How to Achieve Meaningful Use
With ICANotes
As you make your notes using ICANotes, there are 16 measures that will be automatically calculated to determine if you are using electronic health records in a meaningful way. To get your incentive payments you will have to attest that you have met these measures.
In the ICANotes Reports menu please view the Meaningful Use report as you read this document.
In this document I will explain to you what you have to do to meet the Meaningful Use criteria. Many items are very easy to achieve by just doing what you normally do or by doing what is good practice.
1. Up To Date Problem List: The "Problem List" is the diagnoses you make for the patient. It’s as simple as that. When you do an initial evaluation and arrive at one or more diagnoses in the Finish Initial section for at least 80% of your patients, you have achieved this meaningful use measure.
2. Active Medication List: This measure is also very simple. Either order medication for your patient or indicate "No Medication ordered". If you take either of these steps for 80% of your patients, you will achieve this measure.
3. Active Medication Allergy List: Do you ask your patients if they have a history of Adverse Drug Reactions, or if they are "allergic" to any medications? Very likely you do. Their answer can be recorded in two places.
a. Initial or Complete Examination: Medical History. Use the shrub button "Adverse Drug Reactions."
b. Progress Note: Use the button at the top of column two, "Drug Reactions."
In either case, indicating what the adverse drug reaction is or indicating that there is no such history for 80% of your patients will achieve this measure.
4. Record Demographics: This measure is also very easy to achieve. When a new chart is begun and demographics are entered just be sure to include the following for 80% of your patients: ethnicity, race, and preferred language. That's all there is to it.
5. Patient Specific Education: This is new. When you make certain diagnoses for your patient, order certain medications, or record certain test results, you will automatically be offered the ability to print out a sheet providing educational resources for the patient. By simply printing those sheets for just 10% of your patients, you will achieve this meaningful use measure. The sheets contain links to web sites that we feel contain correct and useful information.
6. CPOE: Computerized Physician Order Entry is what this acronym stands for. This measure is to ensure that you can use your EHR to order whatever medications, lab tests, and imaging the patient needs. This measure is only concerned with the ordering of medications, so it is essentially the same as #2 above. Either order medication for your patient or indicate "No Medication ordered" and you will easily meet the 30% requirement of this measure.
7. Vitals, BMI, and Growth Chart: This may not be something you have been routinely doing. To meet this measure you are simply asked to record the Blood Pressure, Height, and Weight for 50% of your patients. ICANotes will automatically calculate the BMI and in the Patient Logs will create graphs of these vital signs if you wish to see them. That's all there is to this measure.
8. Record Smoking Status: Do you routinely ask and record your patient's smoking status? It can be recorded in the Medical History using the shrub buttons "Health and Behavior" and "Tobacco." While making a progress note, it can be recorded in the "Behavior" section. If you record the smoking status of 50% of patients 18 or older you will meet this meaningful use measure.
9. Incorporate Lab Results: This measure is to determine that the tests (chemistries, imaging etc) you order with ICANotes have their results recorded in ICANotes. To order tests use the "Lab Requisition" button on PN2, section 2. To enter test results, use the "Test Results" button on PN1, column 1. If 40% of the tests you order have their results recorded, you will meet this measure.
How to Make a Clinical Summary: The ability to make a clinical summary of your patients' conditions is an important and useful new feature in ICANotes. The summary contains information about your patients’ diagnoses, medications, drug allergies, recent test results, and medical conditions.
A number of meaningful use measures start by making a Clinical Summary. Here's how to do it. After you compile a note push the button called, "Create Clinical Summary" on the Preview Screen. That's it.
If you wish to have the summary included as part of your chart, then push the button "Compile This Note." We'll explain below when to push the button, "Compile This Note and Create a CCR."
This Clinical Summary can be sent to other providers when you request a consult or it can be put into a medical repository like Microsoft's HealthVault where it can, with the correct password, be accessed by other health professionals or by the patient. Giving the patient access to their Clinical Summary has proven to be good practice. Making this basic information available to other medical practitioners improves quality of care and helps avoid testing duplication.
How to Create an Account with Microsoft's HealthVault: In order to electronically share Clinical Summaries with your patient, both you and your patient should go to the HealthVault web site and create accounts for yourselves. It’s easy to do. Go to http://www.healthvault.com and push the button "Create a Free Account."
Important: When your patients create an account they need to add you to the account. Alert your patient that during the sign up process they need to do the following: When they arrive at their HealthVault Home page they should push the "Sharing" tab. Then, push the "Share with Someone You Trust" button. The patient should enter you as a person they trust and must include your email address. When asked to select your sharing level, they should indicate "Custodian". This will give you full access to their account, including the ability to upload documents into the patient's HealthVault.
10. Electronic Copy of Patient Health Information: This measure concerns itself with how quickly patients who request a copy of their Clinical Summary receive it electronically. You get credit for this measure if 50% of the patients who request a clinical summary have electronic access to it within 3 days.
Here's how to make a Clinical Summary electronically available to a patient: Make a Clinical Summary, as described above, and push the button, "Compile This Note and Create a CCR." CCR stands for Continuity of Care Record. It is your Clinical Summary in a standard format that can be electronically sent to HealthVault, other medical storage sites, or any location that has software set to receive and display it.
When you push the button "Compile This Note and Create a CCR", it puts a copy of your clinical summary, in CCR format, into the documents section of the patient's chart and into the patient's section of the upload site.
You will make a copy of the patient's Clinical Summary available to the patient by downloading it from the Upload site and then uploading it to the patient's HealthVault account
To download the CCR from the upload site, go to the patients chart on the upload site (Mozilla Firefox works best), identify the CCR, right-click on its image, and choose "Save File." It will download to your Downloads folder (or, if you prefer, to your desktop.)
Then, sign in to your HealthVault account and switch to your patient's account (you have been made a Custodian of that account (see above), so the patient's name will appear in your HealthVault home page. Once you are in the patient's account, click on "Add, View, or Edit Information." Indicate that you want to add a CCR document to the account, locate the CCR on your desktop, and upload it. That's it. The patient's CCR document is now the latest entry in his or her HealthVault account.
There is one more thing to do. You need to let the ICANotes program know that a summary has been posted in the patient's HealthVault account. Please go to the Preview screen for the patient's note. On the right border, you will see a check box for "Patient Requests a Summary" and "Date Summary Sent to Patient." Check the box and select a date. The program now has all the information it needs to correctly calculate this measure for you.
11. Medication Reconciliation: A medication reconciliation is simply the process of listing the medications the patient is taking at the time of your initial evaluation, deciding whether those medications will be continued, stopped or have their dosage altered, writing additional orders now that the patient is under your care, and arriving at a combined list of the medications you have continued and the new orders you have written.
ICANotes makes this process easy. First, create your medication orders as usual. Then, on PN2 upper-right or Finish Initial upper-right, there are buttons labeled "Medication Reconciliation". Use the Medication Reconciliation form to enter the medications, both OTC and prescribed, that the patient was taking prior to coming under your care. Indicate if you wish to continue, stop, or change the dosage of those medications. Then, push the button "Click Here to Reconcile the Two Lists." The resulting medication list, on both the Reconciliation form and on your clinical note will be the combined list of all medications being continued or newly ordered.
To achieve meaningful use, 50% of your patients should have their medications reconciled using the Reconciliation Form.
12. Patient Summary Record for Referrals: This measure asks a simple question: when you make a referral to another clinician do you send a Clinical Summary?
First, fill out a Referral form. The "Referral" button is on PN2, section 2. After filling out the Referral Form, make a Clinical Summary and include it with your referral form or make it available to the consultant, however you wish. Then, let the program know that the Clinical Summary was provided to the consultant by selecting a date in the "Date Summary Sent to Provider" field on the right margin of the Preview screen. That's it. Do this for 50% of your referrals and you will receive meaningful use credit for this measure.
13. Timely Access: This measure also involves making a Clinical Summary electronically available to your patient by posting it on his or her HealthVault account. Unlike #10 above, it doesn't matter if the patient has requested a Clinical Summary; all this measure requires is for at least 10% of your patients to have had Clinical Summaries posted within four days of your evaluation.
Directions for creating HealthVault accounts and how to post a clinical summary are above.
Please note that the summaries you post at a patient's request in #10 do count for this measure. Also, please note that no matter how many times you see a patient, if you just post a summary once, you will get credit for that patient toward your 10% requirement.
Once the Clinical Summary has been posted on the HealthVault account, you must fill out the "Date Summary Sent to Patient" field on the Preview screen so that the ICANotes program can calculate this measure for you (Please note that ICANotes is working on a simpler way to make Clinical Summaries electronically available to your patients. We will let you know when this new feature becomes available.)
14. Generate and Transmit E-Rx: Meaningful use requires that you use an e- prescription system and that 30% of your prescriptions be e-prescribed. If you use one of the e-Rx companies that ICANotes is integrated, with this measure will be automatically calculated for you, and meeting this measure will be easy.
15. Clinical Summaries: This measure again involves making a Clinical Summary available to your patients. This measure requires that a Clinical Summary be made available for 50% of every out-patient clinical contact, within four days. However, this summary does not require that the Clinical Summary be made available to your patient electronically. So, if you will simply print a Clinical Summary and give it to your patient (perhaps on their way out, or mail or fax it to them) within four days of the contact, you will meet this measure.
Please note: you need to let the program know when the Summary was given to the patient. You can do that by indicating the date in the "Date Summary Sent to Patient" field on the Preview screen.
16. Patient Reminders: This measure is odd because it only applies to patients who are younger than 5 or older than 65. In any case, it asks that you provide "appropriate" reminders to 20% of those patients.
To create a patient reminder, use the "Set or See Reminder" button on the chart face. Use the "New" button to set a reminder and indicate that it is a patient reminder. Set the date of the reminder, who it is to be sent to and why.
For example, you might send a reminder in one week to an office staff person to remind Mr. Jones (who is 65+) to get a lithium level. The office staff person would use the patient's preferred means of communication (set in Demographics) to remind Mr. Jones.
Once the reminder to the patient has been made, the ICANotes program must be informed. Do that by returning to "Set or See Reminder", opening the reminder in question by clicking on it, and indicating in the appropriate fields that the reminder was done and when it was done. That's it.
