• Vital signs, • Smoking status, • Decision support, and • Clinical quality measures (CQMs).
• From the menu set: • Drug-formulary checks, • Lab results, and • Reporting by condition.
Clinical quality measures. To meet the criteria for CQMs, physicians must track a minimum of six CQMs or a maximum of nine: three from the core set, three from an alternate core set if needed, and three from a set of 38. Clinical quality measures align with
the CMS Physician Quality Reporting System (PQRS).
Core set: 1. NQF 0013: Hypertension: Blood pressure Measurement
2. NQF 0028: Preventative Care and Screening Measure Pair: a. Tobacco Use Assessment b. Tobacco Cessation Intervention
3. NQF 0421/PQRI 128: Adult Weight Screening and Follow-up
No percentage is required for Stage 1 meaningful use. Physicians should place in the numerator whatever the EHR cal- culates for these measures. If all of the core measures have a zero numerator, the physician will be prompted to report on the alternate core set:
1. NQF 0024: Weight Assessment and Counseling for Children and Adoles- cents
2. NQF 0041/PQRI 110: Preventive Care and Screening for Influenza Im- munization for Patients 50 Years Old or Older
3. NQF 0038: Childhood Immunization Status
Engaging patients/proving value Proving quality is not just for mean- ingful use and government programs. Employers, too, want to know they are getting the best value for their cost. It’s not enough to practice quality medicine;
52 TEXAS MEDICINE February 2014
physicians must prove quality medicine as well. Part of meaningful use is about en-
gaging patients and families in their own health care. These five meaningful use criteria are related to engaging pa- tients and families:
• From the core set: • Copy of health information, and • Clinical summaries.
• From the menu set: • Patient reminders, • Timely access to patient’s health information, and • Patient education.
Clinical summaries. What’s in a clini- cal summary? This is a frequently asked question from TMA members. The list of what is required is rather extensive:
• Patient name; • Provider’s office contact information; • Date and location of visit; • Updated medication list; • Updated vitals; • Reason(s) for visit; • Symptoms; • Problem list, procedures, and in- structions based on office visit;
• Immunizations or medications ad- ministered during visit;
• Summary of topics covered/consid- ered during visit;
• Time and location of next appoint- ment, scheduled testing, and follow- up;
• List of other appointments, tests, and contact information the patient needs for follow-up care;
• Laboratory and other diagnostic test orders; and
• Test/laboratory results (if received 24 hours after visit).
Meaningful use requires that you of-
fer the clinical summary to at least 50 percent of all patients. If the patient refuses it, you can still count it. Some EHRs use the “print to screen” function to capture the count. Check with your vendor for specifics on how to track this measure.
Personal health records (PHRs) can
help. Physicians can send patient infor- mation directly to the patient’s PHR by using the Direct Secure Messaging pro- tocol. This standard allows the sending of HIPAA-compliant encrypted emails. Physicians typically can get a Direct email address through their local health information exchange (HIE). Patients can get a Direct email address from their PHR company. PHRs may be better than patient por-
tals for various reasons. Most EHR ven- dors charge for patient portals. Portals are silos of patient information, and pa- tients may have multiple portals at mul- tiple clinic locations. By securely using the Direct email and communicating via a patient PHR, physicians don’t have to pay for or administer the patient portal connected with the EHR. The goal of care coordination is about
improving quality and increasing patient safety by having the right information at the right time to enhance decisionmak- ing. This also helps physicians know where else the patient is receiving care
— for example, if the patient has been hospitalized recently.
Health information exchanges Exchanges are in various stages of de- velopment throughout Texas thanks to the $28.8 million grant from the Office of the National Coordinator for HIT. The Health and Human Services Commis- sion, with support from the Texas Health Services Authority (THSA), is oversee- ing grant dissemination for regional HIEs in Texas; details are available from THSA onlne at
www.hietexas.org. Counties that do not have HIE cover-
age are referred to as “white space.” At the very least, physicians have the op- tion of using Direct protocol email in these areas. White-space counties do not have a way to query patient information unless they are part of a hospital-based, private HIE.
Improving population and public health Physicians must choose at least one of the two public health measures from the menu set. There are exclusions for both,
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