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 eligible professional.

An Ophthalmologist can participate in the program via Medicare or Medicaid but not both. Most physicians opt to go via the Medicare route, even though the Medicaid incentive is higher, because Medicare imposes a penalty starting in 2015 while Medicaid does not. So if you participate in the Medicaid program, Medicare will slap you with the penalty for non-participation.

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 in defraying startup costs for conversion to electronic medial records. Just because a task is not easy is not a reason to forego the benefits that derive from the exercise.

PREPARATION

Stage 1 Meaningful Use Requirements

Go to the Meaningful Use page to the bottom of the page for Downloads. Download "EHR Incentive Program MU Stage 1 Requirements Overview" and "EP Attestation Worksheet" files. Fully understand each Core, Menu and Clinical Quality Measures. The second download is very helpful in organizing all your responses, numerators, denominators for the Core Measures. It is rather simple to construct a similar worksheet for the responses, numerators and denominators for the Menu and Clinical Quality Measures. Because even the best prepared attestation will require at minimum 30 minutes of online work, it is best to have all the information at your fingertips to avoid frustrations.

Go to the CMS Registration and Attestation page, to download both the Registration and Attestation guides to get a sense of the process, which will be described in detail below. The Attestation Guide had not been updated for 2013 because only 13 instead of 15 Core Measures are required in 2013 while 15 had been required in 2012.

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->Cinics to the specific reports. For Ophthalmology most of the information can be found under the Automated Measures report or the Standard Measures report which will give the data for the 3 Ophthalmic Clinical Quality Measures.

Core Measures

Computerized Physician Order Entry

The denominator comes from the number of drugs in the Medication box on the right side of the Patient Information 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 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 installing the Greasemonkey add-on with the Allscripts Integration script.

List of Current And Active Diagnoses

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

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 have chosen.

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 drug, choose the "none" option from Issues.

Record Demographics

Set as the default of 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 record 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. It is not necessary to answer part b of the requirement. Fulfilling this requirement means one less Alternate Core Measure to contend with. This was the case in 2012. It remains to be seen if it is the case in 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

At a minimum the summary must contain recording of the Vital Signs, medications, medical conditions and an allergy list. Since most Ophthalmologists don't record Vital Signs, by inference it is not a component of the minimum requirement. CMS source material has not explicitly stated that Ophthalmologists are exempt from including Vital Signs in the Clinical Summaries. 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? for that visit, otherwise you won't get a numerator for this requirement.

Protect Electronic Health Information

You can safely answer yes to this requirement because of the enhancement by this developer 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.

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.

Medication Reconciliation

Be certain to check the box, Medication Reconciliation Performed ?, for the encounter, if you want a value for the numerator.

Transition of Care Summary

Check Transition/Transfer of Care? box for the visit.

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.

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 if you have taken a smoking history.

Alternative Core Measures

Again use zeros for these measures.

Additional Measures

Choose 3 out the 4 available Ophthalmic measures. At this time tracking of these Measures has not been implemented, hence the Standard Measure Report will yield inaccurate denominators and no numerators. A work-around would be to run reports for diagnoses and the corresponding PQRS codes from the Clinical part of the Reports module. The tally must be done manually.

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 number. MU fig 6.png

REGISTRATION

Step 1

The Registration and Attestation website is often difficult to access at peak hours, so it is best to try during off hours. 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

Step3

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

Step 4

After login, 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 receipt of sucessful registration. MU fig 19.png

ATTESTATION

In 2012 it was not possible to print the Attestation after the submission. To be extra careful in documentation, print each page of the Attestation before submission.

Step 1

Login and choose the Attestion 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

All 13 Measures must be reported.

1. CPOE

If the exclusion does not apply, provide the numbers. 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 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 exclusion. MU fig 30.png

9. Smoking History

Provide numbers. MU fig 31.png

10. Clinical Decision Support Rule

Answer yes. MU fig 32.png

11. Electronic Copy of Health Information

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

12. Clinical Summaries

Provide numbers. MU fig 34.png

13. Protection of Health Information

Answer yes. MU fig 35.png

Menu Measures

Public Health Measure

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

Additional Menu Measures

All 8 Measures will be discussed. Choose 4.

1. Formulary Check

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

2. Patient Lists

Answer yes. MU fig 38.png

3. Patient Reminders

If exclusion does not apply, provide numbers. MU fig 39.png

4. Lab Results

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

5. Medication Reconciliation

Provide numbers if exclusion does not apply. MU fig 41.png

6. Transition of Care Summary

Provide numbers if exclusion does not apply. MU fig 42.png

7. Electronic Access

Provide numbers if exclusion does not apply. MU fig 43.png

8. Education Resource

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 the zeros must be used as the numerators and denominators. As a result 3 Additional Clinical Quality Measures must be chosen for reporting. There are 4 available Ophthalmic measures to choose from.

Core Clinical Quality Measures

1. Blood Pressure Measurement

Enter zeros. MU fig 45.png

2. Smoking History and Smoking Cessation Intervention

Use the numbers from the Core Measure for Smoking History for part a of this measure and use zeros for part b. In 2012 answering part a constituted reporting for the entire measure thereby decreasing the number of Alternate Clinical Quality Measure by 1. MU fig 46.png

3. Weight Screening

Enter zeros. 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 zeros. 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 numbers.

2. Diabetic Retinopathy, Severity

Provide numbers.

3. Diabetic Retinopathy, Communication with Primary Care Physician

Provide numbers.

4. Dilate Exam in Diabetic Patient

Provide numbers.

PQRS-EHR Reporting Pilot

You must answer no to E-Reporting, otherwise you will not be able to complete the Attestation. MU fig 51.png

Confirm Submission

It is possible to attest on 1 pass, providing there had been good preparation. MU fig 52.png

Attestation Disclaimer

Agree to the disclaimer.

MU fig 53.png

Attestion Receipt

Attestion sucessful.

MU fig 54.png

CAUTION

In June of 2012 CMS hired Figliozzi and Company to audit Meaningful Use Attestations. Keep good and careful records to support your attestations.

SATISFACTION

CMS will credit your bank account in 60 to 90 days after the attestation. If you have a sense of contentment while a few extra coins jingling in your pockets and you would like to share your good fortune, feel free to go to the OpenEMR homepage and click the orange button. We thank you for your generosity.

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