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EHR Stage 2 Core Measures

On October 7, 2015, CMS released a new Final Rule for the EHR Incentive Program. The rule makes the reporting requirements for meaningful use easier for 2015 through 2017. See Modified Stage 2.

The information below reflects old stage 2 requirements.

For EHR Stage 2, there are 17 required core measures. Providers must meet every core measure or qualify for an exclusion. These measures may require additional setup and extra data entry. 

We are providing the information below to help you prepare for a successful MU reporting period. Our recommendations are only a guide, based on our understanding of  MU requirements. For more details, refer to the Stage 2 Specification Sheets. We recommend that you always contact your state with any questions and for final recommendations.  

Also see Stage 2 Menu Measures.

Some measures offer an exclusion if a provider meets certain criteria. Many of the menu measures from Stage 1 become core measures in Stage 2. 

Core Measure Exclusion? Guidance
Use CPOE for:
 - Medication Orders
 - Laboratory Orders
 - Radiology orders

To be counted as CPOE, the user Logged-On to Open Dental when creating the order must be a provider. Exclusions are available for each order type if you write less than 100 orders of each. 

Medical Orders: Prescriptions are considered medical orders. It is possible you will write more than 100 prescriptions, especially over the course of an entire year.

Lab orders: It is unlikely that dentists will order more than 100 medical laboratory orders (e.g. blood work). 

Radiology orders: We do not know how your state will interpret this measure. Some states allow dental providers to claim an exclusion since they don't usually 'order' outside radiology orders. Other states, such as New Jersey, require that providers manually enter orders for bitewings, panos, etc. Contact your state to find out what is required and get it in writing. We recommend that providers who cannot claim an exclusion set time aside to enter at least 30% of orders. We realize this is an onerous task that is outside of a dental workflow. In addition, we have found a LOINC radiology code for bitewings, but not for other common dental x-rays. We recommend using it. The resulting measure percentage will likely be 100% since order entry increases the denominator and entry by provider increases the numerator (1 order entered by 1 provider equals 100%).

Meanwhile, Open Dental is working on a simpler solution to help incorporate this task into workflow.

Electronic Prescriptions Yes Use eRx - Comprehensive and set up Formulary Checks. An exclusion is available if you write less than 100 prescriptions during the reporting period or don't have a pharmacy that accepts prescriptions within 10 miles. 
Demographics No Enter patient's preferred language, gender, race, ethnicity, and date of birth.
Vital Signs Yes Enter height, weight, and blood pressure for patients who are 3 or older. There are several exclusion options if you believe a measurement has no relevance to scope of practice. Refer to the Record Vital Signs specification sheet.
Smoking Status Yes Record smoking status for patients 13 or older. An exclusion is only available if you see no patients 13 or older.
Clinical Decision Support Rules No/Yes This measure is comprised of two parts:
1. Set up five clinical decision support rules related to four or more Clinical Quality Measures or high priority health conditions. There is no exclusion.
2. Enable and implement drug-drug and drug-allergy interaction checks for the entire reporting period. Use eRx - Comprehensive. An exclusion is available if you write fewer than 100 medication orders during the reporting period.
Patient Electronic Access Yes

This measure is comprised of two parts: 
1. Set up the Patient Portal, then grant access to patients within 4 business days after information is available to provider. Time Sensitive.
2. More than 5% of unique patients seen by the EP during reporting period must view, download, or transmit to a 3rd party their health information. This requires action by the patient. 

There are two possible exclusions:
1. Providers can qualify for an exclusion from both parts of the measure is they do not order or create any of the information that must be available in the portal. Most dentists will create this information, so an exclusion is unlikely. See the Patient Electronic Access specification sheet for details about what information must be available.
2. For the second part of the measure, an exclusion is only available if a provider conducts 50% or more of patient encounters in a county with limited bandwidth (more than 50% of housing units don't have 3Mbps of broadband availability, according to latest information from the FCC).

Clinical Summaries Yes Provide clinical summaries (CCDs) to patients within 1 business day of office visits. An exclusion is only available if you have no office visits during the reporting period. Time Sensitive.
Protect Electronic Health Information No Conduct or review a Security Risk Analysis and implement security updates. See HIPAA.
Incorporate Lab Test Results Yes Import clinical lab test results whose results are negative/positive or in numeric format. This refers to medical lab results (e.g. blood work) which is often outside the scope of a dental practice. An exclusion is available if a provider orders no such tests. 
Patient Lists No Generate at least one report listing patients with a specific condition.
Reminders for Preventive Care/ Followup Yes Send reminders to patients, per patient preference. An exclusion is only available if an EP has no office visits in the 24 months before reporting period.
Patient-specific Education Resources Yes Provide patient specific education resources (identified by Open Dental) to patients with office visits. An exclusion is only available if an EP has no office visits during reporting period.
Medication Reconciliation Yes Reconcile medications when a patient is transitioned to your care and a summary of care is received. An exclusion is available if you do not receive any transitions of care during reporting period.
Summary of Care Yes This measure is comprised of three parts:
1. Provide a Summary of Care when you refer or transition a patient to another care setting or provider.
2. Electronically transmit the Summary of Care to the recipient.
3. Conduct one or more successful exchanges of a Summary of Care document with a recipient who has a different EHR certified technology, or conduct one or more successful tests with the CMS designated test EHR.
An exclusion from all three measures is available if a provider transfers/refers patients to another care setting or provider less than 100 times during reporting period.
Immunization Registry Data Submission Yes Electronically submit immunization data to an immunization registry or immunization information system for the entire EHR reporting period. Administering immunizations is often outside the scope of a dental practice, thus you may qualify for an exclusion. See the Immunization Spec Sheet for exclusion criteria. 
Secure Electronic Messaging Yes This measure requires action by the patient. 5% of patients seen must send a secure email to the provider, and the provider must receive it. This will require 1) setting up the Patient Portal and Secure Web Mail and 2) making sure enough patients use the portal to send a secure web email to the provider. Exclusions are available if provider has no office visits during reporting period, or in cases of limited broadband availability. See the Secure Electronic Messaging specification sheet for details.


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