Promoting Interoperability Meaningful Use Stage 3 for Medicaid 2020
This guide offers you explanations, links, and workflows you can use to report for Meaningful Use Stage 3 for Medicaid 2020.
REPORTING PERIOD AND REQUIREMENTS
The reporting period for 2020:
- Objectives: Any consecutive 90 days in 2020.
- Clinical Quality Measures are to be reported for any consecutive 90 days in 2020.
Who needs to report on Promoting Interoperability for 2019? Medicaid providers who have already been reporting Meaningful Use.
EPs must use 2015 Edition CEHRT to meet Stage 3 Meaningful Use.
ICANotes is a 2015 Edition CEHRT.
STEP 1: REQUEST GROUP RULES
Request that ICANotes enable these rules for your group:
- Meaningful Use Measures
- Patient Portal Sync
- Direct Messaging
- Always Generate CCDA
- Clinical Quality Measures
You can email this request to ticket@icanotes.com or call us at 443-569-8778. This should already have been done.
STEP 2: TURN ON SETTINGS
1. Go to the Chart Room
2. Click on the drawer labeled Settings & Directories
3. On the Personal Info tab, make sure the MU / MIPS / CQM field is checked (as shown in the screenshot above) This is a READ-ONLY field.
Turn on Clinical Decision Support Rules and Patient Education Material.
1. Click the Options Tab on the Specific to Individual tab.
2. Check the following boxes to allow the program to automatically prompt you to print these items:
- Clinical Decision Support Rules
- Patient Education Material
- Objective 1: Protect Electronic Health
- Objective 2: ePrescribing
- Objective 3: Clinical Decision Support
- Objective 4: CPOE
- Objective 5: Patient Electronic Access to Health
- Objective 6: Use CEHRT to Engage With Patients
- Objective 7: Health Information Exchange
- Objective 8: Public Health and Clinical Data
PROMOTING INTEROPERABILITY ORDER OF MEASURES
1. Protect Electronic Health Information (yes/no, done within your practice)
2. ePrescribing (> 60%) Through the use of ePrescribe and DrFirst.
3. Clinical Decision Support (yes/no)
4. CPOE Rx, Radiology, Imaging (RX > 60%, Lab > 60%, Imaging > 60%)
5. Patient Electronic Access
- Measure 1: > 80% Patients can View, Download, Transmit and Access their health information AND their Information is available via API specifications of ICANotes
- Measure 2: Provide Patient Electronic Access to relevant patient-specific education to > 35% of patients
Link to API: https://icanotes.com/api
6. Coordination of Care through Patient Engagement
Attest to all 3 measures & meet thresholds for at least 2 measures
- Measure 1: > 5% of unique patients:
- View, Download or Transmit OR
- Access their patient health info through API OR
- Combination of 1 and 2
- Measure 2: Secure message sent to > 5% of unique patients
- Measure 3: Patient generated health data incorporated into EHR > 5% of patients
7. Health Information Exchange (Summary of Care/Referral/Med Rec)
Attest to all 3 measures & meet thresholds for at least 2 measures. If exclusions met for 2 measures, meet the threshold for the 3rd. If exclusions met for 3 measures, excluded from the entire objective
- Measure 1: For > 50% of transitions of care and referrals sent/made, the EP 1) Creates a summary of care record and 2) Electronically exchanges summary of care record. (Exclusion: If 100 or fewer referrals done)
- Measure 2: For > 40% of transitions of care or referrals received and patients never encountered before, incorporate an electronic summary of care into EHR. (Exclusion: If 100 or fewer referrals received)
- Measure 3: For > 80% of transitions or referrals received in which patients were never encountered before, perform a clinical information reconciliation for:
- Medication
- Medication allergy
- Current problem list
(Exclusion: If 100 or fewer patients never encountered before)
8. Public Health and Clinical Data Registry Reporting
Due to the nature of the behavioral health industry, eligible providers will most likely take an exclusion of this measure.
MEETING OBJECTIVES
You will collect data or report on 8 objectives. You will then go back online and attest to what you have collected. The Promoting Interoperability and the Clinical Quality Measures (CQM) reports (CQM is a QRDA report in XML format) will be generated through ICANotes.
You do not have to collect the required information for every patient – just for the percentage of patients, the government stipulates for each measure. The percentages specified in the threshold for each of the measures tells you how much information you need to collect.
OBJECTIVE 1: PROTECT ELECTRONIC HEALTH INFORMATION (YES/NO ATTESTATION)
Objective: Protect Electronic Health Information (ePHI) created or maintained by the Certified EHR Technology (CEHRT) through the implementation of appropriate technical, administrative, and physical safeguards.
The Security Risk Analysis must be done within your practice sometime during 2020. It is not generated by ICANotes.
Measure: Conduct or review a security risk analysis in accordance with the requirements under 45 CFR 164.308(a)(1), including addressing the security (including encryption) of data created or maintained by CEHRT in accordance with requirements under 45 CFR 164.312(a)(2)(iv) and 45 CFR 164.306(d)(3), implement security updates as necessary, and correct identified security deficiencies as part of the provider’s risk management process.
Measure 1 Eligible professionals (EPs) must attest YES to conducting or reviewing a security risk analysis and implementing security updates as necessary and correcting identified security deficiencies to meet this measure.
Brief Explanation –
A review must be conducted for each EHR reporting period and any security updates and deficiencies that are identified should be included in the provider's risk management process and implemented or corrected as dictated by that process.
Note as per the Law concerning when a Security Risk Analysis must be conducted: https://s3.amazonaws.com/public-inspection.federalregister.gov/2015-25595.pdf
"… it is acceptable for the security risk analysis to be conducted outside the EHR reporting period if the reporting period is less than one full year. However, the analysis or review must be conducted within the same calendar year as the EHR reporting period, and if the provider attests prior to the end of the calendar year, it must be conducted prior to the date of attestation. An organization may conduct one security risk analysis or review which is applicable to all EPs within the organization, provided it is within the same calendar year and prior to any EP attestation for that calendar year. However, each EP is individually responsible for their own attestation and for independently meeting the objective."
Security Risk Analysis Resources: A number of resources that may help you follow those steps and perform a Security Risk Analysis to meet this objective include:
- CMS Security Risk Analysis Tip Sheet: Protect Patient Health Information (Updated: March 2016) https://www.cms.gov/Regulations-and-Guidance/Legislation/EHRIncentivePrograms/Downloads/2016_SecurityRiskAnalysis.pdf
- Security Risk Analysis Tool https://www.healthit.gov/providers-professionals/security-risk-assessment-tool
- ONC's Guide to Privacy and Security of Health Information https://www.healthit.gov/sites/default/files/pdf/privacy/privacy-and-security-guide.pdf
OBJECTIVE 2: ePRESCRIBING (>60%)
Objective: Generate and transmit permissible prescriptions electronically (eRx).
Measure: More than 60% of all permissible prescriptions, or all prescriptions, written by the EP are queried for a drug formulary and transmitted electronically using CEHRT. You must use DrFirst eRx within ICANotes to e-prescribe. This measure will be automatically calculated for you and meeting this measure will be easy.
Denominator: Number of prescriptions written for drugs requiring a prescription in order to be dispensed other than controlled substances during the EHR reporting period; or number of prescriptions written for drugs requiring a prescription in order to be dispensed during the EHR reporting period
Numerator: The number of prescriptions in the denominator generated, queried for a drug formulary and transmitted electronically using CEHRT
Threshold: The resulting percentage must be > 60% in order for an EP to meet this measure
Exclusion: An EP may take an exclusion if any of the following apply:
(1) Writes fewer than 100 permissible prescriptions during the Promoting Interoperability (PI) reporting period;
or
(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 or her EHR reporting period.
OBJECTIVE 3: CLINICAL DECISION SUPPORT (YES/NO ATTESTATION)
Objective: Use clinical decision support to improve performance on high-priority health conditions.
You must satisfy both of the following measures:
Measure 1: Implement five clinical decision support interventions related to four 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 CDS interventions must be related to high-priority health conditions. Yes/No
Measure 2: Enable and implement the functionality for drug-drug and drug-allergy interaction checks for the entire EHR reporting period. This is done through DrFirst and ICANotes. Yes/No
Exclusion: Any EP who writes fewer than 100 medication orders during the EHR reporting period may take an exclusion.
Measure 1
- From the Chart Room, select “Settings + Directories”
- Click the Options Tab on the Specific to Individual tab
- Check the box next to Clinical Decision Support Rule
EPs will attest YES to having enabled clinical decision support for the length of the reporting period to meet this measure.
Clinical Decision Support rules are generated when the note is compiled, offering appropriate recommendations to the doctor at that time. The rules are generated based on patient age, diagnosis, medications, test results, etc. Do not turn off Clinical Decision Support rule or Patient Education Materials if prompted.
Rules include going to treatment algorithms for depression, depression with suicide, elevated BUN lab results, demographics over 65 including BMI, psychosis and more.
Compile the note. You can then view/print our reference documents that are triggered by these types of things mentioned above.
You will know it is a Clinical Decision Support prompt because the window will be labeled Clinical Decision Support when it pops up on their screen.
Do not turn off Clinical Decision Support or Patient Education.
Measure 2
Patient’s drug-drug and drug-allergy reactions must be completed in BOTH ICANotes and in DrFirst.
Prescriber Progress Note, go to the PN, part 1 tab and click the Drug Reactions button.
Fill out all the information in Part I under Drug Reactions. Fill out drug reactions or click None.
DrFirst: Click on the Go to ePrescribe button on PN, Part 2 tab and fill out the appropriate Drug-Drug and Drug-Allergy reactions from DrFirst.
EPs will attest YES to having enabled drug-drug and drug-allergy interaction checks for the length of the reporting period to meet this measure.
Exclusion: Any EP who writes fewer than 100 medication orders during the EHR reporting period.
OBJECTIVE 4: COMPUTERIZED PROVIDER ORDER ENTRY (CPOE) (>60% MEDICATION, >60% LABORATORY, >60% DIAGNOSTIC IMAGING)
Objective: Use CPOE for medication, laboratory, and diagnostic imaging orders directly entered by any licensed healthcare professional, credentialed medical assistant or a medical staff member credentialed to and performing the equivalent duties of a credentialed medical assistant, who can enter orders into the medical record per state, local, and professional guidelines.
Measures: An EP must satisfy all three measures for this objective through a combination of meeting the thresholds and/or exclusions.
Measure 1: Medication (> 60%)
More than 60% of medication orders created by the EP during the EHR reporting period are recorded using computerized provider order entry.
Denominator: Number of medication orders created by the EP during the EHR reporting period
Numerator: The number of orders in the denominator recorded using CPOE
Threshold: The resulting percentage must be > 60% in order for an EP to meet this measure
Exclusion: Any EP who writes fewer than 100 medication orders during the EHR reporting period.
1. Go to the PN, Part 2 tab and click the Go to E-Prescribe button.
2. Enter Medication orders; handled via ePrescribing.
Measure 2: Laboratory (> 60%)
More than 60% of laboratory orders created by the EP during the EHR reporting period are recorded using computerized provider order entry.
Denominator: Number of laboratory orders created by the EP during the EHR reporting period
Numerator: The number of orders in the denominator recorded using CPOE
Threshold: The resulting percentage must be > 60% in order for an EP to meet this measure
Exclusion: Any EP who writes fewer than 100 laboratory orders during the EHR reporting period
1. From the PN, part 2 tab, click the Clinical Order Sheet button.
2. Select the Lab & Imaging & EEG Orders & Lab. Protocols button.
3. Select the New Order button.
4. Enter information for the lab test being ordered.
5. Select the Save button.
Measure 3: Diagnostic Imaging (> 60%)
More than 60% of diagnostic imaging orders created by the EP during the EHR reporting period are recorded using computerized provider order entry.
Denominator: Number of diagnostic imaging orders created by the EP during the EHR reporting period
Numerator: The number of orders in the denominator recorded using CPOE
Threshold: The resulting percentage must be > 60% in order for an EP to meet this measure
Exclusion: Any EP who writes fewer than 100 diagnostic imaging orders during the EHR reporting period
1. From the PN, part 2 tab, click the Clinical Order Sheet button
2. Select the Lab & Imaging & EEG Orders & Lab. Protocols button
3. Select the New Order button
4. Enter information for the lab test being ordered
5. Select the Save button
OBJECTIVE 5: PATIENT ELECTRONIC ACCESS TO HEALTH INFORMATION
The EP provides patients (or patient authorized representative) with timely electronic access to their health information and patient-specific education.
Both measures below must be met through a combination of meeting thresholds and exclusions.
Measure 1: For more than 80 percent of all unique patients seen by the EP:
Upon compile of each note. A CCDA is placed within the portal for patent access and data is delivered for access via the API (https://icanotes.com/api). Be sure to compile note within 48 hours of encounter date
(1) The patient (or the patient-authorized representative) is provided timely access to view online, download, and transmit his or her health information; AND
(2) The provider ensures the patient’s health information is available for the patient (or patient-authorized representative) to access using any application of their choice that is configured to meet the technical specifications of the Application Programming Interface (API) in the provider’s certified electronic health record technology (CEHRT).
Measure 2: The EP must use clinically relevant information from CEHRT to identify patient-specific educational resources and provide electronic access to those materials to more than 35 percent of unique patients seen by the EP during the EHR reporting period.
Measure 1:
Denominator: The number of unique patients seen by the EP during the EHR reporting period.
Numerator: The number of patients in the denominator (or patient-authorized representative) who are provided timely access to health information to view online, download, and transmit to a third party and to access using an application of their choice that is configured to meet the technical specifications of the API in the EP’s CEHRT.
Threshold: The resulting percentage must be > 80% for an EP to meet this measure.
Exclusions: An EP may take an exclusion if any of the following apply:
- He or she has no office visits during the EHR reporting period.
- He or she conducts 50% or more of his or her patient encounters in a county that does not have 50% 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 may exclude the measure.
For Measure 1, EPs must offer all four functionalities (view, download, transmit, and access through API) to their patients, and PHI needs to be made available to each patient for view, download, and transmit within 48 hours of the information being available to the EP for each and every time that information is generated, regardless of how long the patient has been "enrolled".
To implement an API (https://icanotes.com/api), an EP needs to fully enable the API functionality, such that any application chosen by a patient would enable the patient to gain access to their individual health information, provided that the application is configured to meet the technical specifications of the API. EPs may not prohibit patients from using any application, including third-party applications, which meet the technical specifications of the API, including the security requirements of the API.
EPs are expected to provide patients with detailed instructions on how to authenticate their access through the API and provide the patient with supplemental information on available applications that leverage the API.
- A patient who has multiple encounters during the EHR reporting period, or even in subsequent EHR reporting periods in future years, need to be provided access for each encounter where they are seen by the EP
- If a patient elects to "opt-out" of participation, that patient must still be included in the denominator
- If a patient elects to “opt-out” of participation, an EP may count that patient in the numerator if the patient is provided all of the necessary information to subsequently access their information, obtain access through a patient-authorized representative, or otherwise opt-back-in without further follow-up action required by the EP
Measure 2:
The EP must use clinically relevant information from CEHRT to identify patient-specific educational resources and provide electronic access to those materials to > 35% of unique patients seen by the EP during the EHR reporting period.
Use certified EHR technology to identify patient-specific education resources and provide to the patient, if appropriate (> 35% of unique patients are provided resources) Resources will only be counted in the numerator if provided electronically.
Denominator: All unique patients seen during the reporting period
Numerator: Number of patients in the denominator provided patient-specific education resources
Threshold: The resulting percentage must be more than > 10%
Exclusion: Any EP who has no office visits during the EHR reporting period
Paper-based Patient Education Materials will not be counted in numerator, only electronic access. This is a change – providing electronic access only will be counted.
Emailing material to patients will count towards meeting the 35% threshold. Actions included in the numerator must occur within the EHR reporting period if that period is a full calendar year, or if it is less than a full calendar year, within the calendar year in which the EHR reporting period occurs.
If a patient elects to "opt-out" of participation in the Portal, an EP may count that patient in the numerator for Objective 5 Measures 1 and 2 if the patient is provided all of the necessary information to subsequently access their informaiton, obtain access through a patient-authorized representative, or otherwise opt-back-in without further follow-up action required by the EP.
Click the Opt-Out API/Portal in Demographics for those patients who opt-out, see below:
After you compile a note, you will be promoted for Patient Educational Resources Available popup window. Click Yes.
You will be brought to the Patient-Specific Education Materials window. Click the Email button.
You will receive a popup notice stating that the education material was sent by email.
- The Patient-Specific Education Materials area will be automatically populated.
- If the eligible provider sends an email to the patient with the education material outside of ICANotes, the user will need to manually check this box.
OBJECTIVE 6: COORDINATION OF CARE THROUGH PATIENT ENGAGEMENT
Objective: Use CEHRT to engage with patients or their authorized representatives about the patient’s care.
Measures
EPs must attest to all three measures and must meet the thresholds for at least two measures to meet the objective:
Measure 1: More than 5% of all unique patients (or their authorized representatives) seen by the eligible professional (EP) actively engage with the EHR made accessible by the EP and either—
1. View, download or transmit to a third party their health information. When the patient accesses the portal, the system will count that in the numerator.
OR
2. Access their health information through the use of an Application Programming Interface (API https://icanotes.com/api) that can be used by applications chosen by the patient and configured to the API in the EP’s CEHRT.
OR
3. A combination of 1 and 2
Measure 2: For more than 5% of all unique patients seen by the EP during the EHR reporting period, a secure message was sent using the electronic messaging function of CEHRT to the patient (or the patient-authorized representative), or in response to a secure message sent by the patient or their authorized representative.
Send messages to your patients - batch/group messages are ok -- and will count toward denominator.
Measure 3: Patient generated health data or data from a nonclinical setting is incorporated into the CEHRT for more than 5% of all unique patients seen by the EP during the EHR reporting period.
Exclusions:
Measure 1, 2 and 3: An EP may take an exclusion for any or all measures if either of the following applies:
1. He or she has no office visits during the EHR reporting period, or;
2. He or she conducts 50% or more of his or her patient encounters in a county that does not have 50% or more of its housing units with 4Mbps broadband availability according to 2 the latest information available from the Federal Communications Commission (FCC) on the first day of the EHR reporting period.
Measure 1:
Denominator: Number of unique patients seen by the EP during the EHR reporting period.
Numerator: The number of unique patients (or their authorized representatives) in the denominator who have viewed online, downloaded, or transmitted to a third party the patient’s health information during the EHR reporting period and the number of unique patients (or their authorized representatives) in the denominator who have accessed their health information through the use of an API during the EHR reporting period.
Threshold: The resulting percentage must be more than 5%.
Exclusions: An EP may exclude from the measure if he or she has no office visits during the EHR reporting period, or: Any EP that conducts 50% or more of his or her patient encounters in a county that does not have 50% 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 may exclude the measure.
There are four actions a patient might take as part of Measure 1:
1. View their information
2. Download their information
3. Transmit their information to a third party, and
4. Access their information through an API
These actions may overlap, but an EP is able to count the patient in the numerator if they take any and all actions. Therefore, for the first measure, an EP may meet a combined threshold for view, download, and transmit and API actions, or if their technology functions overlap, then any view, download, transmit, or API actions taken by the patient using CEHRT would count toward the threshold.
In order to meet the objective, the following information must be available:
- Patient name
- Provider’s name and office contact information
- The current and past problem list
- Procedures/Laboratory test results
- Current medication list and medication history
- Current medication allergy list and medication allergy history
- Vital signs (height, weight, blood pressure, BMI, growth charts)
- Smoking status
- Demographic information (preferred language, sex, race, ethnicity, date of birth)
- Care plan field(s), including goals and instructions
- Any known care team members including the primary care provider of record
Measure 2:
Denominator: Number of unique patients seen by the EP during the EHR reporting period.
Numerator: The number of patients in the denominator for whom a secure electronic message is sent to the patient (or patient-authorized representative) or in response to a secure message sent by the patient (or patient-authorized representative), during the EHR reporting period.
Threshold: The resulting percentage must be more than 5 percent.
Exclusions: An EP may exclude from the measure if they have no office visits during the EHR reporting period, or;
Any EP that 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 4Mbps broadband availability according to the latest information available from the FCC on the first day of the EHR reporting period may exclude the measure.
Enable Patient Portal Functionality: You must ask ICANotes to enable the Patient Portal functionality on your account.
Second, for each patient seen, you will need to do the following:
- Enter the patient’s Email in Demographics (this field is REQUIRED)
- Make sure you are listed as the Assigned Provider
- Check the Enable box directly below the Email field to enable the patient’s access to the portal
- Invite patients to register for an account on the patient portal
- The patient will receive the following email invitation (example) to register for an account on the patient portal
- Note that the email invitation does not identify the name of your practice. This is to protect the patient’s privacy. You will want to make sure the patient is aware of the portal and how to use it. Please provide patients with these Patient Portal Instructions and encourage them to register and log in.
- You will be able to monitor whether or not a patient has accessed the portal from the Patient Information screen in Demographics. If the patient has registered and logged in successfully, a green checkmark will show next to the name Portal. A Reset PW button will also appear. If the patient needs to have their portal password reset, you can do that for them by clicking the Reset PW button.
- Provide the patient with Patient Portal Instructions
- Regularly check the Patient Portal section of the Messaging Center for secure messages from your patients
- When you reply to a secure message from a patient, they will receive an email at their regular email address notifying them to check the portal for a secure message from their provider
Measure 3:
Patient generated health data or data from a nonclinical setting is incorporated into the CEHRT for more than 5% of all unique patients seen by the EP during the EHR reporting period.
Denominator: Number of unique patients seen by the EP during the EHR reporting period.
Numerator: The number of patients in the denominator for whom data from non-clinical settings, which may include patient-generated health data, is captured through the CEHRT into the patient record during the EHR reporting period.
Threshold: The resulting percentage must be more than 5%.
Exclusions: An EP may exclude from the measure if they have no office visits during the EHR reporting period, or; any EP that conducts 50% or more of his or her patient encounters in a county that does not have 50% 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 may exclude the measure.
For Measure 3, the types of data that would satisfy the measure are broad. They may include but are not limited to, social service data, data generated by a patient or a patient's authorized representative, advance directives, medical device data, home health monitoring data, and fitness monitor data. In addition, the sources of data vary and may include mobile applications for tracking health and nutrition, home health devices with tracking capabilities such as scales and blood pressure monitors, wearable devices such as activity trackers or heart monitors, patient-reported outcome data, and other methods of input for patient and non-clinical setting generated health data. Telehealth platform, personal health records, social determinants of health screening modules, long term care/post-acute care coordination platforms might also be considered. (Note: Data related to billing, payment, or other insurance information would not satisfy this measure.)
For Measure 3, the data may not be information the patient provides to the EP during the office visit, as such data does not meet the intent of the measure to support care coordination and patient engagement in a wide range of settings outside the EP’s immediate scope of practice.
If a provider receives nonclinical information that they have incorporated into the note,
check the Non Clinical Recorded field under About This Note.
OBJECTIVE 7: HEALTH INFORMATION EXCHANGE
Note: This objective must be reported using the doctor user's ID in reports.
Objective: The EP provides a summary of care record when transitioning or referring their patient to another setting of care, receives or retrieves a summary of care record upon the receipt of a transition or referral or upon the first patient encounter with a new patient, and incorporates summary of care information from other providers into their EHR using the functions of CEHRT.
Measures:
EPs must attest to all three measures and must meet the threshold for at least two measures to meet the objective. If the EP meets the criteria for exclusion from two measures, they must meet the threshold for the one remaining measure.
If they meet the criteria for exclusion from all three measures, they may be excluded from meeting this objective.
Measure 1: For > 50% of transitions of care and referrals, the EP that transitions or refers their patient to another setting of care or provider of care:
- Creates a summary of care record using CEHRT; and
- Electronically exchanges the summary of care record
Exclusion: An EP may take an exclusion from the measure if any of the following apply: o He or she transfers a patient to another setting or refers a patient to another provider fewer than 100 times during the EHR reporting period.
Measure 2: For > 40% of transitions or referrals received and patient encounters in which the EP has never before encountered the patient, he/she incorporates into the patient’s EHR an electronic summary of care document.
Exclusion: An EP may take an exclusion from the measure if any of the following apply: The total transitions or referrals received and patient encounters in which he or she has never before encountered the patient, is fewer than 100 during the EHR reporting period.
Measure 3: For > 80% of transitions or referrals received and patient encounters in which the EP has never before encountered the patient, he/she performs a clinical information reconciliation. The EP must implement clinical information reconciliation for the following three clinical information sets:
1. Medication. Review of the patient’s medication, including the name, dosage, frequency, and route of each medication.
2. Medication allergy. Review of the patient’s known medication allergies.
3. Current Problem list. Review of the patient’s current and active diagnoses
Exclusion: An EP may take an exclusion from this measure if the total transitions or referrals received and patient encounters in which the he or she has never before encountered the patient, is fewer than 100 during the EHR reporting period.
Note: Non-medical staff may conduct reconciliation under the direction of the EP so long as the EP or other credentialed medical staff is responsible and accountable for review of the information and for the assessment of and action on any relevant clinical decision support alert.
Measure 1
Denominator: Number of transitions of care and referrals during the EHR reporting period for which the EP was the transferring or referring provider.
Numerator: The number of transitions of care and referrals in the denominator where a summary of care record was created using certified EHR technology and exchanged electronically.
Threshold: The percentage must be > 50% in order for an EP to meet this measure.
Exclusion: An EP may take an exclusion from the measure if any of the following apply:
1. He or she transfers a patient to another setting or refers a patient to another provider less than 100 times during the EHR reporting period.
2. He or she conducts 50% or more of his or her patient encounters in a county that does not have 50% or more of its housing units with 4Mbps broadband availability according to the latest information available from the FCC on the first day of the EHR reporting period.
- Go to Psych PN, part 2 or the Finish Initial tab of your Complete Evaluation
- Click on the Clinical Order Sheet button
- Click the Referral/Consult button
- Click the +New button by Make a Referral at the upper left
- Fill out all the appropriate information
- Hit (1) the Save button, and then hit (2) the Back button
- Compile the note
- Record the date you are sending the referral to the provider on the Preview screen for the compiled note
- Click the eSent to Provider field. See below.
- To get the credit you must send > 50% of your referrals electronically
- Next, click Create Clinical Summary
Note: This objective must be reported using the doctor’s user id to be counted in the reports.
Go to upload.icanotes.com site to retrieve the summary, save and send to the provider using secure methods to protect PHI.
To send or receive a Summary of Care document electronically, sign up for a Kno2 account which can be used to electronically send patient information to other providers from directly within ICANotes. More information is available at https://kno2.com/
Measure 2:
Denominator: Number of patient encounters during the EHR reporting period for which an EP was the receiving party of a transition or referral or has never before encountered the patient and for which an electronic summary of care record is available.
Numerator: Number of patient encounters in the denominator where an electronic summary of care record received is incorporated by the provider into the certified EHR technology.
Threshold: The percentage must be > 40% in order for an EP to meet this measure.
Exclusion: An EP may take an exclusion from the measure if any of the following apply:
- The total transitions or referrals received and patient encounters in which he or she has never before encountered the patient is fewer than 100 during the EHR reporting period
- He or she conducts 50% or more of his or her patient encounters in a county that does not have 50% 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
Measure 3:
Denominator: Number of transitions of care or referrals during the EHR reporting period for which the EP was the recipient of the transition or referral or has never before encountered the patient.
Numerator: The number of transitions of care or referrals in the denominator where the following three clinical information reconciliations were performed: Medication list, medication allergy list, and current problem list.
Threshold: The resulting percentage must be > 80% in order for an EP to meet this measure.
Exclusion: An EP may take an exclusion from this measure if the total transitions or referrals received and patient encounters in which he or she has never before encountered the patient, is fewer than 100 during the EHR reporting period.
When a new patient is referred by another clinician and inpatient encounters in which the EP has never before encountered the patient, complete a medication reconciliation identifying the most accurate list of medications the patient is taking including name, dosage, frequency, and route, by comparing the medical record to an external list of medications obtained from a patient, hospital, or other providers.
At the time of your initial evaluation, decide whether those medications will be continued, stopped or have their dosage altered, writing additional orders now that the patient is under your care, arriving at a final decision and recording the changes.
- Start a new Complete Evaluation
- Go to the Finish Initial tab
- Click the Medication Reconciliation Button
- Complete the Rx section on the Reconciliation Form
- Click the + on the left side to add a medication under step 1 to open the fields to add a new medication
- Click Details if you wish to add more details to the prescription. “Details” is only available when adding medications
- Click the Submit button to add the medication to the column on step 3
Decide how to proceed with the medication:
- Continue – medication, dose, route, and timing remain the same
- Continue but change – the medication dose, route, and timing can be changed
- External provider Rx – used in an outpatient setting to document medications that another doctor prescribes
- Hold – used in an inpatient setting to hold a medication during the patient's admission
- When all of the medications have been added, click the Confirm button
- Once confirmed, the medications will show on Medications in the work area
- Click on Return to Progress Note
- Finish the complete evaluation
- Compile the note. Must do this to get credit
No medications to reconcile? If no medications enter the date on the bottom left of the screen.
Note: This objective must be reported using the doctor’s user id to be counted in the reports.
OBJECTIVE 8: PUBLIC HEALTH AND CLINICAL DATA REGISTRY REPORTING
Objective: The eligible professional (EP) is in active engagement with a public health agency (PHA) or clinical data registry (CDR) to submit electronic public health data in a meaningful way using certified electronic health record technology (CEHRT), except where prohibited, and in accordance with applicable law and practice
An EP must satisfy two measures for this objective. If the EP cannot satisfy at least two measures, they may take exclusions from all measures they cannot meet.
Take exclusions for all 5 of these measures when reporting.
Measure 1: Immunization Registry Reporting: The EP is in active engagement with a PHA to submit immunization data and receive immunization forecasts and histories from the public health immunization registry/immunization information system (IIS).
Measure 2: Syndromic Surveillance Reporting: The EP is in active engagement with a PHA to submit syndromic surveillance data.
Measure 3: Electronic Case Reporting: The EP is in active engagement with a PHA to submit case reporting of reportable conditions.
Measure 4: Public Health Registry Reporting: The EP is in active engagement with a PHA to submit data to public health registries.
Measure 5: CDR Reporting: The EP is in active engagement to submit data to a CDR. Exclusions
If you have any questions about the instructions for one or more of these measures, please call 866-847-3590 or email sales@icanotes.com to schedule training.
REPORT ON 6 CQM'S
Providers must report on 6 CQMs.
Details about CQMs can be found at https://icanotes-ehr.na1.teamsupport.com/knowledgeBase/23994567
Threshold: There is no threshold or percentages attached to CQMs – 6 CQMs must be reported on even if the numerator and denominator are 0.
ICANotes is certified for the 10 CQMs listed below. You will report on 6 of these 11 measures when you attest to Promoting Interoperability for Medicaid for 2019:
- CMS002 Preventive Care and Screening: Clinical Depression and Follow-Up Plan Domain: Population/Public Health
- CMS50 Closing the referral loop: Receipt of specialist report Domain: Care Coordination
- CMS68 Documentation of Current Medications in the Medical Record Domain: Patient Safety
- CMS69 Preventive Care and Screening: BMI Domain: Population/Public Health
- CMS 138 Preventive Care and Screening: Tobacco Domain: Population/Public Health
- CMS 149 Dementia: Cognitive Assessment
- CMS 156 Use of High-Risk Medications in the Elderly
- CMS 161 Adult Major Depressive Disorder (MDD): Suicide Risk Assessment
- CMS165 Preventive Care and Screening: High Blood Pressure and Follow-Up Documented Domain: Clinical Process/Effectiveness
- CNS 177 Child and Adolescent Major Depressive Disorder (MDD): Suicide Risk Assessment
For specialties like psychiatry, providers may not find any Clinical Quality Measures relevant to their practice. For Medicaid, Meaningful Use is acceptable for there to be 0 in the numerators and denominators for all or some of these measures if they are not relevant to a provider’s practice; however, 6 measures must be reported on for Meaningful Use.
CQM PROFILE BUTTON
Click on the CQM button as you compile your note.
The CQM Profile button appears on the right side of the screen in the “About This Note” area.
Click on each CQM measure to read the description of the measure and determine if it applies to your patient for that visit. Check the boxes and select codes as appropriate. You may have several measures that apply to the same patient.
These fields can be manually checked; if you manually check the fields ensure that the information checked is documented in the patient's chart.
HELPFUL RESOURCES
Specific details about measures can be answered via Centers for Medicare and Medicaid Services (CMS). Here are some direct links and phone numbers that may be helpful.
- EHR Information Center Help Desk: (888) 734-6433 / TTY: (888) 734-6563 Hours of operation: Monday-Friday 8:30 am-4:30 pm in all time zones (except on Federal holidays)
- CMS EHR Incentive Programs: www.cms.gov/EHRIncentivePrograms
- HHS Office of the National Coordinator for Health IT: Certified EHR technology list www.cms.gov/EHRIncentivePrograms
- NPPES Help Desk: Visit https://nppes.cms.hhs.gov/NPPES/Welcome.do (800) 465-3203 - TTY (800) 692-2326
- PECOS Help Desk: Visit https://pecos.cms.hhs.gov/ (866)484-8049 / TTY (866)523-4759
- Identification & Authentication System (I&A) Help Desk, PECOS External User Services (EUS) Help Desk: Phone: 1-866-484-8049 – TTY 1-866-523-4759|E-mail: EUSSupport@cgi.com
- State Medicaid Incentive help desks
This document describes how to enter information into ICANotes so that the Meaningful Use report will track the numerators and denominators needed for attestation data.
DRFIRST MEASURE REPORTING (RCOPIA3)
Access DrFirst (by Chart Room buttons, patient demographics, or note).
At the top of the screen, click the Options button.
Under Additional Options, click the MU State 2 Report link.
1. Choose the provider (if you have access to more than you).
2. Choose the Range of Oct 1, 2019, to Dec 31, 2019.
3. Click the Create Report button.
Take note of your results.
You are able to print the report by clicking the Print Report button.
Go to the Meaningful Use Tracking Report lesson for information on how to input this data.
DRFIRST MEASURE REPORTING (RCOPIA4)
Access DrFirst (by Chart Room buttons, patient demographics, or note).
Click the Menu icon in the top left of the window, and select Reports from the dropdown menu.
Under Reports, choose the Meaningful Use Reports link.
1. Under MU REPORT TYPE, choose Stage 2.
2. Choose the provider from the PROVIDERS dropdown menu.
3. Select Date Range under Date.
4. Select the Start Date (10/1/2019).
5. Select the End Date (12/31/2019).
6. Click the Create Report button.
1. Take note of your results.
2. You are able to print the report by clicking the Printer icon.
Go to the Meaningful Use Tracking Report lesson for information on how to input this data.
MEANINGFUL USE TRACKING REPORT
Reporting will be available from the Reports menu bar and choosing the PI MU / MIPS from the dropdown menu.
1. Select the provider from the dropdown menu.
2. Select the 90 day reporting period you would like to report on.
3. Ensure that the Medicaid STAGE 3 2015 Edition tab is selected.
4. Click the measures you want to report.
Inserting DrFirst (Rcopia3 or Rcopia4) Measure Data
If you have obtained the numerator and denominator numbers from the DrFirst Measure Report (Rcopia 3) or DrFirst Measure Report (Rcopia 4) instructions, follow these instructions:
The first area to enter data is under 2) ePrescribing. Click the blue DrFirst link.
Insert the Numerator and Denominator data gathered from DrFirst Rcopia3 or Rcopia 4.
Click the Go button to see the results for the ePrescribing measure.
1. The second area to enter data is under 4) CPOE Rx Radiology Labs. Click the blue DrFirst link.
2. Insert the Numerator and Denominator data gathered from DrFirst Rcopia3 or Rcopia 4.
3. Click the Go button to see the results for the CPOE Rx Radiology Labs measure.
All Measures Report
Follow these directions to run a report for all measures.
Click the Go button by All Measures to get an overview of all the measures.
You may receive this error if you have not entered the DrFirst data retrieved following the DrFirst Measure Report (Rcopia 3) or DrFirst Measure Report (Rcopia 4) instructions.
Click OK to clear the popup window.
This will show the results of all measures.
Print Report
Click the Print Report button.
Once the Print Preview window pops up, ensure the correct printer is selected and then click the OK button.
Individual Measure Reports
Follow these directions for an in-depth look at an individual measure.
Click the Go button by the measure you want to view.
This will show the results of the selected measure.
Print Report
Click the Print Report button.
Once the Print Preview window pops up, ensure the correct printer is selected and then click the OK button.
Keep a copy of your Meaningful Use Tracking Report for six years in the "Book of Evidence" for your practice in case you are ever audited.
NEED HELP?/CONTACT US
ICANotes offers Meaningful Use assistance.
Review this ICANotes Meaningful Use documentation, then contact us at 866-847-3590 or sales@icanotes.com if you wish to schedule training.
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