Home Forums Discussions Meaningful Use Please help with meaningful use ordering/reporting

I'm having issues with meaningful use I think because we're not ordering things through AC. I order a Pneumovax on our paper billing sheets, so it is not counted, even though it is given/documented in AC. What other things will not ordering labs/shots/etc. cause problems with meaningful use, and any work around?

Also, we send appt reminders through Updox, but these are not counted.

As far as the CQM's, for weight screening you just need to add V65.3?

None of my htn patients are showing up in the counter even though they have diagnosis of 401.1 added to their problem list.

And smoking check green box under SH and then check under decision support and document?

How do you codify an LDL below 100? Our labs are imported by Labcorp, but I guess AC doesn't recognize these?

Thanks for any help.

David Lee, MD
IM
Dallas, TX

Just realized you needed a CPT code to count.

David

Yes, the CPT is needed for all of the CQM's to count. Also keep in mind that if AC doesn't know something, it doesn't count it. So, for example, you can obtain labs, but they will not be counted unless they are brought in via an interface.

What about immunizations? The nurse puts them in, but we only order them on paper. I assume we have to order them in AC for them to count, even though they are documented by the nurses without an official order in AC by the doctor?

David

You need to start from scratch. Start with the following:

1) Open chart - check to make sure demographics have all required - Race, ethnicity, language.
2) Go to tobacco - check Never, current, etc - and fill in boxes.
3) Go down and verify codified allergies entered - if not double click and enter or click NKDA.
4) I double click medications on the left and inactivate any meds they have finished or add ones from other doctors, OTC, etc. I then click the button on bottom about reconciling and SAVE.
5) Then I open risk factors boxes and make sure pertinent ones about cholesterol, HTN, diabetes etc are checked and saved.
6) Make sure you have diagnoses in the Assessment section - if you want to be thorough go to the summary sheet, inactivate or change any diagnoses there.
7) Double Click the Health Maintenance in upper right of chart - enter however many you want - I usually enter a template verbage for diet, exercise, reviewed meds, weight, make sure colonoscopy and lipid, etc are done and dated. You would choose this and then go to HM:immunizations to enter vaccines - double click on the hm rule and enter the immunization under that and save.
8) At this point you can save the visit and enter a CPT.
9) Do this for one day and then run the wizard on that day only and see if your numbers are not working then.

then go to HM:immunizations to enter vaccines - double click on the hm rule and enter the immunization under that and save.
8) At this point you can save the visit and enter a CPT.

Can you clarify a bit more for me? The MU requirement seems to be that pts >65 yo have been documented as having rec'd the Pneumovax. Many of my patients have received this before they get to me, so I have been entering "received elsewhere," and approximate date in the date section, and "at previous PCP's office" in the comment section. Obviously, there's no CPT code associated, since I'm not administering the vaccine, but it seems that I should qualify, since I am making sure that they are up-to-date for this HM requirement.

However, my numbers are stuck at "0." What do I need to do differently for this CQM?

Thanks for your help.

David and HPM(your name would be a help),

Learn to use the MU wizard built into AC. It has specific instructions for each measure. In the encounter screen, click the MU box upper right. Clicking the button shows you for that visit whether you have met the criteria before you sign off. Then click view MU wizard. There you can access the detailed instructions. Or, for individual criteria, you can click the "i" infomation button to the left. Pay attention to the bottom of the instructions which tells you how to meet the measure in AC.
For Pneumovax, be sure to enter an approximate prior date since it is counting patients who had it before Jan 1 of the reporting year.

Here are the instructions for Pneumovax:

Description
The percentage of patients 65 years of age and older as of January 1 of the measurement year who have ever received a pneumococcal vaccine.

Rationale
This measure monitors the appropriate and timely use of vaccines among age-appropriate older adults. Each year, 20% of Americans contract influenza (flu) (CDC 2009). Rates of infection are highest among children and immunosuppressed patients, while mortality is highest among adults over 64 years, children under 2 years and persons with chronic medical conditions (CDC 2008). More than 200,000 people are hospitalized for flu-related complications each year; 63% are 65 or older (CDC 2009; Thompson et al. 2004). The health impact of influenza on older adults is substantial and flu short vaccines are the most effective way to prevent severe illness complications and death. This measure facilitates efforts toward infectious disease prevention among a vulnerable subgroup of the population.

Clinical Recommendation
The U.S. Preventive Services Task Force?s Guide to Clinical Preventive Services recommends pneumococcal vaccine for all immunocompetent individuals who are 65 and older or otherwise at increased risk for pneumococcal disease. Routine revaccination is not recommended, but may be appropriate in immunocompetent individuals at high risk for morbidity and mortality from pneumococcal disease (e.g., persons ≥75 years of age or with severe chronic disease) who were vaccinated more than five years previously (USPSTF, 1989).


Definition of terms and additional details are here.

HOW TO DO THIS IN AC: Pneumococcal screening can only be met in patients aged 65 years and older who have had a visit within the past year. In the Most Recent Encounters screen, select the Decision Support button and in the second tab (HM: Immunizations and Shots) enter the information for Pneumococcal vaccine that was given to the patient.

For more information on Decision Support and Vaccinations go to Help or use your F1 key.

Thank you, Donna.
I had read all that, and HAVE been putting in an approximate date, AND have watched the videos of "how to do this," and HAVE used the MU Wizard - and my Pneumovax numbers still say "0". Not sure what I'm missing, but I think I've plumbed the depths of "help" available in AC itself, so was asking here.

Then, I am stumped.
You should talk to Katie at AC, she is the product support specialist for MU.

One additional thought, are you entering the vaccine within the context of a visit? If you add criteria to the decision support section through the summary sheet and not an encounter, I don't think they are counted. You must add a CPT for the visit when you save it for the CQMs entered to be counted.

Thanks for mentioning Katie - I'll definitely contact her if I can't figure this out soon.

As far as your other thoughts: well, I think I have been entering it through the summary sheet (for new-to-me pts who have already had their Pneumovax elsewhere), and it's showing up on the plan (as though it was given that day, even though I'm entering the approximate date it was given: e.g., "10/01/2008"). I have NOT been adding a CPT since I wasn't the one that gave the vax ... so maybe I need to do that. Thanks - that's a very helpful thought.

I'm still having trouble getting this sorted out. I can see the patient and the nurse can give a Pneumovax documented in AC on the same day, but it is not counted unless an order is sent to the nurse. As we use paper billing, this adds unneeded steps to send and have the nurse respond to the order, as opposed to just putting in the order themselves.

And I still haven't figured out why our Labcorp data, which is codified, isn't recognized. Is it because I didn't "order" the HgA1C since we use paper billing?

Thanks for any help.

David Lee, MD
IM
Dallas, TX