The document outlines the requirements and changes for Stage 2 of the Meaningful Use program for 2014. It details core and menu measures for electronic health record (EHR) data reporting, clinical quality measures, and suggested workflows to achieve compliance. Emphasis is placed on specific thresholds for various measures, exclusions, and the importance of documenting patient encounters effectively.

1. Meaningful Use 2014 Stage 2
Kickoff Webinar
Continue success with the EHR Incentive Program

2. Stages of Meaningful Use
STAGE
1
Data capture
and
sharing
STAGE
2
STAGE
3
Advanced
clinical
processes
Improve
outcomes

3. Stages of Meaningful Use (based on year of adoption)
Year of
adoption
Year
2011 2012 2013 2014 2015 2016 2017
2011 1 1 1 2 2 2 3
2012 1 1 2 2 2 3
2013 1 1 2 2 3
2014 1 1 2 2
2015 1 1 2
2016 1 1

4. Stage 2 Requirements
17
CORE
3
MENU
20
MEASURES
9 Clinical Quality Measures (CQMs)
+ You must report at least 9 CQMs directly from Practice Fusion’s

5. CQM Requirements in 2014
+ Requirement: Report at least 9 CQMs that relate to at least 3
National Quality Strategy (NQS) domains:
Patient and Family Engagement Patient Safety
Care Coordination Population and Public Health
Efficient Use of Healthcare Resources Clinical Processes/Effectiveness
+ CMS selected 9 recommended CQMs for adult and pediatric
 The recommended CQM sets focus on areas that represent national public
or disproportionately drive health care costs

6. CQM Reporting Methods in 2014
+ Medicare EPs will submit CQMs to CMS electronically or via attestation
+ Medicaid EPs must submit CQM data to their State Medicaid Agency
+ Reporting period: Entire calendar year or 3 months tied to reporting period for
period for Meaningful Use (Q1/Q2/Q3/Q4)
+ Electronic submission: January 1, 2015 – February 28, 2015
 Medicare EPs have the option to submit a full year of data electronically to receive credit for the EHR
Incentive Program and the Physician Quality Reporting System (PQRS) if using the PQRS EHR reporting
mechanism.

7. Reporting Period
+ 2014 - 3 month quarter reporting period options:
 Q1 (Jan 1 – March 31)
 Q2 (Apr 1 – Jun 30)
 Q3 (Jul 1 – Sept 31)
 Q4 (Oct 1 – Dec 1)
+ Individual state Medicaid programs may allow different
 Check with your state agency for more details

8. New Exclusion Definition for 2014
+ Similar to Stage 1, you may qualify for exclusions for certain measures if
they are outside the scope of your practice
+ Exclusions will no longer count towards meeting the requirements of the
menu measures, so you must first select menu measures that are relevant
to your scope of practice
+ If there aren’t enough menu measures for you to achieve 3 of the 6, you
must attest to an exclusion for the remaining menu measures

9. Is Meaningful Use based on all patients?
+ You must record all patients you see, regardless of their insurance, in
the outpatient setting for Meaningful Use
+ If you see patients in the hospital, you do not need to include them in
Practice Fusion for Meaningful Use
+ At minimum, you must maintain more than 80% of your patients in the
certified EHR for Meaningful Use

10. Review of Stage 2 Measures

11. Changes in Stage 2
Measures
with
Minor
Changes
Measures
with
Additions
Brand
New
Measures

12. PF Workflows are suggestions and
may not be the only way to meet a
measure

13. Measures with Minor Changes from Stage 1
Measure Change
Clinical Summaries Timeframe decreases to 1 business day
Clinical Lab Test Results Now a core measure; Threshold increases to 55%
Demographics Threshold increases to 80%
Smoking Status Threshold increases to 80%
Generate Patient List Now a core measure
Medication reconciliation Now a core measure
Patient-specific education Now a core measure
Protect Health Information Security risk analysis includes additional criteria

14. Clinical Summaries (Core)
+ Measure: Provide clinical summaries to patients within 1 business
day of the office visit for more than 50% of all office visits.
 Because this measure is time sensitive and is based on the total number of office
visits, and not based on the number of unique patients, it is important that you and
your practice develop a sustainable workflow for meeting this measure’s
requirements.
+ Exclusion: Any provider who has no office visits during the reporting
period is excluded from this measure.
+ Business Day: The 24 hour weekday period after midnight on the
DOS is "1 business day."
 For example: If your patient is seen on Friday, the clinical summary needs to be
provided by 11:59 PM on the following Monday.

15. Clinical Summaries (Core)
+ PF Suggested Workflow: Give
patients access to the Patient
Portal
 You can achieve this measure by giving
a patient or an authorized representative
access to the Patient Portal under
Patient Actions from their chart.
 Once a patient has been given access to
the Patient Portal, you will automatically
achieve credit for this measure at the
conclusion of each office visit since the
Patient Portal is updated with any new
information that results from each
encounter.

16. Clinical Summaries (Core)
+ If patient declines the clinical
summary:
 You will receive credit for this measure
as long as you offer all of your patients
clinical summaries at the conclusion of
their office visit.
 If the patient declines to receive the
clinical summary, you must notate this in
the chart note from that date of service
prior to signing it.
 In the Finalize section of the SOAP note,
mark “Patient declined to receive clinical
summary” under the Quality of Care
section.

17. Clinical Lab Test Results as Structured Data (Core)
+ Measure: Incorporate more than 55% of all clinical lab test results
ordered during the reporting period into the EHR as structured data.
+ Exclusion: Any provider who orders no lab tests with results that are
either in positive/negative or numeric format during the reporting
period is excluded.

18. Clinical Lab Test Results as Structured Data (Core)
+ PF Suggested Workflow: Connect your labs to your EHR account

19. Clinical Lab Test Results as Structured Data (Core)
+ Navigate to the Labs/Imaging section and select an individual lab
result.

20. Clinical Lab Test Results as Structured Data (Core)
+ Attribute the result to the correct patient and ensure that the provider
seeking credit for the measure signs the result.

21. Measures with additions and multiple sub-measures
Measure Change
eRx • Threshold increase to 50%
• Incorporation of drug formulary
Vital Signs • Threshold increases to 80%
• New age requirements for height, weight, and blood
pressure
Clinical Decision Support A minimum of 5 CDS rules now required to be enabled during
the entire reporting period
Syndromic Surveillance Data
Submission
Successful ongoing submission now required

22. Measures with additions and multiple sub-measures
Measure Change
CPOE • Addition of lab and radiology orders
• Medication orders threshold increases to 60%
Preventative Care Reminders • No age limitation
• Based on patients seen at least twice in last 24 months
Summary of Care • Now includes 3 sub-measure requirements which
includes sending electronic summary of care records
Immunization Registry Data
Submission
• Successful ongoing submission now required
• Now a core measure

23. CPOE for Medication, Lab, and Radiology Orders (Core)
+ Measure: Use computerized physician order entry (CPOE) to record
the following items during your reporting period:
 Measure 1: More than 60% of medication orders
 Measure 2: More than 30% of lab orders
 Measure 3: More than 30% of radiology orders
+ Exclusion: Any provider who writes fewer than 100 medication,
radiology, or laboratory orders during the reporting period is excluded
from the corresponding measure.

24. CPOE for Medication Orders (Core)
+ PF Workflow:
 From the Plan tab of a SOAP
note or the patient’s Rx List,
select Add Medication.
 Choose the medication you
would like to order and select
Save and Prescribe.
 On the next screen, enter the
details for the prescription
including quantity, SIG, and
refills, then select Print Rx,
Record Rx or Send e-Rx.

25. CPOE for Lab & Imaging Orders (Core)
+ PF Suggested Workflow: Under the
Patient Actions menu of a patient’s
chart, select Add lab/imaging order to
gain access to the ordering workflow.

26. CPOE for Lab and Imaging Orders (Core)
+ Add a Diagnosis to the
order
+ Add the test you would
like to order
+ Click next to move to
the next screen

27. CPOE for Lab and Imaging Orders (Core)
+ Ensure that the provider
seeking credit for this
measure is selected as the
ordering physician
+ Click “Record” to record the
order

28. Preventative Care Reminders (Core)
+ Measure: Send a reminder for more than 10% of all unique patients
who had two or more office visits within the 24 months before the
beginning of the reporting period, per patient preference when
available.
+ Exclusion: Any provider who has had no office visits in the 24 months
before the reporting period.

29. Preventive Care Reminders (Core)
+ PF Suggested Workflow: To find out which of your patients qualify for
this measure, use the Gap Report function of the Meaningful Use
Dashboard that applies to this measure under the Status column.

30. Preventive Care Reminders (Core)
+ This report will list the patients that have had two or more office visits
in the past 24 months so that you can send them an appropriate
reminder.

31. Preventive Care Reminders (Core)
+ Once you send the appropriate reminder to those patients, click the
Patient reminder sent from button in the Appointments tab of the
patient's chart and select your name to receive credit for this measure.
 Anyone in your practice can select the Patient reminder sent from button as long as
you are selected as the provider from which the reminder was sent.

32. Summary of Care (Core)
+ Measure: Provide a summary of care record when you transition or
refer a patient to another setting or provider:
 1) Provide a summary of care record for more than 50% of transitions
 2) Provide an electronic summary of care record for more than 10% of transitions
 3) Conduct one or more successful electronic summary of care exchanges of a
clinical document with a recipient using a different certified EHR OR with a CMS
designated test EHR (completed through DIRECT messaging protocol)
+ Exclusion: Any provider who transfers a patient to another setting or
refers a patient to another provider less than 100 times during the
reporting period is excluded from all three measures.

33. Summary of Care (Measure 1 & 2)
+ PF Suggested Workflow: Electronic summary of care records can be
sent by using the digital referral in Practice Fusion.
 From Charting shortcuts or Patient Actions, select “Send referral.”

34. Summary of Care (Measure 1 & 2)
+ Ensure the referral contains either
a Chart note, clinical summary, or a
clinical document.
+ Your referral must be sent within 24
hours of the patient’s date of
service.
+ In order to get credit for measure 2,
the recipient must open the referral
 Recipient must click on the link from their
email and create or log into their Practice
Fusion account

35. Summary of Care (Measure 3) – Direct Method
+ You must first sign up for Direct
messaging by visiting the
Messages section of your EHR.
+ In order to send a Direct
message, ensure your colleague’s
Direct address must also be
entered under My connections
35

36. Summary of Care (Measure 3) – Direct Method
+ Before sending a direct message,
create a Referral Summary for the
patient
+ Under the Patient Actions drop down
menu from the chart, create the
referral summary by selecting “Create
clinical document”
36

37. Summary of Care (Measure 3) – Direct Method
+ Select Referral Summary
from the Select a document
type drop-down
+ Include all data elements and
click Generate
+ After the Referral Summary
has generated, you can exit
the window by clicking
Dismiss
+ Then, navigate to your
patient’s chart and initiate the
referral
37

38. Summary of Care (Measure 3) – Direct Method
+ In the referral window, select the
provider who will receive the Direct
message
+ Select a Clinical Document for the
patient and send the referral
+ Keep documentation that indicates
you have sent a Direct message
referral with a clinical document to
a provider who uses an EHR other
than Practice Fusion.
38

39. Immunization Registry Data Submission (Core)
+ Measure: Successful ongoing submission of electronic immunization
data to an immunization registry for the entire reporting period, except
where prohibited, and in accordance with applicable law and practice.
+ Exclusion: Any of the following can apply. Any provider who:
 Does not administer any immunizations during the reporting period
 Operates in a jurisdiction where no immunization registry can receive the data
electronically according to the specific certification standards
 Operates in a jurisdiction where no immunization registry provides timely information
on capability to receive immunization data
 Operates in a jurisdiction where no immunization registry that is capable of accepting
the specific certification standards at the start of the reporting period can enroll
additional providers.

40. How is ongoing submission defined?
+ Any of the four criteria below are included under the umbrella of
ongoing submission:
 Ongoing submission was already achieved for a reporting period in a prior year and
continues throughout the current reporting period.
 Registration with the PHA or other body to whom the information is being submitted
of intent to initiate ongoing submission was made by the deadline (within 60 days of
the start of the reporting period) and ongoing submission was achieved.
 Registration of intent to initiate ongoing submission was made by the deadline and
the provider is still engaged in testing and validation of ongoing electronic
submission.
 Registration of intent to initiate ongoing submission was made by the deadline and
the provider is awaiting invitation to begin testing and validation.

41. Immunization Registry Data Submission
+ PF Suggested Workflow: You can register for electronic
submission of Immunization files to your state registry by accessing
the Immunization Settings page.
+ Go to Settings > Templates > My Settings > Immunization Settings
and complete the information in the bottom section labeled
“Electronic Transmission.”
+ Visit our Help Forum post for instructions on how to complete this
process.

42. Brand New Measures
+ Patient Electronic Access & View/Download/Transmit (Core)
+ Secure Electronic Messaging (Core)
+ Imaging Results (Menu)
+ Electronic Notes (Menu)
+ Family History (Menu)
+ Cancer Case Registry (Menu)*
+ Specific Case Registry (Menu)*
*Practice Fusion does not support this measure at this time. Achieving
not required to meet Meaningful Use.

43. Patient Electronic Access (Core)
+ Measure 1: Provide more than 50% of all unique patients seen during
the reporting period online access to their health information within four
business days.
+ Measure 2: More than 5% of all unique patients seen during the
reporting period must view, download their health information or
transmit to a 3rd party.
+ Exclusion: Any provider who:
 Doesn’t order or create any of the information listed for inclusion as part of both measures, except
for "Patient name" and "Provider's name and office, contact information,” may exclude both
measures.
 Conducts 50% or more of their patient encounters in a county that doesn’t have 50% or more of its
housing units with 3Mbps broadband availability according to the latest information available from
the FCC on the first day of the reporting period may exclude only the second measure.

44. Patient Electronic Access (Measure 1)
+ PF Suggested Workflow:
 Give patients or their authorized representatives access to the Patient Portal from
the Patient Actions drop-down menu.
1
2

45. Patients View Online / Download / Transmit (Measure 2)
+ PF Suggested
Workflow: After you
enroll patients in the
Patent Portal, they will
receive an email with
instructions for creating
an account.

46. Patients View Online / Download / Transmit (Measure 2)
+ Encourage your patients to complete the Patient
Portal enrollment either at the office or as soon as
they get home from the appointment using the PIN
code or phone number on their account.
+ Your patients must log into the Patient Portal at
least once during the reporting period in order for
you to get credit for this measure.

47. Auto-invite to the Patient Portal
+ You can now ensure patients aged 18-85 are automatically given
access to their Patient Portal after you sign their chart note.
 As long as you have an email address, a phone number and a chart note signed,
patients will automatically receive an email with instructions on how to register for
their patient portal
 You can enable/disable this under Settings  My Settings  Patient Engagement
Settings

48. Secure Electronic Messaging (Core)
+ Measure: More than 5% of unique patients seen during the reporting
period must send the provider a secure message using the electronic
messaging function of the Patient Portal.
+ Exclusion: Any provider who has no office visits during the reporting
period or any provider who conducts 50% or more of their patient
encounters in a county that doesn’t have 50% or more of its housing
units with 3Mbps broadband availability according to the latest
information available from the FCC on the first day of the reporting
period is excluded from this measure.

49. Secure Electronic Messaging (Core)
+ PF Suggested Workflow: You must first enable secure messaging
for your patients by visiting the Practice settings section.
 Once messaging is enabled, every provider in your practice can use the new feature.

50. Secure Electronic Messaging (Core)
+ After your patient has successfully logged into the Patient Portal, they
must send you a message.
+ You do not need to respond to the messages in order to achieve
credit for this measure.

51. Imaging Results (Menu)
+ Measure: More than 10% of imaging tests ordered during the
reporting period whose result is an image should be accessible
through the EHR.
+ Exclusion: Any provider who orders less than 100 tests whose result
is an image during the reporting period or has no access to electronic
imaging results at the start of the reporting period.

52. Imaging Results (Menu)
+ PF Suggested Workflow: Connect with your imaging center to set up
your EHR for results. Attribute the results to the applicable patient and
provider and sign the results when they are received.
+ Images and imaging results that are scanned into Practice Fusion and
stored in the documents folder may be counted towards this measure.
 Imaging results that are scanned into the EHR will not be counted in the Meaningful
Use Dashboard. You will need to keep track of these results on your own and
maintain the appropriate documentation that supports the value you use during
attestation for at least 6 years.

53. Family Health History (Menu)
+ Measure: Record patient family health history as structured data for
one or more first-degree relatives for more than 20% of all unique
patients seen during the reporting period.
+ Exclusion: Any provider who has no office visits during the reporting
period.

54. Family Health History (Menu)
+ PF Suggested Workflow:
 Click Record New Relative from the Family History section of the patient chart.
 Select a first degree relative (mother, father, sister, brother, daughter, son), enter a
diagnosis, and click Save.

55. Choosing An Encounter Type for Meaningful Use
+ In order to receive credit for Meaningful Use measures based on
unique patients seen during the reporting period, you must sign a note
with an encounter type of “Office visit,” “Home visit,” “Nursing Home
visit,” or “Telemedicine visit.”
+ Providers must navigate to the new HTML chart note to select an
encounter type by clicking “Finalize.”
+ Only the provider who signs the note receives denominator credit.

56. Resources
www.practicefusion.com/meaningfuluse
Meaningful
Use Center
Practice
Fusion
Blogs
Practice
Fusion
Forum

57. Next Steps
Familiarize
yourself with
the new
measures
Use the new
Dashboard, MU
Center, and
Forum
Engage your
patients