Medicfusion Herfert MU2 Attestation Guide 2015 11 03...

© 2015 Medicfusion, Inc.

MEDICFUSION / HERFERT

MEANINGFUL USE STAGE 1 and 2

ATTESTATION GUIDE 2015


The following document is intended to aid in preparation for gathering necessary information to attest in early 2016. All Medicfusion Eligible Providers (EP) who are planning to attest will use October 1, 2015 to December 31, 2015 as their attestation period. This guide will help ensure that you meet or exceed the objectives required for HITECH Meaningful Use. Please read this guide carefully to understand the Meaningful Use Objectives requirements and how to use Medicfusion to meet these benchmarks. Note: some objectives can be satisfied with a single “yes/no” on the attestation test and some measures require regular activity from the provider or staff. Please note the following:

• If an Eligible Provider has NOT attested previously, there is no possibility for an attestation for 2015. This year cannot be your first year to attest.

• If 2015 is the second year for your attestation, please follow Stage 1 attestation objectives. • If 2015 is the third year or more for your attestation, please follow Stage 2 attestation

objectives. • All providers are required to attest to a single set of objectives (Modified Stage 2). This replaces

the core and menu objectives structure of previous stages. • For EPs, there are 10 objectives, including one consolidated public health reporting objective. • In 2015, all providers must attest to objectives and measures using EHR technology certified to

the 2014 Edition (Medicfusion is 2014 HITECH certified). • To assist providers who may have already started working on meaningful use in 2015, there are

alternate exclusions and specifications within individual objectives for providers who were previously scheduled to be in Stage 1 of meaningful use. These include:

1. Allowing providers who were previously scheduled to be in a Stage 1 EHR reporting period for 2015 to use a lower threshold for certain measures.

2. Allowing providers to exclude for Stage 2 measures in 2015 for which there is no Stage 1 equivalent.

• An Eligible Provider is allowed to attest for a total of 5 years or $44,000, whichever occurs first. • You must possess and have access to (for the entire attestation period) certain software for the

collection, storage, retrieval and reporting of data: i) Medicfusion ii) Medicfusion ePrescribe -- Full or Limited Use License

Coming Soon:

• An attestation training video and an actual attestation testing video will follow this document in the next few weeks.


Please review the following links for reference (copy and paste): https://ehrintelligence.com/news/cms-finalizes-rule-modifying-meaningful-use-requirements

https://www.cms.gov/Regulations-and-Guidance/Legislation/EHRIncentivePrograms/Downloads/Stage3_EP.pdf

STAGE 1 AND STAGE 2 OBJECTIVES For the purposes of attestation and by rule of CMS (Centers for Medicare and Medicaid Services), an office visit is calculated utilizing evaluation and management codes only (E/M). An E/M code refers to any code beginning with 992--. A unique patient visit refers to any patient seen for at least one visit during the attestation period. Objective 1 - Protect Electronic Health Information (both Stage 1 and Stage 2) Objective: Protect electronic health information created or maintained by the certified EHR technology through the implementation of appropriate technical capabilities. Measure: Conduct or review a security risk analysis in accordance with the requirements under 45 CFR 164.308 (a)(1), including addressing the security (to include encryption) of ePHI created or maintained in CEHRT in accordance with requirements under 45 CFR 164.312 (a) (2) (iv) and 45 CFR 164.306 (d) (3), and implement security updates as necessary and correct identified security deficiencies as part of the EP’s risk management process. Exclusion: No exclusion Note: Please see this link for the risk tool approved by CMS (copy and paste): http://www.healthit.gov/providers-professionals/security-risk-assessment-tool An EP MUST perform this one time during the 90-day attestation period. What to do in Medicfusion: Program: Medicfusion

https://ehrintelligence.com/news/cms-finalizes-rule-modifying-meaningful-use-requirements



http://www.healthit.gov/providers-professionals/security-risk-assessment-tool


Step 1: Copy and paste the link above and complete the Security Risk Analysis and save the completed document. Objective 2 - Clinical Decision Support Stage 1 For an EHR reporting period in 2015 only, an EP who is scheduled to participate in Stage 1 in 2015 may satisfy the following in place of measure 1 (below): Objective: Implement one clinical decision support rule relevant to specialty or high clinical priority along with the ability to track compliance with that rule. Measure: Implement one clinical decision support rule. Exclusion: No exclusion. Note: There are 5 clinical decision support rules to satisfy this measure already entered for every Medicfusion EP. There is nothing to be done on this measure unless you would like to add your own CDS. Stage 2 Objective: Use clinical decision support to improve performance on high-priority health conditions. In order for EPs to meet the objective they must satisfy both of the following measures: Measure 1: Implement 5 clinical decision support interventions related to 4 or more clinical quality measures at a relevant point in patient care for the entire EHR reporting period. Absent four clinical quality measures related to an EP’s scope of practice or patient population, the clinical decision support interventions must be related to high priority health conditions. Measure 2. The EP has enabled the functionality for drug-drug and drug-allergy interaction checks for the entire EHR reporting period. Exclusion: For the second measure, an EP who writes fewer than 100 medication orders during the EHR reporting period. What to do in Medicfusion: Program: Medicfusion


Note: All 5 clinical decision support rules to satisfy this measure have already been entered for all Medicfusion EPs. There is nothing to be done on this measure unless you would like to add your own CDS. Step 1: Go to Admin/Clinical Decision Support Step 2: Go to Select Rule/Add New Rule Step 3: Complete all fields which appear. All other fields can be chosen individually or in combination to create your own CDS. The CDS rule will display when a SOAP note is opened and the criteria chosen for the CDS rule apply to that patient. Step 4: Click Save


Objective 3 - Computerized Provider Order Entry (CPOE) Stage 1 Objective: Use computerized provider order entry (CPOE) for medication, laboratory and radiology orders directly entered by any licensed healthcare professional who can enter orders into the medical record per state, local and professional guidelines. Alternate for Measure 1 (below): For Stage 1 providers in 2015, more than 30 percent of all unique patients with at least one medication in their medication list seen by the EP during the EHR reporting period have at least one medication order entered using CPOE; or more than 30 percent of medication orders created by the EP during the EHR reporting period are recorded using computerized provider order entry. Alternate Exclusion for Measure 2 (below): Providers scheduled to be in Stage 1 in 2015 may claim an exclusion for measure 2 (laboratory orders) of the Stage 2 CPOE objective for an EHR reporting period in 2015. Alternate Exclusion for Measure 3 (below): Providers scheduled to be in Stage 1 in 2015 may claim an exclusion for measure 3 (radiology orders) of the Stage 2 CPOE objective for an EHR reporting period in 2015. Stage 2 An EP, through a combination of meeting the thresholds and exclusions (or both), must satisfy all three measures for this objective. Objective: Use computerized provider order entry (CPOE) for medication, laboratory and radiology orders directly entered by any licensed healthcare professional who can enter orders into the medical record per state, local and professional guidelines. Measure 1: More that 60 percent of medication orders created by the EP during the EHR reporting period are recorded using computerized provider order entry. Exclusion: Any EP who writes fewer than 100 medication orders during the EHR reporting period. Measure 2: More than 30 percent of laboratory orders created by the EP during the EHR reporting period are recorded using computerized provider order entry. Exclusion: Any EP who writes fewer than 100 laboratory orders during the EHR reporting period.


Measure 3: More than 30 percent of radiology orders created by the EP during the EHR reporting period are recorded using computerized provider order entry. Exclusion: Any EP who writes fewer than 100 radiology orders during the EHR reporting period. Note: This refers to radiology orders referred out to imaging centers, not radiology orders within an EP’s office. What to do in Medicfusion: Program: Medicfusion and Medicfusion eRx You MUST have an eRx license for this measure for the medication CPOE! CPOE for medication: Step 1: Open a Medicfusion SOAP Step 2: Select Plan/Prescription Step 3: Select the Prescribe button Step 4: Use tools provided to prescribe medications electronically Step 5: SAVE


CPOE for laboratory: Step 1: Open a Medicfusion SOAP Step 2: Select Plan/Orders Step 3: Select Category/Labs (in the drop down) Step 4: Make any selection other than non-CPOE Step 5: Select Add Order

CPOE for radiology (imaging) orders Step 1: Open a Medicfusion SOAP Step 2: Select Plan/Orders Step 3: Select Category/Any type of imaging (in the drop down) Step 4: Make any selection other than non-CPOE Step 5: Select Add Order


Objective 4 – Electronic Prescribing Stage 1 Objective: Generate and transmit permissible prescriptions electronically (eRx). Alternate EP Measure: For Stage 1 providers in 2015, more than 40 percent of all permissible prescriptions written by the EP are transmitted electronically using CEHRT. Exclusions: -Any EP who writes fewer than 100 permissible prescriptions during the EHR reporting period; or -Any EP who does not have an pharmacy within his or her organization and there are no pharmacies that accept electronic prescription within 10 miles of the EP’s practice location at the start of his or her EHR reporting period.


Stage 2 Objective: Generate and transmit permissible prescriptions electronically (eRx). Measure: More than 50 percent of permissible prescriptions written by the EP are queried for a drug formulary and transmitted electronically using CEHRT. Exclusions: -Any EP who writes fewer than 100 permissible prescriptions during the EHR reporting period; or -Any EP who does not have an pharmacy within his or her organization and there are no pharmacies that accept electronic prescription within 10 miles of the EP’s practice location at the start of his or her EHR reporting period. What to do in Medicfusion: Program: Medicfusion and Medicfusion eRx You MUST have an eRx license for this measure. Step 1: Open a Medicfusion SOAP

Step 2: Select Plan/Prescriptions Step 3: Select the Prescribe button Step 4: Use tools provided to prescribe and transmit medications. Step 5: SAVE


Objective 5 – Health Information Exchange Stage 1 Objective: Provide EPs the ability to transmit a patient’s health information safely and securely. Measure: The EP who transitions or refers their patient to another setting of care or provider of care must (1) use CEHRT to create a summary of care record; and (2) electronically transmit such summary to a receiving provider for more than 10 percent of transitions of care and referrals. Alternate Exclusion for Stage 1 EPs: Provider may claim an exclusion for the Stage 2 measure that requires the electronic transmission of a summary of care document if, for an EHR reporting period in 2015, they were scheduled to demonstrate Stage 1, which does not have an equivalent measure. All Medicfusion Stage 1 EPs are recommended to claim an exclusion on this objective.


Stage 2 Objective: Provide EPs the ability to transmit a patient’s health information safely and securely. Measure: The EP who transitions or refers their patient to another setting of care or provider of care must (1) use CEHRT to create a summary of care record; and (2) electronically transmit such summary to a receiving provider for more than 10 percent of transitions of care and referrals. 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. Most Medicfusion EPs will claim this as an exclusion as they will not be referring out to another provider of care or setting or receiving from another provider of care or setting 100 patients during the attestation period. What to do in Medicfusion Program: Medicfusion Step 1: Open a patient SOAP note. Step 2: The Generate C-CDA radio button is automatically selected in all Medicfusion sites when a SOAP note is opened. Step 3: By signing the SOAP note, a C-CDA document is automatically created for the EP. It is important that your SOAP notes are completed and signed promptly as the signed date is compared to the visit date for timely delivery of the C-CDA. Re-signing your note at a later date will adversely affect this measure and the generation of an accurate Automated Measures Report. This will in turn negatively affect your ability to attest with correct percentages. DO NOT LEAVE YOUR NOTES UNSIGNED UNTIL THE END OF THE YEAR!! Step 4 (optional): If the patient has an email address on record, they should be encouraged to register for access via the patient portal. The C-CDAs generated from each visit are available on the patient portal for the patient to view, download (retrieve) or transmit (send to another provider via direct messaging). Step 5: To securely transmit the C-CDA document to another provider, go to Clinical and select Direct email. Step 6: Click Compose Step 7: Search for secure email address by entering search criteria and click search. Select results. Step 8: Complete the message and click Send. Note: the C-CDA is automatically attached to the message.


Objective 6 – Patient Specific Education Stage 1 Objective: Use certified EHR technology to identify patient-specific education resources and provide those resources to the patient if appropriate. 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. Alternate Exclusion for Stage 1: An EP may claim an exclusion for the measure of the Stage 2 Patient Specific Education objective if, for an EHR reporting period in 2015, they were scheduled to demonstrate Stage 1 but did not intend to select the Stage 1 Patient Specific Education menu objective. All Medicfusion Stage 1 EPs are recommended to claim an exclusion on this objective.


Stage 2 Objective: Use certified EHR technology to identify patient specific education resources and provide those resources to the patient if appropriate. 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. What to do in Medicfusion: Program: Medicfusion Step 1: All Herfert EPs must first go to Medicfusion/Admin/SOAP Code Wizard and enter evaluation and management codes (i.e. 99201, 99211). Once entered and saved, the code will automatically populate in the Encounter category. This exercise will need to be performed only one time and is part of the Herfert/Medicfusion set up, allowing this Objective to be recorded accurately. Step 2: During the attestation period, any unique patient with a new patient exam or a re-exam, will count in the automated measures report for this Objective. For these patients, open a Medicfusion SOAP. Go to Superbill/Encounter and click on one of the evaluation and management codes now available. Step 3: Click Save All Step 4: Select Plan/Orders Step 5: Select link to Find Patient Education Resources Step 6: Select appropriate drop down under Topic. This will depend on what education resource the EP will want to supply to the patient. Step 7: Click Search Step 8: The text field will populate with education resource selected. Step 9: Click Add Order and Print or Add Order.


Objective 7 – Medication Reconciliation Stage 1 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 performs medication reconciliation for more than 50 percent of transitions of care in which the patient is transitioned into the care of the EP. Alternate Exclusion for Stage 1: Provider may claim an exclusion for the measure of the Stage 2 Medication Reconciliation objective if, for an EHR reporting period in 2015, they were scheduled to demonstrate Stage 1 but did not intend to select the Stage 1 Medication Reconciliation menu objective. All Medicfusion Stage 1 EPs are recommended to claim an exclusion on this objective.


Stage 2 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 performs medication reconciliation for more than 50 percent of transitions of care in which the patient is transitioned into the care of the EP. If a Medicfusion EP receives a transition of care (a patient is referred into the EP’s office) during the attestation period, medication reconciliation will need to be done on half of these patients. Exclusion: Any EP who was not the recipient of any transitions of care during the EHR reporting period. What to do in Medicfusion Program: Medicfusion and Medicfusion eRx You MUST have an eRx license for this measure. Step 1: After receiving a transition of care document from another setting or another provider, open a Medicfusion SOAP and activate eRx for the patient (eRx must be gray) Step 2: Select Medications from the Subjective section Step 2: Select Medications from the Subjective section Step 3: If a transition of care has occurred, both of the following must be checked in order to satisfy this objective:

• Patient has been referred in for care • Medication reconciliation has been performed


Objective 8 – Patient Electronic Access (View, Download and Transmit) Stage 1 Objective: Provide patients the ability to view online, download and transmit their health information within four business days of the information being available to the EP. Measure: More than 50 percent of all unique patients seen by the EP during the EHR reporting period are provided timely access to view online, download, and transmit to a third party their health information subject to the EP’s discretion to withhold certain information. Alternate Exclusion for Stage 1: Providers may claim an exclusion for the second measure of the Stage 2 Patient Electronic Access objective if, for an EHR reporting period in 2015, they were scheduled to demonstrate Stage 1, which does not have an equivalent measure.


Stage 2 Objective: Provide patients the ability to view online, download and transmit their health information within four business days of the information being available to the EP. EP Measure 1: More than 50 percent of all unique patients seen by the EP during the EHR reporting period are provided timely access to view online, download, and transmit to a third party their health information subject to the EP’s discretion to withhold certain information. EP Measure 2: For an EHR reporting period in 2015, at least one patient seen by the EP during the EHR reporting period (or patient-authorized representative) views, downloads or transmits to a third party his or her health information during the EHR reporting period. Exclusion: Any EP who:

1. Neither orders nor creates any of the information listed for inclusion as part of the measures; or

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 4 Mbps broadband availability according to the latest information available from the FCC on the first day of the EHR reporting period.

What to do in Medicfusion Program: Medicfusion Step 1: Open a patient SOAP note. Step 2: The Generate C-CDA radio button is automatically selected in all Medicfusion sites when a SOAP note is opened. Step 3: By signing the SOAP note, a C-CDA document is automatically created and satisfies this measure for the EP. It is important that your SOAP notes are completed and signed promptly as the signed date is compared to the visit date for timely delivery of the C-CDA. Re-signing your note at a later date will adversely affect this measure and the generation of an accurate Automated Measures Report. This will in turn negatively affect your ability to attest with correct percentages. DO NOT LEAVE YOUR NOTES UNSIGNED UNTIL THE END OF THE YEAR!! Step 4: The patient will need to have an email address on record and will need to have registered for access via the patient portal. The C-CDAs generated from each visit are available on the patient portal for the patient to view, download (retrieve) or transmit (send to another provider via direct messaging). Again, to satisfy this objective for a Medicfusion EP, the transmission needs to be done by one patient only during the attestation period.


Objective 9 – Secure Messaging Stage 1 Objective: Use secure electronic messaging to communicate with patients on relevant health information. Measure: For an EHR reporting period in 2015, the capability for patients to send and receive a secure electronic message with the EP was fully enabled during the EHR reporting period. Alternate Exclusion for Stage 1: An EP may claim an exclusion for the measure if, for an EHR reporting period in 2015, they were scheduled to demonstrate Stage 1, which does not have an equivalent measure. Stage 2 Objective: Use secure electronic messaging to communicate with patients on relevant health information. Measure: For an EHR reporting period in 2015, the capability for patients to send and receive a secure electronic message with the EP was fully enabled during the EHR reporting period. This is a yes or no question on the attestation test. Medicfusion EPs have had this functionality enabled for the entire 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 4 Mbps broadband availability according to the latest information available from the FCC on the first day of the EHR reporting period.


Objective 10 – Public Health Reporting Stage 1 Objective: Capability to submit electronic syndromic surveillance data to public health agencies and/or the capability to submit electronic data to immunization registries or immunization information systems and actual submission according to applicable law and practice. Alternate Measure Specification for Stage 1: An EP scheduled to be in Stage 1 in 2015 may meet 1 measure. Exclusions: Same as for Stage 2, below. Stage 2 Objective: Capability to submit electronic syndromic surveillance data to public health agencies and/or the capability to submit electronic data to immunization registries or immunization information systems and actual submission according to applicable law and practice.


Measure Option 1-Immunization Registry Reporting: The EP is in active engagement with a public health agency to submit immunization data. Exclusions: Any EP meeting one or more of the following criteria may be excluded from the immunization registry reporting measure if the EP—

• Does not administer any immunizations to any of the populations for which data is collected by its jurisdiction’s immunization registry or immunization information system during the EHR

reporting period; • Operates in a jurisdiction for which no immunization registry or immunization information

system is capable of accepting the specific standards required to meet the CEHRT definition at the start of the EHR reporting period; or

• Operates in a jurisdiction where no immunization registry or immunization information system has declared readiness to receive immunization data from the EP at the start of the EHR reporting period.

Measure Option 2-Syndromic Surveillance Reporting: The EP is in active engagement with a public health agency to submit syndromic surveillance data. Exclusions: Any EP meeting one or more of the following criteria may be excluded from the syndromic surveillance reporting measure if the EP—

• Is not in a category of providers from which ambulatory syndromic surveillance data is collected by their jurisdiction’s syndromic surveillance system;

• Operates in a jurisdiction for which no public health agency is capable of receiving electronic syndromic surveillance data from EPs in the specific standards required to meet the CEHRT definition at the start of the EHR reporting period; or

• Operates in a jurisdiction where no public health agency has declared readiness to receive syndromic surveillance data from EPs at the start of the EHR reporting period.

Measure Option 3-Specialized Registry Reporting: The EP is in active engagement to submit data to a specialized registry. Exclusions: Any EP meeting at least one of the following criteria may be excluded from the specialized registry reporting measure if the EP—

• Does not diagnose or treat any disease or condition associated with, or collect relevant data this collected by, a specialized registry in their jurisdiction during the EHR reporting period;

• Operates in a jurisdiction for which no specialized registry is capable of accepting electronic registry transactions in the specific standards required to meet the CEHRT definition at the start of the EHR reporting period; or

• Operates in a jurisdiction where no specialized registry for which the EP is eligible has declared readiness to receive electronic registry transactions at the beginning of the EHR reporting period.

Medicfusion Herfert MU2 Attestation Guide 2015 11 03...

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