Setup and Use of Net Health Employee Health and Occupational Medicine to Collect Meaningful Use Data

Objective Number

Eligible Professionals Objectives

Stage 1 Measures

Net Health Employee Health and Occupational Medicine Feature

Core Set of Measures: All 10 Are Required

1

Use Computerized Provider order Entry (CPOE) for medication orders directly entered by any licensed healthcare professional who can enter orders into the medical record per state, local and professional guidelines

More than 30% of unique patients with at least one medication in their medication list seen by the EP have at least one medication order entered using CPOE

Net Health Employee Health and Occupational Medicine: All types of orders, including medications, are entered and stored electronically as structured data during the charting process.

Setup: Keep medications table up to date with medications ordered in your clinic. Include all commonly ordered medications in Wizards on the Orders tab of templates.

Use: Simply use Net Health Employee Health and Occupational Medicine as intended by entering all medication orders in the Charting Workspace.

See endnote 1.

2

Implement drug-drug and drug-allergy interaction checks

The EP has enabled this functionality for the entire reporting period

Net Health Employee Health and Occupational Medicine: After every medication order is entered, Net Health Employee Health and Occupational Medicine runs the Cerner Multum drug interactions check to identify drug-to-drug, drug-to-allergy, and drug-to-disease contraindications.

EMR Parameters Setup: The drug interactions check must be enabled on the Drug Interactions tab. The sensitivity of the check should be adjusted as needed. Optionally, EMR Parameters can be configured for real time pop-up interaction alerts during history taking on the PMH tab.

Medications Setup: Select all medications in the Net Health Employee Health and Occupational Medicine Medications Table from the Cerner Multum database. Confirm that medications already in the med codes table have a Drug ID, which uniquely identifies each med for the interactions check. If not, add the ID from Cerner Multum.

Allergies and Conditions (PMH tab) Setup: When creating medication allergy wizards, select meds and med classes from the Multum list reached by clicking the table icon beside the related field. When setting up Active/Chronic Problems Wizards, include the ICD-9 code for items you want included in the interactions check. This might require adding ICD-9/10 codes to your Net Health Employee Health and Occupational Medicine table.

Use-Allergy and Condition History: Select allergies and diseases and conditions using the properly set up wizards.

Use- Medications History: For medications that are not in your Net Health Employee Health and Occupational Medicine medications table, always locate the medication by using theSelect From Multum button.

Use-Medication Orders: Order meds using properly set up medication wizards, or by selecting from the medications table. If a medication is not in the table, add from Multum.

Warning: Never enter medication history or orders using free text entry. Free text is not structured data.

3

Maintain an up-to-date problems list of current and active diagnoses

More than 80% of all unique patients seen by the EP have at least one entry or an indication that no problems are known for the patient recorded as structured data.

Net Health Employee Health and Occupational Medicine: A problems list for illnesses and conditions is maintained electronically as structured data, codified where appropriate with ICD-9 (or ICD-10) codes.

ICD-9/10 table Setup: Make sure all diagnostic codes typically used in your clinic are in the ICD-9/10 table.

Active/Chronic Problems Setup: Make sure that Illness and Condition Wizards on the PMH tab include the appropriate ICD-9/10 codes.

Assessment Wizard Setup: Make sure that Assessment Wizards include the appropriate ICD-9/10 codes.

Use: Enter all appropriate ICD 9/10 codes related to the current visit on the Assessment tab. Enter past and pre-existing illnesses and conditions on the PMH tab using properly set up Wizards.

4

Generate and transmit permissible prescriptions electronically (eRx).

More than 40% of all permissible prescriptions written by the EP are transmitted electronically using certified technology.

Net Health Employee Health and Occupational Medicine: Prescriptions can be transmitted electronically via Surescripts.

Setup: Set up to use Surescripts for ePrescribing. This includes certain technical tasks that should be performed in consultation with Net Health Technical Support. It also includes registering each prescribing physician with Surescripts.

Use: Use Surescripts to submit prescriptions electronically whenever possible.

See endnote 1.

5

Maintain active medication list

More than 80% of all unique patients seen by the EP have at least one entry (or an indication that the patient is not currently prescribed any medication) recorded as structured data

Net Health Employee Health and Occupational Medicine: A problems list with current medications and inactive medications is maintained electronically as stored data. Data is collected automatically when medication history and prescriptions are entered.

Medication Wizard Setup: When medications are added to the medications table, select from the Multum database.

Medication History Wizards on the PMH and Orders tabs must be set up to add to meds to the Current Medications list (default).

Confirm that the set up for your “No Known Medications” Wizard has the Update Patient Demographic with No Known Medications Indicator box checked. If you began using Net Health Employee Health and Occupational Medicine/Net Health Employee Health and Occupational Medicine with provider charting before 5/1/10 you will need to convert your existing No Medications Wizard to the new type.

Use: Use properly set up med wizards on the PMH and Orders tabs.

6

Maintain active medication allergy list

More than 80% of all unique patients seen by the EP have at least one entry (or an indication that the patient has no known medication allergies) recorded as structured data

Net Health Employee Health and Occupational Medicine: The allergies problems list, which includes medication allergies, is maintained electronically as structured data.

Allergy Wizard Setup: Allergy Wizards on the PMH tab must be set up to be added to the problem's list (default).

Confirm that every existing Medication Allergy Wizard includes either a medication code from your Net Health Employee Health and Occupational Medicine medications list or a medication category code-simply typing in the med does not produce structured data. (A selection list for each is available during Wizard setup, depending on the type of Wizard.)

Confirm that the setup for your "No Known Medication Allergies" Wizard has the Update Patient Demographics with No Known Drug Allergy Indicator box checked. If you began using Net Health Employee Health and Occupational Medicine/Net Health Employee Health and Occupational Medicine with provider charting before 5/1/10 you will need to convert your existing NKDA Wizard to the new type. .

Use: Use medication allergy wizards as intended.

Warning: Never enter an allergy using free text.

7

Record demographics

Preferred language

Gender

Race

Ethnicity

Date of birth

More than 50% of all unique patients seen by the EP have demographics recorded as structured data

Net Health Employee Health and Occupational Medicine: The Patient Demographics window, which is structured data, includes all of these.

Setup: None.

Use: Train front desk staff to enter all appropriate demographics.

8

Record and chart changes in vital signs:

Height

Weight

Blood pressure

Calculate and display BMI

Plot and display growth charts for children 2-20 years, including BMI

For more than 50% of all unique patients age 2 and over seen by the EP, height, weight and blood pressure are recorded as structured data

Net Health Employee Health and Occupational Medicine: The vital signs entry window accessible on the Visits tab of the Charting Workspace and the Results tab of the visit record includes all of these. BMI is calculated automatically from patient's height and weight. Vital signs can be graphed. Includes growth charts for patients 2-20 years old.

Setup: If you have previously used medical activities to record vital signs, remove them from visit category protocols.

Use: Enter vital signs for all appropriate visits using the vital signs entry window (instead of using medical activities as you may have done in the past.)

9

Record smoking status for patients 13 years old or older

More than 50% of all unique patients 13 years old or older seen by the EP have smoking status recorded as structured data

Net Health Employee Health and Occupational Medicine: The Tobacco Use Wizard (PMH tab, Social History) captures this information and more. Some items are displayed on the Patient Demographics window for viewing by users without access Provider Charting.

Setup: Smoking/Tobacco Use Specialty Wizard must be set up and included on appropriate Templates. (It may be that the only template that needs this change is the Basic Default Charting Template.) For Net Health Employee Health and Occupational Medicine to be able to report on this item, this new Wizard type must be used. You might need to remove old smoking or tobacco use Wizards from your templates to prevent users from using them.

Use: Capture tobacco use information using the Smoking/Tobacco Use Specialty Wizard on visits. For visits that are not charted, enter the smoking data manually on the Risk Factors tab of Patient Demographics. Be sure to enter the date! This is used in gathering data for the Meaningful Use report.

10

Report ambulatory clinical quality measures to CMS or the States

For 2011, provide aggregate numerator, denominator, and exclusions through attestation as discussed in section II(A)(3) of this final rule

Net Health Employee Health and Occupational Medicine: CMS Quality Reporting on the Quality Reporting menu can produce these measures. However, for the calculations to be correct, related activity must be entered correctly.

Setup: You need to report on three measures. There are, however, a large number from which you might select. Explaining the setup for all of them is beyond the scope of this document. We have a supplemental document, Setting Up Net Health Employee Health and Occupational Medicine to Report Ambulatory Clinical Quality Measures, which explains each.

Use: Print the CMS Quality Measures Report at the end of the period, selecting the three measures you are reporting, and report the results to CMS.

See endnote 2.

11

Implement one clinical decision support rule relevant to specialty or high clinical priority along with the ability to track compliance with that rule

Implement one clinical decision support rule

Net Health Employee Health and Occupational Medicine: Clinical Practices Guidelines are clinical decision support rules for preventive medicine, disease management and immunizations.

Setup: Setup at least one appropriate Clinical Practices Guideline.

Use: Click theGuidelines button on the Orders tab on all appropriate visits to see if any guidelines apply to this patient.

12

Provide patients with an electronic copy of their health information (including diagnostic test results, problems list, medication lists, medication allergies) upon request

More than 50% of all patients of the EP who request an electronic copy of their health information are provided it within 3 business days

Net Health Employee Health and Occupational Medicine: A formal health record can be printed or exported from the patient chart to electronic file in two industry standard formats ASTM CCR.

Setup: None

Use: Record patient access requests using HIPPA Guard on the date when the patient makes the request. Enter the Access date when the patient receives the electronic copy of their health information.

See endnote 8.

13

Provide clinical summaries for patients for each office visit

Clinical summaries provided to patients for more than 50% of all office visits within 3 business days

Net Health Employee Health and Occupational Medicine: A Clinical Summary can be printed with the Encounter Summary Report.

Setup: None.

Use: The Clinical Summary can be printed from the same point at the Work Status and Encounter Summary reports.

Use: The provider may mark lab tests, imaging/radiology activities, and diagnoses to be withheld from the patient by checking a box on the medical activity record on the visit. This will exclude the activity from the Clinical Summary and the Patient Portal. Unchecking the box includes the activity.

See endnote 3.

14

Capability to exchange key clinical information (for example, problems list, medication list, medication allergies, diagnostic test results), among providers of care and patient authorized entities electronically

Performed at least one test of certified technology's capacity to electronically exchange key clinical information

The mechanism for transmission of health records between providers is still being defined by the certifying body. Once standards are finalized Net Health Employee Health and Occupational Medicine will be enhanced consistent with those standards.

15

Protect electronic health information created or maintained by the certified technology through the implementation of appropriate technical capabilities

Conduct or review a security risk analysis per 45 CFR 164.308 (a)(1) and implement security updates as necessary and correct identified security deficiencies as part of its risk management process

Net Health Employee Health and Occupational Medicine: PHI is protected by a robust array of security measures. They include user codes which control the areas within the program to which a user has access. You can also set password complexity requirements, an inactive period timeout control, and the number of unsuccessful login attempts allowed before locking the account pending review by the designated security administrator. Exporting PHI on reports and in electronic health records (CCD, CCR) requires creating an encrypted file

Setup: When user codes are setup, assign only appropriate access rights to each user. Set other controls for the desired level of protection. See the help topic System Security Management Overview to learn more about security features.

Use: No change to how users now access Net Health Employee Health and Occupational Medicine .

Menu Set of Measures: Select 5 of 10

See endnote 4

1

Implement drug-formulary checks

The EP has enabled this functionality and has access to at least one internal or external drug formulary for the entire reporting period

Net Health Employee Health and Occupational Medicine: When a medication is ordered, Net Health Employee Health and Occupational Medicine checks via Surescripts with the patient's insurance company foreligibility and formulary benefit information.

Setup: You must be using Surescripts to have access to eligibility and formulary information. To enable the feature, in EMR Parameters, on the Prescriptions tab, check Display Eligibility and Formulary Benefit Information during the Prescription Writing Process.

Use: Eligibility and formulary benefit information is automatically displayed side-by-side with the Medication Order Wizard as a prescription is entered. Its purpose is to assist the provider in selecting the most appropriate specific medication to prescribe. If the med is not on the formulary, a list of alternative meds might be displayed, either payer suggested or therapeutic alternatives. If so, the current order can be changed to an alternative med simply by double-clicking that alternative on the formulary list.

2

Incorporate clinical lab-test results into certified technology as structured data

More than 40% of all clinical lab tests results ordered by the EP during the reporting period whose results are either in a positive/negative or numerical format are incorporated in certified technology as structured data

Net Health Employee Health and Occupational Medicine: Lab results can be received electronically or entered manually. Either method stores the results as structured data. Lab panel templates can be created specifically for capturing and viewing sets of labs, and medical activities can be set up to store the result for single labs. The screen for capturing and displaying lab panel results is similar in structure to the one used for capturing drug test panels.

Medical Activity Setup: Create medical activities for lab test panels and/or individual lab test medical activities for as appropriate. Activity Type must be set to Lab Test for both lab panels and lab tests. For lab panels only, Trigger Entry must be set to Lab Test Panel. For lab tests only, Trigger Entry must be set to Lab Value.

Wizard Setup: Add the lab panels and lab tests to appropriate Results and/or Procedures Wizards, making use of the "auto-charge" feature to automatically add the activities to the visit.

Use: Select lab test activities and lab test panels on visits as appropriate. If not receiving results via electronic interface, enter results manually for each test.

3

Generate lists of patients by specific conditions to use for quality improvement, reduction of disparities, research or outreach

Generate at least one report listing patients of the EP with a specific condition

Net Health Employee Health and Occupational Medicine: The Quality Improvement Report creates lists based on demographics, clinical information, and vital signs data, etc.

Setup: Set up wizards for specific conditions on the PMH tab.

Setup: Optionally, set up and memorize reports that will be used repeatedly.

Use: When charting on the PMH tab, enter patient conditions, on the list of problems. Make sure an ICD-9/10 code is entered with each problem. Generate quality improvement reports as needed selecting patients with the condition(s) of interest.

4

Send reminders to patients per patient preference for preventive/ follow up care

More than 20% of all unique patients 65 years or older or 5 years old or younger were sent an appropriate reminder during the reporting period

Net Health Employee Health and Occupational Medicine: Net Health Employee Health and Occupational Medicine can send reminder letters to patients who are due for an immunization, a preventive & wellness service, or a disease management service based on Clinical Guidelines.

Setup: Create and save Clinical Guideline notices for needed purposes. Create or confirm that appropriate guidelines and/or medical activities are set up to correctly select patients.

Use: Use the Letters and List function to send Clinical Guideline reminder letters, using appropriate selection criteria.

5

Provide patients with timely electronic access to their health information (including lab results, problems list, medication lists, medication allergies) within four business days of the information being available to the EP

More than 10% of all unique patients seen by the EP are provided timely (available to the patient within four business days of being updated in the certified technology) electronic access to their health information subject to the EP's discretion to withhold certain information

Net Health Employee Health and Occupational Medicine: The Net Health Employee Health and Occupational Medicine patient portal provides patients with secure access to certain elements of their health information, lab results, problems list, medication lists, medication allergies.

Setup: Build a Web server to host the patient portal Web site. This is, of course, a very technical process involving both hardware and software. It should be done in consultation with Net Health Technical Support.

Setup: Modify certain system parameters as required. These include entering technical values, such as the url of the Website. They include non-technical items such as the text displayed when a patient logs in or when an invitation e-mail is sent to a patient.

Use: When a patient requests access, enter a profile for that patient and send an e-mail with connection information.

Use: The provider may mark lab tests, imaging/radiology activities, and diagnoses to be withheld from the patient by checking a box on the medical activity record on the visit. This will exclude the activity from the Clinical Summary and the Patient Portal. Unchecking the box includes the activity.

See endnote 9.

6

Use certified technology to identify patient-specific education resources and provide those resources to the patient if appropriate

More than 10% of all unique patients seen by the EP are provided patient-specific education resources

Net Health Employee Health and Occupational Medicine: Exitcare Patient Instructions provides over 2000 documents of concise, clear, easily understood discharge instructions. When prescribing drugs, Cerner Multum offers a patient leaflet specific to the medications being ordered.

Setup: Create patient instructions wizards for the INSTRUCTIONS tab, and set up templates to use the appropriate ones. A Wizard can be for a single document or it can present multiple-choice lists from which the provider can select one or more documents.

Use: Print appropriate Exitcare documents and Cerner Multum medication leaflets for patients before they leave the clinic.

7

The EP who receives a patient from another setting of care or provider of care or believes an encounter is relevant should perform medication reconciliation

The EP performs medication reconciliation for more than 50% of transitions of care in which the patient is transitioned into the care of the EP

Net Health Employee Health and Occupational Medicine: Includes a medication reconciliation feature, which reconciles the Net Health Employee Health and Occupational Medicine current medications problems list with Surescripts prescriptions paid for by the patient's current payer.

Setup: Set up to use Surescripts for ePrescribing. This includes certain technical tasks that should be performed in consultation with Net Health Technical Support. It also includes registering each prescribing physician with Surescripts.

Use: On the Orders tab, click the Medication Reconciliation button to see both Net Health Employee Health and Occupational Medicine's current medications list and a list of medications from the patients' prescription history retrieved from the Surescripts Network. If there are medications on the Surescripts list that are not in Net Health Employee Health and Occupational Medicine, drag and drop them to the current medications list.

8

The EP who transitions their patient to another setting of care or provider of care or refers their patient to another provider of care should provide summary of care record for each transition of care or referral

The EP who transitions or refers their patient to another setting of care or provider of care provides a summary of care record for more than 50% of transitions of care and referrals

Net Health Employee Health and Occupational Medicine: Attach Clinical Summary to referral note.

Setup: None required.

Use: When sending a referral note, select either the Clinical Summary or CCR Electronic file to attach to the referral note. Then, select which elements of the patient's record to include.

9

Capability to submit electronic data to immunization registries or Immunization Information Systems and actual submission in accordance with applicable law and practice

Performed at least one test of certified technology's capacity to submit electronic data to immunization registries and follow up submission if the test is successful (unless none of the immunization registries to which the EP submits such information have the capacity to receive the information electronically)

Net Health Employee Health and Occupational Medicine: The Export to State Immunization Registries utility does just that.

Setup:You must obtain from your state the information needed to meet your state's requirements. This will typically include a provider identifier code and name that your state will need to recognize who submitted the data. There might be specific codes needed to identify the vaccine and manufacturer. There may be other requirements. If specific medical activity names or CPT codes, or other government mandated codes are required, make the needed changes in your Medical Activity and CPT Codes tables. It is essential to do this setup before you begin recording your vaccine administrations.

Use: Record vaccinations using the correct codes. Use the Export to State Immunization Registries feature, found by clicking Utilities on the Home Nav Bar, to export vaccinations for a specific period.

Note: Read How to Track H1N1 Immunizationsto learn about Net Health Employee Health and Occupational Medicine's mechanism for efficiently collecting and entering vaccination information.

See endnote 5.

10

Capability to submit electronic syndromic surveillance data to public health agencies and actual submission in accordance with applicable law and practice

Performed at least one test of certified technology's capacity to provide electronic syndromic surveillance data to public health agencies and follow-up submission if the test is successful (unless none of the public health agencies to which the EP submits such information have the capacity to receive the information electronically)

Net Health Employee Health and Occupational Medicine: Under development.

See endnote 6.