1. Stage 2 Beyond the First Year on MU in 2014 Presenters: Randy Marsden – Chief Client Officer Leo Vilenskiy – Senior Customer Support Representative Rebecca Imhoff – Special Projects Coordinator

2.  Please feel free to ask a question at any time via chat  Please include your name and what practice you are from  We will also have a Q and A session at the end of the webinar  The video of the webinar as well as the slides will be available on the Government Regulations in 2014 page on the IO Practiceware Support Website. Ask Questions

3.  Guidance or comments offered by IO do not supersede government regulations and documentation from CMS or ONC.  Successful use of CEHRT is your provider’s responsibility, IO does not assume liability for missed incentive payments or incurred payment adjustments. Disclaimer

4. Core ObjectivesChanges 1CPOE – Meds, Labs, and RadiologyIncreased %, addition of labs and radiology 2E-PrescribingIncreased %, formulary checks 3DemographicsIncreased %, new screen, new options 4Vital signsIncreased %, more exclusions 5Smoking statusIncreased %, new screen, more options 6Clinical decision supportChanged from 1 to 5 rules 7View, download, transmitPatient portal access vs. usage 8Clinical summariesShortened time frame, patient portal 9Security risk analysisAddition of encryption of data at rest 10Lab testsIncreased %, new screen 11Patient listsMore options 12RemindersNew parameters 13Education materialMore options including automation 14Medication reconciliationElectronic method now available 15Transition of carePaper vs. Direct messaging, Send to another HER 16ImmunizationsNo change 17Secure messagingNEW***, Patient portal

5.  Objectives are the numbered goals for MU  Measures are how the objective is measured  Percentage  Attestation  Some Objectives have multiple measures Objectives vs. Measures

6. Measure 1: Medication Orders Measure 2: Radiology Orders Measure 3: Laboratory Orders Record more than 60% of medication orders electronically using CPOE. Record more than 30% of radiology orders electronically using CPOE. Record more than 30% of laboratory orders electronically using CPOE. Numerator: Medication Orders using CPOE Numerator: Radiology orders using CPOE Numerator: Laboratory orders using CPOE Denominator: Medication orders made during the reporting period Denominator: Radiology orders made during the reporting period Denominator: Laboratory orders made during the reporting period Exclusions: Providers who write fewer than 100 medication orders annually Exclusions: Providers who write fewer than 100 radiology orders annually Exclusions: Providers who wrote fewer than 100 laboratory orders CORE 1: Computerized Provider Order Entry (CPOE) % change – was 30%!

7.  Generate and Transmit more than 50% of all permissible prescriptions electronically and query the prescriptions for a drug formulary (was a menu measure in Stage 1)  Exclusions: Providers who write fewer than 100 prescriptions who don’t have either their own pharmacy or one that accepts e-rx within 10 miles of the practice location CORE 2: E‐ Prescribing Numerator Prescriptions transmitted electronically with formulary queries =More than 50% DenominatorPrescription orders made during the reporting period % change – was 40%!

8.  Record preferred language, gender, race(s), ethnicity, and date of birth for more than 80% of patients  Exclusions: None CORE 3: Record Demographics Numerator Patients with all elements of demographics recorded =More than 80% DenominatorPatients seen during the reporting period % change – was 50%!

9.  Record and chart height/ length (all ages), weight (all ages), and blood pressure (age 3 and up) or more than 80% of patients  Exclusions:  Providers who see no patients over the age of two, need only document height/length and weight.  Providers who believe all vital signs are out of the scope of their practice may claim an exclusion to this measure.  Providers who believe blood pressure is out of the scope of their only need to record height/length and weight.  Providers who believe height/length and weight are out of the scope of their practice, need only to record blood pressure. CORE 4: Record Vital Signs Numerator Patients with all elements of vital signs recorded =More than 80% DenominatorPatients seen during the reporting period % change – was 50%!

10.  Record smoking status (age 13 and up).  Exclusions: Providers who see no patients over the age of 12. CORE 5: Record Smoking Status Numerator Patients with smoking status recorded = More than 80% DenominatorPatients (age 13 or older) seen during the reporting period % change – was 50%!

11. Implement CDS interventions to improve quality of care as tracked by CQMs. Measure 1 – Clinical Decision Support (CDS) Measure 2 – Drug-Drug and Drug- Allergy Interactions Implement 5 CDS interventions related to 4 or more CQMs for the entire reporting period Implement drug-drug and drug- allergy interaction checks for the entire reporting period This is an attestation measure, answer YES or NO. Exclusion: NoneExclusion: Provider wrote fewer then 100 medication orders. CORE 6: Clinical Decision Support (CDS) Rule

12. Provide patients the ability to view, download, and transmit their health information within 4 business days. Measure 1 – Timely AccessMeasure 2 – Patient Use Provide timely access to more than 50% of patients to view, download, and transmit their health information Get at least 5 % of your patients to view, download, or transmit their health information Numerator: Patients provided health information within 4 business days Numerator: Patients who viewer, download, and/or transmitted their health information Denominator: Patients seen during the reporting period Exclusions: Providers who don’t create information other than patients name and provider’s name and office contact info Exclusions: (1) Providers who don't create information other than patient name and provider's name and office contact info. (2) Providers who conduct 50% or more encounters in a county that doesn't have 50% or more of housing units using 3Mbps broadband. CORE 7: Patient Electronic Access

13.  Provide clinical summaries within 1 business day for patients for more than 50% of office visits.  Exclusions: Provider had no office visits during the reporting period. CORE 8: Clinical Summaries Numerator Office visits where the patient was provided a clinical summary within 1 business day =More than 50% DenominatorOffice visits during the reporting period

14.  Conduct a security risk analysis as mandated by HIPAA during your reporting period.  This is an attestation measure, answer YES or NO.  Exclusions: NONE. CORE 9: Protect Electronic Health Information

15.  Incorporate lab test values/results for more than 55% of lab tests ordered.  Exclusions: Provider who orders no lab tests where results are in +/- affirmation or numeric format during the reporting period. CORE 10: Clinical Lab‐Test Results Numerator Patients with lab test results ordered by you = More than 55% DenominatorPatients with labs ordered during the reporting period % change – was 40%!

16.  Generate at least one list of patients by specific condition for quality improvement, research, and outreach.  This is an attestation measure, answer YES or NO.  Exclusions: NONE. CORE 11: Patient Lists Was a menu measure

17.  Send appointment reminders to more than 10% of patients seen within 24 months before the beginning of the reporting period, per patient preference.  More than 10% of all unique patients who have had 2 or more office visits with the EP within the 24 months before the beginning of the EHR reporting period were sent a reminder, per patient preference when available  Exclusion: Provider who had no office visits 24 months prior to the reporting period. CORE 12: Patient Reminders Numerator Patients sent reminders =More than 10% DenominatorTotal patients with 2+ visits within 24 months of the reporting period New parameters

18.  Provide patient specific education resources to more than 10% of patients.  Exclusions: Provider had no office visits during the reporting period. CORE 13: Patient‐Specific Education Resources Numerator Patients provided with education resources =More than 10% DenominatorPatients seen during the reporting period Was menu measure, new options available

19.  When a patient is referred to you, perform a medication reconciliation more than 50% of the time.  Exclusions: Provider didn't receive any referrals during the reporting period. CORE 14: Medication Reconciliation Numerator Medication reconciliations performed =More than 50% DenominatorPatients referred from another care setting Electronic reconciliation now available

20. Measure 1 : Provide RecordsMeasure 2 : Provide records via Direct messaging Measure 3 : Send to a different vendor Send a summary of care record for more than 50% of referrals out. Send said summary of care using secure Direct messaging for more than 10% of referrals out. Send said summary of care using secure Direct messaging to a provider who doesn't use IO once. Numerator: Referred patients provided with summary of care by any means Numerator: Referred patients provided with summary of care using Direct This is an attestation measure, answer YES or NO. Denominator: Patients referred to another care setting Exclusions: Provider didn't refer patients to another setting more than 100 times CORE 15: Summary of Care

21.  Submit data to immunization registries.  This is an attestation measure, answer YES or NO.  Exclusions:  Provider doesn't administer immunizations.  Provider has no immunization registry capable of receiving information.  Provider has no immunization registry providing information timely.  Provider has no immunization registry capable of receiving information in the accepted standard at the start of the reporting period. CORE 16: Immunization Registries Data Submission

22.  Receive a secure electronic message from more than 5% of patients  Exclusions: Provider conducts 50% or more encounters in a county that doesn't have 50% or more of housing units using 3Mbps broadband. CORE 17: Use Secure Electronic Messaging Numerator Patients who sent a secure electronic message =More than 5% DenominatorPatients seen during the reporting period New for 2014

23. Eligible Providers Must Report 3 out of 6 objectives. We recommend you do ones in bold. Changes 1Syndromic surveillanceNo change 2Electronic notesNEW*** 3Imaging resultsNEW*** 4Family historyNEW*** 5Report cancer casesNo change 6Report specific casesNEW*** Menu Objectives

24.  Submit syndromic data to a public health agency.  This is an attestation measure, answer YES or NO.  Exclusions  Provider is not in a category of providers that collect this information.  Provider has no public health agency capable of receiving information.  Provider has no public health agency providing information timely.  Provider has no public health agency capable of receiving information in the accepted standard at the start of the reporting period. MENU 1: Syndromic Surveillance Data Submission

25.  Record notes for more than 30% of patients  Exclusions: NONE MENU 2: Electronic Notes Numerator Patients who have at least one note =More than 30% DenominatorPatients seen during the reporting period

26.  When a imaging test is ordered, attach the image and document the interpretation for more than 10% of orders.  Exclusions: Provider orders less than 100 imaging tests or has no access to imaging test results at the start of the reporting period. MENU 3: Imaging results Numerator Imaging tests with attached imaging and explanation =More than 10% DenominatorImaging tests ordered during the reporting period

27.  Record family health history as structured data for more than 20% of patients.  Exclusions: Provider had no office visits during the reporting period. MENU 4: Family Health History Numerator Patients with data for 1+ first-degree relative =More than 20% DenominatorPatients seen during the reporting period

28.  Report cancer case information to a public health central cancer registry.  This is an attestation measure, answer YES or NO.  Exclusions  Provider doesn't diagnose or directly treat cancer  Provider has no cancer registry capable of receiving information.  Provider has no cancer registry providing information timely.  Provider has no cancer registry capable of receiving information in the accepted standard at the start of the reporting period. MENU 5: Report Cancer Cases

29.  Report specific cases to a specialized registry, like IRIS.  This is an attestation measure, answer YES or NO.  Exclusions  Provider doesn't diagnose or directly treat any disease associated with a registry  Provider has no specialized registry capable of receiving information.  Provider has no specialized registry providing information timely.  Provider has no specialized registry capable of receiving information in the accepted standard at the start of the reporting period. MENU 6: Report Specific Cases