2013 Ophthalmologist's Meaningful Use Attestation

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INTRODUCTION

This article is intended for the Ophthalmologist who is attesting to Meaningful Use for the first time in 2013. The Stage 1 Criteria are still in place for this year. Stage 2 Criteria will be implemented in 2014. If you are a member of the American Academy of Ophthalmology, log in and study the webpage, "EHR Central — Ophthalmology Meaningful Use Rule Requirements". Their "Ophthalmology Meaningful Use Attestation Guide, Stage 1 - 2013 Edition" is a great resource.

First and foremost be certain that you are an eligible professional and can participate in the incentive program. On the Getting Started page read the definition of the Eligible Professional.

An Ophthalmologist can participate in the program via Medicare or Medicaid but not both. Failure to adopt an EHR and to successfully attest to Meaningful Use will result in Medicare penalties commencing in 2015.

For colleagues attesting for the first time in 2013, the reporting period is any 90 consecutive day period. The last start date is Oct 1, 2013 while the last date for registration and attestation for a 90 day period in 2013 will be February 28, 2014.

You have invested a great deal of time implementing OpenEMR and possibly allocating financial resources to it, if professional support was necessary. Attestation is no one's idea of a fun time, but the bonus should help to defray startup costs for conversion to electronic medical records; even if the bonus has been decreased as a result of sequestration. Attestation may appear to be daunting, but with resolve and preparation, it can be accomplished by most physicians.

PREPARATION

Stage 1 Meaningful Use Requirements

Go to the bottom of the Meaningful Use page to the Downloads section. You would want "Stage 1 Eligible Professional Meaningful Use Table of Contents". This is a compact document with links explaining each measure. The discussion under Preparation and Attestation will include all 15 Measures despite the fact that only 13 Measures need to be reported. Fully understand each Core, Menu and Clinical Quality Measures.

Go to the Registration & Attestation page to the Attestation Resources section, download "Attestation Worksheet For the Eligible Professional". The 2013 worksheet has 13 Core Measures listed. The 10th Measure, Clinical Quality Measure Reporting; and the 15th Measure, Electronic Transmission of Health Information to Another Professional; have been eliminated. This download is very helpful in organizing all your responses, numerators, denominators for the Core and Menu Measures. It is fairly easy to add the responses and numbers for the Ophthalmic Measures to the worksheet.

With even the most meticulous preparation, attestation will require, at minimum, 30 minutes of online work. It is best to have all the information at your fingertips to avoid frustrations.

While you are there, download both the Registration and Attestation guides to get a sense of the process, which will be described in detail below.

OpenEMR MU Requirement Data Genesis And Tracking

Understand how OpenEMR generates and tracks the data that you will need for attestation and where this information can be found. The data is generated in a number of locations while the tracking can be found in Reports ->Clinics to the specific reports. For Ophthalmology most of the information can be found under the Automated Measures report.

The coding of the 3 Core Clinical Quality Measures, the 3 Alternate Clinical Quality Measures and the 3 Additional Clinical Quality Measures have been completed. The corresponding Standard Measures Report for those 9 Measures is fully functional.

Core Measures

Description AMC details how each Core Measure is calculated.

Computerized Physician Order Entry

The denominator comes from the number of drugs in the Medication box on the right side of the Patient Summary screen while the numerator comes from the drugs in the Prescription box. For Ophthalmologists, most of the drugs in the Medication box are from other offices. If more than 100 drugs are reported and the 30% threshold has not been met, Ophthalmologists are permitted to report on just the drugs that they had prescribed. Presently there is not a separate Medication box for the Ophthalmic drugs. A work-around is to prescribe a medication and be certain to check the E-prescription? box for a particular drug. This will generate data for the CPOE requirement as well as the electronic prescription requirement.

Drug-drug And Drug-allergy Interaction Check

This is accomplished by the installation of the Greasemonkey add-on with the Allscripts Integration script.

List of Current And Active Diagnoses

Be certain that the Medical Problems box is not empty. If the patient is healthy, choose the none box.

E-Prescribing

Put entries into the Prescription box and remember to check the E-Prescribing? box to indicate that this was an electronic prescription. It goes without saying that you will then use the link to Allscripts or any other electronic prescription module that you implemented to complete the prescription.

Active Medication List

List the patient's medications. Choose none if that is the case.

Active Medication Allergy List

Don't leave the Allergies box empty. If the patient has no allergies to drugs, choose the none option from Issues.

Record Demographics

Set as defaults; the Language, Race and Ethnicity of the majority of your patient population from Administration-> Lists->Language, Ethnicity or Race. It will save your staff from needless clicking for each new patient. An account cannot be set up without gender and date of birth. These two pieces of information are also required for this measure.

Record Vital Signs

If you select Exclusion 2, no Vital Signs need to be recorded, but if you choose Exclusion 4 during the attestation, then you are obligated to keep records of blood pressures.

Record Smoking History

Go to History->Lifestyle and choose the appropriate option. The additional advantage of recording the smoking history is that it will satisfy the second Core Clinical Quality Measure Part A regarding Tobacco use.

Clinical Quality Measures Reporting

This Measure has been eliminated for 2013.

Clinical Decision Support Rule

See the CDR Engine page for more details. Passive Alerts are the easiest to implement.

Electronic Copy Of The Health Record

If no patient asks for a copy, then you are off the hook and you can use the exclusion. If there is a request, the copy must be in electronic form such as a CD or a flash drive.

Clinical Summaries

Per §170.304(h), at a minimum, the summary must contain recording of the diagnostic test results, medications, medical conditions and an allergy list. These summaries can be easily printed on the back of the encounter forms and given to the patients on the day of the visit. Don't forget to check the box, Provide Clinical Summary?, in the upper right hand corner, for that visit; otherwise you won't get a numerator for this requirement.

Electronic Transmission To Another Professional

This Measure has also been eliminated in 2013.

Protect Electronic Health Information

You can safely answer yes to this requirement because of the enhancement by Visolve on this page.

Public Health Measures

Choose one and use the exclusion.

Menu Measures

Choose 4 from the list.

Drug Formulary Check

This was implemented by virtue of the Allscripts Integration.

Patient Lists

Go->Reports->Clients->Clinical and run the report for any parameter.

Patient Reminders

CMS does not stipulate the method, manner or frequency of these reminders. See the Patient Reminders Batch and Online Alerts and Patient Reminders.

Clinical Lab Test Results

A simple way to satisfy this requirement is by uploading a scanned document to Documents->Lab Reports. The number of lab results and the number of patients must be tallied manually with this method.

A more complex method is via the Procedures Module as described in articles listed here.

Medication Reconciliation

Be certain to check the Transition/Transfer of Care? box to record the denominator for this Measure. The numerator for transfers into the practice will be recorded by clicking the Medication Reconciliation Performed? box. Mu1inout.png


Transition of Care Summary

Check the Transition/Transfer of Care? box for transfers of patients out of the practice to provide the denominator for this Measure. Go to the Patient Summary->Transactions->Add dialog. Clicking the Sent Medical Records? box will record the numerator. Mu1outgoing.png


Patient Electronic Access

This requires enabling patient portals.

Education Resources

Paper hand-outs will satisfy this requirement. Don't forget to check the box for providing education resources for the particular encounter.

Clinical Quality Measures

The CDR Guide is very helpful in the understanding of the genesis of the numbers for the Clinical Quality Measures.

Core Clinical Quality Measures

Use zeros for the first and third requirements. AAO makes a point that entering zero will not prevent you from receiving the bonus.

You will be able to satisfy the second requirement, Part A, if you have taken a smoking history.

If there had been Tobacco Cessation Intervention, Part B of the second requirement should be reported. The number of patients, who has been designated as current smokers in History->Lifestyle, will be the denominator in the Standard Measures Report. To generate the numerator, go to the Clincal Reminders module of Patient Summary and click Intervention: Tobacco (Due). 1.PNG


A dialog box will appear. Use the PostNuke Calender to enter the date of the intervention, enter the result and click Save. If the date is entered manually, the entry will not be saved and there will be no numerator in the Standard Measures Report. 2a.PNG


Alternate Core Measures

Again use zeros for these measures.

Additional Measures

Choose 3 out the 4 available Ophthalmic measures.

Additional Measures - Conventional Method

To setup the Standard Measures Report for the Ophthalmic Measures, refer to the Clinical Decision Rules Manual.

If you plan to use both the Diabetic Eye Exam and the Diabetic Retinopathy Measures, the second must be set up in such a way to distinguish it from the first measure. There needs to be a different set of ICD-9 codes to track the second measure, otherwise the numbers won't show up in the Standard Measures Report. Rules 1.png


The name of the exam should be different from that of the first Diabetic measure to distinguish between the two measures. Rules 2.png


By clicking Edit under Actions and Yes under Custom Input, the Passive Alert will pop up in Clinical Reminders.

Rules 3.png

Click on the reminder to work on it. Rules 6.PNG


One is less likely to ignore the reminder if one is forced to enter an entry to make the reminder go away and achieve the purpose of the reminder. The date of the entry must be selected from the PostNuke Calendar because free text entry won't work. Rules 7.PNG


Additional Measures - Alternate Method

If you are unable to get it to work, an alternative method would be to run reports for diagnoses and the corresponding PQRS codes from Reports->Clients->Clinical and then tally the results by hand.

Configuring the Clinical Reports for a tally of the number of patients for a given report requires a bit of endurance and a good helping of attention to details if you are not a computer programmer. Read Visolve's 7/3/2013 post in this thread and understand it thoroughly. Backup before starting.

Go->C-drive->xampp->htdocs->openemr->interface->reports.

Open clinical_reports.php with Notepad++.

Into Line 528, which is blank, insert the line of code. Into Line 541, which is also blank, and the new Line 542, insert the 2 lines of code. Clinical reports tally 1.png Into the new Line 764, insert the very long line of code. Indent 4 columns before inserting. Two images are provided due to the length of the code. Clinical reports tally 2.png Clinical reports tally 3.png

NPPES

When you applied for your NPI number online, you were assigned an username and password. If it was a paper application, go to this website to register for an username and password. Both are need to register and log in to the ehrincentives.cms.gov website for the attestation. MU fig 1.png

EHR Certification Number

This number assigned to OpenEMR can be obtained at the Certified Health IT Product List website.

Step 1: To which edition of ONC HIT EHR Certification are you attesting?

Choose the 2011 Edition by clicking that button. MU fig 2.png

Step 2: Select Your Practice Type

Click Ambulatory Practice Type. MU fig 3.png

Step 3: Search for Certified EHR Products

In the middle box, type OpenEMR in the search box. MU fig 4.png

Step 4: Add Products to Your Cart

Choose OpenEMR version 4.1 by clicking Add to the cart. MU fig 5.png


Step 5: Request CMS EHR Certification ID

Click the Get CMS EHR Certification ID button and record the assigned alphanumeric ID. MU fig 6.png

REGISTRATION

Step 1

Go to the Registration and Attestation website to start the process. The first page that you see is that defining the Eligible Professional. MU fig 7.png


Step 2

This step asks you to verify the statements posted. MU fig 8.png


Step 3

This is the login step for which you will need the NPPES username and password. MU fig 9.png


Step 4

After logging in, you will need to click the Registration Tab. MU fig 10.png


Step 5

This will initiate the registration. Click Register. MU fig 11.png


Step 6

Click topic 1, EHR Incentive Program. MU fig 12.png


Step 7

Indicate which program, your Eligible Professional type and the EHR Certification number. MU fig 13.png

Step 8

Fill in the Payee Information. MU fig 14.png

Step 9

Provide your address and contact information. MU fig 15.png

Step 10

Before submitting, be certain that all 3 topics have been completed; then click Proceed with Submission. MU fig 16.png

Step 11

Verify your registration. MU fig 17.png

Step 12

Agree to the Disclaimer. MU fig 18.png

Step 13

Print the receipt of the sucessful registration. MU fig 19.png

ATTESTATION

Although the Review of Results can be printed after submission, to be extra careful in documentation, print each page of the attestation before submission.

Step 1

Log in and choose the Attestation tab, then click Attest. MU fig 20.png

Step 2

Click Attestation Topic 1. MU fig 21.png

Step 3

The EHR Certification number should have been populated for you. Provide the reporting period. MU fig 22.png

Core Menu Measures

Because there had been a confusion as to the number of required measures, the 13 required Measures will be discussed and the 2 deleted Measures will be noted.

1. CPOE

If the exclusion does not apply, provide the source of the data and the numbers, namely the numerator and denominator. MU fig 23.png

2.Drug-Drug Drug-Allergy Interaction Check

Answer yes. MU fig 24.png

3. Diagnosis List

Provide the numbers. MU fig 25.png

4. Electronic Prescriptions

If the exclusion does not apply, answer if data from all patients or only those in OpenEMR and provide numbers. MU fig 26.png

5. Medication List

Provide numbers. MU fig 27.png

6. Allergy List

Provide numbers. MU fig 28.png

7. Demographics

Provide numbers. MU fig 29.png

8. Vital Signs

Choose an exclusion. MU fig 30.png

9. Smoking History

Provide the source of the data and numbers if exclusion does not apply. MU fig 31.png

Clinical Quality Measure Reporting

This measure has been deleted.

11. Clinical Decision Support Rule

Answer yes. MU fig 32.png

12. Electronic Copy of Health Information

If exclusion does not apply, provide data source and numbers. MU fig 33.png

13. Clinical Summaries

Provide data source and numbers if exclusion does not apply. MU fig 34.png

Electronic Transmission of Health Information to Another Professional

This measure has been deleted.

15. Protection of Health Information

Answer yes. MU fig 35a.png

Menu Measures

Public Health Measure

Choose Immunization Registry or Syndrome Surveillance Data Submission and use an exclusion. MU fig 36.png

Additional Menu Measures

All 8 Measures will be discussed. Choose 4.

1. Formulary Check

Answer yes if the exclusion does not apply. MU fig 37.png

2. Patient Lists

Indicate the source of the data and answer yes. MU fig 38.png

3. Patient Reminders

If the exclusion does not apply, give the source of the data and provide numbers. MU fig 39.png

4. Lab Results

If the exclusion does not apply, provide numbers. MU fig 40.png

5. Medication Reconciliation

Provide data source and numbers if the exclusion does not apply. MU fig 41.png

6. Transition of Care Summary

Provide data source and numbers if the exclusion does not apply. MU fig 42.png

7. Electronic Access

Provide data source and numbers if the exclusion does not apply. MU fig 43.png

8. Education Resources

Provide numbers. MU fig 44.png

Clinical Quality Measures

For Ophthalmologists the 3 Core Clinical Quality Measures and the 3 Alternate Clinical Quality Measures are not applicable, but must be answered even if zeros are to be used as the numerators and denominators. As a result, 3 Additional Clinical Quality Measures need to be chosen for reporting. There are 4 available Ophthalmic measures to choose from.

PQRS-EHR Reporting Pilot

You must answer no to eReporting, otherwise you will not be able to complete the attestation. MU fig 51.png

Core Clinical Quality Measures

1. Blood Pressure Measurement

Enter the number for the denominator from the Clinical Quality Measures Report and zero for the numerator. MU fig 45.png

2. Smoking History and Smoking Cessation Intervention

Use the numbers from the Standard Measures Report for Tobacco Use and Intervention. MU fig 46.png

3. Weight Screening

Enter the numbers from the Clinical Quality Measures Report for the denominators, zero for the numerators and the exclusions. MU fig 47.png

Alternate Clinical Quality Measures

1. Weight Assessment for Children and Adolescents

Enter zeros. MU fig 48.png

2. Influenza Immunization for Patients 50 or older

Enter the number from the Clinical Quality Measures Report for the denominator, zero for the numerator and the exclusion. MU fig 49.png

3. Childhood Immunization Status

Enter zeros. MU fig 50.png

Additional Clinical Quality Measures

Choose 3 of the 4 available Ophthalmic Measures. Screenshots are not available.

1. Primary Open Angle Glaucoma, Optic Nerve Exam

Provide the numbers from the Standard Measures Report.

2. Diabetic Retinopathy, Severity

Provide the numbers from the Standard Measures Report.

3. Diabetic Retinopathy, Communication with Primary Care Physician

Provide the numbers from the Standard Measures Report.

4. Dilated Exam in Diabetic Patient

Provide the numbers from the Standard Measures Report.

Confirm Submission

It is possible to attest sucessfully with just one attempt, provided that there had been good preparation. MU fig 52.png

Attestation Disclaimer

Agree to the disclaimer.

MU fig 53.png

Attestation Receipt

Attestation sucessful (give yourself a pat on the back!). Print the receipt and the Review of Results.

MU fig 54.png

CAUTION

In April of 2012 CMS hired Figliozzi and Company to audit Meaningful Use Attestations. Keep meticulous and unimpeachable records to support your attestations. Refer to Figliozzi Audit and CMS Audit Document for more information. "If an Eligible Professional is found not to have met the Meaningful Use requirements for even one of the measures, the entire payment will be recouped." See full article.

TINTINNABULATION

CMS will credit your bank account in 4 to 8 weeks after the attestation. If your skiff of jingling coins sails in with a wave of contentment followed by a second wave of altruism, feel free to go to the OpenEMR homepage and click the orange button. We thank you for your generosity.

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