Produced in Cork, Ireland

 

 

Business Performance ServicesJanuary 2015

Title page

Practice PartnerEHR Meaningful Use Stage 2 GuideConfiguration and End User Training2015 and Beyond

EHR Meaningful Use Stage 2 Guideii Configuration and End User Training January 2015

2015 and Beyond

Copyright notice

Copyright noticeCopyright © 2015 McKesson Corporation and/or one of its subsidiaries. All Rights Reserved.

Use of this documentation and related software is governed by a license agreement. This documentation and related software contain confidential, proprietary, and trade secret information of McKesson Corporation and/or one of its subsidiaries, and is protected under United States and international copyright and other intellectual property laws. Use, disclosure, reproduction, modification, distribution, or storage in a retrieval system in any form or by any means is prohibited without the prior express written permission of McKesson Corporation and/or one of its subsidiaries. This documentation and related software is subject to change without notice.

Publication dateJanuary 2015

ProductPractice Partner

Corporate addressMcKesson Corporation5995 Windward ParkwayAlpharetta, GA 30005

Trademarks Practice Partner® is a registered trademark of McKesson Corporation and/or one of its subsidiaries. All other product and company names may be trademarks or registered trademarks of their respective companies.

Revision history

Date Page (s) Description

08/01/2014 163 Updated the Performance metric section.

08/25/2014 163 Updated chapter 20.

11/25/2014 40 Added a note to step 3 for sites with outbound interface(s).

12/16/2014 151-152 Updated the numerator for Core Objective 17 (Secure Message from Patient) and removed the configuration requirement to set up the Operator ID for Download Messages field on the Provider Maintenance Edit screen.

01/05/2015 various Made various updates to chapters 2, 7, 17, 19, and 23.

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Table of Contents

Table of Contents

Introduction - General Information and Resources . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1Meaningful Use Stage 2 requirements . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1

Reporting periods and payment adjustments . . . . . . . . . . . . . . . . . . . . . . . . . . 1Stage 2 overview guides . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2Stage 2 objectives. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3Registration . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6Attestation . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 8Other useful resource links . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 8Contact us . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 9

Preface - Clinical Encounters . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 11Configuration of Appointment Scheduling . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 12

For Medisoft Clinical and Lytec MD . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 13Configuration of Patient Records. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 15

Access levels . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 15Clinical Encounters screen . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 16

Fields and buttons on the Clinical Encounters screen . . . . . . . . . . . . . . . . . . . . . 16Clinical Encounter New and Edit screen . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 18

Fields and buttons on the Clinical Encounter screen . . . . . . . . . . . . . . . . . . . . . . 18

Chapter 1 - Core Objective 1 - Computerized Physician Order Entry (CPOE) . . . . . . . . . 21Objective . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 21Description . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 21Performance metric. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 21Configuration. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 22Configuration notes . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 26

End user workflow training . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 27End user notes . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 29

Chapter 2 - Core Objective 2- E-Prescribing and Use of Formulary Data . . . . . . . . . . . . 31Objective . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 31Description . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 31Performance metric. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 31

Notes . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 31Configuration for e-Prescribing . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 32Configuration notes . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 32End user workflow for e-Prescribing . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 32

New prescriptions and renewals (from the patient’s chart). . . . . . . . . . . . . . . 32Responding to electronic refill requests . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 34

End user notes . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 34Configuration for formulary implementation . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 34

ePrescribing Configuration utility setup . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 34Patient demographics . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 35

End user workflow for formulary checks . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 36End user notes . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 37

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Chapter 3 - Core Objective 3 - Demographics. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 39Objective . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 39Description . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 39Performance metric. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 39Configuration. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 39

For Medisoft Clinical or Lytec MD . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 41End user training . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 42

End user notes . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 42

Chapter 4 - Core Objective 4 - Vital Signs . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 43Objective . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 43Description . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 43Performance metric. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 43Configuration. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 44

End user training . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 45End user notes . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 45

Chapter 5 - Core Objective 5 – Smoking Status . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 47Objective . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 47Description . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 47Performance metric. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 47Configuration. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 47

End user training . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 49End user training notes . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 49

Chapter 6 - Core Objective 6 – Clinical Decision Support Rule . . . . . . . . . . . . . . . . . . . . 51Objective . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 51Measure 1 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 51Measure 2 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 51Notes. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 51Configuration. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 52

Measure 1: Clinical decision support interventions. . . . . . . . . . . . . . . . . . . . . 52Measure 2: Drug-drug and drug-allergy interaction checks . . . . . . . . . . . . . . 54

End user training . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 55Measure 1: Clinical decision support interventions . . . . . . . . . . . . . . . . . . . . . . . . 55Measure 2: Drug-drug and drug-allergy interaction checks . . . . . . . . . . . . . . . . . 56End user notes . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 56

Chapter 7 - Core Objective 7 - Patient Electronic Access . . . . . . . . . . . . . . . . . . . . . . . . . 57Objective . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 57Description . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 57Performance metric. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 58

Measure 1: Patient has electronic access to his/her health information. . . . . 58Measure 2: Patients view, download, and/or transmit their health information 58Important notes. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 58Exclusions. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 58

Configuration. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 59Measure 1: Patients given electronic access . . . . . . . . . . . . . . . . . . . . . . . . . . . . 59

Configuration for Web View . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 59Configuration notes. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 59End user training for Web View . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 60

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Configuration for RelayHealth. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 60End user notes . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 61

Measure 2: Patient has viewed/downloaded/transmitted health information . . . . 61Access levels . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 61Web View Audit Trail . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 61Obtaining and saving a RelayHealth certificate . . . . . . . . . . . . . . . . . . . . . . . 62RelayHealth Login Metrics . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 62

End user training for Web View (for patients) . . . . . . . . . . . . . . . . . . . . . . . . . . . . 64End user training for RelayHealth (for patients) . . . . . . . . . . . . . . . . . . . . . . . . . . 66End user notes . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 67

Chapter 8 - Core Objective 8 - Clinical Summary . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 69Objective . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 69Description . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 69Performance metric. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 69Configuration. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 69

Access levels . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 69System configuration. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 70Configuration notes . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 72

End user training . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 73End user notes . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 76

Chapter 9 - Core Objective 9 - Security & Risk Analysis . . . . . . . . . . . . . . . . . . . . . . . . . . 79Objective . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 79Description . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 79Performance metric. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 79Exclusions . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 79Notes. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 79

Security measures recommendations in the EHR application. . . . . . . . . . . . . . . . . . . 81Access control/authentication in Practice Partner. . . . . . . . . . . . . . . . . . . . . . . . . 81Chart access control and emergency access . . . . . . . . . . . . . . . . . . . . . . . . . . . . 82Auto-park and log-off features. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 83Operator Audit Trail report . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 84System security events . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 87Notes. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 88

Chapter 10 - Core Objective 10 – Structured Lab Results . . . . . . . . . . . . . . . . . . . . . . . . . 89Description . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 89Objective . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 89Performance metric. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 89Configuration. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 89Configuration notes . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 90

End user workflow . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 91End user notes . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 92

Chapter 11 - Core Objective 11 – Generate Patient List by Problem . . . . . . . . . . . . . . . . 93Objective . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 93Description . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 93Performance metric. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 93

Patient Inquiry . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 94Patient Inquiry configuration . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 94

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Running a Patient Inquiry report . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 94Notes. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 97

Patient registries . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 98Configuration. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 98

Access levels . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 98Setting up a new patient registry . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 98Note template edits. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 99

End user training . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 100End user notes . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 100

Chapter 12 - Core Objective 12 - Generate Patient Reminders . . . . . . . . . . . . . . . . . . . . 101Objective . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 101Description . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 101Performance metric. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 101Configuration. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 101

PRUtils . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 101Access levels . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 102

Configuration notes . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 102End user training . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 103

Patient Demographics. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 103Patient Inquiry . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 104Batch Communication . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 104

Setting up batch communication jobs . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 104Running a Batch Communication Job . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 107

End user notes . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 108

Chapter 13 - Core Objective 13 - Provide Patient-Specific Education . . . . . . . . . . . . . . 109Objective . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 109Description . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 109Performance metric. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 109Notes. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 109Configuration. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 110

End user training . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 113End user notes . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 116

Chapter 14 - Core Objective 14 - Medication Reconciliation . . . . . . . . . . . . . . . . . . . . . . 117Objective . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 117Description . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 117Performance metric. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 117Configuration. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 117

Access levels . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 117Note template edits. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 118

Configuration notes . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 118End user training . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 119

Chapter 15 - Core Objective 15 - Summary of Care Record . . . . . . . . . . . . . . . . . . . . . . 125Objective . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 125Description . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 125Performance metric. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 126

Measure 1: Generate Summary Of Care . . . . . . . . . . . . . . . . . . . . . . . . . . . 126Measure 2: Provide Summary Of Care With A Direct Message . . . . . . . . . . 126

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Measure 3. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 126Important notes . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 126Configuration. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 127

Access levels . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 127PPart.ini edits . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 127Setting up a direct message account with RelayHealth and acquiring direct mes-sage addresses . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 128Direct exchange via RelayHealth (external systems) . . . . . . . . . . . . . . . . . . 129Entry of direct addresses . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 130

End user training . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 133Measure 1: Generate Summary of Care Record . . . . . . . . . . . . . . . . . . . . . 133

End user notes . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 138Measure 2: Sending an electronic summary of care via direct message . . . 138Measure 3: Exchange an electronic summary of care with a provider with a differ-ent EHR or with a CMS test EHR . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 142

Chapter 16 - Core Objective 16 - Submit Vaccine Data to State Immunization Registries . 145

Objective . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 145Description . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 145Exclusion. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 145

Note . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 145Performance metric. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 145Configuration. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 145

Health Maintenance names . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 145Editing the Immunization report . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 146Note template edits. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 147

End user training . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 148Entering immunization information in Health Maintenance. . . . . . . . . . . . . . 148Entering immunization information in a note. . . . . . . . . . . . . . . . . . . . . . . . . 149Creating the .hl7 file for submission to the state registry . . . . . . . . . . . . . . . 149

Chapter 17 - Core Objective 17 - Secure Message from Patient . . . . . . . . . . . . . . . . . . . 151Objective . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 151Description . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 151Performance metric. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 151

Exclusions. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 151Important notes. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 151

Configuration. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 152Access levels . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 152Web View Audit Trail . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 152Obtaining and saving a RelayHealth certificate . . . . . . . . . . . . . . . . . . . . . . 153RelayHealth Secure Messaging Metrics. . . . . . . . . . . . . . . . . . . . . . . . . . . . 153

End user training (for patients) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 154Notes . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 155

Chapter 18 - Menu Objective 1 - Submit Electronic Syndromic Surveillance Data to Public Health Agencies . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 157

Objective . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 157Description . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 157Performance metric. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 157

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Exclusion. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 157Configuration. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 157

End user training . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 158Notes. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 158Submission to local/state health agency . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 159

Chapter 19 - Menu Objective 2 - Electronic Notes . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 161Description . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 161Objective . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 161Performance metric. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 161Note. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 161Configuration. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 161End user workflow. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 161End user notes . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 162

Chapter 20 - Menu Objective 3 - Images and Imaging Results Accessible through CEHRT163

Description . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 163Objective . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 163Performance metric. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 163Configuration. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 163

Access levels . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 163PPart.ini edits . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 164Setting up external systems . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 164

Zoom configuration . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 167Configuration notes . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 167End user workflow. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 168End user notes . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 170

Chapter 21 - Menu Objective 4 - Family History as Structured Data. . . . . . . . . . . . . . . . 171Description . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 171Objective . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 171Performance metric. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 171Note. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 171Configuration. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 172

Special Features: note view vs. grid view. . . . . . . . . . . . . . . . . . . . . . . . . . . 172Access levels . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 172Note template edits. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 173

End user workflow. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 173Recording family history data in the Family History grid. . . . . . . . . . . . . . . . 173Recording family history data in a progress note . . . . . . . . . . . . . . . . . . . . . 179

End user notes . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 179

Chapter 22 - Menu Objectives 5 and 6 - Cancer Registry and Specialized Disease Registry181

Objectives . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 181

Chapter 23 - EHR Performance Metrics Report . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 183Configuring the EHR Performance Metrics report. . . . . . . . . . . . . . . . . . . . . . . . 183

Access levels . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 183PPart.ini settings. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 183

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Running and printing the EHR Performance Metrics report . . . . . . . . . . . . . . . . 183EHR Performance Metrics report example . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 187Information on the EHR Performance Metrics report . . . . . . . . . . . . . . . . . . . . . 1872014 Stage 2Objectives . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 188“Drill-down” patient information on the EHR Performance Metrics report . . . . . . 196

Index . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 199

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List of Figures

List of Figures

Figure 1 Certified Health IT Product List . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 7Figure 2 Certified Health IT Product List . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 7Figure 3 Certified Health IT Product List . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 8Figure 1 Type of Visit Code Maintenance Select screen. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 13Figure 2 Type of Visit New screen. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 13Figure 3 Ppart.ini in Notepad. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 14Figure 4 Operator Maintenance Edit screen . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 23Figure 5 Operator Maintenance Edit screen . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 24Figure 6 Order Name Edit screen - Order Type Laboratory . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 25Figure 7 Order Name Edit screen - Order Type Radiology . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 25Figure 8 Prescription New screen . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 27Figure 9 Rx/Medications screen . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 28Figure 10 New Order screen . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 28Figure 11 Orders screen . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 29Figure 12 Prescription screen . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 33Figure 13 Patient Chart . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 33Figure 14 Patient Chart . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 34Figure 15 ePrescribing Configuration Utility screen . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 35Figure 16 Select Rx Template screen . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 36Figure 17 Prescription New screen . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 37Figure 18 DemSch_Race . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 41Figure 19 Patient New screen . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 42Figure 20 Vital Signs New screen . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 49Figure 21 Health Maintenance Template Edit screen . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 52Figure 22 HM Procedure Rules Edit screen . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 53Figure 23 Prescription Defaults screen . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 54Figure 24 Health Maintenance prompt message. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 55Figure 25 Health Maintenance Summary screen . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 56Figure 26 Special Features screen - General tab . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 59Figure 27 Patient Edit screen - Configuration tab . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 60Figure 28 Reports menu . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 61Figure 29 Web View Audit Trail Report screen . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 62Figure 30 RelayHealth Login Metrics screen. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 63Figure 31 Download My Health Information button . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 64Figure 32 How do you want the PHI document delivered? screen . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 64Figure 33 Download my Health Information screen . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 65Figure 34 CCDA file. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 65Figure 35 Health Records button. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 66Figure 36 Import/Export Health Data link . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 66Figure 37 Download My Data button . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 67Figure 38 Text Results Chart Sections screen . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 71Figure 39 External Systems screen. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 71Figure 40 Clinical Summaries to RelayHealth screen . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 72Figure 41 Patient Clinical Summary Report screen. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 73Figure 42 Clinical Encounter Not Found screen . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 74Figure 43 Render to file screen . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 75

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Figure 44 Export Medical Summary screen . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 75Figure 45 Clinical Encounter New screen . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 77Figure 46 Operator Maintenance Edit screen . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 81Figure 47 Patient Edit screen . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 82Figure 48 Access Level Configuration Edit screen . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 82Figure 49 Break-the-Glass Security screen. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 83Figure 50 Electronic Security screen. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 84Figure 51 Electronic Security screen. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 85Figure 52 Reports menu . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 86Figure 53 Operator Audit Trail Report screen . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 86Figure 54 Electronic Security screen. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 88Figure 55 Order Name Edit screen . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 90Figure 56 Order New screen . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 91Figure 57 Laboratory Data Table screen. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 91Figure 58 Patient Inquiry New Report screen . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 94Figure 59 Enter The Problem Name screen . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 95Figure 60 Operator screen . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 95Figure 61 Select Provider screen . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 95Figure 62 Patient Inquiry New Report screen . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 96Figure 63 Enter File Name screen. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 96Figure 64 Registry Maintenance screen . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 99Figure 65 Patient Edit screen . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 103Figure 66 Batch Communication Select screen . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 104Figure 67 Batch Communication Detail New screen . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 105Figure 68 Letter Template Select screen . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 106Figure 69 Batch Communication Select screen . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 107Figure 70 Job Summary screen . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 107Figure 71 Batch Communication Recipients screen . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 108Figure 72 Clinical Encounter Edit screen . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 110Figure 73 External Systems screen. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 111Figure 74 New External System screen . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 111Figure 75 Pat Ed button. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 113Figure 76 Patient Education module . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 113Figure 77 Problems/Procedures screen . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 114Figure 78 Select the Patient Ed... screen - OK button. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 114Figure 79 Select the Patient Ed... screen - Cancel button. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 115Figure 80 Problems/Procedures screen . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 115Figure 81 Rx/Medications screen . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 119Figure 82 Medication Reconciliation Detail screen . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 120Figure 83 Clinical Encounter New screen . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 120Figure 84 Medication Reconciliation Detail screen . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 121Figure 85 Medication Reconciliation History screen . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 122Figure 86 Medication Reconciliation History screen . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 123Figure 87 New Message screen . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 127Figure 88 DirectActivated= setting. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 128Figure 89 External Systems screen. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 129Figure 90 Direct Exchange via RelayHealth screen . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 129Figure 91 Operator Maintenance Edit screen . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 130Figure 92 Referring Source Maintenance Edit screen. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 131Figure 93 Patient Edit screen . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 132Figure 94 Print Chart Summary screen . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 133Figure 95 Render to file screen . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 133

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Figure 96 Clinical Encounter Not Found screen . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 134Figure 97 Clinical Encounter Edit screen . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 135Figure 98 Export Medical Summary screen . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 135Figure 99 Clinical Encounter Not Found screen . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 136Figure 100 Save As screen . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 136Figure 101 Export Medical Summary Detail Selection screen . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 137Figure 102 Clinical Encounter Edit screen . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 138Figure 103 New Message screen . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 139Figure 104 Select Destination screen . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 139Figure 105 Select Destination screen . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 140Figure 106 New Message screen . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 140Figure 107 Attachments screen. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 141Figure 108 Select Attachment screen . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 141Figure 109 Attachments screen. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 142Figure 110 New Message screen . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 142Figure 111 New Message screen . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 143Figure 112 Health Maintenance Procedure Name Edit screen . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 146Figure 113 Immunizations Selection screen . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 147Figure 114 Health Maintenance Procedure New screen. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 148Figure 115 PPConnect - Immunization Registry Import screen . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 149Figure 116 PPConnect - Immunization Registry Export screen . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 150Figure 117 Reports menu . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 152Figure 118 Web View Audit Trail Report screen . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 153Figure 119 RelayHealth Secure Messaging Metrics screen . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 154Figure 120 Report Syndromic Surveillance screen . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 158Figure 121 NoteTypesRadiology= setting . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 164Figure 122 NoteTypesRadiology= setting . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 164Figure 123 New External System screen . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 165Figure 124 Operator Maintenance Edit screen . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 165Figure 125 Edit External System screen . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 166Figure 126 New External System User screen . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 166Figure 127 Operator Select screen . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 166Figure 128 New External System User screen . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 167Figure 129 Practice Partner Zoom screen. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 168Figure 130 View menu. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 169Figure 131 Select Note screen . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 169Figure 132 Radiology screen. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 170Figure 133 Special Features screen - Records 5 tab . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 172Figure 134 Family History screen . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 174Figure 135 Family History screen . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 175Figure 136 Family Member New screen . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 175Figure 137 Family History Problem New screen . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 176Figure 138 Diagnosis Code Select screen . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 176Figure 139 Family History Problem New screen . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 177Figure 140 Family History screen . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 178Figure 141 Negative Family History New screen . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 178Figure 142 Family History screen . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 179Figure 143 DefaultObjectivesList= setting. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 183Figure 144 EHR Performance Metrics Sign In screen. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 184Figure 145 EHR Performance Metrics Report screen . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 184Figure 146 EHR Performance Metrics Report screen - Stage 2 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 185Figure 147 Directory Path for Export Files screen. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 186

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List of Figures

Figure 148 EHR Performance Metrics report . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 187Figure 149 EHR Performance Metrics report . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 197Figure 150 EHR Performance Metrics report . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 197Figure 151 EHR Performance Metrics report . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 198Figure 152 EHR Performance Metrics report - Print icon . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 198

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Introduction - General Information and Resources

Meaningful Use Stage 2 requirementsThis section provides the general requirements for the first year of Meaningful Use Stage 2, in 2015 and beyond as specified by CMS. Along with the descriptions, several valuable resources are included in the form of links to various CMS tip sheets. These links ensure that you always have the latest information released by CMS pertaining to the various objectives and timelines at your fingertips.

Important noteALL eligible providers (EPs) MUST upgrade to a 2014 certified version of their EHR to meet Stage 2 requirements for Meaningful Use in 2015.

• All Practice Partner customers MUST upgrade to v11 of the product to meet this requirement.

• All Medisoft Clinical customers MUST upgrade to v19 SP1 of the product to meet this requirement.

• All Lytec MD customers MUST upgrade to v2014 SP1 of the product to meet this requirement.

EPS will NOT be able to attest for Stage 2 Meaningful Use with any versions of the EHRs other than the ones listed above.

Reporting periods and payment adjustments • All EPs who have attested for Stage 1 Meaningful Use for at least two years MUST move on to

Stage 2 in 2015.

• All EPs will be attesting for a period of one calendar year (or 365 days) in 2015.

• EPs participating in the Medicare incentive program are required to attest every consecutive year once they start attesting for Meaningful Use.

If they “skip” a year, they move on to the next phase the following year. For example, if an EP attests in 2013 for the first time (Stage 1 Year 1), but skips attestation in 2014 (which would have been Stage 1 Year 2), he/she still will have to move on to Stage 2 Year 1 in 2015.

The EP also will incur payment adjustments in 2016 for non-attestation in 2014 (in addition to not qualifying for the 2014 incentive monies).

• EPs who can only participate in the Medicaid EHR Incentive Program (for example, mid-level providers like nurse practitioners) and/or those who do NOT bill Medicare at all (for example, pediatricians) are not subject to these payment adjustments listed above. Medicaid Incentive policy is different in two respects.

- First, the Medicaid program does not have payment adjustments (no penalties).

- Second, Medicaid providers are not required to participate in consecutive years of the Medicaid EHR Incentive Program. Thus, unlike Medicare providers, Medicaid providers who skip years of participation will resume their meaningful use progression where they left off. For example, if a Medicaid EP skips 2014 (which would otherwise be Stage 1 Year 2) and also skips 2015 but comes back to the Medicaid program in 2016, the EP would be

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Stage 2 overview guides Introduction - General Information and Resources

required to demonstrate Stage 1 Year 2 in 2016 as if the EP had never left the Medicaid program for those two years.

• EPs who are eligible to participate in either Medicare or Medicaid incentive programs but choose to go through Medicaid will be subject to the Medicare payment adjustments if they choose to “skip” a year.

For example, if a family practitioner, who attested through Medicaid for the first time in 2013 (Stage 1 Year 1) “skips” attestation in 2014 (what would otherwise be Stage 1 Year 2), he/she will incur Medicare payment adjustment in 2016 because the EP is considered to be “Medicare-eligible.”

- However, the EP will not be subject to any Medicaid adjustments for non-attestation in 2014.

- The EP can continue in the Medicaid program and can demonstrate Stage 1 Year 2 in 2016 (or later).

For more information on basic eligibility and payment schedules and adjustments, refer to the following tip sheets.

Stage 2 overview guidesThe following table provides links to Stage 2 overview guides.

Tip sheet Location

Medicare EHR Incentive Program - Overview, Payment Schedules, General Rules and Regulations

https://www.cms.gov/Regulations-and-Guidance/Legislation/EHRIncentivePrograms/Downloads/MLN_MedicareEHRProgram_TipSheet_EP.pdf

Medicaid EHR Incentive Program - Overview, Payment Schedules, General Rules and Regulations

https://www.cms.gov/Regulations-and-Guidance/Legislation/EHRIncentivePrograms/Downloads/MLN_MedicaidEHRProgram_TipSheet_EP.pdf

Payment Adjustment and Hardship Exception Rules

http://www.cms.gov/Regulations-and-Guidance/Legislation/EHRIncentivePrograms/Downloads/PaymentAdj_HardshipExcepTipSheetforEP.pdf

Overview guide Location

Stage 2 Final Correction to Rule https://www.federalregister.gov/articles/2012/10/23/2012-25975/medicare-and-medicaid-programs-electronic-health-record-incentive-program-stage-2-corrections

Stage 2 Overview, general information and some FAQs

http://www.cms.gov/Regulations-and-Guidance/Legislation/EHRIncentivePrograms/Downloads/Stage2Overview_Tipsheet.pdf

Official CMS Stage 2 guide for details about the objectives, the requirements, and associated payments and adjustments

http://www.cms.gov/Regulations-and-Guidance/Legislation/EHRIncentivePrograms/Downloads/Stage2_Guide_EPs_9_23_13.pdf

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Introduction - General Information and Resources Stage 2 objectives

Stage 2 objectivesThe following table lists all the Stage 2 objectives with the CMS descriptions and a link to the official CMS tip sheet. Each link displays the CMS document that lists the description, requirements, exclusions, and other details for the objective.

Stage 2 Toolkit - a collection of various Stage 2 tip sheets

http://www.cms.gov/Regulations-and-Guidance/Legislation/EHRIncentivePrograms/Downloads/Stage2_Toolkit_EHR_0313.pdf

Changes between Stage 1 and Stage 2 Objectives

http://www.cms.gov/Regulations-and-Guidance/Legislation/EHRIncentivePrograms/Downloads/Stage1vsStage2CompTablesforEP.pdf

Overview guide Location

Objective Description CMS tip sheet

Core #1 - CPOE

Use Computerized Provider Order Entry (CPOE) for medication, laboratory, and radiology orders directly entered by any licensed healthcare professional who can enter orders into the medical record per state, local, and professional guidelines.

http://www.cms.gov/Regulations-and-Guidance/Legislation/EHRIncentivePrograms/downloads/Stage2_EPCore_1_CPOE_MedicationOrders.pdf

Core #2 - Electronic Prescribing

Generate and transmit permissible prescriptions electronically (eRx).

http://www.cms.gov/Regulations-and-Guidance/Legislation/EHRIncentivePrograms/downloads/Stage2_EPCore_2_ePrescribing.pdf

Core #3 - Record the Demographics

Record the following demographics:

• preferred language

• sex

• race

• ethnicity

• date of birth

http://www.cms.gov/Regulations-and-Guidance/Legislation/EHRIncentivePrograms/downloads/Stage2_EPCore_3_RecordingDemographics.pdf

Core #4 - Vital Signs

Record and chart changes in the following vital signs:

• height/length and weight (no age limit)

• blood pressure (ages 3 and over)

• calculate and display body mass index (BMI)

• plot and display growth charts for patients 0-20 years, including BMI

http://www.cms.gov/Regulations-and-Guidance/Legislation/EHRIncentivePrograms/downloads/Stage2_EPCore_4_RecordVitalSigns.pdf

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Core # 5 - Smoking Status

Record smoking status for patients 13 years old or older.

http://www.cms.gov/Regulations-and-Guidance/Legislation/EHRIncentivePrograms/downloads/Stage2_EPCore_5_RecordSmokingStatus.pdf

Core #6 - Clinical Decision Support Rule

Use clinical decision support to improve performance on high-priority health conditions.

http://www.cms.gov/Regulations-and-Guidance/Legislation/EHRIncentivePrograms/downloads/Stage2_EPCore_6_ClinicalDecisionSupport.pdf

Core # 7 - Patient Portal

Provide patients the ability to view online, download, and transmit their health information within four business days of the information being available to the EP.

http://www.cms.gov/Regulations-and-Guidance/Legislation/EHRIncentivePrograms/downloads/Stage2_EPCore_7_PatientElectronicAccess.pdf

Core #8 - Clinical Summary

Provide clinical summaries for patients for each office visit.

http://www.cms.gov/Regulations-and-Guidance/Legislation/EHRIncentivePrograms/downloads/Stage2_EPCore_8_ClinicalSummaries.pdf

Core #9 - Security & Risks Analysis

Protect electronic health information created or maintained by the certified EHR technology through the implementation of appropriate technical capabilities.

http://www.cms.gov/Regulations-and-Guidance/Legislation/EHRIncentivePrograms/downloads/Stage2_EPCore_9_ProtectElectronicHealthInfo.pdf

Core #10 - Structured Lab Data

Incorporate clinical lab test results into certified EHR technology as structured data.

http://www.cms.gov/Regulations-and-Guidance/Legislation/EHRIncentivePrograms/downloads/Stage2_EPCore_10_ClinicalLabTestResults.pdf

Core #11 - Patient Lists

Generate lists of patients by specific conditions to use for quality improvement, reduction of disparities, research, or outreach.

http://www.cms.gov/Regulations-and-Guidance/Legislation/EHRIncentivePrograms/downloads/Stage2_EPCore_11_PatientLists.pdf

Core #12 - Patient Reminders

Use clinically relevant information to identify patients who should receive reminders for preventive/follow-up care and send these patients the reminders, per patient preference.

http://www.cms.gov/Regulations-and-Guidance/Legislation/EHRIncentivePrograms/downloads/Stage2_EPCore_12_PreventiveCare.pdf

Core #13 - Patient Education

Use clinically relevant information from certified EHR technology to identify patient-specific education resources and provide those resources to the patient.

http://www.cms.gov/Regulations-and-Guidance/Legislation/EHRIncentivePrograms/downloads/Stage2_EPCore_13_PatientSpecificEdRes.pdf

Objective Description CMS tip sheet

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Core #14 - Medication Reconciliation

The EP who receives a patient from another setting of care or provider or care, or believes an encounter is relevant should perform medication reconciliation.

http://www.cms.gov/Regulations-and-Guidance/Legislation/EHRIncentivePrograms/downloads/Stage2_EPCore_14_MedicationReconciliation.pdf

Core #15 - Summary of Care Record

The EP who transitions his/her patient to another setting of care or provider of care, or who refers his/her patient to another provider of care should provide a summary care record for each transition of care or referral.

http://www.cms.gov/Regulations-and-Guidance/Legislation/EHRIncentivePrograms/downloads/Stage2_EPCore_15_SummaryCare.pdf

Core #16 - Immunization Data Submission to State Registry

Capability to submit electronic data to immunization registries or immunization information systems except where prohibited, and in accordance with applicable law and practice.

http://www.cms.gov/Regulations-and-Guidance/Legislation/EHRIncentivePrograms/downloads/Stage2_EPCore_16_ImmunizationRegistriesDataSubmission.pdf

Core #17 - Secure Electronic Messaging

Use secure electronic messaging to communicate with patients on relevant health information.

http://www.cms.gov/Regulations-and-Guidance/Legislation/EHRIncentivePrograms/downloads/Stage2_EPCore_17_UseSecureElectronicMessaging.pdf

Menu #1 - Syndromic Surveillance Data Submission

Capability to submit electronic syndromic surveillance data to public health agencies except where prohibited, and in accordance with applicable law and practice.

http://www.cms.gov/Regulations-and-Guidance/Legislation/EHRIncentivePrograms/downloads/Stage2_EPMenu_1_SyndromicSurveillanceDataSub.pdf

Menu #2 - Record Electronic Notes

Record electronic notes in patient records.

http://www.cms.gov/Regulations-and-Guidance/Legislation/EHRIncentivePrograms/downloads/Stage2_EPMenu_2_ElectronicNotes.pdf

Menu #3 - Imaging Results

Imaging results consisting of the image itself and any explanation or other accompanying information are accessible through CEHRT.

http://www.cms.gov/Regulations-and-Guidance/Legislation/EHRIncentivePrograms/downloads/Stage2_EPMenu_3_ImagingResults.pdf

Menu #4 - Family History as Structured Data

Record patient family health history as structured data.

http://www.cms.gov/Regulations-and-Guidance/Legislation/EHRIncentivePrograms/downloads/Stage2_EPMenu_4_FamilyHealthHistory.pdf

Objective Description CMS tip sheet

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Registration Introduction - General Information and Resources

RegistrationAll EPs must register via the https://ehrincentives.cms.gov/hitech/login.action webpage prior to their first attestation. Refer to the CMS user guides for more information.

To find the Product Registration or CHPL number for the certified version of the EHR used (needed during attestation):

1. Go to http://oncchpl.force.com/ehrcert/CHPLHome.

Menu #5 - Identify and Report Cancer Cases to Central Cancer Registry

Capability to identify and report cancer cases to a public health central cancer registry, except where prohibited, and in accordance with applicable law and practice.

http://www.cms.gov/Regulations-and-Guidance/Legislation/EHRIncentivePrograms/downloads/Stage2_EPMenu_5_ReportCancerCases.pdf

Menu #6 - Identify and Report Specific Cases to a Specialized Registry

Capability to identify and report specific cases to a specialized registry (other than a cancer registry), except where prohibited, and in accordance with applicable law and practice.

http://www.cms.gov/Regulations-and-Guidance/Legislation/EHRIncentivePrograms/downloads/Stage2_EPMenu_6_ReportSpecificCases.pdf

Objective Description CMS tip sheet

User guide Location

Medicare Attestation - Registration User Guide http://www.cms.gov/Regulations-and-Guidance/Legislation/EHRIncentivePrograms/Downloads/EHRMedicareEP_RegistrationUserGuide.pdf

Medicaid Attestation - Registration User Guide http://www.cms.gov/Regulations-and-Guidance/Legislation/EHRIncentivePrograms/Downloads/EHRMedicaidEP_RegistrationUserGuide.pdf

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Introduction - General Information and Resources Registration

2. Click the Combination of 2011 & 2014 edition button.

Figure 1. Certified Health IT Product List

3. Click the Ambulatory Practice Type button.

Figure 2. Certified Health IT Product List

4. In the Search for field, enter the name of your EHR and click the Search button.

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Attestation Introduction - General Information and Resources

5. Locate the correct version of the product from the displayed list and click the Add to cart button.

Figure 3. Certified Health IT Product List

6. Click the Get CMS EHR Certification ID button.

AttestationFor more information on the attestation process and CMS documents that aid the process, refer to the following links provided by CMS. At this time, CMS has not released an official attestation guide for Stage 2. When it is available, McKesson BPS will make it available on our website. McKesson encourages all providers to regularly review the http://www.cms.gov/Regulations-and-Guidance/Legislation/EHRIncentivePrograms website for the latest information.

You can find registration and attestation information at http://www.cms.gov/Regulations-and-Guidance/Legislation/EHRIncentivePrograms/RegistrationandAttestation.html.

Other useful resource linksThe following table includes links to other useful information about Meaningful Use.

Description Location

Data Sharing for Stage 2 with Details of Requirements for Clinical Summaries and Summary of Care Documents

http://www.cms.gov/Regulations-and-Guidance/Legislation/EHRIncentivePrograms/Downloads/Stage2_DataSharing_FactSheetFinal_10182013.pdf

General Information about the Meaningful Use Program

http://www.cms.gov/Regulations-and-Guidance/Legislation/EHRIncentivePrograms/Meaningful_Use.html

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Introduction - General Information and Resources Contact us

Contact usFor all questions and concerns related to Meaningful Use, both general and/or product-related, contact our dedicated Meaningful Use Strategic team.

E-mailPPSMeaningfuluse@mckesson.com

This mailbox is intended for non-critical issues and QA only; all messages will be answered within 48 hours.

For critical issues, contact the Technical Support team by phone or create a new case online.

Phone+1 (855) 368-8326 (Enterprise)

+1 (855) 463-8326 (Independent)

+1 (855) 827-8326 (VAR)

5am−5pm Pacific Time, Monday through Friday

Webhttps://support.practicepartner.com

Consulting servicesMcKesson offers a variety of consulting services for Meaningful Use. For more information, contact your sales representative.

FAQs https://www.cms.gov/Regulations-and-Guidance/Legislation/EHRIncentivePrograms/downloads/faqsremediatedandrevised.pdf

Description Location

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Contact us Introduction - General Information and Resources

EHR Meaningful Use Stage 2 GuideJanuary 2015 Configuration and End User Training 11

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Preface - Clinical Encounters

The Clinical Encounters feature allows users to record details for each provider encounter with patients. A clinical encounter is generally defined as an event where some kind of patient contact with a provider occurs. The EHR Performance Metrics Report uses clinical encounters as a basis for the Meaningful Use calculations. Careful generation and recording of clinical encounters, particularly those of the Office Visit, Office Visit Prev Care, Prenatal Visit, and Telemedicine Visit types, are necessary for accurate Meaningful Use reports.

NOTE: Clinical Encounters have been designed in Practice Partner solely to mine data for Meaningful Use reports. They are NOT related in any way to billing functions or electronic encounter forms.

The basis for most Meaningful Use metrics is the count of “unique patients.” Unique patients are defined as follows:

“A unique patient means that even if a patient is seen multiple times during the EHR reporting period they are only counted once."

For example, if a provider has one patient with two encounters of the Office Visit type, another patient with one such encounter, and a third patient with three such encounters, the EHR Performance Metrics Report will reflect three unique patients.

Patient Records and Appointment Scheduler will automatically create clinical encounter records based on the presence of Type of Visit (TOV) codes, status codes, and/or the .ENC Dot code. Users can also manually add, edit, or delete clinical encounters.

Transition of Care is defined as a clear change in the setting of care. The following table describes transition types.

A single clinical encounter can be designated as both inbound and outbound if necessary.

Transition type Description

Inbound A transition of care is inbound when a patient enters a provider’s care from a different setting (for example, the provider sees a patient after an ER visit the previous day).

Outbound A transition of care is outbound when a patient is referred or transferred to another setting of care (for example, the patient is sent to a specialist by his primary care physician).

Neither A transition of care is neither inbound or outbound when the patient neither enters from another setting of care nor is transitioned to another setting (for example, the patient comes in for an annual physical appointment).

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Configuration of Appointment Scheduling Preface - Clinical Encounters

Configuration of Appointment Scheduling

The Appointment Scheduler will create clinical encounters based on the TOV code associated with the appointment and the status code entered when the patient checks in for his/her appointment. The setup for generation of clinical encounters in Total Practice Partner through the schedule is different than Medisoft Clinical and Lytec MD.

The configuration mentioned below for Practice Partner holds true even if a different practice management system is used for scheduling appointments (for example, Horizon Practice Plus or GE Centricity) as long as the appointments along with the TOV codes and status codes are available in the EHR (for example, inbound scheduling interface).

The trigger for creation of the clinical encounter is always the check-in function, which in turn, enters the appropriate status code in the Status column of the schedule.

These default TOV and status codes must be updated to match the TOV and status codes you use in your EHR. The default values are provided for reference only and are not meant to reflect the values you might use in your system.

In the example AC:I:N, an appointment is created for a single patient with the TOV code AC, a clinical encounter is created for the patient denoting that the transition of care was inbound (I) and it will not be relevant for medication reconciliation (N).

To change the ppart.ini file settings:1. Open the ppart.ini file in a text editor such as Notepad or WordPad.

2. Locate the [ClinEncounters] section.

3. To add a new TOV code to the TOVCodes= list, enter the new TOV code with no space after the comma. The TOV code must be followed immediately by a colon, then followed immediately by an I, O, or N to indicate whether you want the transition of care to be inbound, outbound, or neither. Another colon must follow, immediately followed by Y or N to indicate whether the code will create a clinical encounter that is marked relevant to medication reconciliation. For example, LB:I:N.

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Preface - Clinical Encounters For Medisoft Clinical and Lytec MD

For Medisoft Clinical and Lytec MD1. Select Maintenance > Configuration > Type of Visit Codes. The Type of Visit Code

Maintenance Select screen appears.

Figure 1. Type of Visit Code Maintenance Select screen

2. Click the New button. The Type of Visit New screen appears.

Figure 2. Type of Visit New screen

3. Enter NOR in the Code field.

It is not necessary to complete the Description or Duration fields.

Next, it will be necessary to add the NOR code to the ppart.ini configuration file which is located in the PPART folder.

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For Medisoft Clinical and Lytec MD Preface - Clinical Encounters

Open the file in notepad, then search for the word clinencounters. Add the following to the end of the TOVCodes line (be sure to include the comma):

Figure 3. Ppart.ini in Notepad

If the practice wants all system-created clinical encounters to default with either inbound or outbound transfer of care preselected, use an I or an O instead of the first N.

If the practice wants all system-created clinical encounters to default with Relevant For Meds Reconciliation preselected, use a Y instead of the second N.

In order to create a clinical encounter from a patient appointment, both the TOV and status code must be marked in the PPart.ini and be present on the appointment.

If you have a Medisoft or Lytec scheduling interface, clinical encounters will be created as long as the appointments made are appropriately exported to Medisoft Clinical and Lytec MD along with the TOV code and status code once the patient has been checked in.

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Preface - Clinical Encounters Configuration of Patient Records

Configuration of Patient Records

Users can use the .ENC Dot code to create clinical encounters from notes when a note is permanently saved, or when a note is loaded into Patient Records via Text Data Loader.

The note created for the clinical encounter will include the practice and provider who created the encounter, the date/time the encounter was created, the type of encounter (Office Visit, Transfer of Care, Letter, and so on), whether the transfer of care was inbound (I) or outbound (O), or not recorded (blank), and whether the encounter is relevant to clinical reconciliation (Y or N).

Users can include multiple .ENC Dot codes in one note. This will result in the creation of multiple clinical encounter records.

The system will not create a clinical encounter record from a Dot code if a matching clinical encounter exists for the patient (for example, the patient, date, practice, and encounter type [Office Visit, Transfer of Care, or Letter] are the same).

If necessary, users can modify the clinical encounter after it has been created using Clinical Encounter maintenance.

If any Dot code values are blank when the note is saved, the following will be specified for the clinical encounter:

Provider: If there is a current provider, the current provider will be specified as the provider for the clinical encounter.

Practice: The current practice will be specified as the practice for the clinical encounter.

Type: The type will be specified as Office Visit, Office Visit Prev. Med, Prenatal Visit, or Telemedicine Visit, unless the note is a letter in which case the type will be Letter.

Example of the .ENC Dot code:

.ENC: provider : practice : date : time: type : transfer of care : relevant for medication reconciliation

For example:

.ENC: ABC: 1 : 09/15/13 : 10:00 am : Office Visit : I : Y

Access levelsIn order to use the Clinical Encounters screen, the user need access to do so. This is done in the Access Levels section > Records tab > Clinical Encounters Maintenance.

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Clinical Encounters screen Preface - Clinical Encounters

Clinical Encounters screen

The Clinical Encounters screen lists the clinical encounters that have been added for the current patient. Users can use this screen to add new clinical encounters for the current patient or change or delete existing clinical encounters for the patient.

To open the Clinical Encounters screen when the patient chart is open: 1. Open the Patient Chart for the patient for whom you want to add, edit, or delete clinical

encounters.

2. Select Show > Clinical Encounters. The Clinical Encounters screen appears.

To open the Clinical Encounters screen from the Patient Demographic screen:1. Open the Patient screen for the patient for whom you want to add, edit, or delete clinical

encounters.

2. On the Dates tab, click the Clin. Encounters button. The Clinical Encounters screen appears.

Fields and buttons on the Clinical Encounters screenThe following table describes the fields and buttons on the Clinical Encounters screen.

Field/button Description

Search Encounters area This area allows you to search for a patient's clinical encounters by date, type, practice, provider, and the encounter’s relevancy to medication reconciliation.

When you are finished entering all your search criteria, click the Search button. Clinical encounters matching all the criteria you entered are displayed in the Clinical Encounters list that includes the date, clinical encounter number, encounter type, practice, provider, and Transfer of Care (inbound, outbound, or neither).

Start Date/End Date If you wish to search by date, enter the beginning and ending dates to specify the period that the search is to cover. To search for a single date, enter the same date in both fields.

The start date is defaulted to one year prior to the current date and the end date is defaulted to the current date.

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Preface - Clinical Encounters Fields and buttons on the Clinical Encounters screen

Encounter Type If you wish to search by encounter type, select the encounter type from the drop-down list.

You can use List Maintenance to edit or add to the list of encounter types (ENCOUNTER LIST) that will be available from the drop-down list.

Practice If you wish to search by practice, enter the practice ID in this field, or click the drop-down arrow and select the practice from the Practice Select screen.

Provider If you wish to search by provider, enter the provider ID in this field, or click the drop-down arrow and select the provider from the Provider Select screen.

Sort by Select this check box to view only clinical encounters that are relevant to medication reconciliation.

Clinical Encounters List This lists the clinical encounters that have been added for the selected patient.

Close button Click this button to close the screen.

New button Click this button to add a new clinical encounter for the patient. The Clinical Encounter New screen appears.

See the Adding a clinical encounter topic in Patient Records Help for more information.

Edit button Click this button to edit the currently-selected clinical encounter. The Clinical Encounter Edit screen appears.

See the Editing a clinical encounter topic in Patient Records Help for more information.

Delete button Click this button to delete the currently-selected clinical encounter for the patient. A confirmation message appears. Click the OK button.

You can also delete more than one clinical encounter at a time from the list.

Field/button Description

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Clinical Encounter New and Edit screen Preface - Clinical Encounters

Clinical Encounter New and Edit screen

The Clinical Encounter screen is used when adding or editing clinical encounters for a patient. You can use this screen to add new clinical encounters from the patient demographic screen, or edit existing clinical encounters.

To open the Clinical Encounter <New> or <Edit> screen:1. Open the Clinical Encounters screen.

2. Click New to add a new clinical encounter or click Edit to edit the currently-selected clinical encounter. The Clinical Encounter New screen or Clinical Encounter Edit screen appears.

Fields and buttons on the Clinical Encounter screenThe following table describes the fields and buttons on the Clinical Encounter screen.

Field/button Description

Encounter Number This field displays the assigned encounter number on the Clinical Encounter Edit screen. When a new clinical encounter is created, Patient Records automatically assigns the new encounter a number. The numbers assigned are in sequential order for all patients. For example, if the last encounter added was 100, the new encounter will be number 101.

The number will not be displayed for the encounter until after it has been added. The Clinical Encounter New screen will display Not Yet Assigned.

Date These fields reflect the current date and time.

Type Select the encounter type from the drop-down list.

Provider This field reflects the current provider. To change the current provider, enter the provider ID in this field or click the drop-down arrow and select the provider from the Provider Select screen.

Practice This field reflects the current practice. To change the current practice, enter the practice ID in this field or click the drop-down arrow and select the practice from the Practice Select screen.

Transition of Care

Transition of Care Type Select a transition of care option. You can select Inbound and/or Outbound.

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Preface - Clinical Encounters Fields and buttons on the Clinical Encounter screen

Inbound Select this check box if the patient is being received by the provider from another healthcare organization or setting.

Outbound Select this check box if the patient is being transferred out of your organization to another healthcare organization or setting.

Summary of Care Record provided for Care Coordination Physically

Select this check box if you provided a physical copy of the summary of care record for care coordination (that is, the Chart Summary report or the medical summary record [CCR, CCD, or CCDA]).

Summary of Care Record provided for Care Coordination Electronically

Select this check box if you sent the summary of care record provided for care coordination electronically (that is, the Chart Summary report or the medical summary record [CCR, CCD, or CCDA]).

Provided to Patient

Electronic Clinical Summary Select this check box if you sent the clinical summary electronically to the patient (that is, exported a clinical summary via CCR/CCD/CCDA or an HIE).

The system automatically selects this check box when you send the Patient Clinical Summary report to the patient as a Web View message.

Paper Clinical Summary Select this check box if you provided the printed clinical summary to the patient (that is, the Patient Clinical Summary report).

Use the .CS Dot code to select this check box when working in a progress note. For procedural steps, see the .CS code in the Dot Code topic in the online help.

Patient-Specific Education Materials Select this check box if patient education handouts or other educational materials were printed or e-mailed to the patient using the Patient Records Patient Education module or an external system such as WebMD or the Practice Partner Knowledge base.

Clinical Summary Refused Select this check box if the patient refused a copy of his/her clinical summary.

Use the .CS Dot code to select this check box when working in a progress note. For procedural steps, see the .CS code in the Dot Code topic in the online help.

Field/button Description

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Fields and buttons on the Clinical Encounter screen Preface - Clinical Encounters

Relevant for Clinical Reconciliation Select this check box if the clinical encounter is relevant for medication reconciliation. If you select this check box, you must link the clinical encounter to a medication reconciliation record.

Field/button Description

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Chapter 1 - Core Objective 1 - Computerized Physician Order Entry (CPOE)

ObjectiveUse Computerized Provider Order Entry (CPOE) for medication, laboratory, and radiology orders directly entered by any licensed healthcare professional who can enter orders into the medical record per state, local, and professional guidelines. More than 60% of medication, 30% of laboratory, and 30% of radiology orders created by the EP during the EHR reporting period are recorded using CPOE.

DescriptionTo meet Core Objective 1, providers must enter medications in the Rx/Medications tab of patient chart and enter laboratory and radiology orders in the Order Entry tab.

Performance metric

Measure 1: Medication Orders

DenominatorNumber of medication orders created by the EP during the EHR reporting period. (Number of medications in the Current and Historical tabs associated with the EP’s provider ID within the reporting period. Outside medications and ON NO MEDS entries will not be counted.)

NumeratorPortion of denominator where medications were entered by a licensed operator - one who has the Operator is licensed to enter orders check box selected on the Patient Records tab in Operator Maintenance or the This Operator IS the Provider check box on the General tab in Operator Maintenance.

RatioThe resulting percentage must be more than 60%.

ExclusionAny EP who writes fewer than 100 medication orders during the EHR reporting period.

Measure 2: Radiology Orders

DenominatorNumber of radiology orders created by the EP during the EHR reporting period. (Number of orders with type Radiology in the Order Entry module associated with the EP’s provider ID within the reporting period.)

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Configuration Chapter 1 - Core Objective 1 - Computerized Physician Order

NumeratorPortion of denominator recorded by a licensed operator - one who has the Operator is licensed to enter orders check box selected on the Patient Records tab in Operator Maintenance or the This Operator IS the Provider check box on the General tab in Operator Maintenance.)

RatioThe resulting percentage must be more than 30%.

ExclusionAny EP who writes fewer than 100 radiology orders during the EHR reporting period.

Measure 3: Laboratory Orders

DenominatorNumber of laboratory orders created by the EP during the EHR reporting period. (Number of orders with type Laboratory in the Order Entry module associated with the EP’s provider ID within the reporting period.)

NumeratorPortion of denominator recorded by a licensed operator - one who has the Operator is licensed to enter orders check box selected on the Patient Records tab in Operator Maintenance or the This Operator IS the Provider check box on the General tab in Operator Maintenance.)

RatioThe resulting percentage must be more than 30%.

ExclusionAny EP who writes fewer than 100 laboratory orders during the EHR reporting period.

NotesIf a provider wishes to claim exclusion for medication orders, he/she may be asked to enter the total number of prescriptions issued during the reporting period at the time of attestation. A provider can use the Prescription Output Log report available in the EHR to determine this. For more information, see the Prescription Output Log Report topic in the online help.

If a provider wishes to claim exclusion for the lab and/or radiology orders, he/she may be asked to enter the total number of such orders issued during the reporting period at the time of attestation. A provider may use the Order Analysis report available in the EHR to determine this. This report can be run for the desired provider, date range, and order type. For more information, see the Order Analysis Report topic in the online help.

Configuration

Access levels • All licensed users who enter medications in the Rx/Medications tab, and laboratory and

radiology orders in the Orders tab need access to do so.

- Access Levels > Records > Rx/Medications

- Access Levels > Orders > Patient Orders

- Access Levels > Orders > Provider Orders

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Chapter 1 - Core Objective 1 - Computerized Physician Order Entry (CPOE) Configuration

- Access Levels > Orders > New Orders

• All admin personnel who edit order names to assign appropriate order types need access to do so.

- Access Levels > Orders > Order Names

- Access Levels > Orders > Order Types

• All admin personnel who edit Operator Maintenance need access to do so.

- Access Levels > General > Operators (under the Maintenance/Setup section)

Steps to add and edit access levels have not changed since previous versions of the product. Follows the same steps as before.

Operator MaintenanceComplete the following steps for all operators who are licensed to enter medications, lab, and radiology orders on behalf of the EP.

1. Select Maintenance > Setup > Operators.

2. Enter your password.

3. Select the appropriate operator from the list and click the Edit button. The Operator Maintenance Edit screen appears.

Figure 4. Operator Maintenance Edit screen

4. Select the Patient Records tab.

5. Select the Operator is not a full, signing Provider, but may self-enter an Rx or Order option.

6. Select the Operator is licensed to enter orders check box.

7. Click the OK button.

8. Repeat steps 3-7 for all appropriate operators.

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Configuration Chapter 1 - Core Objective 1 - Computerized Physician Order

McKesson recommends that all operators be assigned a sign-on provider on the General tab as best practice.

Complete the following steps for all providers who prescribe medications and place lab and radiology orders.

1. Select Maintenance > Setup > Operators.

2. Enter your password.

3. Select the appropriate operator from the list and click the Edit button. The Operator Maintenance Edit screen appears.

Figure 5. Operator Maintenance Edit screen

4. On the General tab, enter the operator’s provider ID in the Sign-on Provider field.

5. Select the This Operator IS the above Provider check box and click the OK button.

6. Repeat steps 3-5 for all appropriate providers.

Assign order type values to order namesLaboratory and radiology order names must be assigned the appropriate order type to properly identify them for the performance metrics.

To assign an order type to an order name:1. Select Maintenance > Templates > Order Templates > Order Names.

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Chapter 1 - Core Objective 1 - Computerized Physician Order Entry (CPOE) Configuration

2. Select an order name that is a laboratory or radiology order and click the Edit button. The Order Name Edit screen appears.

Figure 6. Order Name Edit screen - Order Type Laboratory

Figure 7. Order Name Edit screen - Order Type Radiology

3. From the Order Type drop-down list, select Laboratory for lab orders and Radiology for radiology orders (single orders and hidden sets).

4. For lab orders that have structured results, select the Order is for lab test with structured results check box. This is required for the Structured Lab Results objective.

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Configuration notes Chapter 1 - Core Objective 1 - Computerized Physician Order

5. Click the OK button.

6. Repeat steps 2-5 for all laboratory and radiology order names.

Note template editsLab and radiology orders also may be placed using .OR Dot codes and/or Enter labels in notes. Prescriptions may be issued using the .RX Dot code and/or Enter labels in notes.

Consider editing the appropriate note templates with the required Dot code statements and/or Enter labels either directly or embedded within QuickText.

Examples:

.OR: CBC <<PUSH>>

<<Enter|Orders>>

<<Enter|Medications>>

McKesson does not recommend prescribing medications using the .RX Dot code.

For more information on the Push and Enter label markers, see the Push and Enter Label Markers topic in the online help.

Configuration notesAlthough not required to meet this objective, if you wish to link Rx templates to order names for therapeutic medications (not vaccines) delivered in-house (for example, Vit B12 Injection, Albuterol treatments, joint injections) in an attempt to increment the numerator for the metric, complete the required configuration steps in Associating a Prescription Template to an order under the Order Entry Overview section in the online Help.

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Chapter 1 - Core Objective 1 - Computerized Physician Order Entry (CPOE) End user workflow training

End user workflow training

To enter prescriptions in the Rx/Medications section:1. Open patient chart and select the Rx/Medications tab.

2. Click the New button. The Prescription New screen appears.

Figure 8. Prescription New screen

3. In the Rx Template Code field, enter the name of the medication to be prescribed and click the Lookup button.

4. Select the desired preparation of the medication from the Rx Template list and click the OK button.

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End user workflow training Chapter 1 - Core Objective 1 - Computerized Physician Order

5. Enter/change values in the fields as desired and click the OK button. The system adds the medication to the Current tab on the Rx/Medications screen.

Figure 9. Rx/Medications screen

To enter lab and radiology orders in the Order Entry section:1. Click the Orders icon on the toolbar. The New Order screen appears.

Figure 10. New Order screen

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Chapter 1 - Core Objective 1 - Computerized Physician Order Entry (CPOE) End user notes

2. Enter the facility, processor, urgency, diagnosis, and other details at the top of the screen as needed.

3. Use the Order Tree to select laboratory and/or radiology orders, or use the Lookup button to search for orders by name. All lab and radiology orders may be placed on this screen to meet this objective successfully.

4. Click the OK button to place the selected orders. The system appends the orders to the Orders tab in the patient’s chart.

Figure 11. Orders screen

End user notes • Per CMS rules: “Any licensed healthcare professionals and credentialed medical assistants

can enter orders into the medical record for purposes of including the order in the numerator for the objective of CPOE if they can originate the order per state, local, and professional guidelines. Credentialing for a medical assistant must come from an organization other than the organization employing the medical assistant.”

• It is permissible to create duplicate medication, lab, and radiology orders.

• Drug warnings WILL display for .RX Dot codes in notes.

• Drug warnings WILL NOT display for .RX Dot codes contained in notes processed by the Text Data Loader.

• If you are editing a prescription template linked to an order and you attempt to modify the Rx Template Code value, the system displays a warning and prevents you from making the change.

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Chapter 2 - Core Objective 2- E-Prescribing and Use of Formulary Data

ObjectiveMore than 50% of all permissible prescriptions written by the eligible provider are queried for a drug formulary and transmitted electronically to the pharmacy using certified EHR technology.

DescriptionProviders must electronically transmit permissible medications (new prescriptions and renewals). Electronic refill requests received from Surescripts will count in the denominator of the performance metric.

SureScripts or InfoScan formulary data will always be available when prescribing, as long as it has been successfully downloaded and is current.

Performance metric

DenominatorThe number of prescriptions issued by a provider during the reporting period, for which transmission is permissible; this includes all such prescriptions faxed, printed, and transmitted (excludes prescriptions marked as “do not print” or “sample given”) AND all electronic refill requests received by that provider.

NumeratorPortion of the prescriptions in the denominator that were queried for a formulary status* and transmitted electronically AND number of electronic refill requests that were transmitted back to the pharmacy electronically.

* The query for formulary status includes successful Eligibility queries with a response received back from the Surescripts network.

RatioThe resulting percentage should be more than 50%.

Exclusions • Any provider who prescribes a total of less than 100 medications during the reporting period.

• Any provider who does not have a pharmacy within his/her organization and there are no pharmacies that accept electronic prescriptions within 10 miles of the provider's practice location at the start of his/her EHR reporting period.

NotesIf a provider wishes to claim exclusion, he/she may be asked to enter the total number of prescriptions issued during the reporting period at the time of attestation. A provider can use the

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Configuration for e-Prescribing Chapter 2 - Core Objective 2- E-Prescribing and Use of Formulary

Prescription Output Log Report available in the EHR to determine this. For more information, please refer to the “Prescription Output Log Report’ section under the Help Menu.

The concept of only permissible prescriptions refers to the current restrictions established by the Department of Justice on electronic prescribing for controlled substances in Schedule II-V. (The substances in Schedule II-V can be found at http://www.deadiversion.usdoj.gov/schedules/orangebook/e_cs_sched.pdf).

Any prescription not subject to these restrictions would be considered permissible.

Configuration for e-PrescribingAll users who need to transmit prescriptions need appropriate access to do so.

• Access Levels > Records tab > Rx/Medications

• Access Levels > Records tab > Print from Rx/Medications

Steps to access and edit Access Levels have not changed since previous versions of the product. Please follow same steps as before.

Configuration notesNone.

End user workflow for e-Prescribing

New prescriptions and renewals (from the patient’s chart)In the 2014 certified version of the product, a prescription now is required to have an NDC associated with it.

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Chapter 2 - Core Objective 2- E-Prescribing and Use of Formulary Data New prescriptions and renewals (from the patient’s chart)

The end user workflows for electronically transmitting new prescriptions and renewals have not changed from previous versions. Providers may e-Prescribe using their existing workflows.

Figure 12. Prescription screen

Eligibility Request Successful - Automatically done once every 72 hours in the background when a patient’s chart is opened. No special end-user action is required for this.

Figure 13. Patient Chart

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Responding to electronic refill requests Chapter 2 - Core Objective 2- E-Prescribing and Use of Formulary

Figure 14. Patient Chart

Responding to electronic refill requestsThe end user workflows for appropriately responding to electronic refill requests has not changed from previous versions. Providers may respond to electronic refill requests using their existing workflow.

End user notesNo specific actions need to be taken by the end users when prescribing “non-permissible” medications. The system automatically calculates the number of permissible prescriptions written to determine the denominator for this objective (controlled substances like morphine and Oxycontin are NOT counted).

As long as electronic refill requests from Surescripts are responded to correctly and in a timely manner (always reply to the Surescripts request message within 48 hours of receipt), it will count toward the numerator of the metric for this objective.

A provider can choose to Approve, Change, or Deny a refill request and successfully help increment the numerator for the metric.

Configuration for formulary implementation

ePrescribing Configuration utility setupOnce a provider has successfully enrolled in Surescripts for e-Prescribing, he/she will have access to the Surescripts formulary.

Formulary updates are set up for automatic downloads on a weekly basis.You may have to modify the formulary download schedule to avoid conflict with other automated services.

In some environments, you may have to direct the download through a proxy server.

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Chapter 2 - Core Objective 2- E-Prescribing and Use of Formulary Data Patient demographics

To access the e-Prescribing formulary download settings in Patient Records, launch the ePrescribing Configuration utility.

To launch the ePrescribing Configuration utility:1. In the PPart folder, double-click ePrescriptionConfiguration.exe. The ePrescribing

Configuration Utility screen appears.

Figure 15. ePrescribing Configuration Utility screen

2. Enter the Days and Time information as desired to set the time and day of the automatic download each week. All users must be out of the system when this takes place for successful installation of the updates.

3. If the formulary needs to download through a proxy server, complete the IP Address, Port, User Name, and Password fields.

4. Click the Save Config button.

Patient demographicsSurescripts uses five demographic fields to match patient demographics between the EHR and the Surescripts network. Ensure that all patients have the following demographic information entered accurately in order to receive formulary checks.

• First name

• Last name

• Date of birth

• Gender

• Zip code

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End user workflow for formulary checks Chapter 2 - Core Objective 2- E-Prescribing and Use of Formulary

End user workflow for formulary checksFor formulary checking to occur, the ePrescribing utility must perform a query on the patient to match the demographic data, which occurs automatically when the patient’s chart is opened.

The patient’s Rx eligibility displays if the query is successful. A provider prescribing medications will be able to see a color-coded and numbered system that corresponds with the patient’s coverage for that medication on the Select Rx Template screen.

Figure 16. Select Rx Template screen

• Red X (1): drug is not on formulary

• Yellow triangle (2): drug is on formulary, but is not preferred

• Green circle (3): drug is on formulary and is preferred

If you click this button in the Formulary area on the Prescriptions New screen...

Then...

Details the screen displays more information, such as alternative drugs that may have a better formulary status.

Alternative the script will be altered.

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Chapter 2 - Core Objective 2- E-Prescribing and Use of Formulary Data End user notes

Figure 17. Prescription New screen

End user notesMcKesson recommends that you capture and save screen shots of the appropriate areas of the application at the beginning (on day 1), during (regular intervals like monthly or quarterly), and at the end (last day) of the reporting period as supporting documentation for meeting this objective successfully.

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End user notes Chapter 2 - Core Objective 2- E-Prescribing and Use of Formulary

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Chapter 3 - Core Objective 3 - Demographics

ObjectiveRecord demographic data for the following fields: gender, date of birth, race, ethnicity, and preferred language.

DescriptionMore than 80% of all unique patients seen by the eligible provider have demographics recorded as structured data.

Performance metric

DenominatorCount of unique patients with an Office Visit and/or Office Visit Prev Med and/or Prenatal Visit and/or Telemedicine Visit type clinical encounter associated with the reporting provider ID within the reporting date range.

NumeratorPortion of denominator where sex, date of birth, race, ethnicity, and preferred language all are recorded.

RatioThe resulting percentage should be more than 80%.

ExclusionsNone.

Configuration

Access levelsThe ability to add or edit patient demographic data, through the appropriate access levels is sufficient for end user functionality and has remained the same as in previous versions of the EHR.

Patient Demographics sectionThe Race and Ethnicity fields available in the EHR must be enabled. The process to enable these fields has not changed since previous versions of the product.

PPart.ini editsYou may add the Race and Ethnicity options on the Patient screen - General tab to the ppart.ini file.

To add the Race and Ethnicity options to the ppart.ini file:1. Navigate to the ppart.ini file (\ppart folder\ppart.ini).

2. Find the RaceItems=line.

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Configuration Chapter 3 - Core Objective 3 - Demographics

The Race and Ethnicity items should appear near each other in the ppart.ini file.

3. Edit the ppart.ini file as follows.

RaceItems=Am Ind or AK Nat, Asian, Blk or Afr Amer, Nt HI or Ot Pa Is, White, Declined

EthnicityItems01=His or Latino, Not His or Latino, Declined

These are the values recommended by CMS. For more information, refer to the following tip sheet.

http://www.cms.gov/Regulations-and-Guidance/Legislation/EHRIncentivePrograms/downloads/7_Record_Demographics.pdf

IMPORTANT: If your site has an outbound interface (for example, Immunizations or Orders), the interface matches only the first five characters of the race, as the database field has a five-character limit. The Race Demographics menu contains the entries defined as required by Meaningful Use (in ppart.ini), such as Blk or Afr Amer. Accordingly, the cross reference file for this item contains Blk or Afr Amer | Black or African-American. The value retrieved for this item is Blk o, which is NOT in the cross reference file. When you create the Race cross reference, note the character length limitations. In the example above, you must update the cross reference to Blk o | Black or African-American.

4. Save and close the ppart.ini file.

NOTE: At this time, you must also leave your legacy data in this field if you are an existing site with integrated Spirometry or have used these fields previously for other purposes.

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Chapter 3 - Core Objective 3 - Demographics For Medisoft Clinical or Lytec MD

For Medisoft Clinical or Lytec MD

When using Medisoft Clinical or Lytec MD, you will need to make additional changes to the cross-reference file DemSch_Race.ref within ppart. This will allow Communication Manager to synchronize with PP Connect to output the correct race status.

To change the cross-reference file:1. Navigate to your network drive that contains the /ppart folder.

2. Within the \ppart folder, browse to the cross-reference file DemSch_Race.ref.

3. Open the DemSch_Race.ref file and edit the cross-reference file to match the RaceItems you changed in step 4 from the ppart.ini file.

4. Edit the file to match the To image below.

Figure 18. DemSch_Race

NOTE: Notice that the Other (E) race type is blank on the second image as this legacy race value is no longer used by Patient Records, nor does it meet the Meaningful Use guidelines for Race.

Product Default directory for the DemSch_Race.ref file

Medisoft Clinical \ppart\Interface\Medisoft\Rcv\DemSch\Crossref

Lytec MD \ppart\Interface\Lytec\Rcv\DemSch\Crossref

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End user training Chapter 3 - Core Objective 3 - Demographics

End user training

To enter the demographic data elements required for Meaningful Use:1. On the General tab of a new or existing patient’s Patient screen, record data in the following

five fields.

- Date of Birth

- Sex

- Race

- Ethnicity

- Preferred Language

Figure 19. Patient New screen

End user notesAll five fields (Date of Birth, Sex, Race, Ethnicity, and Preferred Language) must be populated for any given patient to successfully meet this Meaningful Use objective.

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Chapter 4 - Core Objective 4 - Vital Signs

ObjectiveRecord and chart changes in the following vital signs.

• height/length and weight (no age limit)

• blood pressure (ages 3 and over)

• calculate and display body mass index (BMI)

DescriptionMore than 80% of all unique patients seen by the eligible provider (EP) during the EHR reporting period have blood pressure (for patients age 3 and over only) and height and weight (for all ages) recorded as structured data.

Performance metric

DenominatorCount of unique patients with an Office Visit and/or Office Visit Prev. Med. and/or Prenatal Care and/or Telemedicine type clinical encounter associated with a given provider ID with the reporting date range.

NumeratorNumber of patients in the denominator, 3 years and older, who have at least one entry of their height, weight, and blood pressure plus number of patients under 3 years of age with at least one entry of their height and weight recorded as structured data.

Alternative metrics denominator 1 (height and weight only, BP excluded)Count of unique patients with an Office Visit and/or Office Visit Prev. Med and/or Prenatal Care and/or Telemedicine type clinical encounter associated with a given provider ID with the reporting date range.

Alternative metrics numerator 1Number of patients in the denominator who have at least one entry of height and weight recorded as structured data.

Alternative metrics denominator 2 (BP only, height and weight excluded)Count of unique patients 3 years and older with an Office Visit and/or Office Visit Prev. Med. and/or Prenatal Care and/or Telemedicine type clinical encounter associated with a given provider ID with the reporting date range.

Alternative metrics numerator 2Number of patients in the denominator, 3 years and older, who have at least one entry of blood pressure recorded as structured data.

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Configuration Chapter 4 - Core Objective 4 - Vital Signs

ExclusionsAny EP who

• sees no patients 3 years or older is excluded from recording blood pressure.

• believes that all three vitals signs of height, weight, and blood pressure have no relevance to his/her scope of practice is excluded from recording them.

• believes that height and weight are relevant to his/her scope of practice, but blood pressure is not, is excluded from recording blood pressure.

• believes that blood pressure is relevant to his/her scope of practice, but height and weight are not, is excluded from recording height and weight.

NotesHeight can be self-reported.

Configuration

Access levelsAccess levels remain the same for this functionality from previous versions of the EHR and do not need to be changed.

Note template editsIf the workflow involves recording vital signs in a note and then exporting them to the Vital Signs section using Dot codes, consider editing the appropriate note templates with the .V1 and .V2 Dot code statements, either directory or embedded within QuickText.

Consider adding the PUSH label marker with these Dot code statements.

Examples:

.V1: Syst. BP <<*>> : Diast BP <<*>> : P. <<*>> <<PUSH>>

.V2: T <<*>> : Height <<*>> : Weight <<*>> <<PUSH>>

The Vital Signs screen can be launched from a note using the Enter label marker. Consider adding this per workflow requirements.

Example:

<<Enter|Vital Signs>>

For more information, see the PUSH and Enter Label Markers topic in the online help.

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Chapter 4 - Core Objective 4 - Vital Signs End user training

End user training

There are no changes to the process of recording vital signs since previous versions of the EHR. Users should follow existing workflows.

1. Select the Vital Signs chart tab and click New, or click the <<Enter|Vital Signs>> label in a note. The Vital Signs New screen appears.

2. Enter vital signs in teh appropriate fields and save.

NOTE: The EHR has the ability to graph the height, weight, and BMI. Actual plotting of growth charts is not required to meet this objective.

For further information on graphing the vitals, refer to the Graphing Vital Signs topic in the online help.

End user notes • The vital sign values required to meet any of the performance metrics described in prior

sections must be obtained during the reporting period, but do not need to be recorded on the same date.

• A value for weight must be recorded to successfully meet any of the performance metrics that require weight. If a patient refuses to be weighed or cannot be weighed for any other reason(s) (for example, the patient is wheelchair bound), McKesson recommends that the user enter the last known most accurate weight on file for that patient and document this clearly in the visit note.

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End user notes Chapter 4 - Core Objective 4 - Vital Signs

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Chapter 5 - Core Objective 5 – Smoking Status

ObjectiveRecord smoking status for patients 13 years old or older.

DescriptionRecord smoking status as structured data for more than 80% of all unique patients 13 years old or older seen by the eligible provider.

Performance metric

DenominatorCount of unique patients that are 13 years old or older with an Office Visit and/or Office Visit Prev. Med. and/or Prenatal Care and/or Telemedicine type clinical encounter associated with a given provider ID during the reporting date range.

NumeratorPortion of the denominator where smoking status is recorded in the Vital Signs section of the EHR.

RatioThe resulting percentage should be more than 80%.

ExclusionAn EP who neither sees nor admits any patients 13 years old or older is excluded from this requirement.

Configuration

Access levelsOperators who enter smoking status information in the Vital Signs section must have appropriate access to do so.

You can grant operators access at Access Levels > Records tab > Vital Signs.

Steps to access/edit access levels have not changed since previous versions of the product. Follow the same steps as before.

Note template editsIf a workflow involves entering smoking status in a progress note and exporting that information to the Vital Signs screen via a Dot code, consider adding the following line directly or embedded within QuickText with or without a picklist containing all of the options listed in “List Maintenance” on page 48.

.V6: Smoking <<*>>

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Configuration Chapter 5 - Core Objective 5 – Smoking Status

List MaintenanceTo meet the requirements for Meaningful Use, sites that are upgrading will see the following options in the Smoking drop-down list on the Vital Signs screen.

• Current every day smoker

• Former smoker

• Never smoker

• Current some day smoker

• Smoker, current status unknown

• Unknown if ever smoked

• Heavy tobacco smoker

• Light tobacco smoker

If more options are desired, you can add them to the SMOKING HABITS list under the List Maintenance section. For more information, see the List Maintenance topic in the online help.

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Chapter 5 - Core Objective 5 – Smoking Status End user training

End user training

The end user workflow for recording smoking status has not changed since previous versions of the product. Users can follow their existing workflow to record smoking status for all patients over the age of 13.

Figure 20. Vital Signs New screen

End user training notes • Smoking status MUST be captured on the Vital Signs screen for appropriate credit toward the

performance metric. It may or may not be recorded in the Social History section.

In addition to this objective, the smoking status information recorded in this field on the Vital Signs screen is used by some of the Clinical Quality Measures; therefore, it is important to document this information accurately.

• It is not necessary to populate the Packs Per Day field on the Vital Signs screen for a given patient to successfully meet this objective.

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End user training notes Chapter 5 - Core Objective 5 – Smoking Status

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Chapter 6 - Core Objective 6 – Clinical Decision Support Rule

ObjectiveImplement clinical decision support rules relevant to specialty to improve performance on high priority health conditions.

Measure 1Implement five clinical decision support interventions that are related to four or more Clinical Quality Measures (CQMs) during the entire reporting period.

In the absence of four CQMs relevant to the EP’s scope of practice or patient population, you must implement clinical decision support interventions for high priority (or high risk) health issues during the entire reporting period.

Performance metricNone. This is a Yes/No attestation.

ExclusionsNone.

Measure 2Implement Drug-Drug and Drug-Allergy interactions checks in the EHR for the entire reporting period.

Performance metricNone. This is a Yes/No attestation.

ExclusionsAny EP who writes fewer than 100 prescriptions during the reporting period.

NotesOn method of implementing clinical decision support interventions in the EHR is by enabling and using Health Maintenance (HM) protocol templates for medications and problems within the EHR. Enabling Active HM Reminders is another option.

In addition, a variety of other features are available throughout the EHR such as clinical elements, order rules, and use of conditional logic in notes, all of which can help the provider attest successfully for this objective.

To successfully meet both measures, the EP must attest that these functions have been in use throughout the entire reporting period.

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Configuration Chapter 6 - Core Objective 6 – Clinical Decision Support Rule

Configuration

Measure 1: Clinical decision support interventions

Special FeaturesYou can enable the Enable Active Health Maintenance reminders and Problem and/or Rx protocol templates settings on the Special Features screen - Records 6 tab.

Steps to access and edit these Special Features settings have not changed since previous versions of the product. Use the same steps as before.

Health Maintenance templatesYou can link individual HM procedures to the appropriate CQM on which the EP may choose to report.

To link HM procedures to the appropriate CQMs:1. Select Maintenance > Templates > Health Maintenance Templates. The Provider/Practice

Selection screen appears.

2. Select the provider whose templates you want to access, or leave the Provider ID field blank to access universal templates.

3. If you are using Appointment Schedule Enterprise, you must select a practice in the Practice ID field.

4. Click the OK button. The Health Maintenance Templates screen appears.

5. Select the appropriate HM template (from any category) and click the Edit button. The Health Maintenance Template Edit screen appears.

Figure 21. Health Maintenance Template Edit screen

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Chapter 6 - Core Objective 6 – Clinical Decision Support Rule Measure 1: Clinical decision support interventions

6. Select the appropriate HM procedure and click the Edit Proc button. The HM Procedure Rules Edit screen appears.

Figure 22. HM Procedure Rules Edit screen

7. In the CQM Measure field, select the appropriate CQM and click the OK button.

8. Repeat steps 1-7 for other procedures on the same template, as well as for other HM templates, as desired. Ensure that at least five HM procedures are linked to corresponding CQMs.

The EHR comes prebuilt with age/sex, medication, and problem/diagnosis HM templates. They are customizable and should be configured as per the practice/provider’s requirements. New protocols also may be added. The process for this configuration has not changed since previous versions of the EHR.

Note template editsBecause other features such as conditional logic statements and clinical elements also can be used to demonstrate clinical decision support interventions, consider editing appropriate note templates to add them as needed. For more information, see the Conditional Logic and Clinical Elements topics in the online help.

Implementing order rulesYou can build and configure order rule files with appropriate order names to demonstrate clinical decision support interventions. For more information, see the Order Rules topic in the online help.

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Measure 2: Drug-drug and drug-allergy interaction checks Chapter 6 - Core Objective 6 – Clinical Decision Support Rule

Measure 2: Drug-drug and drug-allergy interaction checks

To enable drug-drug and drug-allergy interaction checking:1. Select Maintenance > Configuration > Prescription Defaults. The Prescription Defaults

screen appears.

Figure 23. Prescription Defaults screen

2. Select the Drug Interactions tab.

3. Select the Drug Interaction Check check box.

It is important that the Clinical Tools product, which contains drug and allergy interaction checking files, is kept current at all times. As with previous versions of the product, download and install updates at least every quarter. EPs will not be able to meet this measure successfully if at any point during the reporting period, the drug and allergy interaction files are allowed to expire.

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Chapter 6 - Core Objective 6 – Clinical Decision Support Rule End user training

End user training

Measure 1: Clinical decision support interventions

Applying HM protocolsAge/sex health maintenance templates are applied automatically as patients are registered, as long as both date of birth and sex are entered in the patient’s demographics.

Problem/diagnosis and medication protocol templates may be applied when prompted. The EHR will prompt the user to apply these templates if there is a medication protocol template available for the specific medication that a patient is being given, or if a problem is being added to a patient’s problem list for which there is a problem/diagnosis protocol template.

Health Maintenance protocolsAge and sex protocols are applied automatically as patients are registered with date of birth and sex entered in the Demographics screen.

Problem/diagnosis- and medication-specific protocols may be applied when prompted. The EHR will prompt the user to apply these protocols if there is a Health Maintenance template available for the specific medication that a patient is given, or if a problem is added to a patient’s problem list that also has an existing Health Maintenance template.

For more information on how protocol template prompts are triggered and how to add, edit, or delete protocol templates, see the Health Maintenance Templates topic in the online help.

To enable a protocol and view the new items added by the protocol:1. Click Yes when prompted, as shown below.

Figure 24. Health Maintenance prompt message

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2. Select Show > Health Maintenance or select the Health Maintenance tab to go to the patient’s Health Maintenance Summary screen to see the new items that were added by the protocol.

Figure 25. Health Maintenance Summary screen

Measure 2: Drug-drug and drug-allergy interaction checksAs with previous versions of the product, the drug interaction checks display automatically when they have been enabled and the Clinical Tools product is current.

End user notes • Age templates do not advance automatically as patients age naturally. Templates must be

adjusted to patients’ ages monthly using the Age Health Maintenance Utility. See Patient Records Help for details on how to run this utility.

• Recommendations: Capture and save screen shots of the appropriate areas of the application at the beginning (on day 1), during (regular intervals like monthly or quarterly), and at the end (last day) of the reporting period. This can be critical supporting documentation for proving you met the objective, should your successful attestation be audited.

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Chapter 7 - Core Objective 7 - Patient Electronic Access

ObjectiveProvide patients with the ability to view online, download, and transmit their health information within four business days of the information being available to the eligible provider (EP).

DescriptionMore than 50% of all unique patients (or their representatives) seen by the EP are provided electronic access to their health information.

More than 5% of all unique patients (or their representatives) view, download, and/or transmit their health information to a third party.

Information that should be made accessible via portal:

• Patient name

• Provider’s name and office contact information

• Current and past problem list

• Procedures list

• Laboratory test results

• Current medication list and medication history

• Current medication allergy list and medication allergy history

• Vital signs (height, weight, blood pressure, BMI, and growth charts)

• Smoking status

• Demographic information (preferred language, sex, race, ethnicity, and date of birth)

• Care plan field(s), including goals and instructions

• Care team members, including primary care physician (PCP) if available

For further details, refer to the following CMS tipsheet: http://www.cms.gov/Regulations-and-Guidance/Legislation/EHRIncentivePrograms/downloads/Stage2_EPCore_7_PatientElectronicAccess.pdf

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Performance metric Chapter 7 - Core Objective 7 - Patient Electronic Access

Performance metric

Measure 1: Patient has electronic access to his/her health information

Denominator 1Count of unique patients with an Office Visit and/or Office Visit Prev. Med. and/or Prenatal Visit and/or Telemedicine Visit type clinical encounter associated with a given provider ID within the reporting date range.

Numerator 1Portion of the denominator configured to have Web View access (Allow Webview access check box is enabled on the Configuration tab in the Patient Demographics section) or CCDAs have been successfully sent to the RelayHealth portal within four days of the patient’s visit.

Ratio 1The resulting percentage must be more than 50%.

Measure 2: Patients view, download, and/or transmit their health information

Denominator 2Count of unique patients with an Office Visit and/or Office Visit Prev. Med., and/or Prenatal Visit and/or Telemedicine Visit type clinical encounter associated with a given provider ID within the reporting date range.

Numerator 2Portion of the denominator where the patients have logged onto the Web View or RelayHealth portal to view, download, and/or transmit their health information to a third party.

Ratio 2The resulting percentage must be more than 5%.

Important notesPatients with access (username and password) to the Web View or RelayHealth portal are the only ones who have the ability to view, download, and transmit their health information.

The denominator for this objective includes ALL unique patients seen by the EP during the reporting period, not just those who have been given access to the Web View or RelayHealth portal. McKesson recommends that all patients be set up with access to the web portal with a username and password as best practice.

ExclusionsAny EP who:

• neither orders nor creates any of the information listed for inclusion as part of both measures, except for Patient name and Provider’s name and office contact information, may exclude both measures.

• conducts 50% or more of his/her patient encounters in a county that does not have 50% or more of its housing units with 3 Mpbs broadband availability according to the latest information available from the FCC on the first day of the EHR reporting period may exclude only Measure 2.

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Chapter 7 - Core Objective 7 - Patient Electronic Access Configuration

ConfigurationWeb View or RelayHealth portal must be installed and fully integrated prior to all configuration steps.

Measure 1: Patients given electronic access

Configuration for Web View

To set up Special Features:1. Select Maintenance > Configuration > Special Features. The Special Features screen

appears.

Figure 26. Special Features screen - General tab

2. Select the General tab.

3. Select the WebView Installed check box and click the OK button.

If this check box was not selected previously, you must exit the application and log back in.

Configuration notesMcKesson recommends that administrators predetermine a standard methodology for assigning user names and initial (temporary) passwords to patients when providing them with access to Web View. For example, Username = FName, LName and Password = Welcome1.

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End user training for Web View

To enable Web View access for patients:1. Open the Patient screen and select the Configuration tab.

Figure 27. Patient Edit screen - Configuration tab

2. Select the Allow Web View access for patient check box.

3. Enter the patient’s username and initial password in the Login name and Initial password fields.

4. Click the OK button to save.

5. Provide the patient with instructions for accessing Web View.

Configuration for RelayHealthOnce the RelayClinical portal has been installed and integrated with the EHR, no more configuration is required in the application.

CCDAs will be created and sent from Partner to RelayClinical when the following criteria are met:

• Patient has a clinical encounter attached to provider for date of visit.

• Patient has a saved progress note by same provider for same date of visit as the clinical encounter.

NOTE: E-mail addresses for patients are required so that the invitations may be automatically sent from RelayClinical, enabling the patient to join the portal and become an “online patient”.If patients refuse to provide an e-mail address, make sure they receive written instructions to access the RelayClinical web page and sign up to become an “online patient” and therefore be able to view, download, and/or transmit their health information.

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Chapter 7 - Core Objective 7 - Patient Electronic Access End user notes

End user notesWhen a patient logs into the portal for the first time, he/she is prompted to reset his/her (temporary) password.

If a patient needs to reset his/her Web View password any time after that (the password that the patient entered when resetting the temporary password), an operator may assign a new temporary password by clicking the Reset Password button on the Patient Edit screen - Configuration tab. The RelayHealth password reset is done in the RelayHealth portal application.

Measure 2: Patient has viewed/downloaded/transmitted health information

Access levelsOperators who run the Web View Audit Trail report and RelayHealth Login Metrics must have appropriate access to do so.

• Access Levels > Reports > General Reports > Web View Audit Trail report

• Access Levels > General tab > External Systems/Proxy Settings

Web View Audit TrailThe Web View Audit Trail report allows operators to view the details of patients who may have logged in to Web View to view, download, and/or transmit various items from the health record.

To generate the Web View Audit Trail report:1. Select Reports > Web View Audit Trail. The Web View Audit Trail Report screen appears.

Figure 28. Reports menu

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Figure 29. Web View Audit Trail Report screen

2. Enter the provider and date range.

3. In the Event Type section, select all of the desired check boxes.

4. Click the OK button and follow the prompts to generate and print the Web View Audit Trail report.

NOTE: This report is for information and internal tracking purposes. You do not have to run this report to generate the numerator or denominator for the performance metric.

Obtaining and saving a RelayHealth certificateIf RelayHealth patient portal is used, a RelayHealth digital certificate and password is necessary to complete the configuration. This usually is provided to a practice/organization by the RelayHealth portal implementation team.

If you do not have the certificate, contact your account manager, VAR, or the Practice Partner support team.

For detailed instructions on saving the certificate to the application server, see the RelayHealth Certificates topic in the online help.

RelayHealth Login MetricsThis feature in the External Systems menu imports data with details of patients who have logged in to the RelayHealth portal to view, download, and/or transmit various items from their health records.

To generate RelayHealth Login Metrics:1. Select Maintenance > Setup > External Systems. The External Systems screen appears.

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Chapter 7 - Core Objective 7 - Patient Electronic Access RelayHealth Login Metrics

2. Select RelayHealth Login Metric and click the Edit button. The RelayHealth Login Metrics screen appears.

Figure 30. RelayHealth Login Metrics screen

3. Select the Schedule Active check box.

4. Enter a date in the Beginning field and the desired interval in the Runs Every field. The utility will run at the designated time and interval to import the patient login data to the EHR.

5. In the Practice GID field, enter the RelayHealth group ID (or RelayHealth site ID) for your practice/organization. This ID was provided to you when the RelayHealth portal was installed and integrated.

The URL field contains the default address.

The Logging Detail field defaults to the Detail option. The Detail option will include the download date, time, external system name, and the content type. For more information on the other options for this field, see the RelayHealth Login Metrics screen topic in the online help.

6. Click the Choose Certificate button and follow the prompts to select the RelayHealth digital certificate saved as per instructions (in the online help).

7. Enter the password in the Password field.

8. Click the OK button to save the changes.

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End user training for Web View (for patients) Chapter 7 - Core Objective 7 - Patient Electronic Access

End user training for Web View (for patients)

To use Web View:1. Log into the Web View portal with your assigned username and password.

Figure 31. Download My Health Information button

2. Click the Download My Health Information button. The How do you want the PHI document delivered? screen appears.

Figure 32. How do you want the PHI document delivered? screen

3. Refer to the following table for your next step.

If you click this button... Then the system displays the...

Download file Download my Health Information screen. Click the Download button to generate .xml and HTML files containing all of your health information. The .xml file can be exported (transmitted) to a third party. Save the file in the desired location.

Display only CCDA file generated in a human-readable format.

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Chapter 7 - Core Objective 7 - Patient Electronic Access End user training for Web View (for patients)

Figure 33. Download my Health Information screen

Figure 34. CCDA file

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End user training for RelayHealth (for patients)

To use the RelayHealth portal:1. Log in to the RelayHealth portal using the username and password provided by the clinic.

Figure 35. Health Records button

2. Click Health Records. A series of tabs displays, allowing the patient to view his/her health information.

Figure 36. Import/Export Health Data link

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Chapter 7 - Core Objective 7 - Patient Electronic Access End user notes

3. Click Import/Export Health Data to download your health information.

Figure 37. Download My Data button

4. Select PDF or XML format and click the Download My Data button.

5. You can save the file to a local drive and transmit it to a third party using the Export feature, or as an attachment via secure e-mail or FTP.

End user notesOnce the configurations have been completed, when a patient logs in to his/her portal (Web View or RelayHealth) to view, download, and/or transmit his/her health information, the activity is flagged automatically in the database. The numerator for the metric (Measure 2 of the objective) will reflect this when the EHR Performance Metrics report is run.

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Chapter 8 - Core Objective 8 - Clinical Summary

ObjectiveProvide clinical summaries for patients for each office visit.

DescriptionClinical summaries must be provided to patients for more than 50% of all office visits within one business day. The summary must contain an updated medication list, laboratory and other diagnostic test orders, procedures, and other instructions based on clinical discussions that took place during the office visit.

To review the required elements in a Clinical Summary report, see the CMS Tipsheet at:

http://www.cms.gov/Regulations-and-Guidance/Legislation/EHRIncentivePrograms/downloads/Stage2_EPCore_8_ClinicalSummaries.pdf

Performance metric

DenominatorCount of clinical encounters with an encounter type of Office Visit, Office Visit Prev. Med., Prenatal Visit, and Telemedicine Visit.

NumeratorPortion of the denominator where a clinical summary is printed within one day and linked to the clinical encounter.

RatioThe resulting percentage must be more than 50%.

ExclusionAny eligible provider who has no office visits during the EHR reporting period.

NotesA printed clinical summary automatically amends the clinical encounter if done on the same day; a provider will receive credit if the Clinical Summary Refused check box is selected.

Configuration

Access levelsAll operators who will be providing the Patient Clinical Summary report must have access to do so.

Access Levels > Reports > Records Reports > Patient Clinical Summary Report

Operators who will be providing the Patient Clinical Summary report also must have access to all chart sections from which data will be included in the Patient Clinical Summary report.

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System configuration Chapter 8 - Core Objective 8 - Clinical Summary

Access Levels > Records > (all desired chart sections)

If clinical summaries are provided electronically via the RelayHealth portal, access to the external systems is required for users performing the necessary configuration.

Access Levels > General > External Systems/Proxy Settings

If clinical summaries are provided electronically as a CCDA file, the user generating the file must have access to the Export Medical Summary feature and access to all sections of the chart from which data will be included in the CCDA.

Access Levels > Reports > Records Reports > Export Medical Summary

Steps for adding and editing access levels have not changed since previous versions of the product. Follow the same process as before.

System configuration

To set up a chart tab to capture the patient instructions to be included in the Patient Clinical Summary report:Check to see if a chart tab named Patient Instructions (or similar) exists in your system.

If the tab does not exist, complete the following steps.

1. Select Maintenance > Configuration > Customize Patient Chart for Site. The Patient Chart Configuration for Site screen appears.

2. Click on any Undefined chart tab and rename it Patient Instructions. McKesson strongly recommends that you change only Undefined chart tabs. Do not change any existing chart tabs.

To configure the Patient Clinical Summary report defaults:1. Select Maintenance > Configuration > Special Features. The Special Features screen

appears.

2. Select the Records 9 tab.

3. Select the check boxes for items you would like to appear by default on the report.

4. In the Patient Instructions field, indicate which chart tab will be used for patient instructions.

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5. Select the Text Results Chart Sections check box and then click the ellipses button. The Text Results Chart Sections screen appears.

Figure 38. Text Results Chart Sections screen

6. Select the check boxes for all of the areas from which you want data to be included on the Patient Clinical Summary report.

7. Click the OK button to close the Text Results Chart Sections screen.

8. Click the OK button on the Special Features screen.

For the settings to take effect, you must completely exit the program and re-enter.

To send an electronic Patient Clinical Summary report via RelayHealth Portal:1. Select Maintenance > Set Up > External Systems. The External Systems screen appears.

Figure 39. External Systems screen

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2. Select Clinical Summaries to RelayHealth and click the Edit button. The Clinical Summaries to RelayHealth screen appears.

Figure 40. Clinical Summaries to RelayHealth screen

3. Select the Schedule Active check box to enable the Scheduling details fields.

4. Enter the schedule time details and enable the data required to be included in the clinical summary using the check boxes in the Content section.

5. Click the OK button to save the changes.

Configuration notesTo add patient instructions, a user enters a note in the Patient Instructions tab directly during the patient visit and includes it in the printed Patient Clinical Summary report so the patient can have that information to take home. The system also allows the use of the .K and .end Dot codes to push information to the Patient Instructions tab from the progress note. Consider using the <<PUSH>> label marker if necessitated by workflow. For more information, refer to the PUSH and ENTER Labels topic in the online help. The defaults for the three “go back” parameters are set to 14 days and may be changed as desired.

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Chapter 8 - Core Objective 8 - Clinical Summary End user training

End user training

To print a Patient Clinical Summary report on paper:Method 1:

1. Select Reports > Patient Records > Print Clinical Summary for Patient. The Patient Lookup screen appears.

2. Search for and select the appropriate patient. The Patient Clinical Summary Report screen appears.

Figure 41. Patient Clinical Summary Report screen

3. Select the appropriate parameters, including date range.

4. Click the OK button to print.

If there are multiple clinical encounters for the same date of service, a list of clinical encounters displays. The most recent clinical encounter is highlighted. Confirm that this is the clinical encounter you would like updated for the clinical summary objective and click the OK button.

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If there is no clinical encounter in the system for the date of service, the system prompts you to create a new clinical encounter.

Figure 42. Clinical Encounter Not Found screen

Method 2:

1. Open the patient’s chart.

2. Click the Print Cl. Sum. button. The Patient Clinical Summary Report screen appears.

3. Click the OK button to print.

If there are multiple clinical encounters for the same date of service, a list of clinical encounters displays. The most recent clinical encounter is highlighted. Confirm that this is the clinical encounter you would like updated for the clinical summary objective and click the OK button.

If there is no clinical encounter in the system for the date of service, the system prompts you to create a new clinical encounter.

As best practice, McKesson recommends that you always create clinical encounters prior to printing the clinical summary. Avoid creating the clinical encounter when printing the clinical summary. This will help mitigate issues with duplicate encounters that may skew metrics numbers for several objectives.

To create an electronic Patient Clinical Summary report:

NOTE: These files are not encrypted. See HIPAA guidelines before transmitting electronically.

Method 1: Human-readable version

1. With the patient chart open, select Reports > Patient Records > Print Clinical Summary for Patient. The Patient Clinical Summary Report screen appears.

2. Select the appropriate parameters, including date range.

3. Select the Print to File check box and click the OK button.

If there are multiple clinical encounters for the same date of service, a list of clinical encounters displays. The most recent clinical encounter is highlighted. Confirm that this is the

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clinical encounter you would like updated for the clinical summary objective and click the OK button. The Render to file screen appears.

Figure 43. Render to file screen

4. Select the option for the desired output format: RTF, HTML, or Text.

5. Click the Browse button and navigate to the location where you want to save the report.

6. Enter a file name in the Filename field and click the Open button.

7. Click the OK button to run and save the report in the location of your choice.

McKesson recommends that you follow a standard naming convention to be used by all users (for example, FNameLNameDOS) and create shared folders on the network where all of these summaries can be saved and accessed easily.

Method 2: CCDA - Clinical Summary

1. Select Reports > Patient Records > Export Medical Summary. The Export Medical Summary screen appears.

Figure 44. Export Medical Summary screen

2. Select the appropriate parameters, including date range.

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3. Select CCDA - Clinical Summary from the Document Type drop-down list and click the OK button.

If prompted, perform a search for the desired patient on the Patient Lookup screen.

4. On the Save As screen, navigate to the location where you want the report saved.

5. Enter the file name and click the Save button.

6. On the Export Medical Summary Detail Selection screen, select the desired clinical data elements.

7. Click the OK button to run and save the report.

McKesson recommends that you follow a standard naming convention to be used by all users (for example, FNameLNameDOS) and create shared folders on the network where all of these summaries can be saved and accessed easily.

To send an electronic Patient Clinical Summary report via Web View Portal:1. With the patient chart open, select Reports > Patient Records > Print Clinical Summary for

Patient. The Patient Clinical Summary Report screen appears.

2. Select the appropriate parameters, including the date range.

3. Select the Send As WebView Message check box.

This check box is available only if the patient has been given access to Web View and a valid e-mail address is entered on the Patient screen - General tab.

4. Click the OK button. The patient receives a secure message in Web View with the Patient Clinical Summary report as an attachment (in .pdf format).

End user notes • When an operator chooses to print the report, the provider defaults to the current provider,

although it is possible to print for other providers.

• The Print to Screen and Send a WebView Message options have no effect on this report. The EHR performance metrics are incremented appropriately when these options are chosen.

• The Save Report option does not increment the performance metrics. It does not update a corresponding clinical encounter.

• If a patient refuses a clinical summary, you may manually select the Clinical Summary Refused check box on the Clinical Encounter screen. This will count for appropriate credit with proper increments to the performance metrics.

• Printed clinical summaries are not encrypted when printed to file. To encrypt, it is best to generate a CCDA - Clinical Summary file.

• A new Dot code can be used from a note to indicate whether a clinical summary was provided to a patient or if a clinical summary was refused. The simplest versions of the Dot code statements are as follows.

.CS: X (Paper Clinical Summary check box is enabled)

.CD: R (Clinical Summary Refused check box is enabled)

The expanded version of the Dot code that can specify more detail is as follows.

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.CS: X|R: Provider ID: Practice ID: Date: Time: Encounter Code

Consider adding the <<PUSH>> label marker if needed. For more information, refer to the PUSH and ENTER Label Markers topic in the online help.

For more information on the .CS code, see the Dot Code topic in the online help.

Figure 45. Clinical Encounter New screen

• A clinical summary must be provided within three business days of the patient’s visit. If the Patient Clinical Summary report is generated more than three business days after the patient’s visit, it will not increment the performance metrics.

• The Patient Clinical Summary report does not include any data that the current operator does not normally have access to in the specific patient’s chart. This includes any level of blocking access to the data (for example practice-access levels, chart access controls, operator access levels, and lab security levels).

• For ease of workflow, providers may find it beneficial to use the .K and .end Dot codes to send patient instructions from the progress note to the appropriate chart tab, rather than opening the chart tab and creating a separate note. An example of the user of the .K and .end Dot codes with patient instructions might be as follows.

.K: Patient Instructions

[insert patient instructions here]

.end

Consider using the <<PUSH>> label to activate the .K Dot code prior to completion of the note if needed. For more information, see the PUSH and ENTER Label Markers topic in the online help.

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Chapter 9 - Core Objective 9 - Security & Risk Analysis

ObjectiveConduct or review a security risk analysis and implement security measures as necessary and bridge identified security gaps as part of its risk management process.

DescriptionThis section will describe and direct the system administrator to the features within Patient Records that will assist an eligible provider in meeting this objective.

Performance metricNone. This is a Yes/No attestation.

Each provider must attest that he/she conducted a security risk analysis, correctly identified security gaps as part of the risk management process, and successfully implemented measures to bridge these gaps as necessary to minimize the risks and keep all manner of data as safe as reasonably possible. McKesson recommends that all eligible providers (EPs) conduct a thorough security risk analysis at least once every quarter.

ExclusionsNone.

NotesThere are a lot of features in the application that aid in keeping sensitive information secure. In addition to the features available in the EHR itself, EPs must have other general measures in place that may include, but are not limited to the following.

• Standard network security protocols on servers, databases, and workstations.

• Use proper firewalls and anti-viral/anti-malware software, which are updated frequently.

• Signed HIPAA agreements on file for all employees.

• Enforce strict policies and procedures for keeping all Personal Health Information (PHI) and Personal Identifiable Information (PII) secure.

• Use secure VPN connections when accessing EHR from off-site locations and mobile devices.

• Require personnel to change system passwords regularly.

• Ensure that staff members do not share login credentials with others.

• Frequent ongoing education of staff regarding the dangers to the practice/organization due to security breaches and the process they are expected to follow before and after an incident.

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• Conduct regular security checks (walk-through) at all locations and for all personnel to identify gaps.

• All personnel should have unique login IDs and passwords to access their workstations/laptops/mobile devices.

• When using terminal services, Citrix systems, or RDP to access the EHR application, operators are trained to use the Ctrl+Alt+Del feature to lock their workstations when they are away.

• McKesson recommends that system administrators enable the Auto-Log Off features on workstations after a certain period of inactivity.

NOTE: These are suggestions only and are not meant to be a complete list of all items to be covered. Use your best judgment to determine all of the requirements for your practice(s) and provider(s).

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Chapter 9 - Core Objective 9 - Security & Risk Analysis Security measures recommendations in the EHR application

Security measures recommendations in the EHR application

Access control/authentication in Practice Partner • Ensure that all users have unique operator IDs and passwords.

• Ensure that all users have been assigned appropriate role-based access levels.

• Ensure that all providers and non-provider operators with signature privileges only for prescriptions have been assigned unique PINs.

The configuration and setup required for these measures have not changed since previous versions of the product. For more information, see the Operator and Operator Maintenance, Access Levels, and Providers topics in the online help.

Figure 46. Operator Maintenance Edit screen

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Chart access control and emergency access1. Access to individual patient’s chart can be controlled using the Limit access to only these

users and Block these users from access options on the Chart Access tab on the Patient screen.

Figure 47. Patient Edit screen

2. Emergency access to such restricted charts may be granted if warranted using the Break the Glass-Chart Access and Break the Glass-Complete access levels.

Figure 48. Access Level Configuration Edit screen

- Partial Chart Access: The access level for Break the Glass-Chart Access allows a user to access a patient’s chart temporarily, if he/she normally is restricted to view all chart

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information. This should be used solely for the purposes of providing appropriate patient care (for example, in situations when the people with access to the chart are unavailable). Chart tabs that normally are restricted from viewing based on access levels still will be restricted.

- Complete Chart Access: The access level for Break the Glass-Chart allows a user to access a patient’s chart temporarily, if he/she normally is restricted to view all chart information. This should be used solely for the purposes of providing appropriate patient care (for example, in situations when the people with access to the chart are unavailable). Chart tabs that normally are restricted from viewing based on access levels will display in View Only mode.

With these features enabled, users will be prompted to enter a Reason for Access field and then click the Proceed button to access a restricted patient’s chart. Once a reason is provided, an operator can view this patient’s information with the same access level restrictions for the individual. This can be tracked via an Operator Audit trail.

Figure 49. Break-the-Glass Security screen

Once the operator has completed his/her task in the restricted chart and closed it, the operator is restored to his/her original access levels. The restricted chart once again will be restricted. The operator will not have privileges to view any other restricted charts. Each time the operator wants to access a restricted chart, he/she must “break the glass” and provide a reason for access.

Auto-park and log-off featuresMcKesson recommends that all operators be trained to use the Park feature in the application to lock their workstations when they step away.

The system also can be set up to automatically “park” or “lock” the workstations after a certain period of inactivity. This setup is done on the Access 1 tab on the Electronic Security screen for PRUtils.

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The setup and configuration for the Auto-Park feature in PRUtils has not changed since previous versions of the product. For more information, see the PRUtils topic in the online help.

Figure 50. Electronic Security screen

Operator Audit Trail reportThis report lists all operator-recorded events in the EHR. This includes the adding, editing, deleting, and viewing of records.

This report also tracks and records the signing of patient notes and labs. Prescription printing, faxing, and transmitting also is recorded.

The audit trails can be enabled for as many items as desired on the Audit Trail tab of the Electronic Security screen for PRUtils. McKesson recommends that the audit trails be enabled for all of the items listed on the screen.

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Chapter 9 - Core Objective 9 - Security & Risk Analysis Operator Audit Trail report

The steps to enable the audit trail feature in PRUtils has not changed since previous versions of the product. For more information, see the PRUtils topic in the online help.

Figure 51. Electronic Security screen

Run an Operator Audit Trail report regularly. McKesson recommends that random audits be conducted by clinic managers and system administrators frequently to ensure that all standard policies and procedures are being followed consistently.

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The steps to run the different audit trails in the EHR have not changed since previous versions fo the product. For more information, see the Operator Audit Trail Report topic in the online help.

Figure 52. Reports menu

Figure 53. Operator Audit Trail Report screen

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NOTE: To comply with CMS regulations, PHI (for example, patient name, date of birth, SSN) have been removed from the audit reports. The patient ID is displayed along with the date and time of occurrence of each event listed, as well as the operator ID of the user who performed the actions. For more information, see the Operator Audit Trail Report topic in the online help.

System security eventsSystem alerts may be enabled so that a specified operator (for example, a system administrator) is notified when a significant auditable event occurs. This allows the system administrator to be alerted immediately to an event that might indicate a security issue for your organization, and for the system administrator to be able to respond promptly.

The setup for this is done by entering the operator ID of the designated person on the Automatic Notification tab on the Electronic Security screen for PRUtils.

The steps to enable the audit trail feature in PRUtils has not changed since previous versions fo the product. For more information, see the PRUtils topic in the online help.

If a security event occurs, the operator assigned to receive the alert receives a “System security event notification” in his/her operator message inbox in the EHR. The message includes the following information:

• event type

• date/time

• operator’s name and ID

• workstation ID

• user’s Windows log on

• patient name and ID

• reason given for access

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Notes Chapter 9 - Core Objective 9 - Security & Risk Analysis

• operator’s name and ID.

Figure 54. Electronic Security screen

NotesMcKesson recommends that EPs save copies of their Security & Risk Analysis reports as supporting documentation for this objective and to be produced in cases of an audit by CMS.

For reference, see the tipsheet at the following location:

http://www.cms.gov/Regulations-and-Guidance/Legislation/EHRIncentivePrograms/Downloads/SecurityRiskAssessment_FactSheet_Updated20131122.pdf

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Chapter 10 - Core Objective 10 – Structured Lab Results

DescriptionThe EHR provides the ability to indicate which orders store results as structured lab test data (in positive/negative or numeric format.) This objective requires the use of the Order Entry module along with lab data test names. The measure can be met whether lab results are manually entered or loaded from an interface.

ObjectiveMore than 55% of all clinical lab tests results ordered by the eligible provider during the EHR reporting period whose results are either in a positive/negative or numerical format are incorporated in certified EHR technology as structured data.

Performance metric

DenominatorCount of the number of lab test orders placed by a given provider through Order Entry that are marked as Order is for lab test with structured results.

NumeratorPortion of the denominator where the lab result(s) (for tests ordered) are stored as structured data in Lab Data tables.

NotesLab results stored as images (scanned paper results) are not counted.

RatioThe resulting percentage should be more than 55%.

ExclusionAn EP who orders no lab tests whose results are either in a positive/negative or numeric format during the EHR reporting period.

ConfigurationIf an EP has not previously attempted to meet this objective in past years and/or new order names for lab tests with structured results are created, complete the following steps.

To indicate that an order name is a lab test with results that are stored as structured data:

1. Select Maintenance > Templates > Order Templates > Order Names. The Order Names Select screen appears.

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2. Refer to the following table for your next step.

Figure 55. Order Name Edit screen

3. Select the Order is for lab test with structured results check box.

4. Ensure the Order Type value is Laboratory for Single Orders and Hidden Order Sets.

5. Click the OK button.

Configuration notesIf workflow involves placing orders via notes associated with .OR Dot codes, consider adding the <<PUSH>> and/or <<Enter|Orders>> label marker(s) if needed. For more information, see the PUSH and ENTER Label Markers topic in the online help.

If you are... Then...

editing an order name select an order name for an existing lab test with structured results and click the Edit button. The Order Name Edit screen appears.

adding a new order name click the New button. The Order Name New screen appears. Enter all appropriate data for the order.

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End user workflow

Place lab test orders via the Order Entry section in the EHR or from notes using the .OR Dot code. This workflow has not changed since past versions of the product.

Figure 56. Order New screen

Enter lab results for the orders placed in the Laboratory Data tables. You can do this manually or via inbound interface(s) from performing lab(s). This workflow has not changed since past versions of the product.

Figure 57. Laboratory Data Table screen

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End user notes Chapter 10 - Core Objective 10 – Structured Lab Results

End user notes • The act of entering the results in the lab tables (manually or via an interface) has to

automatically complete the order. This is required for appropriate credit on the performance metric.

• Manually changing the status of the order to Completed will not count for credit on the metric.

• Scanned paper results do not populate the lab tables and therefore will not count toward the numerator of the metric for this objective.

• Orders placed on paper forms and/or entered in free-text in the progress notes (without an associated .OR Dot code) are not entered in the Order Entry section and therefore will not count toward meeting this objective.

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Chapter 11 - Core Objective 11 – Generate Patient List by Problem

ObjectiveGenerate lists of patients by specific conditions to use for quality improvement, reduction of disparities, research, or outreach.

DescriptionGenerate at least one report listing patients of the eligible provider with a specific condition.

Performance metricNone. This is a Yes/No objective.

ExclusionsNone.

You can achieve this objective through Patient Inquiry or Patient Registries.

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Patient Inquiry Chapter 11 - Core Objective 11 – Generate Patient List by Problem

Patient Inquiry

Patient Inquiry allows users to view, print, and store a list based on a relational inquiry of the information stored in Patient Records.

Patient Inquiry configurationUsers who need to run Patient Inquiry must have access to this feature.

Access Levels > Reports > General Reports > Patient Inquiry

Steps for adding and editing access levels have not changed since previous versions of the product. Follow the same process as before.

Running a Patient Inquiry report

To run a Patient Inquiry report: • Select Reports > Patient Inquiry. The Patient Inquiry New Report screen appears.

Figure 58. Patient Inquiry New Report screen

6. Click the arrow in the Selection Criteria field to display the drop-down item list.

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Chapter 11 - Core Objective 11 – Generate Patient List by Problem Running a Patient Inquiry report

7. To create a patient list, select one of the Problem List or Diagnosis List options. The Enter The Problem Name screen appears.

Figure 59. Enter The Problem Name screen

8. Enter the appropriate value for the item (for example, name of problem or the ICD-9 code) and enter Y or N in the Active field. Click the OK button. The Operator screen appears.

Figure 60. Operator screen

9. Select the appropriate value (most commonly Equal to) and click the OK button. The Select Provider screen appears.

Figure 61. Select Provider screen

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10. Enter the provider ID and click the OK button.

11. If necessary, repeat steps 2-10 to add more selection criteria with the correct report logic options.

12. On the Patient Inquiry New Report screen, click the Run button. The Enter File Name screen appears.

Figure 62. Patient Inquiry New Report screen

Figure 63. Enter File Name screen

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Chapter 11 - Core Objective 11 – Generate Patient List by Problem Notes

13. Choose a destination folder to store the report and enter a file name (without a file extension) that describes the inquiry (for example, Patient List_ASTHMA_OWK). Click the Open button.

14. When the report is completed, a message displays the number of patients (and the percentage) that matches the criteria selected. If there are no patients who match the criteria selected a No Data Matches Criteria message displays. For either message, click the OK button. The Print screen displays.

15. Click the OK button if you want to print the report.

Patient Records adds the .sel extension to the report selection criteria file and add the .inq extension to the report results file. This file stores the information generated by the patient inquiry - the names and IDs of all patients who match the selected criteria (the “Problem” in this case). Users can use the .inq file as the Patient List to meet this objective successfully.

For more information on the use of the report logic keys and adding more criteria, see the Patient Inquiry topic in the Patient Records Help.

Notes • The process described above will successfully generate a patient list only if problems and

diagnoses have been accurately entered in the Problem List section of the patient chart. As best practice, McKesson recommends that all problems entered in the problem list be accurately coded with the respective ICD-9, ICD-10, and SNOMED codes.

• Users are allowed to add patients manually to the .inq file to update the patient list.

• McKesson recommends that users generate and save at least one Patient Inquiry report for each provider during the reporting period and save that as supporting documentation for attestation.

• Patient Inquiry reports can be used for other purposes such as running batch communication jobs, loading patients to patient registries, Public Health Surveillance report, and so on.

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Patient registries Chapter 11 - Core Objective 11 – Generate Patient List by Problem

Patient registries

Registries are custom lists of patients who have something in common, such as a particular chronic disease. For example, practices might set up a registry for patients with diabetes or patients over the age of 80 who live alone or patients who might be candidates for a particular clinical trial.

Administrators use the Registries Maintenance screens to set up and manage the different registries that are available in Patient Records.

Configuration

Access levelsAdministrators with appropriate access use the Registries Maintenance screens to set up and manage the different registries that are available in Patient Records.

Access Levels > Records > Patient Registries Maintenance

Users who will be adding or removing patients and/or comments and notes to and from the registries will need access to do so.

Access Levels > Records > Patient Registries

Steps for adding and editing access levels have not changed since previous versions of the product. Follow the same process as before.

Setting up a new patient registry

To set up a new patient registry:1. Select Maintenance > Templates > Registries. The Registries Select screen appears.

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Chapter 11 - Core Objective 11 – Generate Patient List by Problem Note template edits

2. Click the New button. The Registry Maintenance screen appears.

Figure 64. Registry Maintenance screen

3. Enter a Registry Name (for example, DIABETIC PATIENTS).

4. Select a Registry Type (for example, Chronic Disease) and an optional Description.

McKesson recommends that all registries built NOT be practice- and/or provider-specific. If there is a practice and/or provider ID in the respective fields, delete them to leave the fields blank.

5. If desired, link the registry to an existing flowchart by clicking the Lookup button.

6. Add columns for desired data elements with appropriate headings by clicking the Insert After button.

7. Move columns as desired using the Move Left and Move Right buttons.

8. Click the OK button to save this registry template.

For detailed information on creating and maintaining registries, see the Registries Maintenance and Patient Registries Overview topics in the Patient Records Help.

Note template editsYou also can add patients to any registry from a note with Dot code .ARS: Registry Name (where Registry Name exactly matches the name built in “Setting up a new patient registry” on page 98.

Example:

.ARS: DIABETES

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Consider editing note templates to include the .ARS Dot codes for existing registries, either directly or embedded within QuickText.

Example:

<<Add to Diabetes Registry>> explodes to

.ARS: DIABETES

Consider adding <<PUSH>> label markers if the workflow requires it. For more information, see the PUSH and ENTER Label Markers topic in the online help.

End user training

To add patients to a registry:1. Select Task > Patient Registries. The Patient Registries screen appears.

2. If necessary, delete the practice and provider IDs when searching for a desired registry.

3. Select the desired registry and click the Edit button. The Patient Registry screen appears.

4. Manually add patients to the registry by clicking the Add Patient button.

If you are adding patients to a registry from a note, you must trigger the .ARS Dot codes are required. When the note is closed or the <<PUSH>> label is triggered, the patient is added to the respective registries.

End user notes • An initial batch load can be done by using an .inq file (generated using Patient Inquiry).

• The system checks for duplicates when adding patients to a registry.

• A single patient can be added to multiple registries.

• A note template may have multiple .ARS Dot codes for several registries (for example, .ARS: DIABETES, .ARS: PACEMAKER).

• The Registry data can be exported to an .inq or .txt file using the Export button.

• McKesson recommends that all providers create at least one registry, add relevant patients to it, export it to a text file, and save that as supporting documentation to meet this objective.

For more information on the use of patient registries, see the Patient Registries Screen topic in the online help.

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Chapter 12 - Core Objective 12 - Generate Patient Reminders

ObjectiveSend reminders to patients per patient preference for preventive/follow-up care.

DescriptionMore than 10% of all unique patients seen at least two times within the last 24 months before the start of the reporting period were sent an appropriate reminder during the EHR reporting period.

Performance metric

DenominatorCount of unique patients who were seen by the eligible provider (EP) at least two times within 24 months of the start of the reporting period.

NumeratorPortion of the denominator receiving a message via either the Web View portal or RelayHealth portal OR printed letter OR a phone call generated through Batch Communications.

RatioThe resulting percentage should be more than 10%.

ExclusionAny EP who had no office visits in the past 24 months.

Configuration

PRUtilsBefore Patient Records can retain data to report on the metric for Generation of Patient Reminders, two PRUtils settings, Audit New Records and Audit Batch Communication Actions, must be enabled.

To run PRUtils:1. Make sure that all users are out of the system, all interfaces (PP Connect) are turned off, and

all data and application services are stopped.

2. Access PRUtils through the client folder.

3. Users with appropriate access must sign in to the initial login screen and then provide the PRUtils password.

4. Select the Audit Trail tab and select the Audit New Records and Audit Batch Communication actions check boxes.

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5. Click the OK button to save changes and exit PRUtils.

Access levelsAdministrators with appropriate access use the Batch Maintenance jobs to set up and manage the different jobs that are set up.

Users who will be running the batch jobs must have access to do so.

Access Levels > Reports > General Reports > Batch Communication Job Setup

Access Levels > Reports > General Reports > Run Batch Communication Job

Steps to access and edit access levels have not changed since previous versions of the product. Use the same steps as before.

Configuration notesAlthough the setup of a Batch Communication job is listed in “End user training” on page 103, it may be completed as part of overall configuration by an administrator.

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Chapter 12 - Core Objective 12 - Generate Patient Reminders End user training

End user training

In order to generate patient reminders in Patient Records, users need to:

1. Set the patient’s reminder preference in Patient Demographics.

2. Generate a patient inquiry file.

3. Run batch communication using the file generated from the patient inquiry.

Patient DemographicsThe options available from the Preference for reminders drop-down list on the Patient screen are Printed, Portal, or Phone.

The Portal option is appropriate only for patients who are set up to receive electronic messages via RelayHealth or Web View.

To set a patient's reminder preference:1. Click the Patient button on the toolbar. The Patient Lookup screen appears.

2. Enter the search criteria and filters you want to use to narrow the search and click the Lookup button.

3. In the search results table, highlight the appropriate patient and click the OK button. The Patient Edit screen appears.

Figure 65. Patient Edit screen

4. On the General tab, select an option from the Preference for reminders drop-down list and click the OK button.

5. Repeat these steps for all patients for whom you want to set a preference.

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McKesson recommends that you complete this process at the time of registration for all new patients and at check-in for all established patients.

Patient InquiryIn order to send out patient reminders, a list of patients who are to receive reminders must be generated via the Patient Inquiry feature.

Detailed steps on how to run Patient Inquiry are located in “Core Objective 11 – Generate Patient List by Problem” on page 93. You also can refer to the Patient Inquiry topic in the online help.

Batch CommunicationThis feature allows operators to automatically generate outbound communications in bulk (that is, multiple separate communications generated in one process), such as alerts to patients about the need for preventive services, or alerts to users about patients who need follow-up care in Patient Records.

Operators can generate patient lists for batch communication jobs using Patient Inquiry and the Overdue HM List report. Operators then can create jobs using the lists and run batch communication to generate printed letters or send web messages via Web View or RelayHealth to the list of patients. After a job has been run, the letter is saved in the Letter section of the Patient Chart for each patient whom it was printed for or transmitted to.

Setting up batch communication jobsOperators can set up batch communication jobs to generate printed letters or web messages to send to patients. When setting up a batch communication job, operators can specify the communication details and configure its output.

To add a job for printed letters: 1. Select Reports > Batch Communication. The Batch Communication Select screen appears.

Figure 66. Batch Communication Select screen

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2. Click the New button. The Batch Communication Detail New screen appears.

Figure 67. Batch Communication Detail New screen

3. Enter the name and description for the new job in the provided fields.

4. To attach a Patient List file (under Subjects), click the Browse button to navigate to a previously-created patient inquiry file (.inq) and then click the OK button.

5. In the Output section, enable the desired modes of output by selecting the Printed Letter and/or Portal Message and/or Phone Message options. You may select more than one type of output for a reminder.

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6. For each of the output options selected, designate a letter template in the Template field by clicking the Select button, which displays the Letter Templates Select screen. This screen displays a list of all letter templates in the system.

Figure 68. Letter Template Select screen

Although a different letter template may be used for each type of output, McKesson recommends that the same template be used for all output types for the sake of consistency and easy tracking of data.

7. Select the Exclude patients with Web Message access option to exclude patients with access to Web View or RelayHealth.

8. Select the Exclude patients without "OK to Mail" recorded option to exclude patients that don't have the OK to Mail check box selected on their Patient Demographic screen.

9. Select one of the Limit to patients with recorded reminder preference options if operators want to exclude patients based on the Preference for reminders field on the General tab of the Patient screen. For example, if operators select Printed, reminders will only be generated for patients with this selected preference.

10. Click the OK button.

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Chapter 12 - Core Objective 12 - Generate Patient Reminders Running a Batch Communication Job

Running a Batch Communication Job

To run a batch communication job:1. Select Reports > Batch Communication. The Batch Communication Select screen appears.

Figure 69. Batch Communication Select screen

2. Highlight the batch communication job and click the Run Job button. Click the OK button at the confirmation message.

3. The Batch Communication - Job Status screen displays the status of the job. If running a printed letters job, the Windows Print screen may appear. If it does, select a printer and then click OK.

4. When the job is complete, the Job Summary screen displays the job's details. To retain the contents of the Job Summary, you can highlight all of the text inside the box and copy and paste it into a Word document.

Figure 70. Job Summary screen

5. Click the Close button.

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6. When the job is complete, a list of recipients who received the latest reminders can be found by highlighting the job on the Batch Communication Select screen and clicking the Recipients button. The Batch Communication Recipients screen appears.

If you want to copy this list, click the Copy button and paste the list into a Word document.

Figure 71. Batch Communication Recipients screen

End user notes • The act of running a batch communication job triggers the performance metric for this

objective.

• The batch communication job should be run at least once during the reporting period for the EP.

• The batch communication job needs to be set up only once (before the first time it is run). If no changes are needed to the output options or the letter templates, subsequent runs may be done with a new current patient list file simply by highlighting the job on the list and clicking the Run button.

• McKesson recommends that EPs create a current patient list using the Patient Inquiry feature prior to every run.

• Patients who opt to receive their reminders via the portal option will receive portal messages with the reminder as an attachment (.pdf document).

Patients with Web View access also will be able to view all reminders in their Letters folder if they have access to the Letters chart tab.

• Reminders do not have to be “printed” for patients who have opted for the phone or web preference for appropriate credit on the performance metric for this objective (as was required in previous versions of the product).

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Chapter 13 - Core Objective 13 - Provide Patient-Specific Education

ObjectiveUse certified EHR technology to identify patient-specific education resources and provide those resources to the patient if appropriate.

DescriptionMore than 10% of all unique patients seen by the eligible provider (EP) are provided patient-specific education resources.

Performance metric

DenominatorCount of unique patients with an Office Visit and/or Office Visit Prev. Med. and/or Prenatal Visit and/or Telemedicine Visit type clinical encounter associated with a given provider ID within the reporting date range.

NumeratorPortion of the denominator where documentation reflects patient-specific education materials were provided (percentage of clinical encounters that have the Patient-Specific Education Materials check box selected).

RatioThe resulting percentage should be more than 10%.

ExclusionAny EP who has no office visits during the reporting period.

Notes • Using the Practice Partner Patient Education module and Infobutton feature to connect to the

UpdtoDate website are means by which the requirements for this objective can be met successfully. (Patient Education is considered an add-on product and must be purchased and installed.)

• Other internal and/or external web-based resources may be used to provide patient education. They must be set up and configured under the External Systems in the EHR. External Systems can be used to access internet websites or internal document repositories. These can be accessed through the Labs, Problems, Allergies, and Rx/Medications areas of the application.

• Printing or e-mailing a prebuilt Practice Partner Patient Education handout will automatically update the clinical encounter.

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• The clinical encounter also can be updated with the following Dot code statement in a note: .ED:Y.

Figure 72. Clinical Encounter Edit screen

ConfigurationIf your practice/provider wants to set up an external system to connect to a healthcare website or an internal document repository, complete the steps in “Part 1 - Setting up a new Patient Education category under the External Systems section” on page 110.

If an External System is set up, best practice is to edit the note templates to add the Dot code statements as listed in “Part 2 - Note template changes” on page 111.

Part 1 - Setting up a new Patient Education category under the External Systems sectionOperators who set up and maintain the external systems must have appropriate access to do so. To enable the access level for External Systems, go to Access Levels > General > External Systems/Proxy Settings. The steps for adding and editing access levels have not changed since previous versions of the product. Follow the same process as before.

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To set up a new Patient Education category in External Systems:1. Select Maintenance > Set Up > External Systems. The External Systems screen appears.

Figure 73. External Systems screen

2. Click the New button. The New External System screen appears.

Figure 74. New External System screen

3. Enter a name and description for the external system (for example, WebMD).

4. In the Type field, select Patient Education.

5. In the URL field, enter the URL you use to access the external system website. You must include the web protocol in the web address (for example, http://www.webmd.com).

6. You can leave the Identifier and Password fields blank.

7. In the Global Consent field, select Yes or leave it blank.

8. Click the Create button to save.

Part 2 - Note template changesYou may want to configure templates and QuickText to facilitate easy documentation in notes of the provision of patient education resources.

A template might include: .ED: <<DEL>> <<Y>>

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A QuickText example might include a QuickText <<Patient Education>> with .ED:Y embedded into it.

Consider adding the <<PUSH>> label marker if needed. For more information, see the PUSH and ENTER Label Markers topic in the online help.

• For easy access to patient education handouts that are used very often (for example, an A1C test handout for diabetic patients at a family practice), you can insert e-link labels for such material into the note templates used most often. For more information, see the Using Permanent Hyperlinks in Note Templates in the online help.

• If a practice uses a lot of preprinted educational pamphlets, brochures, and so on as part of its workflow for education, consider building a picklist or QuickText with the titles of all of the materials to aid in documentation, in addition to the .ED:Y Dot code statement.

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Option 1 - Providing educational materials from Practice Partner’s Patient Education module

Open a patient’s chart and click the Pat Ed button on the toolbar.

Figure 75. Pat Ed button

The prebuilt Practice Partner Patient Education module launches and allows you to search for and print and/or e-mail an appropriate handout for a patient.

Figure 76. Patient Education module

The workflow steps for launching and printing patient education material as described have not changed since previous versions of the product. For more information, see the Patient Education Overview topic in the online help.

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Option 2 - Providing patient education materials from configured external systemsYou can right-click on any of the data elements in the following chart tabs and select Patient Education to access the Patient Education module.

• Lab Data Table

• Most Recent Labs

• Rx/Medications

• Problem Lists

• Allergies

Figure 77. Problems/Procedures screen

If external systems are configured to launch other resources, they will first display upon right-clicking. Highlight and click the OK button.

Figure 78. Select the Patient Ed... screen - OK button

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If you click the Cancel button, Practice Partner’s Patient Education module displays.

Figure 79. Select the Patient Ed... screen - Cancel button

Option 3 - Infobutton searchContext-aware searches allow you to obtain provider and patient reference material based on your patients’ demographics, vital signs, medications, problems, labs, allergies, and procedures.

Right-click on any of the data elements in the following chart tabs and select Infobutton Search - Provider or Infobutton Search - Patient to access the Infobutton search.

• Lab Data Table

• Most Recent Labs

• Rx/Medications

• Problem Lists

• Allergies

Figure 80. Problems/Procedures screen

By default, Practice Partner uses UpToDate® as the knowledge resource for Infobutton searches.

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A subscription to the UpToDate® website is required if you want to use the default Infobutton search configuration.

Your organization can use an alternative knowledge resource for Infobutton searches, if desired. For more information on the UpToDate® integration, see the Infobutton Search topic in the online help.

End user notes • When a patient education handout it printed and/or e-mailed from the Practice Partner Patient

Education module directly, the system automatically updates an existing clinical encounter for that date associated with that provider to select the Patient-Specific Education Materials check box.

If there is no matching clinical encounter for that date and provider, the system prompts the operator to create one.

• McKesson recommends that, as best practice, all sites ensure that clinical encounters are created prior to printing or e-mailing any patient education material. This minimizes the potential for extra clinical encounters that could affect metrics results for multiple objectives.

• When any education material is printed from an external system resource (an external website such as WebMD or an Infobutton resource such as UpToDate®) or educational pamphlets/brochures are given to patients, the system does not automatically update an existing clinical encounter for that date associated with that provider. Therefore, EPs may consider using one of the following options.

- Use the .ED:Y Dot code statement in the progress note for the visit along with a brief description of the material provided (this is the recommended method).

- Manually update the clinical encounter by selecting the Patient-Specific Education Materials check box and enter a brief description of the material provided in the visit note (this method is not recommended).

• Verbal patient education is not considered enough to successfully meet this objective. Patients must be given material that they take with them.

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Chapter 14 - Core Objective 14 - Medication Reconciliation

ObjectiveMedication reconciliation is performed on more than 50% of patients received from another setting of care or provider (inbound transition of care) or on all visits that the eligible provider (EP) believes to be relevant for medication reconciliation.

DescriptionThe eligible provider must perform medication reconciliation for more than 50% patients transitioned into the care of the eligible provider.

The new Medication Reconciliation feature allows users to review a patient’s active medication list while importing a CCDA medical summary file that was obtained from another entity.

If medication reconciliation is performed manually by comparing a paper list to the patient’s active medications in Patient Records, you can record that this reconciliation was done. Medication reconciliation may be performed by all qualified, certified medical professionals.

Performance metric

DenominatorCount of clinical encounters (of any type) marked as inbound transitions of care.

NumeratorPortion of the denominator where medication reconciliation is performed and linked to the clinical encounter.

RatioThe resulting percentage should be more than 50%.

ExclusionIf an eligible provider did not receive any patients from a different setting of care or a different provider during the reporting period, he/she is excluded from this requirement.

NoteTo claim exclusion, EPs must select No next to the appropriate exclusion during attestation and then click the Apply button in order to attest to the exclusion.

Configuration

Access levelsAll operators who perform medication reconciliation must have appropriate access to do so.

Access Levels > Records > Data Reconciliation Maintenance

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Steps to add and edit access levels have not changed since previous versions of the product. Follow the same processes as before.

Note template editsIf the workflow involves completing the medication reconciliation using a Dot code statement in a progress note, consider editing the note templates with the Dot code statements. The basic format of the statement is as follows.

.MRC: Operator ID : Date : Time : Practice ID : Encounter Code

To increase user friendliness for the staff and providers, consider building QuickText or picklist options for the Operator ID and Practice ID fields and using letter codes for the Date and Time fields. Consider adding the <<PUSH>> label marker based on workflow requirements. For more information, see the PUSH and ENTER Label Markers topic in the online help.

Example:.MRC: <<Operator ID...>>: ||DATE|| : ||TIME|| : <<Practice ID...>>: Encounter Code <<PUSH>>

Configuration notesIf medication reconciliation has to be performed at the time of clinical data import into the EHR via a CCD/CCR/CCDA file, then the operator must have access to the Import Medical Summary line item located on the Records Reports tab on the Access Level Configuration Edit screen.

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Notes • Medication reconciliation can be done by several methods within the EHR. However, in order

to receive appropriate credit on the performance metric, it is essential that a clinical encounter with a Transition of Care value of Inbound is created and the medication reconciliation action then be performed and linked to that clinical encounter.

In the interest of standardizing workflow processes across the organization, you may choose to train all operators to perform medication reconciliation at every visit regardless of whether it is inbound. This is completely acceptable and will not affect the metric calculations adversely. The system will filter the required data automatically for the denominator and numerator.

• Although a new clinical encounter may be generated at the time of performing the medication reconciliation from the Rx/Medications tab OR when importing medications as part of a CCDA file OR via Dot codes from a note, McKesson recommends that users always link the medication reconciliation event to an existing clinical encounter. This is best practice. It is best to have the clinical encounter generated prior to performing the medication reconciliation action by any one of these methods.

This will reduce the potential for errors, including duplicate clinical encounters and/or improper linkage of the medication reconciliation action to the appropriate encounter, which can result in the skewing of the metrics for multiple objectives.

To record medication reconciliation from the Rx/Medications tab of a patient’s chart with an available clinical encounter (best practice):

1. Open the patient’s chart and select the Rx/Medications tab. The Rx/Medications screen appears.

Figure 81. Rx/Medications screen

2. Click the Med Rec button. If there is a matching clinical encounter in the system for the current date and provider, the screen updates and displays Meds reconciled mm/dd/yyy hh:mm.

To record medication reconciliation from the Rx/Medications tab of a patient’s chart without a clinical encounter:

1. Open the patient’s chart and select the Rx/Medications tab. The Rx/Medications screen appears.

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2. Click the Med Rec button. If there is no matching clinical encounter in the system for the current date and provider, the Medication Reconciliation Detail screen displays with a list of existing clinical encounters.

Figure 82. Medication Reconciliation Detail screen

3. Click the New button to create a new clinical encounter for the current date and provider on the Clinical Encounter New screen.

Figure 83. Clinical Encounter New screen

4. Select the Inbound check box.

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5. Click the OK button to save the encounter. The Medication Reconciliation Detail screen displays again with the new clinical encounter highlighted.

Figure 84. Medication Reconciliation Detail screen

6. Click the Save button to link the medication reconciliation action to the clinical encounter.

NOTE: From the Medication Reconciliation Detail screen, you can choose an existing encounter from the list (without creating a new one) if you want to link the medication reconciliation action to an old encounter. McKesson does not recommend this method, and it should be avoided as much as possible.

To record medication reconciliation through a Dot code in a progress note:Operators may find a few variations of the basic format of the Dot code if they’ve been configured as suggested. If the operator ID, date, time, practice ID, and encounter code will be entered in free text, it is essential to train all operators to enter each of these values between the colons (:). The format for the .MRC Dot code is as follows.

.MRC: Operator ID : Date : Time : Practice ID : Encounter Code

For example:

.MRC: ABC : 02/10/2014 : 10:00AM : 123 : 18

The Encounter Code field refers to the clinical encounter to which this medical reconciliation will be linked. If an encounter code is not specified, the system will try to match an existing clinical encounter that has the same date as the medication reconciliation action. If there is more than one clinical encounter with the same date, the system will match by operator ID.

The operator ID field is the only required field for this Dot code. The remaining fields will default to the progress note’s date and time and the current practice ID (if available). If an encounter code was entered, the practice ID will default to the practice ID for the matching clinical encounter.

The medication reconciliation record includes the operator and practice who performed the action and the date/time the action was performed (using the hh:mm am/pm and mm/dd/yy formats).

When no time parameter is listed, the .MRC Dot code uses the time of the note as the default time. If documenting the medication reconciliation via the .MRC Dot code, the time entered for the

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medication reconciliation must be later than the time of the clinical encounter to which it is linked. Therefore, if you also are creating a clinical encounter via the .ENC Dot code, ensure that the time indicated in the .ENC Dot code is earlier than the time associated with the .MRC Dot code.

To review a patient’s medication reconciliation history:1. Open the patient’s chart.

2. Select Show > Data Reconciliation > Medicaton Rec. History.

3. Enter your EHR password. The Medication Reconciliation History screen appears.\

Figure 85. Medication Reconciliation History screen

The items on the list may be sorted and filtered by date range, practice, and operator.

All items on the list should have an entry in the Encounter column for appropriate credit on the performance metric.

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If the medication reconciliation is not linked appropriately to a clinical encounter, the Encounter column for that entry is blank. These entries are not counted toward the performance metric.

Figure 86. Medication Reconciliation History screen

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Chapter 15 - Core Objective 15 - Summary of Care Record

ObjectiveThe eligible provider (EP) who transitions or refers his/her patient to another setting of care or provider of care provides a summary of care record for more then 50% of transitions of care and referrals.

DescriptionThe EP who transitions or refers his/her patient to another setting of care or provider of care provides a summary of care record for more than 50% of transitions of care and referrals.

When transferring or referring the care of a patient to another practice/facility/provider, create a summary of care record. Per CMS, the information included in the record must be as follows:

• Patient name

• Referring or transitioning provider’s name and office contact information (EP only)

• Procedures

• Diagnosis for visit (problems addressed)

• Immunizations

• Laboratory test results

• Vital signs

• Smoking status

• Functional status, including activities of daily living, cognitive and disability status

• Demographic information

• Care plan

• Care team

• Reason for referral

• Current problem list

• Current medication list

• Current medication allergy list

For more information on the requirements, refer to the following CMS tip sheet: http://www.cms.gov/Regulations-and-Guidance/Legislation/EHRIncentivePrograms/downloads/Stage2_EPCore_15_SummaryCare.pdf.In the certified version of the EHR, the summary file generated can be printed or electronic. Electronic summaries are created in the preferred CCDA (Consolidated Clinical Document

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Architecture) format.

Performance metricThere are three separate measures that each EP must satisfy to meet this objective successfully.

Measure 1: Generate Summary Of CareMore then 50% of the patients transitioned out or referred by the EP to another provider or setting of care during the reporting period were provided with a summary of care.

DenominatorCount of clinical encounters (of any type) associated with the EP marked as outbound transition of care generated within the reporting period.

NumeratorPortion of the denominator where printing of a Chart Summary report or the create of a CCDA file via the Export Medical Summary report was done. (Either the Summary of Care Record for Care Co-ordination provided physically or Summary of Care Record for Care Co-ordination provided electronically check box in Clinical Encounters is selected.)

Measure 2: Provide Summary Of Care With A Direct MessageMore then 10% of the patients transitioned out or referred by the EP to another provider or setting of care during the reporting period were provided with a summary of care with a direct message to the recipient.

DenominatorCount of clinical encounters (of any type) associated with the EP marked as outbound transition of care generated within the reporting period.

NumeratorPortion of the denominator where the creation of a CCDA file via the Export Medical Summary report was done. (The Summary of Care Record for Care Co-ordination provided electronically check box in Clinical Encounters is selected).

Measure 3Conduct at least one electronic exchange of summary of care with a provider or facility that uses a different EHR OR with a CMS test EHR during the reporting period.

Performance metricNone. This is a Yes/No attestation.

Important notesReferral type orders in the Order Entry module no longer can be used to meet this measure (as it was in previous versions of the product). All EPs must generate either a Chart Summary report (printed) or a CCDA file (electronic) to meet this objective successfully.

Per CMS, instead of a direct message, the electronic summary of care also may be made available via a NwHIN (or similar) exchange to the recipient to successfully meet Measure 2. If providers choose this method, they should refer to the CMS website for details on the process.

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If providers choose to conduct a test exchange of the electronic summary of care with a CMS test EHR to meet Measure 3 successfully, they should refer to the CMS website for details on the process.

Configuration

Access levelsOperators who print the Chart Summary report must have appropriate access to do so.

Access Levels > Reports > Records Reports > Chart Summary Report

Operators who generate the CCDA files must have appropriate access to do so.

Access Levels > Reports > Records Reports > Export Medical Summary

Steps to access and edit access levels have not changed since previous versions of the product. Follow the same steps as before.

Configuration notesThe Chart Summary report layout and format cannot be modified.

The CCDA export format cannot be modified.

PPart.ini editsThe following setting in the PPart.ini file controls the presence of the On Behalf of button on the New Message screen.

Figure 87. New Message screen

To display the On Behalf of button:1. Go to /PPart > PPart.ini.

2. Locate the [RelayHealth] section.

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3. Set DirectActivated=ON.

Figure 88. DirectActivated= setting

4. Save and close the file.

5. Restart the application.

Setting up a direct message account with RelayHealth and acquiring direct message addresses

To meet Measure 2 of this objective, the electronic summary of care must be sent to the recipient provider or facility (for example, specialist or hospital) using a direct message account and a direct address. A direct address is similar to a regular e-mail address with extra encryption standards as required by CMS since sensitive information including PHI is included in the electronic summaries of care.

NOTE: The process described below is required for all providers attesting for Stage 2, regardless of the patient portal being used (Web View or RelayHealth). This is an additional account that is REQUIRED to meet this objective successfully, separate from the patient portal itself.

Contact your account manager or VAR to complete this process. There is an annual cost associated with this service. Your account manager or VAR will provide you with the details.

Include DIRECT ACCOUNT and your organization name in the subject line when using e-mail contact (for example, DIRECT ACCOUNT - FARMVILLE FAMILY MEDICINE).

Include the following information in your call or e-mail message:

• Organization/practice name

• Organization ID

• Name, phone number and e-mail address for primary contact person

• Names and e-mail addresses of all providers and operators who require a direct access (to send and receive messages)

As part of this enrollment process, the contact person will be contacted by Digi-cert for a security check process.

Once you receive the RelayHealth Direct Exchange certificate, save it to your application server. For instructions on saving the certificate, see the RelayHealth Certificates topic in the online help.

• This is a certificate issued to the organization or practice (not individual providers).

• This certificate is linked to all providers in an organization or practice on the RelayHealth systems.

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• This certificate is different than the one given to you if you have the RelayHealth patient portal.

Direct exchange via RelayHealth (external systems)This feature on the External Systems menu helps the integration of the RelayHealth Direct Account Certificate obtained from Digi-Cert mentioned above.

To set up Direct Exchange via RelayHealth:1. Select Maintenance > Setup > External Systems. The External Systems screen appears.

Figure 89. External Systems screen

2. Select Direct Exchange via RelayHealth and click the Edit button. The Direct Exchange via RelayHealth screen appears.

Figure 90. Direct Exchange via RelayHealth screen

3. Select the Schedule Active check box.

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4. Enter a date in the Beginning field and the desired interval in the Runs Every field. The utility will run at the designated interval to import and export direct messages to and from the EHR (similar to an e-mail server).

5. The Logging Detail field defaults to Detail. The Detail option includes the download date, time, external system name, and the content type. For more information on the other options available for this field, see the Direct Exchange via RelayHealth screen topic in the online help.

6. Click the Choose Certificate button and follow the prompts to select the RelayHealth digital certificate saved as per instructions (in the online help).

Entry of direct addresses

Operator MaintenanceYou can add direct addresses obtained for providers and operators from RelayHealth to their profiles so that they are readily available on the Messaging screen.

To add a direct address to a profile:1. Select Maintenance > Setup > Operators.

2. If asked, enter your password.

3. Click the OK button. The Operator screen appears.

4. Select an operator from the list and click the Edit button. The Operator Maintenance Edit screen appears.

Figure 91. Operator Maintenance Edit screen

5. In the Direct field on the General tab, enter the direct address and click the OK button to save.

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Referring sourcesIf referring sources (potential recipients of the summaries of care generated by the providers) have direct addresses, you can add the direct addresses to their profiles so they are readily available on the Messaging screen.

To add a direct address to a profile:1. Select Maintenance > Referring Sources. The Referring Source Maintenance Select screen

appears.

2. Select the referring source and click the Edit button. The Referring Source Maintenance Edit screen appears.

Figure 92. Referring Source Maintenance Edit screen

3. In the Contact Preference field, select Direct.

4. In the Direct field, enter the direct address.

5. Click the OK button to save.

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PatientsIf patients (potential recipients of the summaries of care generated by the providers) have direct addresses, you can enter the direct addresses on the Patient screen so they are readily available on the Messaging screen.

Figure 93. Patient Edit screen

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End user training

Measure 1: Generate Summary of Care Record

To generate a printed summary of care:1. Select Reports > Patient Records > Print Chart Summary. The Print Chart Summary screen

appears.

Figure 94. Print Chart Summary screen

2. Leave the Single Patient option selected.

3. McKesson recommends that you do not select the Print first page data only and Limit first page data check boxes because they might inadvertently eliminate some required data elements.

4. Select the Fax check box to fax the report directly.

5. If you want to print the summary to file, select the Print to file check box.

6. Click the OK button. If you selected the Print to file check box, the Render to file screen appears. Otherwise, skip to step 8.

Figure 95. Render to file screen

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7. Select the desired format and click the Browse button to enter an appropriate name and to choose a destination folder.

8. Look up and select the appropriate patient.

9. Refer to the following table for your next step.

Figure 96. Clinical Encounter Not Found screen

10. The default option is Yes. Do not change this option. Click the OK button.

11. On the next screen, indicate if you want to print any images associated with the most recent progress note that will print as part of the summary. The system generates the report and then prints it to paper, faxes it, or saves it to file. If you selected the Fax check box, a screen appears where you can enter the recipient’s name and fax number.

Is there an existing outbound clinical encounter for the current date and current provider?

Then the system...

Yes generates the report, then prints it to paper, faxes it, or saves it to file.

If you selected the Fax check box, a screen appears where you can enter the recipient’s name and fax number.

This is the last step.

No prompts you to create a clinical encounter on the Clinical Encounter Not Found screen. Continue to step 10.

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This process updates the appropriate clinical encounter to indicate that a printed summary of care document was provided by automatically selecting the Summary of Care Record Provided for Care Coordination Physically check box on the Clinical Encounter screen.

Figure 97. Clinical Encounter Edit screen

To generate an electronic summary of care record:1. Select Reports > Patient Records > Export Medical Summary. The Export Medical Summary

screen appears.

Figure 98. Export Medical Summary screen

2. In the Purpose field, select Transfer of Care.

3. In the Document Type field, select CCDA - Summary of Care.

4. Enter the date range and a password, if desired.

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5. Click the OK button.

6. Look up and select the appropriate patient.

7. Refer to the following table for your next step.

Figure 99. Clinical Encounter Not Found screen

8. The default option is Yes. Do not change this option. Click the OK button. The Save As screen appears.

Figure 100. Save As screen

Is there an existing outbound clinical encounter for the current date and current provider?

Then this screen appears...

Yes Save As.

Continue to step 9.

No Clinical Encounter Not Found screen.

Continue to step 8.

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9. Select a destination folder for the generated file and enter an appropriate name. Click the Save button. The Export Medical Summary Detail Selection screen appears.

McKesson recommends that system administrators agree on a predetermined destination folder on a shared drive and a standard naming convention for all CCDAs generated. This ensures that all operators name and save the files in a standardized manner, which makes searching for and accessing these files easier in the future.

Figure 101. Export Medical Summary Detail Selection screen

10. By default, all data in the various sections of the chart are set to be included in the file. Clear the check boxes for any data types or individual data elements that are not desired. You can expand data type to see individual data elements by clicking the plus sign (+) symbols.

11. Click the OK button.

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This process updates the appropriate clinical encounter to indicate that an electronic summary of care document was provided by automatically selecting the Summary of Care Record Provided for Care Coordination Electronically check box on the Clinical Encounter screen.

Figure 102. Clinical Encounter Edit screen

End user notesIf passwords are used to encrypt the CCDA, send them to the recipient separately from the CCDA itself. This ensures better security.

The format and contents of a printed Chart Summary report cannot be modified.

Measure 2: Sending an electronic summary of care via direct messageAn electronic summary of care record can be sent as a direct message toa nother provider who is not part of your organization or practice using the messaging system in the EHR.

To send an electronic summary of care record via direct message:1. Click the Msg icon on the toolbar. The Messages screen appears.

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2. Click the New button. The New Message screen appears.

Figure 103. New Message screen

3. Click the To button. The Select Destination screen appears.

Figure 104. Select Destination screen

4. Refer to the following table for your next step.

If the recipient is... Then select the...

part of your organization or practice recipient’s operator ID and add it to the To field.

an outside provider External Provider option to display the list of referring sources in the system. Select the provider and add the provider ID to the To field.

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You also may add the provider ID to the On Behalf field, and the direct message will be received by the designated representative of the external provider.

Figure 105. Select Destination screen

5. Click the OK button. The New Message screen appears.

Figure 106. New Message screen

6. Click the Patient button to select the patient whose summary of care record is being sent.

7. Enter an appropriate subject line and a message, if desired.

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8. Click the Attachments button. The Attachments screen appears.

Figure 107. Attachments screen

9. Refer to the following table for your next step.

Figure 108. Select Attachment screen

If you want to attach a... Then click this button...

previously-generated CCDA file New. The Select Attachment screen appears.

Select a previously-generated CCDA file.

new CCDA file Export Medical Summary. The Export Medical Summary screen appears.

Complete the steps at “To generate an electronic summary of care record:” on page 135 to generate a new CCDA file.

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Figure 109. Attachments screen

10. After the CCDA file is added to the Attachments screen, click the Close button to return to the New Message screen.

Figure 110. New Message screen

11. Click the Send button to send the message.

Measure 3: Exchange an electronic summary of care with a provider with a different EHR or with a CMS test EHR

To exchange an electronic summary of care with a provider with a different EHR or with a CMS test EHR:

1. Identify recipient provider(s) who use an EHR different than yours.

2. Enter these providers as referring sources.

- Add an e-mail address (required)

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- Add a direct address if available and/or

- Give them access to the Web View portal (with a user name and password on the Configuration tab) if using the Web View patient portal

3. Generate the CCDA file with the summary of care record as described in “To generate an electronic summary of care record:” on page 135.

4. Follow the steps in “To send an electronic summary of care record via direct message:” on page 138.

McKesson recommends that you request a return receipt for these messages.

Save all records of these exchanges (for example, return receipts, copy of messages in the Sent folder, screen shots, and so on) as supporting documentation for attestation.

Figure 111. New Message screen

NOTE: You may use data from test patients to demonstrate this exchange.

If you want to perform an exchange with a CMS test EHR, contact CMS for more information about the process. The basic process of generating the CCDA file in the EHR remains the same.

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Chapter 16 - Core Objective 16 - Submit Vaccine Data to State Immunization Registries

ObjectiveCapability to submit electronic data to state immunization registries or immunization information systems in accordance with applicable laws and practice.

DescriptionSuccessful ongoing submission of electronic immunization data from EHR to an immunization registry or immunization information system for the entire EHR reporting period. The immunization data file must be in the .hl7 format.

ExclusionAn eligible provider (EP) who administers NO immunizations during the reporting period, or where no immunization registry has the capacity to receive the information electronically, or where it is prohibited.

NoteSubmission to immunization registries requires PP Connect (interface software) for Immunizations to be installed and integrated, which allows the extract of immunization data. Contact your sales representative for more information.

Currently, all states have the ability to receive .hl7 format files with immunization data.

Once the interface is installed, integrated, and configured, the data extract is a manual process.

PP Connect for Immunizations currently does not support bi-directional or real-time data extracts and transfers.

Performance metricNone. Eps are required to periodically submit immunization data to the state registry and save records of all such transactions.

Configuration

Health Maintenance namesImmunizations are tracked in the Health Maintenance section. The certified version of the EHR provides the ability to add universal immunization identifier (CVX) codes. CVX code must be entered on all immunizations that are intended to be sent to an immunization registry. A list of CVX codes can be found at http://www2a.cdc.gov/vaccines/iis/iisstandards/vaccines.asp?rpt=cvx.

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To add a CVX code to an immunization:1. Select Maintenance > Templates > Health Maintenance Names. The Health Maintenance

Procedure Names screen appears.

2. Select an immunization health maintenance name and click the Edit button. The Health Maintenance Procedure Name Edit screen appears.

Figure 112. Health Maintenance Procedure Name Edit screen

3. Select CVX from the Code Type drop-down list.

4. In the HM Code 1 field, enter the corresponding CVX code.

Because different CVX codes are listed for different preparations of the same vaccine, check to see which preparation is used by your practice and enter the appropriate code. Only one code can be entered in each HM Code field.

5. Although not required, McKesson recommends populating the HM Synonyms fields appropriately with other health maintenance names for the same vaccine (for example, Flu Shot and INFLUENZA VACCINE), if applicable.

6. Click the More button to enter additional default immunization-specific information such as dose and route (for example, 0.5 ml and IM for a flu shot).

7. Click the OK button to save the changes.

Editing the Immunization reportAll immunizations that have to be reported electronically to the state immunization registry must be added to the Immunization form.

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Chapter 16 - Core Objective 16 - Submit Vaccine Data to State Immunization Registries Note template edits

To add immunizations to the Immunization form:1. Select Maintenance > Templates > Form Templates > Immunization Form. The

Immunizations Selection screen appears.

Figure 113. Immunizations Selection screen

2. Select the appropriate name from the HM Names list and click the Add button to add it to the HM Immunizations list for it to be considered an immunization.

3. Click the OK button.

Note template editsIf workflow involves entering immunization information in visit notes, they can be loaded into the Health Maintenance section using the .H: Dot codes. Consider editing appropriate note templates with Dot code statements directly or embedded within QuickText.

Examples:

.H: <<Vaccine Name>> <<Vaccine Status>>

.H2: <<mm/dd/yyyy>> : <<Vaccine Name>> <<Vaccine Status>>

.H4: <<Vaccine name>> <<Vaccine status>> : <<dose>> : <<route...>> : <<operator ID...>> : <<location...>> : <<lot>> ; <<exp date>> : <<manufacturer>> : <<device>> : <<vfc status>> : <<facility>>

<<Flu Shot details>>

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End user training

Entering immunization information in Health MaintenanceAll immunizations administered by the EP/practice MUST be recorded in the Health Maintenance section; the .hl7 file will be generated based on the data entered in this section only.

To enter a patient’s immunization information:1. Open a patient’s chart.

2. Select the Health Maintenance tab. The Health Maintenance Summary screen appears.

3. Click the New button. The Health Maintenance Procedure New screen appears.

Figure 114. Health Maintenance Procedure New screen

4. Enter the date of the immunization.

5. Find the procedure in the list and enter an X (if the immunization was administered within the organization) or an E (if the immunization was administered outside the organization).

6. Click the More button to enter additional information.

7. In the More area, you can enter the dose, route, lot number, manufacturer, and so on.

8. Click the OK button.

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Chapter 16 - Core Objective 16 - Submit Vaccine Data to State Immunization Registries Entering immunization information in a note

Entering immunization information in a noteYou also can load immunization information to the Health Maintenance section via a Dot code statement in a note.

Examples:

.H: Influenza vaccine X

.H2: <<mm/dd/yy>> : Influenza vaccine X

.H4: Influenza vaccine X: 0.5ml : IM : NUR : Right Deltoid : 123456 : 12/31/2014 : MERCK: : VFC status unknown : PMSI

NOTE: The immunization information on the Health Maintenance Summary and Historical Health Maintenance Summary screens will be included for a given age range and date range when the .hl7 file is created.

Creating the .hl7 file for submission to the state registryOnce the PP Connect interface has been installed and configured per the requirements of your state registry, an operator (usually a system administrator) must manually export the data by running the interface application.

To create the .hl7 file:1. Start the PP Connect application at P:/PPart/Interface/ImmunizationReg/Immunization

Registry. The PPConnect - Immunization Registry Export screen appears.

Figure 115. PPConnect - Immunization Registry Import screen

2. Enter a value in the Maximum Patient Age field. This value determines the age range for which the vaccine data is collected. The default value is 216 months (18 years). This value must be changed if you plan to extract data for adult vaccines such as a flu shot.

When the export is done for the first time, the tool collects ALL of the vaccine data for the patients in the specified age range (for example, 0-216 months) present in the existing EHR database dating back to 12/31/1849.

3. Click the Browse button to select a destination folder for the generated .hl7 file other than the default setting (P:/PPart/Interface/ImmunizationReg/Snd/Immunization/Messages) and

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enter an appropriate file name. McKesson recommends that the file names follow a standard naming convention that includes the date of export.

4. Click the Export button to run the tool and generate the data file.

The next time the export is run, the tool will collect the vaccine data dating back to the previous run.

Figure 116. PPConnect - Immunization Registry Export screen

5. Once the file is generated and saved, follow the instructions outlined by the state registry to upload the file. Consult your state health department’s website for details.

McKesson recommends that all EPs report immunization data to the state registries on a regular schedule; for example, once a month (or more frequently if required by the state registry).

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Chapter 17 - Core Objective 17 - Secure Message from Patient

ObjectiveUse secure electronic messaging in the EHR to effectively communicate with patients on relevant health matters.

DescriptionAt least one secure electronic message sent to the eligible provider (EP) by more than 5% of unique patients (or their representatives) using the secure messaging functionalities of the EHR.

Performance metric

DenominatorCount of unique patients with an Office Visit and/or Office Visit Prev. Med. and/or Prenatal Visit and/or Telemedicine Visit type clinical encounter associated with a given provider ID within the reporting date range.

NumeratorPortion of the denominator where the EP has received a message from the patient (or his/her representative) from Web View or the RelayHealth portal.

RatioThe resulting percentage must be more than 5%.

ExclusionsAny EP who:

• has no office visits during the EHR reporting period.

• conducts 50% or more of his/her patient encounters in a county that does not have 50% or more of its housing units with 3 Mbps broadband availability according to the latest information available from the FCC on the first day of the EHR reporting period.

Important notesWeb View or the RelayHealth portal must be installed and fully integrated to meet this objective successfully.

Patients with access (username and password) to Web View or the RelayHealth portal will be the only ones who have the ability to send a secure message to providers.

The denominator for this objective includes ALL unique patients seen by the EP during the reporting period, not just those who have been given access to Web View or the RelayHealth portal. McKesson recommends that ALL patients be set up with access to the web portal with a username and password as best practice. To encourage your patients to use the portal to send a

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message to the EP, consider initiating a message to all patients (for example, as a follow-up after each visit). This practice has proven to elicit higher rates of response from the patients.

Configuration

Access levelsOperators who run the Web View Audit Trail report and RelayHealth Secure Messaging Metrics must have appropriate access to do so.

Access Levels > Reports > General Reports > Web View Audit Trail report

Access Levels > General tab > External Systems/Proxy Settings

Steps to access/edit access levels have not changed since previous versions of the product. Follow the same steps as before.

Web View Audit TrailThe Web View Audit Trail report allows operators to view the details of patients who have sent a secure message to a provider in Web View.

To generate the Web View Audit Trail report:1. Select Reports > Web View Audit Trail. The Web View Audit Trail Report screen appears.

Figure 117. Reports menu

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Figure 118. Web View Audit Trail Report screen

2. Enter the provider and date range.

3. In the Event Type section, select all of the desired check boxes.

4. Click the OK button and follow the prompts to generate and print the Web View Audit Trail report.

NOTE: This report is for information and internal tracking purposes. You do not have to run this report to generate the numerator or denominator for the performance metric. No further configuration is required.

Obtaining and saving a RelayHealth certificateIf RelayHealth patient portal is used, a RelayHealth digital certificate and password is necessary to complete the configuration. This usually is provided to a practice/organization by the RelayHealth portal implementation team.

If you do not have the certificate, contact your account manager, VAR, or the Practice Partner support team.

For detailed instructions on saving the certificate to the application server, see the RelayHealth Certificates topic in the online help.

RelayHealth Secure Messaging MetricsThis feature in the External Systems menu allows operators to view details of patients who have sent a secure message to a provider through the RelayHealth portal.

To generate RelayHealth Secure Messaging Metrics:1. Select Maintenance > Setup > External Systems. The External Systems screen appears.

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2. Select RelayHealth Secure Messaging Metric and click the Edit button. The RelayHealth Secure Messaging Metrics screen appears.

Figure 119. RelayHealth Secure Messaging Metrics screen

3. Select the Schedule Active check box.

4. Enter a date in the Beginning field and the desired interval in the Runs Every field.

5. In the Practice GID field, enter the RelayHealth group ID for your practice/organization. This ID was provided to you when the RelayHealth portal was installed and integrated.

The URL field contains the default address.

The Logging Detail field defaults to the Detail option. The Detail option will include the download date, time, external system name, and the content type. For more information on the other options for this field, see the RelayHealth Secure Messaging Metrics screen topic in the online help.

6. Click the Choose Certificate button and follow the prompts to select the RelayHealth digital certificate saved as per instructions (in the online help).

7. Enter the password in the Password field.

8. Click the OK button to save the changes.

NOTE: The RelayHealth Secure Messaging Metrics utility must run successfully to pull the data from RelayClinical into the Practice Partner database. This is necessary for the EHR Performance Metrics report tool to generate the correct numbers for the numerator.

End user training (for patients)Train all patients to log into their Web View or RelayHealth portal and create and send messages to their providers.

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No other tasks are required.

NotesOnce the configurations have been completed, when a provider receives a message from a patient via Web View or the RelayHealth portal, it is “flagged” automatically in the database. The numerator for the metric will reflect this when the EHR Performance Metrics report is run.

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Chapter 18 - Menu Objective 1 - Submit Electronic Syndromic Surveillance Data to Public Health Agencies

ObjectiveCapability to submit electronic syndromic surveillance data to public health agencies and actual submission in accordance with applicable law and practice.

DescriptionPerform at least one test of the certified EHR technology’s capacity to provide electronic syndromic surveillance data to public health agencies, and follow-up submission if the test is successful (unless none of the public health agencies to which an eligible provider (EP) submits such information have the capacity to receive the information electronically).

Performance metricNone.

ExclusionAn EP who does not collect any reportable syndromic information on his/her patients during the EHR reporting period, does not submit such information to any public health agency that has the capacity to receive the information electronically, or if it is prohibited.

ConfigurationNo configuration is required for this objective.

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End user training

To generate the data file for submission:1. Select Reports > Public Health Agency Surveillance. The Report Syndromic Surveillance

screen appears.

Figure 120. Report Syndromic Surveillance screen

2. Select the date ranges for which you want to run the report.

3. Click the Load File button or the Lookup button to load the appropriate diagnosis codes for which you want to run the report.

4. Click the Browse button to select a file location or use the default of ppart\Interface\Reporting\Output\SyndromicSurveillance_YYYYMMDD.hl7.

5. Click the OK button to process and run the file.

NotesIf no codes are selected prior to clicking the OK button, the following warning displays.

No diagnosis codes have been selected. This will generate a report of all active patients. Generation of this report may take a long time. Do you wish to continue?

Click Yes to generate the report or click No to return to the report screen.

The report is a text message that conforms to the HL7 standard. This message must be transmitted to the public health agency.

You can use the Remove button to remove any diagnosis codes from the list.

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Chapter 18 - Menu Objective 1 - Submit Electronic Syndromic Surveillance Data to Public Health Agencies Submission to local/

Submission to local/state health agencyAlmost all state health department websites contain information on the submission of the syndromic surveillance data. Most require the EP to register and create an account after which directions are provided for uploading the .hl7 data file. Some sites use secure FTP or secure e-mails.

All EPs must contact their local and/or state health departments for specific details on submission of the file. Once the EP has submitted the data file, he/she receives a message or letter than confirms receipt of the file with details of whether the transaction was successful and if he/she has met the requirements to meet this objective. Save this message as supporting documentation for attestation.

Once the EP has successfully submitted data for the first time, he/she is required to continue regular submission from that point on. McKesson recommends that EPs generate the data files at regular intervals (for example, once every three months).

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Chapter 19 - Menu Objective 2 - Electronic Notes

DescriptionRecord electronic notes in patient records.

ObjectiveMore than 30% of unique patients seen by the provider during the reporting period must have at least one electronic progress note created, edited, and signed by the eligible provider (EP).

Performance metric

DenominatorCount of unique patients with one or more clinical encounter of type Office Visit, Office Visit Prev. Med, Prenatal Visit, or Telemedicine Visit seen by the provider during the reporting period.

NumeratorPortion of the denominator where at least one progress note exists in the Progress Notes chart tab, which is associated with the provider and is dated the same as the clinical encounter.

RatioThe resulting percentage should be more than 30%.

ExclusionNone.

NoteThe progress note may contain text, drawings, and other content. Providers do NOT have to use note templates to create the progress notes; they may create notes via free text or dictation. McKesson recommends that progress notes always have a signature requirement, which is set up in PRUtils.

ConfigurationOperators creating progress notes must have appropriate access to do so. You can allow these operators access at Access Levels section > Records tab > Progress Notes.

Steps for adding and editing access levels have not changed since previous versions of the product. Follow the same process as before.

End user workflowThe basic steps for creating, saving, and signing a progress note have not changed since previous versions of the product. McKesson encourages providers to follow their existing workflow.

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Ensure that the note is saved and signed by the provider who should receive credit for the objective’s performance metric.

End user notesProgress notes must be saved and signed by the provider to receive appropriate credit toward the metric for this objective. “Shared” or “Open” notes will NOT be used in these calculations.

If a progress note is signed by multiple providers, only the first provider signing the note will receive appropriate credit toward the metric for this objective. For example, a mid-level provider’s note may be precepted by his/her supervising physician, who cosigns it. In this case, only the mid-level provider will receive credit toward the numerator for the metric.

Notes created and saved in chart tabs other than Progress Notes will not be used in the metric calculations.

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Chapter 20 - Menu Objective 3 - Images and Imaging Results Accessible through CEHRT

DescriptionImaging results consisting of the image itself and any explanation or other accompanying information are accessible through CEHRT.

ObjectiveMore than 10% of images and results for imaging tests ordered by the provider during the reporting period must be accessible through CEHRT.

Performance metric

DenominatorTotal number of radiological studies (notes) indexed into a designated chart tab (default tab is X-ray) via Zoom, associated with the provider (provider ID entered in the Ordered By field) during the reporting period.

NumeratorPortion of the denominator (number of notes) that were loaded via Zoom and linked to the CEHRT external system at the time of loading.

RatioThe resulting percentage should be more than 10%.

ExclusionAny EP who orders fewer than 100 tests whose result is a radiological image during the EHR reporting period, or any EP who has no access to electronic imaging results at the start of the EHR reporting period.

NOTE: Radiology reports exported into the X-Ray tab (or any tab designated) via an inbound radiology interface will NOT count towards the denominator.

Configuration

Access levelsOperators who index documents (images and imaging reports) via Zoom must have appropriate access to do so.

Access Levels > Records > Text Data Loader

Operators who set up the required external system must have appropriate access to do so.

Access Levels > General > External Systems/Proxy Settings

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PPart.ini edits Chapter 20 - Menu Objective 3 - Images and Imaging Results

Steps for adding and editing access levels have not changed since previous versions of the product. Follow the save process as before.

PPart.ini editsThe chart tab in which the radiological images and imaging reports for studies ordered by the provider will be stored is specified in the PPart.ini file.

To edit the PPart.ini file:1. Open the PPart.ini file in a text editor such as WordPad.

2. Locate the NoteTypesRadiology= setting in the [External Images] section.

Figure 121. NoteTypesRadiology= setting

3. The default chart tab entered in the NoteTypesRadiology= setting is X-Ray. If the X-Ray chart tab has been renamed at your site (for example, to Radiology), update the setting to match your chart tab name. More than one chart tab may be designated to store images and imaging reports. Separate the chart tab names with a comma and no spaces (for example, X-Ray,Special Studies,Pathology). The chart tab names are case-sensitive and the entries in the PPart.ini file must exactly match the way they appear in the patient chart.

Figure 122. NoteTypesRadiology= setting

4. Save the changes and close PPart.ini.

5. Restart the PMSI Applications and Data Services to update the EHR Performance Metrics report tool.

Setting up external systems

To set up external systems:1. Select Maintenance > Setup > External Systems. The External Systems screen appears.

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Chapter 20 - Menu Objective 3 - Images and Imaging Results Accessible through CEHRT Setting up external systems

2. Click the New button. The New External System screen appears.

Figure 123. New External System screen

3. Enter a name and description for the imaging system (for example, PACS).

4. Select CEHRT from the Type drop-down list.

5. Enter the URL you use to access the imaging website. You must include the web protocol in the web address (for example, https://).

6. You may leave the Identifier and Password fields blank.

7. In the Global Consent field, select Yes or leave it blank.

8. Click the Create button to save.

To set up system users:All providers MUST be added as system users (using their operator IDs; the This Operator IS the above Provider check box must be selected on the Operator Maintenance screen - General tab).

Figure 124. Operator Maintenance Edit screen

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9. Select the newly-created external system from the list and click the Edit button. The Edit External System screen appears.

Figure 125. Edit External System screen

10. Click the System Users button. The External System Users screen appears.

11. Click the New button. The New External System User screen appears.

Figure 126. New External System User screen

12. Click the drop-down arrow in the Operator field. The Operator Select screen appears.

Figure 127. Operator Select screen

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Chapter 20 - Menu Objective 3 - Images and Imaging Results Accessible through CEHRT Zoom configuration

13. Select an operator from the list.

14. Enter the username and password that the operator currently uses to access the external imaging system and click the Create button.

Figure 128. New External System User screen

15. Repeat steps 10-14 to enter all of the operators who will be using Zoom to load images linked to this external system.

16. If you use more than one outside source for imaging documents, repeat steps 2-14 to create a second external system.

Zoom configurationMcKesson recommends setting up the chart tab(s) to require the entry of a provider in the Ordered By field to ensure that the end user enters a provider ID in that field. If the field is left blank, the resulting indexed note will not increment the denominator for the metric.

To configure Zoom:1. Select File > Configuration > Requirements tab.

2. Select the check box(es) for the tab(s) that have been designated to store the radiology images and reports scanned and indexed via Zoom.

Configuration notesProviders must be set up with a username and password directly in the imaging system (for example, PACS used at the hospital) to access and view images and reports. When the external system is set up in the EHR for this system, enter the same username and password on the New External System User screen to allow the operator to seamlessly access the images from the patient’s chart.

For basic Zoom configuration, see the Practice Partner Add-ons User’s Guide. You can find this guide on the BPS Central and VAR Central web pages at http://socialkb.mckesson.com.

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End user workflow Chapter 20 - Menu Objective 3 - Images and Imaging Results

End user workflow

To index an image and document via Zoom1. Select Task > Scan. The Practice Partner Zoom screen appears.

Figure 129. Practice Partner Zoom screen

2. Browse to select a document or image that needs to be indexed. When you select the document/image, it displays on the right side of the screen.

3. Click the Lookup button to select a patient whose chart to which you want to load the image/document.

4. In the Section field, select X-Ray or the name of the chart tab where images and imaging reports are stored. This value must match the name of one of the chart tabs entered in the PPart.ini setting NoteTypesRadiology=.

5. Enter the date of the study.

6. In the Ordered by field, select a provider.

7. In the External System 1 field, select a CEHRT external system.

8. If appropriate, select a CEHRT external system in the External System 2 field. Enter values in both External System fields when warranted (for example, if the actual radiological image and the radiologist’s interpretation report are stored in two separate systems).

9. Click the Save button.

10. When all required documents and images are indexed, click the Close button.

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Chapter 20 - Menu Objective 3 - Images and Imaging Results Accessible through CEHRT End user workflow

To view the image from the patient chart:1. Open the patient chart and select the tab where imaging studies are indexed via Zoom (for

example, the Radiology tab).

2. Open the desired note in the tab. You can access the Select Note screen by selecting View > List of Notes. You then can open a particular note by double-clicking on it.

Figure 130. View menu

Figure 131. Select Note screen

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End user notes Chapter 20 - Menu Objective 3 - Images and Imaging Results

3. Click the Ext Sys1 button to open a browser window, which connects to the external system (for example, PACS). View the image and/or the associated report of the radiological study.

Figure 132. Radiology screen

End user notesWhen you index a document or image, if the Ordered by Outside Provider check box is selected on the Practice Partner Zoom screen, then the study (note) will not be used in the calculations of the metric for this objective. Only notes in the designated chart tabs that are associated with (ordered by) the EP during the reporting period will be used in the calculations of the metric for this objective.

To successfully meet this objective, at least one external system must be specified on the Practice Partner Zoom screen when the image and/or document is indexed.

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Chapter 21 - Menu Objective 4 - Family History as Structured Data

DescriptionRecord patient family history as structured data.

ObjectiveMore than 20% of unique patients seen by the provider during the reporting period must have family history for first degree relatives recorded as structured data.

Performance metric

DenominatorCount of unique patients with clinical encounters of type Office Visit, Office Visit Prev. Med., Prenatal Visit, or Telemedicine Visit.

NumeratorPortion of the denominator where at least one entry exists in the grid section of the Family History tab.

ExclusionAn EP who does not have any patient visits during the EHR reporting period.

NoteAlthough CMS only requires family history documented for first degree relatives to meet this objective, McKesson recommends as best practice that family history also be recorded for maternal and paternal aunts, uncles, grandparents, and grandchildren.

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Configuration Chapter 21 - Menu Objective 4 - Family History as Structured

Configuration

Special Features: note view vs. grid viewThe EHR can be configured to display the grid view or note view on the Family History chart tab. This setting is location on the Special Features screen - Records 5 tab.

Figure 133. Special Features screen - Records 5 tab

The Family History View field has a drop-down menu that allows you to choose the Grid or Note option. When the system is upgraded to the 2014 certified version of the EHR, the default setting is Note for this field. The option chosen determines which view is presented to the operator when he/she accesses the Family History chart tab.

The steps to access the Special Features settings have not changed since previous versions of the product. Follow the same process as before.

Access levelsOperators who record family history must have appropriate access to do so. Access is granted at Access Levels > Records > Family History.

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Chapter 21 - Menu Objective 4 - Family History as Structured Data Note template edits

Steps for adding and editing access levels have not changed since previous versions of the product. Follow the same process as before.

Note template editsIf workflow involves recording family history via notes, a new Dot code, .FH, may be used to record structured family history data in the grid section of the Family History tab.

Basic format for Dot code statement:

.FH: <<Family Member>>: <<Name of Problem>>: <<SNOMED Code>>: <<Age Affected>>: <<Status>>

For example:

.FH: Mother: Coronary Heart Disease: 53741008: 45: Living

The SNOMED code, age affected, and status fields are optional.

Consider building these statements with picklists for the Relative and Condition fields to simplify the process for end users. The picklist for the Condition field could include the top 10-20 chronic problems most pertinent to the EP’s specialty and practice.

For example:

.FH: <<Relative...>>: <<Top25Prob...>>: <<SNOMED Code>> <<*>>: <<Age Affected>> <<*>>: <<Living>> <<Deceased>>

Consider adding <<PUSH>> labels if desired. For more information, see the PUSH and ENTER Label Markers topic in the online help.

End user workflow

Recording family history data in the Family History gridWhen the upgrade to the 2014 certified version of the EHR is completed, the grid section of the Family History tab will be blank for all patients, even if a previously recorded family history note exists. The grid must be populated by the operator. This is a manual process.

To record family history data in the Family History grid:1. Open a patient chart and select the Family History chart tab. The Family History screen

appears.

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NOTE: Steps 2, 3, and 4 have not changed since previous versions of the product.

Figure 134. Family History screen

2. Refer to the following table for your next step.

3. If the patient does not have any prior family history recorded as a note, the system prompts you to create a new note and the Family History template automatically loads.

4. Enter details of the patient’s family history using the QuickText and picklists on the template. Click the Save button.

If the default view is set to... Then...

Note the family history note displays.

Grid skip to step 5.

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Chapter 21 - Menu Objective 4 - Family History as Structured Data Recording family history data in the Family History grid

5. To access the Grid view, click the Family History chart tab again and click the Grid button the Note screen.

Figure 135. Family History screen

6. If the patient is an adopted child, select the Adopted check box.

7. To add a new entry to the grid, double-click the Add a Family Member row, or highlight the Add a Family Member row and click the New button. The Family Member New screen appears.

Figure 136. Family Member New screen

8. Select an entry from the Family Member drop-down list.

9. Select Alive or Deceased from the Status drop-down list and enter the person’s date of birth and name, if known.

10. Click the No Sig Med History button if appropriate, then click OK to save.

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Recording family history data in the Family History grid Chapter 21 - Menu Objective 4 - Family History as Structured

11. To add a new problem for the selected family member, click the Add a Problem button. The Family History Problem New screen appears.

Figure 137. Family History Problem New screen

12. Enter a problem name in the Problem field and click the Lookup button. The Diagnosis Code Select screen appears.

Figure 138. Diagnosis Code Select screen

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Chapter 21 - Menu Objective 4 - Family History as Structured Data Recording family history data in the Family History grid

13. Select the appropriate problem from the list and click the OK button. The Family History Problem New screen reappears.

Figure 139. Family History Problem New screen

14. Enter information in the following fields, as appropriate.

- Active/Inactive

- Age Affected

- Date Last

- Date Resolved

- Note

15. Click the Save and Add New button to add a second problem for the same family member.

16. When you have added all problems for the family member, click the OK button to save.

17. Repeat steps 6-16 to add problems for all other family members.

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18. To add significant negative history, double-click the No Family History of row, or highlight the No Family History of row and click the New button. The Negative Family History New screen appears.

Figure 140. Family History screen

Figure 141. Negative Family History New screen

19. Enter a problem name in the Problem field and click the Lookup button. The Diagnosis Code Select screen appears.

20. Select the appropriate diagnosis and click the OK button.

21. Click the Save and Add New button if you need to add another problem; otherwise, click the OK button.

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Chapter 21 - Menu Objective 4 - Family History as Structured Data Recording family history data in a progress note

22. When all problems have been added to the grid, click the Close button.

Figure 142. Family History screen

Recording family history data in a progress noteFamily history may be captured as discrete data and exported to the Family History grid using the .FH Dot code in progress notes. The Dot code statement is in the following format:

.FH: <<Relative...>>: <<Top25Prob...>>: <<SNOMED Code>> <<*>>: <<Age Affected>> <<*>>: <<Living>> <<Deceased>> <<PUSH>>

For example:

.FH: Mother: Coronary Heart Disease: 53741008: 50: Living <<PUSH>>

You may use <<PUSH>> label markers if workflow demands it.

End user notesAs long as at least one family history note is recorded, you can toggle between the Note view and Grid view.

This objective can be met successfully if the grid has any one of the following:

• at least one entry for at least one family member

• at least one entry in the Negative Family History section

• Adopted check box selected

The presence or absence of a family history note does not affect the performance metric for this objective.

The grid will be blank for all patients at the time of the upgrade to the 2014 certified version of the EHR. McKesson recommends that administrative personnel implement a process where the staff is trained to populate the grid for each patient as part of visit triage.

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End user notes Chapter 21 - Menu Objective 4 - Family History as Structured

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Chapter 22 - Menu Objectives 5 and 6 - Cancer Registry and Specialized Disease Registry

Objectives

Menu objective 5Identify and report cancer cases to central cancer registry.

Menu objective 6Identify and report specific cases to a specialized registry.

The Office of the National Coordinator for Health Information Technology (ONC) does not require an EHR to meet these objectives to be a 2014 certified system.

The 2014 certified version of the EHR currently does not have the capability to meet these two objectives; therefore, providers must choose three of the four remaining menu objectives.

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Objectives Chapter 22 - Menu Objectives 5 and 6 - Cancer Registry and

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Chapter 23 - EHR Performance Metrics Report

This chapter provides step-by-step instructions on how to set up and run the EHR Performance Metrics report for meaningful use. The EHR Performance Metrics report was created to help eligible professionals (EPs) with their responses to particular measures required to qualify for meaningful use incentive payments.

Configuring the EHR Performance Metrics reportAfter the version 11.0 upgrade is completed, it is necessary to confirm the configuration settings in PRUtils for accurate data capture by the EHR Performance Metrics report.

Access levelsOperators who run the EHR Performance Metrics report must have appropriate access to do so.

Access Levels > Reports > Records Reports > EHR Performance Metrics Report

PPart.ini settingsThe EHR Performance Metrics report tool provides an operator the option to run the report for Stage 1 or Stage 2 objectives. Based on the selection, the screen displays the appropriate objectives. It is possible set a default value, which will determine the set of objectives that display when the tool is initialized.

The DefaultObjectivesList= setting in the PPart.ini file allows you to specify whether Stage 1 or Stage 2 will be selected by default.

Figure 143. DefaultObjectivesList= setting

Running and printing the EHR Performance Metrics report

To run the EHR Performance Metrics report:The EHR Performance Metrics report tool is located in the client folder. You can run it from a workstation or from the application server.

1. Go to C:\Program Files\McKesson\Practice Partner\PMSI.Reports.PerformanceMetrics.exe. The EHR Performance Metrics Sign In screen appears.

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McKesson recommends that you create a desktop shortcut for the report for easy access in the future.

Figure 144. EHR Performance Metrics Sign In screen

2. Enter the EHR user ID and password and click the OK button. The EHR Performance Metrics Report screen appears.

Figure 145. EHR Performance Metrics Report screen

3. In the Provider To Report On area, complete one of the following actions.

- Select the All Providers option to run the report for all providers.

- Select the Providers Affiliated with Practice option to run the report for all providers affiliated with a selected practice and enter a practice ID in the field. The report will be generated for all providers who are listed in the Providers Affiliated with Practice section on the General 2 tab of the Practice Maintenance screen for the selected practice.

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Chapter 23 - EHR Performance Metrics Report Running and printing the EHR Performance Metrics report

McKesson recommends using this option if you have multiple clinics under the same organization to aid in tracking and troubleshooting (for example, cardiology clinic, internal medicine clinic, and so on).

- Select the Specific Provider option to run the report for one specific provider.

4. Enter the date range for the report.

5. In the Meaningful Use Performance Objectives field, select whether you want Stage 1 or Stage 2 meaningful use performance objectives to be displayed on this screen. If you select Stage 2, the Stage 2 objectives with associated check boxes display.

Figure 146. EHR Performance Metrics Report screen - Stage 2

6. In the Report Options section of the screen, select the appropriate check boxes for the objectives to be included in the report. Use the Check All and Uncheck All buttons to select or clear all check boxes.

7. Select the Print to File option if you want a .pdf file version of the generated report.

The system prompts you to save the report in a desired destination folder with an appropriate file name. Navigate to the location where you want to save the report. McKesson recommends that you create a dedicated folder in a shared location where all reports can be saved. Consider creating subfolders for each practice and/or provider, so that reports can be accessed easily in the future.

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The default name for the report is EHR Performance Metrics Report mmddyyyy_hhmmss, where mmddyyyy is the date and hhmmss is the time stamp.

Figure 147. Directory Path for Export Files screen

8. Click the Run Report button to generate the EHR Performance Metrics report. When the report has been generated, it displays in the Report Viewer.

9. To print the report from the Report Viewer, click the Print button on the toolbar. The Print screen appears.

NOTE: Run this report often and at regular intervals, ideally at least once a week, to make sure that all providers are meeting the appropriate objectives. If you do not, troubleshooting may be necessary, and the earlier any gaps are detected, the earlier they can be investigated and fixed to ensure that the provider(s) are able to attest successfully. DO NOT wait until the end of the reporting period to run the EHR Performance Metrics report for the first time.

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Chapter 23 - EHR Performance Metrics Report EHR Performance Metrics report example

EHR Performance Metrics report example

Figure 148. EHR Performance Metrics report

Information on the EHR Performance Metrics reportThe following table lists the numerator and denominator line items for each objective displayed on the EHR Performance Metrics report and how they are calculated. This is a useful tool in gap analyses and for identifying solutions to bridge them.

Definitions for terms used in the following table:

Term Definition

Ratio The ratio is the percentage of the objective that was achieved. The ratio value on the report is the numerator value divided by the denominator value expressed as a percentage. For some measurements, if the denominator value is zero, the ratio is displayed as N/A.

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2014 Stage 2Objectives

Unique patients A unique patient means that even if a patient is seen multiple times during the EHR reporting period, he/she is counted only once in the calculation of the metrics.

Term Definition

Report Element Description

Core Objective #1 - CPOE for Medication Orders (Threshold 60%)1. Medication Orders Placed Using CPOE

Number of medication orders placed using CPOE

The number of orders in the denominator recorded by a licensed operator (one who has the Operator is licensed to enter Orders check box selected on the Patient Records tab or the This Operator IS the Provider check box selected on the General tab in Operator Maintenance).

This value is used as the numerator.

Number of medication orders placed Total number of medication orders created by the provider (recorded in the Current and Historical tabs) during the reporting period.

This value is used as the denominator.

Ratio The percentage of medication orders placed using CPOE.

Core Objective #1 - CPOE for Radiology Orders (Threshold 30%)2. Radiology Orders Placed Using CPOE

Number of radiology orders issued using CPOE

The number of radiology orders in the denominator recorded by a licensed operator (one who has the Operator is licensed to enter Orders check box selected on the Patient Records tab or the This Operator IS the Provider check box selected on the General tab in Operator Maintenance).

This value is used as the numerator.

Number of radiology orders placed Number of radiology orders created by the provider during the reporting period.

This value is used as the denominator.

Ratio The percentage of radiology orders placed using CPOE.

Core Objective #1 - CPOE for Laboratory Orders (Threshold 30%)3. Laboratory orders placed using CPOE

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Number of laboratory orders issued using CPOE functionality

The number of laboratory orders in the denominator recorded by a licensed operator (one who has the Operator is licensed to enter Orders check box selected on the Patient Records tab or the This Operator IS the Provider check box selected on the General tab in Operator Maintenance).

This value is used as the numerator.

Number of laboratory orders placed Number of laboratory orders created by the provider during the reporting period.

This value is used as the denominator.

Ratio The percentage of orders placed using CPOE.

Core Objective #2 - E-PrescribingPrescriptions queried for a drug formulary and transmitted electronically (Threshold 50%)Note: “Outside” medications and prescriptions for controlled substances will not be used in these calculations.

Number of prescriptions queried for a drug formulary and transmitted electronically

The portion of the prescriptions in the denominator queried for a drug formulary (returned a successful eligibility response) and transmitted, PLUS all electronic refill requests that were replied to appropriately.

This value is used as the numerator.

Number of prescriptions generated that were permissible for electronic transmission

The total number of permissible prescription records within the reporting period that were printed, faxed, and transmitted; PLUS the total number of electronic refill requests received by the provider from Surescripts.

This value is used as the denominator.

Ratio The percentage of permissible prescriptions that were queried for a drug formulary and transmitted electronically.

Core Objective #3 - Record Demographics (Threshold 80%)

Number of patients for whom demographic data is recorded as structured data

The number of patients in the denominator who have all of the following demographic values recorded.

• Gender

• Preferred language

• Race

• Ethnicity

• Date of birth

This value is used as the numerator.

Report Element Description

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Number of patients seen The number of unique patients seen by the provider within the reporting period.

This value is used as the denominator.

Ratio The percentage of patients for whom all five of the required demographic elements were recorded.

Core Objective #4 - Record Vital Signs (Threshold 80%)

1. Record Vital Signs (Height/Length, Weight, and BP) for patients aged 3 years or older

Number of patients who have at least one entry of height/length, weight, and BP

The number of patients in the denominator who had the following information recorded on the Vital Signs screen.

• Height/length

• Weight

• Systolic and diastolic BP

• BMI (calculated automatically when height and weight are entered)

This value is used as the numerator.

Number of patients seen The total number of unique patients seen who were 3 years or older within the reporting period.

This value is used as the denominator.

Ratio The percentage of patients for whom height, weight, blood pressure, and BMI was recorded.

Core Objective #4 - Record Vital Signs (Threshold 50%)

2. Record Vital Signs (Height/Length and Weight)

Number of patients who have at least one entry of height/length and weight

The number of patients in the denominator who had the following information recorded on the Vital Signs screen.

• Height/length

• Weight

• BMI (calculated automatically when height and weight are entered)

This value is used as the numerator.

Number of patients seen The total number of unique patients seen within the reporting period.

This value is used as the denominator.

Ratio The percentage of patients for whom height, weight, and BMI was recorded.

Report Element Description

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Core Objective #4 - Record Vital Signs (Threshold 80%)

3. Record Vital Signs (BP Only) for Patients Aged 3 Years or Older

Number of patients who have at least one entry for BP

The number of patients in the denominator who had systolic and diastolic BP information recorded on the Vital Signs screen.

This value is used as the numerator.

Number of patient seen The total number of unique patients seen who were 3 years or older within the reporting period.

This value is used as the denominator.

Ratio The percentage of patients for whom BP was recorded.

NOTE: Providers should use only one of the vital signs metrics to report for the Vital Signs objective based on the scope of their practices.

Core Objective #5 - Smoking Status (Threshold 80%)

Record Smoking Status for Patients Aged 13 Years or Older

Number of patients with smoking status recorded as structured data

The number of patients in the denominator who had their smoking status recorded on the Vital Signs screen.

This value is used as the numerator.

NOTE: If historical data exists, this will be used to calculate the total.

Number of patients seen The total number of unique patients seen who were age 13 years or older within the reporting period.

This value is used as the denominator.

Ratio The percentage of patients who have had their smoking status recorded.

Core Objective #7 - Electronic Access to Health Information

1. Patients Provided with Timely Electronic Access to Health Information (Threshold 50%)

Number of patients who had timely access to their health information

• The number of patients (from the denominator) who have been granted access to Web View on the Patient screen - Configuration tab.

OR

• The number of patients (from the denominator) who have had CCDAs generated and sent to RelayClinical within four days after the date of the visit.

This value is used as the numerator.

Report Element Description

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Number of patients seen The total number of unique patients seen by the provider during the reporting period.

This value is used as the denominator.

Ratio The percentage of patients who have access to view, download, and transmit their health information via a web portal.

Core Objective #7 - Electronic Access to Health Information

2. View, Download, and Transmit to a Third Party Patient’s Health Information (Threshold 5%)

Number of patients who viewed online, downloaded, or transmitted their health information

The number of patients who have viewed, downloaded, or transmitted their health information via the Web View or RelayHealth portals during the reporting period.

This value is used as the numerator.

Number of patients seen The total number of unique patients seen by the provider during the reporting period.

This value is used as the denominator.

Ratio The percentage of patients who have viewed, downloaded, or transmitted their health information via a web portal.

Core Objective #8 - Clinical Summaries (Threshold 50%)

Clinical Summaries Provided to Patients within 1 Business Day (at EACH Office Visit)

Number of clinical encounters where a clinical summary was provided to patient within 1 business day

The portion of the denominator for whom a clinical summary was provided within 1 business day of their visit (paper and electronic summaries will be counted in these calculations).

Patients who refused also will be counted in these calculations.

This value is used as the numerator.

Number of clinical encounters The number of clinical encounters associated with the provider during the reporting period.

This value is used as the denominator.

Ratio The percentage of office visits for which a clinical summary was provided within 1 business day of visit.

NOTE: The denominator for the clinical summaries objective is expected to be higher than the denominator of objectives that use the unique patient count, since the clinical summary objective counts all visits a patient has had during the reporting period.

Core Objective #10 - Clinical Lab Tests Recorded as Structured Data (Threshold 55%)

Report Element Description

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Number of applicable tests with results stored as structured data

The number of laboratory orders in the denominator marked Complete automatically by entry of structured lab results in the lab tables. Entry into lab tables can be manual or via an interface.

This value is used as the numerator.

Number of applicable tests ordered The total number of orders placed by the provider in the Order Entry section during the reporting period, which have the Order is for lab test with Structured Results check box selected.

This value is used as the denominator.

Ratio The percentage of lab test orders whose results are stored as structured data.

Core Objective #12: Patient Reminders (Threshold 10%)

Preventive Reminders Sent per Patient Preference

Number of patients who were sent a reminder per patient preference

The number of patients in the denominator who were sent a reminder via phone, letter, or message in the Web View or RelayHealth portals.

This value is used as the numerator.

Number of patients who had 2 or more office visits with the provider within the 24 months prior to the beginning of the reporting period

The total number of patients who had 2 or more Office Visit clinical encounters associated with the provider in the 24 months prior to the beginning of the reporting period.

This value is used as the denominator.

Ratio The percentage of patients who received a reminder during the reporting period.

NOTE: The denominator line item on the report may read Number of patients seen.... This is a misnomer (the calculations on the report are as per the descriptions stated above). This issue will be corrected in a future product update.

Core Objective #13 - Patient Education (Threshold 10%)

Patient-Specific Education Material Provided

Number of patients who were provided patient education material

The portion of patients in the denominator who received patient-specific education materials (the Patient Specific Education Materials check box on the patient’s Clinical Encounters screen is selected).

This value is used as the numerator.

Report Element Description

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2014 Stage 2Objectives Chapter 23 - EHR Performance Metrics Report

Number of patients seen The total number of unique patients seen by the provider within the reporting period.

This value is used as the denominator.

Ratio The percentage of patients who received patient-specific education materials.

Core Objective #14 - Medication Reconciliation (Threshold 50%)

Medication Reconciliation Performed at Relevant Encounters or Transitions of Care

Number of clinical encounters where medication reconciliation was performed

The number of inbound clinical encounters in the denominator that have a medication reconciliation event linked to them.

This value is used as the numerator.

Number of clinical encounters marked as inbound transitions of care

The total number of clinical encounters associated with the provider within the reporting period that have the Inbound check box selected in the Transition of Care Type section.

This value is used as the denominator.

Ratio The percentage of inbound clinical encounters that have a medication reconciliation event linked to them.

Core Objective #15 - Summary of Care

1. Summary of Care Record Provided for Transitions of Care/Referrals (Threshold 50%)

Number of care transitions/referrals where summary of care record was provided

The portion of clinical encounters in the denominator that have either one or both of the Summary of Care Record Provided for Care Coordination check boxes selected.

This value is used as the numerator.

Number of care transitions/referrals The total number of clinical encounters associated with the provider within the reporting period that have the Outbound check box selected in the Transition of Care Type section.

This value is used as the denominator.

Ratio The percentage of outbound clinical encounters that indicate a summary of care record was provided.

Core Objective #15 - Summary of Care

2. Summary of Care Record Provided for Transitions of Care/Referrals and Sent Electronically (Threshold 10%)

Report Element Description

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Number of care transitions/referrals where summary of care was sent electronically

The number of clinical encounters in the denominator that have the Summary of Care Record Provided for Care Coordination Electronically check box selected.

This value is used as the numerator.

Number of care transitions/referrals The total number of clinical encounters associated with the provider within the reporting period that have the Outbound check box selected in the Transition of Care Type section.

This value is used as the denominator.

Ratio The percentage of outbound clinical encounters that indicate a summary of care record was provided.

Core Objective #17 - Secure Messages Sent by Patients to Their Providers (Threshold 5%)

Number of patients who sent a secure message to their provider

The number of patients who have sent a message to their provider via Web View or RelayHealth messaging.

This value is used as the numerator.

Number of patients seen The total number of unique patients seen by the provider within the reporting period.

This value is used as the denominator.

Ratio The percentage of patients who sent a message to their provider.

Menu Objective #2 - Progress Notes Recorded as Text-Searchable Data (Threshold 30%)

Number of patients who have one progress note recorded as text-searchable data

The number of patients (from the denominator) who have at least one progress note associated with the provider, dated within the reporting period, recorded in the Progress Notes chart tab.

This value is used as the numerator.

Number of patients seen The total number of unique patients seen by the provider within the reporting period.

This value is used as the denominator.

Ratio The number of patients who have at least one progress note associated with the provider recorded in the Progress Notes chart tab.

Menu Objective #3 - Imaging Results Accessible through CEHRT (Threshold 10%)

Report Element Description

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“Drill-down” patient information on the EHR Performance Metrics report Chapter 23 - EHR Performance Metrics Report

“Drill-down” patient information on the EHR Performance Metrics report

The EHR Performance Metrics report now has the ability to display the patient-level details that were included in the calculation of the numerator and denominator for each objective. This “drill-down” information includes:

• Patient ID

• Patient name

• Whether the metric was accomplished for that patient

- Y indicates “yes,” which means that patient was counted in the calculation of the numerator.

- N indicates “no,” which means that patient was counted in the calculation of the denominator only.

• Date of the encounter (for relevant encounters only)

Number of imaging results accessible through CEHRT

The number of notes in the denominator that have at least one external system specified when they are indexed into the chart tab using Zoom.

This value is used as the numerator.

Number of imaging results The total number of notes in all the chart tabs specified on the NoteTypesRadiology= line (in the PPart.ini file) associated with the provider created during the reporting period.

This value is used as the denominator.

Ratio The number of notes indexed via Zoom into the specified chart tabs that have at least one external system enabled.

Menu Objective #4 - Family History Recorded as Structured Data (Threshold 10%)

Number of patients with a structured data entry for one or more first-degree relative

The number of patients in the denominator who have at least one entry in the Family History grid.

A note in the Family History chart tab does NOT count in the calculations of the metric.

This value is used as the numerator.

Number of patients seen The total number of unique patients seen by the provider within the reporting period.

This value is used as the denominator.

Ratio The number of patients with at least one entry in the Family History grid.

Report Element Description

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Chapter 23 - EHR Performance Metrics Report “Drill-down” patient information on the EHR Performance Metrics

Figure 149. EHR Performance Metrics report

Figure 150. EHR Performance Metrics report

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“Drill-down” patient information on the EHR Performance Metrics report Chapter 23 - EHR Performance Metrics Report

To access the drill-down patient information: • Double-click the Objective line item to access the drill-down information for that objective.

Figure 151. EHR Performance Metrics report

You can print this drill-down patient-level report by clicking the Print icon in the top left corner of the screen. This is a useful tool in troubleshooting, when the provider is not meeting the metric for a given objective.

Figure 152. EHR Performance Metrics report - Print icon

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Index

Index

2014 Stage 2 objectives 188

AA 142Access Level Configuration Edit screen 82access levels 15adding

CVX codes to immunizations 146direct addresses to profiles 130, 131immunizations to the Immunization form 147Race and Ethnicity options to the ppart.ini

file 39assigning

order types to order names 24Attachments screen 141attestation 8Auto-park feature 83

BBatch Communication Detail New screen 105Batch Communication Recipients screen 108Batch Communication Select screen 104, 107Break-the-Glass Security screen 83buttons

Download My Health Information 64

CCCDA file 65Certified Health IT Product List 7, 8changing

ppart.ini file settings 12chart tabs

setting up 70CHPL numbers

finding 6Clinical Encounter Edit screen 110, 135, 138Clinical Encounter New screen 77, 120Clinical Encounter Not Found screen 74, 134, 136Clinical Summaries to RelayHealth screen 72Computerized Physician Order Entry (CPOE) 21configuring

Patient Clinical Summary report defaults 70contacting McKesson 9CPOE 21creating

.hl7 files 149electronic Patient Clinical Summary report 74

CVX codesadding to immunizations 146

DDefaultObjectivesList= setting 183DemSch_Race 41Diagnosis Code Select screen 176direct addresses

adding to profiles 130, 131Direct Exchange via RelayHealth screen 129direct message

sending electronic summary of care records 138

DirectActivated= PPart.ini setting 128Directory Path for Export Files screen 186documenting

via Zoom 168Download My Health Information button 64Download my Health Information screen 65drug-drug and drug-allergy interaction checking

enabling 54

EEdit External System screen 166EHR Performance Metrics report 187, 197, 198

drill-down patient information 196example 187Print icon 198running 183

EHR Performance Metrics Report screen 184, 185EHR Performance Metrics Sign In screen 184Electronic Security screen 84, 85, 88electronic summaries of care

exchanging with a provider with a different EHR or with a CMS test EHR 142

generating 135electronic summary of care records

sending via direct message 138enabling

drug-drug and drug-allergy interaction checking 54

Web View access for patients 60Enter File Name screen 96Enter The Problem Name screen 95

Index

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enteringimmunization information in a note 149patients’ immunization information 148prescriptions in the Rx/Medications section 27

ePrescribing Configuration utilitylaunching 35setup 34

ePrescribing Configuration Utility screen 35exchanging

electronic summaries of care with a provider with a different EHR or with a CMS test EHR 142

Export Medical Summary Detail Selection screen 137

Export Medical Summary screen 75, 135External Systems

setting up a new Patient Education category 110

external systemssetting up 164

External Systems screen 71, 111, 129

Ffamily history data

recording in a progress note 179recording in the Family History grid 173

Family History Problem New screen 176, 177Family History screen 174, 175, 178, 179Family Member New screen 175files

CCDA 65finding

CHPL numbers 6Product Registration numbers 6

Ggenerating

electronic summaries of care 135printed summaries of care 133RelayHealth Login Metrics 62RelayHealth Secure Messaging Metrics 153

HHealth Maintenance Procedure Name Edit

screen 146Health Maintenance Procedure New screen 148Health Maintenance procedures

linking to the appropriate CQMsClinical Quality Measures

linking HM procedures 52Health Maintenance Summary screen 56

Health Maintenance Template Edit screen 52hl7 files

creating 149HM Procedure Rules Edit screen 53How do you want the PHI document delivered?

screen 64

Iimages

viewing from patient chart 169Immunization form

adding immunizations 147immunization information

entering 148entering in a note 149

immunizationsadding CVX codes 146adding to the Immunization form 147

Immunizations Selection screen 147indexing

images 168Infobutton search 115

JJob Summary screen 107

LLaboratory Data Table screen 91launching

ePrescribing Configuration utility 35Letter Template Select screen 106linking

HM procedures to the appropriate CQMs 52log-off feature 83

MMcKesson

contacting 9Medication Reconciliation Detail screen 120, 121Medication Reconciliation History 123Medication Reconciliation History screen 122, 123menus

Reports 86

NNegative Family History New screen 178New External System screen 111, 165New External System User screen 166, 167New Message screen 127, 139, 140, 142, 143New Order screen 28notes

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Index

entering immunization information 149NoteTypesRadiology= setting 164

Oobjectives

Stage 2 3obtaining

RelayHealth certificate 62, 153Operator Audit Trail Report screen 86Operator Maintenance Edit screen 23, 24, 81, 130,

165Operator screen 95Operator Select screen 166Order Name Edit screen 25, 90order names

assigning order types 24Order New screen 91order types

assigning to order names 24Orders screen 29overview guides

Stage 2 2

Ppatient chart

viewing images 169Patient Clinical Summary report

configuring defaults 70electronic 74printing 73sending electronically via RelayHealth Portal 71sending electronically via Web View Portal 76

Patient Clinical Summary Report screen 73Patient Edit screen 82, 103, 132

Configuration tab 60Patient Education

setting up a new category under the External Systems section 110

Patient Education module 113Patient Inquiry New Report screen 94, 96Patient New 42Patient New screen 42patient registries

setting up new 98patient reminder preference

setting 103PPart.ini

settingsNoteTypesRadiology= 164

ppart.inichanging file settings 12

PPart.ini filesettings

DefaultObjectivesList= 183ppart.ini file

adding Race and Ethnicity options 39PPart.ini settings

DirectActivated= 128PPConnect - Immunization Registry Export

screen 150PPConnect - Immunization Registry Import

screen 149Practice Partner Zoom screen 168Prescription Defaults screen 54Prescription New screen 27, 37Prescription screen 33prescriptions

entering in the Rx/Medications section 27Print Chart Summary screen 133printed summaries of care

generating 133printing

Patient Clinical Summary report 73Problems/Procedures screen 114, 115Product Registration numbers

finding 6profiles

adding direct addresses to 130, 131progress notes

recording family history data 179PRUtils

running 101

RRadiology screen 170recording

family history data in a progress note 179family history data in the Family History grid 173

Referring Source Maintenance Edit screen 131Registry Maintenance screen 99RelayHealth certificate

obtaining 62, 153saving 62, 153

RelayHealth Login Metrics 62generating 62

RelayHealth Login Metrics screen 63RelayHealth Portal

sending an electronic Patient Clinical Summary report 71

RelayHealth portalusing 66

RelayHealth Secure Messaging Metrics 153generating 153

Index

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RelayHealth Secure Messaging Metrics screen 154Render to file screen 75, 133Report Syndromic Surveillance screen 158reports

EHR Performance Metrics 187, 197drill-down patient information 196example 187Print icon 198

EHR Performance Metrics report 198Patient Clinical Summary

configuring defaults 70Reports menu 86running

EHR Performance Metrics report 183PRUtils 101

Rx/Medications screen 28, 119Rx/Medications section

entering prescriptions 27

SSave As screen 136saving

RelayHealth certificate 62, 153screens 42, 123

Access Level Configuration Edit 82Attachments 141, 142Batch Communication Detail New 105Batch Communication Recipients 108Batch Communication Select 104, 107Break-the-Glass Security 83Clinical Encounter Edit 110, 135, 138Clinical Encounter New 77, 120Clinical Encounter Not Found 74, 134, 136Clinical Summaries to RelayHealth 72Diagnosis Code Select 176Direct Exchange via RelayHealth 129Directory Path for Export Files 186Download my Health Information 65Edit External System 166EHR Performance Metrics Report 184, 185EHR Performance Metrics Sign In 184Electronic Security 84, 85, 88Enter File Name 96Enter The Problem Name 95ePrescribing Configuration Utility 35Export Medical Summary 75, 135Export Medical Summary Detail Selection 137External Systems 71, 111, 129Family History 174, 175, 178, 179Family History Problem New 176, 177Family Member New 175Health Maintenance Procedure Name Edit 146

Health Maintenance Procedure New 148Health Maintenance Summary 56Health Maintenance Template Edit 52HM Procedure Rules Edit 53How do you want the PHI document

delivered? 64Immunizations Selection 147Job Summary 107Laboratory Data Table 91Letter Template Select 106Medication Reconciliation Detail 120, 121Medication Reconciliation History 122Negative Family History New 178New External System 111, 165New External System User 166, 167New Message 127, 139, 140, 142, 143New Order 28Operator 95Operator Audit Trail Report 86Operator Maintenance Edit 23, 24, 81, 130, 165Operator Select 166Order Name Edit 25, 90Order New 91Orders 29Patient Clinical Summary Report 73Patient Edit 82, 103, 132

Configuration tab 60Patient Inquiry New Report 94, 96PPConnect - Immunization Registry Export 150PPConnect - Immunization Registry Import 149Practice Partner Zoom 168Prescription 33Prescription Defaults 54Prescription New 27, 37Print Chart Summary 133Problems/Procedures 114, 115Radiology 170Referring Source Maintenance Edit 131Registry Maintenance 99RelayHealth Login Metrics 63RelayHealth Secure Messaging Metrics 154Render to file 75, 133Report Syndromic Surveillance 158Rx/Medications 28, 119Save As 136Select Attachment 141Select Destination 139, 140Select Note 169Select Provider 95Select Rx Template 36Special Features

General tab 59

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Index

Records 5 tab 172Text Results Chart Sections 71Type of Visit Code Maintenance Select 13Type of Visit New 13Vital Signs New 49Web View Audit Trail Report 62, 153

Select Attachment screen 141Select Destination screen 139, 140Select Note screen 169Select Provider screen 95Select Rx Template screen 36sending

an electronic Patient Clinical Summary report via RelayHealth Portal 71

electronic Patient Clinical Summary report via Web View Portal 76

electronic summary of care records via direct message 138

settingpatient reminder preference 103

setting upchart tabs 70ePrescribing Configuration utility 34external systems 164new Patient Education category under the Ex-

ternal Systems section 110new patient registries 98

settingsNoteTypesRadiology= 164

Special Features screenGeneral tab 59

Special Features screen - Records 5 tab 172Stage 2 objectives 3Stage 2 overview guides 2summaries of care

generatingelectronic 135printed 133

TText Results Chart Sections screen 71Type of Visit Code Maintenance Select screen 13Type of Visit New screen 13

Uusing

RelayHealth portal 66Web View 64

utilitiesePrescribing Configuration

launching 35

setting up 34

Vviewing

images from patient chart 169Vital Signs New screen 49

WWeb View

enabling access for patients 60using 64

Web View Audit Trail Report screen 62, 153Web View Portal

sending Patient Clinical Summary report electronically 76

ZZoom

documenting 168indexing images 168