Avatar Meaningful Use Kickoff Guide
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Avatar Meaningful Use
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Kickoff Guide
February 2012Contents CONTENTS .................................................................................................................................................................................. 2 MEANINGFUL USE OVERVIEW ............................................................................................................................................. 3 WHAT IS MEANINGFUL USE ........................................................................................................................................................... 3 WHAT ARE THE REQUIREMENTS FOR STAGE 1 OF MEANINGFUL USE (2011 AND 2012)? .......................................................................... 4 NETSMART’S MEANINGFUL USE RESPONSE ......................................................................................................................... 8 NETSMART’S ROLE ....................................................................................................................................................................... 8 PRODUCTS REQUIRED FOR STAGE 1 ................................................................................................................................................. 8 MEANINGFUL USE INFORMATION SOURCE ........................................................................................................................................ 8 IMPLEMENTATION MODELS .............................................................................................................................................. 10 IMPLEMENTATION MODELS ......................................................................................................................................................... 10 ORDER ENTRY INFORMATION ....................................................................................................................................................... 12 ORDERCONNECT INFORMATION.................................................................................................................................................... 13 ARRA MEASURES REPORTING............................................................................................................................................ 15 CLINICAL QUALITY MEASURES (CQM) ........................................................................................................................................... 16 MEANINGFUL USE MEASURES ...................................................................................................................................................... 18 CREATING THE ARRA MEASURES REPORTS ..................................................................................................................................... 22 MEANINGFUL USE SETUP CHECKLIST OVERVIEW ............................................................................................................... 27
Avatar Meaningful Use Kick Off Guide
Meaningful Use Overview
What is Meaningful Use
The American Recovery and Reinvestment Act of 2009 (ARRA Legislation) authorizes the Centers
for Medicare and Medicaid Services (CMS) to provide reimbursement incentives for eligible
professionals who are successful in becoming “meaningful users” of certified EHR technology.
These incentives were created to encourage adoption of EHRs to achieve specified improvements
in care delivery and promote advancement in health care processes and outcomes.
Simply put, "meaningful use" means providers need to show they're using certified EHR
technology in ways that can be measured significantly in quality and in quantity. In addition to
the monetary incentives, the adoption of EHRs can improve quality of care, advance patient
safety, increase customer satisfaction and enhance office efficiency. Facilities and practices using
a certified EHR may also experience increased profitability through reduced costs and increased
revenue.
While the incentives offer a positive push toward EHR use, do keep in mind that an eligible
provider isn’t meaningfully using a certified EHR by 2015, penalties will be assessed via Medicare
payment reductions. For more details on Meaningful Use, refer to the CMS website at:
http://www.cms.gov/EHRIncentivePrograms/.
How do I Meet Meaningful Use Requirements?
To qualify for incentive payments, meaningful use requirements must be met in the following
ways:
Medicare EHR Incentive Program—Eligible professionals must successfully
demonstrate meaningful use of certified electronic health record technology every
year they participate in the program.
Medicaid EHR Incentive Program—Eligible professionals may qualify for incentive
payments if they adopt, implement, upgrade or demonstrate meaningful use in their
first year of participation. They must successfully demonstrate meaningful use for
subsequent participation years.
Adopted: Acquired and installed certified EHR technology. (For example, can show
evidence of purchase.)
Implemented: Began using certified EHR technology. (For example, provide staff
training or data entry of patient demographic information into EHR.)
Upgraded: Expanded existing technology to meet certification requirements. (For
example, upgrade to certified EHR technology or add new functionality to meet the
definition of certified EHR technology.)
NOTE: An Agency that only provides inpatient services won’t qualify for Meaningful Use. An
Inpatient service is defined as one that is billed using a Place of Service Code of 21 or 23.
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What are the requirements for Stage 1 of Meaningful
Use (2011 and 2012)?
Meaningful use includes both a core set and a menu set of objectives that are specific to eligible
professionals. An eligible provider must have legal access to a certified EHR or a combination of
EHRs that cover 100% of the Stage 1 Meaningful Use requirements, including all of the Menu set.
While an eligible provider can defer “using” five menu criteria they cannot defer “possessing” the
software to meet those five criteria.
For eligible professionals, there are a total of 25 meaningful use objectives. To
qualify for an incentive payment, 20 of these 25 objectives must be met.
There are 15 required core objectives.
The remaining 5 objectives may be chosen from the list of 10 menu set
objectives. Beginning in 2013 these objectives become core.
Core Set for Eligible Professionals:
1. Use CPOE (computerized provider order entry) for medication orders directly entered by any
licensed healthcare professional that can enter orders into the medical record per state, local
and professional guidelines.
Criteria #170.304(a)- Computerized Provider Order Entry
2. Implement drug-drug and drug-allergy interaction checks.
Criteria #170.302(a)- Drug-Drug, Drug-Allergy Checks
3. Maintain an up-to-date problem list of current and active diagnoses.
Criteria #170.302(c)- Problem List
4. Generate and transmit permissible prescriptions electronically (eRx).
Criteria #170.304(b)- ePrescribing
5. Maintain active medication list.
Criteria #170.302(d)- Medication List
6. Maintain active medication allergy list.
Criteria #170.302(e)- Medication Allergy List
7. Record demographics:
a. Preferred language
b. Gender
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c. Race
d. Ethnicity
e. Date of birth
Criteria #170.304(c)- Record Demographics
8. Record and chart changes in 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 2-20 years, including BMI
Criteria #170.302(f)- Vital Signs
9. Record smoking status for patients 13 years old or older.
Criteria #170.302(g)- Smoking Status
10. Report ambulatory clinical quality measures to CMS or, in the case of Medicaid EPs, the States.
Criteria #170.304(j)- Clinical Quality Measures
11. Implement one clinical decision support rule relevant to specialty or high clinical priority.
Criteria #170.304(e)- Clinical Decision Support
12. Provide patients with an electronic copy of their health information (including diagnostic test
results, problem list, medication lists, and medication allergies) upon request.
Criteria #170.304(f)- Electronic Copy
13. Provide clinical summaries for patients for each office visit.
Criteria #170.304(h)- Clinical Summaries of Office Visit
14. Establish the capability to exchange key clinical information (for example, problem list,
medication list, allergies, and diagnostic test results), among providers of care and patient
authorized entities electronically.
Criteria #170.304(i)- Exchange Patient Summary Record
15. Protect electronic health information created or maintained by the certified EHR technology
through the implementation of appropriate technical capabilities.
Criteria #170.302(o)- Access Control
Criteria #170.302(p)- Emergency Access
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Criteria #170.302(q)- Automatic Log-off
Criteria #170.302(r)- Audit Log
Criteria #170.302(s)- Integrity
Criteria #170.302(t)- Authentication
Criteria #170.302(u)- General Encryption
Criteria #170.302(v)- HIE Encryption
Criteria #170.302(w)- Accounting of Disclosures
Menu (Optional) Set for Eligible Professionals:
1. Implement drug-formulary checks.
Criteria #170.302(b)- Drug Formulary Check
2. Incorporate clinical lab-test results into certified EHR technology as structured data.
Criteria #170.302(h)- Incorporate Laboratory Test Results
3. Generate patient lists by specific conditions to use for quality improvement, reduction of
disparities, research or outreach.
Criteria #170.302(i)- Patient Lists
4. Send patient reminders per patient preference for preventive/follow-up care.
Criteria #170.304(d)- Patient Reminder List
5. Provide patients with timely electronic access to their health information (including lab results,
problem list, medication lists, and allergies) within 4 business days of the information being
available to the EP.
Criteria #170.304 (g)- Timely Access
6. Use certified EHR technology to identify patient-specific education resources and provide those
resources to the patient if appropriate.
Criteria #170.302(m)- Patient Education Resources
7. Perform medication reconciliation when the EP receives a patient from another setting of care
or provider of care or believes an encounter is relevant.
Criteria #170.302(j)- Medication Reconciliation
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8. Provide summary of care record for each transition of care or referral when the EP transitions
their patient to another setting of care or provider of care or refers their patient to another
provider of care.
It is derived by the Meaningful Use Measures. There are no direct criteria associated with this.
9. Establish the capability to submit electronic data to immunization registries or immunization
information systems and actual submission in accordance with applicable law and practice.
Criteria #170.302(k)- Immunizations
10. Establish the capability to submit electronic syndromic surveillance data to public health
agencies and actual submission in accordance with applicable law and practice.
Criteria #170.302(l)- Public Health Surveillance
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Netsmart’s Meaningful Use Response
Netsmart’s Role
Netsmart provides solutions that help meet the evolving definition of “meaningful use”. These
include electronic health records, order entry, e-prescribing, Health Information Exchange
connectivity and consumer portals. Avatar™RADplus 2010 electronic health record (EHR) software
has achieved 100 percent ONC-ATCB ARRA ambulatory and inpatient certification, making
Netsmart the first behavioral healthcare software provider to offer a complete ARRA-certified EHR
for Eligible Professionals (EPs).
Products required for Stage 1
RADplus 2010
Cache 2008
Avatar PM 2008
Avatar CWS 2010
Avatar Order Entry 2011 for Inpatient
InfoScriber or OrderConnect for Outpatient
ConsumerConnect
Avatar CareConnect
Meaningful Use Information Source
The following table details where information pertaining to Meaningful Use is entered/processed in
Avatar:
Active Medication Allergy List Ambulatory-OrderConnect
Inpatient-Allergies and Hypersensitivities [Avatar CWS]
Active Medication List Ambulatory-OrderConnect
Inpatient-Client Profile/Physicians Orders [Avatar Order Entry]
Clinical Decision Support Ambulatory-OrderConnect
Inpatient-Client Profile/Physicians Orders [Avatar Order Entry]
Both- Client Health Maintenance
Clinical Quality Measure ARRA Measures Reporting [Avatar CWS]
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CPOE for Medication Orders Ambulatory-OrderConnect
Drug-drug and Drug-allergy Checks Inpatient-Client Profile/Physicians Orders [Avatar Order Entry]
Formulary Checks
Electronic Prescribing OrderConnect
Immunization Registries Client Health Maintenance [Avatar CWS]
Sharing Critical PH Information [Avatar CWS]
Lab Test Results Ambulatory-OrderConnect
Inpatient-Avatar Results Table module (CWS Enhancement #99) –
Results Entry [Avatar CWS]
Meaningful Use Measures ARRA Measures Reporting [Avatar CWS]
Medication Reconciliation Ambulatory-OrderConnect
Inpatient-Medication Reconciliation [Avatar CWS]
Patient Clinical Summaries of Visit Create and Export Clinical Information [Avatar CWS]
Disclosure Management [Avatar PM]
A service associated with ARRA reporting must be rendered.
Patient Electronic Copy of EHR Create and Export Clinical Information [Avatar CWS]
Disclosure Management [Avatar PM]
Patient Reminders Patient Reminder List [Avatar PM]
Patient Specific Education Client/Caregiver Education [Avatar CWS]
Patient Timely Electronic Access to ConsumerConnect
EHR
Problem List Problem List [Avatar CWS]
Sharing Critical PH Information [Avatar CWS]
Record Demographics Preadmission
Admission
Update Client Data
Record Smoking Status Admission [Other Client Data tab]
Update Client Data [Avatar PM]
Summary of Care at Transitions of Discharge Forms [Avatar PM]
Care
Leaves [Avatar PM]
Record Vital Signs Vitals Entry [Avatar CWS]
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Implementation Models
Implementation Models
The products you’ll use for meaningful use will vary based on your implementation, particularly
around medication management and orders. Typically, an outpatient (ambulatory) facility will use
OrderConnect to manage medications and orders; an inpatient (hospital) will use Avatar Order
Entry plus OrderConnect (for E-prescribing).
There are three different implementation approaches related to lab results:
1. Avatar with OrderConnect
2. Avatar with Order Entry
3. Avatar with OrderConnect for outpatient and Order Entry for inpatient
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Here is a summary of forms/products for these two models:
Criteria # Core Criteria Name Avatar Forms/Products in Avatar Forms/Products in
or OrderConnect Model OE Model
Menu
170.302(a) C Drug-drug, drug- OrderConnect Avatar OE
allergy checks
170.302(b) M Drug formulary OrderConnect Avatar OE
check
170.302(c) C Problem list Problem List Same
170.302(d) C Medication list OrderConnect Avatar OE
170.302(e) C Medication allergy OrderConnect CWS Allergies and
list Hypersensitivities
170.302(f) C Vital signs Vitals Entry Same
170.302(g) C Smoking status Admission (Outpatient) Same
Update Client Data
170.302(h) M Incorporate Importing results from Importing results from
laboratory test OrderConnect CareConnect
results
170.302(i) M Patient lists Client List Same
170.302(j) M Medication OrderConnect Medication Reconciliation
reconciliation
170.302(k) M Immunizations Client Health Maintenance Same
Sharing Critical PH Information
170.302(l) M Public health Sharing Critical PH Information Same
surveillance
170.302(m) M Patient education Client/Caregiver Education Same
resources
170.302(n) C Meaningful use ARRA Measures Reporting Same
measures
170.302(o) C Access control Role Definition Same
User Definition
170.302(p) C Emergency access Emergency Access Same
170.302(q) C Automatic log-off User Definition Same
170.302(r) C Audit log Event Log Report Same
170.302(s) C Integrity Create and Export Clinical Same
Information
170.302(t) C Authentication Role Definition Same
User Definition
170.302(u) C General encryption Create and Export Clinical Same
Information
170.302(v) C HIE encryption Create and Export Clinical Same
Information
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Criteria # Core Criteria Name Avatar Forms/Products in Avatar Forms/Products in
or OrderConnect Model OE Model
Menu
170.302(w) C Accounting of Disclosure Management Same
disclosures
170.304(a) C Computerized OrderConnect Avatar OE
provider order
entry
170.304(b) C ePrescribing OrderConnect Same
170.304(c) C Record Admission (Outpatient) Same
demographics Update Client Data
170.304(d) M Patient reminder Patient Reminder List Same
list
170.304(e) C Clinical decision OrderConnect Avatar OE
support
170.304(f) C Electronic copy Create and Export Clinical Same
Information
170.304(g) M Timely access ConsumerConnect Same
170.304(h) C Clinical summaries Create and Export Clinical Same
of office visit Information
170.304(i) M Exchange patient Create and Export Clinical Same
summary record Information
170.304(j) C Clinical quality ARRA Measures Reporting Same
measures
RULE OF THUMB: The system that contains your Medication Orders should also contain
your Allergies. If you are using Avatar Order Entry to enter your Medication Orders then the
Allergies must be recorded within Avatar CWS in the Allergies and Hypersensitivities Form.
If you are using OrderConnect to enter your Medications, then all Allergies should be
entered into OrderConnect.
Order Entry Information
Netsmart’s Avatar Order Entry facilitates the entry of all types of orders relating to client care in
an Inpatient setting. The order types such as Dietary, Lab, Restraint, Therapy, Pharmacy, etc. can
be filed electronically to expedite completion. Electronic filing of these orders provides
uncomplicated subsequent accessing and review of orders.
When using OrderConnect for orders and results, Avatar Order Entry is typically not used.
However, temporarily, the Order Code Set up is needed to define the ARRA Measures Reporting
set up for lab test codes and medication codes. This will eventually be replaced with a new
function outside of Order Entry.
NOTE: Clients implementing Avatar Order Entry will still need OrderConnect to satisfy the
e-Prescribing Meaningful Use requirement.
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NOTE: Clients implementing Avatar Order Entry can meet the e-Prescribing Meaningful Use
requirement if they have an internal pharmacy that they send prescriptions directly to using
an HL7 interface.
OrderConnect Information
Netsmart’s OrderConnect is a secure, Web-based prescribing and medication management
system that can be operated stand alone or integrated within an agency’s existing systems.
OrderConnect is an e-prescribing system that can create and transmit medication orders from the
user’s computer to a pharmacy. OrderConnect is used for Outpatient facilities. There are no
specific Meaningful Use set up requirements for OrderConnect. Details of OrderConnect
implementation requirements can be found within the OrderConnect User Guides.
Meaningful Use Requirements
Implementing OrderConnect will satisfy the Meaningful Use requirement for:
Computerized Provider Order Entry (CPOE)
Electronic Prescribing
Drug-Drug, Drug-Allergy Interaction Checking
Drug Formulary Checking
Medication List
Medication Allergy List
Medication Reconciliation
Clinical Decision Support
Using OrderConnect with Avatar CWS
If OrderConnect is installed at an Agency, there will be no need to use certain Forms within
Avatar CWS since the processes will be handled within OrderConnect. The following processes will
be handled within OrderConnect:
Manage Allergies
Med Orders (external Pharmacy)
E-Prescribing
Drug Interaction Checks
Drug Formulary Checks
Medication Reconciliation
Lab Orders
Lab Results- Manual Entry
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Lab Results- Import from CareConnect
Matching Method from CareConnect to OrderConnect
View Results (display)
Review Results (flag as reviewed)
Results Reconciliation
CWS Forms that should not be used when utilizing OrderConnect
If OrderConnect is installed at an Agency, there will be no need to use the following forms within
Avatar CWS since the processes will be handled within OrderConnect:
Allergies and Hypersensitivities
Medication Reconciliation
Results Entry
Results Review
Results Reconciliation
Results Importing
CWS Processes that will read data received from OrderConnect
The following processes within Avatar CWS will be able read the Medications and Allergies from
OrderConnect:
Create CCD Files
Clinical Quality Measures
Meaningful Use Measures
Education Resources
Client Lists
Client Reminder Lists
ConsumerConnect
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ARRA Measures Reporting
A component of the ARRA EHR certification is the ability to produce reports (paper and electronic)
on select measures. The Centers for Medicare and Medicaid Services (CMS) and state Medicaid
offices will use these measures to determine if a provider qualifies for the incentive monies as
well as to monitor key national health issues. Some items to note:
Measures are for Ambulatory facilities and are provider based
For Ambulatory facilities the report applies to ‘eligible’ providers only; all other
providers are excluded. Eligible providers will be defined in Practitioner Enrollment by
the addition of an ARRA eligible provider field
The report does not include any client electronic protected health information (ePHI);
only counts and calculations (denominator, numerator, exclusions, and percentage
calculations).
Measures are based on specific client services, age ranges, problems, medications,
and allergies. New fields are available in service codes, problem codes, medications
and allergies to identify those codes that apply to each ARRA measure.
The measure denominator is the total number of clients, orders, etc. that comprise
the initial population. For most measures this is the number of unique clients seen by
the EP during the reporting period.
The measure numerator is a subset of the denominator that meets additional criteria
(e.g. only clients with Hypertension).
The exclusion count applies only to a few measures (e.g. excluding clients with
certain diseases or allergies).
Measure Categories
The measures are categorized as follows:
Meaningful Use Measures (MUM)
Clinical Quality Measures (CQM)
Measures are reported in two formats: a human readable report (crystal report) and an electronic
XML format (PQRI 2009 Registry XML Specification). Currently CQM are reported in both formats
while MUM is reported in human readable report only.
Measures Using Attending Practitioner
Currently, the Attending Practitioner is used when processing the following ARRA Measures:
ALL CQM Measures
Electronic Copy to Clients
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Patient Reminders
Medication Reconciliation
Summary of Care for Transitions Out
Future Development for Attending Practitioner
There is Development in process that will limit the need to define the Attending Practitioner as
an Eligible Provider. Below is an outline of what the future development will do:
All CQM Measures- Will use the Rendering Practitioner
Electronic Copy to Clients- Will use the Rendering Practitioner
Patient Reminders- Will use the Rendering Practitioner. Each Eligible Provider who
saw the client during the reporting period will get credit for this Measure.
Medication Reconciliation- When using OrderConnect, the Medication Reconciliation
Practitioner that is sent from OrderConnect will be used. When using Avatar Order
Entry, the Practitioner who filed the Medication Reconciliation record will be used.
Summary of Care for Transitions Out- Will use the Discharge Practitioner if the
movement is a discharge. If the movement was not a discharge, then the Attending
Practitioner will be used.
Clinical Quality Measures (CQM)
Ambulatory facilities are required to provide a minimum of 6 CQM: 3 core and 3 non-cores.
If a core measure has a zero denominator the user must replace it with an alternate
core measure
If there are not 3 non-zero denominator core/alternate core measures then the user
must replace them with non-core measures
If any of the selected non-core measures have a zero denominator then the user
must replace it with another non-core measure
However, it is permissible to report a clinical quality measure that has a zero
denominator if there aren’t 6 measures that apply to the clients served by the eligible
provider.
While there are 38 non-core measures, most are very physical health oriented.
Initially, Avatar will include 4 non-core measures and more non-core measures may
be added in the future.
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NQF Measure Name Population Category
# (i.e. Multiple Numerators/Denominators)
0004 Initiation and Engagement of Alcohol and Age 13-17 with at least one Non-core
Other Drug Dependence Treatment: (a) service
Initiation, (b) Engagement Age 13-17 with at least two
services
Age >17 with at least one
service
Age >17 with at least two
services
Age >13 with at least one
service
Age >13 with at least two
services
0013 Hypertension: Blood Pressure Age >17 with hypertension and Core
Measurement BP recorded
0018 Controlling High Blood Pressure Age 18-85 with hypertension Non-core
and BP < 140/90
0024 Weight Assessment and Counseling for Age 2-17 with BMI recorded Alternate
Children and Adolescents Age 2-17 counseled on Core
nutrition
Age 2-17 counseled on
physical activity
Age 2-11 with BMI recorded
Age 2-11 counseled on
nutrition
Age 2-11 counseled on
physical activity
Age 12-17 with BMI recorded
Age 12-17 counseled on
nutrition
Age 12-17 counseled on
physical activity
0028a Tobacco Use Assessment Age >17 with smoking status Core
recorded
0028b Tobacco Cessation Intervention Age >17 with smoking Core
cessation intervention
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NQF Measure Name Population Category
# (i.e. Multiple Numerators/Denominators)
038 Childhood Immunization Status Age 2 with DTaP vaccine Alternate
Age 2 with IPV vaccine Core
Age 2 with MMR vaccine (or
separately)
Age 2 with HIB vaccine
Age 2 with Hepatitis B vaccine
Age 2 with VZX vaccine
Age 2 with Pneumococcal
vaccine
Age 2 with Hepatitis A vaccine
Age 2 with Rotavirus vaccine
Age 2 with Influenza vaccine
Age 2 with DTaP, IPV, MMR
(or separately), VZV, and
Hepatitis B vaccines
Age 2 with DTaP, IPV, MMR
(or separately), VZV, Hepatitis
B, and Pneumococcal vaccines
0041 Influenza Immunizations for Clients Age Age >= 50 years with Influenza Alternate
50 or Older vaccine Core
0061 Diabetes: Blood Pressure Management Age 18-85 with diabetes and Non-core
BP < 140/90
0105 Antidepressant Medication Management Effective Acute Phase Non-core
Treatment
Effective Continuation Phase
Treatment
0421 Adult Weight Screening and Follow-Up Age >= 65 years Core
Age >= 18 to < 65 years
Meaningful Use Measures
Before an eligible provider (EP) can receive an incentive payment they must complete an
attestation process with their state Medicaid office (Medicaid incentives) or with CMS (Medicare
incentives). This is the process where the EP reports how well they did “meaningfully using” a
certified EHR during the reporting period.
The ARRA Measures Reporting Form creates a report of the Meaningful Use Measures that EPs
then enter to the state Medicaid or CMS website when doing the attestation. In a future ARRA
stage this will become an electronic file report. Also keep in mind that the first participation year
in the Medicaid incentive program does not require you to report MU measures.
Below is a general overview of the MU Measures. The Minimum % column indicates the
percentages for reporting. If the measure does not need to be reported, “NR” will appear in this
column.
Criteria Core/Men MU Measure Minimum % Of
Number u
170.302(o) C Access Control NR NR
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Criteria Core/Men MU Measure Minimum % Of
Number u
170.302(t) C Authentication NR NR
170.302(q) C Automatic log-off NR NR
170.304(d) M Patient Reminder List 20% Clients 65 yrs.
170.302(i) M Generate Patient Lists NR NR
170.304(g) M Timely Access (Online Access to 10% Clients Seen
Health Information)
170.302(k) M Submission to immunization NR NR
registries
170.302(l) M Public health surveillance NR NR
170.302(m) M Client specific education resources 10% Clients Seen
170.302(u) C General Encryption NR NR
170.302(s) C Integrity NR NR
170.302(v) C Encryption when exchanging NR NR
electronic health information
170.302(e) C Maintain active medication allergy list 80% Clients Seen
170.304(a) C Computerized provider order entry 30% Medication Orders
(CPOE)
170.302(d) C Maintain active medication list 80% Clients Seen
170.302(j) M Medication reconciliation 50% Transitions In
170.302(b) M Drug formulary checks NR NR
170.302(a) C Drug-drug, drug-allergy interaction NR NR
checks
170.304(b) C ePrescribing 40% Non-controlled Rx
170.304(e) C Clinical decision support NR NR
170.302(p) C Emergency access NR NR
170.302(f)(1) C Vital signs 50% Clients Seen Age 2+
170.302(f)(2) C Calculate body mass index (BMI) NR NR
170.302(f)(3) C Plot and display growth charts NR NR
170.302(g) C Smoking status 50% Clients Seen Age 13+
170.302(w) C Accounting of disclosures (optional) NR NR
170.304(i) M Clinical Summary-Transition in Care 50% Transitions Out
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Criteria Core/Men MU Measure Minimum % Of
Number u
Out (Exchange clinical information
and patient summary record)
170.304(h) C Clinical summaries (office visit) 50% Clients Seen
170.304(f) C Electronic copy of health information 50% Client Requests
170.302(r) C Audit Log NR NR
170.304(j) C Calculate and submit clinical quality N/A N/A
measures
170.302(m) C Meaningful use measures N/A N/A
170.304(c) C Record demographics 50% Clients Seen
170.302(c) C Maintain up-to-date problem list 80% Clients Seen
170.302(h) M Incorporate laboratory test results 40% Lab Orders
These following measures have a denominator based on all unique patients regardless of whether
the patient’s records are maintained in the EHR.
MU # Measure Objective Provider Measure
170.302(c) Maintain an up-to-date problem More than 80% of all unique patients
list of current and active seen by the EP have at least one entry
diagnoses or an indication that no problems are
known for the patient recorded as
structured data
170.302 (d) Maintain active medication list More than 80% of all unique patients
seen by the EP recorded as structured
data
170.302(e) Maintain active medication More than 80% of all unique patients
allergy list seen by the EP have at least one entry
(or an indication that the patient has no
known medication allergies) recorded as
structured data
170.304 (c) and Record demographics: preferred More than 50% of all unique patients
170.306(b) language, gender, race, seen by
ethnicity, date of birth the EP have demographics recorded as
structured data
170.304 (g) Provide patients with timely More than 10% of all unique patients
electronic access to their health seen by the EP are provided timely
information (including lab (available to the patient within four
results, problem list, medication business days of being updated in the
lists, medication allergies) within certified EHR technology) electronic
four business days of the access to their health information
information being available to subject to the EP’s discretion to withhold
the EP certain information
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170.302 (m) Use certified EHR technology to More than 10% of all unique patients
identify patient-specific seen by the EP are provided patient-
education resources and provide specific education resources
those resources to the patient if
appropriate
These measures have a denominator based on all unique patients whose records are maintained
in the EHR:
MU # Measure Objective Provider Measure
170.304 (a) and Use CPOE for medication More than 30% of unique patients with
170.306 (a) orders directly entered by any at least one medication in their
licensed healthcare professional medication list seen by the EP have at
who can enter orders into the least one medication order entered
medical record per state, local using CPOE
and professional guidelines
170.304 (b) Generate and transmit More than 40% of all permissible
permissible prescriptions prescriptions written by the EP are
electronically (eRx) transmitted electronically using certified
EHR technology
170.302 (f) Record and chart changes in For more than 50% of all unique
vital signs: height, weight, blood patients age 2 and over seen by the EP,
pressure, calculate BMI, plot and height, weight and blood pressure are
display growth charts for recorded as structured data
children 2-20 including BMI
170.302 (g) Record smoking status for More than 50% of all unique patients 13
patients 13 years old or older years old or older seen by the EP have
smoking status recorded as structured
data
170.302 (h) Incorporate clinical lab-test More than 40% of all clinical lab tests
results into certified EHR results ordered by the EP during the
technology as structured data EHR reporting period whose results are
either in a positive/negative or
numerical format are incorporated in
certified EHR technology as structured
data
170.304 (f) and Provide patients with an More than 50% of all patients of the EP
170.306(d) electronic copy of their health who request an electronic copy of
information (including diagnostic their health information are provided it
test results, problem list, within 3 business days
medication lists, medication
allergies), upon request
170.304 (h) Provide clinical summaries for Clinical summaries provided to patients
patients for each office visit for more than 50% of all office visits
within 3 business days
170.304(d) Send reminders to patients per More than 20% of all unique patients 65
patient preference for years or older or 5 years old or younger
preventive/follow up care were sent an appropriate reminder
during the EHR reporting period
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170.302 (j) The EP who receives a patient The EP performs medication
from another setting of care or reconciliation for
provider of care or believes an more than 50% of transitions of care in
encounter is relevant should which the patient is transitioned into the
perform medication care of the EP.
reconciliation (POS 21 or 23)
170.304(i) and The EP who transitions their The EP who transitions or refers their
170.306(f) patient to another setting of care patient to another setting of care or
or provider of care or refers their provider of care provides a summary of
patient to another provider of care record for more than 50% of
care should provide summary of transitions of care and referrals
care record for each transition of
care or referral
Creating the ARRA Measures Reports
Prerequisites
For information to be included in ARRA Measures reporting, the following must be defined in
Avatar:
Service Codes Form: The service code must be associated with one or more ‘Include
Service in ARRA Measures’ fields.
Practitioner Enrollment Form: The practitioner must be associated with ARRA
reporting (Yes selected in the ARRA Reportable Measures field).
The service must be rendered within the reporting period (From Date field to Through
Date field).
The client’s Attending Practitioner is an eligible provider. Future development will
utilize other Practitioners, such as Rendering, for the ARRA Measures Reporting.
The Site Registry Setting must be set to either Ambulatory or Hospital to determine
what will be available for selection on the ARRA Measures Reporting Form.
Launch the ARRA Measures Reporting Form to generate the ARRA Measures Reports for either the
CQM Measures or the Meaningful Use Measures.
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In the Action field:
Select ‘Compile Report’ to assemble Avatar ARRA measures information into a
file.
Select ‘Delete Compile’ to delete a compile assembled in this form. If
appropriate, the ARRA information can be compiled into another file.
Select ‘Edit Compile’ to change meaningful uses measures in a compile (Select
Meaningful Use Measure field).
Select ‘View Report’ to generate a report of information in the compile.
Select ‘Export XML File’ to create and XML file. This requires CareConnect to be
installed or the User will receive a message stating that the action is unavailable
without CareConnect.
In the Through Date field: Enter the report through date. This date field is very
important. Typically, the ARRA Measures Reporting Date for Eligible Providers, in an
Ambulatory setting, should be set to December 31 st. There are a few exceptions to
this rule outlined below:
1st year in the Medicare Incentive program and
2nd year in the Medicaid Incentive program (1st year is
adopt/upgrade/implement – no need to report measures)
With these exceptions, the reporting period is any 90 day period and the ARRA
Measures Reporting Date would then be the last day of that 90 day period.
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The reporting date is important to the Clinical Quality Measure calculations that have
criteria tied to the start or end date. For example: here is part of the calculation for
the Antidepressant Medication Management: (a) Effective Acute Phase Treatment; (b)
Effective Continuation Phase Treatment measure:
The client’s first diagnosis of major depression was assessed anytime within the
date range of: = 245 days before
report end date
The Submission Method dictates the reporting period you wish to run ARRA Measures
Reports on. The field allows you to select 12 months, 6 months or 90 days. Medicare
requires this 90 day period in the first participation year. Medicaid requires 90 days in
the second year.
NOTE: The 6 month time frame is no longer valid. An Eligible Providers will be reporting
first on the 90 day reporting period and then the 12 month reporting period.
In the Name Of Compile field: Enter the compile name.
In the Select Clinical Quality Measures field: Choose the clinical quality measures to
include in the report.
In the Select Meaningful Use Measure field: Choose the meaningful use measures to
include in the report.
Click Process Action.
Overriding Meaningful Use Measures (Edit Compile):
Once an ARRA Measures file has been compiled, individual meaningful use measures included in
the compile can be overridden. Users must select to Edit the compiled file and proceed to page 2
of the Form. This step is necessary for any measure that isn’t currently being automatically
calculated.
In the Select Meaningful Use Measure field, select the ARRA measure. Meaningful use
measured compiled will be available for selection.
'Override' fields - enter the associated override.
Click File Override command button to process the override.
Generate the ARRA Measures report (Action field -> Compile Report), to view the
overrides.
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View Report
A crystal report will be created with two sections:
1. Meaningful Use Section
The report will have multiple providers each with multiple measures.
The human readable report should be in an easy to read format (i.e. not a dump of
the electronic file). In addition to the standard page header (organization name,
report title, report date, page number, etc.) include the following fields:
Reporting Period
Eligible Provider ID
Eligible Provider Name
Eligible Provider NPI
MU Measure Name
Numerator
Denominator
Percentage
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2. Clinical Quality Measures Section
The human readable report should be in an easy to read format (i.e. not a dump of the
electronic file). In addition to the standard page header (organization name, report title,
report date, page number, etc.) include the following fields:
Reporting Period
Eligible Provider ID
Eligible Provider Name
Eligible Provider NPI
Measure Number
Measure Name
Measure Population (if applicable)
Measure Numerator
Measure Denominator
Measure Exclusion
Percentage Reporting
Percentage Performance
The report will have multiple providers each with multiple measures. In addition, some measures
have multiple calculations. An error report is created if the denominator of a clinical quality
measure is zero. This is a signal to run the report again, this time selecting a different measure.
Export XML File
Create an electronic report for the clinical quality measures using the CMS PQRI 2009 Registry
XML Specification format. For Ambulatory only: If a measure has a zero denominator, an error
popup will show “xxx Measure has a zero denominator please select another measure” and
compile will not occur.
Note: The Centers for Medicare and Medicaid Services recently changed their plans
regarding this report. Electronic submission has been deferred until at least 2015 and the
electronic file format will be changed (i.e. the PQRI 2009 version will never be used).
Page 26 of 35
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Meaningful Use Setup Checklist Overview
The following is a brief outline of the Meaningful Use Setup required for Avatar.
Products
Upgrade to Cache 2008
Upgrade to PM 2008
Upgrade to CWS 2010
Implement InfoScriber/OrderConnect including web services to transmit data
Install or Upgrade to Order Entry 2011
Install ConsumerConnect
Install Results Table Module (Avatar CWS 2010 Enhancement #99)
Install Avatar CareConnect Version 1.4
Install CareConnect HL7 Outbound - Immunization Module
Install CareConnect HL7 Outbound - Surveillance Module
Install CareConnect HL7 Outbound – Results Module
Install CareConnect Measure Reporting
Install CareConect HL7 Inbound – Results Module
Product Updates
Install the latest Service Packs and Maintenance Releases for the following products:
RADplus 2010
PM 2008 or CalPM 2007
CWS 2010
OE 2011
ConsumerConnect
CareConnect Version 1.4
CareConnect HL7 Outbound - Results Module
CareConnect HL7 Outbound - Immunization Module
CareConnect HL7 Outbound - Surveillance Module
CareConect HL7 Inbound – Results Module
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Avatar PM Setup
Dictionaries
Update PM Dictionary - Reason for Emergency (File = User, DE = #713)
Update PM Dictionary- Smoker (File= Client, DE = #9603)
Extended Dictionary called ARRA Value (DE= #19603) must be completed for
each dictionary value in the Smoker data element. This is necessary for CQM
Measure “0028b- Tobacco Assessment and Cessation”.
Update CareConnect Dictionary- HL7 Religious Affiliation Value Set (File=Connected
Care Other Tables, DE = #24003)
This is an extended dictionary off of the Religion dictionary field that is recorded
within the Admission Form in Avatar PM. The HL7 Religious Affiliation Value Set
dictionary must be defined in order to associate with the values of the Religion
Dictionary. The extended dictionary is necessary during the generation of the
CCD and Immunization HL7 files.
Update PM Dictionary- Religion (File=Client, DE = #9)
After creating the dictionary codes/values for the HL7 Religious Affiliation Value
Set, these extended dictionary values must be associated with values within
Religion Dictionary.
Update PM Dictionary- Purpose of Information (File=Client, DE = #40007)
This field is displayed in the Disclosure Management Form on the Request Tab
to capture the purpose of the information request. This is a user defined
dictionary and is only used for reporting purposes.
Update PM Dictionary- Authorization Origin (File=Client, DE = #41000)
This field is displayed in the Disclosure Management Form on the Authorization
Tab to capture the origin of the authorization request. This is a user defined
dictionary and is only used for reporting purposes.
Registry Settings
Update PM Registry Settings
Import Reports as Disclosure Management Chart Items
Practitioner > Enrollment > Include NPI Number
Practitioner > Enrollment > Include Tax Identification Number
Forms/Functionality
Admission
To be included in the ARRA Measure statistics clients must have an Attending
Practitioner who is an Eligible Provider.
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Service Code
Add Service Codes
Smoking Cessation Counseling
BMI Dietary Consult
BMI Nutritional Counseling
BMI Physical Activity Counseling
Define services to be included in CCD as Procedures by answering “Yes” in the “Is this
service a Procedure” question within Service Codes Form.
Update Service Codes - CPT Cross Reference
Update Service Codes - ARRA Measures (for all Meaningful Use Measures and for CQM
Measures that were not defaulted for codes by the Site registry setting)
Define services to be a visit for future Site Registry Setting defaulting development
for the MU Measures.
Diagnosis Table Maintenance
Update SNOMED Codes - ARRA Measures (for all Meaningful Use Measures and for
CQM Measures that were not defaulted for codes by the Site registry setting)
Update SNOMED Codes - Include in Syndromic Surveillance Reporting
Enter a new Problem Code called “No Known Problems” that will be used for ARRA
Measures Reporting.
Practitioner Enrollment
Update each Eligible Provider (EP) Practitioner:
ARRA Reportable Measures = Y
ARRA Practitioner Type
NPI Number
Tax Identification Number
Document Management
Setup Document Management
Forms
Categories
User Definition for Document Management
Document Management Defaults
Create Folders on the Server for Documents, Archive Documents and Deleted
Documents.
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Disclosure Management
Import Reports for Disclosure Management
Event Log Definition
Complete the Event Log Definition setup
Emergency Access
Add a User Role for Emergency Access
Update User Definition
Add emergency access user role to those authorized
Avatar CWS Setup
Dictionaries
Update CWS Dictionary - Allergy Reactions (File: CWS, DE: 10002)
Update CWS Dictionary - Allergy Severity (File: CWS, DE: 10003)
Update CWS Dictionary- Status (File: CWS, DE: 10001)
Extended Dictionary- Active Allergy (DE: 10038)
Extended Dictionary- Include in Clinical Screening (DE: 10007)
Update CWS Dictionary- Education Type (File: CWS, DE: 36001)
The following Extended Dictionaries must be set:
Enable Other (DE: 36021)
Include Code in ARRA Measures Numerator (DE: 65016)
Exclude Code in ARRA Measures Numerator (DE: 65017)
Include Code in ARRA Measures Denominator (DE: 65018)
Exclude Code in ARRA Measures Denominator (DE: 65019)
Update CWS Dictionary - Education Recipient (File: CWS, DE: 36003)
Extended Dictionary- Enable Other (DE: 36021)
Update CWS Dictionary - Education Method (File: CWS, DE: 36006)
Update CWS Dictionary - Vaccine (File: Other CWS Tabled Files, DE: 60005)
The following Extended Dictionaries must be set:
Include Code in ARRA Measures Numerator (DE: 65016)
Exclude Code in ARRA Measures Numerator (DE: 65017)
Include Code in ARRA Measures Denominator (DE: 65018)
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Exclude Code in ARRA Measures Denominator (DE: 65019)
Update CWS Dictionary- Wellness Item (File: Other CWS Tabled Files, DE: 60014) for
the Client Health Maintenance information.
Update CWS Dictionary - Status (File: CWS, DE: 16214) for Vitals & Problems
Extended Dictionary- Active Status (DE: 16224)
Update CWS Dictionary – Test Results (File: Other CWS Tabled Files, DE: 99996)
The following Extended Dictionaries must be set:
Search on Code/Value
Enter the Code/Value to Be Searched For
Enter the Comparison Selection
Enter the Value to Compare Against
Update CWS Dictionary – Medications (File: Other CWS Tabled Files, DE: 99995)
Registry Settings
Update CWS Registry Settings
ARRA Measures >Site = A
NOTE: This Registry Setting should not be set until all Allergy Codes, Order Codes, SNOMED
Codes and Service Codes with CPT Cross Reference are setup in your system. This Registry
Setting will default pre-defined inclusions and exclusions for CQM Measures Reporting. This
occurs when defining this Registry Setting and it’s a one-time process.
Include Alerts X Number of Months in Advance
Send Medication Reconciliation To-Do Item to Clinician When These Events
Occur
Send Medication Reconciliation To-Do Item To
Select Directory to Import/Export File
Fields to Match on For Inbound Results
Enable Results Reconciliation
Show Results for the Last XXX Days
Show the Last XXX Results in the Details Chart
Restrict Height Entry to Specific Field
Restrict Weight Entry to Specific Field
Configure Vitals Entry Records
Vitals Entry Restrictions
URL for Test Results Website
URL for Problems Website
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URL for Medications Website
Forms/Functionality
Allergen/Reactant Code Setup (Order Entry implementations only)
Update Allergy Codes to define ARRA Measures (for all Meaningful Use Measures and
for CQM Measures that were not defaulted for codes by the Site registry setting)
Enter a new Allergy Code called “No Known Allergies” that will be used for ARRA
Measures Reporting.
Client/Caregiver Education Instructions Definition
Complete the Instructions Definition
Health Maintenance Guideline Definition
Complete the Guideline Definition
Notification Setup for Results Notification
Complete the Notification Setup for Results Notification
ARRA Measures Setup
Complete the ARRA Measures Setup Form
Document Management
Setup CCD Folder on the Server. The file path is then defined within the ‘Select
Directory to Import/Export File’ Registry Setting.
Order Entry (Order Entry Implementations Only)
Dictionaries
Update CWS Dictionary – Override Code (File: Order Entry Client Information File, DE:
20597)
The following Extended Dictionaries must be set:
Require Override Text with this Override Code
Registry Settings
Perform Age/Problem Based Alert Checks
Use Override Code-Age/Problem Based Alert
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Forms/Functionality
Order Code Setup
Answer the following Alert Questions for Order Codes, if necessary:
Alert When Client is Below Age
Alert When Client is Above Age
Alert When Client Has Any of These Active Problems
Update Order Codes to define ARRA Measures (for all Meaningful Use Measures and
for CQM Measures that were not defaulted for codes by the Site registry setting)
Enter a new Order Code called “No Known Medications” that will be used for ARRA
Measures Reporting.
Answer the ‘Is this Medication a Formulary Item?’ question.
Order Entry Facility Defaults
Answer the ‘Warn User for Non-Formulary Pharmacy Orders’ question.
Order Entry Clinical Screening System Defaults
Complete the system defaults in this form
Infoscriber (Infoscriber Implementations Only)
Registry Settings
For the 'Infoscrib.OrderOutput' table
Start Date + Time
OrderConnect (OrderConnect Implementations Only)
Registry Settings
For the ‘SYSTEM.results_header’ Table:
Maximum Records Retrieved Per Request
Start Date & Time
Enable Interface
User ID for Data Import Web Service
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