Health Information Exchange (Summary of Care) Meaningful Use 2016 Job Aid

Transcription

1 Health Information Exchange (Summary of Care) Meaningful Use 2016 Job Aid Health Information Exchange (Summary of Care/Transition of Care) This document outlines the workflow for meeting this measure in the Clinical Quality Reporting module the CPS/CEMR reporting tool for capturing Meaningful Use data for the 2016 reporting period. Specific questions about the measure, thresholds, exclusions, and attestation for the 2016 reporting period should be directed to the 2016 Program Requirements site and the 2016 Tip Sheet. Denominator/Numerator Denominator o Count 1 for each transition of care or referral during the EHR reporting period for which the EP was the transferring or referring provider. Transition of care indication - Order marked as Transition of Care. (CARETRANSOUT observation term from Stage 1 is no longer used.) The authorizing provider of the order is the EP. The order date is during the reporting period. The data object is TransitionOfCareDenominator. It includes PID, PVID, eventdate (clinical datetime), orderid, and order description. Numerator o Of the transitions of care and referrals in the denominator, count 1 for each one during the reporting period where: A summary of care record was electronically transmitted using CEHRT to a recipient; or A summary of care record was ed to the referred to provider with patient consent per HIPAA requirements; or The recipient receives the summary of care record via exchange facilitated by an organization that is a NwHIN Exchange participant; or The recipient receives the summary of care record in a manner that is consistent with the governance mechanism ONC establishes for the NwHIN. Qualifying events - Includes Provide TOC Referral Summary entries in MUActivityLog that have Electronic delivery method. The event ID is SummaryOfCareTOCReferal. Records an MU Activity Log entry for each TOC sent to a provider. Requires OrderID from the document.tocorderid. o The Save to Chart button is used in the Transition of Care preview window AND the TOC document is sent electronically using a secure messaging system that records the entry in the MUActivityLog with Delivery Method set to Electronic. Required time frame - The EP is the authorizing provider for a TOC order where the order date was within the reporting period. Page 1 of 23

2 MUActivityLog - Beginning with this version, the MUActivityLog database table records event details needed for numerator or denominator calculations. Meaningful Use calculation events cannot be disabled. You can choose to enable or disable other user events from Auditing. For Meaningful Use events (for example, encounters that count towards the Seen By denominator) that occurred before the version upgrade, the information may be stored in other tables, but will still be used as part of measure calculations. Set Up In the previous Meaningful Use Stage 1 release, transitions of care were counted when the CARETRANSOUT observation was included in the chart document and a report or letter containing Chart Summary was either printed or faxed (audit events counted) or CCD chart summary was exported. In this release for MU 2014, the calculation is based on an order document marked as Transition of Care. A Transition of Care CCDA document is generated based on that document, signed by the referring/transferring provider, and is either printed, saved to file for transfer, or sent electronically. Currently electronic transmission is handled by EZAccess Patient Portal, Centricity Clinical Messenger (Kryptiq) or Qvera Interface Engine (QIE) under the SOAP & XDR / XDM for Direct messaging standard. Whenever a transition of care document is sent directly using one of these electronic means it is logged and counted for Meaningful Use. These events are logged in the Patient MU Activity Log which is used for calculating the numerator for the measure. Set order categories and codes as Transition of Care in Administration o Referral order categories are set as Transition of Care by default, so all referral order codes are automatically set and counted for Meaningful Use. Test order categories and codes may be set to be used as Transition of Care where including a CCDA transition of care document with the order is appropriate. In Administration go to Codes > Charts > Codes and Categories and select an order category and/or codes to modify. Page 2 of 23

3 Add secure electronic addresses for approved service providers o You can add a secure electronic address for external service providers associated with referral and test orders to send as Transition of Care. In Administration go to Codes > Charts > Service Providers and select a provider to modify. Enter a secure electronic address (DIRECT) for Service Providers to receive transition of care documents. EZAccess Patient Portal, Kryptiq or QIE use this field to send TOC documents to intended recipients. Page 3 of 23

4 Set a provider as an External Service Provider o By default, users are designated as Internal Service Providers. Providers within your system who might receive transitions of care or referrals from within or outside the system can be designated as an External Service Provider for the purpose of Meaningful Use. A transition of care sent to an internal provider is not counted for Meaningful Use, because it is assumed providers within the same system have shared access to the patient chart. In Administration go to Codes > Charts > Service Providers. Click New. The Add Service Provider window opens. Complete the fields for the new service provider and click Save & Continue. The service providers listed in this file are set as External Service Providers. Required permissions o Users must have existing permissions Chart > Export Summary Documents and Chart > Export Unsigned Chart Data to generate and send Transition of Care documents. o In Administration, select System > User and Resource Management > Users > Security > Security By Group. Select a user or security group. Select these two permissions in the Chart folder: Export Summary Documents Export Unsigned Chart Data EZAccess Patient Portal Setup o Set up Service Layer and C-CDA settings Log into the Patient Portal > Options > Service Layer and C-CDA Settings > select Auto Send Transition of Care (TOC) and select all service providers > Update Page 4 of 23

5 o EZAccess Secure Electronic Address Set Up Clients will have to complete paperwork to receive a Secure Electronic Address. One (1) Secure Electronic Address is provided at no charge and can be used for all providers in the clinic. Additional addresses may be requested at an additional cost. Direct Messaging Settings Check box for Enable Direct Messaging automatically populated by SBS once Secure Electronic Address has been assigned Enter Direct Address (Default) automatically populated by SBS once Secure Electronic Address has been assigned Enter Portal Account Enter error notification Page 5 of 23

6 o Manage Users From the Patient Portal > Manage Users > Search for the provider > Select > Enter Secure Electronic Address > Update Centricity Secure Electronic Address > Update Any user that will be sending TOC documents will need secure address in portal account. Page 6 of 23

7 o Set up Service Providers Log into the Patient Portal > Options > Direct Messaging Settings > Map Service Providers > Edit a Service Provider > Search > enter Search criteria > Search > double click on Secure Electronic Address > Update Page 7 of 23

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9 Referring Provider without Secure Address o This section outlines an alternate setup for meeting this measure in the Clinical Quality Reporting module using Centricity Practice Solution and the EZAccess Patient Portal if the provider being referred to does not have a Secure Electronic Address, but can provide you with an address. Centricity Setup Provider Setup o If the provider being referred to does not have a secure electronic address but does have an address, the provider will need to be set up as both a Referring Provider and Service Provider in Centricity. Referring Provider Administration > Providers and Resources > Referring Providers > New or Search for Referring Provider & Edit > Complete at a minimum the provider s First name, Last name, List name and address > OK Page 9 of 23

10 Service Provider Administration > Codes > Charts > Service Providers > New or Search for an existing provider & Change > enter at a minimum a name and address > OK > enter First and Last name under the Provider Details > OK Page 10 of 23

11 EZAccess Setup This new feature is only available on EZAccess Version or higher o You and find your portal version by going to Settings > App Version (ezaccess) Page 11 of 23

12 o If you need a portal upgrade to have access to this feature please log a ticket at support@quatris.com Provider Setup If the provider being referred to does not have a secure electronic address but does have an address, the provider will need to be given access to the patient portal as a Referring Provider, associated with a Service Provider and then be set up to Auto Receive the TOC documents. o Referring Provider Set Up EZAccess Patient Portal > Manage Users > select Referring Provider in the Type field o Enter the last name of the provider > Search > Select Page 12 of 23

13 o Set Default Password > Set Portal Message Group to All Portal Users > Using the drop down menu select the corresponding Service Provider > Select Auto Send TOC > Update o Check box for Send > Send > Close > the Referring Provider will now appear in an Active status Page 13 of 23

14 NOTE: The provider being referred to will have to log into the portal to retrieve the TOC document, so they must be sent the to know how to access the patient portal. Workflow The workflow presented below is the same for both providers with a secure electronic address and those that need to use the alternate method where the provider can only provide an address. The setup done in the EZAccess Patient Portal by Service Provider will determine how the provider on the receiving end receives the TOC document and will send accordingly as long as a TOC document is created with the workflow outlined. Mark order as Transition of Care in Orders module and generate TOC document o When you configure a referral or test order in the Orders module, you can set the document containing the order to be a Transition of Care (TOC) document and then generate and optionally customize the CCDA document. Create an order and confirm that it is set as Transition of Care. Set disposition to Admin Hold Ensure that the Authorized By: is set to the Authorizing Provider Sign the Order Page 14 of 23

15 Go to the Change Order window Make sure the Authorizing Provider is correct Save and Create to create the CCDA document. Page 15 of 23

16 When the TOC document appears you can customize as needed. Then to send Electronically you must press Save To Chart & Close Once the TOC document is sent Electronically you will come back to the Change Order Screen. Page 16 of 23

17 You will need to change to STATUS to: IN PROCESS NOTE: Orders start in the disposition of ADMIN HOLD then the last step is moving the status to IN PROCESS. The order must remain at this status until the patient hits CQR. o When a Transition of Care CCDA document is saved it appears beneath its parent document in the Document list like an appended document, however the Transition of Care CCDA is sent separately. The document type is Progress Exp: Transition of Care. Page 17 of 23

18 Customizing the Transition of Care CCDA o When you create a transition of care document, it is based on the selected order and the patient s chart summary and appears in a preview screen in CCDA format. Select links in the Table of Contents to review content in the document. Click Customize to select sections or values to exclude. o You can select sections of the document to exclude. A note appears in that section that the information is unavailable. You can also exclude individual clinical items under Laboratory Results, Problems, Medications, and Procedures. When you save the transition of care document, the preview screen refreshes and you can check your changes. o To save and deliver the visit summary, click: Save to File to store to portable media this will not count in CQR for being sent electronically Print and give to the patient this will not count in CQR for being sent electronically Save to Chart and Close to save to the chart and send or deliver later this will count for being sent electronically if set up is done correctly with a secure electronic address NOTE: Save to File and Print actions also save the summary to the chart. Page 18 of 23

19 Send TOC documents o In this release, you can use EZAccess Patient Portal, Centricity Clinical Messenger (Kryptiq) or Qvera Interface Engine (QIE) to send Transition of Care documents electronically to an external provider using a HISP. o For more information about sending TOC using Centricity Clinical Messenger, see Guide to Meaningful Use Stage 2 and other resources on the Kryptiq support site (support.kryptiq.com). Sending TOC with EZAccess Patient Portal There are four(4) options for sending the TOC using the EZAccess Patient Portal. Please work with your Patient Portal Implementation Consultant on these workflow(s). This will vary by clinic. Manual processes: o Send via the portal. Create the TOC document in Centricity > log into Patient Portal > My Messages > Direct Message > New Message > select service provider > enter required fields > select Send TOC > select the TOC to send > Send Message o Send via the SM Advanced Form from within Centricity. Create the TOC document in Centricity > start a new document > search for the SM Advanced Form > select the recipient > select the Transition of Care document from the EMR documents > Sign and Send message. Automatic Processes (recommended) o Set up the appropriate settings for Auto Generating the TOC per setup instructions listed above Auto Generate and Send Transition of Care (TOC) DO NOT USE This option does not allow the user to customize the transition of care document and sends the standard Transition of Care (TOC) document based on the order and document being signed. Document will need to be signed in Centricity before Portal Service will create and send TOC document. Auto Send Transition of Care (TOC) RECOMMENDED This option does allow the user to customize the Transition of Care (TOC) document from the orders screen with Save and Create and once the document is saved to the patient s chart the portal will automatically pick this up and send it via the portal with no other interaction required on the part of the user. Office Visit document does not have to be signed for the Portal Service to create and send the TOC document. This option is consistent with the GE recommended workflow. Under the Referring Provider setup for the alternate workflow for providers without a Page 19 of 23

20 secure address, it is recommended to select the Auto Send TOC option here as well for the same reasons listed above. Sending TOC with Qvera Interface Engine (QIE) When this QIE interface is implemented, LinkLogic automatically creates an HL7 ORM message when the order is signed and places it in a folder where QIE can pick it up. Using QIE to transmit orders electronically, you do not need to manually generate the CCDA after signing the order unless you want to customize the document. When QIE picks up the order message, it automatically generates the TOC document and saves it to the patient chart, which logs the TOC order for Meaningful Use. It includes the CCDA in the message before sending. Sending TOC with Centricity Clinical Messenger After creating a TOC document in the patient chart, switch to the Desktop Messaging tab, and create a message from the sending provider to the external provider for the order. Open the patient chart (if necessary), then select and attach the TOC document and sign and send the message. Referred To Provider Access Secure Electronic Address o If the provider being referred to has a secure electronic address then they should know their internal workflow to retrieve a TOC document. Provider with only an address receiving the TOC document as a Referring Provider user of the EZAccess Patient Portal o Once the TOC document is generated the provider being referred to will receive an e- mail that they have received a Transition of Care document with a link to access the document. Upon logging into the patient portal with their user name and password they will see their message(s) and can Click Here or go to My Messages Tab Click Read Page 20 of 23

21 Click the html version The referred to provider will now be able to see the TOC document. NOTE: While we address this workflow, and you must have a reasonable expectation that the provider being referred to received the TOC document, the provider being sent the TOC document does not have to access it or view it in order to receive credit for sending the TOC document for this measure. Page 21 of 23

22 Best Practices Audit In this release, the calculation is based on an order document marked as Transition of Care, a Transition of Care CCDA document generated based on that document, signed by the referring/transferring provider that is either printed or saved to file for transfer or sent electronically. o In the previous release, transitions of care were counted if the CARETRANSOUT observation was included in the chart document and a report or letter containing Chart Summary was either printed or faxed (audit events counted) or CCD chart summary was exported. This workflow will no longer meet the Meaningful Use requirement. Set order categories and codes as Transition of Care in Administration o Do this at the category level for Referrals and/or Test and Procedure Orders o Set default disposition for Referrals to Admin Hold to allow for customization of the CCDA document. Use Referral Coordinator workflows Send the CCDA document electronically as much as possible Gather secure electronic s for Service Providers and update accordingly Reprinting / updating the Transition of Care CCDA o If you print the Transition of Care (TOC) CCDA and later wish to send an electronic version, you can either select the document using EZAccess Patient Portal to send electronically, or you can regenerate the CCDA and save it to a file. If there have been no changes, the new TOC will be identical. You can also update the TOC to reflect recent changes by regenerating it. Clinical items retrieved for the TOC are always current and active. Audit documentation should be retained for six (6) years past the date of attestation. This measure requires the calculation of a numerator and denominator. These numbers are calculated by Clinical Quality Reporting (CQR). Be sure to print or save the report and keep for your records in the event of an audit. If they require an example of a patient: o Screen shot a patient s document where the document type is Progress Exp: Transition of Care in the chart and the patient was seen during the reporting period (see below for example). Page 22 of 23

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