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TABLE OF CONTENTS

PREFACE

Welcome to MicroMD EMR ......................................................................................................................... i How This Guide is Organized ...................................................................................................................... i Understanding Typographical Conventions .................................................................................................. i

Cross-References ............................................................................................................................................ i Text You Type Using the Keyboard .................................................................................................................. i Keys You Press and Buttons You Click ............................................................................................................. i Dialog Box, Application Window Titles, and Field Names .................................................................................ii Notes, Warnings, and Tips ..............................................................................................................................ii

GENERAL CHANGES

Surescripts Clinical Interoperability Network ............................................................................................... 3 Screening and Prevention .......................................................................................................................... 4 Women’s Health OB Module ..................................................................................................................... 5

Overview ....................................................................................................................................................... 5 The OB Care Record ....................................................................................................................................... 7 OB Genetic Screening ................................................................................................................................... 12 OB Initial Exam ............................................................................................................................................ 15 OB Medical History ...................................................................................................................................... 17 Pregnancy History ........................................................................................................................................ 19 Prenatal Visits .............................................................................................................................................. 25 Fetal Ultrasound .......................................................................................................................................... 28 Labor and Delivery ....................................................................................................................................... 31 Prenatal Care on the Desktop ....................................................................................................................... 32 The OB Dashboard ....................................................................................................................................... 34 The Antepartum Report ................................................................................................................................ 35 The OB Module Workflow ............................................................................................................................ 38

Medical Information in the Encounter Wizard ........................................................................................... 41 New SureScripts Click-through Agreement Acknowledgement .................................................................. 42 Changes to Prescription Processing .......................................................................................................... 43

Tool Tips for Pharmacy Address Information in the Prescription Pad .............................................................. 43 Refill Display Requirements .......................................................................................................................... 43

MEANINGFUL USE

Added LOINC Codes ................................................................................................................................ 44 Drug Interaction Warning Revamp ........................................................................................................... 45 Updated List of Smoking Status Habit Collection Data .............................................................................. 46 Enhanced Data Choices for Race, Ethnicity and Language ........................................................................ 47 Clinical Quality Measures Capture and Export .......................................................................................... 48 RxNorm Codes in the Drug Information Window ...................................................................................... 51 Drug and Allergy Severity Indicators are now separate ............................................................................. 52

MicroMD EMR Update Guide Version 9.0 TOC.1

Table of Contents

High-Risk Medications Condition ............................................................................................................. 54 Data Portability: Bulk Patient CDA Export ................................................................................................ 56 Customizing CDA Export Data ................................................................................................................. 57

CLINICAL QUALITY MEASURES

Clinical Quality Measures List .................................................................................................................. 59

UPDATED FEATURES FROM VERSION 9.0.2

Default Units of Measure in Women’s Health ........................................................................................... 65


Restrictive Access Options in Encounters .................................................................................................. 67

TOC.2 MicroMD EMR Update Guide Version 9.0

PREFACE

WELCOME TO MICROMD EMR From all of us here at Henry Schein Medical Systems, Inc., thank you for selecting MicroMD EMR, the definitive Electronic Medical Records (EMR) solution. This manual is a quick reference to all of the newest features of MicroMD EMR. This manual does not cover hardware setup, networking, or installation of the program.

HOW THIS GUIDE IS ORGANIZED We have organized this guide according to the modules within MicroMD EMR. The discussion consists mainly of the new features within the modules. You can find in-depth information about the entire module in the MicroMD EMR User’s Reference Manual located in the Help menu of MicroMD EMR.

UNDERSTANDING TYPOGRAPHICAL CONVENTIONS Before using this manual, it is important to understand the typographical conventions used to identify and describe information.

Cross-References

Cross-references to chapters, sections, page numbers, headings, etc. are shown in an italic typeface.

e.g., Refer to Error! Reference source not found. on page Error! Bookmark not defined..

Text You Type Using the Keyboard

Text that you type using the keyboard is shown in a Courier typeface.

e.g., Type Anthony Smith in the Name field.

Keys You Press and Buttons You Click

Keys that you press on the keyboard and buttons/icons that you click with the mouse are shown in a bold sans-serif typeface.

e.g., Press Enter.

e.g., Click OK to continue.

MicroMD EMR Update Guide Version 9.0 i

Dialog Box, Application Window Titles, and Field Names

The titles of dialog boxes and application windows are shown in italics. Field names and selections made from drop-down menus, etc. are also shown in italics.

e.g., The Print Preview dialog box appears.

e.g., Select Commercial Insurance from the drop-down list.

Notes, Warnings, and Tips

Notes, tips and warnings are provided throughout the manual. These provide additional information that is important for you to know about the topic.

NOTE | A note is an important piece of information.

STOP | You should definitely read the information in a warning. It could help you prevent a disaster.

TIP | A tip table helps you with some interesting information about different ways to use the program.

ii MicroMD EMR Update Guide Version 9.0

GENERAL CHANGES

SURESCRIPTS CLINICAL INTEROPERABILITY NETWORK Changes have been made to the Surescripts Clinical Interoperability Network, including the importing of messages from other providers, using the fax inbox for incoming messages, enabled processing of CCD/CCR, and the ability to route message CDA from a patient through the portal to the direct network provider.

Figure 1-1 Internal Mail has been enhanced

The Internal Mail is now called Mail, and can be located in the Desktop Navigator as before. Click the New button and you will notice many improvements. We have added many new features to the Mail – New window including a full tool ribbon with Clipboard functionality, Proofing tools, Page Layout options, Insert options, and Editing tools as shown below. Users also have the ability to send Mail to an external provider, if they are part of the Surescripts Interoperability Network.

CHAPTER 1

MicroMD EMR Update Guide Version 9.0 3

SCREENING AND PREVENTION The Screening and Prevention grid has been modified for ease of use and greater capacity for Administered items. The Administered items in Screening and Prevention and Goal Monitoring are now shown on the left side of the sticky note area. The upper area shows the Screening and Prevention program or the Goal , how many have been scheduled, how many completed, date of last admin and date of next scheduled. It is also now possible to administer more than twenty items in both areas.

Figure 1-2 The new Screening & Prevention Layout

4 MicroMD EMR Update Guide Version 9.0

Women’s Health OB Module Chapter 1. General Changes

WOMEN’S HEALTH OB MODULE The Women’s Health OB Module is one of the latest enhancements to MicroMD EMR. Never before has it been easier to view women’s health and pregnancy information. The module includes the following areas:

• OB Care Record

• OB Genetic Screening

• OB Initial Exam

• OB Medical History

• Pregnancy History

• Prenatal visits

• Fetal Ultrasound

• Labor and Delivery

• Prenatal Care on the Desktop

• OB Dashboard

• Antepartum Report

• Prenatal Encounter Wizard

Overview

The Women’s Health OB Module is an enhancement to the Women’s Health module that will greatly increase the usability of the EMR.

NOTE | For an at-a-glance reminder of current pregnancies, look for

the blue OB icon.

Menu Enhancements

The Chart Navigator within a patient’s chart has seen some big changes. As you can see in the image below, several categories have been added to Women’s Health. Additions to the menu include OB Care Record, OB Genetic Screening, OB Initial Exam, OB Medical History, Pregnancy History, Prenatal Visits, and Fetal Ultrasound (formerly Ultrasound).


Figure 1-3 The Women's Health Menu



The OB Care Record

From the chart of a female patient (there is no Women’s Health module in a male patient’s chart), the new OB module’s elements are easy to spot. From the Medical Information tab, select Women’s Health from the Chart Navigator as shown below.

Figure 1-4 The OB Care Record

Create, Edit or View the OB Care Record

Procedure Details

1. From a patient’s chart, select the Medical Information tab.


2. In the list Chart Navigator, select Women’s Health, then select the OB Genetic Screening radio button. This will present a list of OB Genetic Screening items for this patient.

You can also select the line item and click the Edit… button to edit the OB Genetic Screening item, or you can click the Add button to create a new OB Genetic Screening item. These buttons are located in the lower panel and to the right.

3. In the list of pregnancies, double-click the active care record line item (denoted by a check mark in the Active column).

You can also select the line item and click the Edit… button to edit the OB Care Record, or you can click the Add button to create a new OB care record. These buttons are located in the lower panel and to the right.

4. When you are finished editing, creating or viewing an OB Care Record, click the OK button at the bottom of the window to close the record. If no changes have been made, you can also click the “X” in the upper-right corner of the window.

The OB Care Record closes.



Figure 1-5 The OB Care Record

Details of the OB Care Record

The top of all OB Care Records is a blue header that contains pertinent information about the patient including age, date of birth, medical record number, gravida para (clicking on this field will open the Pregnancy Status window where gravida para information can be entered and updated on the fly), LMP (last menstrual period), EDD (estimated due date, which can also be clicked to open the EDD Calculation window. Changes in the data in this window will have an effect on the EDD), and the current number of active pregnancies.


The EDD Calculation Window

Figure 1-6 The EDD Calculation Window

To update the EDD, click to open the EDD Calculation Window. Then adjust the dates as necessary. For each date you adjust, click the corresponding (on the same row) Update button. This will update the EDD wherever it is shown. Click the Change Log button to see the update history of the EDD for this pregnancy.

Adding or Editing the OB Care Record

Procedure Details

1. If the pregnancy is active, the Active Pregnancy checkbox just below the header will be checked. The pregnancy number and active care date are also in this section.

This data is pulled from the Pregnancy History, so it is essential that the pregnancy history be updated before a new OB Care Record is created.

2. The next section of the OB Care Record contains the vital signs information for the patient. To adjust the vital signs, click the icon to the left to open the Add Vital Signs window.

3. In the next section, choose the providers for the patient and the newborn. Chose a provider from the drop-down menu or from the reference list. The Newborn Physician, Referring Provider and Primary Provider are also free-type fields.

4. In the Hospital section, select the facility at which the birth will occur



from the drop-down menu.

5. For the next four questions, answer yes or no appropriately. Note that for each yes answer, you will be prompted for patient education information. Be sure to record this information as it counts toward your Meaningful Use.

6. In the Contact Information section, enter the name and phone number of the husband or domestic partner, and the father of the baby if different.

7. Enter any necessary comments in the Comments section.

8. Enter any insurance information in the Insurance Plans section.

9. Attach any related documents in the Documents Received section.

10. When finished creating or editing the OB Care Record, click the OK button to save.


OB Genetic Screening

Genetic screening is conducted during a pregnancy to maintain awareness and preventative measures. As genetic screening items are added, they will appear in a list in the Medical Information tab as shown in the figure below.

To Add or Edit OB Genetic Screening Items

Procedure Details




2. In the list Chart Navigator, select Women’s Health, then select the OB Genetic Screening radio button. This will present a list of OB Genetic Screening items for this patient.

You can also select the line item and click the Edit… button to edit the OB Genetic Screening item, or you can click the Add button to create a new OB Genetic Screening item. These buttons are located in the lower panel and to the right.

3. When the OB Genetic Screening window opens, select the Yes, No or Not Known radio button for each of the items in the list. If an item requires a Yes answer, select the relationship(s) in the box to the right of the item.

4. There are two pages of OB Genetic Screening items. After finishing the first page, click the Next> button to advance to the second page.

5. When finished, click the Finish button to save and close the window.


Figure 1-7 The OB Genetic Screening window

Note that you can access the OB Care Record or the OB Medical History from this window by using the OB Care and OB Med History buttons respectively.



OB Initial Exam

The OB Initial Exam covers the details of the first prenatal exam.

To Add or Edit an OB Initial Exam

Procedure Details


2. In the list Chart Navigator, select Women’s Health, then select the OB Initial Exam radio button. This will present a list of OB Initial Exam items for this patient.

You can also select the line item and click the Edit… button to edit the OB Initial Exam item, or you can click the Add button to create a new OB Initial Exam item. These buttons are located in the lower panel and to the right.

3. If there has been an initial exam, you can select the line item and click the Edit button to edit the details. If you are adding a new exam, click the Add . . . button.

This will open the Add (or Edit) OB Initial Physical Exam window.

4. For each item in the window, answer by selecting the appropriate radio button.

To instantly set all items as normal, click the Set All to Normal button.

5. Enter any comments in the Comments: text box.

6. When finished, click the Sign button to save and close the window.


Figure 1-8 The OB Initial Exam window

Note that you can access the OB Care Record or the OB Medical History from this window by using the OB Care and OB Med History buttons respectively.



OB Medical History

OB Medical History is a three-part Wizard detailing the patient’s medical history.

Creating or Editing the OB Medical History

Procedure Details


2. In the list Chart Navigator, select Women’s Health, then select the OB Medical History radio button. This will present a list of medical history items for this patient.

You can also select the line item and click the Edit… button to edit the medical history item, or you can click the Add button to create a new medical history item. These buttons are located in the lower panel and to the right.

3. If an OB Medical History item has been created, click the Edit button to edit the item. Otherwise, click the Add… button to create a new OB Medical History record.

This will open the Add (or Edit) OB Medical History wizard window.

4. For each item in the window, answer by selecting the appropriate radio button.

To instantly set all items as negative, click the Set All to Negative button.

5. In the Details field, you can free-type a detail, or choose from the reference book.

To clear all of your entries, click the Clear All Entries button.

6. When finished, click the Next button to continue to the next step of the wizard.

Repeat steps 4-5 above for each item as necessary.

7. Click the Next button when finished to continue to the final step.


8. Repeat steps 4-5 above for each item on this final screen of the wizard.

9. Enter any necessary comments in the Comments text box.

10. When finished, click the OK button to save the new OB Medical History.

Figure 1-9 The OB Medical History wizard



Pregnancy History

The Pregnancy History contains historic information regarding prior pregnancies. These history records can be created, edited and/or deleted. In the Medical Information tab within a patient’s chary, the Pregnancy History is a new addition to the Women’s Health module.

Creating or Editing the Pregnancy

Procedure Details



2. In the list Chart Navigator, select Women’s Health, then select the Pregnancy History radio button. This will present a list of pregnancy history items for this patient.

You can also select the line item and click the Edit… button to edit the chosen pregnancy history item, or you can click the Add button to create a new pregnancy history item. These buttons are located in the lower panel and to the right.

3. If a Pregnancy History item has been created, click the Edit button to edit the item. Otherwise, click the Add… button to create a new Pregnancy History record.

This will open the Add (or Edit) Pregnancy History window. (See screen shot below.)

4. Select the select the pregnancy number from the Pregnancy No drop-down menu.

5. Select the date of the pregnancy from the Date drop-down menus.

6. Select the description of the pregnancy from the Description drop-down.

7. Select the weeks and days of the gestation period in the Gestation at Delivery drop-down menus.

8. Select the Gestational Age from the drop-down menu.

9. Select the Yes or No radio button to determine preterm labor.

10. Select the Type of Delivery from the drop-down menu.

11. Select the hours and minutes from the drop-



down menus to determine the Labor Length.

12. Select the Presentation from the drop-down menu.

13. Select the Time of Day from the drop-down menu.

14. Select the Anesthesia from the drop-down menu.

15. Select the feeding type in the Feeding by: drop-down menu.

16. Select the Place of Delivery from the drop-down menu.

17. Enter any Fetuses or Complications (see instructions later in this chapter) in each section by clicking the Add . . . button.

This will open the Fetus window or the Complications window, both of which are covered later in this chapter.

18. Enter any comments in the Comments section.

19. Click the OK button when finished.


Figure 1-10 The Pregnancy History window

Adding a Fetus to the Pregnancy History

To add fetus information to the pregnancy history, click the Add… button in the Fetuses section. This will open the Fetuses window. Follow the instructions below.

Figure 1-11 The Fetus window



Adding or Editing a Fetus

Procedure Details

1. Enter the fetus number in the Fetus No: field.

2. Enter the Baby’s Name.

3. In the Birth Date fields, first select the general birth date type from the drop-down menu, then choose the correct date from the drop-down calendar.

4. Enter the Time of Day by using the up/down arrows to adjust the time.

5. Indicate the life status of the fetus in the Alive: drop-down menu.

6. Select the correct Gender of the fetus.

7. Select the Type of Delivery from the drop-down menu.

8. Select the Presentation from the drop-down menu.

9. Enter the Weight at Birth in pounds and ounces either by direct entry or with the use of the drop-down menus.

10. Enter the Weight at Release in pounds and ounces either by direct entry or with the use of the drop-down menus.

11. Enter the Apgar score at birth in the Apgar Birth drop-down number pad.

12. Enter the Apgar score at five minutes after birth in the Apgar at 5 Minutes: drop-down number pad.

13. Enter the Height in inches by using the drop-down.

14. Enter the Head Circumference in inches using the drop-down.

15. Enter the Chest Circumference in inches using the drop-down.


16. Select the blood type in the Blood Group drop-down menu.

17. Enter the MSAF status by using the drop-down menu.

18. Determine the status of the Newborn Screen and select the appropriate radio button (Normal or Abnormal).

19. Enter any necessary comments in the Comments text area.

20. Click the OK button when finished adding or editing a fetus.



Adding and Editing Complications

If complications arise during pregnancy, they can be documented here, in the Pregnancy History section.

Figure 1-12 The Complication Window

Adding or Editing a Complication

Procedure Details

1. Enter a Description in the Description: field, or select a pre-written description from the reference book.

2. In the Diagnosed by: field, select a provider from the drop-down menu or use the reference book to look up another provider.

3. In the Stage diagnosed: drop-down menu, select the corresponding month of the pregnancy for the complication you are adding or editing.


Prenatal Visits

The Prenatal Visits section has been enhanced to include more pertinent data about the pregnancy.

Add or Edit a Prenatal Visit

Procedure Details



2. In the list Chart Navigator, select Women’s Health, then select the OB Genetic Screening radio button. This will present a list of prenatal visit items for this patient.

You can also select the line item and click the Edit… button to edit the prenatal visit item, or you can click the Add button to create a new prenatal visit item. These buttons are located in the lower panel and to the right.

3. If there has been a prenatal visit, you can select the line item and click the Edit button to edit the details. If you are adding a new prenatal visit, click the Add . . . button.

This will open the Add (or Edit) Prenatal Visits window.

4. The pregnancy number is in the Pregnancy No: field. This can be edited. It may be automatically completed based on other information already given.

5. If there have been prior prenatal visits, you can view them by selecting the desired visit in the View Prev Visit: drop-down menu.

6. Select the Visit Date: from the drop-down calendar.

7. Select the gestation period with the drop-down number pads for weeks and days in the Week’s Gestation: area.

8. Enter any symptoms since the last menstrual period in the Symptoms since LMP text area.

9. Indicate Pre-Term Labor: with the Yes or No radio buttons.



10. Check the High-Risk Pregnancy check box if this is a high-risk pregnancy.

This places a red exclamation point next to the patient on the desktop so the high-risk pregnancy can be identified at a glance.

11. You can enter any additional signs or symptoms in the Signs / Symptoms free-type area.

12. Enter the important information for each fetus you will be documenting in the Fetal Exam section.

Use the Add… button to add fetal records, or select a record and use the Delete button to delete it.

13. The Pre-Preg Weight, Visit Weight, Since Last Visit and Total for Preg fields will be automatically calculated for you.

14. For each, if any symptom is present, select the correct measure from the corresponding drop-down menu for Edema, Reflexes, Urine Albumin and Urine Glucose.

15. Select the appropriate measures from the corresponding drop-down number pads for both Abdominal girth and Fundal Height.

16. In the Cervical Exam section, select the appropriate measurements from the corresponding drop-down menus for the following fields: Dilated, Position, Effacement, Shape, Firmness and Ultrasound Length.

17. In the Uterine Exam section, indicate the presence of Contractions (using the Yes or No radio buttons), select the Firmness from the drop-down menu, and enter any necessary comments in the Comment: text area.

18. Note that the OB Care Record and the OB Medical History can be accessed at the click of a button from this window.

19. Click the Sign button to sign off on the Prenatal Visit.



Fetal Ultrasound

Figure 1-13 Fetal Ultrasound

Add or Edit a Fetal Ultrasound

Procedure Details




2. In the list Chart Navigator, select Women’s Health, then select the Fetal Ultrasound radio button. This will present a list of fetal ultrasound items for this patient.

You can also select the line item and click the Edit… button to edit the fetal ultrasound item, or you can click the Add button to create a new fetal ultrasound item. These buttons are located in the lower panel and to the right.

3. Select the Pregnancy No. from the drop-down menu.

4. Select the date of the ultrasound in the Measured on drop-down calendar.

Check the Is approx. check box if this date is an approximation.

5. In the Gereral section, select the appropriate measures for Position, Amniotic fluid, Umbilical cord and Weight.

6. In the Loc. Performed: text area, enter the location where the ultrasound was performed.

7. In the Overseen by: drop-down, select the provider overseeing the ultrasound. If the provider is not in the list, click on the reference book and select the provider from the list.

8. In the BPD section, record the biparietal diameter using the Size: and Calculated date: fields.

9. In the Head Circumference section, enter the Size: and the Calculated date: regarding the measurements of the head.


10. In the Heartbeat section, enter the Rate: and Type: of heartbeat observed in the fetus.

11. In the Placenta section, enter the Condition and Position observed using the drop-down menus.

12. In the Abdominal Circumference section, enter the Size: and the Calculated date: regarding the measurements of the abdomen.

13. In the Femur Length section, enter the Size: and the Calculated date: regarding the measurements of the head.

14. If there are any instructions that need to be included, enter them in the Instructions text box.

15. Include any comments in the Comments text box.




Labor and Delivery

Add or Edit Labor and Delivery

Procedure Details


2. In the list Chart Navigator, select Women’s Health, then select the Labor & Delivery radio button. This will present a list of labor and delivery items for this patient.

You can also select the line item and click the Edit… button to edit the labor and delivery item, or you can click the Add button to create a new labor and delivery item. These buttons are located in the lower panel and to the right.

3. The only thing to change in Labor and Delivery is the addition of the header area.

The instructions for adding and editing Labor and Delivery items can be found in Chapter 14, Women’s Health.


Prenatal Care on the Desktop

New to the Desktop is an optional Prenatal Care item that allows users to view a list of patients identified as being under prenatal care.

Figure 1-14 Prenatal Care on the Desktop



Figure 1-15 Prenatal Care on the Desktop

From the view above, a user will be able to see a list of patients under prenatal care. The date range at the top defaults to the current week, but it can be adjusted to present the results you need.

You can also adjust the week’s gestation, facility, patient and provider to pull up different groups of results. A red exclamation point next to the name of a patient indicates that the patient is in a high-risk pregnancy.

In the sticky note preview area below the patient list, you can view the details of the last prenatal visit for the patient selected in the list.


The OB Dashboard

With the new OB options available, a new OB dashboard can be created as shown below. There is a standard OB template available, or you can create a custom template to better fit your practice.

You can access the OB Dashboard from the Prenatal Care area of the Desktop. Simply select the Dashboard icon in the Desktop Tools menu pane, or select the Dashboard button on the right side of the window.

Figure 1-16 The OB Dashboard

Creating an OB Dashboard Template

Procedure Details

1. Select Tools > Clinical Dashboard Templates from the File menu.

This opens the Dashboard Template Manager window.

2. Click the OB Care icon at the bottom-left corner of the window.

This will present a list of OB Templates.

3. Select the OB Dashboard icon. From here you can Edit the existing OB Dashboard Template or create a new one by using the buttons to the right.



The Antepartum Report

Enhancements to the OB visit now allow for the Antepartum Report to be merged from Medical Information. Printing the Antepartum Report is as simple as selecting the patient from the Prenatal Care list (or from the chart) and click the Print Report button from the toolbar to the right as shown below.

Running the Antepartum Report

Procedure Details

1. Select the patient who’s Antepartum Report you would like to print.


2. Click the Print Report button to the right. This will open the Antepartum Report window.

3. After making your selections and assigning criteria to the report, click the OK button. This will close the Antepartum Report window and display the report (shown below).



Figure 1-17 The Antepartum Report


The OB Module Workflow

The following section takes everything you’ve learned about the new OB Module and shows a typical OB encounter.

Creating a New OB Encounter

Procedure Details

1. From the list of Scheduled Visits (on the Desktop), select the patient for whom you would like to create the encounter.

2. Click the New Encounter button from the buttons on the right below the list.

This will open the New Encounter window shown below.

Figure 1-18 Creating a New Prenatal Encounter

Procedure Details

3. From the Record encounter using the: drop-down menu, select Encounter Wizard.

4. In the Reference List Viewer (book icon to the left of the next drop-

NOTE | Any prenatal wizard can be selected. Choose one of the standard prenatal care wizards, or create a new one that better suits



down menu), select Standard Prenatal Care from the Encounter Wizards.

your practice.

5. In the Nature of Encounter section, select the Prenatal radio button.

STOP | Do not forget this important step.

6. Click the OK button. This will open the Encounter tab of the Prenatal Care Encounter window.

7. Step 1 is the Patient’s Medical Information. Click the Go to >> button to see the steps for the wizard.

The items in the menu can be adjusted or re-arranged to suit your needs. They can also be completed in any order you like, but remember:

NOTE | The Pregnancy History must be added before you open an OB Care Record. This ensures that the correct number of pregnancies will appear on the OB Care Record.

8. Click the link for Pregnancy History, then click the Add button to the right.

It is recommended that you add the pregnancy history first.

9. Complete the required fields in the Pregnancy History.

10. Add a new fetus by clicking the Add… button under Fetuses.

This will open the Fetus window. Enter the information on the new fetus and click the OK button when complete.

11. After the Pregnancy History has been completed, click the Vital Signs link, then click the Add… button.

This will open the Vital Signs window.

12. Complete the required fields in the Vital Signs window. Note that you can access the Pregnancy History for editing from this window.

NOTE | Before you select Yes from the Pregnant: drop-down menu, remember again to make sure the pregnancy history has been entered first. Once Yes has been selected, you will be prompted to create an OB Care Record.

13. Select Yes from the Pregnant: drop-down menu.

This will prompt for the creation of an OB Care Record as mentioned above. Click Yes to open the Add OB Care window.

14. Complete the OB Care Record as shown earlier in this chapter.

After completing the OB Care Record, click the OK button.

15. For each of the items in the menu on the left side of the encounter. You can choose to complete any or all of the windows as appropriate.

Complete the information in the various sections as needed. Click the Next > button when you are ready to continue to Step 2 of the wizard.

16. Once in Step 2, you can load a template or a Cliniguide if desired.

We recommend creating an OB Cliniguide ahead of time to assist you in quick data entry. Click the Next > button when you are ready for Step


3.

17. Step 3 is a physical exam window. Complete the necessary fields and click the Next > button to advance to Step 4.

18. Step 4 includes patient diagnoses. Complete the necessary fields and click the Next > button to advance to Step 5.

19. Step 5 includes patient medications. Complete the necessary fields and click the Next > button to advance to Step 6.

20. Step 6 is the Plan section. Complete the necessary fields and click the Finish button to complete the wizard.


Medical Information in the Encounter Wizard Chapter 1. General Changes

MEDICAL INFORMATION IN THE ENCOUNTER WIZARD When adding the medical information into a wizard template, the window has been completely re-designed and users now have the ability to re-order the medical information to best suit their practice.

When a user selects Medical Information to add to a template, the Select Medical Information window (shown below) will appear. From this window, the user can select any item in the Medical History from the list of Available Items and drag and drop it into the Selected Items list as shown below.

Once the items are in the Selected Items list, they can be arranged up or down by using the up and down arrow buttons. The items can also be alphabetized by using the A-Z button.


NEW SURESCRIPTS CLICK-THROUGH AGREEMENT ACKNOWLEDGEMENT If a provider has an SPI (Surescripts Provider Identification) number, the screen below will appear the first time the provider logs into the EMR after upgrading to version 9.0.

Figure 1-19 The Surescripts Click-Through Agreement Acknowledgement

Providers have the option to review the agreement on screen or print it. After review, each provider should accept or decline the agreement. The agreement is necessary for all Surescripts providers to ensure that they are meeting the requirements established by Surescripts for its new 10.6 format, including security, privacy, and regulations designed for the protection of all parties.

Staff members who prescribe for their providers are not eligible to sign the agreement. The agreement must be signed by the provider. Until the provider signs the agreement, prescriptions can only be printed or faxed.

The agreement is also accessible through the main menu at Tools > User Preferences > Prescriptions, or from the Prescription Processor screen.


Changes to Prescription Processing Chapter 1. General Changes

CHANGES TO PRESCRIPTION PROCESSING

Tool Tips for Pharmacy Address Information in the Prescription Pad

Pharmacy addresses have been added to the Prescription Pad to differentiate between pharmacies of the same name with different locations. To view the address, click the Pharmacy: drop-down menu. Then hover the mouse over the arrow next to each pharmacy name on the list. The address will appear in a tool tip as shown in the following screenshot.

Figure 1-20 The pharmacy address tool tip

Refill Display Requirements

To ensure proper prescription refilling, the prescription refill field has been changed to read:

“1” indicated the current dispensing, and the number in the drop-down represents the number of refills.


MEANINGFUL USE

ADDED LOINC CODES LOINC codes have been added to look-up screening and prevention, procedure, lab panels, and nursing care requests.

For example, in the Add Procedure Orders window below, selecting an order will provide a drop-down menu from which to choose the proper LOINC code for the order.

Figure 2-1 Selecting a LOINC code from an order

CHAPTER 2


Drug Interaction Warning Revamp Chapter 2. Meaningful Use

Adding LOINC codes to an order

Procedure Details

1. From the Desktop Navigator, select Orders.

2. Click the New Order button (or the arrow button beside the New Order button) and select the type of order you wish to create.

3. Select a LOINC code from the drop-down menu.

4. Click the OK button when you are finished creating the order.

DRUG INTERACTION WARNING REVAMP Repeat drug-to-drug and drug-to-allergy warnings have been disabled.

Procedure Details

1. In the EMR Manager, click the Reference Lists icon. This will open the Reference List Manager.

2. In the Reference Lists, under the User-Defined Additions tab, select Drug Severities.

3. Click the Add button. This will open the Drug to Drug Severity Level window.


4. In Medication 1 drop-down, select the first medication.

5. In Medication 2 drop-down, select the second medication.

The Original Severity Level will populate automatically.

6. Select the new level from the New Severity Level drop-down.


UPDATED LIST OF SMOKING STATUS HABIT COLLECTION DATA The reference list for smoking habit data has been expanded to reflect a broader selection of smoking habit statuses. This includes any form of tobacco that is smoked, but not all tobacco use. There are now eight different smoking statuses to choose from.

Figure 2-2 Expanded Selections for Smoking Status


Enhanced Data Choices for Race, Ethnicity and Language Chapter 2. Meaningful Use

ENHANCED DATA CHOICES FOR RACE, ETHNICITY AND LANGUAGE Data choices have been modified for race, ethnicity and language. Classifying federal data according to race and ethnicity requires that the option for selecting one or more racial designations be provided. Thus, it is now possible to select two or more racial designations.

STOP | Please note that selecting race for a patient is done in the MicroMD PM, not the EMR. The demographics for a patient will be automatically updated in the EMR when a change is made in the PM. The screen shots in this example are from the MicroMD PM 9.0.

Users can select more than one ethnicity in a patient’s demographics as shown below. In the Race drop-down, utilize the magnifying glass next to the drop-down. One of the selections is “Multiracial”.

Figure 2-3 Selecting multiple ethnicities


CLINICAL QUALITY MEASURES CAPTURE AND EXPORT With the advent of Meaningful Use 2014 measures, users can now run either Stage 1 or Stage 2 reports. The designations for this are in several locations as shown below.

The first location is in the EMR Manager under the System Settings tab.

Figure 2-4 Enabling Stage II Reporting in the EMR Manager

You can also designate between Stage 1 and Stage 2 in the User Preferences of the EMR as shown below.


Clinical Quality Measures Capture and Export Chapter 2. Meaningful Use

Figure 2-5 Selecting Stage 1 or Stage 2 in the User Preferences

Users can also select Stage 1 or Stage 2 when running the CQM report.


Figure 2-6 Selecting Stage 1 or 2 in the CQM Report


RXNORM CODES IN THE DRUG INFORMATION WINDOW

When you click on the information bubble for a medication in the medication list on the prescription window, a Drug Information window will appear. In the screen shot below, you can see that RxNorm codes have been added to every medication.

Figure 2-7 RxNorm Codes in the Drug Information Window


Chapter 2. Meaningful Use

DRUG AND ALLERGY SEVERITY INDICATORS ARE NOW SEPARATE The drug-to-drug and drug-to-allergy severity settings in the User Preferences window are now separate as shown in the screen shot below.

Figure 2-8 Drug and Allergy Warning Level Indicators in the User Preferences Window

Drug-to-drug warnings can also be configured as a system setting in the EMR Manager as shown below, also separating drug-drug and drug-allergy warning levels.


Figure 2-9 Prescription Defaults in the EMR Manager



HIGH-RISK MEDICATIONS CONDITION In the Rule Builder, it is now possible to select the “High-risk Medications” sub-list to add to a rule as shown below.

Figure 2-10 The High-Risk Medications Sub-List

Note that the High-Risk Medications sub-list is also now found in the Medication Reference List under the Smart Button > Quality Measures as shown below.

Procedure Details

1. From the Desktop Navigator, select Prescription Pad from the Desktop Tools.

This will open the Prescription Pad window.

2. Enter a patient into the Patient: field,

or use the look-up icon .

3. Click the button. This will open a pop-up menu shown in the following step.


4. Select Quality Measures Sublists from the pop-up menu.

This will also open a selection list as shown in the following step.

5. Select High Risk Medications from the selection list.

6. Click the Close button when finished.



DATA PORTABILITY: BULK PATIENT CDA EXPORT A user can now export summaries for all patients in CDA format.

In the Administration window (Administration > Administration Panel), check the Bulk Patient CDA Export checkbox. The Bulk Patient CDA Export window will appear.

Figure 2-11 Bulk Patient CDA Export


CUSTOMIZING CDA EXPORT DATA When exporting a patient care plan in CDA format, it is now possible to customize the results for the final report. In the Bulk Patient CDA Export window, check the “E” checkbox before each item you wish to customize as shown below.

Figure 2-12 Editing a Patient Care Record for Export



Table 2-1 Editing CDA Export Data

Procedure Details

1. For each item you would like to edit, check the checkbox in the E column next to the item. Multiple items can be selected for editing.

2. Click the Export button

3. In the Edit Bulk Patient CDA Export

window, check the items you would like to include in the export. If you would like to edit line items from a category, make sure that category is checked.

4. Click the OK button. The export file will build. Once complete, you will

be prompted to select medical information to include.

5. Click the OK button when finished. The CDA file will be built and exported to the destination location.


CLINICAL QUALITY MEASURES

In order to achieve Meaningful Use in 2014, MicroMD EMR has been coded with the following Clinical Quality Measures (CQMs). For more detailed information on 2014 Meaningful Use, please refer to the following MicroMD Manuals: Clinical Quality Measure Calculations 2014 and Objective Measure Calculations 2014.

CLINICAL QUALITY MEASURES LIST • NQF 0002 CMS eMeasure id CMS146v1 (17362): Appropriate testing for children with Pharyngitis.

Percentage of children 2-18 years of age who were diagnosed with pharyngitis, ordered an antibiotic and received a group A streptococcus (strep) test for the episode.

• NQF 0004 CMS eMeasure id CMS137v1 (17363): Initiation and engagement of alcohol and other drug dependence treatment.

• NQF 0018 CMS eMeasure id CMS165v1 (17360): Controlling high blood pressure.

• NQF 0022 CMS eMeasure id CMS156v1 (17357): Percentage of patients 66 years of age and older who are on a high-risk medication.

• NQF 0024 CMS eMeasure id CMS155v1 (17364): Weight assessment and counseling for nutrition and physical activity for children and adolescents.

• NQF 0028 CMS eMeasure id CMS138v1 (17365): Preventive care and screening: tobacco use: screening and cessation intervention.

• NQF 0031 CMS eMeasure id CMS125v1 (17366): Breast cancer screening. Percentage of women 40-69 years of age who had a mammogram to screen for breast cancer.

• NQF 0032 CMS eMeasure id CMS124v1 (17367): Cervical Cancer Screening. Percentage of women 21-64 years of age, who received one or more Pap tests to screen for cervical cancer.

• NQF 0033 CMS eMeasure id CMS153v1 (17368): Chlamydia Screening for Women. Percentage of women 16-24 years of age who were identified as sexually active and who had at least one test for chlamydia during the measurement period.

• NQF 0034 CMS eMeasure id CMS130v1 (17373): Colorectal cancer screening. percentage of adults 50-75 years of age who had appropriate screening for colorectal cancer.

• NQF 0036 CMS eMeasure id CMS126v1 (17374): Use of appropriate medications for asthma. Percentage of patients 5-64 years of age who were identified as having persistent asthma and were appropriately prescribed medication during the measurement period.

• NQF 0038 CMS eMeasure id CMS117v1 (17375): Childhood immunization status. Percentage of children 2 years of age who had four diphtheria, tetanus and acellular pertussis (DTaP); three polio (IPV), one measles, mumps and rubella (MMR); three H influenza type B (HiB); three hepatitis B (Hep B); one chicken pox (VZV); four pneumococcal conjugate (PCV); one hepatitis A (Hep A); two or three rotavirus (RV); and two influenza (flu) vaccines by their second birthday.

• NQF 0041 CMS eMeasure id CMS147v1 (17377): Preventive care and screening: influenza immunization. Percentage of patients aged 6 months and older seen for a visit between October 1 and March 31 who received an influenza immunization OR who reported previous receipt of an influenza immunization.

CHAPTER 3


Chapter 3. Clinical Quality Measures

• NQF 0043 CMS eMeasure id CMS127v1 (17380): Pneumonia vaccination status for older adults. Percentage of patients 65 years of age and older who have ever received a pneumococcal vaccine.

• NQF 0052 CMS eMeasure id CMS166v2 (17387): Use of imaging studies for low back pain. Percentage of patients 18-50 years of age with a diagnosis of low back pain who did not have an imaging study (plain X-ray, MRI, CT scan) within 28 days of the diagnosis.

• NQF 0056 CMS eMeasure id CMS123v1 (17383): Diabetes: Foot exam percentage of patients aged 18-75 years of age with diabetes who had a foot exam during the measurement period.

• NQF 0055 CMS eMeasure id CMS131v1 (17388): Diabetes: Eye exam. Percentage of patients 18-75 years of age with diabetes who had a retinal or dilated eye exam by an eye care professional during the measurement period or a negative retinal exam (no evidence of retinopathy) in the 12 months prior to the measurement period.

• NQF 0059 CMS eMeasure id CMS122v1 (17389): Diabetes: Hemoglobin A1c poor control. Percentage of patients 18-75 years of age with diabetes (type 1 or type 2) who had HbA1c >9.0%.

• NQF 0060 CMS eMeasure id CMS148v1 (17390): Hemoglobin A1c Test for pediatric patients. Percentage of patients 5-17 years of age with diabetes with an HbA1c test during the measurement period.

• NQF 0062 CMS eMeasure id CMS134v1 (17391): Diabetes: Urine protein screening. The percentage of patients 18-75 years of age with diabetes who had a nephropathy screening test or evidence of nephropathy during the measurement period.

• NQF 0064 CMS eMeasure id CMS163v1 (17392): Diabetes: Low density lipoprotein (ldl) management. Percentage of patients18-75 years of age with diabetes whose LDL-C was adequately controlled (<100 mg/dL) during the measurement period.

• NQF 0068 CMS eMeasure id CMS164v1 (17393): Ischemic vascular disease (ivd): Use of aspirin or another antithrombotic. Percentage of patients 18 years of age and older who were discharged alive for acute myocardial infarction (AMI), coronary artery bypass graft (CABG) or percutaneous coronary interventions (PCI) in the 12 months prior to the measurement period, or who had an active diagnosis of ischemic vascular disease (IVD) during the measurement period, and who had documentation of use of aspirin or another antithrombotic during the measurement period.

• NQF 0069 CMS eMeasure id CMS154v1 (17394): Appropriate treatment for children with upper respiratory infection (URI). Percentage of children 3 months-18 years of age who were diagnosed with upper respiratory infection (URI) and were not dispensed an antibiotic prescription on or three days after the episode.

• NQF 0070 CMS eMeasure id CMS145v1(17396): Coronary Artery Disease (CAD): Beta-Blocker Therapy-Prior Myocardial Infarction (MI) or Left Ventricular Systolic Dysfunction (LVEF <40%). Percentage of patients aged 18 years and older with a diagnosis of coronary artery disease seen within a 12 month period who also have a prior MI or a current or prior LVEF <40% who were prescribed beta-blocker therapy.

• NQF 0075 CMS eMeasure id CMS182v1 (17398): Ischemic vascular disease (IVD): Complete lipid panel and LDL control. Percentage of patients 18 years of age and older who were discharged alive for acute myocardial infarction (AMI), coronary artery bypass graft (CABG) or percutaneous coronary interventions (PCI) in the 12 months prior to the measurement period, or who had an active diagnosis of ischemic vascular disease (IVD) during the measurement period, and who had a complete lipid profile performed during the measurement period and whose LDL-C was adequately controlled (< 100 mg/dL).

• NQF 0081 CMS eMeasure id CMS135v1 (17400): Heart Failure (HF): Angiotensin-Converting enzyme (ACE) inhibitor or Angiotensin receptor blocker (ARB) therapy for left ventricular systolic dysfunction (LVSD). Percentage of patients aged 18 years and older with a diagnosis of heart failure (HF) with a current or prior left ventricular ejection fraction (LVEF) < 40% who were prescribed ACE inhibitor or ARB therapy either within a 12 month period when seen in the outpatient setting OR at each hospital discharge.


• NQF 0083 CMS eMeasure id CMS144v1 (17402): Heart failure (HF): Beta-blocker therapy for left ventricular systolic Dysfunction (LVSD). Percentage of patients aged 18 years and older with a diagnosis of heart failure (HF) with a current or prior left ventricular ejection fraction (LVEF) < 40% who were prescribed beta-blocker therapy either within a 12 month period when seen in the outpatient setting OR at each hospital discharge.

• NQF 0086 CMS eMeasure id CMS143v1 (17416): Primary Open Angle Glaucoma (POAG): Optic Nerve Evaluation. Percentage of patients aged 18 years and older with a diagnosis of primary open-angle glaucoma (POAG) who have an optic nerve head evaluation during one or more office visits within 12 months.

• NQF 0088 CMS eMeasure id CMS167v1 (17417): Diabetic Retinopathy: Documentation of Presence or Absence of Macular Edema and Level of Severity of Retinopathy. Percentage of patients aged 18 years and older with a diagnosis of diabetic retinopathy who had a dilated macular or fundus exam performed which included documentation of the level of severity of retinopathy and the presence or absence of macular edema during one or more office visits within 12 months.

• NQF 0089 CMS eMeasure id CMS142v1 (17418): Diabetic Retinopathy: Communication with the Physician Managing Ongoing Diabetes Care. Percentage of patients aged 18 years and older with a diagnosis of diabetic retinopathy who had a dilated macular or fundus exam performed with documented communication to the physician who manages the ongoing care of the patient with diabetes mellitus regarding the findings of the macular or fundus exam at least once within 12 months.

• NQF 0101 CMS eMeasure id CMS139v1 (17420): Falls: Screening for Future Fall Risk. Percentage of patients 65 years of age and older who were screened for future fall risk during the measurement period.

• NQF 0104 CMS eMeasure id CMS161v1 (17422): Major Depressive Disorder (MDD): Suicide Risk Assessment. Percentage of patients aged 18 years and older with a diagnosis of major depressive disorder (MDD) with a suicide risk assessment completed during the visit in which a new diagnosis or recurrent episode was identified.

• NQF 0105 CMS eMeasure id CMS128v1 (17424): Antidepressant Medication Management. Percentage of patients 18 years of age and older who were diagnosed with major depression and treated with antidepressant medication, and who remained on antidepressant medication treatment. Two rates are reported: a. Percentage of patients who remained on an antidepressant medication for at least 84 days (12 weeks). b. Percentage of patients who remained on an antidepressant medication for at least 180 days (6 months).

• NQF 0108 CMS eMeasure id CMS136v1&2 (17425): ADHD: Follow-Up Care for Children Prescribed Attention-Deficit/Hyperactivity Disorder (ADHD) Medication. Percentage of children 6-12 years of age and newly dispensed a medication for attention-deficit/hyperactivity disorder (ADHD) who had appropriate follow-up care. Two rates are reported: a. Percentage of children who had one follow-up visit with a practitioner with prescribing authority during the 30-Day Initiation Phase, and b. Percentage of children who remained on ADHD medication for at least 210 days and who, in addition to the visit in the Initiation Phase, had at least two additional follow-up visits with a practitioner within 270 days (9 months) after the Initiation Phase ended.

• NQF 0110 CMS eMeasure id CMS169v1 (17427): Bipolar Disorder and Major Depression: Appraisal for alcohol or chemical substance use. Percentage of patients with depression or bipolar disorder with evidence of an initial assessment that includes an appraisal for alcohol or chemical substance use.

• NQF 0389 CMS eMeasure id CMS129v1-2 Prostate Cancer (17431): Avoidance of Overuse of Bone Scan for Staging Low Risk Prostate Cancer Patients. Percentage of patients, regardless of age, with a diagnosis of prostate cancer at low risk of recurrence receiving interstitial prostate brachytherapy, OR external beam radiotherapy to the prostate, OR radical prostatectomy, OR cryotherapy who did not have a bone scan performed at any time since diagnosis of prostate cancer.



• NQF 0403 CMS eMeasure id CMS62v1 (17432): HIV/AIDS: Medical Visit. Percentage of patients, regardless of age, with a diagnosis of HIV/AIDS with at least two medical visits during the measurement year with a minimum of 90 days between each visit.

• NQF 0405 CMS eMeasure id CMS52v1 (17433): HIV/AIDS: Pneumocystis jiroveci pneumonia (PCP) prophylaxis. Percentage of patients aged 6 weeks and older with a diagnosis of HIV/AIDS who were prescribed Pneumocystis jiroveci pneumonia (PCP) prophylaxis.

• NQF 0418 CMS eMeasure id CMS2v (17434): Preventive Care and Screening: Screening for Clinical Depression and Follow-Up Plan. Percentage of patients aged 12 years and older screened for clinical depression on the date of the encounter using an age appropriate standardized depression screening tool AND if positive, a follow-up plan is documented on the date of the positive screen.

• NQF 0419 CMS eMeasure id CM68v1-2 (17437): Documentation of Current Medications in the Medical Record. Percentage of visits for patients aged 18 years and older for which the eligible professional attests to documenting a list of current medications using all immediate resources available on the date of the encounter. This list must include ALL known prescriptions, over-the-counters, herbals, and vitamin/mineral/dietary (nutritional) supplements AND must contain the medications' name, dosage, frequency and route of administration.

• NQF 0421 CMS eMeasure id CM69v1 (17439): Preventive Care and Screening: Body Mass Index (BMI) Screening and Follow-Up. Percentage of patients aged 18 years and older with a documented BMI during the encounter or during the previous six months, AND when the BMI is outside of normal parameters, a follow-up plan is documented during the encounter or during the previous six months of the encounter. Normal Parameters: Age 65 years and older BMI => 23 and < 30. Age 18 - 64 years BMI => 18.5 and < 25.

• NQF 0564 CMS eMeasure id CMS133v1 (17440): Cataracts: Complications within 30 Days Following Cataract Surgery Requiring Additional Surgical Procedures. Percentage of patients aged 18 years and older with a diagnosis of uncomplicated cataract who had cataract surgery and had any of a specified list of surgical procedures in the 30 days following cataract surgery which would indicate the occurrence of any of the following major complications: retained nuclear fragments, endophthalmitis, dislocated or wrong power IOL, retinal detachment, or wound dehiscence.

• NQF 0565 CMS eMeasure id CMS133v1 (17441): Cataracts: 20/40 or Better Visual Acuity within 90 Days Following Cataract Surgery. Percentage of patients aged 18 years and older with a diagnosis of uncomplicated cataract who had cataract surgery and no significant ocular conditions impacting the visual outcome of surgery and had best-corrected visual acuity of 20/40 or better (distance or near) achieved within 90 days following the cataract surgery.

• NQF 0608 CMS eMeasure id CMS158v1 (17442): Pregnant women that had HBsAg testing. This measure identifies pregnant women who had a HBsAg (hepatitis B) test during their pregnancy.

• NQF 0710 CMS eMeasure id CMS159v1 (17443): Depression Remission at Twelve Months. Adult patients age 18 and older with major depression or dysthymia and an initial PHQ-9 score > 9 who demonstrate remission at twelve months defined as PHQ-9 score less than 5. This measure applies to both patients with newly diagnosed and existing depression whose current PHQ-9 score indicates a need for treatment.

• NQF 0712 CMS eMeasure id CMS160v1 (17444): Depression Utilization of the PHQ-9 Tool. Adult patients age 18 and older with major depression or dysthymia and an initial PHQ-9 score > 9 who demonstrate remission at six months defined as PHQ-9 score less than 5. This measure applies to both patients with newly diagnosed and existing depression whose current PHQ-9 score indicates a need for treatment.

• NQF 1365 CMS eMeasure id CMS177v1 (17445): Child and Adolescent Major Depressive Disorder (MDD): Suicide Risk Assessment. Percentage of patient visits for those patients aged 6 through 17 years with a diagnosis of major depressive disorder with an assessment for suicide risk.


• NQF 1401 CMS eMeasure id CMS82v1 (17446): Maternal Depression Screening. of children. The percentage of children who turned 6 months of age during the measurement year who had documentation of a maternal depression screening for the mother.

• NQF TBD CMS eMeasure id CMS179v1 (17451): ADE Prevention and Monitoring: Warfarin Time in Therapeutic Range. Average percentage of time in which patients aged 18 and older with atrial fibrillation who are on chronic warfarin therapy have International Normalized Ratio (INR) test results within the therapeutic range (i.e., TTR) during the measurement period.

• NQF TBD CMS eMeasure id CMS90v2 (17452): Functional Status Assessment for Complex Chronic Conditions. Percentage of patients aged 65 years and older with heart failure who completed initial and follow-up patient-reported functional status assessments.

• NQF TBD CMS eMeasure id CMS149v1 (17453): Dementia: Cognitive Assessment. Percentage of patients, regardless of age, with a diagnosis of dementia for whom an assessment of cognition is performed and the results reviewed at least once within a 12 month period.

• NQF TBD CMS eMeasure id CMS22v1 (17454): Preventive Care and Screening: Screening for High Blood Pressure and Follow-Up Documented. Percentage of patients aged 18 years and older seen during the reporting period who were screened for high blood pressure AND a recommended follow-up plan is documented based on the current blood pressure (BP) reading as indicated.

• NQF TBD CMS eMeasure id CMS50v1 (17455): Closing the referral loop: receipt of specialist report. Percentage of patients with referrals, regardless of age, for which the referring provider receives a report from the provider to whom the patient was referred.

• NQF TBD CMS eMeasure id CMS56v1 (17456): Functional Status Assessment for Hip Replacement. Percentage of patients aged 18 years and older with primary total hip arthroplasty (THA) who completed baseline and follow-up (patient-reported) functional status assessments.

• NQF TBD CMS eMeasure id CMS66v1 (17457): Functional Status Assessment for Knee Replacement. Percentage of patients aged 18 years and older with primary total knee arthroplasty (TKA) who completed baseline and follow-up (patient-reported) functional status assessments.

• NQF TBD CMS eMeasure id CMS75v1 (17458): Children Who Have Dental Decay or Cavities. Percentage of children, ages 0-20 years, who have had tooth decay or cavities during the measurement period.

• NQF TBD CMS eMeasure id CMS77v1 (17459): HIV/AIDS: RNA Control for Patients with HIV. Percentage of patients aged 13 years and older with a diagnosis of HIV/AIDS, with at least two visits during the measurement year, with at least 90 days between each visit, whose most recent HIV RNA level is <200 copies/mL.

• NQF TBD CMS eMeasure id CMS61v2 (17460): Preventive Care and Screening: Cholesterol - Fasting Low Density Lipoprotein (LDL-C) Test Performed. Percentage of patients aged 20 through 79 years whose risk factors have been assessed and a fasting LDL-C test has been performed.

• NQF TBD CMS eMeasure id CMS64v2 (17461): Preventive Care and Screening: Risk-Stratified Cholesterol - Fasting Low Density Lipoprotein (LDL-C). Percentage of patients aged 20 through 79 years who had a fasting LDL-C test performed and whose risk-stratified fasting LDL-C is at or below the recommended LDL-C goal.

• NQF TBD CMS eMeasure id CMS65v2 (17462): Hypertension: Improvement in Blood Pressure. Percentage of patients aged 18-85 years of age with a diagnosis of hypertension whose blood pressure improved during the measurement period.

• NQF TBD CMS eMeasure id CMS74v2 (17463): Primary Caries Prevention Intervention as Offered by Primary Care Providers, including Dentists. Percentage of children, age 0-20 years, who received a fluoride varnish application during the measurement period.



The following features were added to the EMR during the version 9.0.2 release and were not included in the original manual.

DEFAULT UNITS OF MEASURE IN WOMEN’S HEALTH In the EMR Manager under Demographics, there is a drop-down menu that will set the default units of measure for several areas of the Women’s Health OB Module.

Figure 4-1 Setting the Default Unit of Measure in the EMR Manager

Procedure Details

1. Log into the EMR Manager, then go to System Settings > Demographics tab.

2. Click the Edit button. This will open the Demographic Defaults window (shown above).

3. In the Vital Signs Units: drop-down, select Imperial or Metric.

This will be the default unit of measure for Vital Signs in the EMR. It will affect the areas of Fetal Ultrashound – sizes, Birth History – newborn data, and Pregnancy History – fetuses.


In each area affected by this setting, there is a manual override for that section only. If you want to specify metric units for one area, but you have already set the default (in the EMR Manager) as Imperial, you can change the unit of measure on that individual screen.

For example, the screen shot below shows the override feature in the Add Ultrasound window.


Chapter 4. Updated features from Version 9.0.2

Figure 4-2 The Manual Override Option on the Add Ultrasound window



The following features were added to the EMR during the version 9.0.3 release and were not included in the original manual.

RESTRICTIVE ACCESS OPTIONS IN ENCOUNTERS Users now have the ability to restrict access to an encounter or to mark it as confidential. Users who have been granted access to restricted or confidential data can now deem an encounter as restricted, and only users with Restricted/Confidential access can view those encounters.

The permission setting to allow an individual access to confidential or restricted information is found on the User Roles and Functions window in the EMR Manager.

NOTE | Only users with Confidential/Restricted access granted may mark an encounter as Confidential or Restricted..

Figure 5-1 Restricted or Confidential Data setting in the EMR Manager


Chapter 5. Updated Features from Version 9.0.3

Table 5-1 To add permissions to view Restricted or Confidential data

Procedure Details

1. Log into the EMR Manager, then go to Users & Facilities.

2. Under the Users tab, select the user for whom you will be setting permissions.

3. Select the Roles tab to the right, then click the Edit button.

This will open the User Roles and Functions window.

4. Check the Restricted or Confidential Data checkbox.


Now this user has permission to view encounters marked as Confidential or Restricted, or to mark an encounter as Confidential or Restricted.

Table 5-2 Marking an Encounter as Confidential or Restricted

Procedure Details

1. Select Encounters from the Desktop Navigator.

2. Double-click an existing encounter to open it, or click the New Encounter button to start a new encounter.

If you are editing an existing encounter, click the Edit button near the top-right corner of the window.

If you are creating a new encounter, enter (or select) the name of the patient, complete any necessary settings, and click the OK button.

3. Mark the counter as Restricted or confidential.

If you are editing an existing encounter, go to the Administration tab, then click the Encounter Header icon near the top-right corner of the window. Check the Restricted / Confidential Data checkbox, then click the OK button.

If you are creating a new encounter, check the Restricted / Confidential Data checkbox during the initial step of the encounter.

4. The encounter is now restricted.


Henry Schein MicroMD760 Boardman-Canfi eld RoadBoardman, OH 44512

www.micromd.com

330-758-8832