Meaningful Use Revisions (2015-2017)

CMS released a revision to the final rule on 10-6-15 that specifies the modified criteria that Eligible Professionals (EPs) must meet in order to participate in the Meaningful Use Incentive Program.  The modifications are documented below and in this CMS Tipsheet.

The new rules are applicable from 2015 through 2017.  One of the major changes is the reduction in the reporting period for 2015.  All EPs have a 90-day reporting period in 2015.  This is a continuous 90-day period and does not have to align to the calendar quarters.

The other major change for 2015 is the reduction in number of objectives from 20 to 10.  The revised, single-set of objectives replaces the previous core and menu set from previous years.  The objectives are listed below:

Objectives (2015):

1. Protect Patient Health Information

Measure: Conduct or review a security risk analysis in accordance with the requirements in 45 CFR 164.308(a)(1), including addressing the security (to include encryption) of ePHI created or maintained in CEHRT in accordance with requirements under 45 CFR 164.312(a)(2)(iv) and 45 CFR 164.306(d)(3), and implement security updates as necessary and correct identified security deficiencies as part of the EP’s risk management process.

Alternate Exclusions and/or Specifications:

None

How do I achieve this measure?

In order to qualify for this measure, the provider must have a security management process in place to “implement policies and procedures to prevent, detect, contain and correct security violations.”  The specifications require the practice to conduct an analysis of potential risks and vulnerabilities to the confidentiality, integrity, and availability of electronic health information.

Some examples of this may include, but are not limited to:

  • Perform Security Risk Analysis/ Assessment
  • Implement Security Policies, such as providing passwords to computers and installing anti-virus software, screensaver for auto-log off, changing options in Preferences > User Security in ChartMaker Clinical
  • Appoint a Security Official – Prepare and Implement Job Responsibilities
  • Implement Audit Control Policies& Procedures
  • Implement Automatic Log-off Processes
  • Install Virus Protection Software
  • Implement Firewall Technology
  • Review and Implement Computer Backup Policies and Procedures
  • Implement Facility Maintenance Log
  • Develop Facility Security and Contingency Plans
  • Create Computer Workstation Use Policies and Procedures
  • Obtain Signed Workforce Confidentiality Agreements form all Physicians and Staff
  • Create Workforce Termination Procedures
  • Implement Sanction Policy
  •  As part of the process in creating such a manual, STI Managed Services can perform a basic Security Risk Analysis on network and hardware vulnerability for your office by request.  The practice is responsible for maintaining HIPAA compliance; however STI will work with you to assure the Information Technology portion of the Security Risk Analysis is complete.  Upon completion of your analysis, you will be informed of STI findings whether positive or negative.  The analysis will include some, but not all, of the examples listed above.

    This service is provided free of charge for Platinum level maintenance clients and for a fee for all other clients.    Contact STI Managed Services (800-487-9135; option 2) for more information.

    Please keep in mind that the analysis completed by STI or another IT vendor is only a subset of this measure.  There are other requirements that must be completed by the practice itself.  If your practice would like a more thorough analysis, we can recommend a vendor to do so.

    2. Clinical Decision Support

    In order for EPs to meet the objective they must satisfy both of the following measures:

    Measure 1: Implement five clinical decision support interventions related to four or more clinical quality measures at a relevant point in patient care for the entire EHR reporting period. Absent four clinical quality measures related to an EP’s scope of practice or patient population, the clinical decision support interventions must be related to high priority health conditions.

    Measure 2: The EP has enabled and implemented the functionality for drug-drug and drug allergy interaction checks for the entire EHR reporting period.

    Exclusion: For the second measure, any EP who writes fewer than 100 medication orders during the EHR reporting period.

    Alternate Exclusions and/or Specifications:  

    For an EHR reporting period in 2015 only, an EP who is scheduled to participate in Stage 1 in 2015 may satisfy the following in place of measure 1:

    Alternate Objective and Measure:

    Objective: Implement one clinical decision support rule relevant to specialty or high clinical priority along with the ability to track compliance with that rule.

    Measure: Implement one clinical decision support rule.

    How do I achieve this measure?

    See instructions on Clinical Decision Support rules.

    3. Computerized Provider Order Entry (CPOE)

    An EP, through a combination of meeting the thresholds and exclusions (or both), must satisfy all three measures for this objective.

    Measure 1: More than 60 percent of medication orders created by the EP during the EHR reporting period are recorded using computerized provider order entry.

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

    Measure 2: More than 30 percent of laboratory orders created by the EP during the EHR reporting period are recorded using computerized provider order entry.

    Exclusion: Any EP who writes fewer than 100 laboratory orders during the EHR reporting period.

    Measure 3: More than 30 percent of radiology orders created by the EP during the EHR reporting period are recorded using computerized provider order entry.

    Exclusion: Any EP who writes fewer than 100 radiology orders during the EHR reporting period.

    Alternate Exclusions and/or Specifications:

    Alternate Measure 1: For Stage 1 providers in 2015, more than 30 percent of all unique patients with at least one medication in their medication list seen by the EP during the EHR reporting period have at least one medication order entered using CPOE; or more than 30 percent of medication orders created by the EP during the EHR reporting period are recorded using computerized provider order entry.

    Alternate Exclusion for Measure 2: Providers scheduled to be in Stage 1 in 2015 may claim an exclusion for measure 2 (laboratory orders) of the Stage 2 CPOE objective for an EHR reporting period in 2015.

    Alternate Exclusion for Measure 3: Providers scheduled to be in Stage 1 in 2015 may claim an exclusion for measure 3 (radiology orders) of the Stage 2 CPOE objective for an EHR reporting period in 2015.

    How do I achieve this measure?

    In order to qualify for this measure, the provider must enter patient medications (through the “Medication” button), lab and radiology orders (using a Procedure Checklist) through ChartMaker Clinical.

    NOTE:  Entering medications through the “Add Medication” functionality on the Face Sheet will not qualify for this measure.

    To configure lab and radiology procedures:

    1. In Clinical, go to Edit > System Tables > Conditions > Procedures
    1. Search for the procedure by typing the description or code

    NOTE:  If you do not have the applicable procedure codes in your database, they should be added through Practice Manager (Administration > Transaction Tables > Procedure).

    1. Highlight the procedure and click “Properties”
    1. Change the “Type” field to either Lab or Image, depending on the procedure

    Lab_SystemTables

    NOTE:  If you do not bill for this procedure, “Auto-charge” should not be selected.

    1. Click “Save”
    1. Repeat steps 2 – 5 for each additional procedure
    1. Click “Close” to close the Procedure Search dialog

     

    To enter a lab or radiology order for a patient:

    1. In an office visit note, select the applicable lab or radiology procedure from a procedure checklist by clicking the + sign

    Labs_ProcedureChecklist

    1. Enter any applicable information on the Order Procedure dialog

    NOTE:  If the checkbox for “Initial order created outside of Clinical” is selected, you will not receive credit for this procedure for this measure.

    1. Click “OK”

     

    To enter medications for a patient:

    1. In an office visit note, click the “Medication” button (Icon_Medication)
    1. Choose “Add Medication”
    1. Search for and select the medication
    1. Enter all appropriate fields and click “Next”

    NOTE:  Designating the medication as “pre-existing” (un-checking the “Started” field) WILL NOT qualify for this measure.  If the medication is a Schedule II controlled substance, a date must be entered in the Earliest Fill Date field.

    1. Select a Location (if necessary) and the patient’s Pharmacy

    NOTE:  If prescribing a controlled substance, you must have your IdenTrust token inserted into your computer and check the box for “Ready to sign” prior to completing Step 6.

    1. Click “Confirm” or “Confirm and Send” (depending on the Transmission selected)
    4. Electronic Prescribing (eRx)

    Measure: More than 50 percent of permissible prescriptions written by the EP are queried for a drug formulary and transmitted electronically using CEHRT.

    Exclusions: Any EP who:

  • Writes fewer than 100 permissible prescriptions during the EHR reporting period; or
  • Does not have a pharmacy within his or her organization and there are no pharmacies that accept electronic prescriptions within 10 miles of the EP's practice location at the start of his or her EHR reporting period.
  • Alternate Exclusions and/or Specifications:

    Alternate Measure: For Stage 1 providers in 2015, more than 40 percent of all permissible prescriptions written by the EP are transmitted electronically using CEHRT.

     

    How do I achieve this measure?

    In order to qualify for this measure, the provider must electronically prescribe medications (excluding controlled substances).

    To electronically prescribe a medication:

    1. In an office visit note, click the “Medication” button (Icon_Medication)
    1. Choose “Add Medication” (or “Renew Medication”)
    1. Search for and select the medication
    1. Enter all appropriate fields and click “Next”

    NOTE:  Select “E-Prescribe” in the Transmission field.  If the medication is a Schedule II controlled substance, a date must be entered in the Earliest Fill Date field.

    1. Select the Location (if necessary) and the patient’s Pharmacy

    NOTE:  If prescribing a controlled substance, you must have your IdenTrust token (see below) inserted into your computer and check the box for “Ready to sign” prior to completing Step 6.

    Sample IdenTrust Token:  IdenTrustToken

    1. Click “Confirm and Send”

    Prescribe_Confirmation

    Alternative Method:  Use the options available (to queue or renew) when you right-click on the medication from the Face Sheet.

    5. Health Information Exchange

    Measure: The EP that transitions or refers their patient to another setting of care or provider of care must (1) use CEHRT to create a summary of care record; and (2) electronically transmit such summary to a receiving provider for more than 10 percent of transitions of care and referrals.

    Exclusion: Any EP who transfers a patient to another setting or refers a patient to another provider less than 100 times during the EHR reporting period.

    Alternate Exclusions and/or Specifications:

    Alternate Exclusion: Provider may claim an exclusion for the Stage 2 measure that requires the electronic transmission of a summary of care document if for an EHR reporting period in 2015, they were scheduled to demonstrate Stage 1, which does not have an equivalent measure.

     

    How do I achieve this measure?

    In order to qualify for this measure, the provider must provide a summary of care record to the receiving provider when a patient is transitioning to a new provider, or has been referred to another provider and still remains under the referring provider’s care.

    To generate a Transition of Care Summary (to fulfill Measure 1):

    1. Go to Chart > Export > Patient Data

    ALTERNATE METHOD:  If you are outside of a patient’s chart, you will use the same steps to access the Transition of Care Summary, however you will need to search for the patient first after opening the Export Patient Document dialog.

    1. Select “Transition of Care Summary” from the Document to Export dropdown

    Transition_FileFormat

    1. Select the appropriate Provider from the “Provider Selection” dropdown
    1. Click “Save”
    1. (Optional) If prompted with the Patient Information Document Exclusions dialog, select the information that you do not want to print on the Transition of Care Summary and click “OK”
    1. Browse to where you would like to save the file and click “Save”

    NOTE:  The file will be named “LastName_FirstName_PatientID” by default.  You can change the name of the file if you prefer.  (The patient ID is not the same as their account number).

    1. Click “OK”

    ExportComplete

    NOTE:  The file(s) will now be saved to the specified location.  The CCD file will be saved as an .xml file and the HTML file will be saved as a .html file.

                                                   CCD:                                         HTML:

    CCD_File  HTML_File

    The HTML file is a human readable formatted document that when opened is displayed in a web browser.  The CCD file is a file format that can be imported into another EHR, therefore it is not in a human readable format.  You may choose to unselect this file format when generating the file if you do not plan to send a copy to another practice.

     

    To generate a Transition of Care Summary and send via a Direct Message (to fulfill Measure 2):

    1. Open the patient’s chart
    1. Go to To-Do > Direct Messaging> Send New Message…

    NOTE:  If the option for Direct Messaging is greyed out, this means your practice has not been configured for this functionality.  Please call Clinical Support for assistance.

    1. Click “To…”
    1. Search for and select the appropriate provider by double-clicking on their name

    ALTERNATE METHOD:  Highlight the appropriate provider in the Search Results box and click “To -->”.

    1. Click “OK”
    1. Enter a “Subject”
    1. Enter a “Message”
    1. Click “Generate and Attach CDA”
    1. Search for and select the appropriate patient
    1. Select the appropriate Provider from the “Provider Selection” dropdown
    1. Click “Save”

    ExportPatientDocument_Save

    1. (Optional) If prompted with the Patient Information Document Exclusions dialog, select the information that you do not want to print on the Transition of Care Summary and click “OK”
    1. Browse to where you would like to save the file and click “Save”

    NOTE:  The file will be named “LastName_FirstName_PatientID” by default.  You can change the name of the file if you prefer.  (The patient ID is not the same as their account number).

    1. Click “OK”

    ExportComplete

    NOTE:  You will see the Transition of Care Summary attached to your Direct Message:

    DM_Attach

    1. Click “Send”

     

    To view previously sent Direct Messages:

    1. Go to To-Do > Direct Messaging > View Sent Messages…

    NOTE:  If you would like to view messages sent by another user in your practice, click the “User” dropdown and select the applicable user.

     

    To document the transition of care (Optional):

    1. In an office visit note, click the “Referral” button (Icon_Referral)
    1. Click “New”
    1. Click “Choose Provider”

    Referral_ChooseProvider

    1. Search for and highlight the appropriate Provider. Click “OK”.
    1. Select at least one diagnosis from the patient’s Problem List

    Referral_Dx

    1. Enter Comments, if applicable
    1. Click “OK”

    Referral_OK

    1. Click “OK” to close the Referral dialog

    NOTE:  Entering information into the office visit note through the “Referral” button will only contribute to the denominator.  Generating the Transition of Care Summary report will contribute to the numerator.  If you enter information through the “Referral” button but do not generate a Transition of Care Summary report, you will never contribute to the numerator (meaning you will only be at 50% for this measure).

    In order to be at 100% for this measure, you either need to:

    a) Enter information into the “Referral” button and generate a Transition of Care Summary report

    or

    b) Generate a Transition of Care Summary report

    6. Patient Specific Education

     

    Measure: Patient specific education resources identified by CEHRT are provided to patients for more than 10 percent of all unique patients with office visits seen by the EP during the EHR reporting period.

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

    Alternate Exclusions and/or Specifications:

    Alternate Exclusion: Provider may claim an exclusion for the measure of the Stage 2 Patient Specific Education objective if for an EHR reporting period in 2015 they were scheduled to demonstrate Stage 1 but did not intend to select the Stage 1 Patient Specific Education menu objective.

     

    How do I achieve this measure?

    In order to qualify for this measure, the provider must provide the patient with educational materials specific to the patient.  In a patient note, you will have the option to select from your pre-defined list or from information found on MedlinePlus.

    To add educational material options to the database:

    1. Go to Edit > System Tables > Education Materials
    1. Click “Add”
    1. Type the description of the educational resource
    1. Click “OK” to close the Education Materials System Table dialog

    NOTE:  Repeat steps 2-3 for any additional educational resource options before clicking “OK”.

     

    To document educational materials using the “Education Materials” button:

    1. In an office visit note, click “Education Materials” (Icon_EducationMaterials_2)
    1. Select the checkbox for the item(s) you would like to document in the current note from the box at the top

    EducMaterial_ItemsSelected

    OR

     

    Click “MedlinePlus” (Icon_MedlinePlus) and either search by selecting one of the patient’s Diagnoses, Medications or Labs from the boxes at the top:

    MedlinePlus_DxMedLab

    Or by typing the subject you are looking for into the following box and clicking “Go”:

    MedlinePlus_Search

    After selecting the appropriate item, click “Save” or “Save and Print”.

    1. Click “OK” to close the Education Materials dialog

    2. Enter an appropriate CPT code

     

    To document educational materials using Clinical Decision Support:

    See the section on “Clinical Decision Support”.  The only step that would be different is when setting up the Rule, the Rule Type should be set to “Education Materials”.

    When possible, using Clinical Decision Support is the preferred method to generating educational materials as the final rule stated, “we agree with the HIT Policy Committee and others that the objective and associated measure should make clear that the EP should utilize certified EHR technology in a manner where the technology suggests patient-specific educational resources based on the information stored in the certified EHR technology.”

    7. Medication Reconciliation

    Measure: The EP performs medication reconciliation for more than 50 percent of transitions of care in which the patient is transitioned into the care of the EP.

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

    Alternate Exclusions and/or Specifications:

    Alternate Exclusion: Provider may claim an exclusion for the measure of the Stage 2 Medication Reconciliation objective if for an EHR reporting period in 2015 they were scheduled to demonstrate Stage 1 but did not intend to select the Stage 1 Medication Reconciliation menu objective.

    How do I achieve this measure?

    In order to qualify for this measure, the provider must perform a medication reconciliation whenever a patient is transferred into their care from another setting (i.e. hospital or skilled nursing care), in the last 60 days. This means the provider must compare what the patient was taking while under the care of the outside provider versus what they are taking under your care.

    To perform a medication reconciliation:

    1. Obtain a list of medications the patient was on under the care of the transferring provider
    1. Open the patient’s chart and compare that list with what is in ChartMaker® Clinical
    1. In a chart note, click “Medication Reconciliation” (Icon_MedicationReconciliation)

    ALTERNATE METHOD: Enter one of the following medication reconciliation codes from within a procedure checklist.  If using this method, you can skip step 4.

  • 1110F – Medication Reconciled (from inpatient facility)
  • 1111F – Medication Reconciled (from outpatient facility)
  • 1111F with 8P - Medications not reconciled with the current medication list in outpatient medical record, reason not otherwise specified
  •  

    1. Select “Yes” to the appropriate method of referral and/or if they are a new patient and “Yes” that Medication Reconciliation was performed and then click “OK”

    MedicationReconciliation

    1. In the same note, enter an appropriate CPT code for the office visit
    8. Patient Electronic Access (VDT)

    Measure 1: More than 50 percent of all unique patients seen by the EP during the EHR reporting period are provided timely access to view online, download, and transmit to a third party their health information subject to the EP's discretion to withhold certain information.

    Measure 2: For an EHR reporting period in 2015, at least one patient seen by the EP during the EHR reporting period (or patient-authorized representative) views, downloads or transmits to a third party his or her health information during the EHR reporting period.

    Exclusions: Any EP who:

  • Neither orders nor creates any of the information listed for inclusion as part of the measures; or
  • Conducts 50 percent or more of his or her patient encounters in a county that does not have 50 percent or more of its housing units with 4Mbps broadband availability according to the latest information available from the FCC on the first day of the EHR reporting period.
  • Alternate Exclusions and/or Specifications:

    Alternate Exclusion: Providers may claim an exclusion for the second measure if for an EHR reporting period in 2015 they were scheduled to demonstrate Stage 1, which does not have an equivalent measure.

     

    How do I achieve this measure?

    In order to qualify for this measure, the provider must submit health information for their patients through the ChartMaker® PatientPortal.  The provider will need to register the patient on the portal first through Practice Manager and then the patient must verify the registration before an exchange of information can occur.  (Once the registration is verified, ChartMaker Clinical will automatically send updates at a pre-configured amount of time.)  The patient must also log into their PatientPortal account and either view (Clinical Summaries or Lab Reports), download or transmit their information to a third party.

    NOTE:  The PatientPortal will need to be configured first before being able to use it.  To request enrollment, visit www.sticomputer.com, click “Enrollments”, fill out the form and click “Submit”.  Please contact STI Clinical Support if you need assistance with this process.

     

    To enroll the patient for the PatientPortal (with an email address):

    1. In Practice Manager, open the patient’s account
    1. On the Patient tab, click “Patient Portal”

    PatientTab_PatientPortal

    NOTE:  You will need the patient’s first name, last name and date of birth documented on their account in order to register the patient.

    1. Click the first “Authorize” option

    PatientPortal_Authorize(email)

    1. Click “Yes”

    PatientPortal_AuthorizeConfirm

    NOTE:  The status of the registration will now display as “pending”.

    PatientPortal_Pending

    1. Click “OK”

    NOTE:  The Patient Portal button will now show as yellow.  Yellow indicates a pending registration.  The button will turn green once the patient completes the registration process.

    PatientPortal_PendingYellow

    1. Click “Save” to close the patient’s account

    NOTE:  The denominator and numerator are not necessarily tied to the same event.  To populate the denominator the provider must have completed an office visit note, with a valid CPT code included, for the patient encounter.  To populate the numerator, the patient must be authorized for the PatientPortal through Practice Manager on the Patient tab and the provider must sign all information being sent to the portal (i.e. progress notes, labs, etc.) within 4 business days of receiving it.


    To enroll the patient for the PatientPortal (without an email address):

    1. In Practice Manager, open the patient’s account
    1. On the Patient tab, click “Patient Portal”

    PatientTab_PatientPortal

    NOTE:  You will need the patient’s first name, last name and date of birth documented on their account in order to register the patient.

    1. Click the second “Authorize” option

    PatientPortal_Authorize(noemail)

    1. Click “Yes”

     

    PatientPortal_AuthorizeConfirm

    NOTE:  The status of the registration will now display as “pending”.

    PatientPortal_Pending

    1. Click “OK”

    NOTE:  The Patient Portal button will now show as yellow.  Yellow indicates a pending registration.  The button will turn green once the patient completes the registration process.

    PatientPortal_PendingYellow

    1. Click “Save” to close the patient’s account
    1. Give the printed instructions to the patient and encourage them to complete registration at a later time

    NOTE:  The denominator and numerator are not necessarily tied to the same event.  To populate the denominator the provider must have completed an office visit note, with a valid CPT code included, for the patient encounter. To populate the numerator, the patient must be authorized for the PatientPortal through Practice Manager on the Patient tab and the provider must sign all information being sent to the portal (i.e. progress notes, labs, etc.) within 4 business days of receiving it.

     

    Steps taken by the patient to complete registration and login to the PatientPortal to View/Download/Transmit information:

    1. Log into their email account and access the email regarding the PatientPortal registration
    1. Click the link to access the PatientPortal to complete registration

    RegistrationEmail

    1. Fill out the required information (Username, Date of Birth, Password, Confirm Password, Security Question and Answer)

    CreateNewAccount

    NOTE:  Date of Birth must match what is documented in Practice Manager/Clinical.

    1. Accept the Terms of Use along with typing the security characters that are displayed in the picture
    1. Click “Register”
    1. Login using the credentials designated in Step 3

    LogOn_cropped

    1. Complete one or all of the following actions:

    a) View Clinical Summaries by clicking “Clinical Summaries”

    b) View Lab results by clicking “Lab Results”

    c) Download information by either going to “Clinical Summaries” or “Lab Reports” and then clicking “Download”

    d) Transmitting a Clinical Summaryor Lab Report by going to “Messages” and then clicking “Send a Direct message”

    9. Secure Messaging

     

    Measure: For an EHR reporting period in 2015, the capability for patients to send and receive a secure electronic message with the EP was fully enabled during the EHR reporting period.

    Exclusion: Any EP who has no office visits during the EHR reporting period, or any EP who conducts 50 percent or more of his or her patient encounters in a county that does not have 50 percent or more of its housing units with 4Mbps broadband availability according to the latest information available from the FCC on the first day of the EHR reporting period.

    Alternate Exclusions and/or Specifications:

    Alternate Exclusion: An EP may claim an exclusion for the measure if for an EHR reporting period in 2015 they were scheduled to demonstrate Stage 1, which does not have an equivalent measure.

     

    How do I achieve this measure?

    In order to qualify for this measure, the provider must receive a secure electronic message via the ChartMaker PatientPortal from a patient that was seen during the reporting period.

     

    To send a secure electronic message via the ChartMaker PatientPortal:

    NOTE:  This will be completed by the patient 

    1. Log into the PatientPortal
    1. Click “Messages”
    1. Click “Send a message”
    1. Select the appropriate Message Type

    NOTE:  As of ChartMaker® Medical Suite 2015, all message types will count toward the calculation of this measure.  Prior to this version, only Message Types of “Refill Request” and “Health Question” counted towards this measure.

    1. Select the applicable Provider from the dropdown

    NOTE:  As of ChartMaker® Medical Suite 2015, the calculation of the numerator has been updated to include all providers that saw the patient within the reporting period as long as one of the provider’s meet the requirements for the measure.  Prior to this version, only the Provider selected in this dropdown received credit for this measure.

    1. Enter a Phone Number
    1. Enter a Message
    1. Click “Send”

    NOTE:  The message will be sent to the list of users configured to receive this Message Type.  This is configured by going to To-Do > New Message/Task.  Click “To” and highlight the applicable Distribution List (Patient Portal Health Questions or Patient Portal Refill Requests) and then click “Edit…”.


     

    NOTE:  None of the following options are required in order to receive credit for this measure.

     

    To delete a message received via the ChartMaker PatientPortal:

    NOTE:  The message will only be removed from the current user’s To Do List (and not the other users configured on the Distribution List). 

    1. Double-click on the message from your To Do List
    1. Click “Delete”

    ALTERNATE METHOD:  Highlight the message from your To Do List and click “Delete”.

     

    To print a message received via the ChartMaker PatientPortal:

    1. Double-click on the message from your To Do List
    1. Click “Print”

    ALTERNATE METHOD:  Highlight the message from your To Do List and click “Print”.

     

    To reply to a message received via the ChartMaker PatientPortal:

    1. Double-click on the message from your To Do List
    1. Click “Reply”
    1. Type your message and click “Send”

     

    To save a message received via the ChartMaker PatientPortal to the patient’s chart:

    1. Double-click on the message from your To Do List
    1. Click “Yes and sign”
    1. Click “Save”
    1. Enter an applicable Heading and click “OK”
    1. (Optional) If prompted with the Patient Information Document Exclusions dialog, select the information that you do not want to print on the Transition of Care Summary and click “OK”
    1. Select a provider and click “OK”

     

    To send the patient a message to their PatientPortal account:

    1. Open the patient’s chart

    NOTE:  This process must be done from within a patient’s chart

    1. Click To-Do > New Patient Portal Message…
    1. Enter a “Subject” and your message
    1. Click “Send”
    10. Public Health and Clinical Data Registry Reporting

    An EP scheduled to be in Stage 2 in 2015 must meet 2 measures.

    EP’s must register with the public health agency no later than 60 days from the first day of their reporting period to be in compliance with measure requirements.

    Measure Option 1 – Immunization Registry Reporting: The EP is in active engagement with a public health agency to submit immunization data.

    Exclusions: Any EP meeting one or more of the following criteria may be excluded from the immunization registry reporting measure if the EP:

  • Does not administer any immunizations to any of the populations for which data is collected by its jurisdiction's immunization registry or immunization information system during the EHR reporting period;
  • Operates in a jurisdiction for which no immunization registry or immunization information system is capable of accepting the specific standards required to meet the CEHRT definition at the start of the EHR reporting period; or
  • Operates in a jurisdiction where no immunization registry or immunization information system has declared readiness to receive immunization data from the EP at the start of the EHR reporting period.
  • How do I achieve this measure?

    In order to qualify for this measure, the provider must submit electronic immunization information to their local immunization registry on an ongoing basis for pediatric and adult patients.  The state of DE, GA, NY, NJ, MD, PA, and VA, and the city of Philadelphia (“KIDS Plus”) currently have immunization registries that accept electronic data.  If the entity that you submit immunization information to does not accept them electronically, then you would meet the exclusion for this measure.

    To send immunization information electronically from ChartMaker Clinical:

    1. Go to sticomputer.com and click “Enrollments”
    1. Under “Immunizations”, find the applicable registry and fill out/download any applicable materials.

    To document immunizations given in ChartMaker Clinical:

    1. Open the patient’s chart and create a note
    1. Select the applicable immunization procedure from a procedure checklist

    ProcedureChecklist_OrderImmunization

    1. Enter the appropriate information (for the patient encounter and/or immunization registry)

    ImmunizationFields(5.4)_blank

    NOTE: The fields with an asterisk are the typical fields the immunization registries are looking for.  The “Permission to Share” checkbox is a required field for patients over the age of 18 in the state of New York.

    1. Click “OK”

    To generate an immunization batch file (manually for non-bi-directional registries):

    1. In Practice Manager, go to Add-ins > Run > Generate Immunization Batch File
    1. Log in using your Practice Manager username and password
    1. In the Format dropdown, select the applicable registry
    1. Select the appropriate Practice

    NOTE:  Leave the Provider field blank

    1. (Optional) Select the applicable Facility

    NOTE:  Depending on the registry, Facility may or may not be required.  The states of DE and NY as well as the city of Philadelphia’s KIDS registry require the Facility.

    1. Enter the Start & End Dates for the appropriate time range
    1. Specify the Output Directory

    NOTE:  This is typically a folder located on your Desktop called “Immunization Batch Files”.

    1. Specify the File Name (i.e. “1234567Vaccine121720012.HL7”)

    NOTE:  It is recommended to include the date the file is created for distinction.  Use the file extension of “.HL7” (instead of .asc).

    1. Click “Save” (Icon_Save) or go to File > Save As

    NOTES:

  • If this is your first time generating a file, you will be prompted to save your default Office Location and Site ID. Complete the following steps to set up your Office Locations:
  • a) Click “OK” when prompted.

    OfficeLocationandSiteID

    b) Select the applicable registry from the “Registry Format” dropdown

    c) Click the lookup button (Icon_Lookup3) to select the default Office Location. Highlight the appropriate Facility and click “OK”.

    d) Enter your practice’s Site ID

    e) Click “Add”

    f) Repeat steps C – E, as needed

    g) Check the box for “Default” for the default Facility

    h) Click “Save”

  • Two files will be created in the location you selected to save the file: The HL7 file and a zipped version of the HL7 file.
  • ImmunizationBatchFile

    1. Close the Vaccine Registry dialog by clicking the red “X” (Icon_RedX)

     

    To upload an immunization batch file to a state registry:

    Follow the steps provided by an STI representative or the immunization registry’s representative to upload the HL7 file.


    Measure Option 2 – Syndromic Surveillance Reporting: The EP is in active engagement with a public health agency to submit syndromic surveillance data.

    Exclusion: Any EP meeting one or more of the following criteria may be excluded from the syndromic surveillance reporting measure if the EP:

  • Is not in a category of providers from which ambulatory syndromic surveillance data is collected by their jurisdiction's syndromic surveillance system;
  • Operates in a jurisdiction for which no public health agency is capable of receiving electronic syndromic surveillance data from EPs in the specific standards required to meet the CEHRT definition at the start of the EHR reporting period; or
  • Operates in a jurisdiction where no public health agency has declared readiness to receive syndromic surveillance data from EPs at the start of the EHR reporting period.
  • How do I achieve this measure?

    In order to qualify for this measure, the provider must submit syndromic information about infectious diseases (such as H1N1, Tuberculosis, Rabies, etc.) to the local CDC in an electronic format.  If your local agency does not have the capacity to accept this information electronically, then you would meet the exclusion for this measure.

    To document syndromic status:

    1. In an office visit note, select a diagnosis
    1. In the CDC Status dropdown, select the appropriate status

    CDCStatus

    NOTE:  The status options are:

    a) Probable

    b) Suspected

    c) Confirmed

    For complete definitions of these statuses, see the CDC’s website.

    1. Click “OK”

     

     To export public surveillance data:

    1. Go to Chart > Export > Public Surveillance Data

    NOTE:  This must be done outside of the patient’s chart.

    1. Select the appropriate practice from the dropdown

    PubSurv_Practice

    1. Select the appropriate data range

    PubSurv_DateRange

    1. Click the (Icon_Ellipsis) in the “Output File” field
    1. Select where you would like to save the file and click “Save”

    NOTE:  The file will be saved in a HL7 format and will be named “PublicSurveillanceData” by default.  You can change the file name if you want.

    1. Click “Export”

    PubSurv_Export

    1. Click “OK”

    PubSurv_FileCreated

    8. Click “Cancel” to close the Public Surveillance dialog

    ADDITIONAL INFORMATION:

  • As of 9/29/14, the current status for the following registries are as follows:
  • State Registry Status
    Delaware Not accepting data electronically from EPs yet
    Georgia Currently accepting data electronically from EPs.  More information can be found at:  http://dph.georgia.gov/meaningful-use
    Maryland Not accepting data electronically from EPs yet
    New Jersey Not accepting data electronically from EPs yet
    New York Not accepting data electronically from EPs yet (outside of NYC)
    Pennsylvania Currently accepting data electronically from EPs through a third party called Health Monitoring Systems (HMS).  HMS can only accept data via an interface which is currently not supported by STI.
    Virginia Currently accepting data electronically from Family Medicine, Internal Medicine, Pediatric, or Infectious Disease EPs.  More information can be found at:  https://www.vdh.virginia.gov/meaningfuluse/mu2/Login/Login.aspx
  • It is recommended that the practice take a screenshot showing the process of sending the submission as well as the file that was sent. Alternately, a letter or email from the registry or public health agency confirming the receipt of the submitted data, including the date of the submission, name of parties involved, and whether the test was successful could be collected as well.
  • Diseases that fall into the CDC reporting requirements are as follows:
  • Diagnosis ICD-9 Code(s)
    Acquired immunodeficiency syndrome (AIDS) 042, 073.93
    Amebiasis V02.2, 006.9, 006
    Anthrax V01.81, 022.3, 022.9, 022
    Aseptic meningitis 100.81, 322.9, 047.9, 047.0, 047.1. 321.2, 348.2, 053.0, 072.9
    Botulism, foodborne 005, 005.1
    Botulism, infant 005.1, 040.41, 771, 005
    Botulism, wound 005.1, 040, 040.42, 005
    Botulism, unspecified 040, 005
    Brucellosis 023.8, 023.9, 780.6, 023.1, 023.2, 277.31, 711.4, 716.9, 066.1, 695.9
    Chancroid 099, 099.9, 289.3, 682.9
    Cholera 001, 001.9, V06.0, V01, V03, 994.9
    Congenital rubella syndrome 771.0, 136.9, 323.9, 760.2, 646.9, V22.2, V82.9, 716.9
    Diphtheria 032.9, 032.89, V06.3, V06.1, V06.2, V06.5, V03.5, V05.9, V02.4, V07.2, 357.4, 344.9, 604.91, 478.30, 716.9, 580.81
    Encephalitis, post chickenpox 052.9, V05.9, 136.9
    Encephalitis, post mumps 072.2, 323.9, 072.9, 322.9
    Encephalitis, post other 323.41, 064, 072.2, 056.01, 323.9, 323.82
    Encephalitis, primary 326, 323.9, 136.29, 011.9, 094.1, 094.89
    Gonorrhea 647, 647.1, V02.7, 098.2, 098.0, V01.6, 098.35, 098.11, V65.4
    Granuloma inguinale 099.2. 099, 686.1, 099.1
    Hansen disease 757.33, V74.2, V82.9, 030.9
    Hepatitis A 070, 573.3, 573, 070.5, 570, 354.5, V02.61, V05.3, 155.0
    Hepatitis B 070, 070.20, 070.21, 070.22, 070.23, 070.31, 070.32, 070.33
    Hepatitis, non-A, non-B
    Hepatitis, unspecified 573.3, 070, 571, 573, 782.4, 070.30, 070.31, 711, 097.9, 646.9, 995.4, 711.90, 084.6, 573,9, 136.9, 155.0, V02.60
    Legionellosis
    Leptospirosis 100.9, 100, 100.89, 100.81, 104.9, V82.9, 136.9, 100-104
    Lyme disease 088.81
    Lymphogranuloma venereum 099, 099.1, 078.8, 099.5, 799.89, 201.9, 569.2
    Malaria 084.6, 084, 647, 771.2, 780.6, 581.81, 573.2, 323.2, 760.2
    Measles 055.9, 055, V06.4, V04.2, 055.2, V05.9, 057.8
    Meningococcal infections 036.3, 036.0, 036.42, 036.89, 036.2, 322.9, 038.9, 716.9, 038.8, 054.9, 429.89, 429.89, 255.8, 323.41, 729.2, 424.90, 255.5, 780.6, 424.9, 136.9, 423.9,
    Mumps 072.9, 072.2, V06.4, 527.2, V05.9, 322.9, 711, 356.9
    Pertussis 033, V06.1, V05.9, V03.6, V06.2, V06.5, 033.9, V03.1, V03.7, V04, 484.3
    Plague 020.9, 020.8, 038.8, V03, 027.2, V05.9, 780.60, V82.9, 020-027
    Poliomyelitis, paralytic 045, 045.9, 730.7, 730, 730.73, V06.3, 138, 344.9, 045.03, 045.92, 045.2, 344.1, 321.2,
    Psittacosis 073.9, 486, 073, 136.9
    Rabies, animal 071, 979.1, V01.5, V04.5, 312.0, 994.9, 136.9
    Rabies, human 071, 979.1, V01.5, V04.5, 312.0, 994.9, 136.9
    Rheumatic fever 391, 729.0, 391.1, 424.9. 398.91, 398.99, 393, 392
    Rocky Mountain spotted fever 082.0, 066.1, 780.60, 082.9
    Rubella 771.0, 056.09, 647, V06.4
    Salmonellosis 003.0, 003.22, 484.8, 003.23, 558.9, 716.9, 486
    Shigellosis 004.9, 004, 004.3, 004.1, 004.2,
    Syphilis, all stages 097.1, 095.9, 090, 647, 090.49, 092, 094.9, 796.4, 453.9, 093.22, 091.4, 410.9, V01.6, 647.04, 759.82, 647.03, 095.5, 647.0, 647.01, 647.02,
    Syphilis, primary 091.2, 091.1, 097.9, 093.9,
    Syphilis, congenital 090, 090.7, 090.49, 090.40, 091.3, 097.3, 097.9, 759.82, 759.82, 379.32, 520.2, 095.5, 095.8, 760.2, 520.4, 738.0, 447.1, 363.13, 583.81
    Tetanus 037, 771.3
    Toxic shock syndrome 040.82, 040,
    Trichinosis 124, 323.41, 323.9
    Tuberculosis 017.2, 011, 012.8, 015.9,
    Tularemia 021
    Typhoid fever 002.0, 002
    Varicella 052.9, 053, V01.79
    Yellow fever 060.9, 060.1

    Measure Option 3 – Specialized Registry Reporting: The EP is in active engagement to submit data to a specialized registry.

    Exclusions: Any EP meeting at least one of the following criteria may be excluded from the specialized registry reporting measure if the EP:

  • Does not diagnose or treat any disease or condition associated with, or collect relevant data that is collected by, a specialized registry in their jurisdiction during the EHR reporting period;
  • Operates in a jurisdiction for which no specialized registry is capable of accepting electronic registry transactions in the specific standards required to meet the CEHRT definition at the start of the EHR reporting period; or
  • Operates in a jurisdiction where no specialized registry for which the EP is eligible has declared readiness to receive electronic registry transactions at the beginning of the EHR reporting period.
  • Alternate Exclusions and/or Specifications:

    Alternate Specification: An EP scheduled to be in Stage 1 in 2015 may meet 1 measure.

    How do I achieve this measure?

    In order to qualify for this measure, the provider must enroll with a specialized registry and submit information to the registry on an ongoing basis.

    STI has partnered with the Genesis Registry (provided by CECity).  More information can be found at info.cecity.com.  CCDAs will be generated for all patients within a specified date range for the provider.  The files will be sent to the STI Health Portal which will then pass them along to CECity via an automatic SFTP process.

    To enroll with CECity:

    1. Go to sticomputer.com and click “Enrollments”
    1. Click “Meaningful Use” and then select "CECity Enrollment", fill out the form and click “Submit”

    It could take up to 3 weeks to complete the process.  After enrollment is complete, and STI has configured your Health Portal for this new service, your provider will receive a To Do List notification similar to this:

    CECityEnrollmentConfirmation

    This To Do List notification should be printed for your records, by clicking “Print”, in case it is needed for attestation and/or an audit.

    NOTE:  The functionality to perform an export of specialized registry data became available in version ChartMaker® Medical Suite 2015.

    Clinical Quality Measures (2015 – 2017):

    Please see our page on the Clinical Quality Measures for more detail on what needs to be achieved in order to meet Meaningful Use.

    Two areas that did not see any change are for Clinical Quality Measures (CQM) and the attestation process.  CQM reporting for EPs will remain as previously finalized and providers must attest by February 29, 2016.  The attestation process cannot happen prior to January 4, 2016, even though you may choose a 90-day period that may end before the close of 2015.

    In regards to payment adjustments, new participants to the Meaningful Use program in 2015 who successfully satisfy all program requirements will avoid the payment adjustments in CYs 2016 and 2017, as long as the EP has attested by February 29, 2016.  For returning participants who successfully demonstrate Meaningful Use will avoid the payment adjustment in CY 2017, as long as they have successfully attested by February 29, 2016.

     

    Changes to Specific Objectives/Measures:

  • Patient Electronic Access, Measure 2: For 2015, instead of the 5 percent threshold, this measure requires that at least 1 patient seen by the EP during the EHR reporting period (or patient authorized representative) views, downloads, or transmits to a third party his or her health information during the EHR reporting period.
  • Secure Electronic Messaging: The 5 percent threshold has been removed and the requirement is now a Yes/No option as to whether the capability for patients to send and receive a secure electronic message with the EP was fully enabled during the EHR reporting period.
  • Public Health Reporting: The public health reporting objectives have been consolidated into one objective with three measure options for EPs. The EP must attest to 2 of the 3 measures in order to receive credit. (Note:  An EP scheduled to be in Stage 1 in 2015 may meet only 1 measure.)
  •  

     

    There are also alternate exclusions and specifications within individual objectives for providers who were previously scheduled to be in Stage 1 of Meaningful Use. These include:

  • Allowing providers who were previously scheduled to be in a Stage 1 for 2015 to use a lower threshold for certain measures.
  • Allowing providers to exclude for Stage 2 measures in 2015 for which there is no Stage 1 equivalent.
  •  

     

    Changes in 2016 and Beyond:

  • In 2016 and 2017, new participants to the program will be allowed to do a 90-day reporting period.
  • Stage 3 Meaningful Use is optional in 2017 and not effective for all providers until 2018.
  • Since Stage 3 is optional in 2017, all Providers who choose to begin Stage 3 in 2017 will have a 90-day reporting period.
  • All providers will be required to comply with Stage 3 requirements beginning in 2018 using EHR technology certified to the 2015 Edition.
  •  

     

    Stage 3 Objectives (2017 [Optional] / 2018):

    1. Protect Patient Health Information
    2. Electronic Prescribing (eRx)
    3. Clinical Decision Support
    4. CPOE
    5. Patient Electronic Access to Health Information
    6. Coordination of Care through Patient Engagement
    7. Health Information Exchange
    8. Public Health Reporting

    Check the types of e-mail notifications you want sent to this address: