu icon ( ):

Current Medications via RxNorm code PMH via SNOMED-CT or ICD code Assessment ICD via SNOMED-CT or ICD code Lab Order/Result via LOINC code

Medline Education flows here when it is selected on individual

screen where it applies

Internal Education User must select check box and click OK button

Prognocis education must be generated by the user clicking OK button to populate the numerator as per defined Type:

Print sends the attached PDF handout to the default printer Brochure indicates pre-printed material was given to patient URL indicates that you have referred the patient to a web site

New triggers enable you to define education per Rx Norm, LOINC, or SNOMED Codes if applicable

Medline Plus Education

RxNorm code

SNOMED-CT

code

ICD code

Medline Plus Education ( )

LOINC code (Labs)

• Built-in education based upon clinical codes (RxNorm, SNOMED, LOINC, ICD, etc.)

See next slide for sample of the Medline Plus education link

• Link within the Education pop-up launches the source link on Medline Plus web page • Education is not stored within PrognoCIS; authored by CDC, NLM, etc.

Medline Plus Education (cont’d)

Flows to Encounter for MU credit

Notes: • User can preview the education before deciding to print or email to patient. • Requires no local configuration & is automatically included with v3 upgrade. • There is no data entry in the PrognoCIS Education Master. • Email templates can be customized under Settings Configuration Email Patient Education Material for sending the information to the patient.

Embedded Web Service

Settings a Configuration a Clinic a Education

Education Master – Internal • Triggers are specified by the Category assigned when defining the Education record • When the trigger applies to an encounter, the Education will be assigned accordingly

under the Encounter TOC Education screen.

The Applicable Range values depend upon the

Category chosen

Medication Reconciliation Core Set 14

50%

Notes: • *Transition of Care – the movement of a patient from one clinical setting to another (e.g.:

inpatient, outpatient, physician office, home health, rehab, etc.). At a minimum, this includes all New Patients and all Patients w/Summary of Care either paper or electronic.

• No Transition = defaults for existing patients when there is no CCD • New Patient = defaults for patient’s 1st encounter in PrognoCIS • Transition with SOC = defaults when a CCD is imported since the last encounter • Transition without SOC = must be manually selected when applicable

Exclusion: An EP who was not the recipient of any transitions of care during the reporting period.

^See Appendix C – Encounter Type Setup

Stage 1 MS-7


• Denominator = total number of unique Transitions of Care encounters* seen by the EP within the reporting period. There are 4 valid TOC statuses to choose from for each encounter.

• Numerator = total number of transitions of care within the reporting period for which the EP reconciled medications, which must exceed 50%.

Face Sheet a Current Medication

Medication Reconciliation – No CCD When manually entering transitional medications, the user specifies the Source as well as whether or not to Add or Remove each one to the Current Medications list.

• Patient indicates that a human verbally informed you of the medications • Ref Doc indicates that the transitioning provider sent a medication list or progress note (but not a CCD) • Ext Rx indicates that the prescription was ordered outside of PrognoCIS

Face Sheet a Current Medication

Medication Reconciliation – with CCD A CCD (Continuity of Care Document) is an electronic Summary of Care (whose format is dictated by CMS) and must be imported prior to starting the encounter.

• Add will apply the medication to PrognoCIS Current Medications • Remove will not apply the medication to PrognoCIS Current Medications

Summary of Care

• Denominator = number of transitions of care/referrals during the reporting period for which the EP was the transferring/referring provider.

• Numerator = # of TOC Letters that are actually in a Sent status w/a CCD-Summary of Care attached • Measure 1 (15a) – can be printed, emailed, downloaded, or via N2N and must exceed 50% • Measure 2 (15b) – must be sent via N2N, which must exceed 10%. Recipient can be a user of

PrognoCIS or other EMR. If a non-PrognoCIS user, it automatically counts for 15c also.

Exclusion: Any EP who transfers/refers a patient to another provider

less than 100 times during the reporting period is excluded from all 3

measures of the overall measure CS-15.

Stage 1 MS-8

Core Set 15a/b 50%/10%

New for Stage 2


Summary of Care Core Set 15c

Yes/No

• Attestation = Yes/No that you have successfully (a) conducted 1 or more electronic exchanges of CCD with a recipient who uses a different CEHRT (not PrognoCIS), or (b) conducted 1 or more tests with the designated CMS EHRT during the reporting period.

Exclusion: Any EP who transfers/refers a patient to another provider

less than 100 times during the reporting period is excluded from all 3

measures of the overall measure CS-15.

• Measure 3 (15c) – must be sent via N2N with CCD attached, which must exceed 10%. If the N2N transmission to satisfy (15b) is to a non-PrognoCIS user, it counts here also.

• Non-PrognoCIS users will have an email other than [email protected])

Stage 1 CS-14

• Select TOC indicator to identify the Letter Out as a transition or referral • Attach the Summary of Care (New Continuity of Care Document) • Select to Print, Email, Download, or N2N to recipient (CCD cannot be faxed)

Patient a Letters Out

New Continuity of Care Document (CCD) is auto-generated for all patients when N2N is enabled. It will compile all applicable PHI at the point when the TOC Letter is actually generated and sent via

secure N2N messaging. Users also have the option of manually creating a real-time Export

CCD via Patient Review Transition of Care.

Numerator 15 a

Summary of Care Attachment

Print, Email, N2N, or Download

See Appendix E – MU Settings Setup Required See Appendix F – N2N Secured Messaging

Letter sent to N2N from PrognoCIS.

N2N delivered to recipient’s email ID.

Sending Summary of Care – N2N Numerator 15 b/c

(N2N only) • Select TOC indicator to identify the Letter Out as a transition or referral • Attach the New Continuity of Care Document (CCD) Summary of Care • Select N2N provider from the Surescripts Directory. PrognoCIS users will have an email

such as [email protected]. Non-PrognoCIS users will have a different email domain (not .prognocis.com).

Secured (N2N) Messaging*

Sending Summary of Care – N2N (cont’d) • The Surescripts Directory provides list of all providers who have registered with Surescripts for

secured messaging. • The Dtls hyperlink will display the provider’s demographic details including secure email address

• PrognoCIS users’ email = [email protected] • Non-PrognoCIS users’ email domain will be different (i.e.: not .prognocis.com).

Immunization Registry Data Submission Core Set 16 Yes/No

• Attestation = EPs must attest Yes only if one of the following applies: 1. Submission previously established remains enabled through entire reporting period 2. Registration w/PHA with intent of starting ongoing submission:

a. 60 days prior to start of the reporting period & achieved such prior to the end of the reporting period

b. EP is currently in testing/validation stage with the registry c. EP is awaiting invitation from the agency to begin testing

*See Appendix E – MU Settings


Stage 1 MS-9

Immunization Registry by State (October 2014)

Live/In Production

Arizona

California

Florida

Illinois

Maryland

Texas

*See Appendix E – MU Settings – Setup Required tab

Exclusions: 1 – EPs who do not administer immunizations

2 – No existing immunization registry available 3 – No existing registry providing timely data

4 – Existing registry cannot accept new EP

WIP/Finalizing

Alabama

Michigan

Missouri

New Mexico

New York

Pennsylvania

• If your state has a Registry, then a test file should be provided ASAP (before you start your reporting period) in order to attest Yes for this measure.

• If your state has a Registry but is not listed above and you are interested in attesting for this measure, please send us an email at: [email protected].

Secure Electronic Messaging Core Set 17

5%

• Denominator = all unique patients seen by EP* during reporting period • Numerator = total number of patients who have sent a secure message to the EP from the

CEHRT (Portal), which must exceed 5%.

Exclusion: (a) Any EP who has no office visits during the reporting period; OR, (b) any EP who conducts more than 50% encounters in a county where

more than 50% housing units do not have 3Mbps broadband service available per FCC prior to the reporting period beginning.

*See Appendix C – Encounter Type Setup Authorized Users must be defined by patient; see Patient Portal Setup.

New Measure

Secure Electronic Messaging (cont’d)

Patients must send a messages from the Patient Portal to their physician in conjunction with your local preferences and settings*.

Patient Portal a Message Center a Compose EP Inbox Message received from Portal

• *EMR Property pp.message.sendto.doctor is user-defined • A = All Docs • P = Primary Doc only • S = Support Person as designated in CL Location

• See Appendix D for details creating Portal User ID

This functionality must be done by the patient or patient’s authorized

representative.

Note: EP will not get numerator credit for this value if a Support person is defined. If there is no

Support person defined, the EP will get credit.

http://www.cms.gov/Regulations-and-Guidance/Legislation/EHRIncentivePrograms/Downloads/ Stage2_MeaningfulUseSpecSheet_TableContents_EPs.pdf

Menu Set Measures

1. Capability to submit electronic syndromic surveillance data to public health agencies 2. Record electronic notes in patient records 3. Access imaging results consisting of the image itself & accompanying explanation within CEHRT 4. Record patient family history as structured data 5. *Capability to identify & report cancer cases to public health center cancer registry 6. *Capability to identify & report specific cases to specialized registry (other than cancer)

EPs must comply with 3 out of 6 measures. When taking

exclusion, all 6 must be reported.

Syndromic Surveillance Data Submission Menu Set 1 Yes/No

Refer to local and state law for applicable rules.

Stage 1 MS-10




Unknown Status

Kentucky

New Mexico

Pennsylvania

Rhode Island

South Carolina

South Dakota

Texas

No Registry Available

Alabama

Alaska

Arizona

California

Connecticut

Florida

Iowa

Kansas

Minnesota

Mississippi

Montana

Syndromic Surveillance Registry by State

Exclusions: 1 – EP not in a category of providers that collect syndromic surveillance data during the reporting period 2 – No existing PHA capable of receiving syndromic data in required format (unless they have an HIE partnership who can handle it for them) 3 – No existing PHA providing timely access/data 4 – Existing immunization registry cannot accept new EP.

Nevada

New Hampshire

New York

North Carolina

Oklahoma

Oregon

Tennessee

Vermont

West Virginia

Wyoming

Registry Available

Arkansas

Colorado

Delaware

Georgia

Hawaii

Idaho

Illinois

Indiana

Louisiana

Maine

Maryland

e

Massachusetts

Michigan

Missouri

Nebraska

New Jersey

North Dakota

Ohio

Utah

Virginia

Washington

Wisconsin

Electronic Patient Notes Menu Set 2

30%

• Denominator = all unique patients seen by the EP* for at least one office visit during the reporting period

• Numerator = patients within the denominator for whom the user has generated an electronic Progress Note, which must exceed 30%, i.e.:

Note: • EP should be closing all encounter timely, which in turn automatically generates the

electronic My Note.



New Measure

Progress Notes My Notes • When an encounter is closed, the default Progress Note is saved as My Note, which is when the

numerator is credited for the Attending Provider (EP).

• While the encounter remains open, the EP must generate a My Note ad-hoc to get credit.

Encounter a Progress Note a My Notes

Can copy the Default or another template (up to 6)

Imaging Results in CEHRT Menu Set 3

10%

• Denominator = all radiology tests ordered during the reporting period • Numerator = orders within the denominator for which Imaging results have been attached

either at the Order or the Test level, which must exceed 10%.

Notes: • Applicable documents must be attached as a Radiology Result and categorized as an

Image or Image and Narrative Attach Type. • Attachments identified only as a Narrative do not count. • Scanned images attached as Other or any other category do not count. • The Attach Type may be assigned directly while attaching the image or via the Results

screen as applicable.

Exclusion: Any EP who orders less than 100 tests for whose result is an image during reporting period; OR any EP who has no access to electronic imaging results at the start of the reporting period.

New Measure

Attaching Imaging Results

CPOE or Encounter TOC Radiology Results *message.attach.radresult.type

Attach Type must = Image, or Image &

Narrative

Attach As must = Rad Result

Family History Menu Set 4

20%

• Denominator = all unique patients seen by the EP* during the reporting period • Numerator = all patients within the denominator who have an entry under Face Sheet

Family History of 1st degree relatives linked to an applicable SNOMED code, which must exceed 20%.

Notes:

• All 1st degree relative values (i.e.: immediate family mother, father, etc.) come pre-defined in PrognoCIS with the appropriate SNOMED-CT codes for the relationship

• The Problem or Ailment must also be mapped to an appropriate SNOMED Code • For Non-Contributory history (when applicable), use SNOMED Code 404684003 (i.e.:

when Family History is unremarkable or normal for a relative)



New Measure

Family History

Encounter Face Sheet Family History *facesheet.familyhistory.byrelation

• SNOMED-CT codes are required for the ailment and 1st degree relationships per 2014 MU Certification

• SNOMED field added to Family Problems & Relations group types tables for user maintenance as needed

Report Cancer Cases Menu Set 5 Yes/No

Exclusions: 1 – EP does not diagnose or directly treat cancer 2 – No existing PHA capable of receiving electronic cancer case data in required format at beginning of reporting period 3 – No existing PHA providing timely access/data 4 – Existing cancer registry cannot accept new EP.

New Measure




Report Specific Cases Menu Set 6 Yes/No

Exclusions: 1 – EP does not diagnose or directly treat any disease associated with a specialized registry sponsored by a national specialty society or PHA 2 – No existing specialized registry capable of receiving electronic case data in required format at beginning of reporting period 3 – No existing PHA/specialty registry providing timely access/data 4 – Existing specialized registry cannot accept new EP.

New Measure

• Attestation = EPs must attest Yes only if one of the following applies: 1. Submission previously established remains enabled through entire reporting period 2. Registration w/Specialized Registry with intent of starting ongoing submission:



Clinical Quality Measures http://www.cms.gov/Regulations-and-Guidance/Legislation/EHRIncentivePrograms/2014_ClinicalQualityMeasures.html

http://www.cms.gov/Regulations-and-Guidance/Legislation/EHRIncentivePrograms/Downloads/CQM2014_GuideEP.pdf

Reporting Clinical Quality Measures

CMS Requirements

9 individual measures from the list of 64 total (see Recommended Core Set for Adults or Peds*)

3 National Strategy Domains from the list of 6 total

http://www.cms.gov/Regulations-and-Guidance/Legislation/EHRIncentivePrograms/Downloads/EP_MeasuresTable_Posting_CQMs.pdf


PrognoCIS Requirements

Applicable Encounter Types* require an appropriate SNOMED Code

Watch the NQF EP Progress Monitor to track performance

Select Encounter TOC Assessment NQF button

Certified NQF Measures for Reporting CQM

NQF-0002 – Appropriate testing for children with Pharyngitis

NQF-0018 – Controlling high blood pressure

NQF-0022 – Use of high-risk medications in the elderly

NQF-0024 – Weight assessment/counseling for nutrition & physical activity for children/adolescents

NQF-0028 – Preventive care/screening: Tobacco use screening and cessation intervention

NQF-0031 – Breast Cancer Screening

NQF-0032 – Cervical Cancer Screening

NQF-0034 – Colorectal Cancer Screening

NQF-0036 – Use of appropriate medications for Asthma

NQF-0041 – Preventive care/screening: Influenza immunization

NQF-0043 – Pneumonia Vaccination Status for older adults

NQF-0052 – Use of imaging studies for Low Back Pain

Certified NQF Clinical Quality Measures

Report a Meaningful Use a NQF-Measures a QRDA-3 Cumulative all NQF

PrognoCIS is certified for 26 NQFs representing all

6 Domains

Certified NQF Measures for Reporting CQM (cont’d)

NQF-0055 – Diabetes: Eye Exam

NQF-0056 – Diabetes: Foot Exam

NQF-0059 – Diabetes: Hemoglobin A1C Poor Control

NQF-0060 – Hemoglobin A1C Test for Pediatric Patients

NQF-0062 – Diabetes: Urine Protein Screening

NQF-0064 – Diabetes: Low Density Lipoprotein (LDL) Management

NQF-0068 – Ischemic Vascular Disease (IVD): Use of Aspirin or other Antithrombotic

NQF-0069 – Appropriate treatment for children with Upper Respiratory Infections (URI)

NQF-0075 – Ischemic Vascular Disease (IVD): Complete Lipid Panel LDL Control

NQF-0083 – Heart Failure (HF): Beta-blocker Therapy for Left Ventricle Systolic Dysfunction (LVSD)

NQF-0086 – Primary Open Angel Glaucoma (POAG): Optic Nerve Evaluation

NQF-0089 – Diabetic Retinopathy: Communication with the Physician Managing Diabetes Care

NQF-0101 – Falls: Screening for Future Fall Risk

NQF-0421 – Preventive care/screening: Body Mass Index (BMI) screening and follow-up

Report a Meaningful Use a NQF-Measures a QRDA-3 Cumulative all NQF

Note: Other NQF measures may be

available on request; however, individual certification may take more than 90-days.

It is suggested to use these standard NQF if at all possible to ensure you are able to

comply within reporting period.

Appendix A - NQF EP Progress Monitor

CMS specifications are defined as Formulas for

Denominator/Numerator criteria

NQF EP Progress Monitor (cont’d)

Zoom icon lets you select applicable codes and add them

to your assessment

Determine which Formula applies to your encounter and track its requirements.

CPT/SNOMED search includes only those

valid per the NQF specifications

If the code is selected from this search, it will

not be added to the Assessment screen

If CPT already present on Assessment, status

of NQF will = Pass

ICD search includes only those valid per the

NQF specifications

If ICD is selected from this search, it will not

be added to the Assessment screen

If ICD already added to Assessment, status

of NQF will = Pass

Read-only


Appendix B – MU Dashboards & Reports Meaningful Use Dashboards

Encounter Dashboard

System Dashboard

Pass

Fail

EP / Action

Meaningful Use Reports

2014-MU – system-level reports by stage that reflect all EP measures based on settings

MU-Eligibility – provides data per EP based upon Medicaid payer to determine eligibility

Patient-Lists – provides lists of patients per defined conditions as per Core Set Measure 11

QRDA – Quality Reporting Data Analysis – two levels of Clinical Quality Measure reports; QRDA-1

reflects individual results for the selected NQF & QRDA-3 reflects cumulative results of all NQFs

(which can be used for attestation of Clinical Quality Measures).

All EPs should monitor your numbers regularly

Encounter-level Validation Dashboard

Encounter TOC a Encounter Close a

• “Healthy fear of the red” Sometimes red will be valid Sometimes user action is required

• Exempt measures will display grayed-out • Defined under MU Settings Provider, OR • Executed at run time based on Age parameters

• System-level measures reflect overall status Auto-invoked upon

Encounter Close

System-level Validation – Core Measures

• indicates the measure is compliant Note: Qualified exclusions count as compliant

although they will actually display with .

• Exempt measures will display grayed-out • Defined under MU Settings by number

• indicates that the EP must take explicit action and indicate it is completed before a green thumb-up will display as compliant

Home Page a ARRA Dashboard a Core Measures

EP must comply with all 17 Core Set Measures

System-level Validation – Menu Measures

Home Page a ARRA Dashboard a Menu Set

• indicates the measure is compliant

• indicates that the measure is failing • Grayed-out measures are N/A as per the MU

Settings defined for EP/Clinic • Exclusions at the measure level do not count

towards the 3 required measures

EP must actually comply with 3 out

of 6 measures or be able to exclude all 6

ARRA Dashboard – EP Action Required

Home Page a ARRA Dashboard

At Least Once Status

EP – indicates that the EP must take an explicit action

that corresponds with the measure to indicate

compliance with a system functionality or CMS

requirement

Action – invokes the Details pop-up which instructs the

EP what action is required and check box which can be

selected to indicate the affirmative

- indicates that the EP has completed the action

Dashboard Blank (MU Settings not Defined)

Indicates the Provider has not been defined

under MU Settings

*See Appendix E – MU Settings

Report a Meaningful Use

Meaningful Use Reports Report Definition • Classification – categorizes the function within Meaningful Use of the specific report • Option Name – defines the report’s content, including specific stage if applicable • Code – identifies the report by the type of structured data it is reporting

Per EP & Reporting Period

Reports a Meaningful Use a Meaningful Use Stage 1 or 2*

Report Equivalent of the Dashboard It is strongly recommended to monitor your progress by using the MU Reports or the Dashboard. All reports are driven by provider and date range based upon MU settings.

T Note: This report does not

include NQF data for Clinical Quality Measures (QRDA-3).

Things to Remember:

MU Settings apply Only measures not excluded under MU Settings will be reflected in the output) Run report for each individual EP and reporting period All required measures should exceed the Minimum Required % Based on circumstances, a status of Pending or 0.00 may be valid

QRDA Reports (Quality Reporting Data Architecture) http://www.cms.gov/Regulations-and-

Guidance/Legislation/EHRIncentivePrograms/Downloads/Guide_QRDA_2014eCQM.pdf

QRDA Overview

Introduced in conjunction with Meaningful Use Stage 2 in 2014; requirement of certification

HL7 format for electronically exchanging Clinical Quality Measures

http://cms.gov/Regulations-and-Guidance/Legislation/EHRIncentivePrograms/eCQM_Library.html

QRDA-1 represents individual patient-level reporting of CQM

Raw, applicable patient data (e.g.: DOS, clinical condition, etc.)

Uses standardized coded data (e.g.: ICD-9-CM, SNOMED-CT CT, etc.)

QRDA-3 represents aggregate (combined-level) reporting of CQM

Aggregated summary quality data for one provider for one or more eCQMs

Cumulative pool of data gathered at the QRDA-1 level

This is the reporting equivalent of the NQF EP Progress Monitor button under the Assessment screen

Applicable in reporting NQFs; i.e.: Clinical Quality Measures

Appendix C – Encounter Type Setup • Exempt from MU Reporting - exclude from MU altogether (e.g.: surgery, hospital, etc.) • It may be necessary to create some new (additional) Encounter Types (e.g.: nurse visits/procedures

or Office Visit – Education only vs Office Visit – E&M, etc.) • Every encounter type requires an appropriate SNOMED Code for NQF compliance

Settings a Configuration a Clinic a Enc Types (*former property arra.exempt.enctypes is now obsolete)

Mandatory!

Seen by EP = All cases where the EP and the patient have an actual physical encounter in which they render any service to the patient should be included in the denominator as Seen by the EP. Also a patient seen through telemedicine would still count as a patient "seen by the EP." However, in cases where the EP and the patient do not have an actual physical or telemedicine encounter, but the EP renders a minimal consultative service for the patient (like reading an EKG), the EP may choose whether to include the patient in the denominator as "seen by the EP" provided the choice is consistent for the entire EHR reporting period.

Office Visit = defined as any billable visit that includes: (1) concurrent care or transfer of care visits; (2) consultant visits; or (3) pro-longed physician service without direct, face-to-face patient contact (e.g.: 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. The visit does not have to be individually billable in instances where multiple visits occur under one global fee.”

Appendix D - Patient Portal Login User ID • CS-7a/7b- Electronic Access to PHI; View/Print Ambulatory Summary • CS-8 – Clinical Summary for all office visits • CS-17 – Secure Electronic Messaging to the EP from the Patient

Patient Register a *Admin a Properties a Login a [various tags apply]

• When an email address is entered under Patient Register, the system will auto-generate a User ID & Password to the portal for the patient

• When there is no email address for the patient, the User ID & Password must be manually generated in conjunction with system configuration*.

Mandatory!

Patient Portal Authorized Users Patients may assign a representative for self and grant access to patient portal account for sake of viewing the Ambulatory Summary and to process messages with the practice on his/her behalf

Admin a Properties a Login a login.types a AU *Patient Portal a Personal Info a Authorized Users

The system auto-generates the User ID and the initial password

The Authorized Person receives an email with the credentials in an attached PDF

The PATIENT’S DOB is the password to open the PDF attachment which includes the AU’s login credentials.

The Submit button will not be enabled unless

the property* is defined.

Appendix E – Meaningful Use Settings

Settings a Configuration a MU Settings

Notes: • In addition to some properties and configuration, user-level customization may apply. • Provider-level and Clinic-level MU Settings can be modified as needed per workflow and

local preference. • User Role security permissions are required.

MU Settings - Provider

Vital Details • Select the EP’s level of exclusion if applicable

ePrescription: • Select if EP is not using EPCS; if this box is not

selected, CS will count in the Denominator.

Reporting Details: • Stage & Reporting Period • Attestation Date (once applicable)

Immunization Information: • Select if EP does not administer vaccinations

Settings a Configuration a MU Settings a Provider

Syndromic Surveillance: • Select if EP does not report syndromic data

Mandatory!

Stage, Reporting Period, & Attest

Date are critical to assign per EP.

Measures: • Applicable Core Set Measures • Applicable Menu Set Measures • Selected NQF

Cancer / Other Registry Submission: • Select if EP does not report cancer registry or

other Special Registry data

MU Settings - Clinic

Settings a Configuration a MU Settings a Clinic

Miscellaneous: • Specify Test Code IDs for applicable elements to

record Vital Signs & Smoking History data • Displays Encounter Type setup values (as defined

under Encounter Type Master)

Dashboard: • MU module enabled for this URL • MU Dashboard displayed at system-level • Dashboard auto-invoke upon Encounter Close

Mandatory!

Every Encounter Type requires an

MU Status Immunization Information: • Status of EP’s readiness with the state registry

that qualifies him/her when attesting Yes. Note: This applies only in cases where there is a state registry available & the EP does immunizations.

Syndromic Surveillance: • Status of EP’s readiness with the local PHA that

qualifies him/her when attesting Yes. Note: This applies only in cases where there is a PHA and local law requires that the EP report such data.

MU Settings – Setup Required

Settings a Configuration a MU Settings a Clinic

Interface Details: • Select the check box for the interface needed • Requested date will reflect when you sent email • Remarks will indicate registry state or lab vendor • Final Status will indicate progress

To request an interface, select the module(s), enter your RSVP

Email, & click the send email button.

Appendix F – N2N Secured Messaging

• N2N recipients must be registered with Surescripts with a secured email as a result of their association through DTAAP/EHNAC.

*http://surescripts.com/network-connections

• DTAAP - Direct Trusted Agent Accreditation Program • Federal standards/protocols meet all federal requirements for

MU & CMS • EHNAC – Electronic Healthcare Network Accreditation Commission

• See https://www.ehnac.org/about/ • N2N – Network to Network connection (secure emessaging) • NwHIN – Nationwide Health Information Network

Surescripts Network Directory Registration/Setup through Surescripts

PrognoCIS will register the EP with Surescripts

A secure N2N (dual-domain) email address will be assigned to the provider (*.prognocis.com)

Letters Out Surescripts Directory

When EP is setup for N2N, Surescripts Directory option will appear under Letters Out Master

Search

Directory Search launches blank until you enter a string of

text to search

Surescripts Directory Search & Details

Patient a Letters Out a Master Search a Surescripts Directory

• Dtls link displays demographics, incl. N2N email ID • Email domain name@[email protected]

Questions & Answers

Review Time!

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