What is the Patient Wellness Handout (PWH)?

1. Performance Measures ReportOffice HoursFocus: Patient Wellness HandoutModerator: Carmen LandMeaningful Use National Team Business AnalystDNC (Contractor) forU.S. Indian Health Service OITLast Updated: November 14, 2011

2. What is the Patient Wellness Handout (PWH)? • Special health summary report created by RPMS for the patient • Tool that provides patients with access to some of the information in their medical record • Includes vital signs, lab results, and medications from the patient's medical record with an easy to read explanation of what the information means • Goal is to support patient education and the delivery of preventive services to improve patient health

3. What is the PWH (continued)? • Combines features of the Resource Patient Management System (RPMS) with the concepts developed by the Agency of Healthcare Research and Quality’s (AHRQ) Putting Prevention into Practice program • These features address the Institute of Medicine’s (IOM) 10 rules of patient centered care, and empower patients to improve their health and satisfaction with medical services

4. Why Use the Patient Wellness Handout (PWH)? • Should be reviewed with patients to facilitate communication between healthcare providers and patients • May result in improved patient outcomes • Can be used for health promotion and disease prevention activities • Can help you meet Meaningful Use requirements

5. How Do I Use the PWH? • Can be generated for patients by any health care provider or support staff. • To print a PWH, you will need to talk to your RPMS site manager to have this application added for you

6. Performance Measures: EPs & EHs/CAHs

7. PWH: EP Performance Measures

8. PWH: EH/CAH Performance Measures

9. EP: Clinical Summaries • What is a Clinical Summary? • “An after-visit summary that provides a patient with relevant and actionable information and instructions containing the patient name, provider’s office contact information, date and location of visit, an updated medication list, updated vitals, reason(s) for visit, procedures and other instructions based on clinical discussions that took place during the office visit, any updates to a problem list, immunizations or medications administered during visit, summary of topics covered/considered during visit, time and location of next appointment/testing if scheduled, or a recommended appointment time if not scheduled, list of other appointments and tests that the patient needs to schedule with contact information, recommended patient decision aids, laboratory and other diagnostic test orders, test/laboratory results (if received before 24 hours after visit), and symptoms.”  - CMS

10. EP: Clinical Summaries • Core Measure • Clinical summaries provided to patients for >50% of all office visits within three business days. • Measure Exclusion • EPs who have no office visits during the EHR reporting period.

11. EP: Clinical Summaries • Denominator Inclusions • Count each patient face-to-face visit with a professional, defined as Service Category of A, S, O or M during the EHR reporting period. Count visits made the first day of the EHR reporting period through four business days prior to the end of the EHR reporting period.

12. EP Clinical Summaries • Numerator Inclusions • Count each patient face-to-face visit in the Denominator WHERE a Patient Wellness Handout (PWH) was generated on or after the visit date/time but within 3 business days of the visit. • Note • All types of PWHs will be included.

13. EP: Clinical Summaries • How to Meet it Using RPMS • Configure Patient Wellness Handout (PWH) within the EHR. • Provide patients their PWH at each patient encounter. • Monitor PWH count report. • The RPMS system automatically maintains a count of each PWH that is printed. • Note • Minimum required data elements include (1) medication list; (2) medication allergy list; (3) problem list; and (4) diagnostic test/lab results.

14. EP: Clinical Summaries • Suggested Work Flow Step • Provide post-visit clinical summary within three business days of patient visit. • Software Requirements • BGO (EHR) v1.1 patch 8 • BJMD (C32) v1 patch 1 • BJPC (PCC) v2 patch 6

15. EP: Patient Reminders • Measure • >20% of all unique patients who are 0-5 or 65+ years for whom a PWH was printed during the EHR reporting period. • Measure Exclusion • EPs who have no patients who are (1) five years old or younger or (2) 65 years or older.

16. EP: Patient Reminders • Denominator Inclusions • Count each patient with an age of 5 years old and younger at the beginning of the EHR reporting period OR 65 years old and older at the beginning of the EHR reporting period and who do not have a date of death recorded or whose health record has not been inactivated.

17. EP: Patient Reminders • Numerator Inclusions: • Count each patient in the Denominator WHERE one or more Patient Wellness Handouts (PWH) were generated during the EHR reporting period. • Note • Printing of the PWH is counted for this measure.

18. EP: Patient Reminders • How to Meet it Using RPMS • Generate and provide a Patient Wellness Handout (PWH) to patients <=5 or 65+ years who are due for a screening/care. • What would lower your rate for this measure? • Not inactivating records for inactive patients according to site policy. • Not inactivating records for deceased patients in a timely manner.

19. EP: Patient Reminders • Suggested Work Flow Step • Printing PWH for specified age ranges, pre- patient visit. • Software Requirements • BGO (EHR) v1.1 patch 8 • BJPC (PCC) v2 patch 6 • BQI (iCare) v2.1

20. EH/CAH: Medication Allergy List • Core Measure • >80% of all unique patients admitted to the EH/CAH inpatient or emergency departments (POS 21 or 23) during the EHR reporting period have at least one entry (or an indication that the patient has no known medication allergies) recorded as structured data • Measure Exclusion • None

21. EH/CAH: Medication Allergy List • Denominator Inclusions • Count each patient with one or more of the following during the EHR reporting period: 1. A hospitalization, defined as Service Category of H. 2. An emergency department visit defined as clinic code of Emergency Department-30 AND a Service Category of A.

22. EH/CAH: Medication Allergy List • Numerator Inclusions • Count each patient in the Denominator WHERE structured data is present during the EHR reporting period specifying either an active adverse reaction to a medication OR has structured data present that documents there are no known allergies. • Note • The list does not have to be updated at every visit to be up-to-date.

23. EH/CAH: Medication Allergy List • How to Meet it Using RPMS • Configure Adverse Reaction Tracking Package parameters • Enable Order Checks in OE/RR Package • Document allergies to include no known allergies through EHR • The Problem List Allergy List (PLAL) Report can be used to identify patient drug allergies that are on the patient’s Problem List but not on their Allergies List • Pharmacy to generate Adverse Reaction tracking non-verified allergies report and verify unverified allergies

24. EH/CAH: Medication Allergy List • What would lower your rate for this measure? • Entering adverse reactions in the Problem List and not in Adverse Reaction Tracking Package • Suggested Work Flow Step • Allergies captured in EHR during patient visit. When data exists in paper form, allergies must be entered into EHR technology • Data may be entered upon patients’ first visit using EHR • Software Requirements • BGO (EHR) v1.1 patch 8 • BJPC (PCC) v2 patch 6

25. EH/CAH: Electronic Copy of Health Information • Core Measure • >50% of all patients of the EP who request an electronic copy of their health information during the EHR reporting period are provided it within three business days • Measure Exclusion • EPs who have received no requests from patients or their agents for an electronic copy of patient’s health information during the EHR reporting period

26. EH/CAH: Electronic Copy of Health Information • Denominator Inclusions • Count each patient of the eligible hospital or CAH meeting ALL conditions shown below: 1. The patient will have at least one hospitalization or emergency department visit within the past 365 days from the end of the EHR reporting period. A hospitalization is defined with a Service Category of H. An emergency department visit defined as clinic code of Emergency Department-30 AND a Service Category of A.

27. EH/CAH: Electronic Copy of Health Information • Denominator Inclusions (cont.) 2. At least once during the EHR reporting period, the patient requested an electronic copy of their health information, which is defined as the Patient/Agent Request Type value in the Release of Information (ROI) package is equal to “Electronic.” 3. The patient requested the information during the first day of the EHR reporting period through four business days prior to the end of the EHR reporting period. This is determined by checking the Date Request Initiated field in ROI. 4. Patients with multiple requests during the EHR reporting period will be counted only once.

28. EH/CAH: Electronic Copy of Health Information • Numerator Inclusions • Count each patient in the Denominator WHERE the patient was given an electronic copy of the health information within three business days from the request date. This is determined by checking the ROI fields of Record Dissemination, where the value is “Electronic” and Disclosure Date.

29. EH/CAH: Electronic Copy of Health Information • How to Meet it Using RPMS • Configure PCC Health Summary, Patient Wellness Handout (PWH), Discharge Summary, and Discharge Instructions within the EHR • Provide the information electronically to the patient, such as by CD provided by the facility or encrypted e-mail (HIM) • Document in Release of Information (ROI) requests for electronic copy of health information (enter as Patient/Agent Request Type=Electronic) • Document in ROI information was provided electronically (enter as Record Dissemination =Electronic) AND record the Disclosure Date

30. EH/CAH: Electronic Copy of Health Information • Suggested Work Flow Step • Provide electronic copy when requested post-patient visit • Document Release of Information using ROI application • Software Requirements • BGO (EHR) v1.1 patch 8 • BJMD (C32) v1 patch 1 • BJPC (PCC) v2 patch 6 • BRN (ROI) v2 patch 3

31. EH/CAH: Medication Reconciliation • Menu Measure • Perform medication reconciliation for >50% of transitions of care in which the patient is admitted to the EH/CAH inpatient or emergency departments (POS 21 or 23) • Measure Exclusion • None

32. EH/CAH: Medication Reconciliation • Denominator Inclusions • Count each patient event of the following types during the EHR reporting period: 1. A hospitalization, defined as Service Category of H AND an admission type of: • (A) Trans-Non IHS Admission • (B) Trans-IHS Admission • (C) Referred Admission

33. EH/CAH: Medication Reconciliation • Denominator Inclusions (continued) OR 2. An emergency department visit, defined as clinic code of Emergency Department-30 AND a Service Category of A with a "Yes" value in the "Was the patient transferred from another facility" field in the ER Visit file. (This field follows the Visit Type in the ER admission process.) • Numerator Inclusions • Count each visit in the Denominator WHERE a Patient Education Code of M-MR is documented on the day of the hospital admission or emergency department visit through the second day.

34. EH/CAH: Medication Reconciliation • Note • The Patient Wellness Handout (PWH) is not required to meet this measure. However, printing the PWH and providing a copy to the patient is encouraged and recommended as it will allow the EH/CAH to meet additional Performance Measures and provide a method by which the provider may produce a medication list and review it with the patient. Documentation of M-MR is the only thing that is counted by RPMS during a transition of care.

35. EH/CAH: Medication Reconciliation • How to Meet it Using RPMS • Provide patient with medication reconciliation PWH • Perform the medication reconciliation for transitions of care • Document Medication Reconciliation patient education code (M-MR) • Suggested Work Flow Step • Complete and document medication reconciliation at the beginning of every patient visit • During patient visit, system enables online comparison of two or more medication lists (the one included in patient’s current EHR and an external list)

36. EH/CAH: Medication Reconciliation • Notes • Printing the Patient Wellness Handout (PWH) and presenting a copy to the patient is recommended as this will allow the EH/CAH to meet additional Performance Measures • This MU Performance Measure addresses medication reconciliation (MR) when an EH/CAH admits a patient, but other accreditation bodies (e.g., the Joint Commission, AAAHC) require MR to be done at every transition of care • Software Requirements • BGO (EHR) v1.1 patch 8 • BJPC (PCC) v2 patch 6

37. References and Resources IHS Meaningful Use website Toolkit: http://www.ihs.gov/meaningfuluse/index.cfm?module=toolkit Centers for Medicare and Medicaid Services EP Core and Menu Set Specification Sheets: https://www.cms.gov/EHRIncentivePrograms/Downloads/EP-MU-TOC.pdf EH/CAH Core and Menu Set Specification Sheets: https://www.cms.gov/EHRIncentivePrograms/Downloads/Hosp_CAH_MU-TOC.pdf

38. IHS Meaningful Use: Contact Information • Chris Lamer, Meaningful Use Project Lead, IHS (615) 669-2747 Chris.Lamer@ihs.gov • Cathy Whaley, Meaningful Use Project Manager, DNC (520) 622-2069 Catherine.Whaley@ihs.gov • Cecelia Rosales, Meaningful Use National Team Lead (505) 248-4359 Cecelia.Rosales@ihs.gov • Carmen Land, Meaningful Use National Team Business Analyst (505) 248-4402 Carmen.Land@ihs.gov

39. Questions?Discussion TimeSign up for the MU Listserv!More questions, contact us at:MeaningfulUseTeam@ihs.gov

40. Meaningful Use Office Hours • Join us each Wednesday at 1 p.m. MST • 1st Week: Medicaid Patient Volume Report • 2nd Week: MU Performance Measures Report • 3rd Week: Clinical Quality Measures Report • 4th & 5th Week: Other MU topics (registration, certification, etc.)

41. Run a Performance Measure Report • Select IHS Kernel Option: CORE • Select IHS Core Option: PCC (Patient Care Component) • Selection Patient Care Component Option: ARP (PCC Management Reports) • Select PCC Management Reports Option: MUR (Meaningful Use Performance reports)

42. Establish Meaningful Use ‘Clean Date’ (MUCD) MUCD was created to allow sites to see EHR order check parameter settings related to MU PM Drug Interaction Checks, which are set incorrectly. Sites should use the data to correct any discrepancies. The MU PM Report will fail one or more of its core elements until the parameters are set properly. When site is configured correctly, the MU ‘Clean Date’ will be set equal to that day’s date. Running the option again doesn’t reset the date. The initial clean date’ remains the same.

43. Establish Meaningful Use ‘Clean Date’ (MUCD) • Ten Order Checks to be enabled and set to mandatory: • Allergy-Contrast Media Interaction • Allergy-Drug Interaction • Critical Drug Interaction • Dangerous Meds for Patients >64 • Estimated Creatinine Clearance • Glucophage-Contrast Media • Glucophage-Lab Results • No Allergy Assessment • Allergy Unassessible • Renal Functions Over Age 65

44. Establish Meaningful Use ‘Clean Date’ (MUCD)

45. Stage 1 MU Performance Report • MU PM Report does not verify CMS Medicare or Medicaid EHR Incentive Program participation eligibility. • Important: this report can indicate Meaningful Use has been achieved by an EP or facility that is not eligible (or not yet registered) to participate in the program. • Please speak to your Area Meaningful Use Coordinator for guidance in determining eligibility.

46. Full or Summary Report Selection • May generate full report or summary report. • Full report includes the cover page and details on each Performance Measure along with corresponding logic. • Full report also includes a summary report. • Summary report does not include programming logic. • Both reports display previous and current performance results as well as Stage 1 targets.

47. Report Period Selection • May run report for full year or a 90-day period • Both coincide with CMS program parameters • The MU program for EPs runs on a calendar year • Report can be run for any date; however, MU cannot be achieved with the RPMS EHR prior to its date of certification and installation. • Example: if the certified version of RPMS EHR is installed at your site on July 27th, users may run this report for periods prior to this date, but MU can only be achieved on performance for a period that begins on or after July 28th.

48. Calculating Previous Period Option for 90-Day Report Period If user chooses to include previous period data, calculate data from the period immediately preceding the selected 90-day report period in the previous step. If user selects June 1, 2011 – August 31, 2011, report will also display March 1, 2011 – May 31, 2011. If user chooses not to include previous period, report will reflect “N/A” in the reports output.

49. Provider Selection IP: Individual Provider User is prompted to enter provider name Full or summary report generated for designated provider SEL: Selected Providers User is prompted to enter multiple provider names Full or summary report generated for each provider TAX: Provider Taxonomy List User is prompted for the taxonomy list name Full or summary report generated for each provider on the list

50. Output Selection Choose from the following output selections: P Print Report on Printer or Screen D Create Delimited output file (for use in Excel) B Both a Printed Report and Delimited File At the “Device” prompt, specify the device to print/display the report. Bug in deliminated report: exclusion column is returning inconsistent results