1. Practice Management System Electronic Medical Records Accelerate Your Practice www.MyVisionExpress.com Stage 1 Meaningful Use with MVE 2014 Practice Management & EHR

2. Meaningful Use is best defined as demonstrating the use of a certified EHR in ways that can be measured as being used in a “meaningful” way This includes using e-Prescribe, using EHR technology for electronic exchange of health information, and to submit clinical quality and other measures What is Meaningful Use? 2

3. 24 Measures (14 Core Measures and 10 Menu Measures) 7 require Yes/No 16 Require a numerator and denominator In addition, you must attest to 6 Clinical Quality Measures Reporting Period for the first year is 90 days minimum Subsequent years is the entire year What is Meaningful Use? 3

4. The incentive is 75% of Medicare Part B The penalties are: 1-3%, 2015-2017 and 3-5%, 2018-2019 There are no penalties for Medicaid providers. Incentive payments are a fixed amount each year and remain constant as long as you meet all eligibility requirements for program participation Incentives and Penalties 4

5. Medicare: Doctors of Optometry Medicaid: Physicians (primary doctors of medicine) Five states now offer Medicaid EHR incentives to Doctors of Optometry (Alabama, Illinois, Kentucky, Ohio, and South Carolina) Who is Eligible? 5

6. Medicare & Medicaid Registration and Attestation System You need: An individual NPI number and user account with a National Plan & Provider Enumeration System (NPPES) web user account. You must also enroll with PECOS Who is Eligible? 6

7. Physicians can set up the Meaningful Use report according to what they are individually attesting to Physicians can also set up vital signs and CPOE exclusions Changes with 2014 7

8. Core #1 CPOE 8 Objective: Use computerized provider order entry (CPOE) for medication orders directly entered by any licensed healthcare professional who can enter orders into the medical record per state, local and professional guidelines. Measure: More than 30 percent of all unique patients with at least one medication in their medication list seen by the EP have at least one medication order entered using CPOE. Alternative Measure: More than 30 percent of medication orders created by the EP or authorized providers of all eligible hospital’s or CAH’s inpatient or emergency department (POS 21 or 23) during the EHR reporting period are recorded using CPOE. Exclusion: Any EP who writes fewer than 100 prescriptions during the EHR reporting period.

9. Core #2 Drug Interaction Checks 9 Objective: Implement drug-drug and drug-allergy interaction checks. Measure: The EP has enabled this functionality for the entire EHR reporting period.

10. Core #2 Drug Interaction Checks 10 This objective has no exclusions E-Prescribe is absolutely needed in order to satisfy this objective You will need to contact your MVE Regional Account Manager to purchase eRx

11. Core #3 Maintain Problem List 11 Objective: Maintain an up-to-date problem list of current and active diagnoses. Measure: More than 80 percent of all unique patients seen by the EP have at least one entry or an indication that no problems are known for the patient recorded as structured data.

12. Core #4 e-Prescribing (eRx) 12 Objective: Generate and transmit permissible prescriptions electronically (eRx). Measure: More than 40 percent of all permissible prescriptions written by the EP are transmitted electronically using certified EHR technology. Exclusion: Any EP who writes fewer than 100 prescriptions during the EHR reporting period. Alternative Exclusion: Any EP who does not have a pharmacy within their organization and there are no pharmacies that accept electronic prescriptions within 10 miles of the EP’s practice location at that start of the EPs reporting period.

13. Core #5 Active Medication List 13 Objective: Maintain active medication list. Measure: More than 80 percent of all unique patients seen by the EP have at least one entry (or an indication that the patient is not currently prescribed any medication) recorded as structured data.

14. Core #6 Active Drug Allergy List 14 Objective: Maintain active medication allergy list. Measure: More than 80 percent of all unique patients seen by the EP have at least one entry (or an indication that the patient has no known medication allergies) recorded as structured data.

15. Core #7 Demographics 15 Objective: Record all of the following demographics: preferred language, gender, race, ethnicity and date of birth Measure: More than 50 percent of all unique patients seen by the EP have demographics recorded as structured data.

16. Core #8 Record Vital Signs 16 Objective: Record and chart changes in the following vital signs: height, weight and blood pressure. Calculate and display body mass index (BMI). Plot and display growth charts for children 2-20 years, including BMI Measure: For more than 50 percent of all unique patients age 2 and over seen by the EP, height, weight, and blood pressure are recorded as structured data. Additional Measure: For more than 50 percent of all unique patients seen by the EP during the EHR reporting period have blood pressure (for patients age 3 and over only) and height and weight (for all ages) recorded as structured data

17. Core #8 Record Vital Signs 17 Exclusion: Any EP who either sees no patients 2 or older, or who believes that all three vital signs of height, weight, and blood pressure of their patients have no relevance to their scope of practice

18. Core #8 Record Vital Signs 18 New Exclusion: Any EP who 1.Sees no patients 3 years or older is excluded from recording blood pressure; 2.Believes that all 3 vital signs of height, weight, and blood pressure have no relevance to their scope of practice is excluded from recording them; 3.Believes that height and weight are relevant to their scope of practice, but blood pressure is not, is excluded from recording blood pressure; or 4.Believes that blood pressure is relevant to their scope of practice, but height and weight are not, is excluded from height and weight

19. Core #9 Record Smoking Status 19 Objective: Record smoking status for patients 13 years old or older. Measure: More than 50 percent of all unique patients 13 years old or older seen by the EP have smoking status recorded as structured data. Exclusion: Any EP who sees no patients 13 years old or older.

20. Core #10 Clinical Quality Measures 20 Objective: Report ambulatory clinical quality measures to CMS. Measure: Successfully report to CMS ambulatory clinical quality measures selected by CMS in the manner specified by CMS. CQM is now a separate objective for reporting ambulatory or hospital clinical quality measures as part of meaningful use. EPs, eligible hospitals, and CAHs will still be required to report on clinical quality measures in order to achieve meaningful use. CMS is removing the standalone objectives that requires providers to attest that they plan to report CQMs because it is redundant.

21. CQM’s branches off to 6-9 additional measures 3 Core CQM: Adult Weight Screening and Follow up Blood Pressure Measurement Preventative Care and Screening Measure Pair: a. Tobacco Use Assessment b. Tobacco Cessation Intervention Core# 10 Clinical Quality Measures 21

22. NQF 0421 Adult Weight Screening and Follow- Up Description: Percentage of patients aged 18 years and older with a calculated BMI in the past six months or during the current visit documented in the medical record AND if the most recent BMI is outside parameters, a follow- up plan is documented. Core# 10 Clinical Quality Measures 22

23. NQF 0013 Hypertension: Blood Pressure Measurement Description: Percentage of patient visits for patients aged 18 years and older with a diagnosis of hypertension who have been seen for at least 2 office visits, with blood pressure (BP) recorded. Core# 10 Clinical Quality Measures 23

24. NQF 0028: Preventative Care and Screening Measure Pair: a. Tobacco Use Assessment, b. Tobacco Cessation Intervention Description: 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 within 24 months b. Percentage of patients aged 18 years and older identified as tobacco users Core# 10 Clinical Quality Measures 24

25. CQM’s branches off to 6-9 additional measures 3 Core Alternative CQM: NQF 0041: Preventative Care and Screening: Influenza Immunization for Patients > 50 years old NQF 0024: Weight Assessment and Counseling for Children and Adolescents NQF 0038: Childhood Immunization Status Core# 10 Clinical Quality Measures 25

26. The attestation will prompt you to choose these three measures if you get a 0/0 in either one of your Core CQMs No percentages are tied to each measurement Attesting to a 0/0 will not effect your attestation Core# 10 Clinical Quality Measures 26

27. CQM’s branches off to 6-9 additional measures 4 Alternative available CQM related to Optometry or Ophthalmology: NQF 0086: Primary Open Angle Glaucoma NQF 0089: Diabetic Retinopathy: Documentation of Presence or Absence of Macular Edema and Level of Severity of Retinopathy NQF 0088: Diabetic Retinopathy: Documentation of Presence or Absence of Macular Edema and Level of Severity of Retinopathy NQF 0055: Diabetes Eye Exam Core# 10 Clinical Quality Measures 27

28. NQF 0086: Primary Open Angle Glaucoma (POAG) Description: Percentage of patients aged 18 years and older with a diagnosis of primary open angle glaucoma (POAG) who have been seen for at least two office visits within the last 12 months. Core# 10 Clinical Quality Measures 28

29. NQF 0089: Diabetic Retinopathy: Documentation of Presence or Absence of Macular Edema and Level of Severity of Retinopathy Description: Percentage of patients 18 years and older with a diagnosis of diabetic retinopathy who had a dilated macular or fundus exam performed with documented communication to the physician during one or more office visits within the last 12 months. Core# 10 Clinical Quality Measures 29

30. NQF 0088: Diabetic Retinopathy: Documentation of Presence or Absence of Macular Edema and Level of Severity of Retinopathy Description: Percentage of patients aged 18 years and older with a diagnosis of diabetic retinopathy who had a dilation macular or fundus exam performed during one or more office visits within the last 12 months. Core# 10 Clinical Quality Measures 30

31. NQF 0055: Diabetes Eye Exam Description: Percentage of patients 18-75 years of age with diabetes who have had an eye exam Core# 10 Clinical Quality Measures 31

32. Core# 10 Clinical Quality Measures 32

33. Core #11 Clinical Decision Support 33 Objective: Implement one clinical decision support rule relevant to specialty or high clinical priority along with the ability to track compliance with that rule. Measure: Implement one clinical decision support rule.

34. Core #12 Electronic Copy of Health Information 34 Objective: Provide patients with an electronic copy of their health information (including diagnostic test results, problem list, medication lists, medication allergies) upon request. Measure: More than 50 percent of all patients who request an electronic copy of their health information are provided it within 3 business days. Exclusion: Any EP that has no requests from patients or their agents for an electronic copy of patient health information during the EHR reporting period.

35. Core #13 Clinical Summaries 35 Objective: Provide clinical summaries for patients for each office visit. Measure: Clinical summaries provided to patients for more than 50 percent of all office visits within 3 business days. Exclusion: Any EP who has no office visits during the EHR reporting period.

36. Core #14 Protect Electronic Health Information 36 Objective: Protect electronic health information created or maintained by the certified EHR technology through the implementation of appropriate technical capabilities. Measure: Conduct or review a security risk analysis in accordance with the requirements under 45 CFR 164.308(a)(1) and implement security updates as necessary and correct identified security deficiencies as part of its risk management process.

37. Core #14 Protect Electronic Health Information 37 Contact your local Regional Extension Center Each state has their own Regional Extension Center You can email or call them to find out how much a Risk Analysis costs and if they are able to do it for your office Prices vary depending on each center

38. Core #14 Protect Electronic Health Information 38 The Risk Analysis Document is available through our Support Central page under Meaningful Use This is an alternative to the Regional Extension Center Carefully Fill out the document and include any documentations needed to explain why a certain procedure or task is not done in your practice The Risk Analysis will need to be provided if you are chosen during an audit

39. Menu Objectives 39 Out of the ten remaining objectives, you must report 5. One out of the five must be a public health objective; o Menu #9 Immunization Registry Reporting o Menu # 10 Syndromic Surveillance Exclusions no longer accepted for Menu objectives until attempt to do objectives you can is done.

40. Menu #1 Drug Formulary Checks 40 Objective: Implement drug formulary checks. Measure: The EP has enabled this functionality and has access to at least one internal or external formulary for the entire EHR reporting period. Exclusion: Any EP who writes fewer than 100 prescriptions during the EHR reporting period.

41. Menu #2 Clinical Lab Test Results 41 Objective: Incorporate clinical lab test results into EHR as structured data. Measure: More than 40 percent of all clinical lab test results ordered by the EP during the EHR reporting period whose results are either in a positive/negative or numerical format are incorporated in certified EHR technology as structured data. Exclusion: An EP who orders no lab tests whose results are either in a positive/negative or numeric format during the EHR reporting period.

42. Menu #3 Patient Lists 42 Objective: Generate lists of patients by specific conditions to use for quality improvement, reduction of disparities, research, or outreach. Measure: Generate at least one report listing patients of the EP with a specific condition.

43. Menu #4 Patient Reminders 43 Objective: Send reminders to patients per patient preference for preventive/follow-up care. Measure: More than 20 percent of all patients 65 years or older or 5 years old or younger were sent an appropriate reminder during the EHR reporting period. Exclusion: An EP who has no patients 65 years old or older or 5 years old or younger with records maintained using certified EHR technology.

44. Menu #5 Patient Electronic Access 44 Objective: 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. Measure: At least 10 percent of all unique patients seen by the EP are provided timely (available to the patient within four business days of being updated in the certified EHR technology) electronic access to their health information subject to the EP’s discretion to withhold certain information Exclusion: Any EP that neither orders nor creates lab tests or information that would be contained in the problem list, medication list, medication allergy list (or other information as listed at 45 CFR 170.304(g)) during the EHR reporting period.

45. Menu #6 Patient-specific Education Resources 45 Objective: Use certified EHR technology to identify patient-specific education resources and provide those resources to the patient if appropriate. Measure: More than 10 percent of all unique patients seen by the EP are provided patient specific education resources.

46. Menu #7 Medication Reconciliation 46 Objective: The EP who receives a patient from another setting of care or provider of care or believes an encounter is relevant should perform medication reconciliation Measure: The EP performs medication reconciliation for more than 50 percent of transitions of care in which the patient is transitioned into the care of the EP. Exclusion: An EP who was not the recipient of any transitions of care during the EHR reporting period.

47. Menu #8 Transition of Care Summary 47 Objective: The EP who transitions their patient to another setting of care or provider of care or refers their patient to another provider of care should provide summary care record for each transition of care or referral. Measure: The EP who transitions or refers their patient to another setting of care or provider of care provides a summary of care record for more than 50 percent of transitions of care and referrals. Exclusion: An EP who neither transfers a patient to another setting nor refers a patient to another provider during the EHR reporting period.

48. Menu #9 Immunization Registries Data Submission 48 Objective: Capability to submit electronic data to immunization registries or immunization information systems and actual submission according to applicable law and practice. Measure: Performed at least one test of certified EHR technology’s capacity to submit electronic data to immunization registries and follow up submission if the test is successful (unless none of the immunization registries to which the EP submits such information has the capacity to receive the information electronically). Exclusion: An EP who administers no immunizations during the EHR reporting period or where no immunization registry has the capacity to receive the information electronically.

49. Menu #10 Syndromic Surveillance Data Submission 49 Objective: Capability to submit electronic syndromic surveillance data to public health agencies and actual submission according to applicable law and practice. Measure: Performed at least one test of certified EHR technology’s capacity to provide electronic syndromic surveillance data to public health agencies and follow-up submission if the test is successful (unless none of the public health agencies to which an EP submits such information has the capacity to receive the information electronically). Exclusion: An EP who does not collect any reportable syndromic information on their patients during the EHR reporting period or does not submit such information to any public health agency that has the capacity to receive the information electronically.

50. Visit Support Central to view more Video Tutorials and How-to Guides in our Knowledgebase. Support.MyVisionExpress.com Support Central 50

51. Heading Goes here51 Thank You for Choosing My Vision Express to Accelerate Your Practice! www.MyVisionExpress.com 877.882.7456 Thank You