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Stage 1:

Meaningful Use

Manual

Promoting

Meaningful Use

in Your Practice

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March 15, 2011

Dear BayCare Connect Participating Physicians and Practices,

We hope you nd this manual helpul or your practices in achieving Meaningul Use.

Thanks to Chris Eakes, Manager, EMR Technical Liaison, and Alex Rennick, Systems Analyst,

or assisting me in preparing this manual. We appreciate the inormation and eedback

provided to us by the eClinicalWorks team.

I you have questions or need assistance, please contact us.

Sincerely,

Patrick Cimino, MD, MPH

Medical Director

BayCare Health System

O - (727) 467.4032 | M - (727) 253.6825 | F - (727) 467.4626

[email protected]

BayCare.org/EMRConnect

BayCare Health System is a leading community-based health system in the Tampa Bay

area. Composed o a network o 10 not-or-prot hospitals, outpatient acilities and

services such as imaging, lab, behavioral health and home health care, BayCare provides

expert medical care throughout a patients lietime.

With more than 214 locations throughout the Tampa Bay area, BayCare connects patients

to a complete range o preventive, diagnostic and treatment services or any health care

need. The extraordinary health care proessionals across the BayCare network seek to

advance the health o their patients and their communities by setting the standard or

compassionate care that respects the dignity o every individual.

BayCare Connect is BayCares initiative to promote EMR implementation in aliated

physician practices.

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What Is Meaningful Use?

Meaningul Use is the term coined by

the Centers or Medicare and Medicaid

Services EHR Incentive Program to

promote the use o EHR by Eligible

Proessionals (EP) to:

Improve the quality o care, eciencies

and saety in treating patients

Reduce health disparities

Engage patients and amilies

Improve care coordination

Improve population and public health

Guarantee adequate privacy and security

protection o PHI

BayCares Commitment to EHR

BayCare has made a huge commitmentto inpatient EHR through the BEACON

project. BayCare Connect is BayCares

commitment to promoting EHR

in physician practices, acilitating

implementation, communication and

interoperability, quality initiatives and

thereore Meaningul Use.

This Meaningul Use manual is providedby BayCare Connect to give guidance

on meeting Meaningul Use with the

eClinicalWorks (eCW) EHR by:

Identiying the eature(s) which cover

each measure

Identiying the settings that need to be

in place

Identiying where data needs to be

recorded

Meeting multiple measures within one

workfow

Evaluating reporting on the local

(practice) level as well as across the

BayCare eCW community

This manual is intended to provide Eligible

Proessionals using the eClinicalWorks

EMR, promoted by BayCare, minimal

inormation on achieving Meaningul

Use. It is by no means all-inclusive and

assumes some prociency with the eCW

EMR. In general, the manual includes only

one straightorward means to achieve

Meaningul Use, while there may be

others appropriate or your practice.

eClinicalWorks has detailed inormation

on Meaningul Use on their support portal

at http://support.eclinicalworks.com. You

will need your User Name and Password

to access this. Particularly helpul is the

Meaningul Use Training Scenarios Guide.

On the support portal go to the main

toolbar to Documents > Meaningul Use(on the lower toolbar) > Step 2.

Further Meaningul Use tracking and

reporting tools are available through

eCWs Meaningul Use, Adoption, Quality

(MAQ) Dashboards in Version 9.

Introduction

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Score Card

What Are the Measures?

Fiteen Core Measures (C)

Five Menu Measures out o a menu o

10 (M)

Within one Core Measure: Six Clinical

Quality Measures

- Three Core CQMs (CQM-C) or

Alternate Core CQMs (CQM-A)

- Three Additional Set CQMs (CQM)

TOTAL: 25 Measures

How do I start?

The registration process is open as

o January 3, 2011, or the Medicare

Incentive. The Medicare and Medicaid

Registration Manuals are available online*

To register, an Eligible Proessional will

need

National Provider Identier (NPI)

National Plan and Provider Enumeration

System (NPPES) User ID and Password

Payee Tax Identication Number (i you

are reassigning your benets)

Payee National Provider Identier

I you need an NPI, go to the ollowing

CMS link:

https://nppes.cms.hhs.gov/NPPES/Welcome.do

Highlights o the 2011 incentives includethe ollowing:

The Eligible Proessional is required to

attest on any 90 days or 2011.

Reporting or 2011 is by attestation. The

Attestation process will be available in

April 2011. In 2012 reporting directly to

CMS will be required.

The Index o the 2011 Meaningul Use

Measures is a separate document attached

to this manual. The Index Measures are

catalogued with letters and numbers or

BayCare Connect is providing these materials to assist our physicians with

the attainment o Meaningul Use. While every eort has been made to

assure the accuracy o the materials within, please recognize that none o the

inormation contained herein constitutes legal or clinical advice and that the

fnal responsibility or achievement o this aim remains the responsibility o the

participating provider(s).

The Meaningul Use process is in evolution so changes will need to be made to

this Manual.

* https://www.cms.gov/EHRIncentivePrograms/20_RegistrationandAttestation.asp

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reerence purposes. They are specic

to this manual and intended to make it

easier to keep track o the measures.

Reer to this while reviewing the manual.

Related Measures are covered together, so

it is helpul to reer to the Index.

Meaningul Use requires that a lot o

inormation in the electronic record be

reportable. It is important that reportable

inormation be entered in structured or

discrete data, like a pick list. This usuallymeans it is fagged or reporting by

being placed in a certain ormat or eld,

e.g. a cell in a table. Generally ree text

is not discrete or structured so is not

reportable. It may be used but should be

limited to areas where reporting is not

crucial.

When data is reerred to as discrete orstructured, it means that it is reportable.

eClinicalWorks has developed the

MAQ Dashboard to track compliance with

the key Meaningul Use Measures that

require structured data and have to meet

a threshold.

The ollowing section describes workfows

where multiple measures can be met.

These workfows are color coded in the

Manual, the Index and the checklist

to acilitate reerence between the

documents. The Index is straight rom

CMS describing the Measures. The

checklist is to help the practices select the

measures where there are choices.

Following are workfow topics where

multiple measures are met in a single

workfow.

Demographics

Vitals

Medication-related Measures

Smoking Status and Cessation

By ully addressing these topics, one can

achieve 15 Meaningul Use Measures,

and at least two CQM Additional Set

Measures.

The remainder o the manual will give

inormation on the other Measures.

Ready? Lets begin our Meaningul Use

journey.

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Demographics

Demographics

Measures Met: C.1.

Race and ethnicity are

government requirements as

listed on the let.

Inormation must be recorded

as structured data

More than 50% o all uniquepatients seen by the EP havedemographics recorded asstructured data Date of birth Gender Race

Ethnicity Preferred language

Race:American Indian or Alaska NativeAsianBlack or Arican AmericanWhite..Unreported/Reused to Report

Ethnicity:Hispanic or LatinoNot Hispanic or LatinoReused to Report

Preferred Language:CreoleEnglishSpanishOther

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C.1. Record Demographics

Threshold: 50%

The Patient Inormation (demographic)

is recorded in the Ino screen o patient

chart and can be accessed rom a variety

o areas in the chart. The Gender and

Date o Birth are on the rst page and

are set by deault as mandatory. Further

demographic inormation can be accessed

by clicking the Additional Ino button in

the lower let o the Patient Inormation,which brings up a second screen with

more elds.

The Additional Ino screen has elds to

record Race, Ethnicity and Language.

A practice should deal with capturing

this inormation through ront oce

workfow.

Race, Ethnicity and Language elds

may be made Mandatory Fields when

the Additional Ino screen is accessed.

From the main Toolbar go to Patients

> Confgure Demographics Mandatory

Fields and check the appropriate boxes

or these felds.

The MAQ reports will track this measure.

Numerator: Unique patients with

language, gender, race, ethnicity and date

o birth ALL recorded as structured data

Denominator: Total unique patients seen

during the reporting period

Demographics (continued)

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Vitals

Vitals

Measures potentially met:C.2.CQM.C.1.CQM.C.2.CQM.A.1.

CQM.C.1. Percentage o patientvisits or patients age 18 andolder with a diagnosis ohypertension who have beenseen or at least two ocevisits, with blood pressure (BP)recorded

CQM.C.2. Percentage opatients age 18 and older witha calculated BMI in the past sixmonths or during the currentvisit documented in the medicalrecord AND i the most recentBMI is outside parameters, aollow-up plan is documented

CQM.A.1. Percentage o patientsage 2-17 who had an outpatientvisit with a Primary CarePhysician (PCP) or OB/GYN whohad evidence o BMI percentiledocumentation, counselingor nutrition and counseling

or physical activity during themeasurement year

C.2. More than 50% o all uniquepatients seen by the EP havevitals recorded as structureddata. BMI-calculated GrowthChart plotted or children ages2-20 including BMI

Record and chart changes in vitalsigns: Height Weight Blood pressure Calculate and display BMI Plot and display growth charts for

children ages 2-20 including BMI

Hypertension: Blood pressuremeasurement (adult or pediatricpractices, depending on practicescope)

Adult weight screening and ollow-up (adult or pediatric, dependingon practice scope)

Weight assessment and counselingor children and adolescents (adultor pediatric practices, depending onpractice scope)

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C.2. Record and chart changes in vitals

Threshold: 50%

To congure the Vitals to be captured, do

the ollowing:

Toolbar EMR > Misc. Confguration

Options > Confgure Categories

Under Confgure Categories use drop

menu to go to Vitals

Choose provider(s) on right and be sure

that BP, Ht, Wt and BMI checked with

other vitals practice monitors. Click

Apply then OK.

You can congure Vitals and Vitals

Ranges by going to the ollowing:

Toolbar EMR > Vitals > ConfgureVitals (A)

Toolbar EMR > Vitals > Confgure

Vitals Range (B)

A

B

The ranges need to be set in the

Confgure Vitals Ranges. For adult BMI,

CQM.C.2., these are specied in NQF 0421

and PQRI 128 as ollows:

Parameters: Age 65 and older BMI > 30 or

< 22; age 18-64 BMI > 25 or < 18.5

Vitals (continued)

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I out o parameter, a ollow-up plan

needs to be documented. One option

would be having an Order Set to include

such things as dietary counseling or

reerring to PCP i a specialist.

CQM.A.1. For the age 2-17 population,

a BMI percentile must be documented.

A growth chart is populated in eCW

as long as the height and weight are

recorded and congured in Vitals as

above. Counseling or Nutrition and

Physical Activity then needs to be

documented. This is on a yearly basis.

This could be achieved through an Order

Set, Preventive Medicine category, CDSS,

Alerts and Education Material in the

treatment window. It should be recorded

in structured data.

A proessional could also choose two

additional set clinical quality measures

by adequately capturing blood pressure,

CQM-7., blood pressure management in

diabetes and CQM-27., blood pressure

management with ischemic vascular

disease (IVD).

Version 9 has several new eatures in the

Vitals that should make some capturing

easier.

In A, there is a check box to have the

height brought orward ater a

certain age.

The Growth Charts can be reerenced to

either the Centers or Disease Control

(CDC), which is the deault, or the World

Health Organization (WHO), by checking

the box shown in A.

The MAQ reports will track measure C.2.

Numerator: Unique patients with height,

weight, BP recorded as structured data

with BMI, including growth chart plot or

children 2-20 years

Denominator: All unique patients seen


Vitals (continued)

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Maintain active medication allergylist

Implement drug ormulary checks

Measures potentially met:C.3.C.4.C.5.C.6.C.7.M.1.

C.4. The EP has enabled thisunctionality or the entire EHRreporting period.

C.5. More than 40% o allpermissible prescriptions writtenby the EP are transmittedelectronically using certied EHRtechnology

C.6. More than 80% o allunique patients seen by theEP have at least one entry (oran indication that the patientis not currently prescribedany medication) recorded asstructured data

C.7. More than 80% o allunique patients seen by the EPhave at least one entry (or anindication that the patient hasno known medication allergies)recorded as structured data

M.1. The EP has enabled thisunctionality and has access toat least one internal or externaldrug ormulary or the entireEHR reporting period

C.3. More than 30% uniquepatients with at least onemedication in their medicationlist seen by the EP have at leastone medication order enteredusing CPOE

Use CPOE or medications ordersdirectly entered by any licensedhealth care proessional

Implement drug-drug and drug-allergy interaction checks

Generate and transmit permissibleprescriptions electronically (eRx)

Maintain active medication list

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C.3. Use Computerized Physician Order

Entry or Medication Orders

Threshold: 30%

CPOE o medications is a basic unction

o the EMR through the Classic Treatment

Window, eCliniSense, Telephone/Web

Encounter and properly structured

Templates and Order Sets. This has

a threshold o 30%. I there is one

medication in the current medications list

during the reporting or a patient seen,then or the patient to count at least one

medication order should be recorded

during the reporting period.

The MAQ reports will track this measure

Numerator: Unique patients with at least

one medication in their medication list

with a computer entered medication

order

Denominator: Total unique patients seen

during the reporting period with at least

one medication in their medication list

C.4. Implement drug-drug and drug-

allergy interaction checks

Following is a description o enabling

this eature in versions PRIOR TO Version9. Version 9 has this eature enabled as

deault and this setting is not present.

Thereore i a Provider is on Version 9 or

the reporting period, this measure is met.

File > Settings > My Settings > User

Settings

While not a Meaningul Use requirement,

the Allergies or Interactions buttons may

indicate a potential concern. To address

any concerns there is a note section at

the bottom o the window giving the

Provider the opportunity to acknowledge

the warning and state why a decision is

made to use a drug with a time stamp

documentation.

C.5. Generate and transmit permissible

prescriptions electronically (eRx)

Threshold: 40%

The ollowing is a brie outline o thesteps a physician must complete to

successully eprescribe.

Providers participating with BayCare

Connect will have their setup acilitated

Medication-related Measures (continued)

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with Surescripts and in eClinicalWorks

or eprescribing.

eClinicalWorks will set up the

appropriate area pharmacy databases.

The practice needs to establish a

workfow to capture the patients

pharmacies in the Patient Inormation

(Ino) > Additional Ino screen which

is typically done by the ront oce.

Multiple pharmacies can be loaded

including a primary pharmacy and mailorder pharmacy.

The provider can now order

prescriptions through the Treatment

window or other prescribing windows.

Once a prescription is complete, the

provider should click the Send button

choosing the ePrescibe Rx option. Faxing

does NOT constitute eprescribing.Electronically received rells may be sent

electronically ater the reconciliation

and approval processes are complete.

I there are problems with a pharmacy

receiving electronic prescriptions and

rells, Surescripts may be contacted online

at Surescripts.com/Support.

MAQ reports track this. The denominator

is the total prescriptions: printed, axed

or eprescribed excluding controlled

substances. The numerator is the

eprescribed prescriptions.

Numerator: Permissible prescriptions

transmitted electronically

Denominator: Total permissible

prescriptions during reporting period

C.6. Maintain Active Medication List

Threshold: 80%

Medication entry is a basic EMR unction.

Providers must be sure to address and

update medications at each visit. The

Medication Veried box should be

checked at each visit. This is important to

conrm medications were checked even

i there are none. This eature is also

important to the Menu measure M.7.,

medication reconciliation with transition

o care.


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The MAQ reports track this measure.

Numerator: All the unique patients seen

during the reporting period with the

Medication Veried box checked whether

they have medications or not



C.7. Maintain Active Medication AllergyList

Threshold: 80%

Medication Allergies must be documented

in a structured ashion in the Allergy

section o the EMR. The Allergies Veried

box should be checked each visit when

allergies are conrmed or added. I there

are no allergies, then clicking either NKDA

or Allergies Veried boxes will check both.


Numerator: All the unique patients seen

during the reporting period with the

Allergies Veried box checked whether

they have allergies or not



M.1. Implement Drug Formulary Checks

This measure requires that at least one

ormulary check must be set up. See

C.5. above or Provider registration

inormation or eprescribing.

Rx Eligibility may be set as a job to run on

a daily basis or the upcoming visits, like

insurance eligibility, and be perormed

automatically. Following is a manual

process or perorming Rx Eligibility.


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The ront oce will need to check Rx

Eligibility and set the ormularies up when

checking patients in.

At the bottom o the Appointment

window, click the Rx Eligibility button.

On the Rx Eligibility screen, click the

Check Rx Eligibility button.

Highlight the desired plan and click the

Set Formulary button at the bottom o

the window.

The insurance Web site will need to be

in the Update Insurance Window File

> Insurance, click on the appropriate

insurance, > Address tab. Then add the

insurance Web site in the appropriate

eld.


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Smoking-related Measures

Smoking-related Measures

Measures potentially met:C.8.

CQM.C.3.CQM-1.

CQM.C.3. Percentage o patientsage 18 and older:a. who have been seen or atleast two oce visits who werequeried about tobacco use oneor more times within 24 monthsb. identied as tobacco userswithin the past 24 months andhave been seen or at leasttwo oce visits, who receivedcessation intervention

CQM-1. Percentage o patientsage 18 and older who werecurrent smokers or tobacco

users, who were seen bya practitioner during themeasurement year and whoreceived advice to quit smokingor tobacco use or whosepractitioner recommended ordiscussed smoking or tobaccouse cessation medications,methods or strategies

C.8. More than 50% uniquepatients age 13 years seen by EPhave smoking status recorded asstructured data

Record smoking status or patientsage 13 or older

Preventive care and screeningmeasure pair:a. Tobacco use assessmentb. Tobacco-cessation intervention

Smoking and tobacco use cessation,medical assistance:a. Advising smokers and tobacco

users to quitb. Discussing smoking and tobaccouse cessation medicationsc. Discussing smoking and tobaccouse cessation strategies

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C.8. Smoking Status As Structured Data

Threshold: 50%

Within eCW, a provider can capture

Smoking Status as structured data in

whatever part o the record the practice

chooses or their work fow, e.g. HPI,

PMH, SH. The status must be captured as

structured data, and it must be mapped

or reporting purposes. The Tobacco

Control Smart Form is one means o

capturing Smoking Status as structureddata. Either way the structured data MUST

be mapped or reporting to be done.

The mappings are done through the

Toolbar Community > Mappings > Smart

Forms or the Tobacco Control Smart Form

Community > Mappings > Structured Data

or custom smoking status capture.

You may work with eCW to be sure this

mapping is appropriately completed. The

MAQdashboard will be the reporting

mechanism.

The three Smoking-related Measures

are closely linked, and two are required.

It makes sense to create a workfow

to accomplish all three. This is a big

dierence or many specialists. I you

consider the health eects o smoking,

this broad eort has potential or great

medical merit. The ollowing is an

example o how to structure up to three

Measures as simply as possible.

This is an example o capturing Smoking

Status through structured data.

Find the Item to record smoking,

typically in the Social History. You can

also create a New Item. I the smoking

Item already exists, open Item by clicking

on it and be sure structured box is

checked.

Click OK and click on the Details section

by the Item and then the custom button.

Click Add and add the ollowing.

- Name: Do you smoke?

- Type: Structured

- Click Mandatory

- Click Customize Structured Text and

Add yes and then no

Add a child

- Name: Do you want to quit?

Smoking-related Measures (continued)

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- Type: Structured

- Trigger: yes

- Click Mandatory

Add a child to the child above

- Name: Do you want to try

medication?

- Type: Structured

- Trigger: yes

- Click Mandatory

The Structured Data will be input as

ollows

The structured data needs to be mapped

in the Community heading on the tool

bar.

To acilitate counseling being

documented, education material supplied,

medication oered and reerral to a

Smoking Cessation program, ollowing

is an example o an Order Set. It is

triggered and linked to the diagnosis

or Nondependent tobacco use disorder,

305.1. It also includes a linkage to a

Smoking Cessation intervention code or

reporting and reminding, Measure

211-CM.


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In summary:

To complete C.8. record the smoking

status.

To complete CQM.C.3. provide the CDC

sheet, or other education material about

quitting, on the Order Set and charge a

counseling code.

To complete CQM-1. oer meds and use

the Order Set or that.

I everything is mapped correctly, C.8. willbe reported in the MAQ reports.

Numerator: All the unique patients age 13

or older with smoking status recorded as

structure data

Denominator: All unique patients age 13

or older seen during reporting period

These CQM measures have no threshold to

measure. They should be reportable based

on the above discussion about structured

data.

Engaging Patients and Families in

Their Health Care Measures

These Measures are intended to enhance

patient access to their health inormation.

C.9. Providing an Electronic Copy o

Health Inormation

Threshold: 50%

This Measure will best be met through the

Patient Portal. It species a threshold o

50% o patients who request an electronic

copy o their health inormation must be

provided it within three business days.

eClinicalWorks has developed a new Portal

called 100 Million Patients. Following is

a brie description o the steps to web

enable a patient. This is typically a ront

oce task.

Go to Patient Ino screen, click on

Options button at bottom and select

Web Enable. Complete the Patient

Username and E-mail which is required.

Password will be set by deault and

emailed to the patient. Version 9 has an

alert or Front Oce to Web enable and

capture e-mail when an appointment is

scheduled, under the Alert Meaningul

Use tab.

On the let Admin band, go to Patient

Portal Settings, under Synchronize, click

Run and set a schedule or the desired

items including Update Web Enabled

Patient data to Web Portal. This setting

is a one-time administrative setting.

Patient will receive an e-mail on how

to log onto the Portal and access their

inormation.

Tracking this is a unction o the eCW

MAQ dashboard. The denominator will

be the patients who go to the portal and

check a Request Record box. I properly

set up, all the patients will be provided


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electronic access to and a copy o their

health inormation (i desired) so it will

meet 100%.

C.10. Providing Clinical Summaries

Threshold 50%

The Visit Summary can be printed rom

two places.

Resource Schedule, right click on the

appointment and click on Print Visit

Summary option.

Progress Note, click on button next to

Print at bottom o Progress Note, then

click on Print Visit Summary option.

Give patient the Summary, which may

include the next appointment. Patients

may also access this Summary through the

Patient Portal i set up to publish.


Numerator: Oce visits with printed or

published clinical summaries

Denominator: All oce visits during

reporting period

Engaging Patients and Families (continued)

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C.11. Maintain an up-to-date problem list

o current and active diagnoses

Threshold: 80%

Maintaining an Active or Current Problem

List is a basic eature o the EMR.

Following are highlights o this eature.

The expectation is 80% compliance so it is

important to address this Measure.

Be sure Chronic Problem ICDs are set up

to deault to the Problem List.

- Billing on toolbar > ICD > ICD Codes

- Find code in question, highlight and

click Update. Be sure Chronic box is

checked.

Adding or Removing a Problem at a Visit

- In Assessment window, click on

Problem List box. Problems can be

added or removed as appropriate

I no Problems exist, click the No known

problems box to get credit or confrming

this.

Adding or Removing a Problem rom the

Dashboard

- In the Overview Tab, go to Problem

List, click the ellipsis, then Add or

Remove as appropriate.

Version 9 has a reminder in the Dashboard

i this has not been addressed with a

problem or No known problems checked.


Numerator: All unique patients seen with

at least one problem noted or No known

problems checked

Denominator: All unique patients during

reporting period

C.12. Implement one clinical decision

making rule with ability to track rule

eCW has over 40 Clinical Decision Making

Support System (CDSS) Alerts as well as

the ability to create custom and patient-

specic Alerts. This Measure can be met

by setting one o these CDSS Alerts. There

are reports that can be run measuring

compliance.

These can be tied to the Meaningul Use

Clinical Quality Measures or PQRI. For

more inormation on other Alerts, reer to

eCW Manuals.

To review the CDSS Measures, EMR >

CDSS > Measures Defnitions.

When a Provider decides to use a CDSS

Measure, go to the list and enable only

the desired CDSS Measure.

Remaining Core Measures

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EMR > CDSS > Measures Confguration

The Provider should only enable those

the practice is interested in monitoring.

This will require the appropriate Security

Settings. Again only one is required or

Stage 1 o Meaningul Use.

Under the Smoking Related Measures

above, CDSS is used to acilitate this by

linking the Order Set to the Measure code

211-CM.

C.13. Report ambulatory clinical quality

measures to CMS or the states

This Core Measure includes reporting

on three out o six Core and Alternate

Clinical Quality Measures and three out o

38 Additional Clinical Quality Measures.

This Measure only requires reporting,

not achieving, a specic threshold o a

standard.

eClinicalWorks has created the Meaningul

Use Adoption, Quality (MAQ) dashboard

to gather this inormation or reporting.

The MAQ dashboard is available in the

Version 9 upgrade. eCW is certied or

MAQ reporting on a number o measures

including the Core and Alternate Clinical

Quality Measures, CQM.C.1., CQM.C.2.,

CQM.C.3., CQM.A.1., CQM.A.2., and

CQM.A.3., as well as three diabetes

measures: CQM-2., CQM-3., and CQM-4.

The PQRI eature is capable o capturing

many o the Meaningul Use Measures

and the Registry can report on them.

Many o the Clinical Quality Measures

have PQRI measures.

C.14. Improve Care Coordination

This Measure has no threshold but at least

one o several eCW eatures will need to

be enabled to meet Stage 1 Meaningul

Use.

eClinicalWorks eHX

- The eHX eature is provided to the

BayCare eClinicalWorks Community

by BayCare Connect.

eClinicalWorks P2P (Provider to

Provider). P2P is set up through

eClinicalWorks but is included by

BayCare Connect as a eature or the

BayCare Connect Community.

Participants receive inormation rom

BayCare Connect when these eatures are

enabled.

C.15. Ensure Adequate Privacy and

Security Protections or Personal Health

Inormation

This Measure deals with compliance

with HIPAA and Security Rules. It merits

attention not only or Meaningul Use,

but also to adequately protect Protected

Health Inormation (PHI) and avoid

potential onerous government sanctions.

The Meaningul Use Training Scenarios

Remaining Core Measures (continued)

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Guide covers this area in detail.

It would be useul to comply with these

regulations to have written practice

policies and procedures and a mechanism

or ensuring that they are being ollowed.

Following are the requirements as

described in the regulations reerenced

in the Meaningul Use Measure, 45 CFR

164.308 (a)(1) and brie reerences to eCW

eatures to assure adherence to same.

Risk analysis

Risk management

- Congure P.S.A.C. categories to

protect condential inormation like

HIV

- Set Security Attributes

By user

By attribute

By role

This will vary by practice but should limit

sta access to only those areas they need

to do their job. The more this is claried

and adhered to the easier it will be to

remain in compliance.

- Confgure Provider Rx Security

- Confgure Authentication Settings

Sanction policy or those who violate the

access policies

Inormation system activity review.

Review logs on a regular basis to

assure the inappropriate accessing o

inormation is not occurring.

Written Policies and Procedures with

documented audits and checklists can

acilitate the adherence to this Measure

and reveal risks hopeully beore they can

cause damage to a practice.

Remaining Menu Measures

M.2. Incorporate clinical lab test results

into certifed EHR technology as

structured data

Threshold: 40%

Providers who adopt eCW will have

BayCare labs and diagnostic results

interaced as structured data. Some

practices either based on volume or their

willingness to pay or the interace may

already have LabCorp and Quest data

coming over as structured data. BayCare

is working with LabCorp and Quest to

provide an interace to all participating

providers in 2011.


Numerator: Number o clinical lab testswith results reported as structured data

Denominator: All electronic labs marked

as received

*It is very important or in house labs to

be marked as received

Remaining Core Measures (continued)

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M.3. Generate lists o patients by

specifc conditions to use or quality

improvement, reduction o disparities,

research or outreach

This Measure only requires that the

Eligible Proessional generate at least

one report listing patients with a specic

condition. This can be readily achieved

through the Registry reporting or Patient

Recall.

M.4. Send reminders to patients perpatient preerence or preventive/ollow

up care

Threshold: 20%

This Measure requires that more than

20% o all unique patients age 65 or

older or age 5 years or younger are sent

an appropriate reminder during the EHR

reporting period.

An EP needs to decide what is important

to his or her practice. This is geared

toward preventive or ollow-up care.

An infuenza vaccination reminder or a

reminder to schedule a ollow-up visit are

good examples.

eClinicalWorks has the capacity to send

messages to patients:

Through Letters in the Patient Recall

section o the Registry Band or the HUB.

Letters to be sent will have a category

box that reminder can be selected or

reporting purposes. Letters are probably

the most straightorward approach to

meet this measure.

Through e-mail i Web-enabled to use

the Patient Portal, under Send eMsg

Through a telephone o preerence in

eMessenger which may include a text

message


Numerator: Number o unique patients

in selected age range who were sent a

reminder

Remaining Menu Measures (continued)

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Denominator: Number o unique patients

in selected age range during the reporting

period

M.5. Provide patients with timely

electronic access to their health

inormation (including lab results,

problem list, medication lists, medication

allergies) within our business days o the

inormation being available to the EP

Threshold: 10%

This Measure can be met with

eClinicalWorks through the new Portal

called 100 Million Patients. The patients

need to be Web-enabled and they will

have access to meet this measure. Reer to

Measure C.9.


Numerator: Number unique patients web

enabled

Denominator: Total number unique

patients during the reporting period

M.6. Use certifed EHR technology to

identiy patient-specifc education

resources and provide those resources to

the patient i appropriate

Threshold: 10%

This Measure can be accomplished

through a variety o means with patient-

specic education materials either printed

or published to the Patient Portal.

Printing can be accomplished through

the Education button on the Treatment

window or through an Order Set.


Numerator: Number o unique patients

who received patient-specic education

materials

Denominator: Number o unique patients

seen during the reporting period

M.7. The EP who receives a patient romanother setting o care or provider o

care or believes an encounter is relevant

should perorm medication reconciliation

Threshold: 50%

This measure requires two steps to be

recorded:

When the appointment is made,

the ront oce needs to check the

Transition o Care box below the Reason

eld, e.g. hospital ollow-up.

When the medications are reviewed

in the Current Medication screen, the

provider must check the Medication

Veried box as discussed in C.6.


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Numerator: Number o patient visits with

Transition o Care and Medication Veried

boxes checked

Denominator: Number o patient visits

with Transition o Care box checked

M.8. The EP who transitions their patient

to another setting o care or provider o

care or reers their patient to another

provider o care should provide summary

o care record or each transition o care

or reerral

Threshold: 50%

This measure is associated with outgoing

reerrals. It may be accessed through the

Treatment window Outgoing Reerral

button or through P2P (reerring and

reerral providers must be P2P enabled)

accessed through the drop down on the T

by the jelly bean, Send eCW P2P Reerral/

Consult.

In the Reerral (Outgoing) window, the

Provider needs to click the Attachments

button at the bottom and then click

either the Attach Medical Summary box

or the Attach CCR/CCD box. Continuity

o Care Record (CCR) and Continuity

o Care Document (CCD) are standard

indices o summary patient demographics

and medical inormation that can be

shared between providers; or example,

problems, medications and allergies. I

associated with a Progress Note that will

appear as an attachment and will suce

as a summary o care.

The reerral can then be axed or sent

through the P2P unction.


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Numerator:Outgoing reerrals with a

summary o care record attached

Denominator: Total Outgoing reerrals


Meaningul Use requires that an Eligible

Proessional perorm either M.9. or M.10.

M.9. Capability to submit electronic

data to immunization registries or

Immunization Inormation Systems andactual submission in accordance with

applicable law and practice

This Measure requires that the Eligible

Proessional complete at least one test

o certied EHR technologys capacity to

submit electronic data to immunization

registries and ollow up submission i

the test is successul (unless none o

the immunization registries to which

the EP submits such inormation have

the capacity to receive the inormation

electronically). This only requires a test

submission. eCW has these uploads

programmed but they will need to be set

up by eCW; Florida Shots is capable o this.

M.10. Capability to submit electronic

syndromic surveillance data to public

health agencies and actual submission

in accordance with applicable law and

practice

This Measure requires that the Eligible

Proessional complete at least one test

o certied EHR technologys capacity to

provide electronic syndromic surveillance

data to public health agencies and ollow-

up submission i the test is successul

(unless none o the public health agencies

to which an EP submits such inormation

have the capacity to receive the

inormation electronically).

The capacity to perorm this Measure

needs to be urther dened by eCW. State

agencies must be capable o accepting the

reporting. As o March 2011 Florida was in

the initial planning stages or this and it is

not clear when this will be available.


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Notes:

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