Meaningful Use Program Requirements for 2018 - Modified Stage 2

Objectives and Measures

Providers that choose to attest to Modified Stage 2 objectives and measures would continue to meet the requirements (including the thresholds) finalized in the 2017 OPPS/ASC final rule.

For Modified Stage 2 in 2018, Providers may attest to objectives and measures using EHR technology certified to the 2014 Edition, 2015 Edition, or a combination of the two.

Providers that choose to attest to Stage 3 objectives and measures would continue to meet the requirements (including the thresholds) finalized in the 2017 Hospital Outpatient Prospective Payment System (OPPS)/Ambulatory Surgical Center (ASC) final rule.

Providers attesting to Stage 3 objectives and measures, have the option to use 2015 Edition CEHRT or a combination of the 2014 and 2015 CEHRT editions, as long as their EHR technology can support the functionalities, objectives, and measures for Stage 3.

EHR Reporting Period in 2018

For all returning participants and all new participants, the EHR reporting period is a minimum of any continuous 90-days between January 1 and December 31, 2018

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

Attestation Requirements: YES/NO: Eligible professionals (EPs) must attest YES to conducting or reviewing a security risk analysis and implementing security updates as necessary and correcting identified security deficiencies to meet this measure.

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

Objective: Use clinical decision support to improve performance on high-priority health conditions.

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:

None

Definition of Terms

Clinical Decision Support – HIT functionality that builds upon the foundation of an EHR to provide persons involved in care processes with general and person-specific information, intelligently filtered and organized, at appropriate times, to enhance health and health care.

Attestation Requirements YES/NO/EXCLUSION

MEASURE 1: EPs must attest YES to implementing 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.

MEASURE 2: EPs must attest YES to enabling and implementing 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.

Additional Information

If there are limited CQMs applicable to an EP's scope of practice, the EP should implement CDS interventions that he or she believes will drive improvements in the delivery of care for the high priority health conditions relevant to their specialty and patient population.

Drug-drug and drug-allergy interaction alerts are separate from the 5 clinical decision support interventions and do not count toward the 5 required for this first measure.

How do I achieve this measure?

In ChartMaker Clinical: In order to qualify for this measure, the provider must implement 5 clinical decision support rules relevant to their specialty.

In order to have the ability to create a decision support rule in ChartMaker Clinical, a user must have the privilege turned on.

To enable the privilege to create decision support rules:

Go to Edit > System Tables > Users

Highlight the user

Click “Properties”

Select “Decision Support” and change the Level to “All”

NOTE: This privilege only controls the ability to create, modify and delete rules. It does not control a user’s ability to see a Decision Support alert.

Click “OK”

ChartMaker Clinical also has the ability to enable the Decision Support pop-up alert per user. Your practice may decide that only the providers should receive the alerts (and not the office staff). This user preference is turned off by default.

To enable the Decision Support alerts:

Log into ChartMaker Clinical as the user you want to configure

Go to Edit > Preferences

Click the “Decision Support” tab

Check the box for “Display Decision Support Alerts”

Click “Set”

6. Click “OK”

To create a decision support rule:

Go to Edit > System Tables > DSS Rule Builder

Click the “Data Points” tab

NOTE: All Data Points labeled with an asterisk (*) are system-defined Data Points and cannot be modified. They may be accessed by selecting “Modify” and then clicking the dropdown menu. If you would like to use an existing Data Point, select it from the Modify dropdown and then skip to Step 6 (if applicable).

To create a new office-defined data point, select “New”
Enter a Data Point Name and Description

Select the “Data Point Type”

NOTE: The options are:

a) Current Dx – allows Data Points to be mapped to specific diagnosis codes (ICD-9)

b) Current Dx ICD10 – allows Data Points to be mapped to specific diagnosis codes (ICD-10)

c) Current Result – allows Data Points to be mapped to specific procedures in order to track results

d) Current Rx – allows Data Points to be mapped to specific medications

e) Current Rx Group – allows Data Points to be mapped to medication groups (Example: Cephalosporins)

f) Procedure Performed – allows Data Points to be mapped to specific procedures

Search for the “Available” Diagnosis/Procedure/Medication/Medication Group (whichever is applicable)

Select the applicable items

TIP: Using the Shift or Ctrl key may be used to select multiple items.

Click “Add >>” to populate the Linked Procedures section

Click “Save”

NOTE: You cannot delete a Data Point once it is created. Repeat these steps for any additional Data Points that may need to be created.

For more information on setting up Clinical Decision Support rules, please see our instructional guide.

3. Computerized Provider Order Entry (CPOE)

Objective: Use computerized provider order entry for medication, laboratory, and radiology orders directly entered by any licensed healthcare professional who can enter orders into the medical record per state, local, and professional guidelines.

Measures: 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.

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.

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.

Exclusions:

Measure 1: Any EP who writes fewer than 100 medication orders during the EHR reporting period. Measure 2: Any EP who writes fewer than 100 laboratory orders during the EHR reporting period. Measure 3: Any EP who writes fewer than 100 radiology orders during the EHR reporting period.

Definition of Terms

Computerized Provider Order Entry (CPOE) – A provider's use of computer assistance to directly enter medical orders (for example, medications, consultations with other providers, laboratory services, imaging studies, and other auxiliary services) from a computer or mobile device.

Laboratory Order – An order for any service provided by a laboratory that could not be provided by a non-laboratory.

Laboratory – A facility for the biological, microbiological, serological, chemical, immunohematological, hematological, biophysical, cytological, pathological, or other examination of from the human body for the purpose of providing information for the diagnosis, prevention, or treatment of any disease or impairment of, or the assessment of the health of, human beings. These examinations also include procedures to determine, measure, or otherwise describe the presence or absence of various substances or organisms in the body. Facilities only collecting or preparing specimens (or both) or only serving as a mailing service and not performing testing are not considered laboratories.

Radiology Order – An order for any imaging service that uses electronic product radiation. The EP can include orders for other types of imaging services that do not rely on electronic product radiation in this definition as long as the policy is consistent across all patients and for the entire EHR reporting period.

Attestation Requirements: DENOMINATOR/NUMERATOR/THRESHOLD/EXCLUSION

MEASURE 1:

DENOMINATOR: Number of medication orders created by the EP during the EHR reporting period. NUMERATOR: The number of orders in the denominator recorded using CPOE.

THRESHOLD: The resulting percentage must be more than 60 percent in order for an EP to meet this measure.

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

MEASURE 2:

DENOMINATOR: Number of laboratory orders created by the EP during the EHR reporting period. NUMERATOR: The number of orders in the denominator recorded using CPOE.

THRESHOLD: The resulting percentage must be more than 30 percent in order for an EP to meet this measure.

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

MEASURE 3:

DENOMINATOR: Number of radiology orders created by the EP during the EHR reporting period. NUMERATOR: The number of orders in the denominator recorded using CPOE.

THRESHOLD: The resulting percentage must be more than 30 percent in order for an EP to meet this measure.

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

How do I achieve this measure?

In ChartMaker Clinical: 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:

In Clinical, go to Edit > System Tables > Conditions > Procedures
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).

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

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

Click “Save”
Repeat steps 2 – 5 for each additional procedure
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

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.

Click “OK

To enter medications for a patient:

In an office visit note, click the “Medication” button
Choose “Add Medication”
Search for and select the medication
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.

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.

Click “Confirm” or “Confirm and Send” (depending on the Transmission selected)

ADDITIONAL INFORMATION:

This measure will always be 100% unless using the “Initial order created outside of Clinical” field in the Order procedure dialog. The query for the numerator is identical to the query for the denominator.

This measure is not encounter based. The calculation includes all orders created in Clinical and is not based on the number of patients seen.

The only data used to determine the denominator is data from the ChartMaker Clinical Module. If a patient encounter was not entered into the ChartMaker Clinical Module, that encounter is not included in the denominator for the statistical calculations on the Meaningful Use Dashboard. Please add these additional patients to the denominator and recalculate the percentage for Attestation purposes.

4. Electronic Prescribing (eRx)

Objective: Generate and transmit permissible prescriptions electronically (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.

Definition of Terms

Prescription – The authorization by an EP to a pharmacist to dispense a drug that the pharmacist would not dispense to the patient without such authorization.

Permissible Prescriptions – “Permissible prescriptions” may include or not include controlled substances based on provider selection and where allowable by state and local law.

Attestation Requirements DENOMINATOR/NUMERATOR/THRESHOLD/EXCLUSIONS

DENOMINATOR: Number of permissible prescriptions written during the EHR reporting period for drugs requiring a prescription in order to be dispensed.

NUMERATOR: The number of prescriptions in the denominator generated, queried for a drug formulary, and transmitted electronically using CEHRT.

THRESHOLD: The resulting percentage must be more than 50 percent in order for an EP to meet this measure.

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.

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.

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

Open a chart note, click on the “Medication” button
Click on “Add Medication” to prescribe a new medication
Enter the medication in the search window>click “Search”>Highlight the medication in the results window>click “Select”

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 dropdown and select “E-Prescribe”. > Click “Next”

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:

Open a chart note, click on the “Medication” button
Click on “Renew Medication”. Select medication from dropdown list.

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

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

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

5. Health Information Exchange

Objective: The EP who transitions their patient to another setting of care or provider of care or refers their patient to another provider of care provides a summary care record for each transition of care or referral.

Measures: 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.

Definition of Terms

Transition of Care – The movement of a patient from one setting of care (hospital, ambulatory primary care practice, ambulatory, specialty care practice, long-term care, home health, rehabilitation facility) to another. At a minimum this includes all transitions of care and referrals that are ordered by the EP.

Summary of Care Record – All summary of care documents used to meet this objective must include the following information if the provider knows it: Patient name; Referring or transitioning provider's name and office contact information (EP only); Procedures; Encounter diagnosis; Immunizations; Laboratory test results; Vital signs (height, weight, blood pressure, BMI); Smoking status; Functional status, including activities of daily living, cognitive and disability status; Demographic information (preferred language, sex, race, ethnicity, date of birth); Care plan field, including goals and instructions; Care team including the primary care provider of record and any additional known care team members beyond the referring or transitioning provider and the receiving provider; Reason for referral (EP only) Health; Current problem list (Providers may also include historical problems at their discretion)*; Current medication list*; Current medication allergy list*

*Note: An EP must verify that the fields for current problem list, current medication list, and current medication allergy list are not blank and include the most recent information known by the EP as of the time of generating the summary of care document or include a notation of no current problem, medication and/or medication allergies..

Current problem lists – At a minimum a list of current and active diagnoses.

Active/current medication list – A list of medications that a given patient is currently taking.

Active/current medication allergy list – A list of medications to which a given patient has known allergies.

Allergy – An exaggerated immune response or reaction to substances that are generally not harmful.

Care Plan – The structure used to define the management actions for the various conditions, problems, or issues. A care plan must include at a minimum the following components: problem (the focus of the care plan), goal (the target outcome) and any instructions that the provider has given to the patient. A goal is a defined target or measure to be achieved in the process of patient care (an expected outcome).

Attestation Requirements: DENOMINATOR/NUMERATOR/THRESHOLD/EXCLUSION

DENOMINATOR: Number of transitions of care and referrals during the EHR reporting period for which the EP was the transferring or referring provider.

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.

THRESHOLD: The percentage must be more than 10 percent in order for an EP to meet this measure. 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.

How do I achieve this measure?

The clinician must electronically send a “Transition of Care” document to the provider they have referred their patient to. The denominator count is capture 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

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

Click on the “To” button

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

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

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

Click “OK” in the Export Box

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.

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

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

6. Patient Specific Education

Objective: Use clinically relevant information from CEHRT to identify patient-specific education resources and provide those resources to the patient.

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.

Definition of Terms

Patient-Specific Education Resources Identified by CEHRT – Resources or a topic area of resources identified through logic built into certified EHR technology which evaluates information about the patient and suggests education resources that would be of value to the patient.

Unique Patient – If a patient is seen by an EP more than once during the EHR reporting period, then for purposes of measurement, that patient is only counted once in the denominator for the measure. All the measures relying on the term ‘‘unique patient’’ relate to what is contained in the patient’s medical record. Not all of this information will need to be updated or even be needed by the provider at every patient encounter. This is especially true for patients whose encounter frequency is such that they would see the same provider multiple times in the same EHR reporting period.

Attestation Requirements: DENOMINATOR/NUMERATOR/THRESHOLD/EXCLUSION

DENOMINATOR: Number of unique patients with office visits seen by the EP during the EHR reporting period.

NUMERATOR: Number of patients in the denominator who were provided patient-specific education resources identified by the CEHRT.

THRESHOLD: The resulting percentage must be more than 10 percent in order for an EP to meet this measure.

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

How do I achieve this measure?

The EP must provide their patient with printed educational material that is clinically relevant. This action is documented in an office visit note through the “Educational Material” 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 add educational material options to the database:

Go to Edit > System Tables > Education Materials

Click “Add”

Type the description of the educational resource.

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

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

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

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

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

Click on the “MedlinePlus” icon:

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

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

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

Medline Plus Search Window

Click “OK” to close the Education Materials dialog

Enter an appropriate CPT code and sign your note

7. Medication Reconciliation

Objective: The EP who receives a patient from another setting of care or provider of care or believes an encounter is relevant performs 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.

Definition of Terms

Medication Reconciliation – The process of identifying the most accurate list of all medications that the patient is taking, including name, dosage, frequency, and route, by comparing the medical record to an external list of medications obtained from a patient, hospital or other provider.

Transition of Care - The movement of a patient from one setting of care (for example, a hospital, ambulatory primary care practice, ambulatory specialty care practice, long-term care, home health, rehabilitation facility) to another.

Referral - Cases where one provider refers a patient to another, but the referring provider maintains his or her care of the patient as well.

Denominator for Transitions of Care and Referrals - The denominator includes transitions of care and referrals (as finalized in the Stage 2 rule where the definition of transitions of care includes: "When the EP is the recipient of the transition or referral, first encounters with a new patient and encounters with existing patients where a summary of care record (of any type) is provided to the receiving EP"(77 FR 53984).

Attestation Requirements: DENOMINATOR/NUMERATOR/THRESHOLD/EXCLUSION

DENOMINATOR: Number of transitions of care during the EHR reporting period for which the EP was the receiving party of the transition.

NUMERATOR: The number of transitions of care in the denominator where medication reconciliation was performed.

THRESHOLD: The resulting percentage must be more than 50 percent in order for an EP to meet this measure.

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

How do I achieve this measure?

The EP 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:

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

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”

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.

8. Patient Electronic Access (VDT)

Objective: Provide patients the ability to view online, download, and transmit their health information within 4 business days of the information being available to the EP.

Measures: EPs must satisfy both measures in order to meet this objective:

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 2017, more than 5 percent of unique patients seen by the EP during the EHR reporting period (or his or her authorized representatives) view, download or transmit to a third party their health information during the EHR reporting period.

Exclusions:

Measure 1: Any EP who neither orders nor creates any of the information listed for inclusion as part of the measures except for “Patient Name” and “Provider’s name and office contact information.”

Measure 2: Any EP who: Neither orders nor creates any of the information listed for inclusion as part of the measures except for “Patient Name” and “Provider’s name and office contact information;” 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.

Definition of Terms

Provide Access – When a patient possesses all of the necessary information needed to view, download, or transmit their information. This could include providing patients with instructions on how to access their health information, the website address they must visit for online access, a unique and registered username or password, instructions on how to create a login, or any other instructions, tools, or materials that patients need in order to view, download, or transmit their information.

View – The patient (or authorized representative) accessing their health information online.

Download – The movement of information from online to physical electronic media. Transmission – This may be any means of electronic transmission according to any transport standard(s) (SMTP, FTP, REST, SOAP, etc.). However, the relocation of physical electronic media (for example, USB, CD) does not qualify as transmission.

Business Days – Business days are defined as Monday through Friday excluding federal or state holidays on which the EP or their respective administrative staffs are unavailable.

Diagnostic Test Results – All data needed to diagnose and treat disease. Examples include, but are not limited to, blood tests, microbiology, urinalysis, pathology tests, radiology, cardiac imaging, nuclear medicine tests, and pulmonary function tests.

Attestation Requirements DENOMINATOR/NUMERATOR/THRESHOLD/EXCLUSION

MEASURE 1:

DENOMINATOR: Number of unique patients seen by the EP during the EHR reporting period. NUMERATOR: The number of patients in the denominator who have access to view online, download and transmit their health information within 4 business days after the information is available to the EP. THRESHOLD: The resulting percentage must be more than 50 percent in order for an EP to meet this measure.

EXCLUSION: Any EP who neither orders nor creates any of the information listed for inclusion as part of the measures except for “Patient Name” and “Provider’s name and office contact information.”

MEASURE 2:

DENOMINATOR: Number of unique patients seen by the EP during the EHR reporting period. NUMERATOR: The number of patients in the denominator who view, download, or transmit to a third party their health information.

THRESHOLD: The resulting percentage must be greater than 5 percent.

EXCLUSIONS: Any EP who— (a) Neither orders nor creates any of the information listed for inclusion as part of the measures except for “Patient Name” and “Provider’s name and office contact information;” or (b) 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.

How do I achieve this measure?

You must be enrolled with ChartMaker® PatientPortal service.

The EP 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):

In Practice Manager, open the patient’s account

On the Patient tab, click “Patient Portal”

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

Click “OK”

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.

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 EP to receive credit for this measure.

The patient will receive an email regarding their Patient Portal registration

Click the link to access the Patient Portal to complete registration

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.

Accept the Terms of Use along with typing the security characters that are displayed in the picture

Click “Register”

9. Secure Messaging

Secure Electronic Messaging

Objective: Use secure electronic messaging to communicate with patients on relevant health information.

Measures: For an EHR reporting period in 2017, for more than 5 percent of unique patients seen by the EP during the EHR reporting 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 EHR reporting period.

Exclusion(s): 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.

Definitions of Terms

Secure Message – Any electronic communication between a provider and patient that ensures only those parties can access the communication. This electronic message could be email or the electronic messaging function of a PHR, an online patient portal, or any other electronic means.

Fully Enabled - The function is fully installed, any security measures are fully enabled, and the function is readily available for patient use.

Attestation Requirements YES/NO/EXCLUSION

DENOMINATOR: Number of unique patients seen by the EP during the EHR reporting 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).

THRESHOLD: The resulting percentage must be more than 5 percent in order for an EP to meet this measure.

EXCLUSIONS: 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.

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:

Open patient’s chart

Click on “To-Do”> “New Patient Portal Message”

Enter subject and your message

Recommended that you save as a chart note

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.

Double click the patient portal message on your “To-Do” List

Click “Reply”

Type in your reply message in top window

Recommended that you save as a chart note

Click “Send”

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

10. Public Health Reporting

Objective: The EP is in active engagement with a public health agency to submit electronic public health data from CEHRT except where prohibited and in accordance with applicable law and practice.

Measure Options:

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

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

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

Exclusions:

Measure 1 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.

Measure 2 Exclusions: 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.

Measure 3 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 required 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.

Definition of Terms

Active engagement means that the provider is in the process of moving towards sending "production data" to a public health agency or clinical data registry, or is sending production data to a public health agency or clinical data registry.

Active Engagement Option 1 - Completed Registration to Submit Data: The EP registered to submit data with the PHA or, where applicable, the CDR to which the information is being submitted; registration was completed within 60 days after the start of the EHR reporting period; and the EP is awaiting an invitation from the PHA or CDR to begin testing and validation. This option allows providers to meet the measure when the PHA or the CDR has limited resources to initiate the testing and validation process. Providers that have registered in previous years do not need to submit an additional registration to meet this requirement for each EHR reporting period.

Active Engagement Option 2 - Testing and Validation: The EP is in the process of testing and validation of the electronic submission of data. Providers must respond to requests from the PHA or, where applicable, the CDR within 30 days; failure to respond twice within an EHR reporting period would result in that provider not meeting the measure.

Active Engagement Option 3 - Production: The EP has completed testing and validation of the electronic submission and is electronically submitting production data to the PHA or CDR.

Production data refers to data generated through clinical processes involving patient care, and it is used to distinguish between data and “test data” which may be submitted for the purposes of enrolling in and testing electronic data transfers.

Attestation Requirements YES/NO/EXCLUSIONS

EPs must attest to at least two measures from the Public Health Reporting Objective measures 1 through 3.

An exclusion for a measure does not count toward the total of two measures. Instead, in order to meet this objective, an EP would need to meet two of the total number of measures available to them. If the EP qualifies for multiple exclusions and the remaining number of measures available to the EP is less than two, the EP can meet the objective by meeting the one remaining measure available to them and claiming the applicable exclusions. If no measures remain available, the EP can meet the objective by claiming applicable exclusions for all three measures.

MEASURE 1:

YES/NO: The EP must attest YES to being 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—

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.

MEASURE 2:

YES/NO: THE EP must attest YES to being in active engagement with a public health agency to submit syndromic surveillance data.

EXCLUSIONS: 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 where no public health agency has declared readiness to receive syndromic surveillance data from EPs at the start of the EHR reporting period.

MEASURE 3:

YES/NO: The EP must attest YES to being 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 required by a specialized registry in their jurisdiction during the EHR reporting period;

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.

Additional Information

For Measure 1, an exclusion does not apply if an entity designated by the immunization registry or immunization information system can receive electronic immunization data submissions. For example, if the immunization registry cannot accept the data directly or in the standards required by CEHRT, but if it has designated a Health Information Exchange to do so on their behalf and the Health Information Exchange is capable of accepting the information in the standards required by CEHRT, the provider could not claim the second exclusion.

For Measure 2, an exclusion does not apply if an entity designated by public health agency can receive electronic syndromic surveillance data submissions. For example, if the public health agency cannot accept the data directly or in the standards required by CEHRT, but if it has designated a Health Information Exchange to do so on their behalf and the Health Information Exchange is capable of accepting the information in the standards required by CEHRT, the provider could not claim the second exclusion.

For Measure 3, a provider may report to more than one specialized registry and may count specialized registry reporting more than once (twice) to meet the required number of measures for the objective.

Providers who have previously registered, tested, or begun ongoing submission of data to registry do not need to “restart” the process beginning at active engagement option 1. The provider may simply attest to the active engagement option which most closely reflects their current status.

In determining whether an EP meets the first exclusion, the registries in question are those sponsored by the public health agencies with jurisdiction over the area where the EP practices and national medical societies covering the EP’s scope of practice. Therefore an EP must complete two actions in order to determine available registries or claim an exclusion: Determine if the jurisdiction (state, territory, etc.) endorses or sponsors a registry; and, Determine if a National Specialty Society or other specialty society with which the provider is affiliated endorses or sponsors a registry.

We continue to allow registries such as Prescription Drug Monitoring Program reporting and electronic case reporting registries to be considered specialized registries for purposes of reporting the EHR Reporting period in 2017.

EPs who were previously planning to attest to the cancer case reporting objective, may count that action toward the Specialized Registry reporting measure. EPs who did not intend to attest to the cancer case reporting menu objective are not required to engage in or exclude from cancer case reporting in order to meet the specialized registry reporting measure.

Providers may use electronic submission methods beyond the functions of CEHRT to meet the requirements for the Specialized Registry Reporting measure.

A specialized registry cannot be duplicative of any of the other registries or reporting included in other meaningful use requirements.

If a provider is part of a group which submits data to a registry, but the provider does not contribute to that data (for example they do not administer immunizations), the provider should not attest to meeting the measure but instead should select the exclusion. The provider may then select a different more relevant measure to meet.

If a provider does the action that results in a data element for a registry in the normal course of their practice and is in active engagement to submit to a registry, but simply has no cases for the reporting period, the provider is not required to take the exclusion and may attest to meeting the measure.

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