In Part 1, we explained the conceptual changes between Meaningful Use Stage 1 and Meaningful Use Stage 2, as well as the new MU stage 2 Menu Set Objectives. If you missed it, read Allscripts TouchWorks 11.4.1 MU Stage 2 Measures for more information.  Part 2 discussed workflows and functionality for the clinical summaries and patient education MU2 measures.

Part 3 of this blog series covers the MU2 measures for Record Family History and Computerized Physician Order Entry.

Record Family History (Menu Set)

Objective: Record patient family health history as structured data.

Measure: More than 20 percent of all unique patients seen by the EP during the EHR reporting period have a structured data entry for one or more first-degree relatives.

In TouchWorks 11.4.1, it’s required that a family member is selected in order to add a new family history problem. It is recommended that the organization have the first degree family members at the top of the family member picklist to make selection easier for the provider. In the scenario where there s no known family history to document for a family member, the provider should select “no pertinent family history” term.

Computerized Physician Order Entry

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

Measure: More than 60 percent of medication, 30 percent of laboratory, and 30 percent of radiology orders created by the EP during the EHR reporting period are recorded using CPOE.

The CPOE objective includes some changes and an increased threshold. Previously, more than 30% of unique patients with at least one medication on their medication list seen by the EP, would have at least one medication order entered using CPOE.

In TouchWorks v11.4.1 the Add Clinical Item (ACI) tabs have changed and are more granular based upon the classification. The ACI now includes new filters, improved search features, problem priority assignment, favorites folder organization, order synonyms, new billing indicators, and redesigned windows and order grouping. These ACI changes can be helpful time savers, but providers will have to adjust to the new design. This adjustment period should be taken into consideration when evaluating the time needed to meet the thresholds for this measure.

To help ensure successful attestation of this measure, administrators should identify any lab or imaging orders that should not count as an order for any Meaningful Use Stage 2 reports and select Do not count as an order for MU Reporting in the Orderable Item Dictionary.

Encouraging the use of order grouping can also help your organization attest to the CPOE objective. This is a new feature in Allscripts TouchWorks version 11.4.1. Order grouping enables providers to create a group of orderable items (across classifications: labs, imaging, referrals, and so on) that can be ordered with one click. Given the increased thresholds, any time saving functionality should be encouraged and will be welcomed. In preparation for use of this feature, you can review if there are any commonly grouped orders (that are not specifically problem based) in which you can administratively setup these groupings by specialty (for example, pre-op testing, and prenatal screenings).

Another time saving functionality is the use of batch editing when users need to make the same change to many orders. This feature was new in version 11.3 and enables users to edit similar fields across medication and non-medication orders (for example, updating to-be-done date).

For those orders that are placed via paper and then entered into the EHR, consider changing the communication method to Record when you enter the order. This includes the order in the denominator, however the provider will not get credit in the numerator as he or she did not use CPOE to originate the order.

For those orders that should only be recorded and not ordered, consider using the Record w/o ordering flag. This will exclude the order from being included in both the numerator and denominator. Our goal here is to ensure that the Reporting feature is accurately representing what is happening and not under or over assessing the completion of this measure.

Benjamin Maultsby, IMBA
Consultant, MBA HealthGroup

*The information provided in this blog was derived from the following sources:
1) Centers for Medicaid and Medicare Services (www.cms.gov)
2) Allscripts; Allscripts Central