In Part 1 of our Meaningful Use Stage 2 series, we explain the conceptual changes between Meaningful Use Stage 1 and Meaningful Use Stage 2, as well as the new MU Stage 2 Menu Set Objectives.  Part 2 covered clinical summaries and patient education MU2 measures and Part 3 described the workflows and functionality measures for Record Family History and Computerized Physician Order Entry.

Part 4 concludes our series by covering MU2 measures for Secured Record Smoking Status &  Summary of Care or Transition of Care Record

Record Smoking Status

Objective:  Record smoking status for patients 13 years old or older.

Measure:  More than 80 percent of all unique patients 13 years old or older seen by the EP have smoking status recorded as structured data.

The smoking status measure sees one of the largest increases in threshold.  CMS now requires smoking status be recorded for 80% of those patients 13yrs or older, whereas previously it was only 50%.  Allscripts advises you to discontinue the use of the “Deny” action to document smoking status or tobacco use.  To meet MU requirements, you must map “denied smoking” to a Centers for Disease Control and Prevention (CDC) term. Unfortunately, “denied smoking” could mean either “former smoker” or “never smoker”.  Because you can’t confidently map to either term, you are left mapping to the most general term “unknown if ever smoked”.  While these items still count in the Allscripts report, we recommend that users start using the specific CDC terms. You can help providers by making sure these terms are included in users favorite lists for Active Problems and Social History, and by removing the other terms from favorite lists.

There are several other considerations when reviewing your organization’s progress towards this measure.  Smoking status only includes forms of tobacco that are smoked.  Other tobacco uses, such as chewing, are excluded.  Also, secondhand smoke is not considered for this measure. The measure does not specify who records the status and how often it needs to be captured for any patient. The presence of smoking status for the patient during the reporting period is sufficient to meet the measure.

There are two new smoking status descriptions that were not included in Stage 1:

Light tobacco smoker = fewer than 10 cigarettes per day or equivalent quantity of cigar or pipe smoke.
Heavy tobacco smoker = greater than 10 cigarettes per day or equivalent quantity of cigar or pipe smoke.

Summary of Care or Transition of Care Record

Objective:  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 care record for each transition of care or referral.

EPs must satisfy both of the following measures in order to meet the objective:

Measure 1:  The EP who transitions or refers their patient to another setting of care or provider of care provides a summary of care record for more than 50 percent of transitions of care and referrals.

Measure 2:  The EP who transitions or refers their patient to another setting of care or provider of care provides a summary of care record for more than 10 percent of such transitions and referrals either (a) electronically transmitted using Certified Electronic Health Record Technology (CEHRT) to a recipient or (b) where the recipient receives the summary of care record via exchange facilitated by an organization that is a Nationwide Health Information Network (NwHIN) Exchange participant or in a manner that is consistent with the governance mechanism The Office of the National Coordinator for Health Information Technology (ONC) establishes for the NwHIN.

Measure 3:  (An EP must satisfy one of the following criteria)

Conducts one or more successful electronic exchanges of a summary of care document, as part of which is counted in “measure 2” (for EPs the measure at §495.6(j)(14)(ii)(B) with a recipient who has EHR technology that was developed designed by a different EHR technology developer than the sender’s EHR technology certified to 45 CFR 170.314(b)(2).

Conducts one or more successful tests with the CMS designated test EHR during the EHR reporting period. The Transition of Care measure has not been changed from Stage 1 to Stage 2, but it does involve some considerations that some organizations have not yet worked with.  The easiest way to meet this measure in Allscripts TouchWorks version 11.4.1 is to implement Direct Messaging.  Begin to review and work with the HIE communities in your area that are enabled for Direct Messaging.

You must obtain a patient’s consent to be able to send a referral electronically via Direct Messaging. This consent can be recorded by setting the value to “Shared” for the communities that have been configured in the community details panel in the patient profile dialog.  If this value is set to Not Shared or Default (Opt-Out), you will not be able to use eReferrals in the perform field for referral orders or choose a Direct community and recipient when manually exporting a summary of care document.

If you are not using the automated summary of care, add the appropriate (MU) Care Summary provided with additional information questions to the orderable items.  This was a required setup for MU1, but is now optional for MU2 as the system has a new automated Summary of Care document provided with each Referral Order.

Direct Messaging for referral orders replace the Allscripts Referral Network.

There are two main workflows supported for sending referrals electronically, both of which will be captured by the MU report:

1. It can be done from the Referral Order when the recipient can receive a Direct Message (from within the Health Care Provider Directory or from Referring Provider Directory)
2. By manually exporting a Summary of Care CCDA from the Chart Viewer

Benjamin Maultsby, IMBA
Consultant, MBA HealthGroup