eBook - Pathways to Meaningful Use

Pathways to Meaningful Use

MU Meaningful Use (MU) Overview

MU Check List … 1, 2, 3

MU Stage 1 Grid NextGen Healthcare MU Pathways

MU Stage 2 Grid NextGen Healthcare MU Pathways

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2

3

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Pathways to Meaningful Use

with NextGen Healthcare Ambulatory Solutions

What is Meaningful Use (MU)?The Health Information Technology for Economic and Clinical Health (HITECH) Act under the American Recovery and Reinvestment Act (ARRA) provides financial incentives to encourage adoption and meaningful use of certified electronic health record (EHR) technology (CEHRT).

The Centers for Medicare and Medicaid (CMS) EHR Incentives Program (in reality two programs) offers up to $44,000 over five years under the Medicare EHR Incentive Program and up to $63,750 over six years under the Medicaid EHR Incentive Program.

HITECH envisioned a three-stage process for implementing the EHR Incentive Program. Each stage has a goal and its own “final rule”— a set of objectives and measures developed by the Department of Health and Human Services (HHS) and published in the Federal Register as regulations. If you meet the Medicare or Medicaid EHR Incentive Program eligibility requirements and successfully meet and report measures for each stage of the program, you earn the incentives.

So far, the government has published final rules for Stage 1 and Stage 2 Meaningful Use (MU1 and MU2). This document outlines what is required of you under each stage.

The vision and purpose of HITECH is to drive the adoption of CEHRT in order to:

• Improve quality, safety, and efficiency• Engage patients and their families• Improve care coordination• Improve population and public health• Ensure privacy and security protections

But Meaningful Use is more than an incentive program. It is a means to a greater end and a likely driver for success in a newly emerging healthcare delivery system. Under value-based reimbursement models, provider payments are calculated based upon improvements in quality care and coordination of care across patient populations. Certified, interoperable EHR technology is the cost of admission.

To learn more about Meaningful Use and the CMS EHR Incentive Programs, read the NextGen Healthcare Meaningful Use eBook.

This document was updated 06/1/2014 and reflects Stage 1 and Stage 2 requirements starting in 2014.

Meaningful Use Overview

https://bridge.nextgen.com/cdn/media_assets/pdf/nextgen-healthcare-ebook-meaningful-use-2014-edu6.pdf

MU Checklist... 1, 2, 31. Register

Before you can attest and earn your incentives, go to www.cms.gov, Regulations and Guidance, and click on EHR Incentive Programs under the Legislation heading to register for either the Medicare or Medicaid EHR Incentive Program. You must pick one program in which to participate (although you may switch one time before 2015). You only need to register for the program once (no need to re-register each year).

• To register for the Medicare EHR Incentive Program, go to the registration link on the CMS EHR Incentive Program homepage and follow the instructions

• To register for the Medicaid EHR Incentive Program, go to the registration link on the CMS EHR Incentive Program homepage and follow the instructions; CMS will send your information to your state for review and completion of your registration process. Go here to find your state’s Medicaid EHR Incentive Program URL

Have this information ready before registering:

• Name, NPI, address, and phone for each Eligible Provider (EP) and Eligible Hospital (EH) being registered

• Taxpayer Identification Number

• CMS EHR Certification Number (optional at registration but recommended, since you will eventually need it to attest)

- Visit the ONC/CHPL website to obtain the correct certification number for your product version

- You must upgrade to the certified version prior to the beginning of the reporting period

• PECOS number (if registering for Medicare EHR Incentive Program)

Registering or attesting on behalf of one or more EPs? If so, visit the I&A Security website to obtain a username and password. (States may have different requirements for their Medicaid EHR Incentive Programs regarding the representation of multiple EPs by a single individual.)1For additional information and to get started, visit the CMS Registration & Attestation site

http://oncchpl.force.com/ehrcert?q=chpl

www.cms.gov

http://www.cms.gov/Regulations-and-Guidance/Legislation/EHRIncentivePrograms/Getting_Started.html

http://www.cms.gov/Regulations-and-Guidance/Legislation/EHRIncentivePrograms/Getting_Started.html

http://www.cms.gov/apps/files/medicaid-hit-sites/

https://www.cms.gov/Regulations-and-Guidance/Legislation/EHRIncentivePrograms/RegistrationandAttestation.html

https://nppes.cms.hhs.gov/IAWeb/warning.do?fwdurl=/login.do

2. Achieve

You will need to use your EHR in a way that aligns with the MU objectives outlined by CMS. This document includes an overview of NextGen® product requirements, as well as a listing of the Stage 1 and Stage 2 objectives with high-level details on how these products are used. In addition to this MU Pathways document, you can find detailed information about achieving MU, as well as white papers, FAQs, webinars, educational information, and more on the MU Resources page on the Knowlege Exchange. At a high level, here are some things you need to know:

• Meaningful Use is a three-stage process. Final rules, requirements, and timelines for Stage 1 and Stage 2 have been published by the federal government

• Your first two years as a meaningful user will be at Stage 1 (unless you started in 2011, in which case 2013 would have been your third year of Stage 1)

• Eligible Professionals (EPs) need to meet a set of Core (required) objectives and also select from a set of Menu objectives.

• There are 13 Core objectives under Stage 1; and 17 Core objectives under Stage 2

Note: CMS has formally retired earlier Stage 1 Core objectives for submitting clinical quality measures and performing one test of health data exchange. (CQMs must still be submitted, but no objective exists for it.)

• A new Stage 1 Core objective requires giving patients the

ability to "view online, download and transmit" personal health information, replacing earlier Core and Menu objectives

• You must meet five out of nine Menu objectives under Stage 1; and three out of six Menu objectives under Stage 2

• Under Stage 1, you must meet one of the two public health reporting Menu objectives (immunization reporting or syndromic disease reporting) unless you qualify for an exemption to both

• Under Stage 2, immunization reporting is now a Core objective, while syndromic reporting remains a Menu objective. Both must be successful and ongoing for meeting the corresponding Stage 2 objectives

• In addition to the Core and Menu objectives, you will need to report a set of Meaningful Use Clinical Quality Measures (CQMs). There is a new set of CQMs for Stage 1 and Stage 2 starting in 2014

• You must meet the MU requirements using the appropriate ONC Certified HIT 2014 Edition of your NextGen Healthcare solutions. Product and version requirements are outlined later in this document2MU Checklist... 1, 2, 3

https://bridge.nextgen.com/?origin=PARTICIPATE&ReturnUrl=https%3A%2F%2Fknowledge.nextgen.com%2Fpe

3Once you have successfully met the objectives for your current MU stage, you will need to attest with CMS (for the Medicare EHR Incentive Program) or your state Medicaid Agency (for the Medicaid EHR Incentive Program). Attestation is how you report the data you captured during your reporting period. It’s the final step prior to being issued an EHR incentive payment.

• First-time attesters, get your login/password for the CMS attestation portal

• Create final MU reports using NextGen® Health Quality Measures (NextGen HQM) and save the reports you use for use during attestations and for reference in the event of a future CMS audit

Visit Knowledge Exchange for detailed white papers on 2014 Stage 1 and Stage 2 objectives and CQMs.

• Stage 1 and Stage 2 (starting in 2014): NextGen HQM required for all MU reporting

• For those beyond their first year of reporting MU, CQMs can be electronically reported

• HQM must be re-installed after upgrading to NextGen® Ambulatory EHR version 5.8 (ONC Certified HIT 2014 Edition)

• Enter the required information for each MU Core/Menu objective into the CMS Attestation portal following the instructions provided on the CMS site. (Follow instructions from your state Medicaid agency if you are participating in the Medicaid EHR Incentive Program)

What to expect after attestation

Payments

• Under Medicare, you should expect to receive a single, annual payment. You will receive this payment in the same manner as your other Medicare reimbursements. This could take up to 60 days or longer, according to experience, after attestation. If you’re in doubt as to the status of the incentive payment, you should contact CMS

• Under Medicaid, check with your state Medicaid agency on timelines and method of payment

Audits

• Both Medicare and Medicaid are conducting MU audits. To be prepared for an audit, keep all reports and evidence that you have met the Yes/No attestation objectives (e.g., Drug Formulary feature enabled). Keep all reports and evidence for at least six years. For more information on audit preparedness visit the Meaningful Use Resources page on the NextGen Healthcare Client Resource Center. If you have received an audit letter and need assistance, please complete this documentation.

MU Checklist... 1, 2,33. Attest

https://www.cms.gov/Regulations-and-Guidance/Legislation/EHRIncentivePrograms/RegistrationandAttestation.html



https://docs.google.com/forms/d/1VcVpMahs4tduZzYvOO74pRwujaX1x6P4B-xZmSWiQ6k/viewform

NextGen Healthcare Product Requirements Overview

* Menu objective – solution required or recommended only if clients choose to attest for the objective ** Stage 1 rule requires clients to select either the immunization or syndromic reporting menu measure, unless you qualify for both exclusions. Starting in 2014, NextGen Ambulatory EHR version 5.8 is required for both Stage 1 and Stage 2. Also, starting in 2014, NextGen KBM Version 8.3 will be the only NextGen KBM version supported for both Stage 1 and Stage 2 Meaningful Use. Earlier NextGen KBM versions will not be supported for Meaningful Use reporting and attestation.

What you need to support your Ambulatory pathway to MU in 2014.

Stage 2

• NextGen Ambulatory EHR v. 5.8

• MU Compliant KBM (NextGen KBM v.8.3 or higher)

• e-Prescribing

• NextGen HQM

• NextGen Patient Portal

• Advanced Audit Utility

• Medical Summary Utility

• ONC Direct Interface

• Lab Interface (recommended)

• Immunization Registry Interface

• Syndromic Reporting interface*

• Specialized Registry Interface*

• Cancer Registry Interface *

Stage 1

• NextGen Ambulatory EHR v. 5.8

• MU Compliant KBM (NextGen® KBM

v.8.3 or higher)

• e-Prescribing

• NextGen HQM

• NextGen® Patient Portal

• Advanced Audit Utility

• Lab Interface (recommended)*

• Immunization registry interface**

OR

• Syndromic Reporting interface**

NextGen Healthcare Pathways to Meaningful Use

Stage 1- Core Set\

ID Objective MeasureProduct Used to

Demonstrate Meaningful Use*

Comments

1 Use CPOE for medicationorders directly entered by any licensed healthcareprofessional who can enterorders into the medical record per state, local, andprofessional guidelines

More than 30% of medication orders created by the EP during the EHR reporting period are recorded using CPOE, or, more than 30% of unique patients with at least one medication in their medication list seen by the EP have at least one medication order entered using CPOE

NextGen Ambulatory EHR 5.8 1. Applies to orders entered by the physician OR entered for the provider by someone who could exercise clinical judgment (in the case that the entry generates any alerts about possible interactions or other clinical decision support aides). This necessitates that the CPOE occurs when the order first becomes part of the patient’s medical record and before any action can be taken on the order

2. Any EP who writes fewer than 100 prescriptions during an EHR reporting period is excluded

3. 2013 - Externally Credentialed Individuals are allowed to enter orders on behalf of EP

2 Implement drug-drug and drug-allergy interaction checks

The EP/eligible hospital/CAH has enabled this functionality for the entire EHR reporting period

NextGen Ambulatory EHR 5.8 1. Must set the minimum drug interaction level to at least one (not zero)

2. EP has enabled this functionality during entire reporting period

3. Yes/No attestation only

3 Maintain an up-to-dateproblem list of current andactive diagnoses

More than 80% of all unique patients seen by the EP or admitted to the eligible hospital’s or CAH’s inpatient or emergency department (POS 21 or 23) have at least one entry or an indication that no problems are known for the patient recorded as structured data

NextGen Ambulatory EHR 5.8

4 Generate and transmitpermissible prescriptionselectronically (eRx)

More than 40% of all permissible prescriptions written by the EP aretransmitted electronically using certified EHR technology

1. NextGen Ambulatory EHR 5.8

2. e-Prescribing enabled

1. Excludes narcotics and DME

2. Any EP who writes fewer than 100 prescriptions during an EHR reporting period is excluded

NextGen Healthcare Pathways to Meaningful Use *Starting in 2014, NextGen Ambulatory EHR version 5.8 is required for both Stage 1 and Stage 2. Also, starting in 2014, NextGen Healthcare clients will need to be on NextGen KBM Version 8.3 or higher. Older NextGen KBM versions will not be updated or supported for MU or ICD-10 purposes.

Stage 1- Core Set\


Demonstrate Meaningful Use

Comments

5 Maintain active medicationlist

More than 80% of all unique patients seen by the EP or admitted to the eligible hospital’s or CAH’s inpatient or emergency department (POS 21 or 23) have at least one entry (or an indication that the patient is not currently prescribed any medication) recorded as structured data


6 Maintain active medication allergy list

More than 80% of all unique patients have at least one entry recorded as structured data or an indication that the patient has no known allergies and is not currently prescribed any medication


7 Record demographics: • Preferred language • Gender • Race • Ethnicity • Date of birth

More than 50% of all unique patients seen by the EP or admitted to the eligible hospital’s or CAH’s inpatient or emergency department (POS 21 or 23) have demo-graphics recorded as structured data


Answers of “unknown”or “refused” or “declines to specify” can be included in number. Multiple races can also be entered

8 Record and chart changes in vital signs: • Height • Weight • Blood pressure • Calculate and display BMI • Plot and display growth

charts for children 2-20 years including BMI

For more than 50% of all unique patients seen by the EP, for all ages have height, weight recorded, and for three years and older have blood pressure recorded as structured data


2. NextGen KBM v.8.3 or higher

1. Excludes an EP who either sees no patients three years or older, or who believes that vital signs (height, weight, and blood pressure) of their patients have no relevance to their scope of practice

2. The exemption may be split to allow providers to exempt the height/weight measure and still report the BP measure (or vice versa) based on relevance to their scope of practice

9 Record smoking status forpatients 13 years old or older

For more than 50% of all unique patients of all ages seen by the EP, have height, weight recorded, and for three years and older have blood pressure recorded as structured data



Excludes an EP who sees no patients 13 years or older.


Stage 1- Core Set\



Comments

10 Implement one clinicaldecision support rule relevant to specialty or high clinical priority along with the ability to track compliance with that rule

Implement one clinical decision support rule


11 Provide patients with the ability to view online, download, and transmit their health information within four business days of the information being available to the EP

More than 50% of all unique patients seen by the EP during the EHR reporting period


2. NextGen Patient Portal

3. Medical Summary Utility

1. Use Medical Summary Utility to create document with required information

2. PHR access should be enabled in file maintenance for NextGen Patient Portal

12 Provide clinical summaries for patients for each office visit

Clinical summaries provided to patients for more than 50% of all office visits within three business days



13 Protect electronic health information created or maintained by the certified EHR technology through the implementation of appropriate technical capabilities

Conduct or review a security risk analysis per 45 CFR 164.308 (a)(1) and implement security updates as necessary and correct all identified security deficiencies as part of its risk management process


2. Advanced Audit Utility


2. This objective is not specific to the use of certified EHR technology, but applies to the implementation of a HIPAA Privacy and Security program and related risk assessment within the practice


Stage 1-Menu Set\



Comments

1 Implement drug formulary checks

Functionality is enabled and provides access to at least one internal or external formulary for the entire EHR reporting period



1. Ensure that you have access to a formulary (e.g., Surescripts formulary) for the entire EHR reporting period

2. Yes/No attestation only measure

2 Incorporate clinical lab test results into certified EHRs as structured data

More than 40% of all clinical laboratory tests ordered during EHR reporting period whose results are in a positive / negative or numerical format are incorporated in certified EHR as structured data


2. Lab interface (recommended)

1. Full bi-directional interface is optimal for ease of reporting.

2. Exclusion for EP who orders no lab tests whose results are either in a positive / negative or numeric format during the EHR reporting period; they would be excluded from this requirement

3 Generate lists of patients by specific conditions to use for quality improvement, reduc-tion of disparities, research, or outreach

Generate at least one report listing patients with a specific condition

NextGen Ambulatory EHR 5.8 1. Relevant to specialty

2. Use ad hoc report writer

3. Attestation only measure

4 Send reminders to patients (per patient preference)for preventive / follow-up care

More than 20% of all unique patients 65 years or older or five years old or younger are sent appropriate reminders during EHR reporting period

NextGen Ambulatory EHR 5.8 1. For electronic communications, secure email, or a patient portal is required

2. Excludes an EP who has no patients 65 years old or older or five years old or younger

3. Captured in Patient demographic template in EHR Reminder Grid

5 Use certified EHR technology to identify patient-specificeducation resources and provide those to the patient if appropriate

More than 10% of all unique patients seen are provided patient-specific education resources

NextGen Ambulatory EHR 5.8 Patient education may be internal or external but needs to be documented as ordered in the KBM


\



Comments

6 Perform medication reconciliation for a patient from another care setting or provider of care

Perform medication reconciliation for more than 50% of transitions of care in which the patient is transitioned in the care of the EP




Use KBM to document care transition and that medication reconciliation was performed

7 Provide summary of care record for patients referred or transitioned to another provider of care or setting of care

Summary of care record is provided for more than 50% of transitions of care or referrals




4. Direct interface (optional)

1. Use Medical Summary Utility to create the summary of care record

2. Objective/measure allows SOC to be printed, but if EP chooses to send electronically, Direct interface is needed

3. Use KBM PHI Log template to document care transition and that it was provided

8 Submit electronic data to im-munization registries orImmunization InformationSystems**

Perform at least one test of certified EHR technology's capacity to submit electronic data to immunization registries and follow up submission if the test is successful (unless none of the immunization registries has the capacity to receive the information electronically)


2. Immunization Registry Interface

1. Exempt if you don’t give immunizations

2. Exempt if state doesn’t accept electronic data

3. If you are not exempt you may require an immunization registry interface or HIE connection

9 Submit electronic syndromicsurveillance data to public health agencies**

Perform at least one test of certified EHR technology's capacity to provide electronic syndromic surveillance data to public health agencies and follow up submission if the test is successful (unless none of the public health agencies have the capacity to receive the information electronically)


2. Public Health Reporting Interface

1. Exemption is permitted if there is no state, city, or county syndromic surveillance data source capable of receiving info from the certified EHR. (Letter of exemption from state must be on file)

2. If your agency can successfully accept, you must continue to report

3. Requires HL7 interface or HIE connection

Stage 1-Menu Set


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Comments

1 Use computerized provider order entry (CPOE) for medication, laboratory, and radiology orders directly en-tered by any licensed health-care professional who can enter orders into the medical record per state, local, and professional guidelines

More than 60 percent of medication, 30 percent of laboratory, and 30 percent of radiology orders created by the EP during the EHR reporting period are recorded using CPOE

NextGen Ambulatory EHR 5.8 1. Any externally licensed healthcare professionals and credentialed medical assistants can enter orders into the medical record for purposes of including the order in the numerator for the objective of CPOE if they can originate the order per state, local, and professional guidelines

2. Any EP who writes fewer than 100 medication, radiology, or laboratory orders during the EHR reporting period is excluded

2 Generate and transmit permissible prescriptions electronically (eRx)

More than 50 percent of all permissible prescriptions, or all prescriptions, written by the EP are queried for a drug formulary and transmitted electronically using CEHRT



1. EPs may exclude or include narcotics. If they include, they must do so for all patients in the reporting period. The rule excludes DME and OTC

2. Any EP who writes fewer than 100 prescriptions during an EHR reporting period or does not have a pharmacy within their organization and there are no pharmacies that accept electronic prescriptions within 10 miles is excluded

3 Record the following demographics: preferred lan-guage, gender, race, ethnicity, date of birth

More than 80 percent of all unique patients seen by the EP have demographics recorded as structured data


Answers of “unknown” or “refused,” or indication that it is against state law to ask for this information are all acceptable in the numerator as long as entered as structured data

4 Record and chart changes in the following vital signs: height/length and weight (no age limit); blood pressure (ages three and over); calculate and display body mass index (BMI); and plot and display growth charts for patients 0-20 years, including BMI

More than 80 percent of all unique patients seen by the EP have blood pressure (for patients age three and over only) and/or height and weight (for all ages) recorded as structured data


2. NextGen KBM 8.3 or higher

1. Can be entered into the patient’s medical record in a number of ways including: direct entry by the EP; entry by a designated individual from the EP’s staff; data transfer from another provider electronically, through an HIE or through other methods; or data entered directly by the patient through a portal or other means

2. Any EP who: A. Sees no patients three years or older is excluded from

recording blood pressure

B. Believes that all three vital signs of height/length, weight, and blood pressure have no relevance to their scope of practice is excluded from recording them

C. Believes that height/length and weight are relevant to their scope of practice, but blood pressure is not, is excluded from recording blood pressure

D. Believes that blood pressure is relevant to their scope of practice, but height/length and weight are not, is excluded from recording height/length and weight

Stage 2-Core Set


\



Comments

5 Record smoking status for patients 13 years old or older

More than 80 percent of all unique patients 13 years old or older seen by the EP have smoking status recorded as structured data



Any EP that neither sees nor admits any patients 13 years old or older is excluded

6 Use clinical decision support to improve performance on high-priority health conditions

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 clinical decision support interventions must be related to high-priority health conditions

Measure 2: The EP has enabled and implemented the functionality for drug-drug and drug-allergy interaction checks for the entire EHR reporting period


1. For the second measure, any EP who writes fewer than 100 medication orders during the EHR reporting period is excluded

2. Second Measure: Yes/No attestation only

7 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 1: More than 50 percent of all unique patients seen by the EP during the EHR reporting period are provided timely (available to the patient within four business days after the information is available to the EP) online access to their health information

Measure 2: More than five percent of all unique patients seen by the EP during the EHR reporting period (or their authorized representatives) view, download, or transmit to a third party their health information




Any EP who:

1. Neither orders nor creates any of the information listed for inclusion as part of both measures, except for “Patient name” and “Provider’s name and office contact information,”may exclude both measures

2. Conducts 50 percent or more of his or her patient encounters in a county that does not have 50 percent or more of its housing units with 3Mbps broadband availability according to the latest information available from the FCC: on the first day of the EHR reporting period may exclude only the second measure

Stage 2-Core Set


\



Comments

8 Provide clinical summaries for patients for each office visit

Clinical summaries provided to patients or patient-authorized representatives within one business day for more than 50 percent of office visits



Excludes an EP who has no office visits during the EHR reporting period

9 Protect electronic health information created or maintained by the certified EHR technology (CEHRT) through the implementation of appropriate technical capabilities

Conduct or review a security risk analysis in accordance with the requirements under 45 CFR 164.308(a) (1), including addressing the encryption/security of data stored 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 provider’s risk management process for EPs


2. Advanced Audit Utility*

3. NextGuard (recommended)

*The Advanced Audit Utility is required for 2014, both Stage 1 and Stage 2

10 Incorporate clinical lab test results into Certified EHR Technology (CEHRT) as structured data

More than 55 percent of all clinical lab tests results ordered by the EP during the EHR reporting period whose results are either in a positive/negative or numerical format are incorporated in Certified EHR Technology as structured data

NextGen Ambulatory EHR 5.8 Any EP who orders no lab tests where results are either in a positive/negative affirmation or numeric format during the EHR reporting period is excluded

11 Generate lists of patients by specific conditions to use for quality improvement, reduc-tion of disparities, research, or outreach

Generate at least one report listing patients of the EP with a specific condition

NextGen Ambulatory EHR 5.8 1. NextGen Ambulatory EHR ad hoc report writer can be utilized to create patient lists


Stage 2-Core Set


\



Comments

12 Use clinically relevant information to identify patients who should receive reminders for preventive/follow-up care and send these patients the reminders, per patient preference

More than 10 percent of all unique patients who have had two 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



1. Any EP who has had no office visits in the 24 months before the EHR reporting period is excluded

2. Captured in Patient demographic template in EHR Reminder Grid

13 Use clinically relevant information from Certified EHR Technology to identify patient-specific education resources and provide those resources to the patient

Patient-specific education resources identified by Certified EHR Technology 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


2. HealthWise Patient Education (Recommended)

Any EP who has no office visits during the EHR reporting period is excluded

14 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

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



Any EP who was not the recipient of any transitions of care during the EHR reporting period is excluded

Stage 2-Core Set


\



Comments

15 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 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

Measure 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

Measure 3: An EP must satisfy one of the following criteria:

Conducts one or more successful electronic exchanges of a summary of care document, part of which is counted in “measure 2” (for EPs the measure at §495.6(j)(14)(ii)(B) with a recipient who has EHR technology that was developed/designed by a different EHR

Conducts one or more successful tests with the CMS-designated test EHR during the EHR reporting period

1. NextGen Ambulatory EHR 5.8 UD1

2. NextGen KBM 8.3 or higher. Multi-RHIO connectivity requires v.8.3.3 or higher

3. ONC-Direct interface

1. Provider must connect using ONC Direct protocol through a registered HISP. A state, regional, or local HIE may or may not include a registered HISP. Engage your NextGen Healthcare representative to assist in discovery to ensure that your method of connectivity meets the MU2 requirement

2. Any EP who transfers a patient to another setting or refers a patient to another provider fewer than 100 times during the EHR reporting period is excluded from all three measures

3. If the provider to whom the referral is made or to whom the patient is transitioned has access to the medical record maintained by the referring provider, then a summary of care record would not need to be provided. In this case, the patient must not be included in the denominator for transitions of care

Stage 2-Core Set


\



Comments

16 Capability to submit electronic data to immunization registries or immunization information systems except where prohibited, and in accordance with applicable law and practice

Successful ongoing submission of elec-tronic immunization data from CEHRT to an immunization registry or immunization information system for the entire EHR reporting period


2. Immunization registry interface

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 timely information 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 the start of their EHR reporting period can enroll additional EPs

17 Use secure electronic messaging to communicate with patients on relevant health information

A secure message was sent using the electronic messaging function of CEHRT by more than five percent of unique patients (or their authorized representatives) seen by the EP during the EHR reporting period



Excluded is 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

Stage 2-Core Set


\



Comments

1 Capability to submit electronic syndromic surveillance data to public health agencies except where prohibited, and in accordance with applicable law and practice

Successful ongoing submission of electron-ic syndromic surveillance data from CEHRT to a public health agency for the entire EHR reporting period


2. Syndromic Reporting interface

Any EP who meets one or more of the following criteria may be excluded from this objective:

1. The EP is not in a category of providers that collects ambulatory syndromic surveillance information on their patients during the EHR reporting period;

2. The EP operates in a jurisdiction for which no public health agency is capable of receiving electronic syndromic surveillance data in the specific standards required by CEHRT at the start of their EHR reporting period;

3. The EP operates in a jurisdiction where no public health agency provides information timely on capability to receive syndromic surveillance data; or

4. The EP operates in a jurisdiction for which no public health agency that is capable of accepting the specific standards required by CEHRT at the start of their EHR reporting period can enroll additional EPs

2 Record electronic notes in patient records

Enter at least one electronic progress note created, edited, and signed by an EP for more than 30 percent of unique patients with at least one office visit during the EHR reporting period. The text of the electronic note must be text searchable and may contain drawings and other content


3 Imaging results consisting of the image itself and any explanation or other ac-companying information are accessible through CEHRT

More than 10 percent of all tests whose result is one or more images ordered by the EP during the EHR reporting period are accessible through CEHRT


Excluded is any EP who orders fewer than 100 tests resulting in an image during the EHR reporting period; or any EP who has no access to electronic imaging results at the start of the EHR reporting period

4 Record patient family health history as structured data

More than 20 percent of all unique patients seen by the EP during the EHR reporting period have a structured data entry for one or more first-degree relatives


Any EP who has no office visits during the EHR reporting period

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Comments

5 Capability to submit cancer case measure data to a public health central cancer registry except where prohibited, and in accordance with applicable law and practice

Successful ongoing submission of cancer case information from CEHRT to a public health central cancer registry for the entire EHR reporting period



3. Cancer Case Measure

Any EP who meets one or more of the following criteria may be excluded from this objective:

1. The EP is not in a category of providers that collect ambulatory cancer case measure information on their patients during the EHR reporting period;

2. The EP operates in a jurisdiction for which no public health agency is capable of receiving electronic cancer case data in the specific standards required by CEHRT at the start of their EHR reporting period;

3. The EP operates in a jurisdiction where no public health agency provides information timely on capability to receive cancer case data; or

4. The EP operates in a jurisdiction for which no public health agency that is capable of accepting the specific standards required by CEHRT at the start of their EHR reporting period can enroll additional EPs

6 Capability to identify and report specific cases to a specialized registry (other than a cancer registry), except where prohibited, and in accordance with applicable law and practice

Successful ongoing submission of specific case information from CEHRT to a specialized registry for the entire EHR reporting period


2. Specialized registry interface

Any EP who meets at least one of the following criteria may be excluded from this objective:

1. The EP does not diagnose or directly treat any disease associated with a specialized registry sponsored by a relevant national specialty society, or a public health agency (PHA) in his/her jurisdiction;

2. The EP operates in a jurisdiction for which no specialized registry sponsored by a relevant national specialty society is capable of receiving electronic information in the specific standards required by CEHRT at the beginning of their EHR reporting period; or

3. PHA does not provide timely information on such capability.

4. PHA is unable to enroll additional EPs on time for the EHR reporting period

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