1.  By phone: 1) Dial +1.213.226.1066 2) Enter conference ID: 614-290-513# Join the audio conference:  Via internet: 1) Click the phone icon 2) Click “Connect”

2. First Year of Meaningful Use in 2014 Presenters: Randy Marsden – Chief Client Officer Leo Vilenskiy – Senior Customer Support Representative Rebecca Imhoff – Special Projects Coordinator

3.  Please feel free to ask a question at any time via chat  Please include your name and what practice you are from  We will also have a Q and A session at the end of the webinar  The video of the webinar as well as the slides will be available on the Government Regulations in 2014 page on the IO Practiceware Support Website. Ask Questions

4.  Documentation sourced for this presentation is from CMS’s website  We may offer an opinion on certain items, but it is up to you how you use this information  We are you EHR provider, not consultants. For further assistance we suggest that you seek professional opinion  Attestation is your responsibility, we can assist to a certain degree Research Statement

5.  Use IO Version 8 software for 90 consecutive days.  To avoid the 2015 penalty, start using IO no later than July 1, 2014  Attest online with CMS no later than October 1, 2014  To avoid the 2016 penalty, start using IO no later that October 1, 2014  Attest online with CMS no later than February 28, 2015  Either scenario will allow you to collect the incentive.  $12,000 in 2014 per provider Deadlines, Penalties, Incentives

6.  Some measures require the entry of a denominator (such as “how many drug prescriptions you have written”) and a numerator (such as “how many of those were e- prescribed”).  Your software includes MU calculators for determining these denominators and numerators so you can enter the answers easily.  Some elements acquire attestation by a simple “Yes” or “No.” The software has easy ways to perform these tests. How attestation works

7.  Don’t wait until October, register now and start running reports  Register at anytime at https://ehrincentives.cms.gov/https://ehrincentives.cms.gov/  Run reports using Admin Utilties  After the reporting period completes, run all reports and print them out.  Submit your numbers and attestation statements on the CMS website.  Retain all records in case of an audit. Performing the Attestation

8.  Use a consultant, like Pat Morris  Phone – 888-476-2631  Email – consultant@excellenceneyecare.comconsultant@excellenceneyecare.com  Web – www.4pmcoe1.comwww.4pmcoe1.com  She will assist with the steps mentioned before Another Alternative

9.  Report on all 14 core measures  Report on 4 of 8 menu measures  Report on 1 of 2 public heath menu measures  Exclusions are available for certain measures. You may apply for exclusions only if there aren’t other options available. What is required during the reporting period

10. Eligible Providers Must Do All 14 Core Measures 1Use CPOE for medication orders 2Implement Drug-drug and drug-allergy interaction checks 3Maintain an up-to-date problem list of current and active diagnoses. 4Generate and transmit drug prescriptions electronically (e-Rx) 5Maintain active medication list 6Maintain active medication allergy list 7Record demographics (preferred language, gender, race, ethnicity, date of birth) 8Record and chart changes in vital signs (Height, Weight, Blood pressure, Calculate and display BMI, Plot and display growth charts for children 2-20 years, including BMI) 9Record smoking status for patients 13 years or older 10Report ambulatory clinical quality measures to CMS or the States 11Implement one clinical decision support rule relevant to specialty or high clinical priority along with the ability to track compliance of that rule. 12Provide patients with an electronic copy of their health information (including diagnostic test results, problem list, medication lists, medication allergies), upon request 13Provide clinical summaries for patients for each office visit 14Protect electronic health information created or maintained by the certified EHR technology through the implementation of appropriate technical capabilities MU Stage 1 Core Measures

11. Use CPOE for medication orders Description  Record more than 30% of medication orders electronically using CPOE. What to do in IO  Prescribe medications using the Rx button from IO’s Plan screen  We only allow CPOE and will not count non-CPOE.  Exclusion: Providers who write fewer than 100 medication orders annually.

12. Implement Drug-drug and drug- allergy interaction checks Description  The provider has enabled this functionality. What to do in IO  Use IO’s e-Prescribing feature. Interactions are triggered on the e-Rx NewCrop screens.  If you do not use NewCrop, you must verify this functionality with your other provider.

13. Maintain an up-to-date problem list of current and active diagnoses. Description  More than 80% of distinct patients seen have at least one entry or an indication that no problems are known for the patient recorded as structured data. What to do in IO  Document your findings in IO in the yellow boxes on the lower left hand side of the main exam screen, just as you always do.  Note: typed findings do not count toward this measure.

14. Generate and transmit drug prescriptions electronically (e-Rx) Description  More than 40% of all permissible prescriptions written by the provider are transmitted electronically using certified EHR technology. What to do in IO  Send all medication prescriptions other than controlled substances and custom drugs electronically. If you routinely send your prescriptions electronically you won’t have to worry about the 40%.  If you do not use NewCrop, you must verify this functionality with your other provider.

15. Maintain active medication list Description  More than 80% of distinct patients seen by the provider have at least one entry (or an indication that the patient is not currently prescribed any medication) recorded as structured data. What to do in IO  Enter the patient’s current medications in the blue meds box on the main exam screen. Prescribe medications from the Rx button on the Plan screen. Medications entered as notes do not count towards this measure.

16. Maintain active medication allergy list Description  More than 80% of distinct patients seen by the provider have at least one entry (or an indication that the patient has no known medication allergies) recorded as structured data. What to do in IO  Enter patient allergies in the red allergies box on the main exam screen. If the allergy is not on the short list under the big buttons, use the Search for Allergens button. If the patient has no allergies you will be prompted to confirm this each time the Checkout button is pressed. Allergy notes do not count towards this measure.

17. Record demographics Description  More than 50% of distinct patients seen by the provider have demographics recorded as structured data.  Demographics Include:  Preferred Language  Gender  Race  Ethnicity  Date of Birth What to do in IO  In the Patient Info screen, enter the 5 required items (listed to the left)  The software is currently set to required this information before the patient checks in. This can be changed from the Admin main screen. Select Setup, Interface Configuration and the check box “MU Checkin.”  Declined to specify is acceptable

18. Record and chart changes in vital signs Description  More than 50% of all unique patients seen have blood pressure (for patients age 3 and over only) and height and weight (for all ages) recorded as structured data.  Possible exclusions:  You saw no patients 3 y/o or older  All the vital signs have no relevance to you  BP has no relevance to you  Height and weight has no relevance to you What to do in IO  We suggest that you claim an exemption for this measure – which you can do if you believe that vital signs have no relevance to the scope of your practice or if you do not see patients age 3 or over (exclusion 2 is the most likely exclusion for ophthalmologists).  Otherwise, record blood pressure using the Blood Pressure exam element. Document height and weight using the Height and Weight exam element. Record BMI by pressing the Calculate BMI button in the Height and Weight Exam element. Display growth charts by pressing the Growth Charts button.

19. Record smoking status for patients 13 years or older Description  More than 50% of distinct patients (age 13 and up) seen by the provider have smoking status recorded as structured data. What to do in IO  Record smoking status at least once in the reporting period using the exam element “Smoking”. You will be reminded to enter Smoking status once per calendar year.  For easy access, we have added this exam element as a favorite exam element for those in the practice who will collect this information.

20. Report ambulatory clinical quality measures to CMS or the States Description  Provide aggregate numerator and denominator through attestation as discussed in section 11(A)(3) of this proposed rule. What to do in IO  To qualify for this measure, you will use the Meaningful Use utility in the Admin Utilities area of IO.

21. CQM Measures IO Supports DomainMeasures Care CoordinationClosing the Referral Loop; receipt of specialist report CMS #50 / NQF #TBD Clinical Process/EffectivenessDiabetes: Eye Exam CMS #131 / NQF#55 Cataracts: 20/40 or Better Visual Acuity within 90 Days following Cataract Surgery CMS #133 / NQF #565 Diabetic Retinopathy: Communication with the Physician Managing Ongoing Diabetes Care CMS # 167 / NQF #88 Diabetic Retinopathy: Communication with the Physician Managing Ongoing Diabetes Care CMS # 142 / NQF #89 Primary Open Angle Glaucoma (POAG): Optic Nerve Evaluation CMS #143 / NQF# 86 Controlling High Blood Pressure CMS #143 / NQF #86 Patient SafetyCataracts: Complications within 30 Days Following Cataract Surgery Requiring Additional Surgical Procedures CMS #132 / NQF #564 Use of High Risk Medication in the Elderly CMS #156 / NQF #22 Documentation of Current Medications in the Medical Record CMS #68 / NQF #419 Population and Public HealthPreventative Care and Screening: Tobacco and Cessation Intervention CMS #138 / NQF #28 Preventative Care and Screening: Body Mass Index (BMI) Screening and Follow Up CMS #138 / NQF #28

22. **You are required to report CQMs for 2014**  You can either report CQMs for the entire year or the 90 days of your MU reporting period **Reporting for the entire year will satisfy PQRS as well**  You can report CQM data either electronically or by attesting on the CMS Registration and Attestation System CQMs and Your First Year

23. Implement one clinical decision support rule relevant to specialty or high clinical priority along with the ability to track compliance of that rule. Description  Implement one clinical decision support rule. What to do in IO  Clinical decision support rules are set up in the Admin Utilities, Clinical Decision Support area of IO. Rules can be set up and alerts created based on patients’ established diagnoses, medications, demographics and lab test results. The alerts are triggered on opening the highlights screen or when entering an exam element.  We have set up one alert for your practice: If a patient’s IOP is under 9 or over 21 an alert will appear on the highlights screen.

24. Patient Electronic Access Description  Provide timely access to more than 50% of patients to view, download, and transmit their health information within 4 business days. What to do in IO  You must have patient portal purchased and enabled prior to your reporting period. Use Transmit Clinical Files to send the health information to the patient portal daily. This can be automated.  Exclusions: Provider who doesn't create information other than patient name and provider's name and office contact info.

25. Provide clinical summaries for patients for each office visit Description  Provide clinical summaries to patients for more than 50% of all office visits within 3 business days. What to do in IO  There are 3 ways to comply with this measure:  ClinicalSummary form in Miscellaneous Letters. You can generate this form for your office visits from the checkout window, or print them in bulk at the end of the day and mail to your patients.  You can turn on auto-printing so that the patient’s chart will print at the end of every visit and can be given to the patient. To turn on auto-print, from the Admin main screen, go to Set up, Interface Configuration, click the checkbox Print Chart and press Done to save. This must be done at each practice location. This will waste lots of paper as some patients will not want their clinical summaries. However, having to print clinical summaries on demand will waste lots of time.  Transmit automatically to the patient portal.

26. Protect electronic health information created or maintained by the certified EHR technology through the implementation of appropriate technical capabilities Description  Conduct or review a security risk analysis per 45 CFR 164.308 (a)(1) and implement security updates as necessary and correct identified security deficiencies as part of its risk management process. What to do in IO  Analyze your practice’s security practices under HIPAA. Identify and correct any problems identified. IO’s security measures are listed in the Mu Memo, but the overall security plan for your practice should be discussed with your network vendor and your HIPAA privacy officer.

27. Eligible providers must do 5 of the following 10 menu measures 1Implement drug formulary checks 2Incorporate clinical lab-test results into EHR as structured data 3Generate lists of patients by specific conditions to use for quality improvement, reduction of disparities, research or outreach 4Send reminders to patients per patient preference for preventive/ follow up care 5Provide patients with timely electronic access to their health information (including lab results, problem list, medication lists, medication allergies) within four business days of the information being available to the provider 6Use certified EHR technology to identify patient-specific education resources and provide those resources to the patient if appropriate 7Perform medication reconciliation for patient received from another care setting or provider or believes an encounter is relevant 8Provide summary of care record for each transition of care or referral YOU MUST ATTEST TO MENU MEASURE 9 OR 10! BECAUSE OPHTHALMOLOGISTS DO NOT ADMINISTER IMMUNIZATIONS OR COLLECT SYNDROMIC INFORMATION, TAKING THE EXCLUSION IS OK – EXCLUSION COUNTS AS PERFORMANCE. 9Capability to submit electronic data to immunization registries or immunization Information Systems and actual submission in accordance with applicable law and practice 10Capability to submit electronic syndromic surveillance data to public health agencies and actual submission in accordance with applicable law and practice. MU Stage 1 Menu Measures

28. *Implement drug formulary checks Description  The provider has enabled this functionality and has access to at least one drug formulary. What to do in IO  Use IO’s e-Prescribing feature. Drug formulary is accessed on the NewCrop screens.

29. Incorporate clinical lab-test results into EHR as structured data Description  More than 40% of all clinical lab tests results ordered by the provider during the EHR reporting period whose results are in either a positive/negative or numerical format are incorporated in certified EHR technology as structured data. What to do in IO  If during the EHR reporting period you ordered no clinical lab tests whose results are expressed in a positive/negative or numeric format, you should apply for an exclusion to this measure. To attest to this exclusion select “NO” next to the appropriate exclusion, then click the APPLY button.

30. *Generate lists of patients by specific conditions to use for quality improvement, reduction of disparities, research or outreach Description  Generate at least one report listing patients of the provider with a specific condition. What to do in IO  From the IO Admin main screen, select Pending Transactions and then Patient Lists/Reminders.  Select your criteria from the list on the left.  Press the magnifying glass icon at the bottom of the screen to generate the list.  Clear the criteria by pressing the icon with circling arrows.  Exit the report screen by pressing the icon with the red arrow.

31. *Send reminders to patients per patient preference for preventive/ follow up care Description  More than 20% of distinct patients 65 years or older or 5 years old or younger were sent an appropriate reminder during the EHR reporting period. What to do in IO  The front desk records patient preference for receiving recalls on the Patient Info screen using the How To Contact box. Contact types are set up by going to the Admin Setup screen, selecting Codes, ContactType, Create a new code, entering the type in the Reference Code box and pressing Done to save.  Order return visits for all patients using the Schedule Appointment button on the Exam’s Plan screen.  Recalls are automatically generated based on clinician order.  Transmit these recalls by email, paper mail (in-house or through an outside mailing service) or telephone.  Compliance is measured by comparing all pending and sent recalls to recalls sent during the reporting period.  Patient reminder lists with communication preference can also be generated based on demographic, appointment and clinical data from Pending Transactions, Patient Lists/Reminders.

32. View, download, transmit (Patient use) Description  At least 5% of your patients viewed, downloaded, or transmitted their health information What to do in IO  Your patients must actually use the portal. When they log-in, they are counted.  Exclusions: Providers who don't create information other than patient name and provider's name and office contact info. 2. Or providers who conduct 50% or more encounters in a county that doesn't have 50% or more of housing units using 3Mbps broadband.

33. Use certified EHR technology to identify patient- specific education resources and provide those resources to the patient if appropriate Description  More than 10% of distinct patients seen by the provider during the EHR reporting period are provided patient- specific education resources. What to do in IO  Set up educational materials under the Written Instructions button on the Plan screen.  From the exam Plan screen, press Written Instructions to order educational material for patients for printing either from the clinical software or at admin checkout.  Print material and give to patient.  Patient education material for medications is available from the e-Prescribing interface. Click the magnifier in the right column of any current or pending medication and you will be able to print monographs and leaflets.  Make sure to document any educational material given to the patient by pressing the Written Instructions button in the Plan so we can calculate your compliance with this measure. Using a note to document educational material given to a patient will not be captured when we calculate percentage compliance.

34. *Perform medication reconciliation for patient received from another care setting or provider or believes an encounter is relevant Description  Reconcile medications for more than 50% of patients transitioned to the care of the provider. What to do in IO  Do nothing if you do not receive any transitions of care during the EHR reporting period.  Otherwise, Scan in the list of medications received from the referring facility.  Open the scanned document, resize the image so you can see the medications entered in IO and the meds on the scanned document.  Compare the medications on each list, discuss any discrepancies with the patient, and make any necessary corrections.  Document the reconciliation by pressing the buttons Transition of Care and Performed in the Med Reconciliation exam element.  You can add any other relevant information by adding a note to the exam element.  You can also document meds reconciliation with an established patient if the provider deems it relevant by pressing the Relevant Encounter button. Relevant encounter reconciliations do not count towards compliance of the meaningful use measure.

35. *Provide summary of care record for each transition of care or referral Description  Provide a summary of care record for more than 50% of transitions of care or referrals made by the provider What to do in IO  Do nothing if you do not refer a patient to another provider or transfer care to another setting during the EHR reporting period. When attesting, select NO next to the appropriate exclusion and click APPLY to attest that you have not referred a patient to another provider or transferred care to another setting during the reporting period.  Otherwise: To calculate compliance with this measure, IO will use as the denominator all visits where one of the following Plan buttons has been selected:  Refer Patient to Another Physician  Send a Consultation Letter (and the letter type has the word “Refer” in it)  Clin Summary, Refer or Transition Care  No Clin Summ, Refer or Transaction Care  For the numerator, IO will count the patients where one of the first three plan items has been selected and exclude patients where No Clin Summ has been selected.  If you document referrals or transitions of care using a note, IO will not be able to calculate compliance.  The summary of care must include at a minimum: diagnostic test results, problem list, medication list and medication allergy list. You can generate a summary of care in several ways.  Send a consultation letter.  Send a print out of the patient’s chart.  Generate and send a CCD (Continuity of Care Document).

36. **Capability to submit electronic data to immunization registries or immunization Information Systems and actual submission in accordance with applicable law and practice Description  Perform at least one test of certified EHR technology’s capacity to submit electronic data to immunization registries and follow up submission if the test is successful (unless none of the immunization registries to which the provider submits such information have the capacity to receive the information electronically). What to do in IO  If you administer no immunizations during the EHR reporting period, select NO next to the appropriate exclusion and click the APPLY button.

37. **Capability to submit electronic syndromic surveillance data to public health agencies and actual submission in accordance with applicable law and practice. Description  Perform at least one test of certified EHR technology’s capacity to provide electronic syndromic data to public health agencies and follow-up submission if the test is successful (unless none of the public health agencies to which a provider submits such information have the capacity to receive the information electronically). What to do in IO  Do nothing if you do not collect any reportable syndromic information on your patients during the EHR reporting period. To attest you did not collect any reportable information during the reporting period, select NO next to the appropriate exclusion and click APPLY to attest.

38.  No only what you do after the reporting period.  What you should do  Register for the program  You can register online at any time  Run reports Regularly  From day 1 of your reporting period you can run reports in IO.  If you are not getting the required results:  You have misunderstood the requirement  You have documented in a way we did not anticipate and therefore could not calculate How to Attest for Meaningful Use

39.  What you should do  Submit your attestation  Use the same website you registered at  It takes about 30-60 minutes per provider  IMPORTANT ** The module will ask for an IO Certification Number. The number you need to enter is : 01102014‐2357‐8  Prepare for an audit  Audits are happening and are unavoidable.  Print your reports from IO as you run them.  Preparing in advance and notifying IO will immediately will ensure that you will make it through successfully. How to Attest for Meaningful Use

40.  Overview of Government Programs in 2014 (Recorded 2/12/14) DownloadDownload  Beyond the First Year of MU in 2014 PQRS and CQM (To be recorded again) Suggested Webinars