NYS HCCN Meaningful Use for Vitera Intergy Webinar #2

Transcription

Presented by Health Choice Network
Marlen Bazan De Leon, Decision Support Manager
Michal Krell, Senior Analyst
Scope of Presentation
 MU Stage 1 vs. Stage 2 comparison, part 2
 What to Expect with Intergy v9
 UDS Updates: 2014 Approved Changes
 Greenway Dashboards V9 Changes
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Table of Contents
Topic
Page
Scope of Presentation
2
Stage 1 vs. Stage 2 Comparison Grid
6
Patient List: Core Objective 11
7
Preventive Care: Core Objective 12
10
•
Health Reminders Tab
12
•
Recalls
14
Patient-Specific Education Resources: Core Objective 13
16
Medication Reconciliation: Core Objective 14
19
•
Clinical Information Reconciliation
22
Summary of Care: Core Objective 15
•
27
Clinical and Referral Summary Notes
29
Immunization Registries Data Submission: Core Objective 16
32
Use Secure Electronic Messaging: Core Objective 17
34
•
Version 9.00 Features regarding Exchange Documents
3
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Table of Contents
Topic
Page
Intergy v9.00 Upgrade
39
•
Additional Key Features
40
•
Form Updates
41
Reported Bugs/Enhancements reference Clinical Summary
43
V9.00 Frequently Asked Questions
52
Greenway Dashboards v9 Changes
56
What are the PA dashboards
57
How would I run a V9 report
61
Meaningful Use Audit Report
68
Dashboards Update to the Clinical Quality Measures
71
Dashboards Update to the Operational Measures
75
UDS Updates: 2014 Approved Changes
79
Table 4: Patient Characteristics- Public Housing
80
•
Where to document inIntergy
83
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Table of Contents
Topic
Page
Table 6A & B: Selected Diagnoses and Services Rendered
84
•
First time diagnosis of HIV line 1-2(a) of Table 6A
85
•
Follow-up Care provided by referral by a Ryan White Clinic
86
Table 6B: Age and Trimester of entry into care
88
Table 7: Deliveries and Infant birth weights
89
Table 6B: Tobacco Use Screening and Cessation Intervention
90
Table 6B: Clinical Depression Screening
92
Table 7: Diabetes Control
95
EHR Capabilities and Quality Recognition Form
97
UDS Contacts
101
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Stage 1 vs. Stage 2 Comparison
Core Objective: In Stage 1 there are 15 core measures, Stage 2 now has 17 in total.
Stage 1:
1.
2.
3.
4.
5.
6.
7.
8.
9.
10.
11.
12.
13.
14.
15.
Stage 2:
CPOE for Medication Orders
Drug Interaction Checks
Maintain Problem List
E-Prescribing
Active Medication List
Medication Allergy List
Record Demographics
Record Vital Signs
Smoking Status
Clinical Quality Measures
Clinical Decision Support Rule
Electronic Copy of Health Information
Clinical Summaries
Electronic Exchange of Clinical
Information
Protect Electronic Health Information
1.
2.
3.
4.
5.
6.
7.
8.
9.
10.
11.
12.
13.
14.
15.
16.
17.
6
CPOE for (a) medication; (b) labs; (c) radiology orders
E-Prescribing
Record Demographics
Record Vital Signs
Record Smoking Status
Clinical Decision Support Rule
Patient Electronic Access
Clinical Summaries
Protect Electronic Health Information
Clinical Lab-Test Results
Patient Lists
Preventive Care
Patient-Specific Education Resources
Medication Reconciliation
Summary of Care
Immunization Registries Data Submission
Use Secure Electronic Messaging
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Patient List: Core Objective 11
• New Core measure, formally a menu objective
• Using the Practice Analytics’ Patient Care Conditions list will satisfy this requirement.
BONUS!
This list can be exported to post recalls.
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Stage 2: Patient Lists
Objective: Generate lists of patients by specific conditions to
use for quality improvement, reduction of disparities,
research, or outreach.
Measure: Generate at least one report listing patients of the
EP with a specific condition.
Exclusion: No exclusion.
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PAs’ Patient Care Conditions list
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Preventive Care: Core Objective 12
• New Core measure, formally a menu objective
• Combining the functionality of the Health reminders with the Practice Analytics’
Patient Care Conditions list to post recalls will satisfy this requirement.
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Stage 2: Preventive Care
Objective: Use clinically relevant information to identify
patients who should receive reminders for preventive/followup care and send these patients the reminders, per patient
preference.
Measure: More than 10 percent of all unique patients who
have had 2 or more office visits with the EP within the 24
months before the beginning of the EHR reporting period
were sent a reminder, per patient preference when available.
Exclusion: Any EP who has had no office visits in the 24
months before the EHR reporting period.
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Health Reminders Tab
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Example of Reminder Details
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Recalls
Generating Recalls utilizing the
Practice Analytics’ Patient Care Conditions list
• Once you’ve generated the Patient Care Conditions list for the condition(s)
desired, export to Excel (the XL button)
• From Excel, save the file as a CSV file
• Open the Batch Post Clinical Recalls window:
 From the Intergy Desktop menu bar, select the Scheduling menu, select
Recalls, and then select Batch Post Clinical Recalls
• Within the Batch Post Clinical Recalls window, select the From File radio button
• Search and Import the CSV file
• Complete the Recall Through Date, For Patients Seen Since field, and then select
the Reason code from the drop down menu
14
• Proceed with additional filters and then Run the batch
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Patient-Specific Education Resources:
Core Objective 13
• New Core measure, formally a menu objective.
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Stage 2: Patient-Specific
Education Resources
Objective: Use clinically relevant information from Certified
EHR Technology to identify patient-specific education
resources and provide those resources to the patient.
Measure: Patient-specific education resources identified by
CEHRT are provided to patients for more than 10 percent of all
unique patients with office visits seen by the EP during the
EHR reporting period.
Exclusion: Any EP who has no office visits during the EHR
reporting period.
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Patient-Specific Education
NEW functionality to right click on patient’s problems, medications,
and labs to generate patient specific education material
 Uses National
Institutes of
Health’s (NIH)
Medline Plus as
default website
 Automatically
captures in MU
numerator when
using this option
NOTE: You can additionally continue to use Forms
to access and indicate education was4/25/2014
given.
18
Medication Reconciliation: Core Objective 14
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Stage 2: Medication Reconciliation
Objective: The EP who receives a patient from another setting
of care or provider of care or believes an encounter is relevant
should perform medication reconciliation.
Measure: The EP who performs medication reconciliation for
more than 50 percent 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.
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Medication Reconciliation
New option on the Meds List for ‘Mark as Reconciled’ added.
TIP: Adding a
reported med while
on an encounter will
auto-set the
reconciled flag for that
encounter.
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NEW!
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
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Importing Clinical Information
for Reconciliation
Step 1:
Step 2:
Step 3:
Step 4:
Step 5:
Patient provides staff with a CD or USB containing the patient’s health
information.
From the patient’s chart, select ‘Exchange Document’
Click ‘Retrieve’
Browse the location, select the file containing the CD or USB, select ‘Open’
Select ‘Save to Chart’
Once you have completed these steps, the window shown in the previous slide will
appear at which time you would select the items from the CCD that you want to
import into the chart.
The next couple of slides have screen shots of these steps.
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Step 1
Patient provides staff
with a CD or USB
containing the patient’s
health information.
Step 2
From the patient’s
chart, select ‘Exchange
Document’
Step 3
Click ‘Retrieve’
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Step 4
Browse the location,
select the file containing
the CD or USB, select
‘Open’
Step 5
Select ‘Save to Chart’
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Final Step
Select the items
from the CCD that
you want to import
into the chart and
select ‘Import’
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Summary of Care: Core Objective 15
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Stage 2: Summary of Care
Objective: The EP who transitions their patient to another setting of care or provider of care or
refers their patient to another provider of care should provide summary care record for each
transition of care or referral.
Measure: EPs must satisfy both of the following measures in order to meet the objective
(1) The EP who transitions or refers their patient to another setting of care or provider
of care provides a summary of care record for more than 50 percent of transitions
of care and referrals.
(2) The EP who transitions or refers their patient to another setting of care or provider
of care provides a summary of care record for more than 10 percent of such
transitions 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 the governance mechanism ONC establishes for the NwHIN.
(3) An EP must satisfy one of the following criteria
(a) Conducts one or more successful electronic exchanges of a summary of care
document, as part of which is counted in "measure 2" or
(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
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less than 100 times during the EHR reporting period is excluded from all three measures.
Clinical and Referral Summaries
NEW CCDA format based on requirements
Notes:
 Clinical and Referral (Summary of Care) Summaries now require Consolidated Clinical
Document Architecture (CCDA) standard. Correspondence letters will no longer meet
the minimum requirement.
 Intergy workflow for Referral Summaries is similar to that for Clinical Summaries.
 Clinical and Referral (Summary of Care) Summaries can now be printed from the
patient’s summary page as well as from the encounter note during the signing of the
note.
 For patient’s registered for secure messaging, a ‘SEND’ option will also appear.
 Once the summary has been generated, the ‘Print Summary’ will change to indicate
the function has been completed and the patient will be marked compliant for this
measure.
 Generating the Summary documents in this format automatically captures in MU
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numerator.
Generating Summary from the
Patient Summary Page
Box changes green once the Clinical Summary
has been
generated for that visit
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Patient’s chart with
access to Patient
Portal will have the
option to ‘Send’
activated 31
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Immunization Registries Data Submission:
Core Objective 16
• Successful submission required, not just a test.
• Exclusions exist based on Registry availability.
4/25/2014
• Greenway will offer submission to State32Registries through their Clinical Exchange.
Stage 2: Immunization Registries
Data Submission
Objective: Capability to submit electronic data to immunization registries or immunization
information systems except where prohibited, and in accordance with applicable law and practice.
Measure: Successful ongoing submission of electronic immunization data from CEHRT to an
immunization registry or immunization information system for the entire EHR reporting period.
Exclusion: Any EP that meets one or more of the following criteria may be 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 immunization information
system during the EHR reporting period;
(2) the EP operates in a jurisdiction for which no immunization registry or immunization
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 immunization
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 immunization
information system that is capable of accepting the specific standards required by CEHRT at
4/25/2014
the start of their EHR reporting period can33 enroll additional EPs.
Use Secure Electronic Messaging:
Core Objective 17
New Core measure
NOTE: Most Secure messages sent by the patient are counted towards this measure.
The following are NOT counted:
• Appointment Requests
• New Patient Request
34
• Billing and Payment
messages
4/25/2014
Stage 2: Use Secure Electronic Messaging
Objective: Use secure electronic messaging to communicate with patients on
relevant health information.
Measure: A secure message was sent using the electronic messaging function of
CEHRT by more than 5 percent of unique patients (or their authorized
representatives) seen by the EP during the EHR reporting period.
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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Version 9 Features
Regarding Exchange Documents
• When generating an Exchange document, you can send a secure message with a
copy of the Exchange document attached.
• In previous versions of Intergy EHR, the Secure Messaging option was selected
from the Via field on the Generate Document dialog box. Now, you use the Send
button on the Generate Exchange Document dialog box.
• When you generate an Exchange document, the system determines whether the
selected patient has a Practice Portal account. If the patient is a Practice Portal
user, the Send button will be available on the Generate Exchange Document dialog
box.
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Generating and Sending an Exchange
Document as a Secure Message Attachment
1.
Within the patient’s chart, select the Exchange button to display the Exchange tab.
2. Click Generate to open the Generate Exchange Document dialog box containing options for
specifying what patient clinical data should be included in the Exchange document.
3. Complete the TO, WHAT, and INCLUDE sections as needed.
4. Click Send to open the Secure Messaging dialog box with the Exchange document automatically
selected as an attachment.
Note: The Send button is only available if secure messaging is available for the patient.
5. Complete the To field with the e-mail address to which you want to send the secure message and
in the text box, enter a message to the patient or authorized recipient. Select additional options
on the Secure Message dialog box, as needed.
Note: If you want to save the secure message, attachments, or both to the patient’s chart, check
the CC Chart box. Before sending the secure message, the system will display a dialog box in which
you can specify options for saving the secure message and attachments to the patient’s chart.
6. Click Send.
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Intergy version 9 Upgrade
Additional key features
• Form Updates
o Additional Smoking Statuses added
o Capturing First-Degree Family History
• A view of the new Clinical and Referral Summaries
o Bugs and enhancements pending Greenway’s review
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Form Updates: Smoking Status
Additional options added to capture more smoking statuses
41
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FORM Updates: Family History
Record Family Hx for ‘first degree’ relatives
Adding one of the
following prefixes to your
finding (diagnosis) will aid
you in meeting this
measure:
•
•
•
•
•
•
42
Maternal History of
Paternal History of
Sororal History of
Fraternal history of
Daughter’s history of
Son’s history of
4/25/2014
Reported Bugs/Enhancements reference
to Clinical Summary - Header
Includes: patient data, emergency contact, guardian, next of kin, insurance/Payer indo,
And encounter data (date, location, provider, care team)
Pending Greenway Review: Care Team is generating
a list of ALL providers that have4/25/2014
ever
43
treated the patient (even if they no longer worked at the clinic.
Reported Bugs/Enhancements reference to
Clinical Summary – Medications Administered
Includes medication administered during the encounter visit.
Pending Greenway
Review:
44
Is pulling in voided medications also.
4/25/2014
to Clinical Summary – Social History
Will contain active (positive or negative) findings that belong to the signed encounter.
2 Items Pending Greenway Review:
Meaningful Use only requires patient’s smoking status, not entire Social History.
Summary was pulling ALL social history from patient’s chart.
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to Clinical Summary - Immunizations
Includes ALL patient Immunizations including any refused or reported.
Pending Greenway Review:
Meaningful Use only requires immunizations
administered or reported on the day of service.
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to Clinical Summary - Instructions
The data for Instructions comes from two places:
1. Patient Education- If you right click on patient’s problems, medications, or labs to generate
patient specific education material, it will note the material was provided in the Summary
2. Instructions or Education Findings- If either of the following findings or their child findings
(encounter note/forms) is selected, they will be included in this section of the summary:
‘Instructions for Patient’ – Medcin ID 74937
‘Education and Counseling’ – Medcin ID 78725
The data was not always pulling
into the Clinical Summary
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to Clinical Summary - Medications
Pending Greenway Review (reported as a patient safety issue):
The same medication is showing under different categories.
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to Clinical Summary –Problems
This section is intended to show active problems and problems related to the
encounter note for that visit. It is showing inactive problems as well.
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Other Sections in a Clinical Summary
•
•
•
•
•
•
•
•
•
•
•
•
Current Advance Directives
Active allergies
Family History (positive or negative) documented during the encounter visit
Patient’s Functional and Cognitive Status
Lab Results for current encounter (including results cited into the note
regardless of their status)
Physical Exam
Plan of Care (pending tests, referrals, care plan, future appointments, pending
tests)
Procedures and Surgical/Medical History
Reason for Referral
Reason for Visit and Chief Complaint
Review of System
Vital Signs
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to Clinical Summary - General
• Ability to remove a specific item that the EP believes may be harmful
• Ability to document and be counted compliant if a patient declines the
summary
• An indication that information is not available under sections that are not
pertinent to the visit (example: no future appointments pending, no labs
reviewed, no medication, etc.)
Follow-ups/Updates:
Please remember we are available for 2 hours each month for office hours at
which time we can provide you with updates to the statuses of the issues
brought up with Greenway regarding the Clinical Summary.
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Frequently Asked Questions
A compilation of the v9.00 frequently asked questions
organized by category.
52
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53
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Greenway Dashboards
V.9 Changes
What are the PA dashboards?
The PA Dashboards
include 12 sets of the
following 12 dashboards:
We will concentrate on the MU Operational and
Clinical Quality Dashboards.
These dashboards allow practices that participate in
the E.H.R incentive program to calculate their
compliance percentage for Operational and Clinical
Quality measures.
 The Operational Quality Measures dashboard
provides a comprehensive review of how well your
practice is meeting the operational functionality
standards for incorporating electronic health records
(EHRs) into daily work processes.
 The Clinical Quality Measures dashboard provides a
comprehensive review of the quality of clinical care
in your practice.
The Criteria tab is used to select measures and high-level
report criteria. The Summary, Measure Details, and Scorecard
tabs each offer a different analysis of important summaries
or details about the data in your Intergy EHR system. The
values you select for dimensions on one tab remain constant
as you navigate to other tabs in the dashboard.
How would I run a V.9 report?
 Choose the type of report you want to run:
Operational or Clinical:
 For the Operational reports, choose Stage 1 or Stage 2,
then choose the requested report:
 You may click the Help button:
The additional Help includes details about the criteria
used for the denominator, numerator and exclusions.
Under the Criteria Tab, use
the Measure criteria box to
define the reporting period,
patient age, gender, inclusion
of exempt patients and other
criteria specific to the report
you chose. For the CPOE
report, you can include all
patients or just the ones who
have prescriptions
documented in their chart.
 Use the Summary tab to fine
tune your report by Employer,
Measure provider, Carrier
Code, Plan Class and Service
Center.
 The measure Details Tab, provides you with the
number of patients in the Numerator, Denominator
and compliance percentage. A list of patients is
displayed, showing name, age and prescriptions.
 Click the Score card Tab to display the score card:
Meaningful Use Audit Report is now available
The operational and the Clinical Quality Measures
dashboards now feature the ability to archive the onscreen scorecard charts used for attesting to your
practice's compliance with Meaningful Use measures.
Archiving a scorecard should be done for each attestation,
since it may be requested by the CMS in case of an audit.
Saving an Audit Scorecard
After preparing the Scorecard, you need to export
the scorecard results before saving them. Click the
Export Audit Scorecard button. You will not notice
any on-screen activity, but the export process take
place behind the scenes.
When the export is complete, the Save Audit
Scorecard button becomes available. Click the Save
Audit Score card button.
A window will display in your default Internet
browser confirming that the save is complete. You
may close that browser window when it displays.
Dashboards Update to the Clinical
Quality Measures
The Clinical Quality Measures dashboards has been
updated to ensure compliance with revised
governmental specifications. Updates include:
 A revision to the logic: Patients criteria for the
denominator such as age, time periods for visits,
exclusions etc. (Cervical Cancer).
 A complete renumbering
Quality Measures
Quality Measures
Quality Measures
Dashboards Update to the
Operational Measures
New Tab for Stage 2 Measures
Dashboard Update to the
 The Stage 1 measures on the Operational Measures
Dashboard have been updated to meet revised
governmental specifications. (Example: Vital Signs)
 There has been a complete renumbering of all
measures on the Dashboard. (MU-1 to Core 1)
 New measure was added. (Patient Access)
Dashboards Update to the
UDS UPDATES:
2014 APPROVED CHANGES
APPROVED UDS CHANGES FOR 2014
Table 4 – Patient Characteristics:
 NEW - For the first time, “residents of public housing” will be
reported on Table 4, Line 26, Selected Patient Characteristics.
 –While the Public Housing Primary Care program (Section
330(i)) has been a part of the 330 program for many years,
the number of patients have not been tracked in the same
way as homeless or agricultural worker patients have
been in the UDS
 –Defined as residents in publicly supported multiple unit
“projects” – either high-rise or low-rise
 –Explicitly excludes scattered site Section 8 housing
 •Most can be identified from a set of known addresses
 –Or may be a characteristic added to registration form
UDS Form:
Where to document in Intergy:
Table 6A – Selected Diagnoses and Services Rendered:
 NEW - The number of patients with a first time diagnosis of HIV
(Not just first time at your center – first time ever ) will be
reported on line 1-2(a) of Table 6A – Selected Diagnoses and
Services Rendered.
 Note that there are no ICD-9 /ICD-10 codes for this
 UDS Form:
NEW
 Patients first ever diagnosed with HIV (reported on
Table 6A, line 1-2a) who receive follow-up care within
90 days of the diagnosis
 –If follow-up care is provided by referral by a Ryan
White clinic or another provider, follow-up must be
completed within 90 days of diagnosis, not within 90
days of referral.
 UDS Form:
Reportable Services:
NEW
 All health centers will now report on prenatal and perinatal
services whether they are provided directly at the health center,
by formal referral to another provider, or by a combination of
the two. This will include:
 –Age and trimester of entry into care on Table 6B
 –Deliveries and infant birth weights on Table 7
 Health centers which diagnose a woman’s pregnancy
but do not directly provide prenatal care must refer
for this care. If they do, they must:
 –Track the referral to establish and record the date
of her first comprehensive obstetrical visit.
 –Track her delivery and record the weight of the
infant(s) at birth.
Table 6B – Quality of Care Measures:
 Tobacco use screening and cessation intervention, formerly
two separate measures (lines 14 and 15), are now combined
into one measure (line 14a)
 –Count as compliant (1) patients who were screened for
tobacco use who were not tobacco users AS WELL AS (2)
those identified as tobacco users who received cessation
intervention.
UDS Form:
NEW: Clinical Depression Screening (6B)
Clinical depression screening of (medical) patients age
12 and older during the reporting period using a
standardized instrument and if screened positive, had a
follow-up plan documented
 UDS Form:
Medcin #
1000004434
1000005032
103274
13166
13176
13177
17989
222873
229508
303626
1000034
304135
304136
Description
Mental health inventory test (MHI-5)
PHQ-9
Psychological testing with interpretation and report
Psychometric California psychiatric inventory (CPI)
Psychometric depression scale
Psychometric depression scale (Beck)
Psychometric Hamilton depression rating scale
Administration of psychological test
Neuropsychological testing battery administered by physician
DSM-IV criteria for major depressive disorder documented
PHQ-9 Depression Scale
Standardized depression screening : mild to moderate symptoms
Standardized depression screening : clinically significant symptoms
Table 7 – Health Outcomes and Disparities:
Diabetes control measure will continue to be all patients
whose last HbA1c in the measurement year is equal to or less
than 9%
–Instead of four categories, reporting will divide compliant
patients into those with HbA1c levels less than 8%, between
8% and 9% and those with HbA1c over 9% or missing during the
reporting year.
–Health centers will no longer be required to report on HbA1c
less than 7%.
 UDS Form:
EHR Capabilities and Quality Recognition Form
 BPHC (Bureau of Primary Health Care) will continue to collect
information on the implementation of electronic health records
(EHRs)
 –Revised questions are found at:
http://bphc.hrsa.gov/policiesregulations/policies/pal201401.pdf
 HRSA will continue to collect information on patient-centered
medical home recognition/certification and accreditation.
Does your center currently have an Electronic Health Record
(EHR) system installed and in use?
a) Yes, at all sites and for all providers
b) Yes, but only at some sites or for some providers
c) No
Does your center send prescriptions to the pharmacy
electronically? (Do not include faxing.)
a) Yes
b) No
c) Not sure
Does your center use computerized, clinical decision
support such as alerts for drug allergies, checks for
drug-drug interactions, reminders for preventive
screening tests, or other similar functions?
a) Yes
b) No
c) Not sure
CONTACTS
Telephone and email support line for UDS reporting questions
and use of UDS data: 866-UDS-HELP or
[email protected]
 •Technical Assistance materials:
 •http://www.bphcdata.net
 •http://bphc.hrsa.gov/healthcenterdatastatistics/index.html

NYS HCCN Meaningful Use for Vitera Intergy Webinar #2

Transcription

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