Configuring axiUm for Meaningful Use

CONFIGURING AXIUM FOR MEANINGFUL USELauralynn Mealing, axiUm ConsultantPaul Delicana, Business Analyst

MEANINGFUL USE (MU)

• List of measures that dictate how to use an EHR

• Goal is to get Providers to use EHRs meaningfully– Complete and accurate information– Better access to information– Patient Empowerment

• An Overall Improvement in Patient Care

MU INCENTIVE PROGRAMS

• Medicare EHR Incentive Program– Total maximum incentive amount of $24,000

• Medicaid EHR Incentive Program– Total maximum incentive amount of $63,750– Last year to receive incentive payments is 2021– State Run 6 Year program (non-continuous)– Last year to Join the program is in 2016– Last year to receive Incentive Payments is in 2021

MEDICAID INCENTIVE PROGRAMYear Requirement for Incentive Payment Incentive Reporting Period

1 Adopt, Implement or Upgrade (AIU) $21,250 N/A

2 STAGE 1 Meaningful Use $8,500 90 Days

3 STAGE 2 Meaningful Use $8,500 Full Year




Total Incentive of $63,750 over 6 years PER Provider

BEFORE YEAR 1

• Register to an Incentive Program– Can only register for one incentive program

• Eligibility Requirements1. Must be a Dentist2. More than 10% of Dentist’s appointments in a non-hospital

setting 3. More than 30% of Dentist’s appointments with Medicaid

Patients• Medicaid Patient Volume Requirement

MEDICAID PATIENT VOLUME• 90 day period in the previous Year• Three ways to calculate– # of appointments the Providers had– # of appointment the Providers had and Start-Checked– # of appointments in the entire clinic

• Group Registration– Can use as a proxy for the Providers Patient volume– Only if it is appropriate for the EP

AXIUM CERTIFICATION• axiUm CE Certification – Valid for axiUm 5.3 CE

• What is a Certified EHR ?– Guarantee that the EHR has the functionality to support

the measures of MU– Certified EHR(EHR Functionality) ≠ Meaningful Use

(Reporting)

AXIUM 5.3 CE

MEDICAID INCENTIVE PROGRAMYear Requirement for Incentive

PaymentIncentive Reporting Period

1 (2013) Adopt, Implement or Upgrade (AIU)

$21,250 N/A

2 (2014) STAGE 1 Meaningful Use $8,500 90 Days

• Once a provider has registered for an EHR Incentive program they are referred to as an “Eligible Professional” an EP• Eligible to receive Incentive payments if they meet the

requirements for the incentive year

MU DASHBOARD

CORE/MENU MEASURE OVERVIEW

MEANINGFUL USE CRITERIA• List of measures that dictate how to use an EHR

• Three Types of Measures1. Core Measures

• The threshold for all these measure have to be met

2. Menu Measures• Threshold for only SOME of there measures have to be met

3. Clinical Quality Measures (CQMs)• No Threshold has to be met

MEANINGFUL USE CRITERIA

• The Core/Menu Measures change at each stages– Stage 1 to 3 gets progressively more difficult– CQMs stay the same

• Stage 1 Meaningful Use Measures– 14 Core Measures– 5 out of 10 Menu Measures (7 to choose from)– 9 out of 64 CQM (15 to choose from)

STAGE 1 CORE MEASURES

Measure # Description aixUm areaCORE 1 CPOE for Medication orders eRxCORE 2 Drug Interaction Checks eRxCORE 3 Maintain Problem List eRxCORE 4 e-Prescribing eRxCORE 5 Active Medication List eRxCORE 6 Active Medication Allergies List eRxCORE 7 Record Demographics Patient Card

STAGE 1 CORE MEASURES

Measure # Description aixUm areaCORE 8 Record Vitals EHR FormCORE 9 Record Smoking Status Alerts TabCORE 10 Clinical Quality Measures * VariesCORE 11 Clinical Decision Support CDS interventionCORE 12 Electronic Copy of Information EHR

CORE 13 Clinical SummariesPatient Attachment

CORE 14 Protect Electronic Information axiUm

STAGE 1 MENU MEASURES

Implemented MENU Measures

MENU 1 Drug Formulary Checks eRx

MENU 3 Patient Lists Infomanager

MENU 4 Patient Reminders Contact Notes

MENU 5 Patient Electronic Access Patient Card

MENU 6 Patient-specific Education Resources EHR

MENU 7 Medication Reconciliation EHR

MENU 9 Immunization Registries EHR (Excluded)

RECORD DEMOGRAPHICSCORE 7 (OF 14)

• MEASURE– More than 50% of patients seen have

demographics recorded• Preferred language/Gender/Race/Ethnicity/DOB

• ATTESTATION– Percentage must be more than 50%

PATIENT CARD, PERSONAL TAB (CORE 7/14)

PATIENT CARD, PERSONAL TAB (CORE 7/14)

PATIENT ELECTRONIC ACCESSMENU 5 (OF 10)

• MEASURE– At least 10% patients provided timely electronic access to health information

• Available within 4 business days of being updated• Patient Access

• ATTESTATION– Percentage must be more than 10%– Exclusion

1. Provider does not need information contained in the problem list, medication lists and medication allergy lists

MU DASHBOARD (MENU 5/10)

CLINICAL DECISION SUPPORT (CDS)CORE 11 (OF 14)

• MEASURE– Implement one clinical decision support rule – EHR functionality that gives a provider general and person-

specific information, intelligently filtered and organized, at appropriate times, to enhance health and health care.

• ATTESTATION– Yes/No





DRUG FORMULARY CHECKSMENU 1 OF (10)

• MEASURE– The EP has enabled and access to at least one formulary

• ATTESTATION– Yes/No– Exclusion

1. EP Writes Fewer than 100 prescriptions

ERX (MENU 1/10)


DRUG INTERACTION CHECKS CORE 2 (OF 14)

• MEASURE– Drug – drug & drug – allergy interaction checks are

enabled for entire reporting period– Use eRx


ERX (CORE 2/14)

MU DASHBOARD (CORE 2/14)

CPOE FOR MEDICATION ORDERSCORE 1 (OF 14)

• MEASURE– More than 30% all unique patients have at least 1 medication

order CPOE (Computerized Provider Order Entry) entered – ALTERNATIVE MEASURE

• More than 30% all prescriptions created by the EP were recorded using CPOE

• ATTESTATION• Percentage must be more than 30%• Exclusion

1. EP Writes Fewer than 100 prescriptions



E-PRESCRIBING (ERX) CORE 4 (OF 14)

• MEASURE– More than 40% permissible prescriptions written are transmitted

electronically (eRx)• Permissible prescriptions are prescriptions written (NOT for controlled substances)

• ATTESTATION– Percentage must be more than 40%– Exclusion

1. Fewer than 100 prescriptions written2. No Pharmacy within 10 miles accepts eRx prescriptions


ACTIVE MEDICATION LIST CORE 5 (OF 14)

• MEASURE– More than 80% patients have at least one active

medication (or indication that no medication is currently prescribed)


EHR, CURRENT MEDICATIONS LIST

In axiUm EHR, Medications tab

In axiUm eRx, Medications section


MAINTAIN MEDICALPROBLEM LISTS CORE 3 (OF 14)

• MEASURE– More than 80% all patients have at least 1 entry or

indication that no medical problems in their problem lists


EHR & ERX PROBLEMS LIST (CORE 3/14)

In axiUm EHR, Alerts tab

In axiUm eRx, Patient Problems section

RECORD SMOKING STATUS CORE 9 (OF 14)

• MEASURE– More than 50% of patients 13 years old or older

have smoking status recorded• ATTESTATION– Percentage more than 50% – Exclusion• No patients 13 years or older seen

EHR, FORMS (CORE 9/14)

In axiUm EHR tab, Update/Review Medical Alerts


MEDICATION ALLERGY LIST CORE 6 (OF 14)

• MEASURE– More than 80% patients have at least one entry in

their medication allergy list or an indication of no medication allergy


EHR, ALERTS TAB In axiUm eRx, Allergies section

In axiUm EHR, Alerts tab (display from entry in eRx)

MU DASHBOARD (CORE 6 OF 14)

RECORD VITAL SIGNS CORE 8 (OF 14)

• MEASURE– More than 50% of patients have blood pressure (for patients age 3 and

over only) and height and weight (for all ages) recorded as structured data.• Plot and Display Growth Charts 2-20 years old, including BMI

• ATTESTATION– Percentage must be more than 50%– Exclusion:

1. No patients 3 years or older seen2. Patient vitals have no relevance3. Blood pressure is not relevant 4. Height and weight are not relevant

EHR, FORMS, MED HIST (CORE 8/14)

Question/Header Answer Type Reference Code

Height and Weight Assessment: - -

Feet: Number PT_STD_HT1

Inches: Number PT_STD_HT2

Height (Inches): Calculated (EPR_GET_HEIGHT_MDH_F) PT_STD_HT

Weight (Lbs): Number PT_STD_WT

BMI: Calculated (EPR_CALC_BMI_STD) PT_STD_BMI

Is BMI reading over 25? Yes/No MDH_BMI

Blood Pressure: - -

Systolic Blood Pressure (mmHg) Number MDH_SBP

Diastolic Blood Pressure (mmHg) Number MDH_DBP

Pulse (BPM): Number PULSE

In axiUm Maintenance, EHR tab, EPR Forms

MEDICAL HISTORY IN EHR

In axiUm EHR, Forms, Medical History Form tab


PATIENT LISTSMENU 3 (OF 10)

• MEASURE– Generate at least one report listing patients with a

specific condition • ATTESTATION– Yes/No


PROTECT ELECTRONIC INFORMATION CORE 14 (OF 14)

• MEASURE– Conduct or review a security risk analysis,

implement security updates and correct identified security deficiencies



• MEASURE– Submit at least one electronic data test to immunization

registries and follow up submission if the test is successful • ATTESTATION

– Yes/No– Exclusion

• Immunizations not performed• No immunization registry electronic receipt capacity


PATIENT SPECIFIC EDUCATIONMENU 6 (OF 10)

• MEASURE– More than 10% patients provided patient-specific

education resources • ATTESTATION–Percentage more than 10%

SUGGESTED AXIUM INPUT(MENU

6/10)


ELECTRONIC COPY OF HEALTH INFO CORE 12 (OF 14)

• MEASURE– More than 50% patients requesting electronic copy of

health information provided it within 3 business days • ATTESTATION– Percentage more than 50%– Exclusion

• No patient requests

AXIUM INPUT IN EHR (CORE 12/14)


CLINICAL SUMMARIES(CORE 13/14)

• MEASURE– Provided a clinical summary to patients, within 3

business days, for more than 50% of all office visits• ATTESTATION– Percentage more than 50% – Exclusion

• No office visits

AXIUM OUTPUT FOR CLINICAL SUMMARY (CORE 13/14)

SAMPLE CLINICAL SUMMARY(CORE 13/14)

SAMPLE CLINICAL SUMMARY(CORE 13/14)

CLINICAL SUMMARY – TECHNICAL DETAILS

• http://wiki.siframework.org/file/view/Companion_Guide_to_CCDA_for_MU2_r0.docx/390200714/Companion_Guide_to_CCDA_for_MU2_r0.docx

• Relevant Information in:– Table 3: MU2 Data Requirements (pg. 23 – 25)

http://wiki.siframework.org/file/view/Companion_Guide_to_CCDA_for_MU2_r0.docx/390200714/Companion_Guide_to_CCDA_for_MU2_r0.docx






CLINICAL QUALITY MEASURES (CQMs) (CORE 10/14)

• MEASURE– Report on 9 CQMs (15 to choose from) – From at least 3 different domains

• Workflows– Some will overlap with the workflows of the

Core/Menu measures– Others are dental related measures


REC ONLINE ATTESTATION

QUESTIONS/COMMENTS?

THANK YOU

Documents

Configuring axiUm for Meaningful Use