Configuring axiUm for Meaningful Use

Configuring axiUm for Meaningful Use
Lauralynn Mealing, axiUm Consultant Paul Delicana, Business Analyst

Meaningful USE (MU) List of measures that dictate how to use an EHR
Goal is to get Providers to use EHRs meaningfully Complete and accurate information Better access to information Patient Empowerment An Overall Improvement in Patient Care

MU Incentive Programs Medicare EHR Incentive Program
Total maximum incentive amount of $24,000 Medicaid EHR Incentive Program Total maximum incentive amount of $63,750 Last year to receive incentive payments is 2021 State Run 6 Year program (non-continuous) Last year to Join the program is in 2016 Last year to receive Incentive Payments is in 2021

MEDICAID INCENTIVE PROGRAM
Year Requirement for Incentive Payment Incentive Reporting Period 1 Adopt, Implement or Upgrade (AIU) $21,250 N/A 2 STAGE 1 Meaningful Use $8,500 90 Days 3 STAGE 2 Meaningful Use Full Year 4 5 STAGE 3 Meaningful Use 6 Total Incentive of $63,750 over 6 years PER Provider Example change in difficulty in stage 2 Need about 9 EP’s for year 1 to pay for the purchase price of the software.

BEFORE YEAR 1 Register to an Incentive Program
Can only register for one incentive program Eligibility Requirements Must be a Dentist More than 10% of Dentist’s appointments in a non-hospital setting More than 30% of Dentist’s appointments with Medicaid Patients Medicaid Patient Volume Requirement

Medicaid Patient volume
90 day period in the previous Year Three ways to calculate # of appointments the Providers had # of appointment the Providers had and Start-Checked # of appointments in the entire clinic Group Registration Can use as a proxy for the Providers Patient volume Only if it is appropriate for the EP

axium Certification axiUm CE Certification What is a Certified EHR ?
Valid for axiUm 5.3 CE What is a Certified EHR ? Guarantee that the EHR has the functionality to support the measures of MU Certified EHR(EHR Functionality) ≠ Meaningful Use (Reporting) Certified EHR + a configured system (included reports) can collect complete data sets measured for MU MU encompasses the calculations and reports of MU measures Certified EHR + Meaningful Use = Standard package to qualify for entire incentive amount (Not just Yr 1) Axium 5.10 through 5.2 are able to produce reports to attest to stage 1

axiUm 5.3 CE

MEDICAID INCENTIVE PROGRAM
Year Requirement for Incentive Payment Incentive Reporting Period 1 (2013) Adopt, Implement or Upgrade (AIU) $21,250 N/A 2 (2014) STAGE 1 Meaningful Use $8,500 90 Days Once a provider has registered for an EHR Incentive program they are referred to as an “Eligible Professional” an EP Eligible to receive Incentive payments if they meet the requirements for the incentive year

Mu DASHBOARD

CORE/MENU MEASURE overview

Meaningful USE CRITERIA
List of measures that dictate how to use an EHR Three Types of Measures Core Measures The threshold for all these measure have to be met Menu Measures Threshold for only SOME of there measures have to be met Clinical Quality Measures (CQMs) No Threshold has to be met Examples of each type

Meaningful USE CRITERIA
The Core/Menu Measures change at each stages Stage 1 to 3 gets progressively more difficult CQMs stay the same Stage 1 Meaningful Use Measures 14 Core Measures 5 out of 10 Menu Measures (7 to choose from) 9 out of 64 CQM (15 to choose from)

Stage 1 Core Measures Measure # Description aixUm area CORE 1
CPOE for Medication orders eRx CORE 2 Drug Interaction Checks CORE 3 Maintain Problem List CORE 4 e-Prescribing CORE 5 Active Medication List CORE 6 Active Medication Allergies List CORE 7 Record Demographics Patient Card PAUL: WHAT IS THE DIFFERENCE BETWEEN CORE 1 AND CORE 4 Core 1 – Computerized Provider Order Entry Same work flow as Core 4 This counts the prescriptions that were sent and NOT sent through eRx Core 4 – e-Prescribing (eRx) This only counts the prescriptions that were sent through eRx

Stage 1 Core Measures Measure # Description aixUm area CORE 8
Record Vitals EHR Form CORE 9 Record Smoking Status Alerts Tab CORE 10 Clinical Quality Measures * Varies CORE 11 Clinical Decision Support CDS intervention CORE 12 Electronic Copy of Information EHR CORE 13 Clinical Summaries Patient Attachment CORE 14 Protect Electronic Information axiUm NOTE CORE 14 is labelled 15 in our pack (was 15 – Core 13 was removed by Gov) Each Core Measure/Menu has Certification Criteria Attestation requirements Attestation Answers Yes – to having complied with the measure No – Not Numerator/Denominator > Percentage Exclusion (some) eg less than 100 prescriptions - excluded

Implemented MENU Measures
Stage 1 Menu Measures Implemented MENU Measures MENU 1 Drug Formulary Checks eRx MENU 3 Patient Lists Infomanager MENU 4 Patient Reminders Contact Notes MENU 5 Patient Electronic Access Patient Card MENU 6 Patient-specific Education Resources EHR MENU 7 Medication Reconciliation MENU 9 Immunization Registries EHR (Excluded) LL- to fix table and remove rows.

Record demographics CORE 7 (of 14)
MEASURE More than 50% of patients seen have demographics recorded Preferred language/Gender/Race/Ethnicity/DOB ATTESTATION Percentage must be more than 50% Percentage NUMERATOR: Number patients who have all demographic elements (or a specific exclusion if patient declined to provide one or more elements or if recording element is contrary to state law) recorded DENOMINATOR: Number of unique patients seen by the EP during the EHR reporting period. NOTE EPs are NOT required to communicate with patient in preferred language in order to meet this objective! WTH!?

Patient card, personal tab (Core 7/14)
Make these field required for Pt Status.

Patient card, personal tab (Core 7/14)
These are additional Images if you need it

Patient electronic access menu 5 (of 10)
MEASURE At least 10% patients provided timely electronic access to health information Available within 4 business days of being updated Patient Access ATTESTATION Percentage must be more than 10% Exclusion Provider does not need information contained in the problem list, medication lists and medication allergy lists PAUL: WILL THIS MENU ITEM ALWAYS BE AN ATESTATION? -Yes… what I mean by attestation is what they have to report to received MU funding In this case given the numerator and denominator values below.. That fraction must be more than 10% for them to get funding Percentage NUMERATOR: Number of patients who have timely (available within 4 business days of being updated) electronic access to health information online. DENOMINATOR: Number of patients seen during reporting period. Exclusion EPs must select NO then click APPLY button to attest

MU Dashboard (menu 5/10)

clinical decision support (CDS) CORE 11 (of 14)
MEASURE Implement one clinical decision support rule EHR functionality that gives a provider general and person-specific information, intelligently filtered and organized, at appropriate times, to enhance health and health care. ATTESTATION Yes/No Clinical Decision Support just means that the EHR will notify the provider of relevant patient information at appropriate times to enhance the decision making capabilities of the provider. You just have to attest Yes for this measure.

We’ve added a new CDS Interventions feature in aixUm 5.3 to support the this measure. Basically Users will be able to create interventions that will look at patient data and pop-up customizable messages to the user. These Interventions can be triggered on a timer or specific action such as selecting a patient. These interventions can be configure to only pop-up for specific users

Close up of the Clinical Intervention Pop-up (This one is about reviewing the Medical Problem List) You can close the intervention by clicking on Dismiss

The set-up of a CDS Intervention is similar the set-up of a status bar indicator. You need the name of a SQL function and the intervention message that will be shown to the user. On the left is the list specific actions that you can be selected to trigger an intervention.

Mu dashboard (menu 5/10)

Drug FormULaRy Checks Menu 1 of (10)
MEASURE The EP has enabled and access to at least one formulary ATTESTATION Yes/No Exclusion EP Writes Fewer than 100 prescriptions Attestation Yes to having functionality enabled Exclusion Enter 0 in exclusion box

Erx (menu 1/10) This is what the provider will see with Drug Formularies Turned on RED NF – The Drug is Not on Formulary BLUE F – The Drug is on Formulary

Mu dashboard (Menu 1/10)

drug interaction checks CORE 2 (of 14)
MEASURE Drug – drug & drug – allergy interaction checks are enabled for entire reporting period Use eRx ATTESTATION Yes/No

eRx (Core 2/14) LL – add heading for screen shot

Mu dashboard (core 2/14)

CPOE for Medication ORDERS CORE 1 (of 14)
MEASURE More than 30% all unique patients have at least 1 medication order CPOE (Computerized Provider Order Entry) entered ALTERNATIVE MEASURE More than 30% all prescriptions created by the EP were recorded using CPOE ATTESTATION Percentage must be more than 30% Exclusion EP Writes Fewer than 100 prescriptions PAUL: IS IT FEWER THAN 100 PRESCRIPTIONS IN THE 90 REPORTING PERIOD? This depends on the eligible provider (EP) some will definitely write less than 100 prescriptions others EP will write more than 100 If they do write less than 100 then it will show that the EP is excluded in the Dashboard (see next slide) Measure New 2013 onwards optional alternative more than 30% of orders created May select either measure for this objective in Stage 1 Will be required for all providers in Stage 2 Percentage Numerator – Number patients having at least one med entered using CPOE OR number med orders entered Denominator – Number unique patients with at least one med in list ‘seen’ by EP OR number meds created

e-Prescribing (eRx) Core 4 (of 14)
MEASURE More than 40% permissible prescriptions written are transmitted electronically (eRx) Permissible prescriptions are prescriptions written (NOT for controlled substances) ATTESTATION Percentage must be more than 40% Exclusion Fewer than 100 prescriptions written No Pharmacy within 10 miles accepts eRx prescriptions Percentage Numerator: Number of prescriptions generated & transmitted electronically Denominator: Number of prescriptions written (other than controlled substances) during reporting period. Exclusions Additional beginning No pharmacy in organization, and none that accept electronic prescriptions within 10 miles of practice location EPs must enter the number of prescriptions written during the EHR reporting period in the Exclusion box

active medication list CORE 5 (of 14)
MEASURE More than 80% patients have at least one active medication (or indication that no medication is currently prescribed) ATTESTATION Percentage must be more than 80% Percentage NUMERATOR: Number of patients who have a medication (or indication that not currently prescribed any medication) recorded DENOMINATOR: Number of patients reporting period.

EHR, Current medications list
In axiUm EHR, Medications tab In axiUm eRx, Medications section

Maintain medical problem lists CORE 3 (of 14)
MEASURE More than 80% all patients have at least 1 entry or indication that no medical problems in their problem lists ATTESTATION Percentage must be more than 80% Percentage Numerator = Number patients who have at least one entry or no probs indicated Denominator = Number unique patients ‘seen’

Ehr & erx problems list (core 3/14)
In axiUm EHR, Alerts tab In axiUm eRx, Patient Problems section

Record smoking status Core 9 (of 14)
MEASURE More than 50% of patients 13 years old or older have smoking status recorded ATTESTATION Percentage more than 50% Exclusion No patients 13 years or older seen NUMERATOR: Number of patients in the denominator with smoking status recorded as structured data DENOMINATOR: Number of unique patients age 13 or older seen by the EP during the EHR reporting period. EXCLUSION: When attesting EPs must enter ‘0’ in Exclusion box

Ehr, forms (core 9/14) In axiUm EHR tab, Update/Review Medical Alerts
Smoking Status is now recorded as a SNOMED Coded Problem in the Medical Alerts section of the EHR Will sync with eRx if added here…but not with medical history Should be reviewed in eRx

medication allergy list CORE 6 (of 14)
MEASURE More than 80% patients have at least one entry in their medication allergy list or an indication of no medication allergy ATTESTATION Percentage must be more than 80% Percentage NUMERATOR: Number of patients who have at least one entry (or indication that patient has no known medication allergies) recorded in med allergy list DENOMINATOR: Number of patients during reporting period.

Ehr, alerts tab In axiUm eRx, Allergies section
In axiUm EHR, Alerts tab (display from entry in eRx)

Mu dashboard (core 6 of 14)

Record vital signs Core 8 (of 14)
MEASURE More than 50% of patients have blood pressure (for patients age 3 and over only) and height and weight (for all ages) recorded as structured data. Plot and Display Growth Charts 2-20 years old, including BMI ATTESTATION Percentage must be more than 50% Exclusion: No patients 3 years or older seen Patient vitals have no relevance Blood pressure is not relevant Height and weight are not relevant Percentage NUMERATOR: Number of patients in the denominator who have at least one entry of their height, weight and blood pressure recorded as structured data DENOMINATOR: Number of unique patients age 2 or over seen by the EP during the EHR reporting period. NEW NUMERATOR / DENOMINATOR (Optional 2013; Required in 2014 and beyond) DENOMINATOR: Number of patients (age 3 or over for blood pressure) during reporting period. NUMERATOR: Number of patients have at least one entry of height, weight and blood pressure (ages 3 and over) recorded EXCLUSION: Additionally, an EP who believes all three vital signs height, weight, and blood pressure have no relevance to their scope of practice would be excluded. Must select NO next to appropriate exclusion, then click the APPLY button to attest to the exclusion. NEW EXCLUSION Any EP who 1. Sees no patients 3 years or older is excluded from recording BP 2. Believes that all three vital signs height, weight, and BP have no relevance to scope of practice 3. Believes that height and weight are relevant to scope of practice, but blood pressure is not, is excluded from recording blood pressure; or 4. Believes that blood pressure is relevant to scope of practice, but height and weight are not, is excluded from recording height and weight.

Ehr, forms, med hist (core 8/14)
In axiUm Maintenance, EHR tab, EPR Forms Question/Header Answer Type Reference Code Height and Weight Assessment: - Feet: Number PT_STD_HT1 Inches: PT_STD_HT2 Height (Inches): Calculated (EPR_GET_HEIGHT_MDH_F) PT_STD_HT Weight (Lbs): PT_STD_WT BMI: Calculated (EPR_CALC_BMI_STD) PT_STD_BMI Is BMI reading over 25? Yes/No MDH_BMI Blood Pressure: Systolic Blood Pressure (mmHg) MDH_SBP Diastolic Blood Pressure (mmHg) MDH_DBP Pulse (BPM): PULSE

Medical history in ehr In axiUm EHR, Forms, Medical History Form tab

Patient lists Menu 3 (of 10)
MEASURE Generate at least one report listing patients with a specific condition ATTESTATION Yes/No Objective does not dictate report(s) which must be generated. EP determines which reports are most useful Report generated could cover every patient or a subset of those patients - discretion of the EP Report requires only patients whose records are maintained using certified EHR technology

Protect electronic information Core 14 (of 14)
MEASURE Conduct or review a security risk analysis, implement security updates and correct identified security deficiencies ATTESTATION Yes/No Risk analysis in accordance with requirements under 45 CFR (a)(1) Identified deficiencies software security update implemented as soon as available, changes in workflow processes or storage methods, or any other necessary corrective action needed to eliminate security deficiency

Immunization Registries menu 9 (of 10)
MEASURE Submit at least one electronic data test to immunization registries and follow up submission if the test is successful ATTESTATION Yes/No Exclusion Immunizations not performed No immunization registry electronic receipt capacity Yes/No Attest YES to having performed at least one test submitting electronic data to immunization registries. Follow up submission if test successful Exclusion Must select NO next to appropriate exclusion(s), then click APPLY button to attest

Patient Specific Education menu 6 (Of 10)
MEASURE More than 10% patients provided patient-specific education resources ATTESTATION Percentage more than 10% Percentage NUMERATOR: Number of patients in the denominator who are provided patient-specific education resources DENOMINATOR: Number of patients during reporting period.

Suggested axium input(menu 6/10)
PAUL: DO YOU HAVE ANY UPDATED INFORMATION ON THE METHOD FOR PATIENT EDUCATION TRACKING? We will be tracking this using the procedure codes Depending on the on the type of patient education they might have to create non-standard procedure code but there are some standard ADA codes they can use such as: D1310 Nutrition Counseling D1320 Tobacco Counseling

Electronic copy of health info Core 12 (of 14)
MEASURE More than 50% patients requesting electronic copy of health information provided it within 3 business days ATTESTATION Percentage more than 50% Exclusion No patient requests PAUL: ANY NEW INFORMATION ON PLAN FOR PROVIDING COPY OF MEDICAL RECORDS WE TALKED ABOUT A PROCEDURE CODE WITH IT SET TO INPROCESS AND THEN COMPLETED WHEN THE TASK IS DONE. Spoke with the team –We can present that Workflow to the Clients This is a non-standard procedure code (D0196 Health Information Fulfillment) Percentage NUMERATOR: Number of patients receiving electronic copy of electronic health information within 3 business days. DENOMINATOR: Number of patients requesting electronic copy of health information four business days prior to end of reporting period Exclusion EPs must enter ‘0’ in the Exclusion box to attest Provision of Info we have a process in the informanager that clients can use (we provide the the Oracle function) to export the information (XML file) that the patient can use a browser to read the xml file.

AXIUM INPUT in ehr (CORE 12/14)
Planned – requested by pt In-Process - started Complete – given to pt

Mu dashboard (cORE 12/14)

Clinical summaries (Core 13/14)
MEASURE Provided a clinical summary to patients, within 3 business days, for more than 50% of all office visits ATTESTATION Percentage more than 50% Exclusion No office visits This measure just means that, at the end of an appointment, you will have to provide patients with a summary of their appointment. Percentage NUMERATOR: Number of office visits for which patient is provided a clinical summary within three business days DENOMINATOR: Number of office visits by EP during reporting period. Exclusion EPs must enter ‘0’ in the Exclusion box to attest Provision The clinical summary can be provided through a PHR, patient portal on the web site, secure , electronic media such as CD or USB fob, or printed copy. If the EP chooses an electronic media, they would be required to provide the patient a paper copy upon request.

AXIUM outPUT for clinical summary (CORE 13/14)
We’ve added a new Clinical Visit Summary feature in aixUm 5.3 to support the this measure. Just go to the scheduler and right click on an appointment to create a summary of the appointment. When generating the summary you can add it directly to patient attachment. PAUL: WILL THIS BE A PRINT OUT FROM THE PATIENT CARE MODULE OR SOMETHING ELSE? To create a Clinical Summary Right Click on an Appointment Select Save Clinical Visit Summary

Sample clinical summary (CORE 13/14)
Double clicking the Clinical Visit Summary attachment will open it up in a browser and this is what you will see. PAUL: WILL THIS BE A PRINT OUT FROM THE PATIENT CARE MODULE OR SOMETHING ELSE? This is what displays in the browser when you open a clinical summary

Sample clinical summary (CORE 13/14)
PAUL: WILL THIS BE A PRINT OUT FROM THE PATIENT CARE MODULE OR SOMETHING ELSE? This is what displays in the browser when you open a clinical summary

clinical summary – Technical Details
Relevant Information in: Table 3: MU2 Data Requirements (pg. 23 – 25)

MU DASHBOARD (CORE 13/14)

clinical Quality Measures (CQMs) (Core 10/14)
Report on 9 CQMs (15 to choose from) From at least 3 different domains Workflows Some will overlap with the workflows of the Core/Menu measures Others are dental related measures In the interest of time we will just briefly go over the CQMs This is the third type of measure. They are all percentage based calculations but there is NO minimum percentage they need to pass. Which means they can report 0% on these measure (however we advise to choose a different measure if that is the case). We suggest choosing the CQMs that have minimal impact on their workflow, such as CQM’s that have workflows that overlap with the Core/Menu measures or CQMs that are dental related. PAUL: I WILL NEED MORE CLARIFICATION ON THIS ONE. This is separate from the MENU and CORE Measures This has no minimum Threshold to meet Calculated using the Reporting Year regardless of length of reporting period The submission process includes exporting the files and just importing it to the REC website There are new CQMs for 2014 We are developing 15 CQMs, our clients only have to report on 9. Not going into too much details as CQM’s a client chooses depends on their current workflows Suffice to say there are a several CQMs that will be simple to implement as the workflows for the CQMs will overlap the workflow of the Core and Menu Measures Examples of Similar workflow as Core and Menu measures CQM 69 – Adult Weight Screening and Follow-up this involves measuring BMI which is already done in the CORE measures Other CQMs are easy to implement because they are Dental Related CQM 75 – Children who have dental decay and cavities

Just explain that the domains are just the Category the CQM is in
Changes to Stage 1 meaningful use objectives, measures, and exclusions Beginning 2014 REMOVED No longer separate objective for reporting CQM’s (Ambulatory/hospital) STILL however, required to report on CQM’s in order to achieve meaningful use. Standalone objective requiring providers to attest that they plan to report on CQM’s REMOVED (because it is redundant) From 2014 Beyond first year MU - electronic submission

MU DASHBOARD (CORE 10/14)

REC ONLINE ATTESTATION
After collecting all that data in the Meaningful Use Dashboard, you will have to submit that data in the State Run REC (Regional Extension Center) website. You can have Meaningful Use Dashboard open in one browser window and the REC website open in another window and just enter the data. Alternatively you can download the data form the Meaningful Use Dashboard as a pdf and use that to enter the data in the REC website You will enter the As mentioned previosuly Each Core Measure/Menu has Certification Criteria/Attestation requirements Attestation Answers circled in red Yes – to having complied with the measure No – Not Numerator/Denominator > Percentage calculated/thresholds Exclusion (some) eg less than 100 prescriptions - excluded exclusion = submitted!

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Configuring axiUm for Meaningful Use

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