I think we need a guidance on how to implement Meaningful Use. I have not been doing any of the recording myself and have to learn how to record each item. I have copied the list and a couple items from the Wiki. Please contribute, a step by step tutorial for many of these requirement might be necessary. Only 3 months of recording is required if starting this year. If starting next year, the whole year is required. Medicare being about 30% of my practice. Saving 9 months effort would be a big deal to me and most people. Example: SOAPware has lessons and a PDF file for downloading. Maintain an up-to-date problem list of current and active diagnoses 80% Maintain active medication list 80% Under "Patients/Medications/Current Longterm" tab, fill "medication name", "dose", "schedule" fields, use [+] or [Add New] button to add a medication to the list. Select a medication, use button to modify or update.. Maintain active medication allergy list 80% Record Demographics 50% Birth Date, Gender, Race, Ethnicity and Preferred language are required.Ethnicity is not recorded in the client currently. Patient specific resources 10% Now and then you wish to handout some instructions on a particular disease, diet, or test result to a patient. The simplest way to do this is to use the text macro system, or boilerplate text. There you can create custom instructions with some variable substitution. Let's work through an actual example of how this might work. Creating the template I often use Salazopyrin as a disease remitting agent in rheumatoid arthritis. I now wish to store a handout on this drug and its use in inflammatory arthritis. 1. Bring up a consult ( any patient ) 2. Click on the "Macros" tab - at the top left 3. Click on the "All" tab below that 4. Then click on "Instructions" in the list below that 5. In the "Search" field in the popup that appears, type "Salazopyrin Handout" 6. I now need some text, and I will grab it from this handout. Highlight all the text and copy it with Control-C 7. Now paste it into the large editing box with Control-V 8. We can tidy up the formatting later on, but now click on the "Save As" button 9. It should now appear in the list of diseases above, and classified as "Docs" 10. Now close this window down Using the template Now, I have the patient in front of me whom I am going to give them this handout. 1. Create a new consult, and change the description to "Salazopyrin handout" 2. In full screen mode, click on "Macros" tab again 3. Click on the "X" and type "Salaz" 4. In the popup that appears, click on "Salazopyrin Handout" 5. Then click on "Accept" 6. Then click on "Save" 7. Click on "Print" to print it out 8. In the Print Letter Dialog, check the "To Patient" box 9. Then click on one of the print buttons at the bottom 10. Give the patient this handout Changing the handout Lets say we want this handout to have bold titles. 1. Bring up the template as above 2. For each word, or set of words, we want to make caps bold, we place |6 in front to change to caps bold, and then terminate it with |1 to return to the normal font 3. After that, click on "Update Template" Now when you use this template, all the formatting is in place. The |6 switches to the default postscript font being used for caps bold. Timely access within 4 days (portal) 10% Use CPOE for medication orders 30% Generate prescriptions by e-Rx 40% Record vital signs in age 2 and over (plot growth charts <= age 20) 50% The recording of Vital Signs is accessed by a function key, and a button in the consult. The reason it is available as a popup is to allow nursing staff to record the vitals without creating the consult first. The particular function key depends on how your system is set up. See the "Settings/User/F-keys" tab. I have the "Vitals" on F5 for my own system. Inside a consult, press F5. You can type in the vitals, press the "Calc BMI" button, and then either insert the results into the current encounter, and save into the database, or just save into the database. Synapse EMR saves these results as numerical values which can be accessed in the Patients/Results/Numerical Results tab. As numerical results they can be graphed and reported upon. Note that if you are entering data in lbs and ins, you have to use the <enter> key on those fields. This then puts the data into the metric fields for the BMI calculation to work. Record smoking status age 13 and over 50% Record under Patients/Social/Social tab. If record using the following method, can Synapse calculate percentage? In "Consultation text" window, use "SOCIAL & FAMILY: history" under "SOAP GUI Templates" menu. Or, click [Detailed] button, use "Social History" under "Subjective" tree menu. Incorporate clinical labs as structured date (HL7) 40% Provide electronic copy of health information on request within 3 business days 50% Provide clinical summaries after each visit 50% Send reminder for preventative care in age 5 and under, or age 65 and over 20% Medication reconciliation on transfer of care 50% Provide CCR on rereferral or care transition 50%
Meaningful Use in Synapse You can see how you are faring now by running the report in Reports/Meaningful Use, and the 2nd column shows the target you need to achieve. Maintain upto date problem list -Use either the Patients/Diagnoses tab, or the “Diagnoses, Manage” applet. You need to have your diagnoses codified. This is so that you can do CCR Maintain Active Medication List -Use either the Patients/Medications tab, or the “Rx, Manage” applet. You need to codify with RxNorm otherwise drug interactions ( and eRx won’t work ) Maintain Active Medication Allergy List -Use the “Rx, Manage” applet. If your patient has no allergies, you must record “NKDA” as the drug and put none, and none for dose and schedule. -To “inactivate” an allergy, click on the drug in the Allergies and then click on “Inactivate” Record Demographics -Record all the patient details including CDC Race, Latino (aka ethnicity according to the OMB), and preferred Language. -Record patient contact preferences in the Miscellaneous/Contact Preferences Patient Specific Resources These include Drugs, Diagnoses and Laboratory Results. If you look at Settings/User/Appointments you can see the default web resources Synapse will look at for these unless you check it, and use Firefox chickenfoot scripts instead. -Drugs *Click on a drug, and then the Firefox lookup. This is recorded in the Synapse database as giving a patient a drug resource -Diagnoses *A click on the Firefox icon in the Diagnoses applet counts as providing a resource -Labs *A click on the Firefox icon with a numerical result highlighted ( Patients/Results/Numerical Results ) will count as providing a resource Timely Access -Provide portal access to 10% of your patient population Use CPOE for Medication Orders -Use Synapse to add your medications as above, and then to prescribe them using the “Rx, Manage” applet Generate Prescriptions by eRx Underlying code is done .. waiting for a LLC to be formed so that we can deal with Surescripts. But you can use another certified product for e-Rx pro tem eg. The free Allscripts one. Record Vital Signs and plot Growth Charts -Use the Vitals popup to record vital signs -For those < 20, plot growth charts from Patients/Growth tab Record Smoking Status in Age >= 13 In a patient consult, click on the “Social” button. Enter smoking status there. If you save the social tab, or this one, it counts as recording smoking status. Notice that the “Social” button goes green if you have recorded the smoking status, otherwise it stays red. Incorporate Clinical Labs as Structured Data -This checks to see what percentage of your results are as HL7 Provide an electronic copy of health information within 3 business days -Click on the “CCR Export’ on the Function List. It asks you if this is a response to a patient request. It assumes that the request was generated at the last visit, and counts the number of business days since then. Holidays are not accounted for … only weekends. Provide Clinical Summaries After Each Visit Click on the “Docs” button at the bottom of the screen. Check the “Give patient their medical summary” prior to printing .. this counts. Send Reminders for Preventative Care The Add New Consult popup now has a “Preventative Recall” check box, and new Preventative tags to use. Medical Reconciliation on transfer of Care You can do this either using a CCR or manually. In the Rx, Manage applet, click on “Reconcile Medications” at the top left. Choose Manual or CCR. If using CCR, you need to click on the “Reconcile Meds” button that is present in the CCR applet, and then import each medication, one at a time. Provide CCR on referral or care transition Answering No to the patient request instead satisfies the provide CCR for patient referral or care transition
