THE CHICAGO HIT REGIONAL EXTENSION CENTERBringing Chicago together through health IT

Achieving Stage 3 Promoting Interoperability with eClinicalWorks

Documenting for Medicaid PI objectives and measures

October 23, 2019

This webinar was developed with support from the Office of National Coordinator for Health Information Technology, the Centers for Medicare &

Medicaid Services, and the Illinois Department of Healthcare and Family Services.

Agenda

• Stage 3 PI Objectives:• Protect Patient Health Information

• e-Prescribing

• Clinical Decision Support (CDS)

• Computerized Provider Order Entry (CPOE)

• Patient Electronic Access to Health Information

• Coordination of Care through Patient Engagement

• Health Information Exchange

• Public Health and Clinical Data Registry Reporting

• Tracking PI Performance

• eCW Resources

Sam Ross, Project Manager

Stage 3 PI Objectives

Objective 1: Protect Patient Health Information

Conduct or review a security risk analysis in accordance with HIPAA requirements, implement updates and correct deficiencies as part of the EP’s risk management process.

• Risk analysis is a subset of complete HIPAA compliance

• Document results of process to identify risks, develop policies/procedures and implement changes as needed

• Must be updated annually to address new risks and updated policies/procedures, completed no later than 12/31

• eCW is certified to ONC and HIPAA standards but does not automatically ensure compliance

Objective 1: Protect Patient Health Information

• eCW has developed business partnerships with four vendors that offer a variety of tools, services and price points for SRA:• The Compliancy Group (http://www.compliancy-group.com/ecw)

• MedTech USA/HIPAAAudit.com (www.MedTechUSA.com/ecw)

• GSG Compliance (info@gsgcompliance.com)

• ecfirst (http://www.ecfirst.com)

• CHITREC has compiled a list of local vendors (provided upon request)

• ONC has the SRA Tool (https://www.healthit.gov/resource/security-risk-assessment-sra-tool)

Objective 2: e-Prescribing

More than 60% of prescriptions written by the EP are queried for a drug formulary and transmitted electronically.

• Exclusion if writing <100 medication orders

• Order may be completed on behalf of a supervising provider

• May choose to include or exclude controlled substances when running Medicaid PI report

• Rx eligibility must be checked each time a prescription is sent, including refills (lasts for 3 days)

• Eligibility checks can be scheduled to run overnight for following day’s scheduled appointments

• Click Rx Eligibility > Check Rx Eligibility from Appointment window

Objective 2: e-Prescribing

• Click the E quick launch to submit eRx refills

Objective 2: e-Prescribing (method 1)

• Click Rx Eligibility > Check Rx Eligibility during refill from E-quick launch

Objective 2: e-Prescribing (method 1)

Objective 2: e-Prescribing (method 2)

• Click Progress Notes > Treatment

• Click the green arrow next to Send Rx and choose ePrescribe Rx

Objective 2: e-Prescribing (method 2)

• Click Check Rx Eligibility during eRx workflow from Progress Notes > Treatment

Objective 2: e-Prescribing (method 3)

• Click Progress Notes > Send

• Select ePrescribe for Mode and click Send

Objective 3: Clinical Decision Support

1. Implement five CDS interventions related to four or more quality measures or high-priority health conditions.

2. Enable and implement the functionality for drug-drug and drug-allergy interaction checks.

• Must satisfy or exclude both measures

• Exclusion from measure 2 if writing <100 medication orders

• Functionality is automatically enabled by eCW and can be customized through several options:• Classic alerts (click EMR > Alerts)• Registry alerts (click Registry icon > Run a query > Save queries)• CDSS alerts (click EMR > CDSS > Measure configuration)• Drug interaction checks (may use Multum or Medi-Span database)

Objective 3, Measure 1: Clinical Decision Support• Click CDSS from Patient Dashboard or the right Chart Panel (ICW)

Objective 3, Measure 2: Drug-Drug and Drug-Allergy Interaction Checks (method 1)• Click Progress Notes > Current Medication > Drug Interaction

Objective 3, Measure 2: Drug-Drug and Drug-Allergy Interaction Checks (method 2)• Click Progress Notes > Treatment > Interaction

Objective 4: Computerized Provider Order Entry (CPOE)

1. More than 60% of medication orders created by the EP are recorded using CPOE.

2. More than 60% of laboratory orders created by the EP are recorded using CPOE.

3. More than 60% of diagnostic imaging orders created by the EP are recorded using CPOE.

• Must satisfy or exclude all three measures

• Exclusion from each measure if <100 orders

• Properly credentialed assistants may place orders on behalf of EP (click Admin > Staff then select staff member and check the Licensed Medical Professional or Credentialed Medical assistant box)

• Orders do not have to be submitted to the pharmacy/lab/imaging center electronically

• Results of labs/images do not have to be received electronically

Objective 4, Measure 1: CPOE Medications

• Click Progress Note > Treatment > Add

Objective 4, Measure 2 and Measure 3: CPOE Labs/Imaging (method 1)

• Click Progress Notes > Lab Reports or Diagnostic Imaging in the Plan section

Objective 4, Measure 2 and Measure 3: CPOE Labs/Imaging (method 2)

• Click Progress Notes > Treatment > Browse in the Labs or Diagnostic Imaging section

Objective 4, Measure 2 and Measure 3: CPOE Labs/Imaging (method 3)

• Click Patient Hub > Labs or DI > New

Objective 5: Patient Electronic Access to Health Information

1. For more than 80% of patients seen by the EP, the patient is provided timely access to health information; and the information is available using any application configured to meet the technical specifications of the Application Programming Interface (API) in the EP’s EHR.

2. The EP must use clinically relevant information from certified EHR to provide electronic access to patient-specific educational materials to more than 35% of unique patients.

• Must satisfy both measures

• Exclusion if EP has no office visits or conducts >50% of encounters in county with <50% 4Mbps broadband

• “Timely access” is within 48 hours; patient must be web-enabled within 48 hours of first visit during reporting period

• Patient who opt-out of portal may be included (must use Appointment window, not Patient Information window)

• User must be signed up for third-party educational material vendor and publish material to portal (Custom education, Order Set education, and Rx education no longer count)

Objective 5, Measure 1: Patient Electronic Access (method 1)

• Enter an e-mail address and click the “W” button from the Appointment window

Objective 5, Measure 1: Patient Electronic Access (method 2)

• Set visit status to Arrived from Appointment window then enter e-mail address or check Don’t Web Enable box and provide reason

Objective 5, Measure 2: Patient Education (method 1)

• Click Progress Notes > Treatment > Education > Patient Education

• Select education based on Dx or Rx and click Publish to Portal

Objective 5, Measure 2: Patient Education (method 2)

• Click Progress Notes > Send > For Patients

• Select the educational material and click Save and Publish to Portal

Objective 6: Coordination of Care through Patient Engagement

1. More than 5% of patients seen by the EP actively engage with the EHR to view, download, or transmit their health information. Access could also be through an Application Programming Interface (API).

2. More than 5% of unique patients seen by the EP are sent a secure message. A response to a secure message also counts for this measure.

3. Patient generated health data or data from a non-clinical setting is incorporated into the EHR for more than 5% of patients seen.

• Must report on all 3 measures and satisfy 2 measures

• Patient must be registered for portal to be eligible for numerator of each measure

• Not necessary that patients respond to message to earn credit

• Must enable the Interoperability Hub for patients to have access to health information through an API (Admin > Product Activation > Interoperability Hub > Activate), which may incur additional costs

Objective 6, Measure 1: View, Download, Transmit

• Patient visits portal URL, enters username/password and clicks Sign In

Objective 6, Measure 2: Secure Messaging (Desktop-based)

• Click Patient Hub > Send eMsg

• Enter information in the Subject/Message sections (or Load template), check the Preventive/Follow-up care message box and click Send

Objective 6, Measure 2: Secure Messaging (Browser-based)

• Click Patient Hub > Send Message then choose the eMessage mode

• Enter the Subject and Message, check the Health Maintenance box and click Send

Objective 6, Measure 2: Secure Messaging (reply to message from patient)

• Click T quick-launch > Web Encounter then choose link in Patient column

• Click Reply to patient, check the Preventive/Follow-up care message (desktop) or Health Maintenance (browser) box, enter a message and click Send

Objective 6, Measure 3: Patient-Generated Health Data (import Questionnaire from portal)

• Click Progress Notes > healow Hub icon (red square bracket with downward-facing arrow)

• Click Import Current Page to import all or click download icon next to individual answer to import just that answer

Objective 6, Measure 3: Patient-Generated Health Data (review tracker data)

• Click Progress Notes > healow Hub tracker icon (blue squiggly line)

Objective 7: Health Information Exchange

1. More than 50% of outgoing transitions of care (ToC), have a summary of care (SoC) sent electronically.

2. For more than 40% of incoming ToC (including new patients), the EP requests a SoC and incorporates to the patient’s record when available.

3. More than 80% of incoming ToC have reconciled medication, allergy and problem lists.

• Must report on all 3 measures and satisfy 2 measures

• Exclusions available from each measure if <100 ToC

• Document all outgoing/incoming ToC, regardless of how or whether patient records are exchanged (denominator)

• Send or receive SoC electronically (numerator)

• Incoming ToC excluded from measure 2 if partner does not respond to request for SoC

• Reconcile medication, allergy and problem lists from SoC or manually

Objective 7, Measure 1: Send Summaries of Care (method 1)• Click Progress Notes > Treatment > Outgoing Referral

• Click the green arrow next to the Send Referral button and choose Send Electronically

Objective 7, Measure 1: Send Summaries of Care (method 2)• Click Progress Notes > Send > eTransmit > Send

Objective 7, Measure 1: Send Summaries of Care (method 3)• Click T quick-launch link > Send eCW P2P Patient Record (or Send eCW P2P

Referral/Consult) > Send Referral

• Must check box to Attach CCR/CCD

Objective 7, Measure 2: Receive Summaries of Care• Click Practice > Resource Scheduling (or provider’s schedule icon) to

open an existing appointment or create a new appointment (method 1)

• Click Progress Notes > Chief Complaints (method 2)

• Click Transition of Care and check either the Transition of Care –Electronic summary of care record received or NOT received box

• If the SoC was received, check the box for the related incoming ToCencounter from the list of referrals below

Objective 7, Measure 3: Clinical Information Reconciliation (electronic)• Click Progress Notes > DRTLA (from the ICW pane on the right) then click

the CCR link for a referral

• Click the blue left arrow icon next to any item from the problem list, medications, or allergies to reconcile by importing into the note

Objective 7, Measure 3: Clinical Information Reconciliation (problem list, method 1)

• Click Progress Notes > Assessments

• Check the box(es) in the PL column for all ICD codes to add and click PL Verified

Objective 7, Measure 3: Clinical Information Reconciliation (problem list, method 2)

• Click Progress Notes > Assessments > Problem List

• Check the No known problems box

Objective 7, Measure 3: Clinical Information Reconciliation (problem list, method 3)

• Click Progress Notes > Overview then click the ellipsis (orange box with three white dots) from the Problem List section of the ICW pane

• Check the No known problems box

Objective 7, Measure 3: Clinical Information Reconciliation (medications, allergies)

• Click Progress Notes > Current Medication then check the Verified box

• Click Progress Notes > Allergies/Intolerance then check the N.K.D.A box or add allergies and click the Allergies Verified box

Objective 8: Public Health and Clinical Data Registry Reporting

1. Actively engage with two of the following:

2. Immunization Registry - submit immunization data and receive immunization forecasts

3. Syndromic Surveillance - submit data

4. Electronic Case Reporting - submit data on reportable conditions

5. Public Health Registry Reporting - submit data to public health registries

6. Clinical Data Registry - submit data to CDRs

• Must satisfy two measures unless excluded from all remaining (not possible for Illinois EPs)

• eCW supports integration with Illinois immunization registry (ICARE)

• Illinois public health is testing eCW integration for Prescription Monitoring Program (ILPMP); submit an eCW support request to encourage move towards production

• eCW is not currently certified for CDC Health Care Surveys, but is working with CDC

• For 2019, EPs may still meet measure through registration of intent for ILPMP, Health Care Surveys or other registries that accept submission of CCD/QRDA

Tracking PI Performance

MAQ Dashboard

• Click Meaningful Use from the main toolbar

• Click the green down arrow then click Add New Extraction Request

• Select Stage 3, check Objective and eCQMs, choose a duration (90-day minimum), select provider(s) then click Submit

Medicaid PI Dashboard

• Click Stage 3 > Meaningful Use > 2019 Measure Set > Objectives

• From the Select View drop-down list, choose Score Card

• Objective and measure numerator/denominators will appear with red/yellow/green indicating compliance

eCW Resources

• Request supporting documents from your eCW representative

• Open a case and reference:• Stage 3 Medicaid PI guide• MAQ dashboard guide• Patient portal users guide• P2P users guide

Questions