TMG Meaningful Use

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Outpatient Meaningful Use for WorldVistA

Hello. My name is Kevin Toppenberg, MD. I am a primary care physician in Greeneville, TN. I have been active in the VistA community for at least 7 years, and have used VistA in my office during this time. I have decided to pursue meaningful use certification with VistA. This page will document my progress towards this, and record notes that I make to myself along the way. I hope this is helpful to others.

In CMS terminology, I am an "Eligible Provider" (EP), not a hospital. Also, I am going after Medicare (not Medicaid) certification. So my discussion below will be targeted accordingly.

NOTE: This page was originally created by Kevin Toppenberg, whose namespace is TMG. Enhancements have been made to this page, to include more general information for those seeking to attest to Meaningful Use Stage One in an outpatient setting.

Q: Where can I find the certification status of WorldVistA?

  • Go to CMS Certified Health IT Products
  • Search for "WorldVistA" -- NOTE: the search engine on this page is flaky. I found that when I clicked the search button, it would return a list of ALL technology. But when I then simply clicked search AGAIN (with WorldVistA still in the search term box), then it would find it.

Q: There seem to be so many steps involved in getting ready for Stage One attestation. It's overwhelming. Any overview sites?

Q: What's the bottom line? What do I have to do to be ready to attest meaningful use?

  1. Meet 20 of 25 "Meaningful Use Objectives" source
    • Must meet 15 "core" measures
    • Must also meet 5 of 10 possible "menu" set measures
  2. Meet 6 of 41 "Clinical Quality Measures (CQM's)" source
    • Must meet 3 required core quality measures
    • must also meet 3 of 38 possible additional quality measures
  3. Attest to meeting requirements using Y/N answers and by supplying data from the Quality Measures package.

(TO-DO SMH: Reference and write about the Quality Measures package.)

Q: Can you tell me more about the 15 "core" meaningful use measures? (all are required)

(Detailed instructions on meeting these will be provided in more detail below.)

Measure Link to CMS Source VISTA fulfillment Attestation Type
CPOE -- Provider directly enters in orders Source Fulfillment Rate > 30%
Implement drug-drug and drug-allergy interaction checks Source Fulfillment Yes/No
Maintain an up-to-date problem list of current and active diagnoses Source Fullfillment Rate > 80%
Generate and transmit permissible prescriptions electronically (eRx) Source not available Rate > 40%
Maintain active medication list Source Fulfillment Rate > 80%
Maintain active medication allergy list Source Fulfillment Rate > 80%
Record required demographics Source Fulfillment Rate > 50%
Record required vital signs Source Fulfillment Rate > 50%
Record smoking status for patients aged 13 yrs and up Source Fulfillment Rate > 50%
Report clinical quality measures to CMS Source Fulfillment Yes/No (Measures are reportable rates however)
Implement 1 clinical decision support rule Source Fulfillment Yes/No
Provide patients with an electronic copy of their health information Source Fulfillment Rate > 50%
Provide clinical summaries for patients for each office visit within 3 days Source Fulfillment Rate > 50%
Perform at least 1 test of exchanging key clinical information with another entity electronically Source Fulfillment Yes/No
Protect electronic health information Source

1 2 3 4 5 6

Yes/No

Here is the logic in the Quality Measures package:

Measure Quality Measures Package Logic
CPOE -- Provider directly enters in orders Check for the presence of electronically prescribed medications stored in the Non-VA Multiple in file 55 for this patient
Implement drug-drug and drug-allergy interaction checks Not checked. Report YES.
Maintain an up-to-date problem list of current and active diagnoses Checks active problems.
Generate and transmit permissible prescriptions electronically (eRx) Check for the presence of electronically prescribed medications stored in the Non-VA Multiple in file 55 for this patient
Maintain active medication list Check for the presence of electronically prescribed medications stored in the Non-VA Multiple in file 55 for this patient
Maintain active medication allergy list Check for the presence of allergies for this patient
Record required demographics Check for the presence of Sex, DOB, Primary ID, Preferred Language, Race, Ethnicity for this patient. Lack of any one disqualifes you.
Record required vital signs Check vital signs from July 3rd 2011 to present for this patient.
Record smoking status for patients aged 13 yrs and up Check health factors in the category Tobacco; see if patient will have these. If none found in the category, each possible health factor in a list is tried by itself.
Report clinical quality measures to CMS Not checked. Report YES.
Implement 1 clinical decision support rule Not checked. Report YES.
Provide patients with an electronic copy of their health information MISSING
Provide clinical summaries for patients for each office visit within 3 days MISSING
Perform at least 1 test of exchanging key clinical information with another entity electronically Not checked. Report YES.
Protect electronic health information Not checked. Report YES.

Q: What about the 5 "menu" set of meaningful use objectives? (5 of 10 possible are required)

Measure Link to CMS Source VISTA fulfillment Attestation Type
Implement drug formulary checks Source Fulfillment Yes/No
Incorporate lab results into EHR as structured data Source Fulfillment Rate > 40%
Generate list of patients by specific conditions for quality improvement Source Fulfillment Yes/No
Send patient reminders per patient preference Source NOT DONE NOT DONE
Provide patients with timely electronic access to their health information Source NOT DONE NOT DONE
Provide patient-specific education resources Source Fulfillment Rate > 10%
Perform medication reconcilliation Source Fulfillment Rate > 50%
Send summary care record to other providers Source Fulfillment Rate > 50%
Submit data to immunization registries Source Fulfillment Yes/No
Submit syndromic surveillance data Source NOT DONE NOT DONE

How are each of the measures tracked in the Quality Measures package

Measure Quality Measures package logic
Implement drug formulary checks Not Checked. Report YES.
Incorporate lab results into EHR as structured data Not checked. If you use Lab Package, report 100%; otherwise, 0%.
Generate list of patients by specific conditions for quality improvement Not Checked. Report YES.
Send patient reminders per patient preference NOT DONE
Provide patients with timely electronic access to their health information NOT DONE.
Provide patient-specific education resources NOT DONE
Perform medication reconcilliation If you use electronic prescribing, automatically marked as YES.
Send summary care record to other providers NOT TRACKED IN QUALITY MEASURES
Submit data to immunization registries Report YES. NOT TRACKED.
Submit syndromic surveillance data NOT DONE

Q: What about the required Clinical Quality Measures (CQM)?

You must report the 3 core measures. If any of the 3 core measures are reported with zero values for the denominator, you are required to pick an alternate core measure to report in addition, even if these yield zero. For example if: NQF 0028 & NQF 0421 are 0; report 2 measures from the alternate core measures.

In addition to the core/alternate core measures, you need to report an additional 3 measures from the additional list of 38 CQMs.

Click here for a list of all measures afrom the CMS website along with the instructions just above.

NB: If you see the numerator and denomiator logic filled out, it means that the measure is fully supported in the Quality Measurement Package. If they are not there, then they are unsupported; you may still report on them, but you will have to do extra work on your end to make them work.

Core Measures

Measure Description Sources Denominator in VISTA Numerator in VISTA
NQF0013 Hypertension: Blood Pressure Measurement details2 Patients with Hypertenstion Blood Pressure recorded as a Vital
NQF0028 Tobacco: Use Asessment details Patients Health factors in NFQ0028AB Tobacco Managment Dialog
Tobacco Cessation Intervention details Patients who smoke Health factors in NFQ0028AB Tobacco Managment Dialog
NQF0421 Adult Weight Screening and Follow-up details Patients with high BMI Health factors in MU NQF0421 BMI DI

Alternate Core Measures

If you reported 0 for all 3 core measures, you must report on all 3 alternate core measures even if you will report zeroes for all 6 measures.

Measure Description Sources Denominator in VISTA Numerator in VISTA
NQF 0024 BMI for age 2-18 details Obese Patients in the Date Range (using Vitals package) ICD9/CPT codes V65.3, 97802, G0270, S9449, S9452, S9470
NQF 0041 Influenza vaccination details Patients Immunization (IM FLU, 3 yrs) in MU NQF0041 INFLUENZA MANAGEMENT DI
NQF 0038 Childhood immunization status details Patients <= 2 yo Dialog MU NQF0038 IMMUNE MANAGEMENT DI

Additional Core Measures

An additional 3 from a list of 38 CQM's must be reported. Only the first three are supported by the Quality Measures package right now. If you need to add more, get in contact with George Lilly or Sam Habiel.

Measure Description Sources Denominator in VISTA Numerator in VISTA
NQF0059 Diabetes: Hemoglobin A1c Poor Control details Diabetics via Meds or Diagnosis Lab HEMOGLOBIN A1C or Health Factor PQRI HBA1C>9 MK
NQF0061 Diabetes: Low Density Lipoprotein (LDL) Management and Control details Diabetics via Meds or Diagnosis Lab LDL CHOLESTEROL or Health Factor PQRI LDL < 100
NQF0064 Diabetes: Blood Pressure Management details Diabetics via Meds or Diagnosis Blood Pressure entered via Vitals Package.
The rest of these are not fully supported in the Quality Measures package.
NQF0081 Heart Failure (HF): Angiotensin-Converting Enzyme (ACE) Inhibitor or Angiotensin Receptor Blocker (ARB) Therapy for Left Ventricular Systolic Dysfunction (LVSD) details
NQF0070 Coronary Artery Disease (CAD): Beta-Blocker Therapy for CAD Patients with Prior Myocardial Infarction (MI) details
NQF0043 Pneumonia Vaccination Status for Older Adults details
NQF0031 Breast Cancer Screening details
NQF0034 Colorectal Cancer Screening details
NQF0067 Coronary Artery Disease (CAD): Oral Antiplatelet Therapy Prescribed for Patients with CAD details
NQF0083 Heart Failure (HF): Beta-Blocker Therapy for Left Ventricular Systolic Dysfunction (LVSD) details
NQF0105 Anti-depressant medication management: (a) Effective Acute Phase Treatment, (b)Effective Continuation Phase Treatment details
NQF0086 Primary Open Angle Glaucoma (POAG): Optic Nerve Evaluation details
NQF0088 Diabetic Retinopathy: Documentation of Presence or Absence of Macular Edema and Level of Severity of Retinopathy details
NQF0089 Diabetic Retinopathy: Communication with the Physician Managing Ongoing Diabetes Care details
NQF0047 Asthma Pharmacologic Therapy details
NQF0001 Asthma Assessment details
NQF0002 Appropriate Testing for Children with Pharyngitis details
NQF0387 Oncology Breast Cancer: Hormonal Therapy for Stage IC-IIIC Estrogen Receptor/Progesterone Receptor (ER/PR) Positive Breast Cancer details
NQF0385 Oncology Colon Cancer: Chemotherapy for Stage III Colon Cancer Patients details
NQF0389 Prostate Cancer: Avoidance of Overuse of Bone Scan for Staging Low Risk Prostate Cancer Patients details
NQF0027 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 details
NQF0055 Diabetes: Eye Exam details
NQF0062 Diabetes: Urine Screening details
NQF0056 Diabetes: Foot Exam details
NQF0074 Coronary Artery Disease (CAD): Drug Therapy for Lowering LDL-Cholesterol details
NQF0084 Heart Failure (HF): Warfarin Therapy Patients with Atrial Fibrillation
NQF0073 Ischemic Vascular Disease (IVD): Blood Pressure Management details
NQF0068 Ischemic Vascular Disease (IVD): Use of Aspirin or Another Antithrombotic details
NQF0004 Initiation and Engagement of Alcohol and Other Drug Dependence Treatment: a)Initiation, b) Engagement details
NQF0012 Prenatal Care: Screening for Human Immunodeficiency Virus (HIV)
NQF0014 Prenatal Care: Anti-D Immune Globulin -- NQF 0014
NQF0018 Controlling High Blood Pressure details
NQF0032 Cervical Cancer Screening details
NQF0033 Chlamydia Screening for Women details
NQF0036 Use of Appropriate Medications for Asthma details
NQF0052 Low Back Pain: Use of Imaging Studies details
NQF0075 Ischemic Vascular Disease (IVD): Complete Lipid Panel and LDL Control details
NQF0575 Diabetes: Hemoglobin A1c Control (<8.0%) details