micromd emr update guide version 9 update... · text that you type using the keyboard is shown in a...

MicroMD EMr vErsion 9.0 u p d at e g u i d e

TABLE OF CONTENTS

PREFACE

Welcome to MicroMD EMR ......................................................................................................................... i How This Guide is Organized ...................................................................................................................... i Understanding Typographical Conventions .................................................................................................. i

Cross-References ............................................................................................................................................ i Text You Type Using the Keyboard .................................................................................................................. i Keys You Press and Buttons You Click ............................................................................................................. i Dialog Box, Application Window Titles, and Field Names .................................................................................ii Notes, Warnings, and Tips ..............................................................................................................................ii

GENERAL CHANGES

Surescripts Direct Secure Messaging .......................................................................................................... 1 Screening and Prevention .......................................................................................................................... 4

MEANINGFUL USE

Added LOINC Codes .................................................................................................................................. 5 Drug Interaction Warning Revamp ............................................................................................................. 6 Updated List of Smoking Status Habit Collection Data ................................................................................ 7 Enhanced Data Choices for Race, Ethnicity and Language .......................................................................... 9 Clinical Quality Measures Capture and Export .......................................................................................... 10 RxNorm Codes in the Drug Information Window ...................................................................................... 13 Drug and Allergy Severity Indicators are now separate ............................................................................. 14 High-Risk Medications Condition ............................................................................................................. 16 Data Portability: Bulk Patient CDA Export ................................................................................................ 18 Customizing CDA Export Data ................................................................................................................. 19

CLINICAL QUALITY MEASURES

UPDATED FEATURES FROM VERSION 9.0.2

Default Units of Measure in Women’s Health ........................................................................................... 26


Restrictive Access Options in Encounters .................................................................................................. 29

MicroMD EMR Update Guide Version 9.0 TOC.1

Table of Contents

TOC.2 MicroMD EMR Update Guide Version 9.0

PREFACE

WELCOME TO MICROMD EMR From all of us here at Henry Schein Medical Systems, Inc., thank you for selecting MicroMD EMR, the definitive Electronic Medical Records (EMR) solution. This manual is a quick reference to all of the newest features of MicroMD EMR. This manual does not cover hardware setup, networking, or installation of the program.

HOW THIS GUIDE IS ORGANIZED We have organized this guide according to the modules within MicroMD EMR. The discussion consists mainly of the new features within the modules. You can find in-depth information about the entire module in the MicroMD EMR User’s Reference Manual located in the Help menu of MicroMD EMR.

UNDERSTANDING TYPOGRAPHICAL CONVENTIONS Before using this manual, it is important to understand the typographical conventions used to identify and describe information.

Cross-References

Cross-references to chapters, sections, page numbers, headings, etc. are shown in an italic typeface.

Text You Type Using the Keyboard

Text that you type using the keyboard is shown in a Courier typeface.

e.g., Type Anthony Smith in the Name field.

Keys You Press and Buttons You Click

Keys that you press on the keyboard and buttons/icons that you click with the mouse are shown in a bold sans-serif typeface.

e.g., Press Enter.

e.g., Click OK to continue.

MicroMD EMR Update Guide Version 9.0 i

Chapter 1. General Changes Understanding Typographical Conventions

Dialog Box, Application Window Titles, and Field Names

The titles of dialog boxes and application windows are shown in italics. Field names and selections made from drop-down menus, etc. are also shown in italics.

e.g., The Print Preview dialog box appears.

e.g., Select Commercial Insurance from the drop-down list.

Notes, Warnings, and Tips

Notes, tips and warnings are provided throughout the manual. These provide additional information that is important for you to know about the topic.

NOTE | A note is an important piece of information.

STOP | You should definitely read the information in a warning. It could help you prevent a disaster.

TIP | A tip table helps you with some interesting information about different ways to use the program.

ii MicroMD EMR Update Guide Version 9.0

GENERAL CHANGES

SURESCRIPTS DIRECT SECURE MESSAGING Changes have been made to the Surescripts Direct Secure Messaging, including the importing of messages from other providers, using the fax inbox for incoming messages, enabled processing of CCD/CCR, and the ability to route message CDA from a patient through the portal to the direct network provider.

Surescripts CIN is a network that allows for the creation of “direct secure e-mail addresses” for providers participating in MU and the transmission of secure e-mails. This tool is integrated with MicroMD EMR and the Patient Portal to allow providers to meet Core MU Measures for:

• Core 7: Allow patients the ability to View, Download and Transmit their electronic medical records – Through the Patient Portal providers can post patient electronic medical records (CDA documents) for patient Viewing, Download and Transmission. Patients also have the ability to “Transmit” as part of this requirement by securely sending their electronic medical records through the patient portal to a provider that has a direct secure e-mail address set up through one of the Surescripts Clinical Network Partners listed to the right. Direct secure e-mail addresses set up through non-Surescripts partner sources currently will not transmit through the Surescripts CIN.

• Core 15: Securely send other providers a Summary of Care Record for transitions of care – Locate providers direct secure e-mail addresses on the MicroMD EMR Surescripts CIN directory (or add a new provider’s direct secure e-mail address) and send secure Summary of Care Records securely and electronically for transitions of care. Providers can securely e-mail Summary of Care records through MicroMD EMR to providers with a direct secure e-mail address set up through one of the Surescripts Clinical Network Partners listed to the right. Direct secure e-mail addresses set up through non-Surescripts partner sources currently will not transmit through the Surescripts CIN.

• Core 17: Use Secure Electronic Messaging to communicate with patients on relevant health information – Also accomplished through the provider’s direct secure e-mail address

Practices with EPs participating in MU will need the following direct secure e-mail addresses:

• 1 direct secure email address for the practice: Required for secure messaging patients through the patient portal and ability for patients to send a Summary of Care records to their referring provider if they have been given that providers direct secure address (Core 7 and 17)

• 1 direct secure email address for each provider doing MU: Securely send Summary of Care documents to other referring providers on the Surescripts network and communicate relevant healthcare info securely with patients (Core 15 and 17)

• 1 direct secure email address for each additional location that will need its own secure direct address: If a location needs to manage their direct secure e-mails separately from another practice, they will need an additional direct secure e-mail address for each location for secure messaging patients through the patient portal and ability for patients to send a Summary of Care records to their referring provider if they have been given that providers direct secure address (Core 7 and 17)

Surescripts Clinical Network (CIN) Partners

Providers with direct secure e-mail addresses through these EMR vendors and organizations can be securely e-mailed from MicroMD EMR through the Surescripts Clinical Network.

CHAPTER 1

MicroMD EMR Update Guide Version 9.0 1

Chapter 1. General Changes Surescripts Direct Secure Messaging

Providers with a direct secure e-mail address through another source will not be able to receive direct secure e-mails through MicroMD EMR.

EHRs and Health Technology Vendors

• Adaptamed

• Advanced Data Systems

• AssistRx

• Bizmatics

• Chart Logic

• ClinixMD

• CureMD

• DAW Systems

• Epic

• Falcon (Davita)

• GE Healthcare

• GeniusDoc

• MicroMD

• Glostream

• Greenway Medical Technologies

• HealthFusion

• Henry Schein

• Inofile

• MEDENT

• Medical Office Solutions

• Medical Office Technologies

• Meditab

• MEDITECH

• Merge Healthcare

• NewCrop

• NextGen

• OA Systems

• Patient Point (Greatwater Software)

• SCI Solutions

• SRS Software

• STI Computer

• Success EHS

• Vitera

• Zirmed

DirectTrust accredited organizations

• CareAccord

• Cerner

• Covisint

• DataMotion

• DigiCert

• EMR Direct

• Illinois HIE (via Inpriva)

• Infomedtrix

• ICA (Informatics Corporation of America)

• Inpriva

• IOD corporation

• Iowa HIE (via ICA)

• MaxMD

• MedAllies

• MRO corporation

Patients and providers can transmit a wide range of formats of clinical data over the Surescripts Direct Secure Messaging service through the MicroMD Secure Chart Patient Portal. Both the practice and patient must be configured to use provider-to-provider direct secure email or patient-to-provider direct secure email.

2 MicroMD EMR Update Guide Version 9.0

Surescripts Direct Secure Messaging Chapter 1. General Changes

Figure 1-1 Mail has been enhanced

The Internal Mail is now called Mail, and can be located in the Desktop Navigator as before. Click the New button and you will notice many improvements. We have added many new features to the Mail – New window including a full tool ribbon with Clipboard functionality, Proofing tools, Page Layout options, Insert options, and Editing tools as shown below. Users also have the ability to send Mail to an external provider, if they are part of the Surescripts Interoperability Network.


Chapter 1. General Changes Screening and Prevention

SCREENING AND PREVENTION The Screening and Prevention grid has been modified for ease of use and greater capacity for Administered items. The Administered items in Screening and Prevention and Goal Monitoring are now shown on the left side of the sticky note area. The upper area shows the Screening and Prevention program or the Goal , how many have been scheduled, how many completed, date of last admin and date of next scheduled. It is also now possible to administer more than twenty items in both areas.

Figure 1-2 The new Screening & Prevention Layout


MEANINGFUL USE

ADDED LOINC CODES LOINC codes have been added to look-up screening and prevention, procedure, lab panels, and nursing care requests.

For example, in the Add Procedure Orders window below, selecting an order will provide a drop-down menu from which to choose the proper LOINC code for the order.

Figure 2-1 Selecting a LOINC code from an order

CHAPTER 2


Chapter 2. Meaningful Use Drug Interaction Warning Revamp

Table 2-1 Adding LOINC codes to an order

Procedure Details

1. From the Desktop Navigator, select Orders.

2. Click the New Order button (or the arrow button beside the New Order button) and select the type of order you wish to create.

3. Select a LOINC code from the drop-down menu.

4. Click the OK button when you are finished creating the order.

DRUG INTERACTION WARNING REVAMP Repeat drug-to-drug and drug-to-allergy warnings have been disabled.

Procedure Details

1. In the EMR Manager, click the Reference Lists icon. This will open the Reference List Manager.

2. In the Reference Lists, under the User-Defined Additions tab, select Drug Severities.

3. Click the Add button. This will open the Drug to Drug Severity Level window.


Updated List of Smoking Status Habit Collection Data Chapter 2. Meaningful Use

4. In Medication 1 drop-down, select the first medication.

5. In Medication 2 drop-down, select the second medication.

The Original Severity Level will populate automatically.

6. Select the new level from the New Severity Level drop-down.

7. Click the OK button when finished.

UPDATED LIST OF SMOKING STATUS HABIT COLLECTION DATA The reference list for smoking habit data has been expanded to reflect a broader selection of smoking habit statuses. This includes any form of tobacco that is smoked, but not all tobacco use. There are now eight different smoking statuses to choose from.


Chapter 2. Meaningful Use Updated List of Smoking Status Habit Collection Data

Figure 2-2 Expanded Selections for Smoking Status


Enhanced Data Choices for Race, Ethnicity and Language Chapter 2. Meaningful Use

ENHANCED DATA CHOICES FOR RACE, ETHNICITY AND LANGUAGE Data choices have been modified for race, ethnicity and language. Classifying federal data according to race and ethnicity requires that the option for selecting one or more racial designations be provided. Thus, it is now possible to select two or more racial designations.

STOP | Please note that selecting race for a patient is done in the MicroMD PM, not the EMR. The demographics for a patient will be automatically updated in the EMR when a change is made in the PM. The screen shots in this example are from the MicroMD PM 9.0.

Users can select more than one ethnicity in a patient’s demographics as shown below. In the Race drop-down, utilize the magnifying glass next to the drop-down. One of the selections is “Multiracial”.

Figure 2-3 Selecting multiple ethnicities


Chapter 2. Meaningful Use Clinical Quality Measures Capture and Export

CLINICAL QUALITY MEASURES CAPTURE AND EXPORT With the advent of Meaningful Use 2014 measures, users can now run either Stage 1 or Stage 2 reports. The designations for this are in several locations as shown below.

The first location is in the EMR Manager under the System Settings tab.

Figure 2-4 Enabling Stage II Reporting in the EMR Manager

You can also designate between Stage 1 and Stage 2 in the User Preferences of the EMR as shown below.


Clinical Quality Measures Capture and Export Chapter 2. Meaningful Use

Figure 2-5 Selecting Stage 1 or Stage 2 in the User Preferences

Users can also select Stage 1 or Stage 2 when running the CQM report.


Chapter 2. Meaningful Use Clinical Quality Measures Capture and Export

Figure 2-6 Selecting Stage 1 or 2 in the CQM Report


RXNORM CODES IN THE DRUG INFORMATION WINDOW

When you click on the information bubble for a medication in the medication list on the prescription window, a Drug Information window will appear. In the screen shot below, you can see that RxNorm codes have been added to every medication.

Figure 2-7 RxNorm Codes in the Drug Information Window


Chapter 2. Meaningful Use

DRUG AND ALLERGY SEVERITY INDICATORS ARE NOW SEPARATE The drug-to-drug and drug-to-allergy severity settings in the User Preferences window are now separate as shown in the screen shot below.

Figure 2-8 Drug and Allergy Warning Level Indicators in the User Preferences Window

Drug-to-drug warnings can also be configured as a system setting in the EMR Manager as shown below, also separating drug-drug and drug-allergy warning levels.



Figure 2-9 Prescription Defaults in the EMR Manager



HIGH-RISK MEDICATIONS CONDITION In the Rule Builder, it is now possible to select the “High-risk Medications” sub-list to add to a rule as shown below.

Figure 2-10 The High-Risk Medications Sub-List

Note that the High-Risk Medications sub-list is also now found in the Medication Reference List under the Smart Button > Quality Measures as shown below.

Procedure Details

1. From the Desktop Navigator, select Prescription Pad from the Desktop Tools.

This will open the Prescription Pad window.

2. Enter a patient into the Patient: field,

or use the look-up icon .

3. Click the button. This will open a pop-up menu shown in the following step.



4. Select Quality Measures Sublists from the pop-up menu.

This will also open a selection list as shown in the following step.

5. Select High Risk Medications from the selection list.

6. Click the Close button when finished.



DATA PORTABILITY: BULK PATIENT CDA EXPORT A user can now export summaries for all patients in CDA format.

In the Administration window (Administration > Administration Panel), check the Bulk Patient CDA Export checkbox. The Bulk Patient CDA Export window will appear.

Figure 2-11 Bulk Patient CDA Export



CUSTOMIZING CDA EXPORT DATA When exporting a patient care plan in CDA format, it is now possible to customize the results for the final report. In the Bulk Patient CDA Export window, check the “E” checkbox before each item you wish to customize as shown below.

Figure 2-12 Editing a Patient Care Record for Export



Table 2-2 Editing CDA Export Data

Procedure Details

1. For each item you would like to edit, check the checkbox in the E column next to the item. Multiple items can be selected for editing.

2. Click the Export button

3. In the Edit Bulk Patient CDA Export

window, check the items you would like to include in the export. If you would like to edit line items from a category, make sure that category is checked.

4. Click the OK button. The export file will build. Once complete, you will

be prompted to select medical information to include.

5. Click the OK button when finished. The CDA file will be built and exported to the destination location.


CLINICAL QUALITY MEASURES

In order to achieve Meaningful Use in 2014, MicroMD EMR has been coded with the following Clinical Quality Measures (CQMs). For more detailed information on 2014 Meaningful Use, please refer to the following MicroMD Manuals: Clinical Quality Measure Calculations 2014 and Objective Measure Calculations 2014.

• NQF 0002 CMS eMeasure id CMS146v1 (17362): Appropriate testing for children with Pharyngitis. Percentage of children 2-18 years of age who were diagnosed with pharyngitis, ordered an antibiotic and received a group A streptococcus (strep) test for the episode.

• NQF 0004 CMS eMeasure id CMS137v1 (17363): Initiation and engagement of alcohol and other drug dependence treatment.

• NQF 0018 CMS eMeasure id CMS165v1 (17360): Controlling high blood pressure.

• NQF 0022 CMS eMeasure id CMS156v1 (17357): Percentage of patients 66 years of age and older who are on a high-risk medication.

• NQF 0024 CMS eMeasure id CMS155v1 (17364): Weight assessment and counseling for nutrition and physical activity for children and adolescents.

• NQF 0028 CMS eMeasure id CMS138v1 (17365): Preventive care and screening: tobacco use: screening and cessation intervention.

• NQF 0031 CMS eMeasure id CMS125v1 (17366): Breast cancer screening. Percentage of women 40-69 years of age who had a mammogram to screen for breast cancer.

• NQF 0032 CMS eMeasure id CMS124v1 (17367): Cervical Cancer Screening. Percentage of women 21-64 years of age, who received one or more Pap tests to screen for cervical cancer.

• NQF 0033 CMS eMeasure id CMS153v1 (17368): Chlamydia Screening for Women. Percentage of women 16-24 years of age who were identified as sexually active and who had at least one test for chlamydia during the measurement period.

• NQF 0034 CMS eMeasure id CMS130v1 (17373): Colorectal cancer screening. percentage of adults 50-75 years of age who had appropriate screening for colorectal cancer.

• NQF 0036 CMS eMeasure id CMS126v1 (17374): Use of appropriate medications for asthma. Percentage of patients 5-64 years of age who were identified as having persistent asthma and were appropriately prescribed medication during the measurement period.

• NQF 0038 CMS eMeasure id CMS117v1 (17375): Childhood immunization status. Percentage of children 2 years of age who had four diphtheria, tetanus and acellular pertussis (DTaP); three polio (IPV), one measles, mumps and rubella (MMR); three H influenza type B (HiB); three hepatitis B (Hep B); one chicken pox (VZV); four pneumococcal conjugate (PCV); one hepatitis A (Hep A); two or three rotavirus (RV); and two influenza (flu) vaccines by their second birthday.

• NQF 0041 CMS eMeasure id CMS147v1 (17377): Preventive care and screening: influenza immunization. Percentage of patients aged 6 months and older seen for a visit between October 1 and March 31 who received an influenza immunization OR who reported previous receipt of an influenza immunization.

• NQF 0043 CMS eMeasure id CMS127v1 (17380): Pneumonia vaccination status for older adults. Percentage of patients 65 years of age and older who have ever received a pneumococcal vaccine.

CHAPTER 3


Chapter 3. Clinical Quality Measures

• NQF 0052 CMS eMeasure id CMS166v2 (17387): Use of imaging studies for low back pain. Percentage of patients 18-50 years of age with a diagnosis of low back pain who did not have an imaging study (plain X-ray, MRI, CT scan) within 28 days of the diagnosis.

• NQF 0056 CMS eMeasure id CMS123v1 (17383): Diabetes: Foot exam percentage of patients aged 18-75 years of age with diabetes who had a foot exam during the measurement period.

• NQF 0055 CMS eMeasure id CMS131v1 (17388): Diabetes: Eye exam. Percentage of patients 18-75 years of age with diabetes who had a retinal or dilated eye exam by an eye care professional during the measurement period or a negative retinal exam (no evidence of retinopathy) in the 12 months prior to the measurement period.

• NQF 0059 CMS eMeasure id CMS122v1 (17389): Diabetes: Hemoglobin A1c poor control. Percentage of patients 18-75 years of age with diabetes (type 1 or type 2) who had HbA1c >9.0%.

• NQF 0060 CMS eMeasure id CMS148v1 (17390): Hemoglobin A1c Test for pediatric patients. Percentage of patients 5-17 years of age with diabetes with an HbA1c test during the measurement period.

• NQF 0062 CMS eMeasure id CMS134v1 (17391): Diabetes: Urine protein screening. The percentage of patients 18-75 years of age with diabetes who had a nephropathy screening test or evidence of nephropathy during the measurement period.

• NQF 0064 CMS eMeasure id CMS163v1 (17392): Diabetes: Low density lipoprotein (ldl) management. Percentage of patients18-75 years of age with diabetes whose LDL-C was adequately controlled (<100 mg/dL) during the measurement period.

• NQF 0068 CMS eMeasure id CMS164v1 (17393): Ischemic vascular disease (ivd): Use of aspirin or another antithrombotic. Percentage of patients 18 years of age and older who were discharged alive for acute myocardial infarction (AMI), coronary artery bypass graft (CABG) or percutaneous coronary interventions (PCI) in the 12 months prior to the measurement period, or who had an active diagnosis of ischemic vascular disease (IVD) during the measurement period, and who had documentation of use of aspirin or another antithrombotic during the measurement period.

• NQF 0069 CMS eMeasure id CMS154v1 (17394): Appropriate treatment for children with upper respiratory infection (URI). Percentage of children 3 months-18 years of age who were diagnosed with upper respiratory infection (URI) and were not dispensed an antibiotic prescription on or three days after the episode.

• NQF 0070 CMS eMeasure id CMS145v1(17396): Coronary Artery Disease (CAD): Beta-Blocker Therapy-Prior Myocardial Infarction (MI) or Left Ventricular Systolic Dysfunction (LVEF <40%). Percentage of patients aged 18 years and older with a diagnosis of coronary artery disease seen within a 12 month period who also have a prior MI or a current or prior LVEF <40% who were prescribed beta-blocker therapy.

• NQF 0075 CMS eMeasure id CMS182v1 (17398): Ischemic vascular disease (IVD): Complete lipid panel and LDL control. Percentage of patients 18 years of age and older who were discharged alive for acute myocardial infarction (AMI), coronary artery bypass graft (CABG) or percutaneous coronary interventions (PCI) in the 12 months prior to the measurement period, or who had an active diagnosis of ischemic vascular disease (IVD) during the measurement period, and who had a complete lipid profile performed during the measurement period and whose LDL-C was adequately controlled (< 100 mg/dL).

• Measure NQF 0081 CMS eMeasure id CMS135v1 (17400): Heart Failure (HF): Angiotensin-Converting enzyme (ACE) inhibitor or Angiotensin receptor blocker (ARB) therapy for left ventricular systolic dysfunction (LVSD). Percentage of patients aged 18 years and older with a diagnosis of heart failure (HF) with a current or prior left ventricular ejection fraction (LVEF) < 40% who were prescribed ACE inhibitor or ARB therapy either within a 12 month period when seen in the outpatient setting OR at each hospital discharge.



• NQF 0083 CMS eMeasure id CMS144v1 (17402): Heart failure (HF): Beta-blocker therapy for left ventricular systolic Dysfunction (LVSD). Percentage of patients aged 18 years and older with a diagnosis of heart failure (HF) with a current or prior left ventricular ejection fraction (LVEF) < 40% who were prescribed beta-blocker therapy either within a 12 month period when seen in the outpatient setting OR at each hospital discharge.

• NQF 0086 CMS eMeasure id CMS143v1 (17416): Primary Open Angle Glaucoma (POAG): Optic Nerve Evaluation. Percentage of patients aged 18 years and older with a diagnosis of primary open-angle glaucoma (POAG) who have an optic nerve head evaluation during one or more office visits within 12 months.

• NQF 0088 CMS eMeasure id CMS167v1 (17417): Diabetic Retinopathy: Documentation of Presence or Absence of Macular Edema and Level of Severity of Retinopathy. Percentage of patients aged 18 years and older with a diagnosis of diabetic retinopathy who had a dilated macular or fundus exam performed which included documentation of the level of severity of retinopathy and the presence or absence of macular edema during one or more office visits within 12 months.

• NQF 0089 CMS eMeasure id CMS142v1 (17418): Diabetic Retinopathy: Communication with the Physician Managing Ongoing Diabetes Care. Percentage of patients aged 18 years and older with a diagnosis of diabetic retinopathy who had a dilated macular or fundus exam performed with documented communication to the physician who manages the ongoing care of the patient with diabetes mellitus regarding the findings of the macular or fundus exam at least once within 12 months.

• NQF 0101 CMS eMeasure id CMS139v1 (17420): Falls: Screening for Future Fall Risk. Percentage of patients 65 years of age and older who were screened for future fall risk during the measurement period.

• NQF 0104 CMS eMeasure id CMS161v1 (17422): Major Depressive Disorder (MDD): Suicide Risk Assessment. Percentage of patients aged 18 years and older with a diagnosis of major depressive disorder (MDD) with a suicide risk assessment completed during the visit in which a new diagnosis or recurrent episode was identified.

• NQF 0105 CMS eMeasure id CMS128v1 (17424): Antidepressant Medication Management. Percentage of patients 18 years of age and older who were diagnosed with major depression and treated with antidepressant medication, and who remained on antidepressant medication treatment. Two rates are reported: a. Percentage of patients who remained on an antidepressant medication for at least 84 days (12 weeks). b. Percentage of patients who remained on an antidepressant medication for at least 180 days (6 months).

• NQF 0108 CMS eMeasure id CMS136v1&2 (17425): ADHD: Follow-Up Care for Children Prescribed Attention-Deficit/Hyperactivity Disorder (ADHD) Medication. Percentage of children 6-12 years of age and newly dispensed a medication for attention-deficit/hyperactivity disorder (ADHD) who had appropriate follow-up care. Two rates are reported: a. Percentage of children who had one follow-up visit with a practitioner with prescribing authority during the 30-Day Initiation Phase, and b. Percentage of children who remained on ADHD medication for at least 210 days and who, in addition to the visit in the Initiation Phase, had at least two additional follow-up visits with a practitioner within 270 days (9 months) after the Initiation Phase ended.

• NQF 0110 CMS eMeasure id CMS169v1 (17427): Bipolar Disorder and Major Depression: Appraisal for alcohol or chemical substance use. Percentage of patients with depression or bipolar disorder with evidence of an initial assessment that includes an appraisal for alcohol or chemical substance use.

• NQF 0389 CMS eMeasure id CMS129v1-2 Prostate Cancer (17431): Avoidance of Overuse of Bone Scan for Staging Low Risk Prostate Cancer Patients. Percentage of patients, regardless of age, with a diagnosis of prostate cancer at low risk of recurrence receiving interstitial prostate brachytherapy, OR external beam radiotherapy to the prostate, OR radical prostatectomy, OR cryotherapy who did not have a bone scan performed at any time since diagnosis of prostate cancer.



• NQF 0403 CMS eMeasure id CMS62v1 (17432): HIV/AIDS: Medical Visit. Percentage of patients, regardless of age, with a diagnosis of HIV/AIDS with at least two medical visits during the measurement year with a minimum of 90 days between each visit.

• NQF 0405 CMS eMeasure id CMS52v1 (17433): HIV/AIDS: Pneumocystis jiroveci pneumonia (PCP) prophylaxis. Percentage of patients aged 6 weeks and older with a diagnosis of HIV/AIDS who were prescribed Pneumocystis jiroveci pneumonia (PCP) prophylaxis.

• NQF 0418 CMS eMeasure id CMS2v (17434): Preventive Care and Screening: Screening for Clinical Depression and Follow-Up Plan. Percentage of patients aged 12 years and older screened for clinical depression on the date of the encounter using an age appropriate standardized depression screening tool AND if positive, a follow-up plan is documented on the date of the positive screen.

• NQF 0419 CMS eMeasure id CM68v1-2 (17437): Documentation of Current Medications in the Medical Record. Percentage of visits for patients aged 18 years and older for which the eligible professional attests to documenting a list of current medications using all immediate resources available on the date of the encounter. This list must include ALL known prescriptions, over-the-counters, herbals, and vitamin/mineral/dietary (nutritional) supplements AND must contain the medications' name, dosage, frequency and route of administration.

• NQF 0421 CMS eMeasure id CM69v1 (17439): Preventive Care and Screening: Body Mass Index (BMI) Screening and Follow-Up. Percentage of patients aged 18 years and older with a documented BMI during the encounter or during the previous six months, AND when the BMI is outside of normal parameters, a follow-up plan is documented during the encounter or during the previous six months of the encounter. Normal Parameters: Age 65 years and older BMI => 23 and < 30. Age 18 - 64 years BMI => 18.5 and < 25.

• NQF 0564 CMS eMeasure id CMS133v1 (17440): Cataracts: Complications within 30 Days Following Cataract Surgery Requiring Additional Surgical Procedures. Percentage of patients aged 18 years and older with a diagnosis of uncomplicated cataract who had cataract surgery and had any of a specified list of surgical procedures in the 30 days following cataract surgery which would indicate the occurrence of any of the following major complications: retained nuclear fragments, endophthalmitis, dislocated or wrong power IOL, retinal detachment, or wound dehiscence.

• NQF 0565 CMS eMeasure id CMS133v1 (17441): Cataracts: 20/40 or Better Visual Acuity within 90 Days Following Cataract Surgery. Percentage of patients aged 18 years and older with a diagnosis of uncomplicated cataract who had cataract surgery and no significant ocular conditions impacting the visual outcome of surgery and had best-corrected visual acuity of 20/40 or better (distance or near) achieved within 90 days following the cataract surgery.

• NQF 0608 CMS eMeasure id CMS158v1 (17442): Pregnant women that had HBsAg testing. This measure identifies pregnant women who had a HBsAg (hepatitis B) test during their pregnancy.

• NQF 0710 CMS eMeasure id CMS159v1 (17443): Depression Remission at Twelve Months. Adult patients age 18 and older with major depression or dysthymia and an initial PHQ-9 score > 9 who demonstrate remission at twelve months defined as PHQ-9 score less than 5. This measure applies to both patients with newly diagnosed and existing depression whose current PHQ-9 score indicates a need for treatment.

• NQF 0712 CMS eMeasure id CMS160v1 (17444): Depression Utilization of the PHQ-9 Tool. Adult patients age 18 and older with major depression or dysthymia and an initial PHQ-9 score > 9 who demonstrate remission at six months defined as PHQ-9 score less than 5. This measure applies to both patients with newly diagnosed and existing depression whose current PHQ-9 score indicates a need for treatment.

• NQF 1365 CMS eMeasure id CMS177v1 (17445): Child and Adolescent Major Depressive Disorder (MDD): Suicide Risk Assessment. Percentage of patient visits for those patients aged 6 through 17 years with a diagnosis of major depressive disorder with an assessment for suicide risk.



• NQF 1401 CMS eMeasure id CMS82v1 (17446): Maternal Depression Screening. of children. The percentage of children who turned 6 months of age during the measurement year who had documentation of a maternal depression screening for the mother.

• NQF TBD CMS eMeasure id CMS179v1 (17451): ADE Prevention and Monitoring: Warfarin Time in Therapeutic Range. Average percentage of time in which patients aged 18 and older with atrial fibrillation who are on chronic warfarin therapy have International Normalized Ratio (INR) test results within the therapeutic range (i.e., TTR) during the measurement period.

• NQF TBD CMS eMeasure id CMS90v2 (17452): Functional Status Assessment for Complex Chronic Conditions. Percentage of patients aged 65 years and older with heart failure who completed initial and follow-up patient-reported functional status assessments.

• NQF TBD CMS eMeasure id CMS149v1 (17453): Dementia: Cognitive Assessment. Percentage of patients, regardless of age, with a diagnosis of dementia for whom an assessment of cognition is performed and the results reviewed at least once within a 12 month period.

• NQF TBD CMS eMeasure id CMS22v1 (17454): Preventive Care and Screening: Screening for High Blood Pressure and Follow-Up Documented. Percentage of patients aged 18 years and older seen during the reporting period who were screened for high blood pressure AND a recommended follow-up plan is documented based on the current blood pressure (BP) reading as indicated.

• NQF TBD CMS eMeasure id CMS50v1 (17455): Closing the referral loop: receipt of specialist report. Percentage of patients with referrals, regardless of age, for which the referring provider receives a report from the provider to whom the patient was referred.

• NQF TBD CMS eMeasure id CMS56v1 (17456): Functional Status Assessment for Hip Replacement. Percentage of patients aged 18 years and older with primary total hip arthroplasty (THA) who completed baseline and follow-up (patient-reported) functional status assessments.

• NQF TBD CMS eMeasure id CMS66v1 (17457): Functional Status Assessment for Knee Replacement. Percentage of patients aged 18 years and older with primary total knee arthroplasty (TKA) who completed baseline and follow-up (patient-reported) functional status assessments.

• NQF TBD CMS eMeasure id CMS75v1 (17458): Children Who Have Dental Decay or Cavities. Percentage of children, ages 0-20 years, who have had tooth decay or cavities during the measurement period.

• NQF TBD CMS eMeasure id CMS77v1 (17459): HIV/AIDS: RNA Control for Patients with HIV. Percentage of patients aged 13 years and older with a diagnosis of HIV/AIDS, with at least two visits during the measurement year, with at least 90 days between each visit, whose most recent HIV RNA level is <200 copies/mL.

• NQF TBD CMS eMeasure id CMS61v2 (17460): Preventive Care and Screening: Cholesterol - Fasting Low Density Lipoprotein (LDL-C) Test Performed. Percentage of patients aged 20 through 79 years whose risk factors have been assessed and a fasting LDL-C test has been performed.

• NQF TBD CMS eMeasure id CMS64v2 (17461): Preventive Care and Screening: Risk-Stratified Cholesterol - Fasting Low Density Lipoprotein (LDL-C). Percentage of patients aged 20 through 79 years who had a fasting LDL-C test performed and whose risk-stratified fasting LDL-C is at or below the recommended LDL-C goal.

• Measure NQF TBD CMS eMeasure id CMS65v2 (17462): Hypertension: Improvement in Blood Pressure. Percentage of patients aged 18-85 years of age with a diagnosis of hypertension whose blood pressure improved during the measurement period.

• Measure NQF TBD CMS eMeasure id CMS74v2 (17463): Primary Caries Prevention Intervention as Offered by Primary Care Providers, including Dentists. Percentage of children, age 0-20 years, who received a fluoride varnish application during the measurement period.



The following features were added to the EMR during the version 9.0.2 release and were not included in the original manual.

DEFAULT UNITS OF MEASURE IN WOMEN’S HEALTH In the EMR Manager under Demographics, there is a drop-down menu that will set the default units of measure for several areas of the Women’s Health OB Module.

Figure 4-1 Setting the Default Unit of Measure in the EMR Manager

Procedure Details

1. Log into the EMR Manager, then go to System Settings > Demographics tab.

2. Click the Edit button. This will open the Demographic Defaults window (shown above).

3. In the Vital Signs Units: drop-down, select Imperial or Metric.

This will be the default unit of measure for Vital Signs in the EMR. It will affect the areas of Fetal Ultrashound – sizes, Birth History – newborn data, and Pregnancy History – fetuses.


In each area affected by this setting, there is a manual override for that section only. If you want to specify metric units for one area, but you have already set the default (in the EMR Manager) as Imperial, you can change the unit of measure on that individual screen.

For example, the screen shot below shows the override feature in the Add Ultrasound window.


Chapter 4. Updated features from Version 9.0.2

Figure 4-2 The Manual Override Option on the Add Ultrasound window


Chapter 4. Updated features from Version 9.0.2



The following features were added to the EMR during the version 9.0.3 release and were not included in the original manual.

RESTRICTIVE ACCESS OPTIONS IN ENCOUNTERS Users now have the ability to restrict access to an encounter or to mark it as confidential. Users who have been granted access to restricted or confidential data can now deem an encounter as restricted, and only users with Restricted/Confidential access can view those encounters.

The permission setting to allow an individual access to confidential or restricted information is found on the User Roles and Functions window in the EMR Manager.

NOTE | Only users with Confidential/Restricted access granted may mark an encounter as Confidential or Restricted..

Figure 5-1 Restricted or Confidential Data setting in the EMR Manager


Chapter 5. Updated Features from Version 9.0.3

Table 5-1 To add permissions to view Restricted or Confidential data

Procedure Details

1. Log into the EMR Manager, then go to Users & Facilities.

2. Under the Users tab, select the user for whom you will be setting permissions.

3. Select the Roles tab to the right, then click the Edit button.

This will open the User Roles and Functions window.

4. Check the Restricted or Confidential Data checkbox.


Now this user has permission to view encounters marked as Confidential or Restricted, or to mark an encounter as Confidential or Restricted.

Table 5-2 Marking an Encounter as Confidential or Restricted

Procedure Details

1. Select Encounters from the Desktop Navigator.

2. Double-click an existing encounter to open it, or click the New Encounter button to start a new encounter.

If you are editing an existing encounter, click the Edit button near the top-right corner of the window.

If you are creating a new encounter, enter (or select) the name of the patient, complete any necessary settings, and click the OK button.

3. Mark the counter as Restricted or confidential.

If you are editing an existing encounter, go to the Administration tab, then click the Encounter Header icon near the top-right corner of the window. Check the Restricted / Confidential Data checkbox, then click the OK button.

If you are creating a new encounter, check the Restricted / Confidential Data checkbox during the initial step of the encounter.

4. The encounter is now restricted.


Henry Schein MicroMD760 Boardman-Canfield RoadBoardman, OH 44512

www.micromd.com

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