2015 User Conference Pre-Conference: Meaningful Use Stage 1 2015 April 23, 2015 Presented by: Angela Schnack Training Specialist EHR Session Isn’t this what it is all about? “We've made more progress with EHRs in the past 2 years than we have in 20." Farzad Mostashari, MD (former ONC Chief) 2015 Office Practicum User Conference Meaningful Use Stage 1 Today’s Objectives: ▪ Define key elements of Meaningful Use ▪ Identify required fields in Office Practicum to capture MU data ▪ Interpret Quality Improvement Calculator (QIC) metrics 2015 Office Practicum User Conference Meaningful Use Stage 1 Stage 1 - Year 1: AIU: Adopt, Implement or Upgrade If you are in this stage, you will need the 2014 CEHRT edition of Office Practicum Stage 1 ● Stage 1 - Year 2: ● Stage 1 & 2 no longer split ● 2015 is 90 days using Modified Stage 2 Objectives ● 2016 - full year reporting unless new to MU CEHRT: Certified Electronic Health Record Technology 2015 Office Practicum User Conference 2018 Stage 3 Proposed ruling in process *May elect to move to Stage 3 in 2017, required to in 2018 Stage 2 ● Stages 1 & 2 are no longer split. ● Combined into one with modified reporting Stage 1 2015 Office Practicum User Conference Note: ● 2016 Last year to initiate participation in Medicaid EHR incentive program ● 2021 Last year to receive Medicaid EHR incentive payment. First Reporting Year - Prepare ●Begin now ● Designate a Meaningful Use Team ● Check QIC to identify areas the measures are not met ● Meet regularly with staff and providers - share results ● Develop workflow changes if necessary 2015 Office Practicum User Conference Meaningful Use Stage 1(Modified Stage 2) What needs to be reported? Under New Proposed Ruling: ■ 9 Objectives Required ■ 13 required core objectives ■ 5 Menu objectives from a list of 9 available in OP ■ 9 Clinical Quality Measures Required ▪ Must be chosen from at least 3 of 6 Domains 2015 Office Practicum User Conference Meaningful Use Stage 1 Let’s get started! 2015 Office Practicum User Conference CPOE - (Modified Stage 2 Objective) Use CPOE for more than 60% medications, 30% of laboratory, and 30% of radiology Exclusion: Fewer than 100 medications, laboratory or radiology orders written during the reporting period 907A Denominator: Total medications written during the reporting period Numerator: Medications written with a Purpose of "Med - to dispense"•or "Med - office sample" or "Med - office administered 907B Denominator: Total Lab requisitions written during the reporting period Numerator: Labs with a result date 907C Denominator: Numerator: Total Radiology Lab requisitions written during the reporting period Radiology Labs with a result date 2015 Office Practicum User Conference CPOE - Minimum Requirement* CPOE: Computerized Physician Order Entry >30% ▪ Medication written using: ▪ Med-to dispense ▪ Med- office sample ▪ Med-Administered ▪ Unique Patient ▪ Visit during reporting period *For EP’s who would have been Stage 1 in 2015, this is the minimum requirement to meet the objective. 2015 Office Practicum User Conference E-Prescribing (Modified Stage 2) > 50% (May elect the lesser - >40%)* ▪Medication written using: ▪ Med-to dispense ▪ e-Rx ID ▪All medications written during the reporting period Exclusion: 1. Any EP who writes fewer than 100 prescriptions during the EHR reporting period. 2. Any EP who does not have a pharmacy within their organization and there are no pharmacies that accept electronic prescriptions within 10 miles of the EP's practice location at the start of his/her EHR reporting period. 2015 Office Practicum User Conference *EP’s who would have been in Stage 1 reporting may report the lesser percentage Clinical decision support rule (Intervention) How do we do this? Care Plans 2015 Office Practicum User Conference Interventions - (Modified Stage 2) ▪ 5 Interventions required ▪ Must be able to track compliance ▪For EP’s who would have been Stage 1 in 2015 Must report minimum of one intervention 2015 Office Practicum User Conference Patient Access (Modified Stage 2) >50% ▪Provide timely online access to health information ▪ Within 4 business days* after information available to EP ▪ 5% View, Download or Transmit ▪ View, Download or Transmit (at least one patient) ▪All visits during reporting period You must have the portal implemented at your practice so patients can have accounts created *The QIC excludes weekends, but not holidays 2015 Office Practicum User Conference Protect electronic health information Attest to Only Cyber Security Checklist 2015 Office Practicum User Conference Patient Specific Education Resources >10 % ▪ Patient education given checked ▪ Unique patient ▪ Visit during reporting period 2015 Office Practicum User Conference Patient specific education resources ▪ When a task is created during the visit, the box will automatically be checked ▪ Manually checking the box will populate the QIC ▪ Utilize a text area in the note to document the education given 2015 Office Practicum User Conference Medication Reconciliation (Previously Menu) >50% ▪ Med reconciliation selected as performed or not required ▪ Referral tracking entry created -OR▪ Response to Referral performed 2015 Office Practicum User Conference Summary of Care for Referrals (Previously Menu) >50% ▪ Include care summary box checked ▪ Referral to specialist created 2015 Office Practicum User Conference Secure Messaging (Modified Stage 2) Attest To Only (>5% unique patients seen are sent secure electronic message) ▪ Functionally is fully enabled ▪ Message sent to portal by Provider ▪ No minimum patient usage threshold% You must have the portal implemented at your practice to attest functionality is fully enabled 2015 Office Practicum User Conference Demonstration Let’s Try It! 2015 Office Practicum User Conference Questions? 2015 Office Practicum User Conference Public Health Objective - New ▪ Single Objective with multiple options ▪ Report “active engagement” for 2 of the 5 ▪ ▪ ▪ ▪ ▪ Immunization Registry - bidirectional (if available) Syndromic Surveillance Case Reporting Public Health Registry Reporting (up to 3 of this type) - other than IIS Clinical Data Registry Reporting (up to 3 of this type) - includes ACOs and other non-governmental groups (ePROS) ▪ Multiple exemptions apply ▪ ▪ Not available to the EP in their area As long as you either registered within 60 days of the start of your reporting period and are awaiting an invitation from the other party, or are in Testing/Validation, or in Production, you are covered for this objective. EP’s who would have been Stage 1 in 2015 only required to report a single objective 2015 Office Practicum User Conference Objectives Removed But...Best Practices ▪ Objectives that have been removed from reporting: ▪ ▪ ▪ ▪ ▪ ▪ ▪ Record Demographics Problem List Medication List Allergies Vital Signs Risk Assessment Patient Exit Note (Clinical Visit Summary) ▪ Assumption is you are already doing this CMS is no longer “looking over your shoulder” Note: If you are also participating in PCMH, these still apply to meet the standards. 2015 Office Practicum User Conference Record Demographics (Previously Core) >50% ▪ ▪ ▪ ▪ ▪ ▪ ▪ Gender Date of birth Language Ethnicity Race Unique Patient Visit during reporting period *All 5 fields must be completed 2015 Office Practicum User Conference Up to date Problem List (Previously Core) >80% ▪Problem marked as active/tracking ▪SNOMED Code or ▪No Active Problems ▪Unique Patient ▪Visit during reporting period 2015 Office Practicum User Conference Active Medication List (Previously Core) >80% ▪Entered as structured data with NDC code ▪Chronic Flag= Y or ▪No Active Medications ▪Unique Patient ▪Visit during reporting period 2015 Office Practicum User Conference Medication Allergy List (Previously Core) >80% ▪Medication Allergy marked as active ▪Medication with NDC # ▪SNOMED Code or ▪No Active Medication Allergies ▪Unique Patient ▪Visit during reporting period 2015 Office Practicum User Conference Interaction Checking Attest to Only ▪ Med/Med ▪ Med/Allergy ▪ Must be available and enabled during reporting period 2015 Office Practicum User Conference Vital Signs >50% ▪ Measurements recorded (in the vitals/growth tab): ▪ Height ▪ Weight ▪ BP ▪ BMI calculated ▪ Growth measurements plotted ▪ Unique patient ▪ Visit during reporting period ▪ All ages for height/weight ▪ Patient >3 years for BP ▪ Ages 2-20 for BMI and Growth charts 2015 Office Practicum User Conference Risk Assessment >50% ▪Smoking status recorded ▪Unique patient ▪Visit during reporting period ▪13 years or older 2015 Office Practicum User Conference Clinical Summaries >50% ▪Patient exit note created ▪ Electronic or printed ▪ Within 3 business days* ▪All visits during reporting period 2015 Office Practicum User Conference MU Stage 1 - Menu Measures There will not be any Menu Measures to choose from in 2015 through 2017 in Modified Stage 2 Reporting •5 of 9 measures must be reported •1 Measure must be from the Public Health Menu Options •Measures are performance based with some "Attest Only" 2015 Office Practicum User Conference Drug Formulary Checks (Previously Menu) ▪ From the medication finder, the Check Formulary box is available. For all connected payers, Office Practicum is fully integrated with DrFirst to populate any formulary information available. This is “attest to” only 2015 Office Practicum User Conference Patient List by Specific Conditions - Menu ▪ Attest to Only ▪ This can be accomplished by using the demographic analysis/recall report 2015 Office Practicum User Conference Clinical Lab Test Results (Previously Menu) >40% ▪ Positive/Negative result or numeric value ▪ All labs ordered during reporting period Hearing/Vision do not count toward total If your practice has a lab interface, this can be more easily achieved 2015 Office Practicum User Conference Patient Reminders (Previously Menu) >20% ▪ Reminder or recall sent using Patient Message Exchange* ▪ Unique patient ▪ 5 years and younger *Must have and use the Patient Message Exchange in OP for Reminders 2015 Office Practicum User Conference Demonstration Let’s Try It! 2015 Office Practicum User Conference Questions? 2015 Office Practicum User Conference Intermission 2015 Office Practicum User Conference Meaningful Use 2015 Office Practicum User Conference Have you run the QIC? Quality Improvement Calculator Threshold not met Exclusions; no minimum threshold; no data Threshold met 2015 Office Practicum User Conference Lets run the QIC Let’s Run the QIC! 2015 Office Practicum User Conference Questions? 2015 Office Practicum User Conference Clinical Quality Measures What needs to be Reported? ● Clinical Quality Measures (9 total) ● Must come from at least 3 of the 6 policy domains ○ Patient and family engagement ○ Patient Safety ○ Care Coordination ○ Population and Public Health ○ Efficient use of Healthcare Resources ○ Clinical Processes/Effectiveness No required threshold/passing metrics for CQM’s 2015 Office Practicum User Conference Clinical Quality Measures QRDA file Patient QRDA III file Provider Patient files 2015 Office Practicum User Conference Clinical Quality Measures LET’S TAKE A LOOK BY DOMAIN The information presented are the reports delivered in the QIC for the 2014 CQM’s. Must have OP 14 installed for the 2015 CQM calculations. 2015 Office Practicum User Conference Clinical Quality Measures PEDIATRIC SUGGESTED CLINICAL QUALITY MEASURES Measure Domain Appropriate Testing for Children with Pharyngitis Efficient Use of Healthcare Resources Appropriate Treatment for Children with Upper Respiratory Infection (URI) Efficient Use of Healthcare Resources Chlamydia Screening for Women Population/ Public Health Weight Assessment and Counseling for Nutrition and Physical Activity for Children and Adolescents Population/ Public Health Childhood Immunization Status Population/ Public Health 2015 Office Practicum User Conference Clinical Quality Measures PEDIATRIC SUGGESTED CLINICAL QUALITY MEASURES Measure Domain Preventive Care and Screening: Screening for Clinical Depression and Follow-Up Plan Population/ Public Health ADHD: Follow-Up Care for Children Prescribed Attention Deficit/Hyperactivity Disorder (ADHD) Medication Clinical Process/ Effectiveness Children who have dental decay or cavities Clinical Process/ Effectiveness Use of Appropriate Medications for Asthma Clinical Process/ Effectiveness 2015 Office Practicum User Conference Clinical Quality Measures EFFICIENT USE OF HEALTHCARE RESOURCES Measure: NQF 0002 Appropriate Testing for Children with Pharyngitis ● ● ● ● Patients 2-18 years old Coding on visit for Pharyngitis Strep test complete Antibiotic prescribed, if appropriate 2015 Office Practicum User Conference Clinical Quality Measures EFFICIENT USE OF HEALTHCARE RESOURCES Measure: NQF 0069 Appropriate Treatment for Children with Upper Respiratory Infection (URI) ● Patients 3 months - 18 years old ● Coding on visit for Upper Respiratory Infection ● Antibiotic not prescribed up to 3 days after the diagnosis 2015 Office Practicum User Conference Clinical Quality Measures POPULATION AND PUBLIC HEALTH Measure: NQF 0033 Chlamydia Screening for Women ● Sexually Active women aged 16-24 ● One Chlamydia test done during the reporting period 2015 Office Practicum User Conference Clinical Quality Measures POPULATION AND PUBLIC HEALTH Measure: NQF 0033 Chlamydia Screening for Women Suggested Documentation in OP ● ● ● ● ● Problem List entry for Sexually Active Set Visibility level on problem list entry for confidentiality Make active the Chlamydia Care Plan Enroll in Chlamydia Care Plan Test for Chlamydia 2015 Office Practicum User Conference Clinical Quality Measures POPULATION AND PUBLIC HEALTH Measure: NQF 0024 Weight Assessment and Counseling for Nutrition and Physical Activity for Children and Adolescents ● Children 3-17 years ● BMI calculated ● Documented counseling for nutrition (V65.3) and physical activity (V65.41) during the reporting period. ○ *ICD-10 Code Z71.3 - Nutrition ○ *ICD-10 Code Z71.89 - Physical Activity 2015 Office Practicum User Conference Clinical Quality Measures POPULATION AND PUBLIC HEALTH Measure: NQF 0024 Weight Assessment and Counseling for Nutrition and Physical Activity for Children and Adolescents Suggested Documentation in OP: ● ICD-9 code included with well visit: V65.41 (Physical Activity Counseling) *ICD-10=Z71.89 ● ICD9 code included with well visit: V65.3 (Nutrition Counseling) *ICD-10=Z71.3 ● Height/Weight taken at visit to calculate BMI ● Templates include documentation (Anticipatory Guidance) 2015 Office Practicum User Conference Clinical Quality Measures POPULATION AND PUBLIC HEALTH Measure: NQF 0038 Childhood Immunization Status ● Follow vaccine schedule for vaccines administered prior to 2nd birthday ● ● ● ● ● ● ● ● ● ● 2015 Office Practicum User Conference 4 DTaP 3 IPV 1 MMR 3 HiB 3 Hep B 1 Varicella 4 PCV 1 Hep A 2-3 Rotavirus 2 flu Demonstration Let’s try it! 2015 Office Practicum User Conference Clinical Quality Measures POPULATION AND PUBLIC HEALTH Measure: NQF 0418 Screening for Clinical Depression and Follow-Up Plan ● 12 years and older prior to the beginning of the measure period ● Screening for depression on date of visit ● If positive, follow up plan documented on date of visit 2015 Office Practicum User Conference Clinical Quality Measures POPULATION AND PUBLIC HEALTH Measure: NQF 0418 Screening for Clinical Depression and Follow-Up Plan Suggested Documentation in OP: ● Survey complete for depression ○ Add survey to templates ○ Risk Assessment ● If survey is positive, plan documented for follow-up ○ document in the Plan of the note ○ document in the Counseling of the note (can set visibility) ○ Follow-up task for return visit for depression 2015 Office Practicum User Conference Clinical Quality Measures CLINICAL PROCESSES/EFFECTIVENESS Measure: NQF 0108_a Follow-Up Care for Children Prescribed ADHD Medication ● ● ● ● Patients aged 6-12 years Newly prescribed ADHD medication during initial visit Follow up care 30 days after prescribing medication 2 additional follow-up visits after the initial 30 days (within 9 months) 2015 Office Practicum User Conference Clinical Quality Measures CLINICAL PROCESSES/EFFECTIVENESS Measure: NQF 0108_a Follow-Up Care for Children Prescribed ADHD Medication Suggested Documentation in OP: ● First time prescribing ADHD Medication ● Follow-up visit within 30 days of prescribing ● 2 additional follow-up visits after the initial 30 days ○ must be charted within 9 months ○ must have remained on the medication prescribed 2015 Office Practicum User Conference Clinical Quality Measures CLINICAL PROCESSES/EFFECTIVENESS Measure: CMS75v1 Children with Dental Decay or Cavities ● Patients aged 0-20 years ● Dental cavities or tooth decay noted during the reporting period 2015 Office Practicum User Conference Clinical Quality Measures CLINICAL PROCESSES/EFFECTIVENESS Measure: CMS75v1 Children with Dental Decay or Cavities Suggested Documentation in OP: ● ICD code on visit for Dental Decay/cavities -OR● Problem List entry for Dental Decay/cavities ● Document findings in visit note 2015 Office Practicum User Conference Clinical Quality Measures CLINICAL PROCESSES/EFFECTIVENESS Measure: NQF 0036 Use of Appropriate Medications for Asthma ● Patients aged 5-64 years ● Persistent Asthma identified ● Asthma medication prescribed during the reporting period 2015 Office Practicum User Conference Clinical Quality Measures CLINICAL PROCESSES/EFFECTIVENESS Measure: NQF 0036 Use of Appropriate Medications for Asthma Suggested Documentation in OP: ● Problem List entry for Persistent Asthma ○ SNOMED code with the word persistent -OR○ Stage/Severity with the word persistent ● Asthma medication prescribed during the reporting period 2015 Office Practicum User Conference Demonstration Let’s try it! 2015 Office Practicum User Conference Questions? 2015 Office Practicum User Conference Clinical Quality Measures ALTERNATE PEDIATRIC REPORTS AVAILABLE IN OFFICE PRACTICUM Measure Domain Child and Adolescent Major Depressive Disorder: Suicide Risk Assessment Patient Safety Closing the Referral Loop: Receipt of Specialist Report Care Coordination Influenza Immunization Population and Public Health Initiation and Engagement of Alcohol and Other Drug Dependence Treatment Clinical Processes/Effectiveness Hemoglobin A1c Test for Pediatric Patients Clinical Processes/Effectiveness Primary Caries Prevention Intervention Clinical Processes/Effectiveness 2015 Office Practicum User Conference Clinical Quality Measures PATIENT SAFETY Measure: NQF 1365 Child and Adolescent Major Depressive Disorder: Suicide Risk Assessment ● Patients aged 6-17 years ● Diagnosis of MDD ● Suicide risk assessment completed at each visit during the measurement period. 2015 Office Practicum User Conference Clinical Quality Measures CARE COORDINATION Measure: CMS50v1 Closing the Referral Loop: Receipt of Specialist Report ● No age restriction ● Referral created during the reporting period ● Report received from the provider the patient was referred (specialist) 2015 Office Practicum User Conference Clinical Quality Measures POPULATION AND PUBLIC HEALTH Measure: NQF 0041 Influenza Immunization ● 6 months and older ● Seen between October 1 and March 31 ● OR prior influenza immunization 2015 Office Practicum User Conference Clinical Quality Measures CLINICAL PROCESSES/EFFECTIVENESS Measure: NQF 0004_a Initiation and Engagement of Alcohol and Other Drug Dependence Treatment ● Patients 13 years and older ● Diagnosis of AOD during a visit in the first 11 months of the reporting period ● Treatment initiated within 14 days of the diagnosis 2015 Office Practicum User Conference Clinical Quality Measures CLINICAL PROCESSES/EFFECTIVENESS Measure: NQF 0060 Hemoglobin A1c Test for Pediatric Patients ● Patients aged 5-17 years ● Diabetes recorded on the Problem List ● Visit during the reporting period and a visit 12 months prior ● HgbA1c test done during the reporting period 2015 Office Practicum User Conference Clinical Quality Measures CLINICAL PROCESSES/EFFECTIVENESS Measure: CMS74v2 Primary Caries Prevention Intervention ● Patients aged 0-20 years ● Fluoride varnish application during the reporting period 2015 Office Practicum User Conference Clinical Quality Measures OTHER REPORTS AVAILABLE IN OFFICE PRACTICUM Measure Domain Documentation of Current Medication Patient Safety Preventive Care and Screening Pair: Tobacco Use Assessment and Tobacco Cessation Intervention Population and Public Health Adult Weight Screening and Follow-up Population and Public Health Maternal Depression Screening Population and Public Health Screening for High Blood Pressure and Follow-Up Documented Population and Public Health 2015 Office Practicum User Conference Clinical Quality Measures OTHER REPORTS AVAILABLE IN OFFICE PRACTICUM Measure Domain Use of Imaging Studies for Low Back Pain Efficient Use of Healthcare Resources Controlling High Blood Pressure Clinical Processes/Effectiveness Antidepressant Medication Management Clinical Processes/Effectiveness 2015 Office Practicum User Conference Clinical Quality Measures PATIENT AND FAMILY ENGAGEMENT No reporting will be available within this domain in Office Practicum for Pediatrics. 2015 Office Practicum User Conference Clinical Quality Measures PATIENT SAFETY Measure: NQF 0419 Documentation of Current Medications ● 18 years and older prior to the beginning of the reporting period ● Complete medication list to include OTC’s, herbals, vitamins, etc. ● Must contain name, dosage, frequency and route 2015 Office Practicum User Conference Clinical Quality Measures POPULATION AND PUBLIC HEALTH Measure: NQF 0028 Preventive Care and Screening Pair: Tobacco Use Assessment and Tobacco Cessation Intervention ● 18 years and older ● Risk Assessment/Smoking Status evaluated ● If positive, counseling done or smoking cessation prescribed 2015 Office Practicum User Conference Clinical Quality Measures POPULATION AND PUBLIC HEALTH Measure: NQF 00421 Adult Weight Screening and Follow-up ● 18 years and older ● BMI calculated and outside the normal parameters during the encounter or 6 months prior ● Follow up plan documented 6 months prior to reporting period or during the reporting period. 2015 Office Practicum User Conference Clinical Quality Measures POPULATION AND PUBLIC HEALTH Measure: NQF 1401 Maternal Depression Screening ● Child turned 6 months within the reporting period ● Visit during the reporting period ● Maternal screening done between 0 - 6 months (Edinburgh or PHQ-2 surveys) 2015 Office Practicum User Conference Clinical Quality Measures POPULATION AND PUBLIC HEALTH Measure: CMS22v1 Screening for High Blood Pressure and Follow-Up Documented ● 18 years and older ● Problem list entry for Hypertension ● Recommended follow up documented 2015 Office Practicum User Conference Clinical Quality Measures EFFICIENT USE OF HEALTHCARE RESOURCES Measure: NQF 0052 Use of Imaging Studies for Low Back Pain ● Patient aged 18-50 years ● Visit coded for low back pain ● No imaging studies within 28 days of the diagnosis 2015 Office Practicum User Conference Clinical Quality Measures CLINICAL PROCESSES/EFFECTIVENESS Measure: NQF 0018 Controlling High Blood Pressure ● Patients aged 18-85 years ● Hypertension recorded on Problem List prior to the reporting period or 6 months within the reporting period ● Blood Pressure measured less than 140/90 during the reporting period 2015 Office Practicum User Conference Clinical Quality Measures CLINICAL PROCESSES/EFFECTIVENESS Measure: NQF 0105_a Antidepressant Medication Management ● Patients 18 years and older ● Diagnosis of major depression 6 months prior or the first 6 months of the reporting period ● Treatment with antidepressant medication for at least 84 days 2015 Office Practicum User Conference Action Items ▪ Update to latest OP version to receive new ▪ ▪ ▪ ▪ ▪ ▪ ▪ QIC with 2014 reports Decide on reporting period Choose Menu Measures Choose your Public Health objectives Choose Clinical Quality Measures for reporting Run QIC to determine a baseline Share results with your staff Create strategies and develop internal workflows to ensure measures are met 2015 Office Practicum User Conference Resources 2014 Definition Stage 1 of Meaningful Use Meaningful Use Core and Menu Set Objectives Introduction to EHR Incentive Program for Eligible Professionals Stage 1 Worksheet Federal Register Regional Extension Centers OP Patient Portal OP Demographic Analysis and Recall Report OP Patient Message Exchange 2015 Office Practicum User Conference Meaningful Use - Stage 1 2015 Office Practicum User Conference Meaningful Use - 2015 We want your feedback! 2015 Office Practicum User Conference