Meaningful Use Stage 2- Core Measure 01 CPOE Configuration Guide

MU Core 01 CPOE This guide will provide instructions on how to configure the necessary setup to enable TouchWorks EHR to work for MU Core 01: Use computerized physician order entry (CPOE) for medications, lab, and radiology orders directly entered by any licensed healthcare professionals who can enter orders into the medical record per state, local, and professional guidelines. Final Rule Requirements 1. More than 60% of medication orders created by the eligible provider (EP) during the reporting period were created using CPOE 2. More than 30% of lab orders created by the EP during the reporting period were created using CPOE 3. More than 30% of imaging orders created by the EP during the reporting period were created using CPOE Core Objective: Menu Objective: Numerator 1: The number of orders in the denominator recorded created using CPOE Numerator 2: The number of orders in the denominator recorded created using CPOE Numerator 3: The number of orders in the denominator recorded created using CPOE Denominator 1: The number of medication orders created by the EP during the reporting period Denominator 2: The number of lab orders created by the EP during the reporting period Denominator 3: The number of imaging orders created by the EP during the reporting period Exclusion 1: Any EP who writes less than 100 medications during the reporting period Exclusion 2: Any EP who writes less than 100 lab orders during reporting period Exclusion 3: Any EP who writes less than 100 imaging orders during reporting period Objective is shared across eligible professionals: : : Objective must be recorded during the reporting period: : : Prerequisites Requires: Core EHR - Rx Functionality Availability: Prior to v11.2: Core EHR - Lab & Imaging Orders Functionality Availability: Configuration Steps Prior to v11.2: Enhanced v11.4.1 1. As part of this workflow, prescription, lab, and radiology orders must be implemented. If you have not implemented any of these features and are looking for implementation assistance, please contact your account manager 2. As an organization, you have an option in regards to how you determine which users are licensed healthcare professionals who can enter orders into the medical record per state, local, and professional guidelines. a. Option 1: Use existing non- med orders and medication order security codes to assign to users who can create non -med and medication orders Copyright 2013 Allscripts Healthcare, LLC. 2

b. Option 2: Use license field in TWUser Admin to determine if the user who created the non-med or medication order can count in the numerator (field is available in 11.4.1 for non-providers) 3. Perform setup based upon choosing options in step 2 a. Option 1: Use Security i. Review user security (TWAdmin/Security Admin/Security or TWAdmin/TWUser Admin/Security) Verify the appropriate staff members have the authority to prescribe medications: a. Can renew b. Can prescribe c. Can reprint/resend prescriptions d. Medication order protocol Verify appropriate staff has authority to order non-medication orders: a. Order edit b. n-medication order protocol Addition order securities to consider: a. Override Do t Release Order (appropriate only if you are using the capability to flag orders as Do t Release. If you are using it, it is best practice that your providers, clinical staff, and office managers have access to this capability). b. Option 2: Use License Field i. In 11.4.1 the following section was updated and is now available for users and user/providers TWAdmin TWUser Admin Select User Licenses/IDs ii. For User/Providers and Users, add the appropriate license types that apply Certified Clinical Medical Assistant Certified medication Assistant DEA Number (available only for user/providers) Licensed Practical Nurse (available 11.4.1 HF5, or via script if on a version prior) Licensed Vocational Nurse (available 11.4.1 HF5, or via script if on a version prior) NPI (available only for user/providers) Registered Medical Assisant Registered Nurse State License (available only for user/providers) UPIN (available only for user/providers) Copyright 2013 Allscripts Healthcare, LLC. 3

ii. The License Type field is controlled by the License Type Dictionary (TWAdmin Dictionary License Type). This is an enforced dictionary that you cannot add to w/o a script from Allscripts. 4. Ensure all orders are appropriately classified under the appropriate classification in the Orderable Item Dictionary (OID) classification. a. The report will look at labs as anything under the Laboratory classification only and imaging/radiology orders under Dx Imaging classification only. If you have orders in other classifications that should be included for this report reclassify them with an appropriate location classification (Laboratory or Dx Imaging). b. In 11.4.1, the ACI tabs change and tabs will be more granular based upon the classification (for example, other diagnostic testing will have its own tab called Procedures). i. The Lab tab contains orders that are classified under "Laboratory". ii. The Rad tab contains orders that are classified under Dx Imaging. iii. The Procs tab contains orders that are classified under Other Diagnostic Testing. iv. The FU/Ref tab contains orders that are classified under Follow Up and Referrals. v. The Supplies tab contains orders that are classified under Supplies vi. The Findings tab contains orders that are classified under Clinical Findings (for example,. repeat blood pressure check order where a patient comes in once a week for 8 weeks to have their blood pressure taken). vii. The Instruct tab contains orders that are classified under Instructions & Precautions. c. You can re-classify orders using Drag/Drop in the OID or you can use SSMT content category OID Orderable Item, Parent Class column. 5. Identify and update any orders that should be excluded for MU Reporting a. Dictionary Steps i. Go to TWAdmin Dictionaries and choose Orderable Item in Dictionary drop down box. ii. At bottom of screen, use scroll on right search for Behavior option. Click on arrows left of Behavior to expand window. iii. Check the Do not include for MU Reporting checkbox. b. SSMT Steps i. Content Category = OID- Orderable Item ii. Make modifications as necessary in excel for DotIncludeForMUReporting column Copyright 2013 Allscripts Healthcare, LLC. 4

Workflow Considerations For orders adoption, ensure that your providers can place an order without being forced to complete details unless absolutely necessary. This means to configure all required fields to allow the provider to save the order and continue his or her workflow. Consider requiring the provider to complete the information only when they are absolutely the only one who can answer the question correctly and in a timely manner (not required for Meaningful Use Stage 2 reporting). Encourage the use of: o CareGuides and Quicksets for your providers (not required for Meaningful Use Stage 2 reporting). o Specialty favorites and QuickLists created for ad hoc ordering workflows (not required for Meaningful Use Stage 2 reporting). o Order interfaces in workflows where providers are receiving results for the orders (not required for Meaningful Use Stage 2 reporting). o Medical necessity checking for understanding which tests are covered by Medicare for the associated diagnosis (not required for Meaningful Use Stage 2 reporting). o Order grouping. This is a new feature in 11.4.1. Order grouping enables providers to create a group of orderable items (across classifications: labs, imaging, referrals, and so on) that can be ordered with one click. In preparation for use of this feature, prior to your upgrade, you can review if there are any commonly grouped orders (that are not specifically problem based) in which you can administratively setup this groupings by specialty (for example, pre-op testing, prenatal screenings). This is an optional planning activity that you can do prior to the upgrade to 11.4.1 o Batch editing when users need to make the same change to many orders. This is a new feature introduced with 11.3 that enables users to edit similar fields across medication and non-medication orders (for example, updating to-be-done date) (not required for Meaningful Use Stage 2 reporting). For those orders that are placed via paper and then entered into the EHR, consider changing the communication method for these orders to Record when you enter the order. This includes the order in the denominator, but the provider will not get credit in the numerator as he or she did not use CPOE to originate the order. For those orders that should only be recorded and not ordered, consider using the Record w/o ordering flag. This will exclude the order from being included in both the numerator and denominator. How TouchWorks Calculates the MU2 Report As an organization you will have the ability to choose to use the license field or security codes for reporting this measure. The MU2 CPOE report is delivered using security codes. If your organization chooses to use the license field, then you will need to request the report change via a SupportForce Case. This case will then have a L3 opened that will be assigned to Dev Common Solutions. Numerator 1 w/security: Medication Orders: Includes all medication orders in the denominator, except where Rx Action is Record. Numerator 1 w/license: Medication Orders: Includes all medication orders in the denominator that are created by a user that has a license type that is not Medicaid Number, or Medicare Number, or SSN Excludes any medication order where Rx Action is Record Denominator 1: Medication Orders: Counts each Medication Ordered or Renewed during the reporting period (date is reflected by the Encounter Date) Copyright 2013 Allscripts Healthcare, LLC. 5

AND: The medication in any status except EIE (entered in error). This includes Rx and Med Admin medications. Also includes unverified and discontinued medications. AND: The prescription actions is ONE of the following: Call Rx, Dispense Rx, Dispense Sample, Print, Record, Send to Retail, or Send to Mail Order Ordered By, Authorized By, or Supervised By is the EP. Excludes: o Pharmacy supplies. o Prescriptions with the Record w/o ordering flag Numerator 2 w/security: Lab Orders: Includes all lab orders in the denominator except those where Communication Status is Record. Numerator 2 w/license: Lab Orders: Includes all lab orders in the denominator that are created by a user that has a license type that is not Medicaid Number, or Medicare Number, or SSN Excludes any lab order where Order Action is Record Denominator 2: Lab Orders: Counts each Laboratory order Ordered during the reporting period (date is reflected by the Encounter Date) OR: The order was created by the inbound orders interface only if they required authorization (retrospective or prospective). OR: The order is a scheduled order, using the encounter date. AND: The within the Laboratory classification section of the Orderable Item Dictionary. AND: The in any status except EIE. Ordered By, Authorized By, or Supervised By is the EP Excludes: o Orders flagged as Do not count as an order for MU Reporting in the Orderable Item dictionary. o OR: Record w/o Ordering flag is selected o OR: the order was created outside of TouchWorks in the following instances: Unsolicited orders received as results. Orders created by inbound orders interface (for example, reflex orders coming from the lab interface). Carbon copies of labs from outside the system, even if the EP is the ordering, authorizing, or supervising provider. Numerator 3 w/security: Imaging Orders: Includes all imaging orders in the denominator except those where Communication Status is Record. Numerator 3 w/license: Includes all imaging orders in the denominator that are created by a user that has a license type that is not Medicaid Number, or Medicare Number, or SSN Excludes any imaging order where Rx Action is Record Denominator 3: Imaging Orders Counts each Radiology order Ordered during the reporting period (date is reflected by the Encounter Date) OR: The order was created by the inbound orders interface only if they required authorization (retrospective or prospective). OR: The order is a scheduled order, using the encounter date. Copyright 2013 Allscripts Healthcare, LLC. 6

AND: The Radiology order is within the Dx Imaging classification section of the Orderable Item Dictionary. AND: The Radiology order is in any status except EIE. Ordered By, Authorized By, or Supervised By is the EP Excludes: o Orders flagged as Do not count as an order for MU Reporting in the Orderable Item dictionary. o OR: Record w/o Ordering flag is selected o OR: the order was created outside of TouchWorks in the following instances: Unsolicited orders received as results. Orders created by inbound orders interface (for example, reflex orders coming from the lab interface). Carbon copies of labs from outside the system, even if the EP is the ordering, authorizing, or supervising provider. Exclusions Exclusion 1 (medications): If the number of medications orders that have created by the EP during the chosen reporting period is less than 100, the provider will be excluded from the first objective only. Exclusion 2 (lab orders): If the number of lab orders that have created by the EP during the chosen reporting period is less than 100, the provider will be excluded from the second objective only. Exclusion 3 (imaging orders): If the number imaging orders that have created by the EP during the chosen reporting period is less than 100, the provider will be excluded from the third objective only. Indicators Medication Orders When the numerator divided by denominator is greater than 60% When the numerator divided by denominator is between 50% and 60% When the numerator divided by denominator is below 50% Lab and Imaging Orders When the numerator divided by denominator is greater than 30% When the numerator divided by denominator is between 20% and 30% When the numerator divided by denominator is below 20% Copyright 2013 Allscripts Healthcare, LLC. 7

Calculation Flow Diagram: ------------------------------------------------------------------------------------------DENOMINATOR------------------------------------------------------------------------------------------ Core #1 CPOE: Medication (With Security) Medication Ordered or Renewed during Medication any status not Entered in Error? Any presription action Call Rx, Dispense Rx, Dispense Sample, Print, Record, Send to Mail or Send to Retail? Is Pharmacy Supply? Record w/o Ordering? Medication ordered Rx Action of Record? Met t Met ------------------------------------------------------------------------------------------DENOMINATOR------------------------------------------------------------------------------------------ --------------------NUMERATOR-------------------- Core #1 CPOE: Medication (With License) Medication Ordered or Renewed during Medication any status not Entered in Error? Any presription action Call Rx, Dispense Rx, Dispense Sample, Print, Record, Send to Mail or Send to Retail? Is Pharmacy Supply? Record w/o Ordering? Medication ordered Rx Action of Record? Created By user or provider has a license type that is NOT SSN, Medicaid Number, Medicare Number or NADEA Number? Met t Met -----------------------------------------------------------------------------------------------------------------------------DENOMINATOR----------------------------------------------------------------------------------------------------------------------------- Core #1 CPOE: Lab Orders (With Security) Ordered during Order created by user, inbound orders interface with retrospective or prospective authorization or scheduled? classified under the Laboratory category in the OID? Status Entered in Error? Order flagged as Do not count as an order for MU Reporting in the OID? Order has Record w/o Ordering flagged? Order created outside of TouchWorks? Record? Met t Met -----------------------------------------------------------------------------------------------------------------------------DENOMINATOR----------------------------------------------------------------------------------------------------------------------------- -------------------NUMERATOR------------------- Core #1 CPOE: Lab Orders (Wtih License) Ordered during Order created by user, inbound orders interface with retrospective or prospective authorization or scheduled? classified under the Laboratory category in the OID? Status Entered in Error? Order flagged as Do not count as an order for MU Reporting in the OID? Order has Record w/o Ordering flagged? Order created outside of TouchWorks? Laboratory order Communication Status is Record? Created By user or provider has a license type that is NOT SSN, Medicaid Number, Medicare Number or NADEA Number? Met t Met -----------------------------------------------------------------------------------------------------------------------------DENOMINATOR----------------------------------------------------------------------------------------------------------------------------- -NUMERATOR- -NUMERATOR- -NUMERATOR- Core #1 CPOE: Radiology Orders (With Security) Radiology order is Ordered during Order created by user, inbound orders interface with retrospective or prospective authorization or scheduled? Radiology order is classified under the Dx Imagning category in the OID? Status Entered in Error? Order flagged as Do not count as an order for MU Reporting in the OID? Order has Record w/o Ordering flagged? Order created outside of TouchWorks? Record? Met t Met -----------------------------------------------------------------------------------------------------------------------------DENOMINATOR----------------------------------------------------------------------------------------------------------------------------- -------------------NUMERATOR------------------- Core #1 CPOE: Radiology Orders (Wtih License) Radiology order is Ordered during Order created by user, inbound orders interface with retrospective or prospective authorization or scheduled? Radiology order is classified under the Dx Imagning category in the OID? Status Entered in Error? Order flagged as Do not count as an order for MU Reporting in the OID? Order has Record w/o Ordering flagged? Order created outside of TouchWorks? Radiology order Communication Status is Record? Created By user or provider has a license type that is NOT SSN, Medicaid Number, Medicare Number or NADEA Number? Met t Met Copyright 2013 Allscripts Healthcare, LLC. 8

Reporting & Final Rule Considerations For all scheduled orders (medication administration, labs, imaging), the parent orders are not counted; only the scheduled child orders that pertain to the timeframe of the reporting period. The report will use the encounter date for the child of the scheduled order. Encounter date is the date used to capture when the medication was ordered/renewed. Even if there is a Do not fill before date that is outside the reporting period, the report will use only the Encounter Date The entry of Active Medications does not count as a medication order. OTC medications will be included in the medication denominator. Immunizations are not included in the medication denominator. This includes immunizations ordered under the Rx or Immun tabs in the ACI. If the EP seeing the patient records the patient s active medications that he or she did not prescribe, the EP should not be recorded in the ordering provider field. The EP should also indicate Record w/o ordering when documenting those medications or use the Medication Hx tab in the ACI. If the EP seeing the patient records the patient active or past orders that he or she did not order, the EP should not be recorded in the ordering provider field. The EP should also indicate Record w/o ordering when documenting those orders. If the medication or non-medication order has been documented with Record w/o ordering selected, that order will not be considered as part of the denominator and numerator. For lab and radiology denominators, all communication methods are included (Print Requisition, Print Label, Send to Performing Location, Perform Order, Call Order, Dispense Order, Print Requisition and Label, Record). Additional Information Here is a list of reference documents, and where you can find them in the system. Certified Workflows: ClientConnect > Toolbox > Product Documentation > Allscripts TouchWorks EHR > Certified Workflows o Intake Process with Order (E3) Document o Chart Review Basic (F1) and Detail (F2) Document o Order Processing Introduction (I0) Document o n-medication Order Processing (I2) Document o Order Provider Authorization (I3) Document o Order Financial Authorization (I4) Document o Order Specimen Data Collection (I5) Document o Order entry Introduction (H0) Document o Ad Hoc Prescription (H1) Document Ad Hoc Prescription: With/Without Supervision (H1a) Document Ad Hoc Prescription: Entering for a Provider (H1b) Document o Medication Reconciliation & Management (H2) Document o Med Administration (H3) Document o Ad Hoc Diagnostic Orders (H5) Document o Order Reminders (H8) Document o Quicksets (H9) Document o CareGuides (H10) Document o Orders Completion (K2) Document o Rx Renewals Introduction (L) Document o Prescription Renewals (L1) Document o SureScripts Renewals (L2) Document o Tracking Overdue Orders (Q2) Document Copyright 2013 Allscripts Healthcare, LLC. 9

Application Design and Behavior Resource (ADBR): ClientConnect >Toolbox > Product Documentation > Allscripts TouchWorks EHR > Pick your version > Manual Guides > Application Design and Behavior Resource (ensure you save it to your PC). Join Monthly Order/Results Special Interest Group Access CareGuide documentation: o ClientConnect >Toolbox > Product Documentation > Allscripts TouchWorks EHR > 11.4 > Manual Guides CareGuide Administration Guide CareGuide User Guide o TouchWorks EHR CareGuide updates: https://clientconnect.allscripts.com/blogs/eehrcg Review orders enhancements: o Batch clinical item enhancement documentation: ClientConnect > Toolbox > Product Documentation > Allscripts TouchWorks EHR > 11.3 > Enhancement Supplements. o Insert 11.4.1 enhancement supplements (post 11.4.1 GA) Copyright 2013 Allscripts Healthcare, LLC. 10