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Our previous video showed how to use the patient
Use incentives program in 2011 and 2012. Our previous video showed how to use the patient
summary screen to
enter much of the "structured data" that's required to demonstrate Meaningful Use. In
this video, we'll
discuss actions that are performed elsewhere in InteliDOX, and give system administrators
a quick rundown
of systemwide features that can be used to support Meaningful Use.
Please note that this video was recorded using a "beta test" version of the software, so
the program may
look slightly different at your practice.
In our previous video, we demonstrated how to export the contents of a patient summary
screen to a
Continuity of Care Record, or CCR file, that can be transmitted to another provider. InteliDOX
can also
import CCR files, as well as CCD, or Continuity of Care Document, files that are received
from other
providers. If you receive a clinical summary file for one of your patients from another
provider, please
call Businet's tech support staff for help with importing the file into InteliDOX. CCR
or CCD files are
stored in a specially configured image corral, and can be viewed and indexed the same way
that you manage
scanned image files. An optional but easy-to-satisfy Meaningful
Use measure is allowing patients to access their basic clinical
information in a "timely" way. InteliDOX meets that requirement using the patient portal,
a secure web site
that ties into InteliDOX to let patients view their allergy list, active mediction list,
problem list, and
some test results. Patients register themselves for the portal using identifying information
like their
first and last name, date of birth, and Social Security Number. So long as the information
they provide
matches the information stored in InteliDOX, you don't have to do anything special to grant
them access,
but you'll see reports from the portal show up as messages in image corrals to let you
know once a patient
has registered. Another optional-but-easy measure is providing
patient-specific educational resources. InteliDOX has had
the option to configure patient information sheets for years, but if your system administrator
hasn't set
that up yet, now's the time. You select the information sheets that are appropriate for
a patient using a
specially-configured iPaper form; the selected sheets are sent to the patient's Queued Patient
Printing
list, where they can easily be printed as the patient checks out.
Another Meaningful Use measure that's optional in this first stage of the incentive program
is patient
reminders. You can meet this measure by sending appropriate reminder messages to at least
20% of your
patients who are aged 65 or older, or 5 or younger. For example, you might want to remind
your older
patients to get their flu and pneumonia vaccinations, and/or send reminders to parents about their
kids'
immunization schedules. Your system adminstrator, with Businet's help, can set up templates
with the
appropriate wording for the reminder notices, and the new Clinical Search and Reminders
report is used to
actually generate the notices.
The Clinical Search and Reminders report can also be used to generate all kinds of reports
on the fly,
based on demographic information like patient age and sex, problem descriptions, medications,
allergies,
and test results. To pass this Meaningful Use measure, you just need to run at least
one report of patients
with a specific condition, such as diabetes, arthritis, or whatever diagnoses are relevant
to your
practice.
As I mentioned when I was talking about the Medications section on the patient summary
screen, you should
now be ePrescribing whenever possible instead of using the traditional prescription module.
It's not
necessary to create electronic prescriptions for vaccinations that are administered in
the office, or for
controlled substances since you'll still have to print those, but you should try to use
ePrescribing for
everything else. If the patient's preferred pharmacy can't accept electronic prescriptions
yet, that's OK;
our ePrescribing partner will automatically fax those prescriptions for you. Most pharmacies
are set up to
accept electronic prescriptions, though, and ePrescribing can be fast for you (especially
after you've
saved the meds you prescribe most often to your "favorites" list), fast for your patients
(since the
prescription may arrive at the pharmacy before they do), safer for your patients (since the
ePrescribing
system automatically checks for drug-to-drug and drug-to-allergy interactions), and possibly
cheaper for
them too (since insurance formulary information is automatically displayed whenever it's available).
Information available through the ePrescribing network may also make it easier and more accurate
to perform
medication reconciliation for patients who have just transitioned into your practice.
The PBM/Pharmacy
History option may show some medications that you weren't aware of, and it's easy to add
prescriptions from
the Previous Drug History list to the patient's active medications list. Once you've reviewed
the patient's
meds list, click the "Mark all active medications as verified" button.
A core requirement of Meaningful Use is CPOE, or Computerized Physician Order Entry. In
this first stage of
Meaningful Use, CPOE applies only to the ordering of medications. The use of ePrescribing or
the
traditional InteliDOX prescription module by licensed personnel, who can enter orders
in the medical record
per state, local, and professional guidelines, should satisfy the CPOE requirement.
Another core requirement is Clinical Decision Support, or CDS, rules. InteliDOX currently
has one CDS rule
that's based on the patient's BMI, or Body Mass Index. If the BMI is considered out-of-range
based on the
patient's age, the pop-up window that's displayed when you click on the "to-dos" indicator will
let you
know, and will suggest procedure codes that can be posted on the patient summary screen
to indicate that
you've addressed the issue.
Because some of the Meaningful Use requirements apply to a high percentage of your patients—for
example, at
least 80% of patients who have an appointment during the measurement period need to have
at least one
diagnosis code on their problem list—you should run the Meaningful Use Calculations
reports often,
preferably every day. Just select a provider, then click the "MU" indicator at the bottom
right corner of
their picture. The first report you'll see includes patients who have an appointment
scheduled for today,
and lists each of the Meaningful Use measures. If a measure is highlighted in pink, that
means this
provider hasn't reached the required percentage for that measure based on today's appointments.
You may be
able to increase the percentage for the measure by clicking the "View missing items" link
for the measure,
clicking on the name of a patient shown on the list, then updating their chart with the
required
information, for example, updating their problem list. When you click the Finished button at
the bottom of
the list, the Meaningful Use Calculations report will be updated to reflect any changes
you've made to
patient charts. The "View all items" link shows both patients who do and don't meet
that measure. Measures
for which the provider has reached the required percentage will be highlighted in green. Measures
that are
gray are those that aren't tied to specific patients but require a particular feature
to be tested at least
once.
The Meaningful Use Calculations report for "today" is helpful because it can help you
identify patients
from whom you may need to gather additional information, such as their preferred language
or smoking
status. You can also run the report for the reporting period you've chosen (which is 90
consecutive days in
your first calendar year of participation in the incentive program, and the full calendar
year in
consecutive years), or for a custom date range, which can be any length of time from a single
day to a full
year. For example, if the "My Reporting Period" report shows that you're way behind for the
90-day period
that you want to report on, you could try running the "custom date range" report for
a different time frame
to see if those numbers are better.
This screen also includes a Quality Reporting tab that shows how your practice is doing
on a number of
clinical quality measures. For each quality measure that's available, the report shows
the "patient
population" (which is the number of your patients that the measure could potentially apply to,
which is
often based on the patient's age and existing diagnoses), the denominator (which may depend
on some
additional criteria to select patients, such as those who've had at least a certain number
of office
visits), the numerator (the number of patients to whom the appropriate care has been delivered),
and
exclusions (the number of patients who are excluded from the measure because a condition
such as an allergy
or other problem that makes the generally-recommended care inadvisable). Although CMS doesn't currently
require you to set any goals with regard to quality measures, you do have to report on
at least 6 of them,
even if you haven't met any of the measures. The first three measures on the list ("adult
weight screening
and followup," "hypertension: blood pressure management," and "preventive care and screening
for tobacco
use and cessation intervention") are suitable for practices that see mostly adult patients
and check
patients' vital signs. If none of your patients meet the conditions for one or more of these
quality
measures—for example, if your practice treats only patients under the age of 18, or measuring
vital signs
is considered irrelevant to your specialty—there are 3 alternative measures on which you can
report:
influenza vaccinations for patients aged 50 or older, weight assessment and counseling
for children and
adolescents, and childhood immunization status. You must report on at least 3 of these 6 measures,
even if
you have to report that the measures don't apply to any of your patients. You must also
report on at least
3 more clinical quality measures; you can choose whichever ones are most relevant to
your practice. Again,
you're not required at this stage to meet any particular goals with regard to clinical
quality measures,
other than reporting the numbers shown on this screen, but if you're interested in seeing
what kind of data
must be entered in InteliDOX to increase a measure's numerator (which is the number of
patients who are
receiving the recommended care), click the "Help" button for that measure.
If you're a "regular" InteliDOX user, not someone who's in charge of managing the InteliDOX
system, you can
tune out now; the rest of this video is intended for system administrators, and talks about
how to
configure user accounts and global settings to achieve Meaningful Use.
Some meaningful use requirements apply to features that need to be turned on in InteliDOX,
or tested at
least once:
Some of the requirements are integrated into ePrescribing. If you're not already signed
up for
ePrescribing, you'll need to be to achieve Meaningful Use. When providers ePrescribe,
features like drug-
to-drug and drug-to-allergy interaction checking and drug formulary checking are automatically
available.
Whenever possible, lab test results need to be stored electronically in a "structured"
format; faxed lab
reports (even those those that are stored within a computer system) don't qualify. If
you're not already
using an HL7 interface that automatically retrieves results from labs, please contact
us to discuss this.
You'll need to perform at least one test of electronically submitting information to an
immunization
registry and/or a public health surveillance system.
Immunization information is entered using InteliDOX's traditional prescription module;
we'll help you set
up vaccines on your medications list with the CVX codes and other information that immunization
registries
require. When a prescription is created for a medication that has a CVX code, InteliDOX
will automatically
create a file that's ready to be sent to an immunization registry, and we'll show you
how to transmit these
files as attachments to email messages.
Public health surveillance reporting files are also created automatically for patients
who have a scheduled
appointment, a complete set of vitals with the same date as the appointment, and a diagnosis
on the problem
list that is associated with a Centers for Disease Control code and has an onset or "diagnosed
on" date
that matches the appointment date. When such a diagnosis is added to the patient's problem
list and the
summary screen is saved, a pop-up message will ask if the user wants to "report electronically,"
and if
that option is chosen, a file containing the reportable information will be created. We'll
show you how to
transmit that file as an email attachment.
Security is a big part of Meaningful Use, but since InteliDOX has had many of the required
features for
years, the new requirements shouldn't be a big deal for you.
To satisfy the "audit log" requirement, you can run the Security Audit report. The Security
Audit report
has been updated to include actions that would fall under the optional "accounting of disclosures"
measure,
like emailing, faxing, and exporting patient data.
The "emergency access" requirement is satisfied by InteliDOX's "patient blocking" feature,
which lets you
restrict access to certain patient accounts, like VIPs or employees of the practice who
are also patients.
If you use patient blocking, we recommend that somebody in the practice be given the
right to override
blocking when necessary, so even if that employee wouldn't necessarily be allowed to view a
certain
patient's chart under normal circumstances, they can temporarily give themselves that
right in an
emergency.
The "automatic logoff" requirement is satisfied by InteliDOX's "screen blanking" feature.
Once the
InteliDOX screen has blanked itself, users will need to enter a special 5-digit password
or their regular
InteliDOX password to get back into InteliDOX. You can set a default screen blanking interval
for everybody
on the Global Settings screen, and if necessary, you can adjust settings for individual users
who need
shorter or longer blanking intervals using a special file on those users' workstations.
InteliDOX has a new global option to "zip and encrypt" patient files that haven't been
accessed in a given
time period, such as "15 days"; this supports the "general encryption" requirement. When
a user views a
chart that's been automatically compressed and encrypted, the files will be uncompressed
and decrypted in a
matter of seconds. Encrypting files that are being sent to another provider is done by
entering an
encryption password while exporting the patient summary screen to a Continuity of Care Record,
which was
demonstrated in our first video.
The requirement to ensure "integrity" of patient data is satisfied by InteliDOX's new ability
to export
Continuity of Care Records then calculate a SHA-1 hash value for the exported file.
To calculate a hash
value for a file, use the "Calculate a SHA-1 file hash" button on the Security screen.
The resulting value
can be copied and pasted, and transmitted (for example, by email) along with the CCR
file. The recipient
can generate their own hash value for the file they received, and verify that it matches
the hash value you
sent them.
You should already be creating unique InteliDOX user accounts for each of your users; this
meets the
"access control" requirement. The requirement to authenticate users who
access the EHR is satisfied by requiring InteliDOX users to log
in with a valid username and password.
If you need help turning on, configuring, or using any of these features, please contact
us.