1. Meaningful Use Made Easy Step by Step Approach to Stage 1 Compliance and 2013 Changes My Vision Express Practice Management and EMR Software Presented by: Denise Ramos / Insight Software, LLC MyVisionExpress.com © 2013 Insight Software, LLC. All rights reserved.

2. What is Meaningful Use? Meaningful Use is best defined as demonstrating the use of a certified EHR in ways that can be measures as being used in a “meaningful” way. This includes: 1.Using e-Prescribe 2.Using EHR technology for electronic exchange of health information 3.Using EHR technology to submit clinical quality and other measures EPs must comply with certain objectives in three stages. During Stage 1, they must comply with 20 objectives: 15 from a “core set”, plus 5 that they must select from a “menu set” of 10 objectives. © 2013 Insight Software, LLC. All rights reserved.

3. What is Meaningful Use? 25 Measures 9 require Yes/No 16 require a numerator and a denominator In addition, you must attest to 6 Clinical Quality Measures. Reporting Period The 1 st year - 90 days minimum Subsequent years - The entire year © 2013 Insight Software, LLC. All rights reserved.

4. What is the incentive and what are the penalties? Incentive: 75% of Medicare Part B Penalties: 1%-3% Medicare, 2015-2017 3%-5% Medicare, 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. © 2013 Insight Software, LLC. All rights reserved.

5. Who is Eligible and how do you register? Medicare: Doctors of Optometry Medicaid: Physicians (primarily doctors of medicine) Five states now offer Medicaid EHR incentives to Doctors of Optometry (Alabama, Illinois, Kentucky, Ohio and South Carolina) Medicare & Medicaid Registration and Attestation System https://ehrincentives.cms.gov/hitech/login.action https://ehrincentives.cms.gov/hitech/login.action 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 © 2013 Insight Software, LLC. All rights reserved.

6. 1.Computerized Provider Order Entry (CPOE) Alternate Measure: Based on the total number of medication orders created during the EHR reporting period. An EP, eligible hospital, or CAH may select either measure for this objective. More than 30 percent of medication orders created by the EP or authorized providers of the eligible hospitals or CAHs inpatient or emergency department (POS 21 or 23) during the EHR reporting period are recorded using CPOE. 2.Electronic Prescribing Additional 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 EPs practice location at the start of his/her HER reporting period. New Stage 1 Changes for 2013 © 2013 Insight Software, LLC. All rights reserved.

7. New Stage 1 Changes for 2013 3. Record and Chart Changes in Vital Signs This new measure amends that age limit to recording blood pressure for patients ages 3 and over and height and weight for patients of all ages. New Exclusions: Any EP who: Sees no patient 3 years or older is excluded from recording blood pressure; Believes that all three vital signs of height, weight, and blood pressure have no relevance to their scope of practice is excluded from recording them; Believes that height and weight are relevant to their scope of practice, but blood pressure is not, is excluded from recording blood pressure; or Believes that blood pressure is relevant to their scope of practice, but height and weight are not, is excluded from recording height and weight. © 2013 Insight Software, LLC. All rights reserved.

8. New Stage 1 Changes for 2013 4. Electronic Exchange of Key Clinical Information Beginning in 2013, the objective for electronic exchange of key clinical information will no longer be required for Stage 1 for EPs, eligible hospitals, and CAHs. 5.Report Clinical Quality Measures CQM is now a separate objective for reporting ambulatory or hospital clinical quality measures as a 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 objective that requires providers to attest that they plan to report on CQMs because it is redundant. © 2013 Insight Software, LLC. All rights reserved.

9. Meaningful Use of Certified EHR Technology with My Vision Express This Complete EHR is 2011/2012 compliant and has been certified by an ONC-ATCB in accordance with the applicable certification criteria adopted by the Secretary of Health and Human Services. This certification does not represent an endorsement by the U.S. Department of Health and Human Services or guarantee the receipt of incentive payments. 1. CPOE for Medication Orders  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. Exclusion: Any EP who writes fewer than 100 prescriptions during the EHR reporting period. Core Set of Objectives © 2013 Insight Software, LLC. All rights reserved.

10. Meaningful Use of Certified EHR Technology with My Vision Express This Complete EHR is 2011/2012 compliant and has been certified by an ONC-ATCB in accordance with the applicable certification criteria adopted by the Secretary of Health and Human Services. This certification does not represent an endorsement by the U.S. Department of Health and Human Services or guarantee the receipt of incentive payments. 2. Drug Interaction Checks  Objective: Implement drug-drug and drug-allergy interaction checks. Measure: The EP has enabled this functionality for the entire EHR reporting period. Core Set of Objectives © 2013 Insight Software, LLC. All rights reserved.

11. Meaningful Use of Certified EHR Technology with My Vision Express This Complete EHR is 2011/2012 compliant and has been certified by an ONC-ATCB in accordance with the applicable certification criteria adopted by the Secretary of Health and Human Services. This certification does not represent an endorsement by the U.S. Department of Health and Human Services or guarantee the receipt of incentive payments. 3. Maintain Problem List  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. Core Set of Objectives © 2013 Insight Software, LLC. All rights reserved.

12. Meaningful Use of Certified EHR Technology with My Vision Express This Complete EHR is 2011/2012 compliant and has been certified by an ONC-ATCB in accordance with the applicable certification criteria adopted by the Secretary of Health and Human Services. This certification does not represent an endorsement by the U.S. Department of Health and Human Services or guarantee the receipt of incentive payments. 4. e-Prescribing (eRx)  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. Core Set of Objectives © 2013 Insight Software, LLC. All rights reserved.

13. Meaningful Use of Certified EHR Technology with My Vision Express This Complete EHR is 2011/2012 compliant and has been certified by an ONC-ATCB in accordance with the applicable certification criteria adopted by the Secretary of Health and Human Services. This certification does not represent an endorsement by the U.S. Department of Health and Human Services or guarantee the receipt of incentive payments. 5. Active Medication List  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. Core Set of Objectives © 2013 Insight Software, LLC. All rights reserved.

14. Meaningful Use of Certified EHR Technology with My Vision Express This Complete EHR is 2011/2012 compliant and has been certified by an ONC-ATCB in accordance with the applicable certification criteria adopted by the Secretary of Health and Human Services. This certification does not represent an endorsement by the U.S. Department of Health and Human Services or guarantee the receipt of incentive payments. 6. Medication Allergy List  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. Core Set of Objectives © 2013 Insight Software, LLC. All rights reserved.

15. Meaningful Use of Certified EHR Technology with My Vision Express This Complete EHR is 2011/2012 compliant and has been certified by an ONC-ATCB in accordance with the applicable certification criteria adopted by the Secretary of Health and Human Services. This certification does not represent an endorsement by the U.S. Department of Health and Human Services or guarantee the receipt of incentive payments. 7. Record Demographics  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. Core Set of Objectives © 2013 Insight Software, LLC. All rights reserved.

16. Meaningful Use of Certified EHR Technology with My Vision Express This Complete EHR is 2011/2012 compliant and has been certified by an ONC-ATCB in accordance with the applicable certification criteria adopted by the Secretary of Health and Human Services. This certification does not represent an endorsement by the U.S. Department of Health and Human Services or guarantee the receipt of incentive payments. 8. Record Vital Signs  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. Exclusion: Any EP who either sees no patients 2 years 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. Core Set of Objectives © 2013 Insight Software, LLC. All rights reserved.

17. Meaningful Use of Certified EHR Technology with My Vision Express This Complete EHR is 2011/2012 compliant and has been certified by an ONC-ATCB in accordance with the applicable certification criteria adopted by the Secretary of Health and Human Services. This certification does not represent an endorsement by the U.S. Department of Health and Human Services or guarantee the receipt of incentive payments. 9. Record Smoking Status  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. © 2013 Insight Software, LLC. All rights reserved. Core Set of Objectives

18. Meaningful Use of Certified EHR Technology with My Vision Express This Complete EHR is 2011/2012 compliant and has been certified by an ONC-ATCB in accordance with the applicable certification criteria adopted by the Secretary of Health and Human Services. This certification does not represent an endorsement by the U.S. Department of Health and Human Services or guarantee the receipt of incentive payments. 10. Clinical Quality Measures (CQMs)  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. Core Set of Objectives © 2013 Insight Software, LLC. All rights reserved.

19. Physician Quality Reporting System? Beginning in 2012 and continuing in 2013, there are two reporting methods available for reporting the Stage 1 measures: 1. Attestation 2. e-Reporting Pilots: Physician Quality Reporting System EHR Incentive Program Pilot for EPs eReporting Pilot for eligible hospitals and CAHs Physicians who qualify, may earn a bonus payment on all allowable Medicare charges. 2013 = 0.5% 2014 = 0.5% A penalty of 1.5% for not doing PQRS begins in 2015. A penalty in 2015 will apply depending on 2013 performance. © 2013 Insight Software, LLC. All rights reserved.

20. Meaningful Use of Certified EHR Technology with My Vision Express This Complete EHR is 2011/2012 compliant and has been certified by an ONC-ATCB in accordance with the applicable certification criteria adopted by the Secretary of Health and Human Services. This certification does not represent an endorsement by the U.S. Department of Health and Human Services or guarantee the receipt of incentive payments. 11. Clinical Decision Support Rules  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. Core Set of Objectives © 2013 Insight Software, LLC. All rights reserved.

21. Meaningful Use of Certified EHR Technology with My Vision Express This Complete EHR is 2011/2012 compliant and has been certified by an ONC-ATCB in accordance with the applicable certification criteria adopted by the Secretary of Health and Human Services. This certification does not represent an endorsement by the U.S. Department of Health and Human Services or guarantee the receipt of incentive payments. 12. Electronic Copy of Health Information  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. Core Set of Objectives © 2013 Insight Software, LLC. All rights reserved.

22. Meaningful Use of Certified EHR Technology with My Vision Express This Complete EHR is 2011/2012 compliant and has been certified by an ONC-ATCB in accordance with the applicable certification criteria adopted by the Secretary of Health and Human Services. This certification does not represent an endorsement by the U.S. Department of Health and Human Services or guarantee the receipt of incentive payments. 13. Clinical Summaries  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. Core Set of Objectives © 2013 Insight Software, LLC. All rights reserved.

23. Meaningful Use of Certified EHR Technology with My Vision Express This Complete EHR is 2011/2012 compliant and has been certified by an ONC-ATCB in accordance with the applicable certification criteria adopted by the Secretary of Health and Human Services. This certification does not represent an endorsement by the U.S. Department of Health and Human Services or guarantee the receipt of incentive payments. 14. Electronic Exchange of Clinical Information  Objective: Capability to exchange key clinical information (for example, problem list, medication list, medication allergies, and diagnostic test results), among providers of care and patient authorized entities electronically. Measure: Performed at least one test of certified EHR technology’s capacity to electronically exchange key clinical information. Core Set of Objectives © 2013 Insight Software, LLC. All rights reserved.

24. Meaningful Use of Certified EHR Technology with My Vision Express This Complete EHR is 2011/2012 compliant and has been certified by an ONC-ATCB in accordance with the applicable certification criteria adopted by the Secretary of Health and Human Services. This certification does not represent an endorsement by the U.S. Department of Health and Human Services or guarantee the receipt of incentive payments. 15. Protect Electronic Health Information  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. Core Set of Objectives © 2013 Insight Software, LLC. All rights reserved.

25. Meaningful Use of Certified EHR Technology with My Vision Express HIT Regional Extension Center http://www.healthit.gov/providers- professionals/regional-extension-centers- recs Choose your state and the links will aid you with the Security Analysis risk. Meaningful Use and Security © 2013 Insight Software, LLC. All rights reserved.

26. Meaningful Use of Certified EHR Technology with My Vision Express This Complete EHR is 2011/2012 compliant and has been certified by an ONC-ATCB in accordance with the applicable certification criteria adopted by the Secretary of Health and Human Services. This certification does not represent an endorsement by the U.S. Department of Health and Human Services or guarantee the receipt of incentive payments. 1. Drug Formulary Checks  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. Menu Set of Objectives © 2013 Insight Software, LLC. All rights reserved.

27. Meaningful Use of Certified EHR Technology with My Vision Express This Complete EHR is 2011/2012 compliant and has been certified by an ONC-ATCB in accordance with the applicable certification criteria adopted by the Secretary of Health and Human Services. This certification does not represent an endorsement by the U.S. Department of Health and Human Services or guarantee the receipt of incentive payments. Menu Set of Objectives 2. Clinical Lab Test Results  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. © 2013 Insight Software, LLC. All rights reserved.

28. Meaningful Use of Certified EHR Technology with My Vision Express This Complete EHR is 2011/2012 compliant and has been certified by an ONC-ATCB in accordance with the applicable certification criteria adopted by the Secretary of Health and Human Services. This certification does not represent an endorsement by the U.S. Department of Health and Human Services or guarantee the receipt of incentive payments. 3. Patient Lists  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. Menu Set of Objectives © 2013 Insight Software, LLC. All rights reserved.

29. Meaningful Use of Certified EHR Technology with My Vision Express This Complete EHR is 2011/2012 compliant and has been certified by an ONC-ATCB in accordance with the applicable certification criteria adopted by the Secretary of Health and Human Services. This certification does not represent an endorsement by the U.S. Department of Health and Human Services or guarantee the receipt of incentive payments. 4. Patient Reminders  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. Menu Set of Objectives © 2013 Insight Software, LLC. All rights reserved.

30. Meaningful Use of Certified EHR Technology with My Vision Express This Complete EHR is 2011/2012 compliant and has been certified by an ONC-ATCB in accordance with the applicable certification criteria adopted by the Secretary of Health and Human Services. This certification does not represent an endorsement by the U.S. Department of Health and Human Services or guarantee the receipt of incentive payments. 5. Patient Electronic Access  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. Menu Set of Objectives © 2013 Insight Software, LLC. All rights reserved.

31. Meaningful Use of Certified EHR Technology with My Vision Express This Complete EHR is 2011/2012 compliant and has been certified by an ONC-ATCB in accordance with the applicable certification criteria adopted by the Secretary of Health and Human Services. This certification does not represent an endorsement by the U.S. Department of Health and Human Services or guarantee the receipt of incentive payments. 6. Patient-specific Education Resources  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. Menu Set of Objectives © 2013 Insight Software, LLC. All rights reserved.

32. This Complete EHR is 2011/2012 compliant and has been certified by an ONC-ATCB in accordance with the applicable certification criteria adopted by the Secretary of Health and Human Services. This certification does not represent an endorsement by the U.S. Department of Health and Human Services or guarantee the receipt of incentive payments. Meaningful Use of Certified EHR Technology with My Vision Express 7. Medication Reconciliation  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. Menu Set of Objectives © 2013 Insight Software, LLC. All rights reserved.

33. Meaningful Use of Certified EHR Technology with My Vision Express This Complete EHR is 2011/2012 compliant and has been certified by an ONC-ATCB in accordance with the applicable certification criteria adopted by the Secretary of Health and Human Services. This certification does not represent an endorsement by the U.S. Department of Health and Human Services or guarantee the receipt of incentive payments. 8. Transition of Care Summary  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. Menu Set of Objectives © 2013 Insight Software, LLC. All rights reserved.

34. Meaningful Use of Certified EHR Technology with My Vision Express This Complete EHR is 2011/2012 compliant and has been certified by an ONC-ATCB in accordance with the applicable certification criteria adopted by the Secretary of Health and Human Services. This certification does not represent an endorsement by the U.S. Department of Health and Human Services or guarantee the receipt of incentive payments. 9. Immunization Registries Data Submission*  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. Menu Set of Objectives © 2013 Insight Software, LLC. All rights reserved.

35. Meaningful Use of Certified EHR Technology with My Vision Express This Complete EHR is 2011/2012 compliant and has been certified by an ONC-ATCB in accordance with the applicable certification criteria adopted by the Secretary of Health and Human Services. This certification does not represent an endorsement by the U.S. Department of Health and Human Services or guarantee the receipt of incentive payments. 10. Syndromic Surveillance Data Submission*  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. Menu Set of Objectives © 2013 Insight Software, LLC. All rights reserved.

36. Meaningful Use of Certified EHR Technology with My Vision Express What do you need to do to prepare? Make sure that all your set up is complete: OID, HealthVault, e- Prescribe, Alerts, Exam Summary letter, Outside physicians and Education Resources. Use your Meaningful Use Wizard! It is the best tool you can use to ensure you are satisfying all of the objectives. What do you need to do towards the end of the reporting period? Perform one electronic exchange of health information, Security analysis risk, Patient list. Attestation Calculator © 2013 Insight Software, LLC. All rights reserved.

37. Meaningful Use of Certified EHR Technology with My Vision Express Thank you for attending For more information or to schedule a training session, contact: Denise Ramos Phone: 1-877-882-7456 ext 713 denise@myvisionexpress.com Web: www.MyVisionExpress.com © 2013 Insight Software, LLC. All rights reserved.