How To
- How to add a Patient
- How to check Eligibility
- How to add an Appointment
- How to add a Chart record. Mode #1
- How to add a Chart record. Mode #2
- How to add a Visit Code
- How to add Vital Signs
- How to add Family history
- How to add Common Allergies
- How to add Medication Allergies
- How to add Immunization
- How to add Functional and Cognitive status
- How to add Risk Category assessment
- How to add Laboratory Order
- How to add Laboratory Result
- How to add Diagnostic Imaging Order
- How to add Diagnostic imaging Result
- How to add Medication
- How to add Prescription
- How to add Medication Order not done
- How to add Problem/Diagnosis
- How to add Procedure
- How to add Procedure Intolerance
- How to add Goals
- How to add Instructions
- How to add Interventions
- How to add Referral
- How to add External Document
- How to add Care Team Member
- How to add SuperBill
- How to add Communication
Billing
ACI Transition
MIPS
PQRS
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Depression Utilization of the PHQ-9 Tool (CMS 160v3, NQF 0712)
Description
Adult patients age 18 and older with the diagnosis of major depression or dysthymia who have a PHQ-9 tool administered at least once during a 4-month period in which there was a qualifying visit.
Denominator: Adult patients age 18 and older with an office visit and the diagnosis of major depression or dysthymia during each four month period.
Numerator: Adult patients who have a PHQ-9 tool administered at least once during the four month period.
Denominator Exclusion: If one of the following happened:
- Patients who died;
- Patients who received hospice services;
- Patients who were permanent nursing home residents;
- Patients with a diagnosis of bipolar disorder;
- Patients with a diagnosis of personality disorder;
Denominator Exceptions: None.
How to meet denominator requirements:
- Patients age >=18
- Patient has at least one visit with one of the following visit codes: 90791, 90792, 90832, 90834, 90837.
99324 Domiciliary or rest home visit for the evaluation and management of a new patient, which requires these 3 key components: A problem focused history; A problem focused examination; and Straightforward medical decision making. Counseling and/or coordination of care with other physicians, other qualified health care professionals, or agencies are provided consistent with the nature of the problem(s) and the patient's and/or family's needs. Usually, the presenting problem(s) are of low severity. Typically, 20 minutes are spent with the patient and/or family or caregiver. 99326 Domiciliary or rest home visit for the evaluation and management of a new patient, which requires these 3 key components: A detailed history; A detailed examination; and Medical decision making of moderate complexity. Counseling and/or coordination of care with other physicians, other qualified health care professionals, or agencies are provided consistent with the nature of the problem(s) and the patient's and/or family's needs. Usually, the presenting problem(s) are of moderate to high severity. Typically, 45 minutes are spent with the patient and/or family or caregiver. -
Preventive Care and Screening: Screening for High Blood Pressure and Follow-Up Documented (CMS 22v3)
Description
Percentage of patients aged 18 years and older seen during the reporting period who were screened for high blood pressure AND a recommended follow-up plan is documented based on the current blood pressure (BP) reading as indicated
Denominator: All patients aged 18 years and older before the start of the measurement period.
Numerator: Patients who were screened for high blood pressure AND have a recommended follow-up plan documented, as indicated if the blood pressure is pre-hypertensive or hypertensive.
Denominator Exclusion: Patient has an active diagnosis of hypertension.
Denominator Exceptions: Patient Reason(s): Patient refuses to participate OR Medical Reason(s): Patient is in an urgent or emergent medical situation where time is of the essence and to delay treatment would jeopardize the patient’s health status. This may include but is not limited to severely elevated BP when immediate medical treatment is indicated.
How to meet denominator requirements:
- Patients age >=18
- Patient has at least one visit with one of the following visit codes: 90791, 90792, 90832, 90834, 90837.
99334 Domiciliary or rest home visit for the evaluation and management of an established patient, which requires at least 2 of these 3 key components: A problem focused interval history; A problem focused examination; Straightforward medical decision making. Counseling and/or coordination of care with other physicians, other qualified health care professionals, or agencies are provided consistent with the nature of the problem(s) and the patient's and/or family's needs. Usually, the presenting problem(s) are self-limited or minor. Typically, 15 minutes are spent with the patient and/or family or caregiver. 99326 Domiciliary or rest home visit for the evaluation and management of a new patient, which requires these 3 key components: A detailed history; A detailed examination; and Medical decision making of moderate complexity. Counseling and/or coordination of care with other physicians, other qualified health care professionals, or agencies are provided consistent with the nature of the problem(s) and the patient's and/or family's needs. Usually, the presenting problem(s) are of moderate to high severity. Typically, 45 minutes are spent with the patient and/or family or caregiver. 99334 Domiciliary or rest home visit for the evaluation and management of an established patient, which requires at least 2 of these 3 key components: A problem focused interval history; A problem focused examination; Straightforward medical decision making. Counseling and/or coordination of care with other physicians, other qualified health care professionals, or agencies are provided consistent with the nature of the problem(s) and the patient's and/or family's needs. Usually, the presenting problem(s) are self-limited or minor. Typically, 15 minutes are spent with the patient and/or family or caregiver. 99326 Domiciliary or rest home visit for the evaluation and management of a new patient, which requires these 3 key components: A detailed history; A detailed examination; and Medical decision making of moderate complexity. Counseling and/or coordination of care with other physicians, other qualified health care professionals, or agencies are provided consistent with the nature of the problem(s) and the patient's and/or family's needs. Usually, the presenting problem(s) are of moderate to high severity. Typically, 45 minutes are spent with the patient and/or family or caregiver. 99334 Domiciliary or rest home visit for the evaluation and management of an established patient, which requires at least 2 of these 3 key components: A problem focused interval history; A problem focused examination; Straightforward medical decision making. Counseling and/or coordination of care with other physicians, other qualified health care professionals, or agencies are provided consistent with the nature of the problem(s) and the patient's and/or family's needs. Usually, the presenting problem(s) are self-limited or minor. Typically, 15 minutes are spent with the patient and/or family or caregiver.
Meaningful Use | Stage 1
Core Objectives EP must complete 13 core objectives
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Computerized provider order entry (CPOE) for Medication Orders
Objective Use computerized provider order entry (CPOE) for medication orders directly entered by any licensed healthcare professional who can enter orders into the medical record per state, local and professional guidelines.
Measure More than 30 percent of all unique patients with at least one medication in their medication list seen by the EP have at least one medication order entered using CPOE.
Optional Alternate: More than 30 percent of medication orders created by the EP during the EHR reporting period are recorded using CPOE.
Exclusion Any EP who writes fewer than 100 prescriptions during the EHR reporting period.
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Drug-drug and drug-allergy interaction checks
Objective Implement drug-drug and drug-allergy interaction checks.
Measure The EP has enabled this functionality for the entire EHR reporting period.
Exclusion No exclusion.
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Maintain problem list
Objective Maintain an up-to-date problem list of current and active diagnoses.
Measure More than 80 percent of all unique patients seen by the EP have at least one entry or an indication that no problems are known for the patient recorded as structured data.
Exclusion No exclusion.
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E-Prescribing (eRx)
Objective Generate and transmit permissible prescriptions electronically (eRx).
Measure More than 40 percent of all permissible prescriptions written by the EP are transmitted electronically using certified EHR technology.
Exclusion 1. Any EP who writes fewer than 100 prescriptions during the EHR reporting period.
2. Any EP who 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/her EHR reporting period.
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Medication list
Objective Maintain active medication list.
Measure More than 80 percent of all unique patients seen by the EP have at least one entry (or an indication that the patient is not currently prescribed any medication) recorded as structured data.
Exclusion No exclusion.
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Medication allergy list
Objective Maintain active medication allergy list.
Measure More than 80 percent of all unique patients seen by the EP have at least one entry (or an indication that the patient has no known medication allergies) recorded as structured data.
Exclusion No exclusion.
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Record demographics
Objective Record all of the following demographics:
(A) Preferred language
(B) Gender
(C) Race
(D) Ethnicity
(E) Date of birthMeasure More than 50 percent of all unique patients seen by the EP have demographics recorded as structured data.
Exclusion No exclusion.
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Record and chart changes in vital signs
Objective Record and chart changes in the following vital signs:
(A) Height
(B) Weight
(C) Blood pressure
(D) Calculate and display body mass index (BMI)
(E) Plot and display growth charts for children 0-20 years, including BMIMeasure For more than 50 percent of all unique patients seen by the EP during the EHR reporting period have blood pressure (for patients age 3 and over only) and height and weight (for all ages) recorded as structured data.
Exclusion Any EP who:
1. Sees no patients 3 years or older is excluded from recording blood pressure;
2. Believes that all three vital signs of height, weight, and blood pressure have no relevance to their scope of practice is excluded from recording them;
3. Believes that height and weight are relevant to their scope of practice, but blood pressure is not, is excluded from recording blood pressure; or
4. Believes that blood pressure is relevant to their scope of practice, but height and weight are not, is excluded from recording height and weight.
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Record smoking status
Objective Record smoking status for patients 13 years old or older.
Measure More than 50 percent of all unique patients 13 years old or older seen by the EP have smoking status recorded as structured data.
Exclusion Any EP who sees no patients 13 years or older.
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Implement clinical decision support rules
Objective Implement one clinical decision support rule relevant to specialty or high clinical priority along with the ability to track compliance with that rule.
Measure Implement one clinical decision support rule.
Exclusion No exclusion.
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Provide patients with timely electronic access to their health information
Objective Provide patients the ability to view online, download and transmit their health information within four business days of the information being available to the EP.
Measure More than 50 percent of all unique patients seen by the EP during the EHR reporting period are provided timely (available to the patient within 4 business days after the information is available to the EP) online access to their health information, with the ability to view, download, and transmit to a third party.
Exclusion Any EP who neither orders nor creates any of the information listed for inclusion, except for "Patient name" and "Provider's name and office contact information, may exclude the measure.
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Clinical summaries
Objective Provide clinical summaries for patients for each office visit.
Measure Clinical summaries provided to patients for more than 50 percent of all office visits within 3 business days.
Exclusion Any EP who has no office visits during the EHR reporting period.
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Protect electronic health information
Objective Protect electronic health information created or maintained by the certified EHR technology through the implementation of appropriate technical capabilities.
Measure Conduct or review a security risk analysis in accordance with the requirements under 45 CFR 164.308(a)(1) and implement security updates as necessary and correct identified security deficiencies as part of its risk management process.
Exclusion No exclusion.
Menu Objectives EP must complete 5 objectives out of 9 from menu set
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Drug-formulary checks
Objective Implement drug formulary checks.
Measure The EP has enabled this functionality and has access to at least one internal or external formulary for the entire EHR reporting period.
Exclusion Any EP who writes fewer than 100 prescriptions during the EHR reporting period.
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Clinical Lab Test Results
Objective Incorporate clinical lab test results into EHR as structured data.
Measure More than 40 percent of all clinical lab test 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.
Exclusion An EP who orders no lab tests whose results are either in a positive/negative or numeric format during the EHR reporting period.
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Generate lists of patients by specific conditions
Objective Generate lists of patients by specific conditions to use for quality improvement, reduction of disparities, research, or outreach.
Measure Generate at least one report listing patients of the EP with a specific condition.
Exclusion No exclusion.
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Patient Reminders
Objective Send reminders to patients per patient preference for preventive/follow-up care.
Measure More than 20 percent of all patients 65 years or older or 5 years old or younger were sent an appropriate reminder during the EHR reporting period.
Exclusion An EP who has no patients 65 years old or older or 5 years old or younger with records maintained using certified EHR technology.
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Patient-specific Education Resources
Objective Use certified EHR technology to identify patient-specific education resources and provide those resources to the patient if appropriate.
Measure More than 10 percent of all unique patients seen by the EP are provided patient-specific education resources.
Exclusion No exclusion.
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Medication reconciliation
Objective The EP who receives a patient from another setting of care or provider of care or believes an encounter is relevant should perform medication reconciliation.
Measure The EP performs medication reconciliation for more than 50 percent of transitions of care in which the patient is transitioned into the care of the EP.
Exclusion An EP who was not the recipient of any transitions of care during the EHR reporting period.
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Summary of care record for each transition of care/referrals
Objective The EP who transitions their patient to another setting of care or provider of care or refers their patient to another provider of care should provide summary care record for each transition of care or referral.
Measure 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.
Exclusion An EP who neither transfers a patient to another setting nor refers a patient to another provider during the EHR reporting period.
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Immunization Registries Data Submission*
Objective Capability to submit electronic data to immunization registries or immunization information systems and actual submission according to applicable law and practice.
Measure Performed 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 to which the EP submits such information has the capacity to receive the information electronically), except where prohibited.
Exclusion An EP who administers no immunizations during the EHR reporting period, where no immunization registry has the capacity to receive the information electronically, or where it is prohibited.
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Syndromic Surveillance Data Submission*
Objective Capability to submit electronic syndromic surveillance data to public health agencies and actual submission according to applicable law and practice.
Measure Performed 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 to which an EP submits such information has the capacity to receive the information electronically) except where prohibited.
Exclusion An EP who does not collect any reportable syndromic information on their patients during the EHR reporting period, does not submit such information to any public health agency that has the capacity to receive the information electronically, or if it is prohibited.
* At least 1 public health objective must be selected.
Meaningful Use | Modified Stage 2
Objectives EP must complete 10 objectives, including one consolidated public health reporting objective.
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Objective 1: Protect Patient Health Information
How to meet requirements of the ObjectiveObjective Protect electronic protected health information (ePHI) created or maintained by the Certified EHR Technology through the implementation of appropriate technical capabilities.
Measure Conduct or review a security risk analysis in accordance with the requirements in 45 CFR 164.308(a)(1), including addressing the security (to include encryption) of ePHI created or maintained in Certified EHR Technology in accordance with requirements under 45 CFR 164.312(a)(2)(iv) and 45 CFR 164.306(d)(3), and implement security updates as necessary and correct identified security deficiencies as part of the EP’s risk management process.
Exclusion None.
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Objective 2: Clinical Decision Support
How to meet requirements of the ObjectiveObjective 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.
Exclusion For the second measure, any EP who writes fewer than 100 medication orders during the EHR reporting period.
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Objective 3: Computerized provider order entry (CPOE)
How to meet requirements of the ObjectiveObjective Use computerized provider order entry (CPOE) for medication, laboratory and radiology orders directly entered by any licensed healthcare professional who can enter orders into the medical record per state, local and professional guidelines.
Measure 1 More than 60 percent of medication orders created by the EP during the EHR reporting period are recorded using computerized provider order entry.
Exclusion for Measure 1 Any EP who writes fewer than 100 medication orders during the EHR reporting period.
Measure 2 More than 30 percent of laboratory orders created by the EP during the EHR reporting period are recorded using computerized provider order entry.
Exclusion for Measure 2 Any EP who writes fewer than 100 laboratory orders during the EHR reporting period.
Measure 3 More than 30 percent of radiology orders created by the EP during the EHR reporting period are recorded using computerized provider order entry.
Exclusion for Measure 3 Any EP who writes fewer than 100 radiology orders during the EHR reporting period.
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Objective 4: E-Prescribing (eRx)
How to meet requirements of the ObjectiveObjective Generate and transmit permissible prescriptions electronically (eRx).
Measure More than 50 percent of permissible prescriptions written by the EP are queried for a drug formulary and transmitted electronically using Certified EHR Technology.
Exclusion Any provider who:
- Writes fewer than 100 permissible prescriptions during the EHR reporting period;
- Does not have a pharmacy within his or her 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 5: Health Information Exchange
How to meet requirements of the ObjectiveObjective The EP who transitions their patient to another setting of care or provider of care or refers their patient to another provider of care provides a summary care record for each transition of care or referral.
Measure The EP that transitions or refers their patient to another setting of care or provider of care must (1) use Certified EHR Technology to create a summary of care record; and (2) electronically transmit such summary to a receiving provider for more than 10 percent of transitions of care and referrals.
Exclusion Any EP who transfers a patient to another setting or refers a patient to another provider less than 100 times during the EHR reporting period.
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Objective 6: Patient Specific Education
How to meet requirements of the ObjectiveObjective Use clinically relevant information from Certified EHR Technology to identify patient-specific education resources and provide those resources to the patient.
Measure Patient specific education resources identified by 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.
Exclusion Any EP who has no office visits during the EHR reporting period.
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Objective 7: Medication reconciliation
How to meet requirements of the ObjectiveObjective The EP who receives a patient from another setting of care or provider of care or believes an encounter is relevant performs medication reconciliation.
Measure The EP performs medication reconciliation for more than 50 percent of transitions of care in which the patient is transitioned into the care of the EP.
Exclusion Any EP who was not the recipient of any transitions of care during the EHR reporting period.
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Objective 8: Patient Electronic Access (VDT)
How to meet requirements of the ObjectiveObjective Provide patients the ability to view online, download, and transmit their health information within 4 business days of the information being available to the EP.
Measure 1 More than 50% of all unique patients seen by the eligible provider (EP) during the EHR reporting period are provided timely access to view online, download, and transmit to a third party their health information subject to the EP’s discretion to withhold certain information.
Measure 2 For an EHR reporting period in 2016, at least one patient seen by the EP during the EHR reporting period (or patient-authorized representative) views, downloads or transmits his or her health information to a third party during the EHR reporting period.
Exclusion Any provider who:
- neither orders nor creates any of the information listed for inclusion as part of the measures except for “Patient Name” and “Provider’s name and office contact information”;
- 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 may exclude Measure 2 only. -
Objective 9: Secure Messaging
How to meet requirements of the ObjectiveObjective Use secure electronic messaging to communicate with patients on relevant health information.
Measure For an EHR reporting period in 2016, for at least 1 patient seen by the EP during the EHR reporting period, a secure message was sent using the electronic messaging function of Certified EHR Technology to the patient (or the patient-authorized representative), or in response to a secure message sent by the patient (or the patient-authorized representative) during the EHR reporting period.
For an EHR reporting period in 2017, for more than 5 percent of unique patients seen by the EP during the EHR reporting period, a secure message was sent using the electronic messaging function of Certified EHR Technology to the patient (or the patient-authorized representative), or in response to a secure message sent by the patient (or the patient-authorized representative) during the EHR reporting period.
Exclusion Any EP who has no office visits during the EHR reporting period, or any EP who conducts 50 percent or more of his or her patient encounters in a county that does not have 50 percent or more of its housing units with 4Mbps broadband availability according to the latest information available from the FCC on the first day of the EHR reporting period.
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Objective 10: Public Health Reporting
How to meet requirements of the ObjectiveObjective The EP is in active engagement with a public health agency to submit electronic public health data from CEHRT except where prohibited and in accordance with applicable law and practice.
Measure Option 1 Immunization Registry Reporting: The EP is in active engagement with a public health agency to submit immunization data.
Exclusion Any EP meeting one or more of the following criteria may be excluded from the immunization registry reporting measure if the EP:
- Does not administer any immunizations to any of the populations for which data is collected by its jurisdiction's immunization registry or immunization information system during the EHR reporting period;
- Operates in a jurisdiction for which no immunization registry or immunization information system is capable of accepting the specific standards required to meet the CEHRT definition at the start of the EHR reporting period; or
- Operates in a jurisdiction where no immunization registry or immunization information system has declared readiness to receive immunization data from the EP at the start of the EHR reporting period.Measure Option 2 Syndromic Surveillance Reporting: The EP is in active engagement with a public health agency to submit syndromic surveillance data.
Exclusion Any EP meeting one or more of the following criteria may be excluded from the syndromic surveillance reporting measure if the EP:
- Is not in a category of providers from which ambulatory syndromic surveillance data is collected by their jurisdiction's syndromic surveillance system;
- Operates in a jurisdiction for which no public health agency is capable of receiving electronic syndromic surveillance data from EPs in the specific standards required to meet the CEHRT definition at the start of the EHR reporting period; or
- Operates in a jurisdiction where no public health agency has declared readiness to receive syndromic surveillance data from EPs at the start of the EHR reporting period.Measure Option 3 Specialized Registry Reporting: The EP is in active engagement to submit data to a specialized registry.
Exclusion Any EP meeting at least one of the following criteria may be excluded from the specialized registry reporting measure if the EP:
- Does not diagnose or treat any disease or condition associated with, or collect relevant data that is collected by, a specialized registry in their jurisdiction during the EHR reporting period;
- Operates in a jurisdiction for which no specialized registry is capable of accepting electronic registry transactions in the specific standards required to meet the CEHRT definition at the start of the EHR reporting period; or
- Operates in a jurisdiction where no specialized registry for which the EP is eligible has declared
readiness to receive electronic registry transactions at the beginning of the EHR reporting period.
* EPs must meet two public health measures in 2016 and 2017.
Meaningful Use
Meaningful use is using certified electronic health record (EHR) technology to:
- Improve quality, safety, efficiency, and reduce health disparities
- Engage patients and family
- Improve care coordination, and population and public health
- Maintain privacy and security of patient health information
Ultimately, it is hoped that the meaningful use compliance will result in:
- Better clinical outcomes
- Improved population health outcomes
- Increased transparency and efficiency
- Empowered individuals
- More robust research data on health systems