TMG Meaningful Use
From VistApedia
Contents
- 1 Outpatient Meaningful Use for WorldVistA
- 1.1 Q: Where can I find the certification status of WorldVistA?
- 1.2 Q: There seem to be so many steps involved in getting ready for Stage One attestation. It's overwhelming. Any overview sites?
- 1.3 Q: What's the bottom line? What do I have to do to be ready to attest meaningful use?
- 1.4 Q: Can you tell me more about the 15 "core" meaningful use measures? (all are required)
- 1.5 Q: What about the 5 "menu" set of meaningful use objectives? (5 of 10 possible are required)
- 1.6 Q: What about the required Clinical Quality Measures (CQM)?
Outpatient Meaningful Use for WorldVistA
Hello. My name is Kevin Toppenberg, MD. I am a primary care physician in Greeneville, TN. I have been active in the VistA community for at least 7 years, and have used VistA in my office during this time. I have decided to pursue meaningful use certification with VistA. This page will document my progress towards this, and record notes that I make to myself along the way. I hope this is helpful to others.
In CMS terminology, I am an "Eligible Provider" (EP), not a hospital. Also, I am going after Medicare (not Medicaid) certification. So my discussion below will be targeted accordingly.
NOTE: This page was originally created by Kevin Toppenberg, whose namespace is TMG. Enhancements have been made to this page, to include more general information for those seeking to attest to Meaningful Use Stage One in an outpatient setting.
Q: Where can I find the certification status of WorldVistA?
- Go to CMS Certified Health IT Products
- Search for "WorldVistA" -- NOTE: the search engine on this page is flaky. I found that when I clicked the search button, it would return a list of ALL technology. But when I then simply clicked search AGAIN (with WorldVistA still in the search term box), then it would find it.
Q: There seem to be so many steps involved in getting ready for Stage One attestation. It's overwhelming. Any overview sites?
- I recommend starting with this overview: CMS EHR Meaningful Use Overview. The information I am posting here is from this site.
- Alternatively, here are the slides from a CMS webinar presentation.
- Here is another CMS document (2010) document with similar detail.
- A very good presentation from IHS giving an overview of Meaningful Use can be found here
Q: What's the bottom line? What do I have to do to be ready to attest meaningful use?
- Meet 20 of 25 "Meaningful Use Objectives" source
- Must meet 15 "core" measures
- Must also meet 5 of 10 possible "menu" set measures
- Meet 6 of 41 "Clinical Quality Measures (CQM's)" source
- Must meet 3 required core quality measures
- must also meet 3 of 38 possible additional quality measures
- Attest to meeting requirements using Y/N answers and by supplying data from the Quality Measures package.
(TO-DO SMH: Reference and write about the Quality Measures package.)
Q: Can you tell me more about the 15 "core" meaningful use measures? (all are required)
(Detailed instructions on meeting these will be provided in more detail below.)
| Measure | Link to CMS Source | VISTA fulfillment | Attestation Type |
|---|---|---|---|
| CPOE -- Provider directly enters in orders | Source | Fulfillment | Rate > 30% |
| Implement drug-drug and drug-allergy interaction checks | Source | Fulfillment | Yes/No |
| Maintain an up-to-date problem list of current and active diagnoses | Source | Fullfillment | Rate > 80% |
| Generate and transmit permissible prescriptions electronically (eRx) | Source | not available | Rate > 40% |
| Maintain active medication list | Source | Fulfillment | Rate > 80% |
| Maintain active medication allergy list | Source | Fulfillment | Rate > 80% |
| Record required demographics | Source | Fulfillment | Rate > 50% |
| Record required vital signs | Source | Fulfillment | Rate > 50% |
| Record smoking status for patients aged 13 yrs and up | Source | Fulfillment | Rate > 50% |
| Report clinical quality measures to CMS | Source | Fulfillment | Yes/No (Measures are reportable rates however) |
| Implement 1 clinical decision support rule | Source | Fulfillment | Yes/No |
| Provide patients with an electronic copy of their health information | Source | Fulfillment | Rate > 50% |
| Provide clinical summaries for patients for each office visit within 3 days | Source | Fulfillment | Rate > 50% |
| Perform at least 1 test of exchanging key clinical information with another entity electronically | Source | Fulfillment | Yes/No |
| Protect electronic health information | Source | Yes/No |
Here is the logic in the Quality Measures package:
| Measure | Quality Measures Package Logic |
|---|---|
| CPOE -- Provider directly enters in orders | Check for the presence of electronically prescribed medications stored in the Non-VA Multiple in file 55 for this patient |
| Implement drug-drug and drug-allergy interaction checks | Not checked. Report YES. |
| Maintain an up-to-date problem list of current and active diagnoses | Checks active problems. |
| Generate and transmit permissible prescriptions electronically (eRx) | Check for the presence of electronically prescribed medications stored in the Non-VA Multiple in file 55 for this patient |
| Maintain active medication list | Check for the presence of electronically prescribed medications stored in the Non-VA Multiple in file 55 for this patient |
| Maintain active medication allergy list | Check for the presence of allergies for this patient |
| Record required demographics | Check for the presence of Sex, DOB, Primary ID, Preferred Language, Race, Ethnicity for this patient. Lack of any one disqualifes you. |
| Record required vital signs | Check vital signs from July 3rd 2011 to present for this patient. |
| Record smoking status for patients aged 13 yrs and up | Check health factors in the category Tobacco; see if patient will have these. If none found in the category, each possible health factor in a list is tried by itself. |
| Report clinical quality measures to CMS | Not checked. Report YES. |
| Implement 1 clinical decision support rule | Not checked. Report YES. |
| Provide patients with an electronic copy of their health information | MISSING |
| Provide clinical summaries for patients for each office visit within 3 days | MISSING |
| Perform at least 1 test of exchanging key clinical information with another entity electronically | Not checked. Report YES. |
| Protect electronic health information | Not checked. Report YES. |
| Measure | Link to CMS Source | VISTA fulfillment | Attestation Type |
|---|---|---|---|
| Implement drug formulary checks | Source | Fulfillment | Yes/No |
| Incorporate lab results into EHR as structured data | Source | Fulfillment | Rate > 40% |
| Generate list of patients by specific conditions for quality improvement | Source | Fulfillment | Yes/No |
| Send patient reminders per patient preference | Source | NOT DONE | NOT DONE |
| Provide patients with timely electronic access to their health information | Source | NOT DONE | NOT DONE |
| Provide patient-specific education resources | Source | Fulfillment | Rate > 10% |
| Perform medication reconcilliation | Source | Fulfillment | Rate > 50% |
| Send summary care record to other providers | Source | Fulfillment | Rate > 50% |
| Submit data to immunization registries | Source | Fulfillment | Yes/No |
| Submit syndromic surveillance data | Source | NOT DONE | NOT DONE |
How are each of the measures tracked in the Quality Measures package
| Measure | Quality Measures package logic |
|---|---|
| Implement drug formulary checks | Not Checked. Report YES. |
| Incorporate lab results into EHR as structured data | Not checked. If you use Lab Package, report 100%; otherwise, 0%. |
| Generate list of patients by specific conditions for quality improvement | Not Checked. Report YES. |
| Send patient reminders per patient preference | NOT DONE |
| Provide patients with timely electronic access to their health information | NOT DONE. |
| Provide patient-specific education resources | NOT DONE |
| Perform medication reconcilliation | If you use electronic prescribing, automatically marked as YES. |
| Send summary care record to other providers | NOT TRACKED IN QUALITY MEASURES |
| Submit data to immunization registries | Report YES. NOT TRACKED. |
| Submit syndromic surveillance data | NOT DONE |
Q: What about the required Clinical Quality Measures (CQM)?
You must report the 3 core measures. If any of the 3 core measures are reported with zero values for the denominator, you are required to pick an alternate core measure to report in addition, even if these yield zero. For example if: NQF 0028 & NQF 0421 are 0; report 2 measures from the alternate core measures.
In addition to the core/alternate core measures, you need to report an additional 3 measures from the additional list of 38 CQMs.
Click here for a list of all measures afrom the CMS website along with the instructions just above.
NB: If you see the numerator and denomiator logic filled out, it means that the measure is fully supported in the Quality Measurement Package. If they are not there, then they are unsupported; you may still report on them, but you will have to do extra work on your end to make them work.
Core Measures
| Measure | Description | Sources | Denominator in VISTA | Numerator in VISTA |
|---|---|---|---|---|
| NQF0013 | Hypertension: Blood Pressure Measurement | details2 | Patients with Hypertenstion | Blood Pressure recorded as a Vital |
| NQF0028 | Tobacco: Use Asessment | details | Patients | Health factors in NFQ0028AB Tobacco Managment Dialog |
| Tobacco Cessation Intervention | details | Patients who smoke | Health factors in NFQ0028AB Tobacco Managment Dialog | |
| NQF0421 | Adult Weight Screening and Follow-up | details | Patients with high BMI | Health factors in MU NQF0421 BMI DI |
Alternate Core Measures
If you reported 0 for all 3 core measures, you must report on all 3 alternate core measures even if you will report zeroes for all 6 measures.
| Measure | Description | Sources | Denominator in VISTA | Numerator in VISTA |
|---|---|---|---|---|
| NQF 0024 | BMI for age 2-18 | details | Obese Patients in the Date Range (using Vitals package) | ICD9/CPT codes V65.3, 97802, G0270, S9449, S9452, S9470 |
| NQF 0041 | Influenza vaccination | details | Patients | Immunization (IM FLU, 3 yrs) in MU NQF0041 INFLUENZA MANAGEMENT DI |
| NQF 0038 | Childhood immunization status | details | Patients <= 2 yo | Dialog MU NQF0038 IMMUNE MANAGEMENT DI |
Additional Core Measures
An additional 3 from a list of 38 CQM's must be reported. Only the first three are supported by the Quality Measures package right now. If you need to add more, get in contact with George Lilly or Sam Habiel.
| Measure | Description | Sources | Denominator in VISTA | Numerator in VISTA |
|---|---|---|---|---|
| NQF0059 | Diabetes: Hemoglobin A1c Poor Control | details | Diabetics via Meds or Diagnosis | Lab HEMOGLOBIN A1C or Health Factor PQRI HBA1C>9 MK |
| NQF0061 | Diabetes: Low Density Lipoprotein (LDL) Management and Control | details | Diabetics via Meds or Diagnosis | Lab LDL CHOLESTEROL or Health Factor PQRI LDL < 100 |
| NQF0064 | Diabetes: Blood Pressure Management | details | Diabetics via Meds or Diagnosis | Blood Pressure entered via Vitals Package. |
| The rest of these are not fully supported in the Quality Measures package. | ||||
| NQF0081 | Heart Failure (HF): Angiotensin-Converting Enzyme (ACE) Inhibitor or Angiotensin Receptor Blocker (ARB) Therapy for Left Ventricular Systolic Dysfunction (LVSD) | details | ||
| NQF0070 | Coronary Artery Disease (CAD): Beta-Blocker Therapy for CAD Patients with Prior Myocardial Infarction (MI) | details | ||
| NQF0043 | Pneumonia Vaccination Status for Older Adults | details | ||
| NQF0031 | Breast Cancer Screening | details | ||
| NQF0034 | Colorectal Cancer Screening | details | ||
| NQF0067 | Coronary Artery Disease (CAD): Oral Antiplatelet Therapy Prescribed for Patients with CAD | details | ||
| NQF0083 | Heart Failure (HF): Beta-Blocker Therapy for Left Ventricular Systolic Dysfunction (LVSD) | details | ||
| NQF0105 | Anti-depressant medication management: (a) Effective Acute Phase Treatment, (b)Effective Continuation Phase Treatment | details | ||
| NQF0086 | Primary Open Angle Glaucoma (POAG): Optic Nerve Evaluation | details | ||
| NQF0088 | Diabetic Retinopathy: Documentation of Presence or Absence of Macular Edema and Level of Severity of Retinopathy | details | ||
| NQF0089 | Diabetic Retinopathy: Communication with the Physician Managing Ongoing Diabetes Care | details | ||
| NQF0047 | Asthma Pharmacologic Therapy | details | ||
| NQF0001 | Asthma Assessment | details | ||
| NQF0002 | Appropriate Testing for Children with Pharyngitis | details | ||
| NQF0387 | Oncology Breast Cancer: Hormonal Therapy for Stage IC-IIIC Estrogen Receptor/Progesterone Receptor (ER/PR) Positive Breast Cancer | details | ||
| NQF0385 | Oncology Colon Cancer: Chemotherapy for Stage III Colon Cancer Patients | details | ||
| NQF0389 | Prostate Cancer: Avoidance of Overuse of Bone Scan for Staging Low Risk Prostate Cancer Patients | details | ||
| NQF0027 | Smoking and Tobacco Use Cessation, Medical Assistance: a) Advising Smokers and Tobacco Users to Quit, b) Discussing Smoking and Tobacco Use Cessation Medications, c) Discussing Smoking and Tobacco # Use Cessation Strategies | details | ||
| NQF0055 | Diabetes: Eye Exam | details | ||
| NQF0062 | Diabetes: Urine Screening | details | ||
| NQF0056 | Diabetes: Foot Exam | details | ||
| NQF0074 | Coronary Artery Disease (CAD): Drug Therapy for Lowering LDL-Cholesterol | details | ||
| NQF0084 | Heart Failure (HF): Warfarin Therapy Patients with Atrial Fibrillation | |||
| NQF0073 | Ischemic Vascular Disease (IVD): Blood Pressure Management | details | ||
| NQF0068 | Ischemic Vascular Disease (IVD): Use of Aspirin or Another Antithrombotic | details | ||
| NQF0004 | Initiation and Engagement of Alcohol and Other Drug Dependence Treatment: a)Initiation, b) Engagement | details | ||
| NQF0012 | Prenatal Care: Screening for Human Immunodeficiency Virus (HIV) | |||
| NQF0014 | Prenatal Care: Anti-D Immune Globulin -- NQF 0014 | |||
| NQF0018 | Controlling High Blood Pressure | details | ||
| NQF0032 | Cervical Cancer Screening | details | ||
| NQF0033 | Chlamydia Screening for Women | details | ||
| NQF0036 | Use of Appropriate Medications for Asthma | details | ||
| NQF0052 | Low Back Pain: Use of Imaging Studies | details | ||
| NQF0075 | Ischemic Vascular Disease (IVD): Complete Lipid Panel and LDL Control | details | ||
| NQF0575 | Diabetes: Hemoglobin A1c Control (<8.0%) | details | ||
