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2015 User Conference
Pre-Conference: Meaningful Use Stage 1 2015April 23, 2015
Presented by:
Angela SchnackTraining Specialist
EHR Session
2015 Office Practicum User Conference
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
Stage 1
If you are in this stage, you will need the 2014 CEHRT edition of Office Practicum
CEHRT: Certified Electronic Health Record Technology
● 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
2015 Office Practicum User Conference
Stage 1
Stage 2
Stage 32018 Stage 3Proposed ruling in process*May elect to move to Stage 3 in 2017, required to in 2018
Note: ● 2016 Last year to initiate participation in Medicaid
EHR incentive program● 2021 Last year to receive Medicaid EHR incentive
payment.
● Stages 1 & 2 are no longer split.
● Combined into one with modified reporting
2015 Office Practicum User Conference
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
CPOE - (Modified Stage 2 Objective)
Use CPOE for more than 60% medications, 30% of laboratory, and 30% of radiologyExclusion: Fewer than 100 medications, laboratory or radiology orders written during the reporting period
907A
907B
907C
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
Denominator: Total Lab requisitions written during the reporting period
Numerator: Labs with a result date
Denominator: Total Radiology Lab requisitions written during the reporting period
Numerator: 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 periodExclusion:
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.
*EP’s who would have been in Stage 1 reporting may report the lesser percentage
2015 Office Practicum User Conference
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)
▪ Med reconciliation selected as performed or not required
▪ Referral tracking entry created
-OR-▪ Response to
Referral performed
>50%
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
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
>80%
▪Problem marked as active/tracking▪SNOMED Code or▪No Active Problems▪Unique Patient▪Visit during reporting period
Up to date Problem List (Previously Core)
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 totalIf 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
Have you run the QIC?
Quality Improvement Calculator
Threshold not met
Exclusions; no minimum threshold; no data
Threshold met
2015 Office Practicum User Conference
Clinical Quality Measures
● 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
What needs to be Reported?
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 HEALTHMeasure: NQF 0033
Chlamydia Screening for Women
● 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
Suggested Documentation in OP
2015 Office Practicum User Conference
Clinical Quality Measures
POPULATION AND PUBLIC HEALTHMeasure: 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 HEALTHMeasure: NQF 0024
Weight Assessment and Counseling for Nutrition and Physical Activity for Children and Adolescents
● 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)
Suggested Documentation in OP:
2015 Office Practicum User Conference
Clinical Quality Measures
POPULATION AND PUBLIC HEALTHMeasure: NQF 0038
Childhood Immunization Status● Follow vaccine schedule for vaccines
administered prior to 2nd birthday● 4 DTaP● 3 IPV● 1 MMR● 3 HiB● 3 Hep B● 1 Varicella● 4 PCV● 1 Hep A● 2-3 Rotavirus● 2 flu
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
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
POPULATION AND PUBLIC HEALTHMeasure: NQF 0418
Screening for Clinical Depression and Follow-Up Plan
Clinical Quality Measures
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/EFFECTIVENESSMeasure: NQF 0108_a
Follow-Up Care for Children Prescribed ADHD Medication
● 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
Suggested Documentation in OP:
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
● ICD code on visit for Dental Decay/cavities-OR-
● Problem List entry for Dental Decay/cavities
● Document findings in visit note
Suggested Documentation in OP:
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
● 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
Suggested Documentation in OP:
2015 Office Practicum User Conference
Clinical Quality Measures
ALTERNATE PEDIATRIC REPORTS AVAILABLE IN OFFICE
PRACTICUMMeasure 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 1365Child 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: CMS50v1Closing 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 HEALTHMeasure: 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 0419Documentation 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 HEALTHMeasure: 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 HEALTHMeasure: 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 HEALTHMeasure: 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
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
Clinical Quality Measures
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 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
Clinical Quality Measures
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