Meaningful Use in Prime Suite: Stage 2 Core Objective 10 ... · 7 | Meaningful Use in Prime Suite: Stage 2 Core Objective 10 – Clinical Lab Test Results Not for distribution except

1 | Meaningful Use in Prime Suite: Stage 2 Core Objective 10 – Clinical Lab Test Results © Greenway Health, LLC. All rights reserved. Confidential and proprietary. Not for distribution except to authorized persons.

Meaningful Use in Prime Suite: Stage 2 Core Objective 10 – Clinical Lab Test Results

Greenway Prime Suite

Table of Contents

Measure Overview ............................................................................................................................ 2

Prime Suite Help Topics ....................................................................................................................................... 2 Recommended Training Courses ......................................................................................................................... 2

Denominator Criteria ........................................................................................................................ 3

Numerator Criteria ............................................................................................................................ 3

Threshold ......................................................................................................................................... 4

Exclusions ......................................................................................................................................... 4

Prime Suite Setup ............................................................................................................................. 4

How to Achieve this Measure ............................................................................................................ 4

Appendix .......................................................................................................................................... 7

Lab Order CPT Codes ............................................................................................................................................ 7 Reconciling Results in Vocabulary Reconciliation ................................................................................................ 9 Reconciling Orders in Vocabulary Reconciliation ................................................................................................ 9 Mapping SNOMED, LOINC or RxNorm Codes .................................................................................................... 11 eOrders (Electronic Orders) and Lab Reports .................................................................................................... 14 Document Import – Saving Inbound Lab Reports to the Chart ......................................................................... 15

2 | Meaningful Use in Prime Suite: Stage 2 Core Objective 10 – Clinical Lab Test Results Not for distribution except to authorized persons. Confidential and proprietary. © Greenway Health, LLC. All rights reserved. | Last Modified: 8/12/15

Measure Overview

Core 10 – Stage 2 Clinical Lab Test Results reports the percentage of orders that were ordered during the reporting period that have a result value that is reported in a positive, negative, or numerical format and the results were incorporated into the Certified EHR Technology as structured data. This measure requires that more than 55% of all clinical lab test results ordered in Prime Suite by the EP during the EHR reporting period whose results are either in a positive/negative or numerical format have a lab result report associated to the order in Prime Suite as structured data. This can be done in Prime Suite electronically or manually utilizing Document Import, Results, or Flowsheets.

Note - This measure requires setup work in Prime Suite: 1. Results and Orders must be reconciled under Vocabulary Reconciliation. 2. Concepts have to be mapped to the appropriate LOINC code to receive numerator credit. 3. If you have multiple lab interfaces, the Results and Orders will need to be mapped for each interface. If you have a PrimeEXCHANGE interface this is much easier to capture, otherwise you will have to enter 55% of your labs manually

Prime Suite Help Topics For more information and documentation that includes screenshots, please see the following Prime Suite Help topics:

Lab results into EHR (Stage 2 or Later)

Introducing Meaningful Use

Introducing Meaningful Use Dashboard

Results

In-office Procedures vs Results

Orders Tracking

Vocabulary Reconciliation

Vocabulary Administration

Flowsheet Admin eOrders and Vocabulary Workflow Changes

Map Unmapped Orders

Document Import

Result Entry Dialog

Recommended Training Courses These are located on the Customer Community Training page; it is highly recommended that you view them:

Clinical Vocabulary and Orders – Introduction

Clinical Vocabulary and Orders – Part 1




Reconciling Vocabulary in Prime Suite

Orders and Orders Tracking in Prime Suite

Vocabulary Administration in Prime Suite

Importing Clinical Documents into Prime Suite

Creating and Editing Flowsheets (optional)

Denominator Criteria

This measure counts the number of lab tests ordered during the EHR reporting period by the EP (Eligible Provider) whose results are expressed in a positive or negative affirmation or as a numeric value. Orders with a future order date are not considered for numerator or denominator credit until the order date arrives. Refer to the section below called "Lab Order CPT Codes" for a list of lab CPT codes that will count in the denominator.

There are several ways to enter a lab order in Prime Suite that will count in the denominator. The document must be linked to a visit and a Save action taken on the note to be counted in the denominator. Orders may be added in Prime Suite using one of the 3 workflows:

1. Patient lab orders that were entered/recorded by selecting “Add Order” during the reporting period under the Plan section of a Prime Suite History & Physical, Procedure, Progress, Orders, or Quick Note.

2. Patient lab orders that were entered/recorded by selecting “Add Order Set” during the reporting period under the Plan section of a Prime Suite History & Physical, Procedure, Progress, Orders, or Quick Note.

3. Patient lab orders that were entered/recorded by selecting “In Office Results” under the Results section of a Prime Suite History & Physical, Progress, or Orders Note.

Numerator Criteria

The numerator counts the number of lab test results whose results are expressed in a positive or negative affirmation or as a number which are incorporated as structured data in Prime Suite. The results may be recorded electronically or manually using one of the following four workflows.

1. Lab Results reports that come into Prime Suite via an HL7 lab result interface as structured data. These results must be associated (linked) to the corresponding order.

2. Lab results that come into Prime Suite via Document Import may be saved as structured data by selecting the “Save + Add Results” button which saves the lab report to the patient’s chart and opens the Lab Results – Result Entry dialog box so that the results may be recorded as structured data.

3. Lab Results may be manually recorded in the “Result” section of an H&P, Progress, or Orders Note by selecting “In Office Results” and adding the result manually as structured data.

4. Lab Results may be manually recorded in a Flowsheet by adding the result manually as structured data.


Threshold

The resulting percentage must be more than 55% in order for an EP to meet this measure.

Exclusions

If an EP orders no lab tests whose results are either in a positive/negative or numeric format during the EHR reporting period they would be excluded from this requirement. EPs must select NO next to the appropriate exclusion, then click the APPLY button in order to attest to the exclusion.

Prime Suite Setup

1. Log into Prime Suite 2. Reconcile Results - This setup must be done to receive numerator credit.

For “step by step” instructions, refer to the section in the Appendix below called "Reconciling Results in Vocabulary Reconciliation."

3. Reconcile Orders - This setup must be done to receive denominator credit.

For “step by step” instructions, refer to the section in the Appendix below called "Reconciling Orders in Vocabulary Reconciliation."

4. Map existing concepts or orders with the appropriate LOINC, CPT or RxNorm codes in Vocabulary

Admin. Results are traditionally are mapped to LOINC codes and Orders will be mapped to CPT/HCPCS codes.

For “step by step” instructions, refer to the section in the Appendix below called "Mapping SNOMED, LOINC or RxNorm Codes."

How to Achieve this Measure

1. Log into Prime Suite

2. Access the Patient List if it is not in focus when the Clinician Desktop loads

The patient must be checked in to associate a visit with the document.

Click on “Greenway” to load the Desktop and Patient List if the user is already logged into Prime Suite and the Clinician Desktop isn’t in view.

3. Select Patient from the Patient List


4. Navigate to the Patient’s Chart by clicking on the “Navigate to Chart” icon

Note - Alternate: click on Chart > Patient Chart > Select Patient (Visit will not be linked)

5. Select Visit – validate that the correct Visit is linked.

Note - A visit must be associated to the order to get denominator credit.

If the visit isn’t linked - Click on Select Visit

In the Visit Search dialog box; click on Search

Click on the Visit in the list

Click on OK

Note that Select Visit now displays Visit: mm/dd/yyyy (visit date)

6. Click on Create Note

7. Select either H & P, Orders, Procedure, Progress, or Quick Note

8. Click on Select Template

9. Select the desired template from the Template Library

10. Click on Plan

The EP must be the Ordering Physician in the Note.

A Save action must be taken on the Note.

Save(Hold Charges)

Save (Charges Ready)

Save and Sign

11. Add lab orders using one or more of the following options:

Note - Gives Denominator credit when the document is saved.

Select an order from Common Orders or Unmapped Orders

Click on Add Order to add lab orders individually

Click on Add Order Set to add a group of predefine order

12. Map Order to a Diagnosis

The order may be mapped to one or more diagnoses

Click on (MapDx)

Select one or more of the Diagnoses in the “Available” list

Click the single right arrow to move the selection from “Available” to the “Selected” column.

If the entire list needs to be moved; simply click on the double right arrow to move them to the “Selected” column.

Click OK to save the diagnosis mapping


13. Review the orders to make sure the following is correct

CPT Code

Order Date – defaults to Visit Date.

Order Tracking Status – Defaults to “Ordered” or based on the template’s setting

Quantity – defaults to 1

Billable vs Non-Billable – defaults to Billable or based on template’s setting

Stat – defaults to unselected

Ordering Provider – defaults to the billable provider select for the visit. If there is no visit linked; then it defaults to the user that created the note.

Verify the Diagnosis Mapping

14. “Save” or “Save and Sign” document

15. Alternate workflow if using eOrders

After clicking on Save the Orders Requisition link is available

Click on Orders Requisition

Validate that the information is correct

Select Destination

Select/Edit Practice Location

Select/Edit Account Number

Enter Specimen Collection details

Select Billing Type

Validate/Edit Diagnosis Mapping

Select Priority

Select Modality

Add Comments if applicable

Verify/Edit Ordering Physician

Click Submit to send the Orders Requisition to the selected destination

16. Click on Save (Hold Charges), or Save (Charges Ready) or Save and Sign

17. Results entered as structured data into the patient’s chart.

Note - Gives numerator credit when the result is recorded as structured data.)

Results added electronically via eOrders. For instructions, refer to the section in the Appendix below called "eOrders (Electronic Orders) and Lab Reports."

Results added electronically via Inbound Labs. For instructions, refer to the section in the Appendix below called "Document Import – Saving Inbound Lab Reports to the Chart."

Results added manually. For instructions, refer to the section in the Appendix below called "Document Import – Saving Inbound Lab Reports to the Chart."


Appendix

Lab Order CPT Codes

80048 80051 80053 80061 80069 80074 80076 80100 80101 80102 80150 80152

80154 80155 80156 80157 80158 80159 80160 80162 80164 80166 80168 80169

80170 80171 80172 80173 80174 80175 80176 80177 80178 80180 80182 80183

80184 80185 80186 80188 80192 80194 80195 80196 80197 80198 80199 80200

80201 80202 80203 80299 80500 81001 81003 81005 81015 81025 81200 81205

81206 81207 81209 81210 81220 81221 81222 81223 81225 81226 81227 81229

81235 81240 81241 81242 81243 81245 81250 81251 81252 81253 81255 81256

81257 81260 81261 81263 81264 81265 81267 81270 81275 81280 81287 81290

81291 81292 81293 81295 81296 81298 81299 81301 81302 81303 81310 81315

81317 81318 81330 81331 81332 81340 81342 81350 81355 81374 81377 81381

81383 81400 81401 81402 81403 81404 81405 81406 81407 81408 81479 81507

81599 82003 82010 82013 82017 82024 82030 82040 82042 82043 82055 82085

82088 82103 82104 82105 82106 82107 82108 82131 82135 82136 82139 82140

82143 82145 82150 82154 82157 82163 82164 82172 82175 82180 82205 82232

82239 82247 82248 82261 82274 82300 82306 82308 82310 82330 82340 82360

82373 82374 82375 82378 82379 82380 82384 82390 82397 82415 82435 82436

82438 82441 82465 82480 82482 82486 82491 82492 82495 82507 82520 82523

82525 82528 82530 82533 82540 82541 82542 82550 82552 82553 82565 82570

82575 82585 82595 82600 82607 82608 82610 82626 82627 82633 82634 82638

82651 82652 82656 82657 82668 82670 82672 82677 82679 82690 82693 82705

82710 82725 82728 82735 82742 82746 82747 82757 82777 82784 82785 82787

82941 82943 82945 82947 82950 82951 82952 82955 82963 82977 82978 82985

83001 83002 83003 83010 83013 83018 83020 83021 83036 83051 83080 83088

83090 83150 83497 83498 83516 83519 83520 83525 83527 83540 83550 83605

83615 83625 83655 83661 83664 83690 83695 83698 83700 83704 83718 83721

83727 83735 83785 83789 83805 83825 83835 83840 83872 83873 83874 83880

83883 83885 83887 83915 83916 83918 83919 83921 83925 83930 83935 83937

83945 83950 83951 83970 83986 83992 83993 84022 84066 84075 84080 84081

84100 84105 84110 84120 84132 84133 84134 84140 84143 84144 84145 84146

84152 84153 84154 84155 84156 84157 84163 84165 84166 84181 84202 84206

84207 84210 84238 84244 84252 84255 84260 84270 84275 84295 84300 84305

84311 84377 84378 84392 84402 84403 84425 84430 84431 84432 84436 84439

84442 84443 84445 84446 84449 84450 84460 84466 84478 84479 84480 84481

84482 84484 84520 84540 84545 84550 84560 84585 84586 84588 84590 84591

84597 84600 84620 84630 84681 84702 84703 84999 85004 85014 85018 85025

85027 85041 85045 85048 85049 85060 85130 85210 85220 85230 85240 85245

85246 85247 85250 85260 85270 85280 85290 85291 85292 85293 85300 85301

85302 85303 85305 85306 85307 85335 85347 85360 85362 85379 85384 85385


85397 85410 85415 85420 85421 85520 85540 85549 85597 85598 85610 85611

85613 85635 85652 85660 85670 85705 85730 85732 85810 86003 86005 86022

86038 86060 86140 86141 86146 86147 86148 86152 86157 86160 86161 86162

86200 86215 86225 86226 86235 86255 86256 86277 86300 86301 86304 86305

86308 86316 86317 86329 86331 86332 86334 86335 86336 86337 86340 86341

86352 86355 86356 86357 86359 86360 86361 86376 86430 86431 86480 86592

86602 86603 86606 86611 86612 86615 86617 86618 86622 86628 86631 86632

86635 86638 86641 86644 86645 86651 86652 86653 86654 86658 86663 86664

86665 86666 86671 86677 86682 86684 86687 86688 86694 86695 86696 86698

86701 86702 86703 86704 86705 86706 86707 86708 86709 86710 86713 86735

86738 86747 86753 86756 86757 86762 86765 86777 86778 86780 86784 86787

86788 86789 86790 86800 86803 86804 86828 86849 86850 86870 86880 86900

86901 86905 86906 86940 87015 87040 87045 87046 87070 87075 87076 87077

87081 87086 87101 87102 87106 87107 87109 87110 87116 87140 87149 87168

87169 87172 87177 87186 87188 87190 87205 87206 87207 87209 87210 87230

87252 87253 87254 87255 87260 87265 87270 87271 87275 87276 87278 87279

87280 87281 87290 87299 87300 87301 87324 87328 87329 87338 87340 87350

87389 87425 87427 87449 87471 87476 87480 87481 87486 87491 87493 87496

87497 87498 87501 87502 87510 87516 87517 87521 87522 87529 87532 87533

87535 87536 87556 87581 87591 87621 87633 87641 87650 87660 87661 87798

87799 87802 87804 87807 87899 87900 87901 87902 87903 87904 87905 87912

88104 88108 88112 88142 88155 88161 88164 88172 88173 88175 88184 88185

88187 88199 88230 88233 88235 88237 88239 88248 88249 88261 88262 88264

88267 88269 88271 88273 88274 88275 88280 88285 88289 88312 88358 88360

88365 88381 89051 89055 89060 89160 89190 89310 89320 89321 89999


Reconciling Results in Vocabulary Reconciliation When lab results get imported electronically sometimes the terms from the lab do not get matched up to the items in Vocabulary Admin, and they need to be reconciled:


2. Click on Chart

3. Click on Vocabulary Reconciliation

4. Defaults to “Results”

5. Select a Term Name from the list by clicking on it once

6. Select one of the following Options

Find a match – returns a list of possible matches

Select the desired Result (Concept) form the list to reconcile the term.

The term is reconciled and removed from the list

The user may receive a prompt to make a term a synonym of a concept message. This allows the use to make a term synonymous of a concept. EX: HGB is synonymous with Hemoglobin.

Create New – Allows the user to create a new concept.

Note - This feature is disabled if the Term Name has a red question mark displaying after the name.

The user can create a new concept from the “Find a Match” option once selected

If the user selected Create New from the main page; then the details will prefill in the Result Term Definition dialog

Select the Category

Select the Data Type

Select Unit of Measure if it did not prefill

Configure Ranges

Map SNOMED, LOINC, RxNorm and/or Datasource Facility

Add Synonyms if applicable

Add Specialties (optional)

Click Save

Ignore Term – allows the user to move the Term Name to the “ignored term list”

The user can access ignored terms at a later time by selecting “Show ignored term list”

The ignored terms may be reconciled once they are displayed

View Sample – Allows the user to see a sample of the term as it is displayed in a lab report

Reconciling Orders in Vocabulary Reconciliation 1. Log into Prime Suite

2. Click on Chart

3. Click on Vocabulary Reconciliation


4. Defaults to “Orders”

Note - The UOM column will not display once Orders loads

5. Select a Term Name from the list by clicking on it once

6. Select one of the following Options

Find a match – returns a list of possible matches

Select the desired Term form the list to reconcile it

The term is reconciled and removed from the list

The user may receive a prompt to make a term a synonym of a concept message. This allows the use to make a term synonymous of a concept. EX: HGB is synonymous with Hemoglobin.

Create New – Allows the user to create a new concept.

Note - This feature is disabled if the Term Name has a red question mark displaying after the name.

The user can create a new concept from the “Find a Match” option once selected

If the user selected Create New from the main page; then some of the details will prefill in the Order Definition dialog

Select the Category

Enter the CPT/HCPCS code (may enter more than one code)

Enter the Proc. Master code

Enter the Datasource Facility (may enter more than one code)

Select Options

Billable – defaults the code to a billable status

In-Office – Makes the code available under In-Office Results

Default Status – sets a default status in Orders Tracking

Add Synonyms if applicable

Add Associated Observations/Results


Click Save

Ignore Term – allows the user to move the Term Name to the “ignored term list”

The user can access ignored terms at a later time by selecting “Show ignored term list”

The ignored terms may be reconciled once they are displayed

View Sample – Allows the user to see a sample of the term as it is displayed in a lab report


Mapping SNOMED, LOINC or RxNorm Codes

Note - Not required for Labs to EHR but is required for Clinical Quality Measures


2. Click on Chart

3. Click on Vocabulary Admin

4. Defaults to Results

Type the Result that needs to be edited or reviewed

Click Search

Double click or click on View/Edit link

5. Edit/Add Mapping

Click on the SNOMED line to add the SNOMED Code

Click on LOINC line to add the LOINC Code

Click on RxNorm line to add the RxNorm Code

Add Datasource Facility

Add Synonyms (optional)


Click Save

6. To enter a new Result, click Add New

Enter Full Name

Enter Short Name

Select Category

Select Data Type

Enter UOM

Configure Ranges

Add Mapping

Click on the SNOMED line to add the SNOMED Code

Click on LOINC line to add the LOINC Code

Click on RxNorm line to add the RxNorm Code




Click Save

7. Click on Orders

Type the Order that needs to be edited or reviewed


Click Search

Double click or click on View/Edit link

Edit/Add Mapping

Click on the CPT/HCPCS line to add the CPT/HCPCS Code

Click on Proc. Master line to add the master CPT/HCPCS code


Select Options

Billable – when checked, the orders billable status defaults to Billable

In-Office – when checked the order is available under Results > In Office Results

Default Status – sets the order’s status to the selected status. The defaulted status is “Ordered”


Add Associated Observations/Results (optional)


Add Question Set (optional)

Click Save

8. To enter a new Order, click Add New

Enter Full Name

Enter Short Name

Select Category

Note - The Lab Procedure category should be selected for this measure.

Edit/Add Mapping

Click on the green plus (+) sign to the right of the CPT/HCPCS line to add the CPT/HCPCS Code

Verify the Proc. Master code that populated when the CPT/HCPCS code was added


Select Options

Billable – when checked, the orders billable status defaults to Billable

In-Office – when checked the order is available under Results > In Office Results

Default Status – sets the order’s status to the selected status. The defaulted status is “Ordered”


Add Associated Observations/Results (optional)


Add Question Set (optional)

Click Save


Example of the Result Term Definition Webpage Dialog (Concept):


Example of the Order Definition Webpage Dialog:

eOrders (Electronic Orders) and Lab Reports 1. The Lab Result Document is automatically associated to the order when it is returned into Prime Suite

and saved to the patient’s EHR.

2. The Order Status is changed from its current status to “Returned”

3. The Lab Result Document is placed in the Unsigned Document List and in the patient’s Document List

4. Discrete Result values are automatically entered as structured data into Results and/or Flowsheets containing the equivalent concept(s).


Document Import – Saving Inbound Lab Reports to the Chart Lab Reports imported via a Lab Interface


2. Click on the Document Import icon or System > Document Import

3. Under Chart Actions, click on Document Import

4. Choose a patient (N/A for labs imported via a lab interface)

5. Click on “Select from Document List”

6. Select an Electronic Lab report from the available documents

The users filter settings will determine which document types display in the list.

Lab Results must be selected to see the electronic lab reports in the Document List.

7. Notice that the Patient Name now displays the patient’s name in the electronic lab report. Verify that

they match.

8. Select the associated Order(s)

Click on the associated order once to highlight it; clicking a second time deselects it.

To select multiple orders; single click on the first order, then while holding down the Ctrl key click on the additional orders to be associated to the report.

The user’s filters will determine which order statuses are seen in the list.

9. Verify the Date – defaults to the Lab Report Date. It changes to the order’s create date when the order

is selected.

10. Verify the Document Name – defaults to the selected Order Name. Click Override if the name needs to be edited or changed

11. Select Document Type

12. Indicate if the document has been “authenticated or signed”

If “No” then Assign the document to the provider

If “Yes” then select the provider who signed it

13. Click Save

The report is saved to the patient’s chart and the results will auto-populate the concepts under Results or in a flowsheet containing the equivalent concept(s).

If the patient’s chart does not have the concept added under Results or in a flowsheet; they will display once it is added to the patient’s chart.

Lab reports imported via Fax (Save & Add)




4. Choose a Patient


5. Click on “Select from Document List”

6. Select a Fax from the available documents

The users filter settings will determine which document types display in the list.

Fax must be selected to see the lab reports that were received by fax transmission.

7. Review the pages from the selected fax under the All column

Faxes may contain multiple pages

These pages may be for multiple patients

8. Move only the pages that need to be associated to the order from the All column to the Selected

column

9. Preview the pages to validate they are the correct pages for the order





11. Verify the Date

Defaults to the Lab Report Date.

It changes to the order’s create date when the order is selected.

12. Verify the Document Name –

Defaults to the selected Order Name

Click Override if the name needs to be edited or changed


14. Indicate if the document has been authenticated or signed”



15. Click Save & Add Results

Manually enter the Lab Results into the appropriate fields

Add Reference Range (Optional)

Add Result Flag (Optional)

Add Notes (Optional)

Click Save – this saves the results as structured data


Lab reports imported via Scanning (Save & Add) 1. Log into Prime Suite



4. Choose a Patient

5. Click on “New Import”

6. Load the Lab Report pages into the Scanner that is configured to import documents into Prime Suite

7. Click on the Scanner icon

8. Follow the prompts in the Scanner Interface

9. The pages will display in the All column

Note - For this workflow; it is not recommended that reports for multiple patients be scanned at the same time in order to reduce the chance of error.

10. Move the pages that need to be associated to the order from the All column to the Selected column

11. Preview the pages to validate they are the correct pages for the order





13. Verify the Date

Defaults to the Lab Report Date.

It changes to the order’s create date when the order is selected.

14. Verify the Document Name

Defaults to the selected Order Name

Click Override if the name needs to be edited or changed


16. Indicate if the document has been authenticated or signed”



17. Click Save & Add Results

Manually enter the Lab Results into the appropriate fields

Add Reference Range (Optional)

Add Result Flag (Optional)


Add Notes (Optional)

Click Save – this saves the results as structured data