Advancing Care Information (ACI) Objectives

Measures for 2017

 
Base Score Measures (50 Points)

  • Protect Patient Health Information
  • Electronic Prescribing
  • Provide Patient Access
  • Health Information Exchange
  • You must complete all 4 base score measures to receive 50 points. Completing some of the measures will NOT earn you partial credit. Failure to complete a security risk assessment will yield 0 points for the ACI category. You only need to have 1 in the numerator for Electronic Prescribing, Provide Patient Access, and Health Information Exchange to receive credit as based score measures.

    Performance Score Measures (Earn up to 90 Points):

  • Immunization Registry Reporting = 0 or 10%
  • Health Information Exchange = 20%
  • Medication Reconciliation = 10%
  • Patient-Specific Education = 10%
  • Provide Patient Access = 20%
  • Secure Messaging = 10%
  • View, Download and Transmit = 10%
  • You must complete all base score measures in order to earn any additional credit, up to 90 points, for the performance scored measures. Select the measures that best suit your practice.

    View the objectives/measures specification facts, including how to achieve within ChartMaker Medical Suite, below:

    Electronic Prescribing

    Objective: Electronic Prescribing

    Measure: At least one permissible prescription written by the MIPS eligible clinician is queried for a drug formulary and transmitted electronically using CEHRT.

     

    Reporting Requirements:   

    • NUMERATOR: The number of prescriptions in the denominator generated, queried for a drug formulary, and transmitted electronically using CEHRT. 
    • DENOMINATOR: Number of prescriptions written for drugs requiring a prescription in order to be dispensed other than controlled substances during the performance period; or number of prescriptions written for drugs requiring a prescription in order to be dispensed during the performance period. 
    • Exclusion: Any MIPS eligible clinician who writes fewer than 100 permissible prescriptions during the 2017 performance period.

     

    Scoring Information: 

    Required for Base Score (50%): Yes

    Percentage of Performance Score (up to 90%): 0%

    No bonus points available

     

    How do I achieve this measure?

    The clinician needs to enter a new or renewed prescription in the patient’s EMR and send it electronically during their performance period. The denominator is achieved when the prescription is entered in a patient’s chart. The numerator is achieved when the prescription is sent electronically. ChartMaker’s Drug Formulary function is automatically turn on. You only need ONE in the numerator to receive credit for this base score measure.

    NOTE: If a clinician does not write ANY prescriptions during their performance period they can report that they meet the exclusion. As long as the other 3 base score measures are completed, the clinician will receive 50 points with the eRx exclusion. 

     

    Enter a new prescription in the patient’s EMR and send it electronically:

    1. Open a chart note, click on the “Medication” button 

          2. Click on “Add Medication” to prescribe a new medication

          3. Enter the medication in the search window; click “Search”; Highlight the medication in the results window; click “Select”

    4. Enter all appropriate fields. If the clinician’s preference is set to “E-Prescribe” then the transmission method will default to “E-Prescribe”. If not, click drop-down and select “E-Prescribe”.  Click “Next”

     

    5. Select the Patient’s pharmacy, if they have more than one on file.  Click “Confirm”

     

     

    Enter a renewed prescription in the patient’s EMR and send it electronically:

    1. Open a chart note, click on the “Medication” button

    2. Click on “Renew Medication”. Select medication from drop-down list.

    3. All appropriate fields will populate as it was previously prescribe. If the clinician’s preference is set to “E-Prescribe” then the transmission method will default to “E-Prescribe”. If not, click dropdown and select “E-Prescribe”. > Click “Next”

    4. Select the Patient’s pharmacy, if they have more than one on file. > Click “Confirm”

     

    Set Clinician’s preference to “E-Prescribe” (Optional)

    1. The clinician will have to log into Clinical.
    2. Click on “Edit” > “Preference”
    3. Click on the “Prescription” tab in the Preferences dialog box
    4. Select “E-Prescribe” as the user’s “Default Destination”
    5. Click on the “Set” button > Click “OK”

     

    Health Information Exchange

    Objective: Health Information Exchange

    The MIPS eligible clinician that transitions or refers their patient to another setting of care or health care clinician (1) uses CEHRT to create a summary of care record; and (2) electronically transmits such summary to a receiving health care clinician for at least one transition of care or referral.

     

    Reporting Requirements

    • NUMERATOR: The number of transitions of care and referrals in the denominator where a summary of care record was created using CEHRT and exchanged electronically. 
    • DENOMINATOR: Number of transitions of care and referrals during the performance period for which the EP was the transferring or referring health care clinician. 

     

    Scoring Information

    • Required for Base Score (50%): Yes
    • Percentage of Performance Score (up to 90%): Up to 20%
    • No bonus points available.  

     

    How do I achieve this measure?

    The clinician must electronically send a “Transition of Care” (or “CDA”) document to the provider they have referred their patient to. The denominator count is captured when a TOC is generated or the clinician documents who they are referring their patient to through the use of the “Referral” button. You receive credit towards the numerator once the TOC is sent electronically to that provider. The two requirements, create a TOC and send it electronically, can both be achieved through Direct Messaging.

     

    To generate and send a Transition of Care Summary through Direct Messaging

    1. Open the patient’s clinical chart
    2. Click on: To-Do>Direct Messaging>Send New Message

    1. Click on the “To” button

     

    1. Enter the last name of the provider you are sending the document to. Enter city, state and addition fields to narrow the search results.
    2. Click “Search”
    3. Click on the provider in the search result window to highlight and Click “To”
    4. Click “OK”

     

    8. Click on the drop-down arrow to select the provider who is sending the document.

    9. You must enter a comment in the subject in “Subject” field

    10. Click “Generate and Attach CDA”

     

    1. Select the provider under the “Provider Selection” dropdown.
    2. Click “Save”

     

    1. Check items in the “Document Exclusion” window that you do not want to appear> Click “OK”

    1. Click “OK” in the Export Box

     

    1. Click “Send”

     

     

    To document the transition of care through the “Referral Button” (Optional):

    NOTE: You may use the “Referral” button in an office visit note to document who you are referring your patient but this will only get you in the denominator. You must generate and send the Transition of Care Summary through Direct Messaging to receive credit in the numerator.

     

    1. In an office visit note, click the “Referral” button
    2. Click “New”

    1. Click “Choose Provider”. Search and highlight the provider name. Click “OK”
    2. Select at least one diagnosis from the patient’s Problem List
    3. Enter Comments, if applicable
    4. Click “OK
    5. Click “OK” to close the “Referral” dialog box

    Immunization Registry Reporting

    Objective: Public Health Reporting

    Measure: Immunization Registry Reporting 

    The MIPS eligible clinician is in active engagement with a public health agency to submit immunization data.

     

    Reporting Requirements

    To meet this measure, MIPS eligible clinicians must attest YES to being in active engagement with a public health agency to submit immunization data.

     

    Scoring Information

  • Required for Base Score: No
  • Percentage of Performance Score: 0 or 10%
  • Eligible for Bonus Score: No
  •  

    How to achieve this measure?

    Any EC who administers any immunizations must be registered with a Public Health Registry to electronically submit immunization information on their pediatric and/or adult patients. The EC will be in compliance with this measure if they register no later than 60 days from the first day of your reporting period.

     

    To enroll with your state’s Public Health Registry for immunization reporting:

  • Contact STI at 610-650-9700 to begin the enrollment process
  • The is no additional cost for this service
  • STI will configure your system and provide the necessary training
  •  

    To document immunizations given in ChartMaker Clinical

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

    1. Enter the appropriate information
    2. 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
    2. 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
    2. 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” or go to File > Save As

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

     

    NOTE: 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.

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

    c) Click the lookup button  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”

     

    NOTE: 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.

     

    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.

    For Bi-Directional Immunization instructions: See our Quick Reference Card

    Medication Reconciliation

    Objective: Medication Reconciliation

    Measure: Medication Reconciliation

    The MIPS eligible clinician performs medication reconciliation for at least one transition of care in which the patient is transitioned into the care of the MIPS eligible clinician.

     

    Reporting Requirements 

    • NUMERATOR: The number of transitions of care or referrals in the denominator where the following three clinical information reconciliations were performed: medication list, medication allergy list, and current problem list. 
    • DENOMINATOR: Number of transitions of care or referrals during the performance period for which the MIPS eligible clinician was the recipient of the transition or referral or has never before encountered the patient.

     

    Scoring Information  

    • Required for the Base Score: No
    • Percentage of Performance Score: Up to 10%
    • Eligible for bonus score: No

     

    How do I achieve this measure?

    The EC documents their clinical reconciliation through the “Medication Reconciliation” button, along with selecting a valid CPT code for that office visit on a new patient or on a patient that was referred to them by another provider. The denominator is calculated by the CPT code and when “Yes” is selected for the method of referral or new patient within the “Medication Reconciliation” button. The numerator count is captured when “Yes” is selected that a reconciliation was performed.

     

    To document a medication reconciliation was performed:

    1. In a chart note, click on the “Medication Reconciliation” button

    2. 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”

    3. In the same note, enter an appropriate CPT code for the office visit.

    NOTE: An alternative method is through the use of a procedure checklist with valid codes in lieu of the “Medication Reconciliation” button. STI does recommend that you update your template(s) with the “Medication Reconciliation” button.

     

     

     

    Patient Specific Education

    Objective: Patient Electronic Access

    Measure: Patient Specific Education 

    The MIPS eligible clinician must use clinically relevant information from CEHRT to identify patient-specific educational resources and provide access to those materials to at least one unique patient seen by the MIPS eligible clinician.

     

    Reporting Requirements

    • NUMERATOR: The number of patients in the denominator who were provided access to patient-specific educational resources using clinically relevant information identified from CEHRT during the performance period. 
    • DENOMINATOR: The number of unique patients seen by the MIPS eligible clinician during the performance period. 

    Scoring Information

    • Required for the Base Score: No
    • Percentage of Performance Score: Up to 10%
    • Eligible for bonus score: No

    How do I achieve this measure?

    The EC must provide their patient with printed educational material that is clinically relevant. This action is documented in an office visit note through the “Educational Materials” button which will count towards the numerator count.  The denominator count is achieved by selecting a valid CPT code for the office visit within the same note.

    In a patient note, you will have the option to select from your pre-defined list or from information found on MedlinePlus.

     

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

    1. In an office visit note, click the “Education Materials” button

    1. Select the checkbox for the item(s) from your pre-defined list

    OR

    Click on the “MedlinePlus” icon:

    Search by selecting one of the patient’s Diagnoses, Medications or Labs that appear in the top

    OR

    Type the subject you are looking for into the search box and clicking “Go”

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

     

    Medline Plus Search Window

    1. Click “OK” to close the Education Materials dialog
    2. Enter an appropriate CPT code and sign your note

     

    To add educational material options to the database:

    1. Go to Edit > System Tables > Education Materials

    1. Click “Add”
    2. Type the description of the educational resource.

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

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

    Security Risk Analysis

    Objective: Protect Patient Health Information

    Measure: Security Risk Analysis 

    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 data created or maintained by CEHRT in accordance with requirements in 45 CFR164.312(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 MIPS eligible clinician’s risk management process.

    Reporting Requirements

    • To meet this measure, eligible clinicians must attest YES to conducting or reviewing a security risk analysis and implementing security updates as necessary and correcting identified security deficiencies.

    Scoring Information

  • Required for Base Score (50%): Yes
  • Percentage of Performance Score (up to 90%): 0
  • Eligible for Bonus Score: No
  • 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.

    Tools to complete the assessment:

    HIT Security Risk Assessment Tool (Downloadable Tool to Complete Assessment -** MUST BE COMPLETED DURING YOUR REPORTING PERIOD DATE RANGE**)

    Provide Patient Access

    Objective: Patient Electronic Access 

    Measure: Provide Patient Access 

    At least one patient seen by the MIPS eligible clinician during the performance period is provided timely access to view  online, download, and transmit to a third party their health information subject to the MIPS eligible clinician’s discretion to withhold certain information.

     

    Reporting Requirements

    • NUMERATOR: The number of patients in the denominator (or patient authorized representative) who are provided timely access to health information to view online, download, and transmit to a third party. 
    • DENOMINATOR: The number of unique patients seen by the MIPS eligible clinician during the performance period. 

     

    Scoring Information

    • Required for the Base Score: Yes
    • Percentage of Performance Score: Up to 20%
    • Eligible for bonus score: No

     

    How do I achieve this measure?

    You must be enrolled with ChartMaker® PatientPortal service.

    The EC must complete and signed an office note with a valid CPT code. Authorization must be sent, within 4 business days of the visit, to either the patient or patient’s authorized representative for them to register for the Patient Portal.  

     

    To enroll to receive ChartMaker® PatientPortal service:

    Go To: www.sticomputer.com>Enrollments>Patient Portal>Patient portal Enrollment

     

    To enroll/authorize the patient for the Patient Portal (with or without an email):

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

     

    1. Click the first “Authorize” option if the patient provides you with their email address

                    Or Click the second “Authorize” option if the patient does not have an email address.

    NOTE: If the patient does not have an email address - Give printed instructions to the patient and encourage them to complete registration at a later time

    1. Click “OK”

    1. Click “Yes” to confirm you want to authorize the patient to use the Patient Portal.

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

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

     

    Steps taken by the patient to complete registration and login to the Patient Portal

    NOTE: This does not need to be complete by the patient for the EC to receive credit for this measure.

    1. The patient will receive an email regarding their Patient Portal registration
    2. Click the link to access the Patient Portal to complete registration

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

    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
    2. Click “Register”

     

     

     

    Secure Electronic Messaging

    Objective: Secure Electronic Messaging

    Measure: Secure Electronic Messaging 

    For at least one patient seen by the MIPS eligible clinician during the performance period, a secure message was sent using the electronic messaging function of CEHRT to the patient (or the patient authorized representative), or in response to a secure message sent by the patient (or the patient authorized representative), during the performance period.

     

    Reporting Requirements   

    • DENOMINATOR: Number of unique patients seen by the MIPS eligible clinician during the performance period.
    • NUMERATOR: The number of patients in the denominator for whom a secure electronic message is sent to the patient (or patient-authorized representative), or in response to a secure message sent by the patient (or patient-authorized representative), during the performance period. 

     

    Scoring Information

    • Required for Base Score (50%): No
    • Percentage of Performance Score (up to 90%): Up to 10%
    • No bonus points available

     

    How do I achieve this measure?

    The EC sends a new or replied secure message to a patient through ChartMaker® PatientPortal. The secure message and an office visit must occur within the clinician’s reporting period. All message types will count toward the calculation of this measure.

     

    To send the patient a new secure message:

    1. Open patient’s chart
    2. Click on “To-Do”> “New Patient Portal Message”

    1. Enter subject and your message

    *Recommended that you save as a chart note

    1. Click “Send

    Reply to a message sent from the patient:

    NOTE: The clinician MUST REPLY to the patient’s message to get credit for this measure.

     

    1. Double click the patient portal message on your “To-Do” List
    2. Click “Reply”

     

    1. Type in your reply message in top window

    *Recommended that you save as a chart note

    1. Click “Send”

    *NOTE: Saving as a chart note you can change the heading of the note if desired. Click “OK”

    View, Download or Transmit (VDT)

    Objective: Patient Electronic Access

    Measure:  View, Download or Transmit 

    At least one patient seen by the MIPS eligible clinician during the performance period (or patient-authorized representative) views, downloads or transmits their health information to a third party during the performance period.

     

    Reporting Requirements

    • NUMERATOR: The number of unique patients (or their authorized representatives) in the denominator who have viewed online, downloaded, or transmitted to a third party the patient’s health information during the performance period.  
    • DENOMINATOR: Number of unique patients seen by the MIPS eligible clinician during the performance period. 

     

    Scoring Information

    • Required for the Base Score: No
    • Percentage of Performance Score: Up to 10%
    • Eligible for bonus score: No 

     

    How do I achieve this measure?

    EC will need to be enrolled to receive ChartMaker® PatientPortal service.

     

    The EC will need to enter a valid CPT code in their office visit note and submit health information for their patient through the ChartMaker® PatientPortal.  The EC will need to “Provide Patient Access” first through Practice Manager and 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 Patient Portal account and either view Clinical Summaries or Lab Reports, download or transmit their information to a third party.

     

    To enroll to receive ChartMaker® PatientPortal service:

    Go To: www.sticomputer.com>Enrollments>Patient Portal>Patient portal Enrollment

     

    Authorize patient to access their Patient Portal

    See instructions under “Provide Patient Access” measure

     

    Patient completes registration for Patient Portal

    1. The patient will receive an email regarding their Patient Portal registration
    2. Click the link to access the Patient Portal to complete registration

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

    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
    2. Click “Register”

     

    1. Login using the credentials designated in Step 3

     

    1. Complete one or all of the following actions:
    2. a) View Clinical Summaries by clicking “Clinical Summaries”
    3. b) View Lab results by clicking “Lab Results”
    4. c) Download information by either going to “Clinical Summaries” or “Lab Reports” or then clicking “Download”
    5. d) Transmitting a Clinical Summary or Lab Report by going to “Messages” and then clicking “Send a Direct message”

     

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