2014 Workflows - CHUG



TABLE OF CONTENTS – NEW 2014 Workflows (EMR 9.8; CPS 12; MU 2014) TOC \o "1-1" \h \z TABLE OF CONTENTS – NEW 2014 Workflows (EMR 9.8; CPS 12; MU 2014) PAGEREF _Toc383419491 \h 1General Setup/Workflow Changes PAGEREF _Toc383419492 \h 3Workflow 1A: Office Visit – Computerized Physician Order Entry (CPOE) – (Stage 1 Core Measure 1 (medications); Stage 2 Core Measure 1 (medications, labs, imaging) PAGEREF _Toc383419493 \h 5Workflow #2A: Office Visit – Using new FH/SH form for Family History- (Stage 2 Menu Measure 4) PAGEREF _Toc383419494 \h 7Workflow #3A: Office Visit –Risk Factors for Smoking Status/History (Stage 1 Core Measure 9; Stage 2 Core measure 5) PAGEREF _Toc383419495 \h 8Workflow #4A: Documenting TRANSFER IN (Stage 1 Core Measure 13; Stage 2 Core Measure 15) PAGEREF _Toc383419496 \h 9Workflow #4B: Office Visit – Reconciling Medications (and Problems and Allergies) (Stage 1 Menu Measure 7, Stage 2 Core Measure 14) PAGEREF _Toc383419497 \h 10Workflow #5A: Office Visit – Producing a Clinic Visit Summary for the Patient (Stage 1 Core Measure 8, Stage 2 Core Measure 8,) PAGEREF _Toc383419498 \h 12Workflow #5B: Office Visit – Documenting Transfer OUT & Producing a CCDA to send OUT (Stage 1 Menu Measure 7, Stage 2 Core Measure 15) PAGEREF _Toc383419499 \h 14Workflow #6A: Office Visit – Ordering and Giving Vaccinations (Stage 1 Menu Measure 8, Stage 2 Core Measure 16) PAGEREF _Toc383419500 \h 16Workflow #6B: Office Visit – Ordering and giving medications in the office (Stage 1 Core Measure 1, Stage 2 Core Measure 1) PAGEREF _Toc383419501 \h 18Workflow #7: Office Visit – Documenting a CARE PLAN PAGEREF _Toc383419502 \h 19Workflow #8: Office Visit – Using the INFO button (producing patient specific education material) (Stage 1 Menu Measure 5, Stage 2 Core Measure 13) PAGEREF _Toc383419503 \h 20Workflow #9: Producing Patient Reminders (Stage 1 Menu Measure 4, Stage 2 Core Measure 11) PAGEREF _Toc383419504 \h 21Workflow #10: Office Visit – Documenting Vital Signs (Stage 1 Core Measure 8, Stage 2 Core Measure 4) PAGEREF _Toc383419505 \h 22Workflow #11: Office Visit – Using Clinical Decision Support (Stage 1 Core Measure 10, Stage 2 Core Measure 6) PAGEREF _Toc383419506 \h 23Workflow #12: Imaging Result in the EHR (Stage 2 Menu Measure 3) PAGEREF _Toc383419507 \h 24APPENDIX PAGEREF _Toc383419508 \h 259 Clinical Quality Measures (CQR Release 1 2014) PAGEREF _Toc383419509 \h 25Additional Clinical Quality Measures (CQR Release 2 ) PAGEREF _Toc383419510 \h 25Appendix #1 – Medication Administration form PAGEREF _Toc383419511 \h 27Appendix #2 – Family History using FH-SH-CCC form PAGEREF _Toc383419512 \h 38Appendix #3 – Social History using the FH-SH-CCC form PAGEREF _Toc383419513 \h 41Appendix #4B – Reconciliation Form PAGEREF _Toc383419514 \h 43Appendix 5A - CCDA Functionality & Workflows (Clinic Visit Summary) PAGEREF _Toc383419515 \h 45Appendix 5B - CCDA Functionality & Workflows (Produce a CCDA for a transition of care – out) PAGEREF _Toc383419516 \h 48Appendix #6A – Immunization Form PAGEREF _Toc383419517 \h 50Appendix #7 – Care Plan Form PAGEREF _Toc383419518 \h 64Appendix #8 – New User Fields PAGEREF _Toc383419519 \h 68Appendix #9 – New Orders Setup PAGEREF _Toc383419520 \h 69Appendix #10 – New Service Provider Fields PAGEREF _Toc383419521 \h 70General Setup/Workflow ChangesThe User Table has new fields for each EP as well as Credentialing for MAs) (see Appendix 8)EP (yes/no)Incentive ProgramCurrent StageReporting Year AttestedLicensed or Credentialed (what state and year)Privilege/Security ChangesALERTS/FLAGS = Hide flags/alerts sent to other usersCHART = Access Clinical Decision SupportCHART = Export Summary Documents (Needed for CCDA)CHART = Export Unsigned Chart Data (Needed for CCDA)CLINICAL INQUIRIES/REPORTS = Export PatientsCLINICAL INQUIRIES/REPORTS = Print Reminders for patientsCOMMON EVENT MODEL = MonitoringCOMMON EVENT MODEL = Subscription ModificationLINKLOGIC/REGISTRATION = Change Patient Specific Access RightsREGISTRATION = Modify First Visit DateSETUP = Change clinical report settingsThe CCDA is used in several ways of MU2014 Core Measure 8 (CVS) – Stage 1 supply patients with summary w/i 3 daysFor BOTH stage 1 & stage 2 (2014) you MUST NO LONGER USE THE HANDOUT PATIENT INSTRUCTIONS OR CLNICAL VISIT SUMMARY – the CCDA is used now for the CVSThe CCDA is what is used when receiving a clinical summary from another provider as well as generating a clinical summary when referring to a providerThe CCDA is used to transfer clinical information about the patient to Clinical Quality Reporting (CQR) for clinical data about PQRI, Meaningful Use, etc.Workflow 1A: Office Visit – Computerized Physician Order Entry (CPOE) – (Stage 1 Core Measure 1 (medications); Stage 2 Core Measure 1 (medications, labs, imaging)Key Considerations2014 Rules now count medications given in the office as part of this measure of CPOE for medications. The CCC-Basic (new) Medication Administration form now allows for documentation in such a way to count for this measure.Changes to Medication Administration now constitute a CLINICAL LIST CHANGE in the application and therefore creates a clinical list lock when updated and not signedAny NON-DRUG item that is categorized as so on the medication list is NOT counted in this measureNew Data MEL Symbols have been addedWorkflow StepsFront DeskClinical StaffProviderTaskCPS StepsXXOrder Labs and Imaging through the Order ModuleThe authorizing provider must be an EP. The user entering the order must be licensed or certified to do so. XPrinting/Sending prescriptionsNew category field in the New Medication screen must be set to Drug on the drop down list. EP must be in Authorized By field.New prescribing method of Pending Approval?added allows for EP to review and print/send prescription if entered by a non-EPXXDocument In-Office Medication AdministrationsOpen/Use the new Medication Administration form in an update. See HYPERLINK \l "Appendix1" Appendix #1ConfigurationSetup Orders at CATEGORY or CODE level as a Lab or Imaging Order ( HYPERLINK \l "Appendix9" Appendix 9)Configure users in Setup/Administration to indicate which are Eligible Professionals, EP’s reporting stage and year, and which users are Licensed or CredentialedBuild and update Administered Medications custom lists in Settings/Administration moduleWorkflow #2A: Office Visit – Using new FH/SH form for Family History- (Stage 2 Menu Measure 4)Key ConsiderationsThe following must be done by the provider: The EP can participate in collecting, documenting, or viewing the family history. The EP must sign the office visit note(s).For any returning patient after upgrade, previous family history will appear and be available, but new first degree relative specific Family History will be required.Changes to Family History now constitute a CLINICAL LIST CHANGE in the application and therefore creates a clinical list lock when updated and not signed Workflow StepsFront DeskClinical StaffProviderTaskCPS StepsXXCapturing first degree relative specific family history – (FH-SH-CCC Form) FH-SH-CCC Form has been updated in this version. Form now requires capture of first degree relatives.For details on using new FH-SH-CCC form refer to HYPERLINK \l "Appendix2" Appendix 2XMake changes to patient completed forms – (PatientLink, Web Forms, etc.)Any forms that the patient completes on their own (either paper or electronic) can be changed to reflect new opportunity for first degree relatives.ConfigurationUpdate all forms that are given to patients for completing a family history. This includes paper forms and electronic forms (i.e. PatientLink, Web Forms, etc.)Allow for additional time to capture first degree relative specific family history during appointmentsUse the FH-SH-CCC form to capture this – CCC 8.3.8 text files include SNOMED Codes for Family Practice specialty by default. If your practice uses any other specialty CCC content you must update the SNOMED codes for that specialty. Use this website for SNOMED codes: #3A: Office Visit –Risk Factors for Smoking Status/History (Stage 1 Core Measure 9; Stage 2 Core measure 5)Key ConsiderationsThe following must be done by the provider: The EP may participate in the collection, documentation, or review of a patient’s Health Risk Factors (including smoking)The measure captures data for patients age 13 and upWorkflow StepsFront DeskClinical StaffProviderTaskCPS StepsXXDocumenting Patient’s Smoking StatusValues are available for documenting a patient’s smoking status on the FH-SH-CCC form. For details on using the updated form refer to HYPERLINK \l "Appendix3" Appendix 3XMake changes to patient completed forms – (PatientLink, Web Forms, etc.)Any forms that the patient completes on their own (either paper or electronic) should be changed to reflect new opportunity for smoking status options.ConfigurationUpdate all forms that are given to patient’s for completing a smoking status/historyWorkflow #4A: Documenting TRANSFER IN (Stage 1 Core Measure 13; Stage 2 Core Measure 15)Key ConsiderationsThe office visit documentation must be signed by EPTransfer IN means that a patient’s care has been transitioned into your practice from another setting, or referred to your practice.See HYPERLINK \l "Workflow4B" Workflow 4B for workflow instructions on reconciling patient information received from the referring providerSee HYPERLINK \l "Appendix4B" Appendix 4B for step-by-step instructions on reconciling patient information received from the referring providerWorkflow StepsFront DeskClinical StaffProviderTaskCPS StepsXXIdentify a patient as being transferred IN to your practice (having been referred to your practice from outside of your organization)When starting a NEW DOCUMENT a check box is available to denote that the patient is being TRANSFERRED IN for the purpose of this visit documentation. XXIf not done so yet during the start of the encounter, when ENDING AN UPDATE a check box is available to denote that the patient is being TRANSFERRED IN for the purpose of this visit documentation.ConfigurationMake sure all staff understand the definition of TRANSFER IN patient/visit Screen Shots of TOC Check Box Workflow #4B: Office Visit – Reconciling Medications (and Problems and Allergies) (Stage 1 Menu Measure 7, Stage 2 Core Measure 14)Go back to Transfer In WorkflowKey ConsiderationsThe office visit documentation must be signed by EPIf no CCDA documentation is received, then skip steps 1 and 2 of this workflowThe reconciliation form is a WEB Based HTML form that cannot be edited at this time, nor is it required for use in 2014 MU measures. If used to reconcile medications the form will check the box MEDS REVIEW which is the data that qualifies for meeting this measure.When using the Reconciliation form the button to MARK AS REVIEWED will remove the CCDA from being available for any other reconciliation (including if the current document is discarded without signature)Workflow StepsFront DeskClinical StaffProviderTaskCPS StepsXXReconcile Medications, Problems and Allergies Click the Reconciliation button from one of the following forms to launch the Reconciliation HTML form.HPI-CCCProblems-CCCCPOE A&P-CCCMU CORE ChecklistXXSee HYPERLINK \l "Appendix4B" Appendix 4B for Instructions on completing the ReconciliationXOn the MU CORE Checklist form check mark the Mark as Reviewed check box for Problems, Medications, and Allergies if not done so alreadyConfigurationDetermine WHO will be the person to reconcile medications, problems and allergiesWho will import CCDAs received by the practiceIf using custom forms, a button to launch the reconciliation form can be built by using the following function: {SHOW_HTML_FORM("//localserver/EncounterForms/reconciliation/index.html","Reconciliation")}Workflow #5A: Office Visit – Producing a Clinic Visit Summary for the Patient (Stage 1 Core Measure 8, Stage 2 Core Measure 8,)Key ConsiderationsThe PATIENT INSTRUCTIONS HANDOUT can no longer be used in 2014 to count toward MU measure. Please use the new Generate CVS button for the Clinical Visit SummaryStage 2 requirement changed to provide patient clinical visit summary with 1 business day. Stage 1 requirement was to provide within 3 business days.A signed E&M service order must be entered for this patient to be counted for this measureWorkflow StepsFront DeskClinical StaffProviderTaskCPS StepsXXCreate Clinical Visit Summary Click the Generate CVS button from the Patient Instructions-CCC form within an updateORRight click on a signed Office Visit document from the patient’s chart then click Create Clinical Visit SummaryXXOptional: Customize the Clinical Visit Summary prior to giving to patientIn the clinical Visit Summary screen click the Customize button and select which items to add or remove from the CVS. See HYPERLINK \l "Appendix5A" Appendix 5A for complete steps.XDetermine how it will be given to the patientChoose Print, Save To File, or Save to Chart and Close (to send via Secure Messaging at a later time) XDocument a declined CVS If a Patient DECLINES a CVS then this should be indicated on the bottom of the MU CORE Checklist form (and will only be used for THIS VISIT REPORTING).ConfigurationDetermine what if any customizations will be allowed to the CVS prior to producing for the patientHow will patient electronic address be known / relevant to end userWhat (if any) external media will be allowed to save the file to and give to the patient Security Needed to Generate a CCDA for a chart/patient CHART = Export Summary DocumentsCHART = Export Unsigned Chart Data If using custom forms, and NOT using CCC you can add a button to generate the Clinical Visit Summary by using the following function: {MEL_GEN_CVS()}Workflow #5B: Office Visit – Documenting Transfer OUT & Producing a CCDA to send OUT (Stage 1 Menu Measure 7, Stage 2 Core Measure 15)Key ConsiderationsThe referral is required to be AUTHORIZED BY the EP, and placed by the EP or licensed health care professional.Any Referral order (either by individual order code or by order category) can be designated as part of a TRANSFER OUT event so that when that order is placed, the system will mark this event as a referral out (or TRANSFER OUT) for which a CCDA should be generated, no further action by the end user is requiredSee HYPERLINK \l "Appendix5B" Appendix 5B for Step-by-Step instructionsWorkflow StepsFront DeskClinical StaffProviderTaskCPS StepsXPlacing a Referral Order“Authorized by” for the referral order is required to be the EPREASON field entry is required when ordering a referral. Sign Referrals/Orders/DocumentXManage Referral and send appropriate documentation to Service Provider / Generating a CCDAThe Referral Coordinator will manage the referral including generating the CCDA Reason is now requiredFrom Orders tab of chart, change order and fill in desired fieldsClick Save & CreateSAVE to CHART & CLOSE = may send to provider through Secure MessagingThis will attach to the office visit as an AppendConfigurationService Provider Setup – new field for secure electronic address ( HYPERLINK \l "Appendix10" Appendix #10)When sending electronically (if using centricity clinical messenger – sure scripts – Kryptiq will provide the address in Service Provider (this process from Kryptiq)Order Setup – Referral and Test orders can be managed in Administration/Settings to “Use as Transition of Care” on the category or individual order levelSecurity Needed to Generate a CCDA for a chart/patientCHART = Export Summary DocumentsCHART = Export Unsigned Chart Data Anything looking at OBS terms, can be mapped to (custom/other) OBS termsWorkflow #6A: Office Visit – Ordering and Giving Vaccinations (Stage 1 Menu Measure 8, Stage 2 Core Measure 16)Key ConsiderationsThe document must be signed by the EPImmunizations are now considered a CLINICAL LIST and unsigned vaccines/immunizations entered on the form as given/done will active the clinical list lock for that document until the document is signed (however, no evidence of this is seen in the View Clinical List Changes window)See HYPERLINK \l "Appendix6" Appendix 6A for step by step instructionsWorkflow StepsFront DeskClinical StaffProviderTaskCPS StepsXOpt IN/OUTDetermine this patient’s participation in registry per practice and state regulations. Check registrationregistry tab to verify if correctXOrder immunizations to be given todayUsing the new Immunization Management form double click on the blue circle next to the vaccine you wish to be given, and complete the required fieldsXCommunicate shots neededThe request for a shot can only be seen on the Immunization Management form itselfCommunicate to staff regarding the need to give a shotXGiving the shotDocument on the Immunization Management FormXGive Patient a recordPrint History View, Letter or Handout for patient if desiredConfigurationIf using Qvera (QIE) for DPH immunization integration this new data model has to be usedComplete Immunization setup in AdministrationRemove all old versions of the Immunization Management form from favorites and templatesCreate new Custom Lists for Immunization Management FormEdit Letters, Handouts, Reports, History Views to accommodate new Immunization table/model.Remove the report in crwrpts folder (Immun.rpt) for the Immunization Management report (it will no longer be accurate)Workflow #6B: Office Visit – Ordering and giving medications in the office (Stage 1 Core Measure 1, Stage 2 Core Measure 1)Key ConsiderationsThe following must be done by the provider: The note must be signed by the EP.This now counts towards the numerator and denominator for CPOE event(s).Workflow StepsFront DeskClinical StaffProviderTaskCPS StepsXRequest a medication to be administered todayThe Provider must request a medication be given to a patient using the Medication Administration form.Utilizing the Medication Administration form appears to translate text into the narrative of the note indicating the medication to be given HYPERLINK \l "Appendix1" Appendix1XCommunicate Medication Event to staffRoute/Flag & communicate to staff the need for medication administration.XGive/Administer medicationUsing the Medication Administration form, document the medication given today ConfigurationCreate new Custom Lists for new form ( HYPERLINK \l "Appendix1" Appendix #1)Workflow #7: Office Visit – Documenting a CARE PLANKey ConsiderationsThe documentation must be signed by the EPIf a Care Plan is documented, it will be included in the CVS (CCDA) for the patient. However a Care Plan is not required at this time to be documented per MU Guidelines.Although you can add and modify a care plan, there is not a way to delete a care plan at this timeWorkflow StepsFront DeskClinical StaffProviderTaskCPS StepsXDocumenting a Care Plan in CPSIn an update, add the Care Plan Management formXDocument Plan per Problem/DiagnosesSee HYPERLINK \l "Appendix7" Appendix #7XAssess Progress of PlanYou can review an existing care plans by going to the patient’s chartHistories section and selecting to view the Care Plan Hx View, or opening the Care Plan Management form while in an update.ConfigurationDetermine Document Template Setup, use of favorites, ADD FORMWorkflow #8: Office Visit – Using the INFO button (producing patient specific education material) (Stage 1 Menu Measure 5, Stage 2 Core Measure 13)Key ConsiderationsTruven is the 3rd party vendor installed with CPS 12/EMR 9.8 (separate contract is required with Truven or other 3rd party vendor)The INFO BUTTON is located in the patient’s chart in the Problems, Medications, and Flowsheet screens. (It is important to note that these buttons are not at this time available during an UPDATE window)In the flowsheet view, the Info Button will only work on an imported lab resultThe handout does NOT have to be printed by the EP, but an office visit signed by the EP is required in the chart during the reporting period.Workflow StepsFront DeskClinical StaffProviderTaskCPS StepsxLook Up Relevant patient infoWith the Problem or Medication or Flowsheet item (Lab Result) highlighted, click the INFO BUTTONxPrint Relevant patient infoChoose to print or otherwise share this info with patientConfigurationDecide if you will use the default vendor Truven, or if you want to utilize a different vendorConfigure URL in Setup/AdministrationWorkflow #9: Producing Patient Reminders (Stage 1 Menu Measure 4, Stage 2 Core Measure 11)Key ConsiderationsCPS12/EMR 9.8 cannot produce a list of patient due a vaccination or immunizationGenerating letters from the inquiry module occurs one at a time and cannot be stopped once startedMeasure is counted for patients with a Contact by: value of LetterWorkflow StepsFront DeskClinical StaffProviderTaskCPS StepsXRun an Inquiry to find a list of the patients for whom a reminder is dueUse the Inquiry ModuleXXSigning the letters generated and saved to a patient chartThese letters will go to a user desktop and must be individually signed, but the signer does not have to be the provider.ConfigurationLetters to be used for this purpose should be placed in a folder with the word “Actionable” in its titleSecurity Permission required for persons doing this actionClinical Inquiries/Reports>Print reminders for patients. This setting defaults ON after upgrade. Need to remove this permission from users or groups you do not wish to print remindersNew data symbol PATIENT.CONTACTBY can be added to letters, banners or other customizationsWorkflow #10: Office Visit – Documenting Vital Signs (Stage 1 Core Measure 8, Stage 2 Core Measure 4)Key ConsiderationsThe encounter documentation must be signed by the EPThe CCC-Basic Vital Signs form can be edited to include additional buttons for moving around the application and performing certain tasksThe Vital Signs-CCC form has reference available for high/low events such as BP/BMI info (MU Core item #6 )Workflow StepsFront DeskClinical StaffProviderTaskCPS StepsXTake a review vital signs for patients with an office visitUsing the Vital Signs-CCC form update height, weight, BP for all patients seenBMIGrowth Chart infoConfigurationUpdate Vital Signs form with necessary links to other forms, and functionality, as needed. If not using the provided CCC form, change data fields in your custom form to only accept numeric valuesWorkflow #11: Office Visit – Using Clinical Decision Support (Stage 1 Core Measure 10, Stage 2 Core Measure 6)Key ConsiderationsFor Stage 1 only 1 CDS is required. For Stage 2 5 CDS’s are required. For both stages Drug/Drug and Drug/Allergy interaction checking is an additional requirement.Recommended references to use: Vital Signs Form – (reference for abnormal BP, temp, respirations, pulse included on form)CPOE form (CCC-Basic) – has the following CDS reference materials built inReference for Diabetes Patients (ACE/ARB & Contraindication. Aspirin therapy & Contraindication, Smoking Status, TEST/SERVICES DUE) Preventive Health CareScreening PSAThe Drug/Drug Drug/Allergy interaction is separate from the 5 CDS interventions, but are a requirement of this measureWorkflow StepsFront DeskClinical StaffProviderTaskCPS StepsXDetermine the clinical decision support rules to be used by each EP for attestation.No action needed. This is built into CPS/CEMR automaticallyConfigurationIf not already there, create a new Security Group named “CDS Access” in Setup/Administration and assign your selected users to this groupAssign users you wish to see clinical decision support data to the “CDS Access” security groupAssign security groups, or individual user as you wish to the permission of “Access Clinical Decision Support” of the Chart FolderWorkflow #12: Imaging Result in the EHR (Stage 2 Menu Measure 3)Key ConsiderationsThe EP must be the responsible provider for an Imaging Reports document typeWorkflow StepsFront DeskClinical StaffProviderTaskCPS StepsXAn ImageLink Interface EP receives an ImageLink Interface result in the EMR which links to an image view.EP is responsible provider (and likely signer, but not required) of Document TypeXScan/Import imaging reportScanning Imaging Results – Results should have a document type OTHER THAN Imaging Report, since this would count against the EPConfigurationSince the interpretation of this measure indicates that an Image is required to be linked to the document in the EMR, GE’s Best Practice solution to meet this measure is to have an ImageLink Interface with a vendor who sends both narrative result reports and a link to a stored image.? An interface that links to a PACS system where images can then be viewed is ideal as well.Other opportunities to meet this measure would be-????????? If the patient presents with a CD of image files, then utilize one or more of those files to attach as an external image through your document management (scanning/indexing) solutionStarting with your reporting period, it is recommended to only use the document type of Imaging Report in the EMR for documents which meet the criteria above.? Any other use of the document type Imaging Report may lead to inaccurate measure reporting.? All other text-only imaging result reports should be brought into the application as a different document type (either when scanning/indexing, or through any integration currently enabled)APPENDIXCMS-22Preventive Care and Screening:? Screening for High Blood PressureCMS-65Hypertension: Improvement in blood pressureCMS-69Body Mass Index (BMI) Screening and Follow-UpCMS-117Childhood Immunization StatusCMS-122Diabetes: Hemoglobin A1c Poor ControlCMS-123Diabetes: Foot ExamCMS-124Cervical Cancer ScreeningCMS-125Breast Cancer ScreeningCMS-126Use of Appropriate Medications for AsthmaCMS-127Pneumonia Vaccination Status for Older AdultsCMS-130Colorectal Cancer ScreeningCMS-131Diabetes: Eye ExamCMS-134Diabetes: Urine ScreeningCMS-138Tobacco Use: Screening and Cessation InterventionCMS-139Falls: Screening for Falls RiskCMS-147Influenza ImmunizationCMS-148Hemoglobin A1c Test for Pediatric PatientsCMS-155Weight Assessment and Counseling for Nutrition and Physical Activity for Children and AdolescentsCMS-163Diabetes: Low Density Lipoprotein (LDL) Management and ControlCMS-165Controlling High Blood PressureCMS-166Use of Imaging Studies for Low Back Pain MeasureCMS-182Ischemic Vascular Disease (IVD): Complete Lipid Panel and LDL ControlAppendix #1 – Medication Administration formClick to go back to CPOE or Medication Administration workflowMedication AdministrationThe Medication Administration form is intended to assist in the documentation of medications administered during a patient encounter. These can include injectable meds, oral meds, infusions, or any other kind medication. Medications captured through this form are stored discretely in the database and counted toward the Meaningful Use Stage 1 and Stage 2 CPOE measures.Before You Begin:The Medication Administration form contains several dropdown lists that are edited using a new custom list editor. Practices must be sure to configure custom lists and the associated medications there first, before using the form. The CCC Basic package comes with a Text Component that can be used to pre-populate commonly administered medications into pre-built custom lists. This Text Component can also be configured with custom data. To load the content, open a chart update for any patient and insert the Text Component called “MedAdmin-DeliveryData”. Once loaded, discard the document. The form will now be loaded with any content configured within that Text Component.Administered Medication Custom Lists1 - Access the Administered Medication Custom List editor through Administration>Charts>Chart (CPS), or Go>Setup>Settings>Charts (EMR).2 – Any number of custom lists names can be created or modified using the New, Change, Remove, or Copy buttons located at the top of the screen. Once selected, add medications to the selected list by clicking the “Add New Medication” button. Existing medications can be modified or removed by clicking the Change or Remove buttons next to the medications. 3 – After clicking the Add New Medication button, search for and select the desired medication from the Medication Reference List. (This will be displayed as the “Reference Name”.) Once selected, the “Display Name” can be modified in the Edit Medication window and will be what the user sees in the form.4 – The DDID and NDC numbers will display automatically if chosen form the Reference list. (Additional NDC numbers can be linked if desired.) The medication can be linked to an order by clicking the Change button to the right of the Order caption. The Medication Administration can be used to push an order to the Orders module if the Order is linked to the medication. 5 –Once the Edit Order window opens, the user can attach an Order to the medication. (Note: The Order must first be built in the Centricity Orders module.) The Order Type, Order Category, Code, and Code Description are pulled from the Orders module using the Lookup buttons. Priority, Comment, Modifier, and Units are optional fields that can be used to provide further details.6 – Once the Order is linked, the user can then move on to adding default options for Route, Site, Dose, and Units (units of measure for the Dose) using the associated Change buttons.7 – When finished, click OK. Continue to add additional medication to the custom list(s) as desired.Using the Medication Administration FormThe Medication Administration is designed to allow for multiple steps in the workflow of administering medications during a patient encounter. The form allows for a provider to request that a medication be administered (today or at a future date), and then allows for another clinician to then document the administration of the medication itself.1 - The Administration Meds Summary allows the user to see a quick overview of any medications a provider has requested to be administered, the Start and Stop Dates, and the name of the provider who requested it. This information appears in top section of the form titled “Meds Due for Administration. The associated details are listed in the “Details For” section below.2 – All administered medications must start with a request. To add or modify a request, the provider can click the “New” button, or the “Add/Update Request”.Add/Update Request Tab290576029527501 – Select a custom list to choose from. 2 – Select the medication from the custom list. 3 – An indication of a potential allergy or contraindication to the selected medication may be displayed.4 – A diagnosis can be selected to associate to the medication, either from the dropdown list which will display the patient’s current problem list, or by clicking the Problems button to access the Update Problems dialogue.5 – Select a “Requested By” provider or click the “Me” button to insert their own name.6 – Enter a Start Date7 – Enter a Stop Date. Using the buttons to the right will calculate a stop date based on the start date.8 – Enter any Instructions for the clinician who will administer the medication.9 – Enter any additional Comments.10 – Commit the RequestAdminister Medication TabOnce the request has been entered, the provider or another clinician can document the administration of the medication that was requested by going to the Administer Medication tab.1 – Enter the user name of the person administering the medication, or click the “Me” button.2 – Enter a Route. This dropdown list is prepopulated based on the default values entered in the custom list enter for the specified medication.3 – Enter a Site. This dropdown list is prepopulated based on the default values entered in the custom list enter for the specified medication.4 – Enter a Manufacturer. This dropdown list is prepopulated based on the default values entered in the custom list enter for the specified medication.5 – Select a problem from the patient’s problem list. If entered when requested, this will already be populated.Clicking the “Manage Lots” button will open a separate window where multiple lot numbers can be stored. The lot numbers are set up by Manufacturer.To set up Lot #s:1 – Choose a manufacturer from the dropdown list.2 – Enter the Lot# and associated Expiration Date. 3 – Click Add.Continue documenting administration:6 – Choose a lot number from the dropdown list of predefined values. Expiration date will default based on the value set up for the associated lot number.7 – Enter the amount given or choose from the dropdown list of predefined values. This dropdown list is prepopulated based on the default values entered in the custom list enter for the specified medication.8 – Choose the Unites for the Dose given. This dropdown list is prepopulated based on the default values entered in the custom list enter for the specified medication.9 – Enter a Start and Stop time for the beginning and end of the administration, or use the buttons to auto-fill the values.10 – Enter any Comments for the administration.11 – Check the box to have the form automatically enter orders for the medication.12 – Commit the Administration.1 – If the “Auto Generate Orders” checkbox had been checked when committing the medication, a new window will allow the user to select an order for the Medication Administration charge. (In addition to committing the order for the actual medication itself if set up that way.) Select the procedure from the dropdown list. (Note: the order category called “Medication Administration” must exist in the orders setup under Services.)2 – Enter a Comment3 – Enter the number of units to charge for.4 – Click Order5 –The user can Skip this step entirely if desiredExample Text Translation: (modifiable within the “MedAdminTextTranslation” Text Component:Appendix #2 – Family History using FH-SH-CCC formClick to go back to Family History workflowChoose the Relationship for which the user would like to update Family History, and Refresh the page. (OR Indicate No Known Family History or No Known Relative)Check the appropriate boxes to indicate family history (customizable through CCC Text File Editor)Enter a Comment if desired. Then click Save. Note: Comments will apply to all checked items when saved. To enter a different comment per item, check the individual box and save one at a time.Repeat for additional relationships as needed. To modify or Remove a previously stored Family History item for an individual relationship, choose the Relationship (if not already selected) and Refresh, as done in Step 1, then choose the Item to modify or remove: To modify comments, make the changes in the Comment field, then click the Save Updates button. To remove an item, choose a removal reason then click the Remove button. Saved Family History items will display in the Family Hx Summary area. To indicate that Family History has been reviewed during the visit, check the reviewed – no changes required box. General Comments can be written to apply to the patient’s entire Family History, stored in the observation term “FAMILY HX”. Any prior family history data stored in this observation term will display here:Appendix #3 – Social History using the FH-SH-CCC formClick to go back to Smoking Status workflowSocial History has been updated to include updated acceptable language for capturing smoking status. To capture Smoking Status, select from the radio button options. If “Current” is selected, choose a specific option from the additional drop-down list that appears:If appropriate, indicate that the patient has been counseled to quit by marking the relevant checkbox. Once the appropriate options have been selected for smoking status, choose additional relevant social history from the list boxes (optional, and customizable with the CCC Text File Editor).Once all appropriate options have been selected, click the Insert Selected Values button. Social History information will appear in the edit field.If Social History was completed prior to the visit and no changes are to be made, indicate by clicking the reviewed – no changes required checkbox. Changes can be made to smoking status by simply making the change and clicking the Insert Selected Values button again. Other changes would need to be cleared from the edit field first, and then re-inserted. Social History can be cleared completely by clicking the Clear All SH button.Appendix #4B – Reconciliation FormGo back to Transfer In Workflow or Reconcile Medications workflowSelect the document you wish to reconcile in the Documents to Reconcile fieldThe Forms defaults to the Problems tab so we will start with problems2933700306705On the problem list on the left side (Imported Problems), check mark the problems you wish to add to the patients chart then click Add To ListOn the problem list on the right side (Active Patient Problem List), you can check mark problems in the patient chart to edit or remove if desired.1933575741680474345076073047053502101851962150208280Click on the Allergies tab to reconcile allergies and the Medications tab to reconcile medications using the same steps as above.If a document has been imported and has NOT YET been used to reconcile clinical list information then that document will appear at the top of the screen as a choice for DOCUMENT TO RECONCILE.There is a separate tab for managing PROBLEMS, ALLERGIES, and MEDICATIONSChoose from the left partition anything in the CCDA you wish to have brought over to the CPS Chart.Once completed with the exchange you can MARK AS REVIEWEDThe mark as reviewed button IS NOT about reviewing the clinical list, but rather about reviewing the CCDA and once marked as reviewed this CANNOT be undone, and that CCDA will no longer be available for use in reconciliation. .Appendix 5A - CCDA Functionality & Workflows (Clinic Visit Summary) HYPERLINK \l "Appendix5A_Ref" Go back to Clinical Visit Summary workflowThe Consolidated Clinical Document Architecture (or CCDA) document is a standard HTML document that contains a variety of information required for specific Meaningful Use workflows and EMR certification, generated for communicating clinical information to patients and providers. The following will outline the specific contents of the CCDA, and go through several of the workflows for generating and consuming CCDA documents in the CPS or C-EMR application to meet specific MU Phase 2 DA OverviewThe CCDA document contains the following information as required by CMS:The CCDA document contains the information as it is structured in the chart at the time the CCDA was generated. Updating the chart will not update the information in any previously saved CCDA documents.Required PermissionsIn order to generate the CCDA document, the user must have the following privileges:Chart>Export Summary DocumentsChart>Export Unsigned Chart DataWorkflows for Generating the CCDAClinical Visit Summary (MU Stage 2: CORE Measure 8)The Clinical Visit Summary is intended to be provided to patients at the conclusion of their visit, within 1 business day, for >50% of all office visits. It can be printed and handed to the patient or saved to a file and sent electronically. To generate the CCDA specifically for this requirement, the user must follow the steps outlined below. The patient also has the option to decline the Clinical Visit Summary. In this case, the chart should indicate this by populating the observation term “PTDECLINECVS”, in order to still be counted toward the measure. A checkbox is available at the bottom of the MU CORE Checklist form to accomplish this.1162050278765NOTE: For this workflow, in order to count the patient in the numerator of the measure, a signed Office Visit E&M code must have been entered through the Orders module. Following the documentation of the encounter, while the update is still In Progress, generate the Clinical Visit Summary from within the update by using a button on a form component, utilizing a Quicktext, or by another means that utilizes the Data Symbol “MEL_GEN_CVS”.OROnce the document has been signed, generate the Clinical Visit Summary from the Chart ribbon:For CPS: Choose More>Create Clinical Visit SummaryFor EMR: Choose Actions>Document>Create Clinical Visit SummaryOR3 – Right-Click on the document and choose “Create Clinical Visit Summary”Appendix 5B - CCDA Functionality & Workflows (Produce a CCDA for a transition of care – out) HYPERLINK \l "Appendix5B_Ref" Go back to Transfer Out workflowTransition of Care Summary The Transition of Care Summary is intended to be provided to another of the patient’s providers when referred to them by the EP. This is to be done for >50% of transitions of care and referrals. This is to be specifically transmitted electronically (through a secure message) for 10% of transitions of care and referrals. To generate the CCDA for this requirement, the user must follow the steps outlined below. If a Referral or Test and Procedure order is being generated, the provider has the option to select whether this order is to be used for a Transition of Care (or this can be defaulted)The provider (or a delegate) can select the provider of service (Internal or External) where the patient is being referred.The order should be left on Admin Hold when signed.From within the Change Order dialogue, a user can modify the referral information.The Transition of Care Summary is then created by clicking the Generate button. Once generated, the TOC Summary can be printed, or saved to the chart and sent electronicallyAppendix #6A – Immunization Form HYPERLINK \l "Appendix6_Ref" Go back to Vaccine workflowImmunization ManagementThe Immunization Management form is intended to assist in the documentation of immunizations administered during a patient encounter. Immunizations captured through this form are stored discretely in the database in a new Immunization table. It is important to note this new data structure, since all previous immunization form releases (including the “Immunization Management – CCC”, “Immunization Management – GE”, and others) stored immunization data into observation terms. Customers who have previously captured immunization data using observation terms will want to migrate their data to the new table using the Immunization Migration tool (released with CPS12/EMR9.8), before using this form.Before You Begin:The Immunization Management form contains several dropdown lists that are edited using a new custom list editor. Practices must be sure to configure custom lists and the associated vaccines there first, before using the form.Immunization Custom Lists Access the Immunization Custom List editor through Administration>Charts>Chart (CPS), or Go>Setup>Settings>Charts (EMR).Any number of custom lists names can be created or modified using the New, Change, Remove, or Copy buttons located at the top of the screen. Once selected, add vaccine groups to the selected list by clicking the “Add New Vaccine Group” button. Existing Vaccine Groups can be modified or removed by clicking the Change or Remove buttons next to each listed. After clicking the Add New Vaccine Group button, search for and select the desired vaccine group from the list provided. (Individual vaccine types will be added to each group in a later step)Once the vaccine group has been chosen, individual vaccine types can be added to the group by clicking the Change button to the right of “Vaccine(s)”. A separate window will open, allowing the user to select vaccine types by clicking “Add New Vaccine”.Once a vaccine type has been selected, the Edit Vaccine window will open, allowing the user to customize related information which appears in dropdown lists in the Immunization Management form. The Vaccine name, NDC#, DDID#, CVX code, and Manufacturer of the vaccine type chosen will display automatically.The user can attach an Order to the vaccine. (Note: The Order must first be built in the Centricity Orders module.) The Order Type, Order Category, Code, and Code Description are pulled from the Orders module using the Lookup buttons. Priority, Comment, Modifier, and Units are optional fields that can be used to provide further details.Once the Order is linked, the user can then move on to adding default options for Route, Site, Dose, and Units (units of measure for the Dose) using the associated Change buttons.Once finished with the individual vaccine type, click OK and continue to build additional vaccine types for the Vaccine Group as needed.Once finished adding vaccine types, click OK until returned to the Edit Vaccine Group window. The user can add a placeholder for every number of immunizations that can be given in the series by clicking the Change button to the right of Series. This is also where the schedule for the vaccine can be set up.In the “Series List” window that opens, click Add New Series. Add the first number in the series for the vaccine group. (The should be a series number “1” at a minimum, for those vaccines that are either given only once or are given multiple times but not on a regular schedule. Example: Flu).Optional: Enter the Minimum Age in months for the series #.Optional: Enter the Maximum Age in months for the series #.Enter the Minimum Interval in days (the minimum time between when the last vaccine in the series was given and when this vaccine in the series should be given.)Click OK. Continue for additional series numbers.When returned to the Edit Vaccine Group window, complete the Vaccine Group information by entering the VIS Date for the vaccine group, and optionally any default Instructions.Repeat the above steps for all other vaccine groups for the custom list selected.Immunization Administration Encounter Form WorkflowThe Immunization Management is designed to allow for multiple steps in the workflow of administering vaccinations during a patient encounter. The form allows for a provider to request that a medication be administered today, and then allows for another clinician to then document the administration of the vaccination itself.Immunization Administration OverviewCustom list selectorUser can choose to view the immunization schedule in various views.Only Vaccine Groups that have been set up on the chosen custom list will display. Various indications of historical immunizations for the patient will show in the corresponding rows.Example Icon – Indicates that the patient may be due for the immunization.If a vaccine is not due, this allows the user to document an immunization off schedule.Link to a Questionnaire page.Link to Icon Legend (describes the various icon meanings that appear on this form)Link to Preload page – allows quick entry of historical immunization data.Detailed History – Shows a detailed history of every immunization documented for the patient.Administered Today section – Shows immunization either requested or administered during today’s visit.Check this checkbox before documenting administration to have the form automatically enter the order for the immunization.Check this checkbox to add an allergy to eggs to the patient’s problem list.Immunization Administration OverviewProvider Workflow (Optional)If the provider wishes to indicate that a vaccine should be given, he/she can do so by clicking one of the icons on the overview tab corresponding to the vaccine desired, which will bring up the Administration window.Indicate the series # to be given (if not defaulted).Indicate the date to be administered.Click the Hold button.Immunization Administration OverviewClinician Workflow (Documenting the Immunization)If the provider had requested that a vaccination be administered, an indication will display in the “Administered Today” section of the overview page. Double-Clicking on the “+” icon will take the user back to the Administration page to document the details of the immunization.If the vaccine was administered:Choose Given (default)Choose VFC Eligibility (Optional)Choose Vaccine type administered (will default as indicated in custom list setup)Enter VIS Date (will default as indicated in custom list setup)Enter Manufacturer (will default as indicated in custom list setup)Enter Amount Given (will default as indicated in custom list setup)Enter Units (will default as indicated in custom list setup)Indicate who administered the vaccine, or click the “Me” buttonEnter Time of administrationEnter Comments (Optional)Use Manage Lots to set up lists of Lot numbers to choose from:Choose a manufacturer from the dropdown list.Enter the Lot# and associated Expiration Date. Click Add.If the vaccine was NOT administered:Select Not GivenEnter ReasonOnce the form has been filled out:Click Hold to save the data and come back to the form laterORClick Done to complete the documentationTo Note an Adverse ReactionAt the time of administration, or at a later time, an adverse reaction can be noted for a given vaccine. Click on the vaccine in the patient’s history to reopen the administration window. Then select Adverse Reaction. The Adverse Reaction window will open:Enter the Onset Date of the reactionEnter the Time of the reactionEnter the date the reaction stoppedEnter a Reaction DescriptionEnter the Criticality of the ReactionIndicate who noted the reactionCheck the box to add an indicate of an allergy to the vaccine on the patient’s allergy listClick SaveIcon Legend:Appendix #7 – Care Plan FormClick to go back to Care Plan workflowCare Plan ManagementThe Care Plan Management form is intended to assist in the documentation of an individual patient’s care plan by entering problem-specific goals and/or targets. The Care Plan is a required component of the Clinical Visit Summary. While it is not required to document a Care Plan for a patient, it is required that if a plan of care has been established for a patient, that it appear on the Clinical Visit Summary required for Meaningful Use.Before You Begin:The Care Plan Management form contains several dropdown lists that can be pre-loaded with default content, including problem-specific goals, targets, and instructions. To load the content, open a chart update for any patient and insert the Text Component called “Care Plan – Configuration Data”. Once loaded, discard the document. The form will now be loaded with any content configured within that Text Component.Care Plan Management - Overview page:The View radio buttons allow the user to toggle between “Goals Met” (goals that have been marked as complete with a Met Date), “Goals Not Met”, and “All” (a combination of both).The Add button allows the user to add a new goal. The Update button allows the user to update an existing goal.– If adding a new goal, several fields are required. The first required field is “Set Date”, or the start date of the goal.– The user should link the goal to an existing problem on the patient’s problem list by selecting it from the “Select Problem” dropdown.– The goal can then be entered in either the “Select Goals” dropdown (displays a list of configurable goals), or via free-text in the “Enter Goals Here” edit field.Optionally, the user can establish a target for the goal in the “Target” edit field.Optionally, the user can enter instructions for the goal by selecting from the “Select Instructions” field (displays a list of configurable values), or via free-text in the “Enter Instructions Here” edit field.Clicking Save and Continue will allow the user to enter additional goals. Clicking Save and Close will return the user to the Care Plan overview page.Once returned to the overview page, the user can continue to Add new goals, Update existing ones or exit the form by closing the window. Note: You can only update goals that have not been met.To indicate that a goal has been met, enter a “Met Date” and check the “Met” checkbox. Each time the Care Plan Management is used, current and past goals can be displayed and/or updated.Example Text Translation: (modifiable within the “Care Plan Text Translate” Text Component.Adding or Changing Care Plan dropdown listsTo add or change a goal, target, or instruction for a given problem, the Text Component called “Care Plan – Configuration Data” must be modified and loaded. See CCC Basic Release Notes for instructions.Appendix #8 – New User Fields HYPERLINK \l "General_Setup" Go back to General SetupEach User setup (for EPs as well as non-EP Licensed/Certified Health Care professionals) will need to be completed – This information can be gathered early and put on the Master User Table/Spreadsheet used by the OrganizationAppendix #9 – New Orders SetupClick to go back to Workflow 1A ConfigurationIdeally at the CATEGORY LEVEL Orders can be classified as LABROATORY or IMAGING (which will assist with reporting CPOE orders)Additionally, the Order Category can be used to default the status of being a TOC (Transition of Care) – most likely REFERRAL ORDERS. Make sure that Orders setup as Referrals in CPS (but are actually imaging tests) are appropriate tagged.Appendix #10 – New Service Provider FieldsGo back to Transfer Out ConfigurationThere is a new field for Secure Electronic Address to associate with each service provider setup in the Service Provider Table. Please check with your GE EMR Consultant if this field requires manual set-up.Secure Electronic Addresses are assigned when providers register with a Health Information Secure Portal (HISP).If the provider to whom the patient is being sent is a member of a HISP, the electronic address will be available from the HISP directory. For providers who are not members of a HISP, a direct address book will need to be created that contains the secure email addresses for those providers.2476500810895 ................
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