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Meaningful Use Measures: Electronic Copy of Health Information – Meaningful Use Monday

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Meaningful Use Core Measure: More than 50% of all patients who request an electronic copy of their health information are provided it within 3 business days.

Exclusion: Any EP who receives no requests for this information in electronic format.

 This measure is distinguished from  the clinical summary measure, (discussed in the previous Meaningful Use Monday post), in two major ways:

1)      “Electronic copy of health information” covers all health information that the provider has regarding the patient, whereas the “clinical summary” is a snapshot of a particular visit.

2)      This measure is driven by requests made by patients or their agents—electronic access must be provided in response to at least 50% of the specific requests received by a provider. By contrast, clinical summaries have to be provided for 50% of office visits, regardless of whether or not the patient asked to receive the information. 

The measure is limited to the information that is contained electronically in the EHR, and it can be delivered in any electronic format, including patient portal, CD, USB fob, etc. 

An interesting note about the future of this measure: The Meaningful Use Workgroup has recommended to the HIT Policy Committee that this measure be dropped in Stage 2 because it is incorporated into other objectives. There is already a menu measure in Stage 1 that requires providing “timely electronic access to health information.”

Lynn Scheps is Vice President, Government Affairs at EHR vendor SRSsoft. In this role, Lynn has been a Voice of Physicians and SRSsoft users in Washington during the formulation of the meaningful use criteria. Lynn is currently working to assist SRSsoft users interested in showing meaningful use and receiving the EHR incentive money. Check out Lynn’s previous Meaningful Use Monday posts.

July 11, 2011 I Written By

Lynn Scheps is Vice President, Government Affairs at EHR vendor SRSsoft. In this role, Lynn has been a Voice of Physicians and SRSsoft users in Washington during the formulation of the meaningful use criteria. Lynn is currently working to assist SRSsoft users interested in showing meaningful use and receiving the EHR incentive money.

Meaningful Use Measures: Clinical Summaries – Meaningful Use Monday

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Meaningful Use Core Measure: Provide clinical summaries to patients for more than 50% of all office visits within 3 business days.

Exclusion: Any EP who has no office visits during the reporting period.

The clinical summary provides clinical information associated with a specific recent visit. (It does not encompass the entire patient chart.) This measure may appear daunting upon first reading of the requirements, but the guidance below should make it achievable. 

The clinical summary can be delivered by one of two means: electronic media, (e.g., patient portal, secure e-mail, CD or USB fob), or a printed copy. According to advice received from CMS, the easiest way for a physician to meet this measure is to employ a patient portal as the default option. Following each office visit, the EP (or staff) simply uploads the clinical summary to the portal and advises the patient how to access it there. It is only if the patient requests a paper copy that it has to be printed and handed to him or sent by FAX or mail.

Whether the patient accesses the portal or not, the EP will have satisfied the requirement. It is the availability of the clinical summary within the 3-day timeframe—not the patient’s actions—that counts.

As for the content of a clinical summary, the measure defines it to include a comprehensive amount of information, some of which goes beyond the basics typically captured in a digital chart, for example, topics discussed, date of next appointment, tests that should be scheduled with contact information, etc. However, the measure specifications go on to say that to be counted in the numerator of the measure, clinical summaries can be limited to information recorded in the EHR.

Lynn Scheps is Vice President, Government Affairs at EHR vendor SRSsoft. In this role, Lynn has been a Voice of Physicians and SRSsoft users in Washington during the formulation of the meaningful use criteria. Lynn is currently working to assist SRSsoft users interested in showing meaningful use and receiving the EHR incentive money. Check out Lynn’s previous Meaningful Use Monday posts.

June 27, 2011 I Written By

Lynn Scheps is Vice President, Government Affairs at EHR vendor SRSsoft. In this role, Lynn has been a Voice of Physicians and SRSsoft users in Washington during the formulation of the meaningful use criteria. Lynn is currently working to assist SRSsoft users interested in showing meaningful use and receiving the EHR incentive money.

Clearing the Air on the Smoking Measures – Meaningful Use Monday

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Smoking is a major and costly health problem. Because it is such a high priority for CMS, smoking is addressed in the Stage 1 meaningful use requirements by three distinct measures, which has caused a fair amount of confusion. I will try to clarify.

The first is a core meaningful use measure. Therefore, every eligible professional (EP) must satisfy this requirement, unless they can attest to meeting the exclusion.

Core Meaningful Use Measure: Record Smoking Status

More than 50% 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.

Description:

  • Smoking status must be recorded as one of the following 6 categories: current every day smoker; current some day smoker; former smoker; never smoker; smoker, current status unknown; unknown if ever smoked.
  • The information does not have to be updated at every visit—it simply has to be in the patient’s record, (i.e., no need to ask a non-smoker whether he has taken up the habit yet!)

The other two smoking-related measures are clinical quality measures. There is a different minimum age for the patient population—18, as opposed to 13—and these measures encompass tobacco use in addition to smoking. EPs must report on 6 CQMs—3 Core CQMs and 3 Additional CQMs. Like all CQMs (for Stage 1 meaningful use), neither of these measures have required thresholds that must be met.

The Core CQM (NQF 0028 – Preventive Care and Screening Measure Pair, defined below) must be reported by all providers—there are no exclusions, even if the EP’s EHR generates zero denominators for this measure. In that case, the EP reports zero and must also select and report on an alternate core CQM. This is a 2-part measure that assesses the intervention/treatment provided related to smoking cessation, e.g., counseling and/or medication, and it is based on a 2-year timeframe.

The Additional CQM: (NQF 0027 – Smoking and Tobacco Use Cessation, Medical Assistance, defined below) is one of the 38 Additional CQMs, from which EPs must select and report on three, so this measure is an option, not a requirement. It sounds a lot like NQF 0028 above, unless you read the extremely detailed measure specifications. (We’ll leave that responsibility to the EHR vendors, since the CQM data EPs report must be generated by the EHR!) The major difference is that this measure only involves advice and counseling—it does not ask about intervention—and it has a shorter measurement period than NQF 0028.

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NQF 0028: Core Clinical Quality Measure: Preventive Care and Screening Measure Pair: a. Tobacco Use Assessment, b. Tobacco Cessation Intervention

a) Percentage of patients aged 18 years and older who have been seen for at least 2 office visits who were queried about tobacco use one or more times with 24 months

b) Percentage of patients aged 18 years and older identified as tobacco users within the past 24 months and have been seen for at least 2 office visits who received cessation intervention.

NQF 0027: Additional Clinical Quality measure: Smoking and Tobacco Use Cessation, Medical Assistance: a. Advising Smokers and Tobacco Users to Quit, b. Discussing Smoking and Tobacco Use Cessation Medications, c. Discussing Smoking and Tobacco Use Cessation Strategies

Percentage of patients 18 years of age or older who were current smokers or tobacco users, who were seen by a practitioner during the measurement year and who received advice to quit smoking or tobacco use, or whose practitioner recommended or discussed smoking or tobacco use cessation medications, methods or strategies.

Lynn Scheps is Vice President, Government Affairs at EHR vendor SRSsoft. In this role, Lynn has been a Voice of Physicians and SRSsoft users in Washington during the formulation of the meaningful use criteria. Lynn is currently working to assist SRSsoft users interested in showing meaningful use and receiving the EHR incentive money. Check out Lynn’s previous Meaningful Use Monday posts.

June 20, 2011 I Written By

Lynn Scheps is Vice President, Government Affairs at EHR vendor SRSsoft. In this role, Lynn has been a Voice of Physicians and SRSsoft users in Washington during the formulation of the meaningful use criteria. Lynn is currently working to assist SRSsoft users interested in showing meaningful use and receiving the EHR incentive money.