Home Forums Discussions Meaningful Use Meaningful Use Question

Menu 1: Formulary Status Check. Does this mean that one instance of checking a medication against a patient's formulary will meet the criteria or does it mean that every patient's formulary should be checked when writing prescriptions?

My comment is in regard to the original questions of meaningful use. I am still using V6.09. I have been using this version since about July 15th.

When I am documenting in the patients chart, in the upper right corner, clicking on the meaningful use icon will bring up a screen showing the criteria and what is happening with the current encounter as well as what the meaningful use goals are. It will shows the past 90 days. You can click on entire practice summary just above the columns and it shows you where you are at for all visits over the past 90 days.

In 6 weeks, I have passed the benchmarks for all the basic 15 measures and 4 out of 5 of the selected menu items. In fact, I changed my menu selections because I had met the criteria for menu items that I didn't really understand but the computer recognized that I was doing.

I have not figured out how to make the numerators or denominators work. I have gone into reports section and generated numerators and denominators there by creating individual reports. Eg. total number of patients with 250 in icd code. total number of patients with 250 and hgac in tracked data within 12 months etc.

When we had a consultant supplied to us by a grant that created our regional health extension (REC)center, he said that we did not need to provide electronic reports to cms for mu at this time but simply the attestation that we could provide the reports if requested even if they were not supplied electonically. We need to have numerators and denominators even if they were generated by paper reports in case of audits down the road.

I understand from this board that the numerator and denominator in the meaningful use section is ????buggy??. Has anyone been able to get the numerator or denominator area to work? I be interested in hearing about that.

In past versions, I have been unable to use the decision support very effectively. Creating rules, etc. I have instead just been using tracked data. I have about 15 items that I'm tracking and I can generate reports and use them in a "meaningful" way to meet benchmarks. I got my P4P money this way through medicare. I'm ready if they audit me. I wonder if it's worse than an IRS audit??
nancy

Nancy,
Sorry, can't help you with the numerator/denominator question.
Perhaps you or someone can help me with a question.
Core 13: Clinical Summaries. Are we supposed to give patients the CCD at each visit? or is it enough to just Print Instructions and give them the summary of plan letter?

John,
If you go into the meaningful use wizard within the patients chart in the right corner just above the vital signs, you will see it turn from red to green in the "current encounter" area once you print the plan box. I believe that you only need to print the visit summary. AC will also print a CCD with a separate click if you want it to but it is a pretty useless piece of paper for a patient. I have had two patient ask for electronic copies of their records and I have given electronic copies of their records to both of them. One of them happens to be a corporate compliance officer for a large hospital corp far away. We played with the meaningful use wizard to see when it would go from red to green and give me credit. There are multiple ways to go about exporting a patients chart to a thumb drive. It turned green when we transferred the CCR from the summary page. When we were done we went to another computer and just tried to see what we had and it was the CCR. There were not any notes or anything.
I think in the wizard...when it goes from red to green, you have met the measure. It is easy to quickly check how you are doing during encounters while working throughout the day. I had to play with it to get the hang of it.
That's all I know.
nancy

Thanks--good advice to watch the "traffic lights" and be sure they go from red to green. :-)

At first they didn't seem to budge but now I have every one of them way over goal except the clinical summary. I didn't start printing that and giving it to patients right away but I was giving them educational handouts and it seemed like a good way to prove that I had sent the script electronically so I was printing it the past few weeks and I'm almost at the benchmark for that. Will probably be there by the end of next week. It has been 6 weeks that I've used the V6 with the wizard. We were planning to play with it and make a concerted effort after the first of October so that we could attest by the end of December but we are almost there pretty effortlessly already.

In regards to the clinical summary - my interpretation and the way that the MU wizard on AC works is that you must print the CCD. This is based on what is required - I think Allergies, meds, etc. I think you could design your own instruction form by checking boxes for allergies, meds, etc. but it would not do the numerators and denominators for the MU wizard.

For people who are wondering the 6.0.10 MU wizard will do the numerator and denominator correctly for the requirements (6.09) does not work correctly as this was one of the fixes.

I've been getting credit when I view the CCD but not print it for the patient. I believe this printout is useless for the patient from my standpoint. As far as instructions, I will print instructions for patients but usually hand write them. My patients seem to respond better and KEEP my hand written,larger print instructions versus the typed instructions that show up when I try to print them with Amazing Charts.

I've always written instructions for patients and on notepads with my company logo, email address (which isn't on the Amazing Charts printout), and office phone/fax. I have my instructions worded in the Plan section as well when I finished note -- so I have documentation that way (i.e. patient given hand written notes on the above plans, etc). Any thoughts on what other people have noticed with patients getting the CCD printout/instructions printout?

I've done a little digging...probably a big mistake.

CMS defines a "Clinical Summary" as follows:
"An after-visit summary that provides a patient with relevant and actionable information and instructions containing the patient name, provider?s office contact information, date and location of visit, an updated medication list, updated vitals, reason(s) for visit, procedures and other instructions based on clinical discussions that took place during the office visit, any updates to a problem list, immunizations or medications administered during visit, summary of topics covered/considered during visit, time and location of next appointment/testing if scheduled, or a recommended appointment time if not scheduled, list of other appointments and tests that the patient needs to schedule with contact information, recommended patient decision aids, laboratory and other diagnostic test orders, test/laboratory results (if received before 24 hours after visit), and symptoms."
http://www.cms.gov/EHRIncentivePrograms/Downloads/13ClinicalSummaries.pdf

The "Continuity of Care Document" (CCD) is different from the Clinical Summary. CCD is a "an XML-based markup standard intended to specify the encoding, structure and semantics of a patient summary clinical document for exchange." (Wikipedia) As I understand it, the CCD is supposed to include all the patient's information. The way AC seems to use the term "CCD" differently. In AC the CCD info only includes certain info and not others.

It doesn't appear that the AC "Print Instructions" process with/without the CCD doesn't seem to meet all the criteria for a "Clinical Summary."

The clinical summary will include a med list if you check the box to include it. It will print anything that is in the plan box. It will include immunizations given and immunizations and medications prescribed. If the patient needs specific instructions they can be added as well. It will include patient education handouts if the box is clicked just above the plan. If you use any EBM clinical support it documents that too. It would be pretty useless to list the 15 active diagnoses on a clinical summary sheet everytime you see a patient. I would say it would be exceptionally silly because when I go back I have a difficult time figuring out what I saw the patient for when some of the icd codes take the place of the diagnosis I actually gave the patient. I have asked my professional coder to please leave my diagnosis in the diagnosis area as well as the coded diagnoses so that I have some meaningful information for the care of the patient the next time I see them.
I don't think that the point is to meet all the criteria at this point. For example, you only need to give an electronic copy of the chart to half the patients who ask for it. I have done so for 100% at this point. Some of my summaries have been three or four pages long. Apparently I've started major consuming paper again. Staples will be happy.

We are printing out the instructions/summary letter for patients but just previewing the CCD. CCD gives too much information - past and present meds. We are internal medicine - 75% geriatrics and the past and present meds can often be quite extensive, utilizing 4 pages IN ADDITION to the letter.

Our patients are calling us regarding the letters themselves - HM screening for high blood pressure; their interpretation is that they are being told that they HAVE high blood pressure.

I have started do the patient instruction print outs and have found that a good system is to write out the instructions I want the patient to have in their letter. Then I print it out for them. Then I finish my notes in Plan with items that would be confusing to the patient.