EHR Reporting

There are 51 individual measures which may be reported using an EHR in 2012, including all Clinical Quality Measures (CQMs) which are part of Meaningful Use. Primaris provides extended expertise with measures related to preventive care, but will also assist with any EHR-based measures.

While you must report a minimum of three individual measures, you may report as many measures as you like to increase your chances of reporting success. Built-in software can greatly reduce the additional time needed to report additional measures.

The measure specifications for EHR-based measures can be found here (note: this link will take you to a CMS Web site page asking you to accept a license agreement. The specifications are part of the ZIP file you will then download). Make sure you understand the documentation requirements for the measures you select. Work with your EHR vendor if you have questions.

Use the clinical decision support function of your EHR to set alerts to identify all eligible cases for your measures. Many vendors have pre-defined alerts that align with PQRS measures. Work with your vendor to “turn-on” or define selected alerts.

A sample workflow might be as follows: At the time the patient checks in, the front desk reviews alerts for prevention services that are due. The patient is queried as to whether any of the services were performed outside the clinic (such as a flu shot, mammogram or colonoscopy), and if so, where and when they were done. The patient’s response is documented as a note for the clinical staff. The patient is given educational brochures on prevention screens that are due and the EHR is documented to reflect educational materials given.

A standing order for flu and pneumococcal vaccine is a possible way to ensure all eligible patients are properly vaccinated. As staff perform and document vitals and the patient history, a standing order would allow administration of needed vaccines. Staff should be comfortable discussing the provider’s position on vaccines (e.g., “All Dr. X’s patients are vaccinated unless there is a specific medical reason to not vaccinate. The vaccines can save your life—and if you’re around children, may prevent you from spreading disease to them. The pneumococcal vaccine protects against the bacterium that causes middle ear infection, sinus infections, pneumonia, blood stream infections and meningitis. These diseases occur year-round, unlike influenza.”) Vaccines or medical exclusions are documented.

Nursing staff may also be assigned the responsibility to review tobacco use status and provide cessation counseling. Staff should be educated on how to counsel and should have patient education resources available. Smoking status and cessation counseling are documented. Nursing staff may also open discussion about the need for a mammogram and/or colorectal cancer screening and ask if the patient has any questions after reading the brochures provided by the front desk. Nurses should be familiar with all options for colorectal cancer screening, as some patients may oppose a colonoscopy (due to cost or other reasons), but be accepting of the FOBT or newer FIT screens. Medicare coverage of these screens can also be addressed.

After completing the visit, the provider reviews what has been done regarding prevention services thus far. The provider gives a convincing, strong recommendation and staff is asked to assist the patient in scheduling a mammogram and/or colonoscopy, or providing supplies for FOBT/FIT screening. Orders are documented using CPOE. Changes and additions to education, orders, counseling, referrals, or prescription are made and documented. A visit summary, including prevention care recommendations and follow-up appointments, is given to the patient.

Qualified software can generate monthly reports to track the status of patients for each quality measure. (Primaris can also help you establish these reports.) Your I.T. consultant can schedule a task for the EHR to automatically run the reports on the same day every month. Identify patients who have not met the measure and discuss results among staff and physicians at monthly meetings. Determine why patients did not meet the measure. Establish a plan for improvement.

Before February 28, 2013 you will need to create the required reporting file from your EHR system and upload it to CMS through the PQRS Portal. Notify your vendor that you plan to participate in EHR-based reporting, so you will receive high priority for any necessary upgrades. Submit the file to CMS and collect your incentive payment.