Meaningful Use Stage 2- Menu Measure 3 Imaging Results Configuration Guide

Transcription

1 Enterprise EHR Meaningful Use Stage 2- Menu Measure 3 Imaging Results Cnfiguratin Guide Last Updated: January 30, 2014 Cpyright 2013 Allscripts Healthcare, LLC.

2 MU Menu 3 Imaging Results This guide will prvide instructins n hw t cnfigure the necessary setup t enable Enterprise EHR t wrk fr MU Menu 03: Imaging results cnsisting f the image itself and any explanatin f ther accmpanying infrmatin are accessible thrugh CEHRT Final Rule Requirements Mre than 10% f all tests whse result is ne r mre images rdered by the eligible prfessinal (EP) during the EHR reprting perid (RP) are accessible thrugh the certified EHR technlgy (CEHRT) Cre Objective: Menu Objective: Numeratr: The number f results in the denminatr that are accessible thrugh CEHRT Denminatr: The number f scans and tests whse result is ne r mre images rdered by the EP during the EHR RP Exclusin: Any EP wh rders less than 100 tests whse result is an image during the E HR RP OR any EP wh has n access t electrnic imaging results at the start f the RP. Objective is shared acrss Eligible Prfessinals: Yes: N: Objective must be recrded during the reprting perid : Yes: N: Prerequisites Requires: Cre EHR - Results Availability: Prir t v11.2: Enhanced with v11.4.1: AND Requires: Cre EHR - Orders Availability: Prir t v11.2: Enhanced with v11.4.1: Optinal: Imagelink Availability: Prir t v11.2: Optinal: Scan Availability: Prir t v11.2: Optinal: Results Interface Availability: Prir t v11.2: As part f this bjective, imaging rders and imaging results must be implemented. If yu have nt implemented any f these features and are lking fr implementatin assistance, please cntact yur Accunt Manager. If yu wuld like t cnsider implementing Imagelink, which allws yur prviders t assess the image frm the result, please cntact yur Accu nt Manager fr implementatin details. Cnfiguratin Steps Checklist Cpyright 2013 Allscripts Healthcare, LLC. 2

3 1. Review Imaging Orders Classificatin Ensure all imaging rders are apprpriately classified under the Dx Imaging Orderable Item Dictinary (OID) classificatin. Yu can re-classify rders using Drag/Drp in the OID r yu can use SSMT cntent categry OID Orderable Item, Parent Class clumn. Dictinary Steps G t TWAdmin Dictinaries Resultable Item dictinary (RID). Click n rderable item, that is placed in the rders hierarchy in the wrng parent class and drag it t the crrect parent classificatin. SSMT Steps Cntent Categry = OID- Orderable Item Cntent Categry Order Type= Imaging 2. Identify and update any rders that shuld be excluded fr MU Reprtin g Dictinary Steps G t TWAdmin Dictinaries and chse Orderable Item in Dictinary drp dwn bx. At bttm f screen, use scrll n right search fr Behavir ptin. Click n arrws left f Behavir t expand windw. Check the D nt include fr MU Reprting checkb x. Cpyright 2013 Allscripts Healthcare, LLC. 3

4 SSMT Steps Cntent Categry = OID- Orderable Item Make mdificatins as necessary in excel fr DNtIncludeFrMUReprting clumn 3. Ensure the system is setup t cunt if a imaging reprt has access t an image If yu are already using Imagelink tday, yu will need t make a change t the interface in v fr it t set the Image Accessible field fr the rder. Map parameter #175 t be the same parameter allws values f N = N; Y = Yes; D = Request Delete The mapping will have t check the value and if (@HasExternalStrageData.value = Y) = Y; Else = N This als captures the case ernalstragedata is blank, null i.e. nt defined If the image is available in anther system that yur prviders have access t and the results interface sets the Image Accessible flag n the rder. The inbund results interface will need t update the Image Accessible flag n the rder. Result Interface Changes Cpyright 2013 Allscripts Healthcare, LLC. 4

5 If it s determined the use f imagelink isn t required, then the rganizatin can map parameter 175 as they see fit. The key in case f audit is that they have access t the system where the infrmatin fr the result fr the rder resides. If nt the access t an image is nt available, then #175 t N. The setting can als be set manually by ging t TWAdmin Dictiaries Orderable Item The setting can als be set via SSMT Cntent Categry = Orderable Item Clumn = ImageAccessible 4. Ensure that the results are fllwing the verificatin prcess fr the rdering prvider (r apprpriate staff member) Cpyright 2013 Allscripts Healthcare, LLC. 5

6 Wrkflw Cnsideratins D yur prviders always have access t the radilgy reprt? Fr this measure bth the reprt and the image need t be accessible. The reprt will need t be resulted by the results interface, entered manually as a result, entered as a dcument and linked t the rder as a result, r scanned and linked t the rder as a result Implementatin f a results interface and Imagelink will significantly help with the achievement f this meaningful use bjective. If yu need additinal assistance in implementing a results interface r Imagelink, please cntact yur Accunt Man ager. Determine wrkflws fr dcumenting that a prvider has access t an image, if yu are nt using Imagelink: D yur prviders always have access t the image via anther system? If yes, des that access meet CMS s definitin f access? Can the results interface set the Image Access flag cnsistently fr all rdering prviders? Or just fr sme? If yu are nt using Imagelink r a results interface, can yu scan r imprt in any f the images? If yes, wh will be ding this activity? Ensure that th e wrkflws includes attaching the scanned dcument and reprt t the riginating rder. Fr rders adptin, ensure that yur prviders can place an rder withut being frced t cmplete rder details unless abslutely necessary. This means t default al l required fields t allw the prvider t save the rder and cntinue his/her wrkflw. We recmmend t nly require the prvider t cmplete the infrmatin, when they are abslutely the nly ne that can answer the questin timely and crrectly (nt req uired fr MU2 reprting). Fr results verificatin, ensure that the verify results tasks, wrklists, and Clinical Desktp views are apprpriately assigned t verifying users. Encurage the use f CareGuides, Quicksets, and Order Grups fr yur prvi ders (nt required fr MU2 reprting). Order Grups is a new feature with v It is the ability t create a grup f rderable items (acrss classificatins: labs, imaging, referrals, etc.) that can be rdered by a prvider in ne click. In preparatin fr use f this feature (prir t yur Cpyright 2013 Allscripts Healthcare, LLC. 6

7 upgrade), yu can review if there are any cmmnly gruped rders (that are nt specifically prblem based) in which yu can administratively setup this grupings by specialty. Ex. Pre - Op Testing, Prenatal Screenings. Encurage the use f specialty favrites and Quick Lists created fr ad hc rdering wrkflws (nt required fr MU2 reprting). Encurage the use f rder interfaces in wrkflws where yu are receiving results fr the rders (nt required fr MU2 reprting). Encurage the use f medical necessity checking fr understanding which tests are cvered by Medicare fr the assciated diagnsis (nt required fr MU2 reprting). Intrduce the use f batch editing when users need t make the same chang e t many rders. This is a new feature intrduced with v11.3 that allws users t edit similar fields acrss meds and nn-med rders, such as updating t be dne date r changing pharmacies (nt required fr MU2 reprting). Fr thse rders that are placed via paper and the entered int the EHR, we recmmend that yu change the cmmunicatin methd t these rders t Recrd when yu create the rder. This will place the rder in the denminatr, but the prvider will nt get credit in the numeratr as he/she did nt use CPOE t riginate the rder. Fr thse rders that shuld nly be recrded and nt rdered, we recmmend t use the Recrd w/ rdering flag, this will exclude this rder frm being in bth the numeratr and denminatr. Cpyright 2013 Allscripts Healthcare, LLC. 7

8 Hw EEHR Calculates the MU2 Reprt Numeratr: The system will cunt any imaging rder in the denminatr that has: Any interface result indicated as having the image accessible OR: Any rder that has a dcument assciated r attached t its result that indicates image accessible OR: Any rder manually resulted that indicates the image is accessible Denminatr: Cunts each radilgy rder created by the EP during the EHR reprting perid AND: Order is in a Resulted r Cmpleted status. Includes any rders created by an inbund rders interface, nly if the rders required authrizatin (includes retrspective and prspective authrizatin) ex. Reflex Orders cming frm the inbund rders interface AND: EP is listed as the Ordered By r Supervised By r Authrized By prvider AND: Order created date during the reprting perid (date is reflected by the Created Date) AND: Order is classified in the Dx Imaging classificatin in the OID Excludes Any rder flagged as D nt include fr MU Reprting in the OID OR: Orders created utside f EEHR in the fllwing instances: Unslicited rders received as results Carbn cpies f labs frm utside system, even if the EP is the rdering, authrizing, r supervising prvider (includes thse rders frm Native Integratin) OR: If Recrd w/ Ordering flag is checked fr the rder Exclusin: This will include thse results that are entered withut an rder already existing This will include thse rders yu entered as histry When the denminatr cunt is less than 100 Any EP wh has n access t electrnic imaging results at the start f the EHR RP (will be attestatin and is nt captured as a reprt calculatin) Indicatrs: When the numeratr divided by denminatr is greater than 55% Cpyright 2013 Allscripts Healthcare, LLC. 8

9 When the numeratr divided by denminatr is between 45% and 55%. When the numeratr divided by denminatr is belw 45%. Calculatin Flw Diagram: Reprting & Final Rule Cnsideratins Unslicited results will nt cunt as part f the denminatr. The rder fr the res ult must be placed in the system (by a user r rders interface) and the result needs t be assciated with that rder. The riginating rder needs t be in the EEHR fr the system t be able t determine if the results are applicable fr the EP s reprt ( ex. If there were hspital based labs). When using Imagelink, ensure that the interface is setup t check the Image Accessible flag in rder fr it t cunt fr reprting. When using Imagelink, the reprt des nt cunt the wrkflws when the rder is in an in prgress state in the numeratr. This is the case where the perfrming prvider is awaiting the image fr their impressin. Dcuments that are flagged as Image Accessible will need t be attached as a result t the rder fr them t cunt in the numeratr. CMS has defined "accessible" as "either incrpratin f the image and accmpanying inf in EHR OR an indicatin that the image and inf are available in anther technlgy and link t Cpyright 2013 Allscripts Healthcare, LLC. 9

10 it. Yu can demnstrate this by: directly linking t images stred in the EHR system r prviding a cntext-sensitive link t an external applicatin which prvides access t images and their assciated narrative. By cntext sensitive link we mean that the link t the image will ideally include parameters that en able access t the images themselves rather than access t a system which wuld require lgin, patient search, image selectin, and (finally) image viewing. Hwever, we agree with cmmenters that there is insufficient penetratin f single sign-n r services-riented integratin capabilities between EHR technlgy and PACS systems, and that the fluidity with which this access is enabled may nt be under the CEHRT s cntrl. We therefre d nt explicitly require that this link prvide immed iate access as described abve. If yur rganizatin prvides access t images ther than Imagelink, yu will need t review the abve t ensure yur image access meets the CMS bjective. CMS did nt put any restrictins arund the quality f the image r the stru cture f the image. DICOM standard is nt required and scanned images may be cunted in the numeratr. CMS has stated that there are n requirements n the retentin requirements f the image. CMS has stated that the image itself des nt need t be stred in the EHR. The measure lks at if the prvider has access t thse images - it des nt state that the prvider must view thse images. Additinal Infrmatin Fllwing is a list f reference dcuments, and where yu can find them in the system. Certified Wrkflws: ClientCnnect Tlbx Prduct Dcumentatin Allscripts Enterprise EHR Certified Wrkflws Ad Hc Dx Order: With/Withut Supervisin (H6a) Dcument Ad Hc Dx Order: Entering fr a Prvider (H6b) Dcument Quicksets (H10) Dcument Charging fr Orders (J3) Dcument Nn-Medicatin Order Prcessing (J6) Dcument Order Specimen/Data Cllectin (J10) Dcument CareGuides (H11) Dcument Entry f Paper Results (R1) Dcument In-Huse Testing (R2) Dcument Cpyright 2013 Allscripts Healthcare, LLC. 10

11 Results Verificatin (R3) Dcument Results Cmmunicatin (R5) Dcument Appintment Check-Out (K3) Dcument Applicatin Design and Behavir Resurce (ADBR): ClientCnnect Tlbx Prduct Dcumentatin Allscripts Enterprise EHR Pick yur versin Manual Guides Applicatin Design and Behavir Resurce (ensure yu SAVE it t yur PC) Jin Mnthly Order/Results Special Interest Grup via ClientCnnect CareGuide Dcumentatin ClientCnnect Tlbx Prduct Dcumentatin Allscripts Enterprise EHR 11.4 Manual Guides CareGuide Administratin Guide CareGuide User Guide Enterprise EHR CareGuide Updates: Orders Enhancements: ClientCnnect Tlbx Prduct Dcumentatin Allscripts Enterprise EHR 11.3 Enhancement Supplements Batch Clinical Item Edit Enhancement Dcumentatin Cpyright 2013 Allscripts Healthcare, LLC. 11