1. society
2. welfare
3. healthcare

Attesting for Meaningful Use
Stage 2
Confidential and Proprietary Information of Vitera
Healthcare Solutions, LLC. Presentations are for
informational purposes only.
1
GETTING THERE TOGETHER
• During this presentation, we will help you:
• Understand key program changes with the MUII Final Rule
• Accurately capture and report data for MUII Objectives
• Apply role-based MUII workflows to your practice
2
2
WHAT STAGE 2 MEANS TO YOU
With Stage 2 the focus of Meaningful Use shifts from data capture to usability
● New Criteria
– Starting in 2014, providers participating in the EHR Incentive Programs who have met Stage 1 two or more
years will need to meet Stage 2 criteria
● Improving Patient Care
– Stage 2 includes new objectives to improve patient care through better clinical decision support, care
coordination and patient engagement
● Interoperability
– There is a greater emphasis on interoperability and patient engagement, with the latter requiring action on
the patient’s end in order for the objective to be met
3
3
OVERVIEW
● Program Changes
–
–
–
–
–
–
Revised CEHRT Definition
Eligibility Expansion
Attestation
Payment Adjustments
Hardship Exceptions
Stage 1 Objective Changes
● Clinical Quality Measures
– Alignment
– Reporting
– Core CQMs
● Stage 2 Objectives
– Attesting with Intergy v9
● Appendix
– Stage 2 Objectives, detailed breakdown
4
4
Meaningful Use Stage 2 Final Rule Overview
PROGRAM CHANGES
5
5
REVISED CERTIFIED EHR TECHNOLOGY DEFINITION
Starting in 2014, all EHR Incentive Programs participants will have to adopt certified EHR
technology that meets the Base EHR definition per ONC’s Standards & Certification Criteria
2014 Final Rule, regardless of Stage
● There is no longer a distinction between “Stage 1 Certified” or “Stage 2 Certified”
● All EPs must have EHR technology certified to the 2014 Edition EHR certification criteria with
capabilities certified:
– to meet the Base EHR definition
– for the MU core set objectives & measures for the stage of MU they seek to achieve unless the EP can meet
an exclusion
– for the MU menu set objectives & measures for the stage of MU they seek to achieve
● Vitera will continue to offer a complete certified EHR via ‘Intergy Meaningful Use Edition v9’
– Intergy EHR v9, Intergy Practice Portal and Practice Analytics QME
– Intergy Meaningful Use Edition will be required to meet the Base EHR definition
– Intergy Meaningful Use Edition will meet all core, menu, and CQM objectives
6
6
REVISED CERTIFIED EHR TECHNOLOGY DEFINITION
2014 Edition EHR Certification Criteria Required to Satisfy the Base EHR Definition
EHR technology that:
Certification Criteria
Vitera Solution
Includes patient demographic and clinical
health information, such as medical
history and problem lists
•
•
•
•
Demographics § 170.314(a)(3)
Problem List § 170.314(a)(5)
Medication List § 170.314(a)(6)
Medication Allergy List § 170.314(a)(7)
• Intergy v9
• Intergy EHR v9
Has the capacity to provide clinical
decision support
• Clinical Decision Support § 170.314(a)(8)
• Intergy EHR v9
Has the capacity to support physician
order entry
• Computerized Provider Order Entry §
170.314(a)(1)
• Intergy EHR v9
Has the capacity to capture and query
information relevant to health care quality
• Clinical Quality Measures § 170.314(c)(1)
through (3)
• Intergy v9
• Intergy EHR v9
• Practice Analytics QME
Has the capacity to exchange electronic
health information with, and integrate
such information from other sources
• Transitions of Care § 170.314(b)(1) and (2) • Intergy v9
• Data Portability § 170.314(b)(7)
• Intergy EHR v9
• Intergy Practice Portal
• Privacy and Security § 170.314(d)(1)
Has the capacity to protect the
confidentiality, integrity, and availability of
through (8)
health information stored and exchanged
• Intergy v9
• Intergy EHR v9
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7
ELIGIBILITY EXPANSION
Stage 2 introduces a change to the definition of a hospital-based EP
● EPs who can demonstrate that they fund the acquisition, implementation, and maintenance of
CEHRT, including supporting hardware and interfaces needed for meaningful use without
reimbursement from an eligible hospital or CAH — in lieu of using the hospital’s CEHRT — can be
determined non-hospital-based and potentially receive an incentive payment.
● Determination will be made through an application process
● If and when a nonhospital-based determination has been made, the EP would then have to meet
the same requirements of the EHR incentive program as any other EP with a sole exception:
– The EP would include in their attestation all encounters at all locations, including those in the inpatient and
emergency departments of the hospital, rather than just outpatient locations
– Hospital encounters essentially become ‘outpatient encounters’ for the purposes of the EHR Incentive
Program
8
8
ELIGIBILITY EXPANSION
The definition of what constitutes a Medicaid patient encounter has changed, adding
flexibility in the look-back period for overall patient volume
● The rule now includes encounters for anyone enrolled in a Medicaid program, including Medicaid
expansion encounters (except stand-alone Title 21), and those with zero-pay claims
● You may now include as a Medicaid encounter, service rendered on any one day to a Medicaidenrolled individual, regardless of payment liability
– This includes zero-pay claims and encounters with patients in Title 21-funded Medicaid expansions, but not
separate CHIPs
– Previously you could only include as a Medicaid encounter, service rendered on any one day where Medicaid
paid for all or part of the service or Medicaid paid the co-pays, cost-sharing, or premiums
● Zero-pay claims include:
–
–
–
–
Claim denied because the Medicaid beneficiary has maxed out the service limit
Claim denied because the service wasn’t covered under the State’s Medicaid program
Claim paid at $0 because another payer’s payment exceeded the Medicaid payment
Claim denied because claim wasn’t submitted timely
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9
ELIGIBILITY EXPANSION
The definition of what constitutes a Medicaid patient encounter has changed, adding
flexibility in the look-back period for overall patient volume
● CHIP encounters:
– Previously you could only include CHIP encounters for patients in Title 19 Medicaid expansion programs
– Now you may include CHIP encounters for patients in Title 19 and Title 21 Medicaid expansion programs
– Stand-alone CHIP programs still cannot be included in Medicaid patient volume calculation
10
10
ATTESTATION
● Reporting Period Reduction
– All participants will have a 3-month reporting period in 2014
– Medicare and Medicaid providers in their first year of meaningful use will utilize any continuous 90-day
period within cy2014
– Medicare providers beyond their first year of meaningful use will utilize a 3-month quarter EHR reporting
period per the following schedule:
• January 1, 2014-March 31, 2014
• April 1, 2014-June 30, 2014
• July 1, 2014-September 30, 2014
• October 1, 2014-December 31, 2014
– Medicaid providers beyond their first year of meaningful use will utilize a reporting period subject to their
State requirements. This will either be an continuous 90-day period or a 3-month quarter as defined by the
State’s quarterly calendar.
– Attestation can occur anytime immediately following the end of the 90-day reporting period but no later
than February 28 of the following calendar year
11
11
EP PAYMENT ADJUSTMENTS
EPs must continue to demonstrate meaningful use every year to avoid payment adjustments
in subsequent years. Payment adjustments are based on prior years’ reporting periods
● For an EP who has demonstrated meaningful use in 2011 or 2012:
Payment Adjustment Year
Based on Full Year EHR Reporting Period
2015
2013
2016
2014
2017
2015
2018
2016
2019 2020
2017 2019
● For an EP who demonstrates meaningful use in 2013 for the first time:
Payment Adjustment Year
Based on 90 day EHR Reporting Period
Based on Full Year EHR Reporting Period
2015
2013
2016
2017
2018
2019
2020
2014
2015
2016
2017 2019
2017
2018
2019
2015
2016
2017 2019
● For an EP who demonstrates meaningful use in 2014 for the first time:
Payment Adjustment Year
Based on 90 day EHR Reporting Period
Based on Full Year EHR Reporting Period
2015 2016
2014* 2014
2020
– *In order to avoid the 2015 payment adjustment, first-time meaningful users must attest no later than
October 1, 2014, which means they must begin their 90 day EHR reporting period no later than July 1, 2014
12
12
EP PAYMENT ADJUSTMENTS
For EPs eligible for both Medicaid and Medicare programs, AIU does not equal meaningful
use. A provider receiving a Medicaid incentive for AIU would still be subject to the Medicare
payment adjustment
● Congress mandated that an EP must be a meaningful user in order to avoid the payment
adjustment; therefore receiving a Medicaid EHR incentive payment for adopting, implementing, or
upgrading your certified EHR Technology would not exempt you from payment adjustments if
eligible for both programs
13
13
EP HARDSHIP EXCEPTIONS
EPs can apply for hardship exceptions in the following categories:
● Infrastructure
– Demonstrate that they are in an area without sufficient internet access or face insurmountable barriers to
obtaining infrastructure (e.g., lack of broadband)
● New EPs
– Newly practicing EPs who would not have had time to become meaningful users can apply for a 2-year
limited exception to payment adjustments
● Unforeseen Circumstances
– Examples may include a natural disaster or other unforeseeable barrier
● EPs must demonstrate that they meet the following criteria
– Lack of face-to-face or telemedicine interaction with patients
– Lack of follow-up need with patients
– EPs whose primary specialties are anesthesiology, radiology or pathology will receive a hardship exception
based on this criterion as of July 1st of the year preceding the first payment adjustment year
● EPs who practice at multiple locations must demonstrate that they:
– Lack control over availability of CEHRT for more than 50% of patient encounters
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14
EP HARDSHIP EXCEPTIONS
● EPs must apply for hardship exceptions to avoid the payment adjustments
● Hardship exceptions will be granted only if CMS determines that providers have demonstrated that
those circumstances pose a significant barrier to their achieving meaningful use
● Applications need to be submitted no later than July 1 of the year before the payment adjustment
year, however earlier submission is encouraged
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15
STAGE 1 OBJECTIVE CHANGES
Stage 1 Objective
Changes to Objective
Effective Year
CPOE
• Change: Addition of an alternative measure
• More than 30 percent of medication orders created by the EP during the
EHR reporting period are recorded using CPOE
• Optional 2013+
eRx
• Change: Additional exclusion
• Any EP who does not have a pharmacy within their organization and
there are no pharmacies that accept eRx within 10 miles of the EP’s
practice at the start of his/her EHR reporting period
• Required 2013+
Vital Signs
• Change: Age Limitations on Growth Charts and Blood Pressure increased
from 2 to 3
• Change: Splitting the EP exclusion so that BP and Height/Weight are
evaluated separately in terms of relevance to scope of practice
• More than 50 percent of all unique patients seen by the 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
• Optional 2013
• Required 2014+
Electronic Exchange
of Key Clinical
Information
• Requirement removed effective 2013
• Required 2013+
16
16
STAGE 1 OBJECTIVE CHANGES
Stage 1 Objective
Changes to Objective
Effective Year
Public Health
Objectives
• Change: Addition of "except where prohibited" to the objective
regulation text for the public health objectives under § 495.6
• Required 2013+
Report ambulatory
clinical quality
measures to
CMS or the States
• Change: Objective is incorporated directly into the definition of a
meaningful EHR user and eliminated as an objective because it is
redundant
• Required 2013+
Electronic Copy of
Health Information
(Stage 1 Core
Objective)
• Change: Replace these 2 objectives with the Stage 2 objective and one of • Required 2014+
the two Stage 2 measures
• New Objective: Provide patients the ability to view online, download
and transmit their health information within 4 business days of the
Timely Electronic
information being available to the EP.
• New Measure: More than 50 percent of all unique patients seen by the
Access to Health
Information (Stage 1
EP during the EHR reporting period are provided timely (within 4
Menu Set Objective)
business days after the information is available to the EP) online access
to their health information subject to the EP's discretion to withhold
certain information.
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STAGE 1 OBJECTIVE CHANGES
Stage 1 Objective
Clinical Summaries
Changes to Objective
• Change: New IEHR workflow. Visit Summary must be provided in CCD
format and can no longer be generated as clinical correspondence.
Effective Year
• Required 2014+
• New Clinical Summary window on patient chart summary page. Provider
can provide the CCD as a printed document or electronically via portal
secure messaging or external media.
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STAGE 2 OBJECTIVES
Stage 2
17 core objectives
3 of 6 menu objectives
20 total objectives
19
19
Meaningful Use Stage 2 Final Rule Overview
CLINICAL QUALITY MEASURES
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ALIGNMENT
In 2014 and beyond, reporting programs (i.e., PQRS, eRx reporting) will be streamlined in
order to reduce provider burden
● 2014 represents CMS’s commitment to aligning quality measurement reporting among programs,
including Hospital Inpatient Quality Reporting Program, PQRS, CHIPRA, and ACO programs
● Alignment includes:
–
–
–
–
Choosing the same measures for different program measure sets
Coordinating quality measurement stakeholder involvement efforts and opportunities for public input
Identifying ways to minimize multiple submission requirements and mechanisms
Alignment with HHS Priorities requiring CQM selection to occur across the 6 HHS National Quality Strategy
domains
● No longer a core objective of the EHR Incentive Programs, however still required in order to
demonstrate meaningful use
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21
REPORTING
Reporting CQM data is no longer a core objective of the EHR Incentive Programs, however it
is still required in order to demonstrate meaningful use
● Beginning
2014 all Medicare EPs in2014
theirand
second
yearfor
andallbeyond
MU must
Prior toin2014
Beyond
Stagesof
ofdemonstrating
Meaningful Use
electronically
data9 to
Complete
6 out of 44report their CQM
Complete
outCMS
of 64
– or
Medicaid
EPs will
report
their 1CQM
data to
• 3 core
• Choose
3 alternate
coreelectronically
at least
measure
in 3their
NQSstate
Health Domains
• 3 menu
• Recommended core CQMs include:
• 9 CQMs for the adult population
• 9 CQMs for the pediatric population
● Attestation is required for EPs in their 1st year of demonstrating MU because it is the only reporting
method that would allow them to meet the submission deadline of October 1 to avoid a payment
adjustment
● Groups with EPs in their 1st year of demonstrating MU can report as a group, however the
individual EP(s) who are in their 1st year must attest to their CQM results by October 1 to avoid a
payment adjustment
22
22
REPORTING
Category
st
EPs in 1 Year of
Demonstrating
MU
Data Level
Aggregate
Payer
Level
All payer
Submission Type
Attestation
Reporting Schema
Submit 9 CQMs from EP measures table (includes
adult and pediatric recommended core CQMs),
covering at least 3 domains
EPs Beyond the 1st Year of Demonstrating Meaningful Use
Option 1
Aggregate
All payer
Electronic
Submit 9 CQMs from EP measures table (includes
adult and pediatric recommended core CQMs),
covering at least 3 domains
Option 2
Patient
Medicare
Only
Electronic
Satisfy requirements of PQRS EHR Reporting
Option using CEHRT
Group Reporting (only EPs Beyond the 1st Year of Demonstrating Meaningful Use)
EPs in an ACO
Patient
(Medicare Shared
Savings Program
or Pioneer ACOs)
Medicare
Only
Electronic
Satisfy requirements of Medicare Shared Savings
Program of Pioneer ACOs using CEHRT
EPs reporting via Patient
PQRS group
reporting options
Medicare
Only
Electronic
Satisfy requirements of PQRS group reporting
options using CEHRT
23
23
REPORTING IN 2013
● In 2012 and 2013, there are two reporting methods available for reporting the Stage 1 measures
– Attestation
– PQRS EHR Incentive Program Pilot for EPs
● Medicaid providers submit CQMs through their state-based attestation submissions
● If an EP seeks to use EHR technology certified only to the 2014 Edition EHR certification criteria for
reporting CQMs in 2013, they can only report those CQMs that are included in both the Stage 1
and Stage 2 final rules.
– For EPs, this would exclude the option of reporting NQF 0013, 0027, 0084 from the CQMs in the Stage 1 final
rule.
– Since NQF 0013 is a core CQM in the Stage 1 final rule, EPs would select one of the alternate core CQMs to
replace it.
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CORE CQMS
CMS selected the CQMs for the proposed core set based on analysis of several factors
● Conditions that:
–
–
–
–
Contribute greatest to morbidity and mortality
Represent national public/population health priorities
Are common to health disparities
Disproportionately drive healthcare costs
● Measures that:
– Enable CMS, States, and the provider community to measure quality of care in new dimensions
– Include patient and/or caregiver engagement
25
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Meaningful Use Stage 2
ATTESTING WITH INTERGY V9
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MEANINGFUL USE STAGE 2 WITH INTERGY V9
Overview
●Patient Visit workflow
– Hands on Intergy
●Post Visit workflows
– Hands on Intergy
●Reporting workflow
– Hands on MU Dashboards
27
27
ACHIEVING MEANINGFUL USE WITH INTERGY
Patient
Visit
Post Visit
Reporting
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PATIENT VISIT - REGISTRATION
Core 3 - Record demographics for >80% of patients including language, sex, race, ethnicity and DOB.
Select this link to see
the full language for
the MU requirement
Intergy has been enhanced to
support multiple patient races
and to include additional
language codes
29
29
PATIENT VISIT - NURSE
Core 4 - Record Vitals for more than 80% of patients for BP (age 3+) or height/weight
• Age Limits on growth charts and BP increased from 2 to 3
• Splitting the EP exclusion so that BP and height/weight are evaluated separately in terms of relevance to
scope of practice
No enhancements were needed for
this measure
30
30
PATIENT VISIT - NURSE
Core 5 - Record Smoking Status for more than 80% of patients 13+
• New Statuses
• Increase threshold
.
Intergy has been enhanced to
include the additional smoking
statuses
Tip:
The additional smoking status
options will be automatically
available on forms that currently
use the smoking status dropdown
31
31
PATIENT VISIT - NURSE
Menu 4 - Record Family Hx for first degree relatives for more than 20% of patients.
• New Menu Objective
Encounter note forms and Visit
note templates can be used to
capture family history.
Tip:
Specific family prefixes must be
used to count towards the measure
(ie: paternal, maternal)
32
32
PATIENT VISIT - NURSE
Core 14 - Record Medication Reconciliation for more than 50% of patients who have been
transitioned into the care of the EP.
• Former menu objective
Intergy has been enhanced with a
new option on the Meds List for
‘Mark as Reconciled’. Selecting this
option will count towards the
numerator for the measure
Tips:
Adding a reported med while on an
encounter will auto-set the
reconciled flag for that encounter
Users must still indicate that the
patient has been transitioned into
EP’s care for counting in the
denominator
33
33
PATIENT VISIT - NURSE
Medication Reconciliation - Enhanced CCD Import
Enhanced CCD Import for clinical
information reconciliation
• Side-by-side comparison with
CCD and patient chart
• Consolidated view for
importing medications,
problems and allergies
• Data import based on industry
standard coding systems
(SNOMED, RxNorm), giving the
ability to import a CCDA from
any other practice
34
34
PATIENT VISIT - NURSE
Core 16 - Submit to Immunization Registries.
• Former menu objective
• Successful submission required, not just a test
• Exclusions exist based on Registry availability
Vitera will offer submission to State Registries through the
Vitera Clinical Exchange.
Enhanced Immunizations to allow
entry of Immunity as a reason to
not administer a vaccine
• Vaccine will show as Immune in
EHR
• Immunity will prevent recalls
for the vaccine from being
generated
35
35
PATIENT VISIT - NURSE
Immunization Administration Enhancements .
Additional Enhancements for
Immunizations:
New fields for: Admin Route,
Amount, and VIS Sheets
•
Route uses same default logic
as Site does
•
Amount is defaulted from setup
•
VIS sheets are defaulted based
on last VIS sheets used for the
vaccine
36
36
PATIENT VISIT - PROVIDER
Core 6 - 1) Implement 5 CDS interventions related to 4+ CQMs or high priority health condition
2) Enable and implement drug-drug and drug-allergy interaction checks
• Changed from 1 CDS rule to 5 CDS rules
Health Management can be used
to satisfy the first requirement.
Specific CQM data can be setup as
needed
Rx DUR can be used to satisfy the
second requirement.
Tip: the practice can manage which
DUR warnings appear in Practice
configuration
37
37
PATIENT VISIT - PROVIDER
Core 1 Record more than 60% of Meds, 30% of Labs and 30% Radiology Orders with CPOE.
– Now includes Lab and Radiology
– Threshold increase for medications
To count towards this measure,
Providers can either:
•
Enter the Orders themselves
or
•
A User who has been assigned
a “Scribe” User Role (in
Practice Maintenance) can
enter the Orders for the
provider
38
38
PATIENT VISIT - PROVIDER
Core 2 More than 50% of permissible Rx are queried for a formulary and transmitted electronically.
• Threshold increase
• New Exclusion - Does not have a pharmacy within organization and no pharmacies that accept e-Rx within
10 miles of the EP's practice location
EHR has been enhanced to perform
a formulary check for Rx Renewals
and Rx Authorizations
Tip: If using RxHub formulary, no
patient setup is required to perform
formulary checking.
39
39
PATIENT VISIT - PROVIDER
Core 13 - Patient Education is provided to more than 10% of unique patients.
• Former menu objective
Intergy EHR has been enhanced to
include right click access to patient
education from problems, meds
and labs
• Uses NIH’s Medline Plus as
default website
• Automated capture in MU
numerator when using this
option
Can also continue to use Forms to
access education and indicate
education was given
40
40
PATIENT VISIT - PROVIDER
Supporting - Problem based Care Plan
Intergy EHR has been enhanced to
allow Problem based Care Plan
entry.
•
New Page on Problem screen to
enter Care Plan
•
Full history is saved when the
Care Plan is changed
•
Care Plans can be inserted into
the Encounter Note and Visit
note, and the CCDA
•
Multiple options to Cite Care
Plans into notes
•
Quick Text for Care Plans are
stored at the Problem type
level (ie: ICD code or Finding ID)
41
41
PATIENT VISIT - PROVIDER
Supporting – Personal Quick Text
Intergy has been enhanced to
support User level Quick Text
•
This is now available in ALL
Places where quick text is used.
•
The system will remember the
“shared” and “personal” quick
text checkboxes for each type of
quick text
•
Quick Text security is confined
to Shared Quick Text.
42
42
PATIENT VISIT - PROVIDER
Menu 2 More than 30% of Visits contain an Electronic Note signed by the provider.
• The electronic note is text searchable and may contain drawings and other content
• New menu objective
The following types of documents
will count for the measure:
•
Encounter Note – signed by
the provider
•
Visit Note – signed by the
provider
•
Transcription Docs – approved
by the provider
43
43
PATIENT VISIT - PROVIDER
Core 8 - Clinical Summaries are provided within one day for more than 50% of patient visits.
• Now required to generate Clinical Summary in the CCDA format.
Intergy has been enhanced to
provide a one click workflow for
meeting this measure.
There is a new option on the
patient summary page to Print the
Clinical Summary. This option will
generate a CCD with all required
sections.
If the patient is registered for
secure messaging, then a Send
option also displays
Once the summary has been
generated, the area will turn green
to indicate it has been done.
44
44
PATIENT VISIT - PROVIDER
Core 15 1) Generate a Referral Summary for more than 50% of transitions of care.
2) Electronically send >10% of referral summaries.
⁃ electronically transmitted using CEHRT to a recipient or
⁃ where the recipient receives the summary of care record via exchange facilitated by an organization
that is a NwHIN Exchange participant or in a manner that is consistent with NwHIN standards.
3) An EP must satisfy one of the following criteria:
⁃ Conducts one or more successful electronic exchanges of a summary of care document, with a
recipient who has EHR technology from a different EHR technology developer than the sender's
EHR technology.
⁃ Conducts one or more successful tests with the CMS designated test EHR during the EHR reporting
period.
Exclusion: Any EP who transfers a patient to another setting or refers a patient to another provider
less than 100 times during the EHR reporting period is excluded from all three measures.
Referral Summaries also require CCDA technology.
Intergy workflow for Referral Summaries is similar to that for Visit Summaries
45
45
PATIENT VISIT - PROVIDER
Clinical Summary and Referral Summary - Generate Exchange Documents
Enhanced CCD generation screen
• Document type will default
based on recipient
• Sections will default for each
document type based on MU
requirements
• Sections can be changed
for a single visit or
permanently.
• Send option is available if
patient is registered for secure
messaging, or if sending to
Referring Provider.
46
46
Intergy – Patient Visit
TESTING HANDS ON
47
47
ACHIEVING MEANINGFUL USE WITH INTERGY
Patient
Visit
Post Visit
Reporting
48
48
AFTER PATIENT VISIT
Core 7
•
•
•
•
1) More than 50% of patients are provided timely online access to their info
2) More than 5% of patients view, download or transmit their info.
Former menu objective
Consolidated patient electronic info request with timely access
New exclusion
Threshold increase
Practice portal has been enhanced
to support Download and Transmit
options.
•
These options are available to
the patient when viewing their
clinical summary
•
When download or sent, the
CCD will be delivered in both
XML and a Viewable format.
Tip: Once a patient has been given
a PIN letter for the portal, they
have access to the portal and will
meet the first requirement.
49
49
AFTER PATIENT VISIT
Supporting – Practice Portal Report
Intergy has been enhanced to include
a New Report to let you manage
Practice Portal patients
Report is based on appointments, so
you can discover the Portal status of
patients either before or after their
visit.
50
50
AFTER PATIENT VISIT
Core 11 Generate at least 1 report listing patients with a specific condition.
• Former menu objective
Using the Practice Analytics’ Patient
Care Conditions list will satisfy this
requirement.
In addition you can export the list of
patients that are generated from this
screen for Posting Recalls.
To create recalls using this method:
• Generate the list for the
condition(s) desired,
• Export to Excel (the XL button).
• From Excel, save the file as a CSV
file.
• Import the file in Intergy
51
51
AFTER PATIENT VISIT
Core 12 More than 10% of patients with 2+ visits within 24 months before reporting period were
sent a Reminder (recall) per patient preference.
• Former menu objective
Intergy has been enhanced to allow
posting of recalls from a file.
• This option is intended to work
with files exported from Practice
Analytics
• A single recall reason will be used
for all recalls posted.
• All other options on the screen
work the same as with the other
modes
52
52
AFTER PATIENT VISIT
Core 17 A secure message was sent using the electronic messaging function of CEHRT by more than
5% of unique patients (or their authorized representatives) seen by the EP
• New Objective
Most Secure messages sent by the
patient are counted towards the
measure.
The following are NOT counted:
Appointment Requests
New Patient Request
Billing and Payment messages
53
53
AFTER PATIENT VISIT
Menu 1 - Capability to submit Electronic Syndromic Surveillance data.
• New Objective
Intergy has been enhanced to include
a New Report to let you create
Syndromic Surveillance files for
submission.
•
The Report is based on signed
encounter/visit notes.
•
Will report on selected
assessments via the ICD code.
•
HL7 2.5.1 Compliant
54
54
AFTER PATIENT VISIT
Core 10 More than 55 % of Lab Orders contain structured results.
Lab Orders Groups are counted as a
single entry for the denominator for
Labs
If the Lab Order has at least one Lab
Result linked to a Test or Favorite, the
Lab Order will be counted in the
Numerator
Tip: Manually entered results will be
counted as structured data
55
55
AFTER PATIENT VISIT
Menu 3 More than 10% of all tests whose result is one or more images ordered by the EP during the
EHR reporting period are accessible through CEHRT.
Radiology Order Groups are counted
for the denominator.
If the Order Group has at least one
Image linked to the Order, the
Radiology Order Group will be
counted in the Numerator
Tip: For proper counting, Order
Types can be changed in Practice
Analytics if needed.
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Intergy – Administrative
TESTING HANDS ON
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ACHIEVING MEANINGFUL USE WITH INTERGY
Patient
Visit
Post Visit
Reporting
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REPORTING
Meaningful Use Dashboard Enhancements
The Meaningful Use
Dashboards have been
enhanced to include the
2014 MU Measures for both
Stage 1 and Stage 2
To toggle between Stage 1
and Stage 2, select the
appropriate tab in the middle
of the screen.
Some measures have two
requirements. If multiple
requirements exist, a
dropdown will display for
selection
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REPORTING
Dashboard Auditing Enhancements
The Dashboards have
been Enhanced to allow a
scorecard to be saved for
future review
Once the Scorecard is
prepared, select the
Export Audit Scorecard
and the Save Audit
Scorecard buttons.
(both options must be
selected to generate the
Audit)
When you want to review
Scorecards later, you can
select the Audit Scorecard
History option, and select
a file to review.
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REPORTING
Dashboard Auditing Enhancements
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REPORTING
Dashboard CQM Enhancements
The CQM Dashboard has
been enhanced to allow
creation of a file for
submission to CMS.
Select the measures for the
Scorecard and the provider
the score card is for, then
select Prepare Scorecard
Submission
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REPORTING
Dashboard CQM Enhancements
These screens will walk you through the process
of creating the score card.
On the third screen, enter the file name to save
the CQM Scorecard under.
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Intergy – Reporting
TESTING HANDS ON
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Appendix
STAGE 2 OBJECTIVES
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STAGE 2 CORE OBJECTIVES
Core
Objective
1. CPOE
Measure
• More than 60% of medication, 30% of laboratory, and 30% of
radiology orders are created using CPOE
Exclusion
• Any EP who writes fewer than 100 medication, radiology, or
laboratory orders during the EHR reporting period.
2. e-Prescribing
(eRx)
• More than 50% of Rx are queried for a drug formulary and
transmitted electronically
Change from Stage 1
• Order-centric
• Inclusion of lab and
radiology
• Threshold increase from
more than 30% for
medications
• Threshold increase from
more than 40%
• New Exclusion
Exclusion:
• Any EP who:
• (1) Writes fewer than 100 permissible prescriptions during
the EHR reporting period.
• (2) Does not have a pharmacy within their organization and
there are no pharmacies that accept electronic
prescriptions within 10 miles of the EP's practice location
at the start of his/her EHR reporting period.
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STAGE 2 CORE OBJECTIVES
Core Objective
3. Record
Demographics
Measure
• More than 80% of all unique patients seen by the EP have the
following demographics recorded: Language, Sex, Race, Ethnicity,
DOB
Change from Stage 1
• Threshold Increase
from more than 50%
• No Exclusion
4. Record Vital
Signs
• More than 80 percent of all unique patients seen by the EP have
blood pressure (for patients age 3 and over only) and/or height
and weight (for all ages) recorded as structured data.
• Threshold Increase
from more than 50%
Exclusion
• Any EP who:
• (1) Sees no patients 3 years or older is excluded from
recording blood pressure.
• (2) Believes that all 3 vital signs of height/length, weight,
and blood pressure have no relevance to their scope of
practice is excluded from recording them.
• (3) Believes that height/length and weight are relevant to
their scope of practice, but blood pressure is not, is excluded
from recording blood pressure.
• (4) Believes that blood pressure is relevant to their scope of
practice, but height/length and weight are not, is excluded
from recording height/length and weight.
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STAGE 2 CORE OBJECTIVES
Core Objective
5. Record Smoking
Status
Measure
• More than 80% of all unique patients 13+ seen by the EP have
smoking status recorded
Exclusion
• Any EP that neither sees nor admits any patients 13 years old
or older.
6. Clinical Decision
Support Rule
• Measure 1: Implement 5 CDS interventions related to 4 or
more CQMs. Absent 4 CQMs related to an EP’s scope of
practice or patient population, the CDS interventions must be
related to high-priority health conditions.
• Measure 2: The EP has enabled and implemented the
functionality for drug-drug and drug-allergy interaction checks
Exclusion
• For the second measure, any EP who writes fewer than 100
medication orders during the EHR reporting period.
Change from Stage 1
• 2 new statuses
• Threshold increase from
more than 50%
• 1 rule attestation
increased to 5 rules
• Consolidated drugdrug/drug-allergy
objective into a measure
for this objective
• New Audit options
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STAGE 2 CORE OBJECTIVES
Core
Objective
7. Patient
Electronic
Access
Measure
Change from Stage 1
• Measure 1: More than 50% of all unique patients seen are provided
• Former menu objective
timely (within 4 business days after the information is available to the
• Consolidated patient
EP) online access to their health information subject to the EP's
discretion to withhold certain information.
electronic info request
with timely access
• Measure 2: More than 5% of all patients seen(or their authorized
• Patient accountability
representatives) view, download, or transmit to a third party their
health information.
• New exclusion
Exclusion
• Any EP who:
• New IEHR workflow
• (1) 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.
• (2) Conducts 50 percent or more of his or her patient
encounters in a county that does not have 50 percent or more
of its housing units with 3Mbps broadband availability
according to the latest information available from the FCC on
the first day of the EHR reporting period may exclude only the
second Measure
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STAGE 2 CORE OBJECTIVES
Core
Objective
8. Clinical
Summaries
Measure
• Clinical summaries provided to patients within one business day for
more than 50% of office visits.
Change from Stage 1
• Must provide CCD
• New IEHR workflow
Exclusion
• Any EP who has no office visits during the EHR reporting period.
9. Protect
Electronic
Health
Information
• Conduct or review a security risk analysis, implement security
updates as necessary and correct identified security deficiencies
10. Clinical
Lab-Test
Results
• More than 55% of all lab tests ordered are linked to structured results • Threshold increase from
more than 40%
Exclusion
• Any EP who orders no lab tests where results are either in a
• PA logic change
positive/negative affirmation or numeric format during the EHR
reporting period.
Unchanged
• No Exclusion
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STAGE 2 CORE OBJECTIVES
Core Objective
Measure
Changes from Stage 1
11. Patient Lists
• Generate at least one report listing patients of the EP
with a specific condition.
• No Exclusion
• Former menu objective
12. Preventive
Care
• More than 10% of all unique patients who have had 2 or
more office visits with the EP 2 years during or prior to
the reporting period were sent a reminder, per patient
preference when available.
• Former menu objective
Exclusion
• Any EP who has had no office visits in the 24 months
before the EHR reporting period.
13. PatientSpecific
Education
Resources
• No age thresholds
• Can utilize Batch Recall Posting
• New IEHR workflow
• Patient-specific education resources are provided for
more than 10% of all unique patients with office visits
seen by the EP
• Former menu objective
Exclusion
• Any EP who has no office visits during the EHR reporting
period.
• New IEHR workflow
• Infobutton standard
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STAGE 2 CORE OBJECTIVES
Core Objective
14. Medication
Reconciliation
Measure
• The EP who performs medication reconciliation for more than
50% of transitions of care in which the patient is transitioned
into the care of the EP.
Exclusion
• Any EP who was not the recipient of any transitions of care
during the EHR reporting period.
Change from Stage 1
• Former menu objective
• PA logic update-automated
numerator capture
• New IEHR workflow
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STAGE 2 CORE OBJECTIVES
Core Objective
15. Summary of
Care
Measure
• Measure 1: Provide a summary of care record for more than 50% of
transitions of care and referrals.
• Measure 2: Provide a summary of care record for more than 10% of
transitions of care and referrals either:
(a) electronically transmitted using CEHRT to a recipient or
(b) where the recipient receives the summary of care record via
exchange facilitated by an organization that is a NwHIN Exchange
participant or in a manner that is consistent with NwHIN standards.
Change from Stage 1
• Former menu objective
• New electronic measure
• New measure requiring
receipt
• New IEHR workflow
• Measure 3: An EP must satisfy one of the following criteria:
(a)Conducts one or more successful electronic exchanges of a
summary of care document, with a recipient who has EHR
technology from a different EHR technology developer than the
sender's EHR technology.
(b)Conducts one or more successful tests with the CMS designated
test EHR during the EHR reporting period.
Exclusion
• Any EP who transfers a patient to another setting or refers a
patient to another provider less than 100 times during the EHR
reporting period is excluded from all three measures.
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STAGE 2 CORE OBJECTIVES
Core Objective
16. Immunization
Registries Data
Submission
Measure
• Successful ongoing submission of electronic immunization data
from CEHRT to an immunization registry or immunization
information system for the entire EHR reporting period.
Change from Stage 1
• Former menu objective
• Successful submission
required, not just a
test
Exclusion
• Any EP that meets one or more of the following criteria may be
• New IEHR workflow
excluded from this objective:
• (1) the EP does not administer any of the immunizations to
any of the populations for which data is collected by their
jurisdiction's immunization registry or information system
during the EHR reporting period;
• (2) the EP operates in a jurisdiction for which no
immunization registry or information system is capable of
accepting the specific standards required for CEHRT at the
start of their EHR reporting period;
• (3) the EP operates in a jurisdiction where no immunization
registry or information system provides information timely
on capability to receive immunization data; or
• (4) the EP operates in a jurisdiction for which no
immunization registry or information system that is capable
of accepting the specific standards required by CEHRT at
the start of their EHR reporting period can enroll additional
EPs.
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STAGE 2 CORE OBJECTIVES
Core Objective
17. Use Secure
Electronic Messaging
Measure
• A secure message was sent using the electronic
messaging function of CEHRT by more than 5% of
unique patients (or their authorized representatives)
seen by the EP
Change from Stage 1
• New objective
Exclusion
• Any EP who has no office visits during the EHR reporting
period, or any EP who conducts 50 percent or more of
his or her patient encounters in a county that does not
have 50 percent or more of its housing units with 3Mbps
broadband availability according to the latest
information available from the FCC on the first day of
the EHR reporting period.
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STAGE 2 MENU OBJECTIVES
Starting in 2014 exclusions claimed for menu objectives will no longer count towards the
number of menu objectives needed
Menu Objective
1. Syndromic
Surveillance Data
Submission
Measure
Change from Stage 1
• Successful ongoing submission of electronic syndromic
• Successful
surveillance data from CEHRT to a public health agency for
submission required,
the entire EHR reporting period.
not just a test
Exclusion
• Any EP that meets one or more of the following criteria may
• New IEHR workflow
be excluded from this objective:
• (1) the EP is not in a category of providers that collect
ambulatory syndromic surveillance information
• (2) the EP operates in a jurisdiction for which no public
health agency is capable of receiving electronic
syndromic surveillance data in the standards required
by CEHRT at the start of their reporting period;
• (3) the EP operates in a jurisdiction where no public
health agency provides information timely on capability
to receive syndromic surveillance data; or
• (4) the EP operates in a jurisdiction for which no public
health agency that is capable of accepting the specific
standards required by CEHRT at the start of their EHR
reporting period can enroll additional EPs.
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STAGE 2 MENU OBJECTIVES
Menu Objective
2. Electronic Notes
Measure
• Enter at least one electronic progress note created, edited
and signed by an EP for more than 30% of unique patients
with at least one office visit during the reporting period.
Change from Stage 1
• New objective
• New IEHR workflow
• The text of the electronic note must be text searchable and
may contain drawings and other content
• No exclusion.
3. Imaging Results
• More than 10% of all tests whose result is one or more
images ordered by the EP during the EHR reporting period
are accessible through CEHRT.
• New objective
• New IEHR workflow
Exclusion
• Any EP who orders less than 100 tests whose result is an
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.
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STAGE 2 MENU OBJECTIVES
Menu Objective
4. Family Health
History
Measure
• More than 20% of all unique patients seen by the EP during
the EHR reporting period have a structured data entry for
one or more first-degree relatives.
Change from Stage 1
• New objective
Exclusion
• Any EP who has no office visits during the EHR reporting
period.
5. Report Cancer
Cases
• This is an optional criterion which we will not be certified to
and is not required to be considered a complete certified
EHR.
• New objective
6. Report Specific
Cases
• Capability to submit to a registry “other than a cancer or
immunization registry.”
• New objective
• The specialized registry cannot be duplicative of any of the
other registries included in other meaningful use objectives
and measures.
• EPs will attest YES/NO to successfully submitting specific case
information from their CEHRT to a specialized registry for the
entire reporting period.
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