Objectives

Provide a Summary of Care record for each transition of care: We have never had to change the discharge code in the past, why now?

This is needed in order to capture the denominator for this objective. Thrive uses discharge codes to calculate the number of transitions of care and referrals for which the EP was the transferring or referring provider.

What if we do not take vital signs on most visits?

According to the CMS Stage 1 Specification Sheets, an EP may be excluded from recording and charting changes in vital signs if "…[the EP] either sees no patients 2 years or older, or who believes that all three vital signs of height, weight, and blood pressure of their patients have no relevance to their scope of practice."

For 2014 and beyond, additional exclusions will be added to the Stage 1 measure. According to the specification sheet, the 2014 exclusions may include "any EP who: a.) sees no patients 3 years or older is excluded from recording blood pressure b.) believes that all three vital signs of height, weight, and blood pressure have no relevance to their scope of practice is excluded from recording them c.) believes that height and weight are relevant to their scope of practice, but blood pressure is not, is excluded from recording blood pressure d.) believes that blood pressure is relevant to their scope of practice, but height and weight are not, is excluded from recording height and weight."

For additional information, please refer to the CMS website.

Will there be changes to the Stage 1 objectives following 2014 certification? If so, what are they?

Yes, there will be changes to certain Stage 1 objectives following 2014 certification. The objectives that will be changing are CPOE, Electronic Prescribing, Record and Chart Changes in Vital Signs, Electronic Exchange of Key Clinical Information, Report Clinical Quality Measures, Public Health Reporting and Electronic Copy of and Electronic Access to Health Information. Please refer to CMS for more information on the changes to these measures and objectives.

Is there a guide that explains how each National Quality Forum (NQF) measure is calculated within the Thrive System?

At this time, there is not a guide that explains how each National Quality Forum (NQF) measure is calculated with the software. Evident programmed our NQF report in accordance with CMS requirements for the 2014 quality measures.

Evident programmed the following 2014 Clinical Quality Measures (CQMs):

• NQF 0028- Preventive Care and Screening Measure: Tobacco Use: Screening and Cessation Intervention
• NQF 0024- Weight Assessment and Counseling for Nutrition and Physical Activity for Children and Adolescents
• NQF 0069- Appropriate Treatment for Children with Upper Respiratory Infection (URI)
• NQF 0002- Appropriate Testing for Children with Pharyngitis
• NQF 0018- Controlling High Blood Pressure
• NQF 0034- Colorectal Cancer Screening
• NQF 0059- Diabetes: A1c Poor Control
• NQF 0608- Pregnant Women that had HBsAg Testing
• NQF 0036- Use of Appropriate Medications for Asthma

If you encounter an issue with patients not pulling to the NQF Clinic Tables Report, please contact Evident support via the Internet Call Management System or by calling Evident.

What if none of our local pharmacies will accept electronic prescriptions?

According to the CMS Stage 1 specification sheets, an EP may be excluded if "[the EP] does not have a pharmacy within their organization and there are no pharmacies that accept electronic prescriptions within 10 miles of the EP's practice location at the start of his/her EHR reporting period." For additional information, please refer to the CMS website.

Do custom education documents count for Meaningful Use?

Yes, providers may utilize custom education documents aside from those provided through Micromedex. According to the CMS Patient-specific Education Resources objective specification sheet, "Education resources or materials do not have to be stored within or generated by the certified EHR. However, the provider should utilize certified EHR technology in a manner where the technology suggests patient-specific educational resources based on the information stored in the certified EHR technology. The provider can make a final decision on whether the education resource is useful and relevant to a specific patient."

How do you add custom documents?

Hospital administrators are educated on the process for adding custom education documents to the Thrive System during the implementation of hospital applications. We recommend that clinic staff follow up with the hospital administrator on any requests to add customized education documents within the Thrive System.

Do edited education documents count for Meaningful Use?

The current functionality of the Thrive Provider EHR software does include education documents within the numerator when the "Edit" option is selected. The document will open as a Word document. After printing or reviewing the education document with a patient, users must select to save and exit the document in order for that unique patient to be counted within the numerator, for the Patient Specific Education Resources objective.

If an EP is unable to meet the measure of a Meaningful Use objective because it is outside of the scope of their practice, will the EP be excluded from meeting the measure of that objective under the Medicare and Medicaid EHR Incentive Programs?

Some Meaningful Use objectives provide exclusions and others do not. Exclusions are available only when CMS regulations specifically provide for an exclusion. EPs may be excluded from meeting an objective if they meet the circumstances of the exclusion. The statistics report will still calculate a percentage, but when the provider attests online there will be an area to include the exclusion. We recommend that sites refer to the CMS website for more information regarding these exclusions.

If an EP is unable to meet a Meaningful Use objective for which no exclusion is available, then that EP would not be able to successfully demonstrate Meaningful Use and would not receive incentive payments under the Medicare and Medicaid EHR Incentive Programs.

How should EPs select menu objectives for the Medicare and Medicaid EHR Incentive Programs?

EPs participating in Stage 1 of the EHR Incentive Programs are required to report on a total of five Meaningful Use objectives from the menu set of 10. When selecting their five objectives, EPs must choose at least one option from the public health menu set. If an EP is able to meet the measure of one of the public health menu objectives but can be excluded from the other, the EP should select and report on the public health menu objective they are able to meet. If an EP can be excluded from both public health menu objectives, the EP should claim an exclusion. Starting in 2014, meeting the exclusion criteria will no longer count as reporting a Meaningful Use objective from the menu set. An EP must meet the measure criteria for five objectives in Stage 1, or report on all of the menu set objectives through a combination of meeting exclusions and meeting the measures.

If the denominators for all three of the Stage 1 core clinical quality measures are zero, do I have to report on the additional clinical quality measures for EPs under the Medicare and Medicaid EHR Incentive Programs?

If the denominator value for all three of the core clinical quality measures is zero, an EP must report a zero denominator for all such core measures, and then must also report on all 3 alternate core clinical quality measures. If the denominator values for all three of the alternate core clinical quality measures is also zero, an EP still needs to report on three additional clinical quality measures. Zero is an acceptable denominator provided that this value was produced by certified EHR technology.

How do we receive credit for the Visit Reminders measure?

Preventative has to be "completed." The user will need to select "Complete" for a preventative once a patient has been reminded to schedule their visit.

Will we be able to send controlled substances electronically?

No, sending controlled substances electronically is not a requirement for Meaningful Use and cannot be done at this time.

My facility does not perform many immunizations. Do we still have to report this data?

According to the final rule, an Eligible Hospital or Critical Access Hospital may be exempt if they do not administer any of the immunizations to any of the populations for which data is collected by their jurisdiction’s immunizations registry or immunization information system during the EHR reporting period. Evident recommends each facility contact the state public health agency for confirmation of exclusion - and to request a letter of exclusion (for auditing purposes).

Where will the Meaningful Use Stage 1 and Stage 2 Statistics Report be located?

The Meaningful Use Stage 1-2011, Stage 1-2014 and the Meaningful Use Stage 2 Statistics Reports are now found under the following path: Hospital Base Menu > Other Applications And Functions > Word Processing > AdHoc Report
These new reports will now be listed under the middle column.

Does my facility still have to perform the Key Clinical Information Exchange in 2014?

Beginning in 2013, the objective for electronic exchange of key clinical information will no longer be required for Stage 1 for EPs, EHs and CAHs. CMS is moving instead to a more robust requirement for electronic health information exchange as a part of the Stage 2 objective for providing a summary of care record following a transition of care or referral.

Who can enter in medication orders to meet the measure for CPOE?

Any licensed healthcare professional can enter orders into the medical record for purposes of including the order in the numerator for the measure of the CPOE objective if they can enter the order per state, local and professional guidelines. The order must be entered by someone who could exercise clinical judgment in the case that the entry generates any alerts about possible interactions or other clinical decision support aides. This necessitates that CPOE occurs when the order first becomes part of the patient's medical record and before any action can be taken on the order. Each provider will have to evaluate on a case-by-case basis whether a given situation is entered according to state, local and professional guidelines, allows for clinical judgment before the medication is given, and is the first time the order becomes part of the patient's medical record.