Objectives

When will your software be ready for Meaningful Use Stage 2?

Evident certified our EP software to meet 2014 Meaningful Use certification in 2013.

Is there an audit log we can run to see how often patients are logging into the Patient Portal?

There will be an audit log incorporated into the Version 1900 software for the View, Download & Transmit core objective for Stage 2.

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.

How should EPs select Stage 2 menu objectives for the Medicare and Medicaid EHR Incentive Programs?

EPs participating in Stage 2 are required to report three Meaningful Use objectives from the menu set of six. 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 three objectives in Stage 2, or report on all of the menu set objectives through a combination of meeting exclusions and meeting the measures.

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.

For Stage 2, what are the changes for CPOE measures?

In Stage 2, CPOE for medication order entry threshold has been increased to 60%, and CPOE laboratory and radiology orders have been added with a threshold of more than 30% orders recorded in a Certified EHR Technology (CEHRT).

Do I have to have an interface for Quality Measures in Stage 2 of Meaningful Use?

No – Initially, CMS indicated plans to require electronic submissions for Clinical Quality Measure (CQM) data but no specifications were provided and the electronic submission requirement was later retracted. The current process for submitting Quality Measures remains acceptable. More information is available on the CMS website.

Why do we have to see the Drug Formulary checks for every prescription? Can we turn this off?

No, this cannot be turned off. This is a requirement for Stage 2 and it is also a requirement of SureScripts. The EHR must check every possible prescription for the existence of a relevant formulary.

Will we still be able to enter "UTR" if we are unable to read certain vital signs for a patient?

Users will no longer be able to add alpha characters within the height, weight and blood pressure field. According the Stage 2 specification sheet for Recording Vital Signs, the only information required to be inputted by the provider is the height and weight, and/or blood pressure of the patient. The certified EHR technology will calculate the BMI and growth chart is applicable to a patient based on age.

Will the path to make changes to the clinical monitoring checks remain the same for Stage 2?

The path to edit the clinical monitoring checks will remain within Table Maintenance for Stage 2.

Will the reporting for Drug-Drug and Drug-Allergy Interaction Checks become more detailed for Stage 2?

Yes, reporting for Drug-Drug and Drug-Allergy Interactions Checks become more detailed in Stage 2. Sites must attest that severity level intervention checks are adjustable by users with the appropriate privileges.

Will Evident initially set up the parameters for the Drug-Drug and Drug-Allergy Interaction Checks, or is this something that sites will be responsible for?

The sites will be responsible for this setup.

Will users have to select a Destination when selecting "No Active Meds" to receive credit?

Yes, users must first select a Destination with Medication Reconciliation (i.e. Clinic Discharge) before selecting "No Active Meds" to receive credit within the numerator on the statistics report.

If a provider gets the Clinical Decision Support (CDS) alert, how can they let the nurse know?

Typically the alert is sent to the person that needs to take action upon the alert. If the nurse needs to perform an action for an alert, the nurse can subscribe to that alert and receive it instead of the provider. Or the alert can be sent to both and just be informational for the physician. Some of the alerts that are triggered at account creation will remove themselves as the nurse records the missing information. Each alert is different and can be subscribed to independent of the others.

Will users be able to adjust what information is viewable on the Continuity of Care Document (CCD) for a patient?

Yes, EPs will be able to adjust what information is made viewable on the Continuity of Care Document (CCD) for a patient. According to the Stage 2 Clinical Summaries objective, "If an EP believes that substantial harm may arise from the disclosure of particular information, an EP may choose to withhold that particular information from the clinical summary."

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).

Is there a certain amount of Family Health History that must be entered per patient?

There are no parameters to the amount of Family Health History that must be entered. The Stage 2 Specification Sheet for the Family Health History objectives states that the measure is a minimum and not a limitation to the amount of health history that can be recorded.

What happens if a patient is unable to provide any Family Health History?

There will be an option for the user to select No Known Family History. According to the Stage 2 objective for Family Health History, "For patient who are asked about their family health history, but do not know their family history, it is acceptable for the provider to record the patient's family history as 'unknown'."

Is there an option for No Known Family History?

Yes, the user will be able to mark "No Known Family History" within the Family Health History application. According to the Stage 2 objective for Family Health History, "For patient who are asked about their family health history, but do not know their family history, it is acceptable for the provider to record the patient's family history as 'unknown'."

Will patient lists be created through AdHoc reports?

Yes, Evident has programmed functionality to create patients lists within the Report Dashboard in order to comply with the Stage 2 Patient Lists objective.

Will patient lists have to be gathered through multiple reports or can this information be generated in an all-inclusive report?

Users can run one all-inclusive report that can pull information from existing templates. Users will also have the ability to exclude certain patient demographic information.

What happens if a patient declines the copy of their summary?

According to the Stage 2 objective for Clinical Summaries, "in the event that a clinical summary is offered to and subsequently declined by the patient, that patient may still be calculated in the numerator." There will be a field incorporated in the MP-EHR visit screen that will allow a user to enter whether or not a patient accepted a copy of their clinical summary.

Will the medications section be improved within the Continuity of Care Document (CCD)?

Yes, the medications section has been improved from the original Continuity of Care Document (CCD). Discontinued medications do not default to pull to the CCD but can be included if the user chooses. Information within the CCD is listed in a table format, making it much easier to read. Medications are no longer listed by the date that they were entered.

How will the provider be notified that they have a message from a patient?

The provider will receive a notification icon on their home screen that there is a message from a patient. Selecting the icon will launch the provider into the message screen to address the patient's message. If there is more than one message, the provider will be taken to the account list screen. In this screen, visits with messages attached to them will appear. The visits in bold will indicate there are new messages on this visit. Visits with messages will remain on the account list until deleted by the provider.

How will the patient be notified that they have received a response from the provider?

Patients will log in to their Patient Portal accounts and access the Message Center. The patient should see their name and list of patients for whom the patient is an authorized representative. There will be an icon with a numeric indicator showing how many messages are in the patient's inbox.

Can the CCD be downloaded to a flash drive or CD?

Yes, the Continuity of Care Document (CCD) will be able to be exported to a flash drive or CD. The Clinical Summaries objective can be met through one of these methods, or by printing the summary or making it available through the Patient Portal.

What if the patient does not have the means to electronically access Clinical Summaries?

Per the Stage 2 Specification Sheet for Clinical Summaries, sites must provide paper copies of the clinical summaries to patients upon request.

Will each provider be required to see Clinical Decision Support (CDS) interventions?

Yes, each provider will be required to have a minimum of five Clinical Decision Support (CDS) interventions activated during the entire reporting period.

Who will be maintaining the information within each of the interventions?

After the initial setup, it will be the site's responsibility to keep each intervention up to date. The websites that the users are being launched to will not be able to be changed due to the National Quality Forum (NQF) that is attached to the intervention.

How is it determined what users will be able to receive and view alerts?

This is part of the behavior and role setup in security. ( ie: Physicians Group vs. Nursing Group)

Can everyone be setup to view the "More Information" button?

Yes, this is also part of the role setup in security.

Does my facility have to perform a security risk analysis for Meaningful Use Stage 2?

As with Meaningful Use Stage 1, each facility will have to review or conduct a security risk analysis of the certified EHR prior to the end of the reporting period. A new review must occur for each subsequent reporting period. Parameters of the risk analysis are defined in 45 CFR 164.308(a)(1) created by the HIPAA Security Rule.

I see there are multiple objectives that are not listed for Meaningful Use Stage 2, that were required with Meaningful Use Stage 1. Does my facility have to continue the Stage 1 objectives?

Yes, there are some Meaningful Use Stage 1 objectives that have been incorporated into Meaningful Use Stage 2 objectives. In order to meet the new Stage 2 objectives, the previous Stage 1 objectives must be met.

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.

For Stage 2, can Drug-Drug and Drug-Allergy interaction checks count toward the five required clinical decision support interventions?

No. The final rule states that in order to meet the Clinical Decision Support objective, Drug-Drug and Drug-Allergy interactions have to be turned on for the entire reporting period in addition to four clinical support interventions related to four or more clinical quality measures.

The Imaging menu object reads as follows: “Imaging results consisting of the image itself and any explanation or other accompanying information are accessible through Certified EHR Technology.” What does “accessible through Certified EHR Technology” mean?

According to CMS, “accessible through Certified EHR Technology” is defined as either incorporation of the image and accompanying information into Certified EHR Technology, or as an indication in Certified EHR Technology that the image and accompanying information are available for a given patient in another technology with a link to that image and accompanying information.

What elements should our facility be documenting on the summary of care for Meaningful Use?

Recently, we have been provided with the following correspondence from CMS. While problems, medication list  and medication allergy list are the key components to populate the numerator of the summary of care measure, CMS now states they will be looking for the CCD to have all of the below elements populated below, if known.  If your facility has attested, Evident recommends that your facility reviews all of the patients in your attestation period contained in the numerator, and make sure the data elements below are documented If known, since this information has recently been made available to us.

We apologize for any inconvenience this FAQ has caused but want to make sure you are aware of recent CMS information. Please also note that any FAQs that are released after the final rule are regarded as “sub-regulatory guidance” by CMS and must be followed within a reasonable amount of time. CMS also communicates the updated FAQs to auditors who utilize the information for  Meaningful Use audits.

FAQ response from CMS: 

Thank you for your recent inquiry. Below is the information you requested regarding the meaningful measures for transitions of care. Our response focuses on the measure for eligible hospitals (EHs), but the eligible professional (EP) measure is essentially the same.

As adopted by CMS, the Stage 1 and Stage 2 objectives require hospitals that transition their patient to another setting of care or provider of care or refer their patients to another provider of care (including long-term care) to provide a summary care record for more than 50 Percent or transitions of care and referrals.

For the Stage 1 measure, CMS did not specify the contents of the summary of care record. While the hospital can send an electronic or paper copy of the summary care record directly to the next provider or can provide it to the patient to deliver to the next provider, if the patient can reasonably expected to do so. However, beyond the CMS requirements, in order to meet this objective and its measures, the hospital must use the capabilities and standards of certified EHR technology (CEHRT) established by the Office of National Coordinator for Health IT (ONC), specifically, the standards found at 45 CFR 170. 205(a)(1) and (2). The ONC has defined the content of a summary of care record to include at a minimum, diagnostic results, problem list, medication list, medication allergy list, and procedures.

For the Stage 2 measure, CMS specifies that the summary of care record must include the following elements:
* 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.
* Discharge instructions
* Current problem list (Hospitals may also include historical problems at their discretion).
* Current medication list, and
* Current medication allergy list.

If the provider does not have the information available to populate one or more of the fields listed, either because they can be excluded from recording such information (for example, vital signs) or because there is no information to record (for example, laboratory tests), the provider may leave the field(s) blank. The only exception to this is the problem list, medication list, and medication allergy list. In the event that there are no current or active diagnoses for a patient, the patient is not currently taking any medications, or the patient has no known medication allergies, confirmation of no problems, no medications, or no medication allergies would satisfy the measure of this objective. In circumstances where there is no information available to populate one or more of the fields listed previously, either because the eligible hospital or CAH can be excluded from recording such information (for example, vital signs) or because there is no information to record (for example, laboratory tests), the eligible hospital or CAH may leave the field(s) blank and still meet the objective and its associated measure.

Beyond the CMS requirements, in order to meet the Stage 2 objective and its three measures, the hospital must use the capabilities and standards of certified EHR technology (CEHRT) established by the Office of National Coordinator for Health IT (ONC), specifically, the standards found at 45 CFR 170.314(b)(2), (g)(1), (g)(2). The ONC has defined the content of a summary of care record to include “at a minimum, the Common MU Data Set and the following data expressed, where applicable, according to the specified standard(s):
(A) Encounter diagnoses. The standard specified in § 170.207(i) or, at a minimum, the version of the standard specified § 170.207(a)(3);
(B) Immunizations. The standard specified in § 170.207(e)(2);
(C) Cognitive status;
(D) Functional status; and
(E) Ambulatory setting only. The reason for referral; and referring or transitioning provider’s name and office contact information.
(F) Inpatient setting only. Discharge instructions.”

For further information regarding the certification and standards criteria, you should contact the ONC at: 
• (202) 690-7385;
• E-mail: onc.request@hhs.gov; or
• Visit its Web site at http://healthit.hhs.gov.

The purpose of providing the summary of care records is to assure that the provider to whom the patient is transferred or referred obtains the  most recent information on the patient that may be crucial to his/her care.  A summary of care record that does not include the required contents as defined by the ONC could not be counted in the numerator of the measure.

The tracking number for this inquiry is 330002. If you have further questions, please visit the CMS Medicare & Medicaid EHR Incentive Programs Website located at http://cms.gov/EHRIncentivePrograms/. You will find accurate and up-to-date information about the programs, including eligibility, payment amounts, requirements, upcoming events and more. Bookmark the above link and check back often to learn more about these programs, or contact the EHR Information Center at (888) 734-6433.

The Medicare and Medicaid EHR Incentive Programs listserv provides timely, authoritative information about the programs, including registration and attestation updates and details about the payment process. The listserv messages are another CMS resource to provide you with the latest news about the Incentive Programs. On average, two messages are sent per week. Information on how to join the listserv can be found at http://www.cms.gov/Regulations-and-Guidance/Legislation/EHRIncentiveProg....

Thank you,

The EHR Information Center

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.