Stage 1:

Meaningful Use
Manual

Promoting
Meaningful Use
in Your Practice
March 15, 2011

Dear BayCare Connect Participating Physicians and Practices,

We hope you find this manual helpful for your practices in achieving Meaningful Use.

Thanks to Chris Eakes, Manager, EMR Technical Liaison, and Alex Rennick, Systems Analyst,
for assisting me in preparing this manual. We appreciate the information and feedback
provided to us by the eClinicalWorks team.

If you have questions or need assistance, please contact us.

Sincerely,

Patrick Cimino, MD, MPH

Medical Director
BayCare Health System
O - (727) 467.4032 | M - (727) 253.6825 | F - (727) 467.4626
Patrick.Cimino@baycare.org

BayCare.org/EMRConnect

BayCare Health System is a leading community-based health system in the Tampa Bay
area. Composed of a network of 10 not-for-profit hospitals, outpatient facilities and
services such as imaging, lab, behavioral health and home health care, BayCare provides
expert medical care throughout a patient’s lifetime.

With more than 214 locations throughout the Tampa Bay area, BayCare connects patients
to a complete range of preventive, diagnostic and treatment services for any health care
need. The extraordinary health care professionals across the BayCare network seek to
advance the health of their patients and their communities by setting the standard for
compassionate care that respects the dignity of every individual.

BayCare Connect is BayCare’s initiative to promote EMR implementation in affiliated

physician practices.
Introduction
What Is Meaningful Use? • Identifying
 the settings that need to be
Meaningful Use is the term coined by in place
the Centers for Medicare and Medicaid
• Identifying
 where data needs to be
Services EHR Incentive Program to
recorded
promote the use of EHR by Eligible
Professionals (EP) to: • Meeting
 multiple measures within one
workflow
• Improve
 the quality of care, efficiencies
and safety in treating patients • Evaluating
 reporting on the local
(practice) level as well as across the
• R
 educe health disparities
BayCare eCW community
• Engage
 patients and families
This manual is intended to provide Eligible
• Improve
 care coordination Professionals using the eClinicalWorks
EMR, promoted by BayCare, minimal
• Improve
 population and public health
information on achieving Meaningful
• Guarantee
 adequate privacy and security Use. It is by no means all-inclusive and
protection of PHI assumes some proficiency with the eCW
EMR. In general, the manual includes only
one straightforward means to achieve
BayCare’s Commitment to EHR
Meaningful Use, while there may be
BayCare has made a huge commitment others appropriate for your practice.
to inpatient EHR through the BEACON
eClinicalWorks has detailed information
project. BayCare Connect is BayCare’s
on Meaningful Use on their support portal
commitment to promoting EHR
at http://support.eclinicalworks.com. You
in physician practices, facilitating
will need your User Name and Password
implementation, communication and
to access this. Particularly helpful is the
interoperability, quality initiatives and
Meaningful Use Training Scenarios Guide.
therefore Meaningful Use.
On the support portal go to the main
This Meaningful Use manual is provided toolbar to Documents > Meaningful Use
by BayCare Connect to give guidance (on the lower toolbar) > Step 2.
on meeting Meaningful Use with the
Further Meaningful Use tracking and
eClinicalWorks (eCW) EHR by:
reporting tools are available through
• Identifying
 the feature(s) which cover eCW’s Meaningful Use, Adoption, Quality
each measure (MAQ) Dashboards in Version 9.

:: 3
 BayCare Connect is providing these materials to assist our physicians with
the attainment of Meaningful Use. While every effort has been made to
assure the accuracy of the materials within, please recognize that none of the
information contained herein constitutes legal or clinical advice and that the
final responsibility for achievement of this aim remains the responsibility of the
participating provider(s).

The Meaningful Use process is in evolution so changes will need to be made to

this Manual.

Score Card • National Plan and Provider Enumeration

System (NPPES) User ID and Password
What Are the Measures?
• Payee Tax Identification Number (if you
• Fifteen
 Core Measures (C)
are reassigning your benefits)
• Five
 Menu Measures out of a menu of
• Payee National Provider Identifier
10 (M)
If you need an NPI, go to the following
• Within
 one Core Measure: Six Clinical
CMS link:
Quality Measures
https://nppes.cms.hhs.gov/NPPES/Welcome.do
-T
 hree Core CQMs (CQM-C) or
Alternate Core CQMs (CQM-A) Highlights of the 2011 incentives include
the following:
-T
 hree Additional Set CQMs (CQM)
• The Eligible Professional is required to
TOTAL: 25 Measures
attest on any 90 days for 2011.
How do I start?
• Reporting for 2011 is by attestation. The
The registration process is open as Attestation process will be available in
of January 3, 2011, for the Medicare April 2011. In 2012 reporting directly to
Incentive. The Medicare and Medicaid CMS will be required.
Registration Manuals are available online*
The Index of the 2011 Meaningful Use
To register, an Eligible Professional will Measures is a separate document attached
need to this manual. The Index Measures are

• National
 Provider Identifier (NPI) catalogued with letters and numbers for

* https://www.cms.gov/EHRIncentivePrograms/20_RegistrationandAttestation.asp
4 ::
reference purposes. They are specific These workflows are color coded in the
to this manual and intended to make it Manual, the Index and the checklist
easier to keep track of the measures. to facilitate reference between the
documents. The Index is straight from
Refer to this while reviewing the manual.
CMS describing the Measures. The
Related Measures are covered together, so
checklist is to help the practices select the
it is helpful to refer to the Index.
measures where there are choices.
Meaningful Use requires that a lot of
information in the electronic record be
reportable. It is important that reportable Following are workflow topics where
information be entered in structured or multiple measures are met in a single
discrete data, like a pick list. This usually workflow.
means it is “flagged” for reporting by
Demographics
being placed in a certain format or field,
e.g. a cell in a table. Generally free text Vitals
is not discrete or structured so is not Medication-related Measures
reportable. It may be used but should be
Smoking Status and Cessation
limited to areas where reporting is not
crucial. By fully addressing these topics, one can
achieve 15 Meaningful Use Measures,
When data is referred to as discrete or
and at least two CQM Additional Set
structured, it means that it is reportable.
Measures.
eClinicalWorks has developed the
MAQ Dashboard to track compliance with The remainder of the manual will give
the key Meaningful Use Measures that information on the other Measures.
require structured data and have to meet
Ready? Let’s begin our Meaningful Use
a threshold.
journey.
The following section describes workflows
where multiple measures can be met.

:: 5
 Demographics

Demographics

More than 50% of all unique

patients seen by the EP have
demographics recorded as
structured data Information must be recorded
• Date of birth
as structured data
• Gender
• Race
• Ethnicity
• Preferred language

Race:
American Indian or Alaska Native
Asian
Black or African American
White
…..
Unreported/Refused to Report
Race and ethnicity are
Ethnicity: government requirements as
Hispanic or Latino listed on the left.
Not Hispanic or Latino
Refused to Report

Preferred Language:
Creole
English
Spanish
Other

Measures Met: C.1.

6 ::
Demographics (continued)

C.1. Record Demographics Race, Ethnicity and Language fields

Threshold: 50%
The Patient Information (demographic)
is recorded in the Info screen of patient
chart and can be accessed from a variety
of areas in the chart. The Gender and
Date of Birth are on the first page and
are set by default as mandatory. Further
demographic information can be accessed
by clicking the Additional Info button in
the lower left of the Patient Information,
which brings up a second screen with
more fields.
may be made Mandatory Fields when
the Additional Info screen is accessed.
From the main Toolbar go to Patients
> Configure Demographics Mandatory
Fields and check the appropriate boxes
for these fields.
The MAQ reports will track this measure.
Numerator: Unique patients with
language, gender, race, ethnicity and date
of birth ALL recorded as structured data
Denominator: Total unique patients seen
during the reporting period

The Additional Info screen has fields to

record Race, Ethnicity and Language.
A practice should deal with capturing
this information through front office
workflow.

:: 7
 Vitals

Vitals

Record and chart changes in vital
signs:
• Height
• Weight
• Blood pressure
• Calculate and display BMI
• Plot and display growth charts for
children ages 2-20 including BMI
C.2. More than 50% of all unique
patients seen by the EP have
vitals recorded as structured
data. BMI-calculated Growth
Chart plotted for children ages
2-20 including BMI

CQM.C.1. Percentage of patient

Hypertension: Blood pressure
measurement (adult or pediatric
practices, depending on practice
scope)
visits for patients age 18 and
older with a diagnosis of
hypertension who have been
seen for at least two office
visits, with blood pressure (BP)
recorded

Adult weight screening and follow-
up (adult or pediatric, depending
on practice scope)
CQM.C.2. Percentage of
patients age 18 and older with
a calculated BMI in the past six
months or during the current
visit documented in the medical
record AND if the most recent
BMI is outside parameters, a
follow-up plan is documented

CQM.A.1. Percentage of patients

age 2-17 who had an outpatient
Weight assessment and counseling visit with a Primary Care
for children and adolescents (adult Physician (PCP) or OB/GYN who
or pediatric practices, depending on had evidence of BMI percentile
practice scope) documentation, counseling
for nutrition and counseling
for physical activity during the
measurement year
Measures potentially met:
C.2.
CQM.C.1.
CQM.C.2.
CQM.A.1.

8 ::
Vitals (continued)

C.2. Record and chart changes in vitals

Threshold: 50%

To configure the Vitals to be captured, do

the following:

• Toolbar
 EMR > Misc. Configuration
Options > Configure Categories

• Under
 Configure Categories use drop
menu to go to Vitals

• Choose
 provider(s) on right and be sure A
that BP, Ht, Wt and BMI checked with
other vitals practice monitors. Click
Apply then OK.

The ranges need to be set in the

You can configure Vitals and Vitals
Configure Vitals Ranges. For adult BMI,
Ranges by going to the following:
CQM.C.2., these are specified in NQF 0421
• Toolbar
 EMR > Vitals > Configure and PQRI 128 as follows:
Vitals (A)
Parameters: Age 65 and older BMI > 30 or
• Toolbar
 EMR > Vitals > Configure < 22; age 18-64 BMI > 25 or < 18.5
Vitals Range (B)

:: 9
Vitals (continued)

If out of parameter, a follow-up plan Version 9 has several new features in the
needs to be documented. One option Vitals that should make some capturing
would be having an Order Set to include easier.
such things as dietary counseling or
• In A, there is a check box to have the
referring to PCP if a specialist.
height brought forward after a
CQM.A.1.  For the age 2-17 population, certain age.
a BMI percentile must be documented.
• The Growth Charts can be referenced to
A growth chart is populated in eCW
either the Centers for Disease Control
as long as the height and weight are
(CDC), which is the default, or the World
recorded and configured in Vitals as
Health Organization (WHO), by checking
above. Counseling for Nutrition and
the box shown in A.
Physical Activity then needs to be
documented. This is on a yearly basis. The MAQ reports will track measure C.2.
This could be achieved through an Order Numerator: Unique patients with height,
Set, Preventive Medicine category, CDSS, weight, BP recorded as structured data
Alerts and Education Material in the with BMI, including growth chart plot for
treatment window. It should be recorded children 2-20 years
in structured data.
Denominator: All unique patients seen
A professional could also choose two during the reporting period
additional set clinical quality measures
by adequately capturing blood pressure,
CQM-7., blood pressure management in
diabetes and CQM-27., blood pressure
management with ischemic vascular
disease (IVD).

10 ::
Medication-related Measures
Medication-related Measures
Use CPOE for medications orders
directly entered by any licensed
health care professional
Implement drug-drug and drug-
allergy interaction checks
Generate and transmit permissible
prescriptions electronically (eRx)
Maintain active medication list
Maintain active medication allergy
list
Implement drug formulary checks
Measures potentially met:
C.3.
C.4.
C.5.
C.6.
C.7.
M.1.
C.3. More than 30% unique
patients with at least one
medication in their medication
list seen by the EP have at least
one medication order entered
using CPOE
C.4. The EP has enabled this
functionality for the entire EHR
reporting period.
C.5. More than 40% of all
permissible prescriptions written
by the EP are transmitted
electronically using certified EHR
technology
C.6. 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
C.7. 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
M.1. The EP has enabled this
functionality and has access to
at least one internal or external
drug formulary for the entire
EHR reporting period
:: 11
Medication-related Measures (continued)

C.3. Use Computerized Physician Order File > Settings > My Settings > User
Entry for Medication Orders Settings

Threshold: 30%

CPOE of medications is a basic function

of the EMR through the Classic Treatment
Window, eCliniSense, Telephone/Web
Encounter and properly structured
Templates and Order Sets. This has
a threshold of 30%. If there is one
medication in the current medications list
during the reporting for a patient seen,
then for the patient to count at least one
medication order should be recorded
during the reporting period.
While not a Meaningful Use requirement,
The MAQ reports will track this measure the Allergies or Interactions buttons may
Numerator: Unique patients with at least indicate a potential concern. To address
one medication in their medication list any concerns there is a note section at
with a computer entered medication the bottom of the window giving the
order Provider the opportunity to acknowledge
the warning and state why a decision is
Denominator: Total unique patients seen
made to use a drug with a time stamp
during the reporting period with at least
documentation.
one medication in their medication list
C.5. Generate and transmit permissible
C.4. Implement drug-drug and drug-
prescriptions electronically (eRx)
allergy interaction checks
Threshold: 40%
Following is a description of enabling
this feature in versions PRIOR TO Version The following is a brief outline of the
9. Version 9 has this feature enabled as steps a physician must complete to
default and this setting is not present. successfully eprescribe.
Therefore if a Provider is on Version 9 for • Providers participating with BayCare
the reporting period, this measure is met. Connect will have their setup facilitated

12 ::
Medication-related Measures (continued)
with Surescripts and in eClinicalWorks
for eprescribing.
• eClinicalWorks will set up the
appropriate area pharmacy databases.
• The practice needs to establish a
workflow to capture the patient’s
pharmacies in the Patient Information
(Info) > Additional Info screen which
is typically done by the front office.
Multiple pharmacies can be loaded
including a primary pharmacy and mail
order pharmacy.
• The provider can now order
prescriptions through the Treatment
window or other prescribing windows.
Once a prescription is complete, the
provider should click the Send button
choosing the ePrescibe Rx option. Faxing
does NOT constitute eprescribing.
Electronically received refills may be sent
electronically after the reconciliation
and approval processes are complete.
If there are problems with a pharmacy
receiving electronic prescriptions and
refills, Surescripts may be contacted online
at Surescripts.com/Support.
MAQ reports track this. The denominator
is the total prescriptions: printed, faxed
or eprescribed excluding controlled
substances. The numerator is the
eprescribed prescriptions.
Numerator: Permissible prescriptions
transmitted electronically
Denominator: Total permissible
prescriptions during reporting period
C.6. Maintain Active Medication List
Threshold: 80%
Medication entry is a basic EMR function.
Providers must be sure to address and
update medications at each visit. The
Medication Verified box should be
checked at each visit. This is important to
confirm medications were checked even
if there are none. This feature is also
important to the Menu measure M.7.,
medication reconciliation with transition
of care.
:: 13
Medication-related Measures (continued)
The MAQ reports track this measure.
Numerator: All the unique patients seen
during the reporting period with the
Medication Verified box checked whether
they have medications or not
Denominator: All unique patients seen
during the reporting period
C.7. Maintain Active Medication Allergy
List
Threshold: 80%
Medication Allergies must be documented
in a structured fashion in the Allergy
section of the EMR. The Allergies Verified
box should be checked each visit when
allergies are confirmed or added. If there
are no allergies, then clicking either NKDA
or Allergies Verified boxes will check both.
14 ::
The MAQ reports track this measure.
Numerator: All the unique patients seen
during the reporting period with the
Allergies Verified box checked whether
they have allergies or not
Denominator: All unique patients seen
during the reporting period
M.1. Implement Drug Formulary Checks
This measure requires that at least one
formulary check must be set up. See
C.5. above for Provider registration
information for eprescribing.
Rx Eligibility may be set as a job to run on
a daily basis for the upcoming visits, like
insurance eligibility, and be performed
automatically. Following is a manual
process for performing Rx Eligibility.
Medication-related Measures (continued)

The front office will need to check Rx

Eligibility and set the formularies up when
checking patients in.

• At
 the bottom of the Appointment
window, click the Rx Eligibility button.

• On
 the Rx Eligibility screen, click the
Check Rx Eligibility button.

• Highlight
 the desired plan and click the
Set Formulary button at the bottom of
the window.

• The
 insurance Web site will need to be
in the Update Insurance Window File
> Insurance, click on the appropriate
insurance, > Address tab. Then add the
insurance Web site in the appropriate
field.

:: 15
Smoking-related Measures
Smoking-related Measures
Record smoking status for patients
age 13 or older
Preventive care and screening
measure pair:
a. Tobacco use assessment
b. Tobacco-cessation intervention
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
Measures potentially met:
C.8.
CQM.C.3.
CQM-1.
16 ::
C.8. More than 50% unique
patients age 13 years seen by EP
have smoking status recorded as
structured data
CQM.C.3. Percentage of patients
age 18 and older:
a. who have been seen for at
least two office visits who were
queried about tobacco use one
or more times within 24 months
b. identified as tobacco users
within the past 24 months and
have been seen for at least
two office visits, who received
cessation intervention
CQM-1. Percentage of patients
age 18 and older who were
current smokers or tobacco
users, who were seen by
a practitioner during the
measurement year and who
received advice to quit smoking
or tobacco use or whose
practitioner recommended or
discussed smoking or tobacco
use cessation medications,
methods or strategies
Smoking-related Measures (continued)

C.8. Smoking Status As Structured Data This is an example of capturing Smoking

Status through structured data.
Threshold: 50%
• Find the Item to record smoking,
Within eCW, a provider can capture
typically in the Social History. You can
Smoking Status as structured data in
also create a New Item. If the smoking
whatever part of the record the practice
item already exists, open Item by clicking
chooses for their work flow, e.g. HPI,
on it and be sure structured box is
PMH, SH. The status must be captured as
checked.
structured data, and it must be mapped
for reporting purposes. The Tobacco
Control Smart Form is one means of
capturing Smoking Status as structured
data. Either way the structured data MUST
be mapped for reporting to be done.

The mappings are done through the

Toolbar Community > Mappings > Smart
Forms for the Tobacco Control Smart Form
Community > Mappings > Structured Data
for custom smoking status capture.

You may work with eCW to be sure this

mapping is appropriately completed. The
MAQ dashboard will be the reporting
mechanism.
The three Smoking-related Measures
are closely linked, and two are required.
It makes sense to create a workflow
to accomplish all three. This is a big
difference for many specialists. If you
consider the health effects of smoking,
this broad effort has potential for great
medical merit. The following is an
example of how to structure up to three
Measures as simply as possible.
• Click OK and click on the Details section
by the Item and then the custom button.
• Click Add and add the following.
- Name: Do you smoke?
- Type: Structured
- Click Mandatory
- Click Customize Structured Text and
Add yes and then no
• Add a child
- Name: Do you want to quit?

:: 17
Smoking-related Measures (continued)
- Type: Structured
- Trigger: yes
- Click Mandatory
• Add a child to the child above
- Name: Do you want to try
medication?
- Type: Structured
- Trigger: yes
- Click Mandatory
The Structured Data will be input as
follows
18 ::
The structured data needs to be mapped
in the Community heading on the tool
bar.
To facilitate counseling being
documented, education material supplied,
medication offered and referral to a
Smoking Cessation program, following
is an example of an Order Set. It is
triggered and linked to the diagnosis
for Nondependent tobacco use disorder,
305.1. It also includes a linkage to a
Smoking Cessation intervention code for
reporting and reminding, Measure
211-CM.
Smoking-related Measures (continued)
In summary:
• To
 complete C.8. record the smoking
status.
• To
 complete CQM.C.3. provide the CDC
sheet, or other education material about
quitting, on the Order Set and charge a
counseling code.
• To
 complete CQM-1. offer meds and use
the Order Set for that.
If everything is mapped correctly, C.8. will
be reported in the MAQ reports.
Numerator: All the unique patients age 13
or older with smoking status recorded as
structure data
Denominator: All unique patients age 13
or older seen during reporting period
These CQM measures have no threshold to
measure. They should be reportable based
on the above discussion about structured
data.
Engaging Patients and Families in
Their Health Care Measures
These Measures are intended to enhance
patient access to their health information.
C.9. Providing an Electronic Copy of
Health Information
Threshold: 50%
This Measure will best be met through the
Patient Portal. It specifies a threshold of
50% of patients who request an electronic
copy of their health information must be
provided it within three business days.
eClinicalWorks has developed a new Portal
called 100 Million Patients. Following is
a brief description of the steps to web
enable a patient. This is typically a front
office task.
• Go to Patient Info screen, click on
Options button at bottom and select
Web Enable. Complete the Patient
Username and E-mail which is required.
Password will be set by default and
emailed to the patient. Version 9 has an
alert for Front Office to Web enable and
capture e-mail when an appointment is
scheduled, under the Alert Meaningful
Use tab.
• On the left Admin band, go to Patient
Portal Settings, under Synchronize, click
Run and set a schedule for the desired
items including Update Web Enabled
Patient data to Web Portal. This setting
is a one-time administrative setting.
• Patient will receive an e-mail on how
to log onto the Portal and access their
information.
Tracking this is a function of the eCW
MAQ dashboard. The denominator will
be the patients who go to the portal and
check a Request Record box. If properly
set up, all the patients will be provided
:: 19
Engaging Patients and Families (continued)

electronic access to and a copy of their Give patient the Summary, which may
health information (if desired) so it will include the next appointment. Patients
meet 100%. may also access this Summary through the
Patient Portal if set up to publish.
C.10. Providing Clinical Summaries
The MAQ reports track this measure.
Threshold 50%
Numerator: Office visits with printed or
The Visit Summary can be printed from
published clinical summaries
two places.
Denominator: All office visits during
• Resource
 Schedule, right click on the
reporting period
appointment and click on Print Visit
Summary option.

• Progress
 Note, click on button next to
Print at bottom of Progress Note, then
click on Print Visit Summary option.

20 ::
Remaining Core Measures
C.11. Maintain an up-to-date problem list
of current and active diagnoses
Threshold: 80%
Maintaining an Active or Current Problem
List is a basic feature of the EMR.
Following are highlights of this feature.
The expectation is 80% compliance so it is
important to address this Measure.
• Be
 sure Chronic Problem ICD’s are set up
to default to the Problem List.
- Billing on toolbar > ICD > ICD Codes
- F ind code in question, highlight and
click Update. Be sure Chronic box is
checked.
• Adding
 or Removing a Problem at a Visit
- In Assessment window, click on
Problem List box. Problems can be
added or removed as appropriate
If no Problems exist, click the No known
problems box to get credit for confirming
this.
• Adding
 or Removing a Problem from the
Dashboard
-In the Overview Tab, go to Problem
List, click the ellipsis, then Add or
Remove as appropriate.
Version 9 has a reminder in the Dashboard
if this has not been addressed with a
problem or No known problems checked.
The MAQ reports track this measure.
Numerator: All unique patients seen with
at least one problem noted or No known
problems checked
Denominator: All unique patients during
reporting period
C.12. Implement one clinical decision
making rule with ability to track rule
eCW has over 40 Clinical Decision Making
Support System (CDSS) Alerts as well as
the ability to create custom and patient-
specific Alerts. This Measure can be met
by setting one of these CDSS Alerts. There
are reports that can be run measuring
compliance.
These can be tied to the Meaningful Use
Clinical Quality Measures or PQRI. For
more information on other Alerts, refer to
eCW Manuals.
To review the CDSS Measures, EMR >
CDSS > Measures Definitions.
When a Provider decides to use a CDSS
Measure, go to the list and enable only
the desired CDSS Measure.
:: 21
Remaining Core Measures (continued)
EMR > CDSS > Measures Configuration
The Provider should only enable those
the practice is interested in monitoring.
This will require the appropriate Security
Settings. Again only one is required for
Stage 1 of Meaningful Use.
Under the Smoking Related Measures
above, CDSS is used to facilitate this by
linking the Order Set to the Measure code
211-CM.
C.13. Report ambulatory clinical quality
measures to CMS or the states
This Core Measure includes reporting
on three out of six Core and Alternate
Clinical Quality Measures and three out of
38 Additional Clinical Quality Measures.
This Measure only requires reporting,
not achieving, a specific threshold of a
standard.
eClinicalWorks has created the Meaningful
Use Adoption, Quality (MAQ) dashboard
to gather this information for reporting.
The MAQ dashboard is available in the
Version 9 upgrade. eCW is certified for
MAQ reporting on a number of measures
including the Core and Alternate Clinical
Quality Measures, CQM.C.1., CQM.C.2.,
CQM.C.3., CQM.A.1., CQM.A.2., and
CQM.A.3., as well as three diabetes
measures: CQM-2., CQM-3., and CQM-4.
The PQRI feature is capable of capturing
22 ::
many of the Meaningful Use Measures
and the Registry can report on them.
Many of the Clinical Quality Measures
have PQRI measures.
C.14. Improve Care Coordination
This Measure has no threshold but at least
one of several eCW features will need to
be enabled to meet Stage 1 Meaningful
Use.
• eClinicalWorks eHX
- The eHX feature is provided to the
BayCare eClinicalWorks Community
by BayCare Connect.
• eClinicalWorks P2P (Provider to
Provider). P2P is set up through
eClinicalWorks but is included by
BayCare Connect as a feature for the
BayCare Connect Community.
Participants receive information from
BayCare Connect when these features are
enabled.
C.15. Ensure Adequate Privacy and
Security Protections for Personal Health
Information
This Measure deals with compliance
with HIPAA and Security Rules. It merits
attention not only for Meaningful Use,
but also to adequately protect Protected
Health Information (PHI) and avoid
potential onerous government sanctions.
The Meaningful Use Training Scenarios
Remaining Core Measures (continued)

Guide covers this area in detail. • Information

 system activity review.
Review logs on a regular basis to
It would be useful to comply with these
assure the inappropriate accessing of
regulations to have written practice
information is not occurring.
policies and procedures and a mechanism
for ensuring that they are being followed. Written Policies and Procedures with
documented audits and checklists can
Following are the requirements as
facilitate the adherence to this Measure
described in the regulations referenced
and reveal risks hopefully before they can
in the Meaningful Use Measure, 45 CFR
cause damage to a practice.
164.308 (a)(1) and brief references to eCW
features to assure adherence to same. Remaining Menu Measures
• Risk
 analysis M.2. Incorporate clinical lab test results
into certified EHR technology as
• Risk
 management
structured data
-C
 onfigure P.S.A.C. categories to
Threshold: 40%
protect confidential information like
HIV Providers who adopt eCW will have
BayCare labs and diagnostic results
- Set Security Attributes
interfaced as structured data. Some
• By user practices either based on volume or their
• By attribute willingness to pay for the interface may
already have LabCorp and Quest data
• By role
coming over as structured data. BayCare
This will vary by practice but should limit is working with LabCorp and Quest to
staff access to only those areas they need provide an interface to all participating
to do their job. The more this is clarified providers in 2011.
and adhered to the easier it will be to
The MAQ reports track this measure.
remain in compliance.
Numerator: Number of clinical lab tests
- Configure Provider Rx Security
with results reported as structured data
- Configure Authentication Settings
Denominator: All electronic labs marked
• Sanction
 policy for those who violate the as received
access policies
*It is very important for in house labs to
be marked as received

:: 23
Remaining Menu Measures (continued)

M.3. Generate lists of patients by the most straightforward approach to

specific conditions to use for quality meet this measure.
improvement, reduction of disparities,
research or outreach

This Measure only requires that the

Eligible Professional generate at least
one report listing patients with a specific
condition. This can be readily achieved
through the Registry reporting or Patient
Recall.

M.4. Send reminders to patients per

patient preference for preventive/follow
up care
• Through e-mail if Web-enabled to use
Threshold: 20%
the Patient Portal, under Send eMsg
This Measure requires that more than
• Through a telephone of preference in
20% of all unique patients age 65 or
eMessenger which may include a text
older or age 5 years or younger are sent
message
an appropriate reminder during the EHR
reporting period.

An EP needs to decide what is important

to his or her practice. This is geared
toward preventive or follow-up care.
An influenza vaccination reminder or a
reminder to schedule a follow-up visit are
good examples.

eClinicalWorks has the capacity to send

The MAQ reports track this measure.
messages to patients:
Numerator: Number of unique patients
• Through
 Letters in the Patient Recall
in selected age range who were sent a
section of the Registry Band or the HUB.
reminder
Letters to be sent will have a category
box that reminder can be selected for
reporting purposes. Letters are probably

24 ::
Remaining Menu Measures (continued)

Denominator: Number of unique patients Printing can be accomplished through

in selected age range during the reporting the Education button on the Treatment
period window or through an Order Set.

M.5. Provide patients with timely The MAQ reports track this measure.
electronic access to their health
Numerator: Number of unique patients
information (including lab results,
who received patient-specific education
problem list, medication lists, medication
materials
allergies) within four business days of the
information being available to the EP Denominator: Number of unique patients
seen during the reporting period
Threshold: 10%
M.7. The EP who receives a patient from
This Measure can be met with
another setting of care or provider of
eClinicalWorks through the new Portal
care or believes an encounter is relevant
called 100 Million Patients. The patients
should perform medication reconciliation
need to be Web-enabled and they will
have access to meet this measure. Refer to Threshold: 50%
Measure C.9. This measure requires two steps to be
The MAQ reports track this measure. recorded:

Numerator: Number unique patients web • When the appointment is made,

enabled the front office needs to check the
Transition of Care box below the Reason
Denominator: Total number unique
field, e.g. hospital follow-up.
patients during the reporting period
• When the medications are reviewed
M.6. Use certified EHR technology to
in the Current Medication screen, the
identify patient-specific education
provider must check the Medication
resources and provide those resources to
Verified box as discussed in C.6.
the patient if appropriate

Threshold: 10%

This Measure can be accomplished

through a variety of means with patient-
specific education materials either printed
or published to the Patient Portal.

:: 25
Remaining Menu Measures (continued)

referral providers must be P2P enabled)

accessed through the drop down on the T
by the jelly bean, Send eCW P2P Referral/
Consult.

In the Referral (Outgoing) window, the

The MAQ reports track this measure.
Numerator: Number of patient visits with
Transition of Care and Medication Verified
boxes checked
Provider needs to click the Attachments
button at the bottom and then click
either the Attach Medical Summary box
or the Attach CCR/CCD box. Continuity
of Care Record (CCR) and Continuity
of Care Document (CCD) are standard
indices of summary patient demographics
and medical information that can be
shared between providers; for example,
problems, medications and allergies. If
associated with a Progress Note that will
appear as an attachment and will suffice
as a summary of care.

Denominator: Number of patient visits

with Transition of Care box checked

M.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

Threshold: 50%

This measure is associated with outgoing

referrals. It may be accessed through the
Treatment window Outgoing Referral The referral can then be faxed or sent

button or through P2P (referring and through the P2P function.

26 ::
Remaining Menu Measures (continued)
The MAQ reports track this measure.
Numerator: Outgoing referrals with a
summary of care record attached
Denominator: Total Outgoing referrals
during the reporting period
Meaningful Use requires that an Eligible
Professional perform either M.9. or M.10.
M.9. Capability to submit electronic
data to immunization registries or
Immunization Information Systems and
actual submission in accordance with
applicable law and practice
This Measure requires that the Eligible
Professional complete at least one test
of certified EHR 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). This only requires a test
submission. eCW has these uploads
programmed but they will need to be set
up by eCW; Florida Shots is capable of this.
M.10. Capability to submit electronic
syndromic surveillance data to public
health agencies and actual submission
in accordance with applicable law and
practice
This Measure requires that the Eligible
Professional complete at least one test
of certified EHR 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 an EP submits such information
have the capacity to receive the
information electronically).
The capacity to perform this Measure
needs to be further defined by eCW. State
agencies must be capable of accepting the
reporting. As of March 2011 Florida was in
the initial planning stages for this and it is
not clear when this will be available.
:: 27
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BC110477-0311