Allscripts TouchWorks MU Stage 2 Measures
The conceptual change from Meaningful Use Stage 1 to Meaningful Use Stage 2 is a movement from patient engagement to patient action. Under MU1 rules, providers were required to meet all 14 core objectives and 5 of 10 menu set objectives; however, all but one of the menu set objectives under MU1 are now part of the core. Several of Stage 1 objectives are no longer required as individual objectives and are made part of other more comprehensive objectives in Stage 2. For example, “implement drug-drug and drug-allergy interaction checks” is no longer a separate objective and is made part of the more comprehensive Computerized Provider Order Entry (CPOE) objective in Stage 2.
NEW MU Stage 2 Menu Set Objectives
There are 5 new menu set objectives and 1 new core objective. Eligible Providers (EP) must choose 17 of 20 core objectives and 3 of 6 menu set objectives in MU Stage 2. The new measures include Secure Messaging, Completion of an Electronic Note, Recording Family History, Incorporating Results Imaging, and ongoing submission of registry information. Additionally, the minimum percentage thresholds required in MU2 for many measures have been raised. For example, the minimum threshold for recording smoking status has risen from 50% to 80%.
Under the revised timeline, Stage 2 will be extended through 2016 and Stage 3 will begin in 2017 for those providers that have completed at least two years in Stage 2. The goal of this change is two-fold: first, to allow Centers for Medicare and Medicaid Services (CMS) and the Office of the National Coordinator for Health Information Technology (ONC) to focus efforts on the successful implementation of the enhanced patient engagement, interoperability and health information exchange requirements in Stage 2; and second, to utilize data from Stage 2 participation to inform policy decisions for Stage 3.
Everyone must be using a 2014 and MU2 certified Electronic Health Record (EHR) to meet compliance with MU2 and International Statistical Classification of Diseases and Related Health Problems (ICD)-10. This means a lot of work on upgrades, new functionality, and new workflows to meet the new measures and increased thresholds. Many of the workflow changes discussed here are not changes that are forced by the movement from MU1 to MU2, but rather they are changes that will help you easily achieve the higher thresholds of MU2.
Part 1 of this blog series covers the MU Stage 2 measures for Secure Messaging, View Download Transmit
We discuss how these MU2 measures are related to Allscripts TouchWorks EHR version 11.4.1 workflows and functionality.
Objective: Use secure electronic messaging to communicate with patients on relevant health information.
Measure: A secure message was sent using the electronic messaging function of Certified Electronic Health Record Technology (CEHRT) by more than 5 percent of unique patients (or their authorized representatives) seen by the EP during the EHR reporting period.
One of the new measures is a clear example of the patient engagement goal. As the patient will be messaging your staff electronically, you will need to put workflows and processes in place for staff to receive and reply to the tasks. This includes understanding how long before these communication tasks become overdue, and monitoring any overdue communication tasks. Your organization will need to focus on getting your patients enrolled and participating in your patient portal. You will also want to focus on your internal marketing campaign to your providers and staff to promote patient adoption of your portal. If your providers and staff see the benefit, they will be your best salespeople. Finally you will need to ensure that there is a system administrator that is monitoring the messages being sent to and from the patient portal.
View Download Transmit
Objective: Provide patients the ability to view online, download and transmit their health information within four business days of the information being available to the EP.
Measure 1: More than 50 percent of all unique patients seen by the EP during the EHR reporting period are provided timely (available to the patient within 4 business days after the information is available to the EP) online access to their health information.
Measure 2: More than 5 percent of all unique patients seen by the EP during the EHR reporting period (or their authorized representatives) view, download, or transmit to a third party their health information.
The first measure allows for an additional day, as compared to MU Stage 1, to provide the patient with access to their health information; however, CMS adds the second measure for patient engagement. Your organization will need to review from a workflow perspective who will be responsible for documenting if the patient was provided access for registration (ex. given a brochure to your website to sign up), and where this will be documented (Practice Management System or EHR) Will this be done by the clinical teams or by the office staff? Which users will be prompted for the MU alert and what action will they take upon seeing the alert? Review how registration access will be given to your patients (ex. Is it an educational brochure? Is website access added to the clinical summary?)
Allscripts TouchWorks EHR version 11.4.1 includes the ability to capture if the patient was given information to register for your patient portal. This field is called the Portal Registration Status and is available as a MU alert and is updated in the Patient Profile. This value can be populated from your practice management system’s registration interface as well. This is an excellent way to record that the patient has received access and helps track the first portion of the measure.
As the second part of this measure involves patient engagement, your organization will need to focus on getting your patients enrolled and participating in your patient portal or alternative patient engagement solution. You will also want to focus on your internal marketing campaign to your providers and staff to promote patient adoption of your portal. If your providers and staff see the benefit, they will be your best salespeople.
Organizations should ensure that there is a system administrator monitoring the messages being sent to and from patient portal.
Finally, the system will automatically generate the Continuity of Care Document (CCD) and send it to patient portal when the patient communication method for clinical summary is Patient Portal or Patient Portal & Print. If you do not want the patient to automatically receive information the preference can be set to one of the following values: Do Not Send-Patient is Adolescent and Do Not Send-Provider Discretion.
Benjamin Maultsby, IMBA
Consultant, MBA HealthGroup