Clinical Decision Support (Medicaid)

There are two parts to this measure: implementing clinical decision support and implementing drug-drug and drug-allergy interaction checks.

• Implementing Clinical Decision Support
• Implementing Drug Interaction Checks

Implementing Clinical Decision Support

By default, Eyefinity turned on five clinical decision support rules that are related to clinical quality measures:

• Age-related macular degeneration (ARMD)
• Diabetes and the eye
• High-risk medication
• Primary open angle glaucoma (POAG)
• Primary open angle glaucoma intraocular pressure (IOP) control

As long as you finalize five exams where one of these conditions is indicated, you'll fulfill the measure. To create additional clinical decisions support rules, perform the following steps:

1. In ExamWRITER, click Tools and select Clinical Decision Support.
2. Click New to create a new condition.
3. Type a name in the Condition Name text box.
4. Record one or more criteria, such as a diagnosis code medication, medication allergy, blood pressure, or BMI.
5. Type a requirement in the Requirement text box, such as an action to take.
6. Type the name of a Source or a link to a website, and type any Source Notes (e.g., “See page 3”) as needed.
7. Click Save.

When you finalize an exam, if the criteria that you set up matches the patient’s problem list, medication list, demographics, or laboratory test results, you’ll receive a patient alert to take an action.

Implementing Drug Interaction Checks

When you use the ExamWRITER ePrescribing Interface, you automatically send patient medication allergy and medication history textual information (without codes) from ExamWRITER to the interface. When you prescribe a medication that interacts negatively with another medication or patient medication allergy, a warning message may appear. Drug-drug interaction and drug-allergy warnings may not appear, however, if the medication has a red triangle to the left of its name; these triangles indicate that the medication was entered by hand, rather than selected from a list, was transferred with a code that the ExamWRITER ePrescribing Interface did not recognize, or was transferred as textual information from ExamWRITER to the interface.

To receive more conclusive warning messages, click Manage Medications and reselect the patient's other medications or medication allergies from the medication list. For more information go to ePrescribing Help.

If you are not using the ExamWRITER ePrescribing interface, then you must use a third-party ePrescribing or interaction check service that is certified and capable of generating a report of your meaningful use. Third-party services do not integrate with ExamWRITER. If you use another ePrescribing service, you will need to enter the patient medication and allergy information twice: once in ExamWRITER and once in the third-party service.

This objective has two measures:

• Measure 1. Implement five clinical decision support (CDS) interventions related to four or more clinical quality measures at a relevant point in patient care for the entire EHR reporting period. Absent four CQMs related to an EPs scope of practice or patient population, the CDS interventions must be related to high-priority health conditions.
• Measure 2. Enable and implement the functionality for drug-drug and drug-allergy interaction checks for the entire EHR reporting period.

Threshold

This is a Yes/No measure. The EP must attest Yes.

An EP who writes fewer than 100 medication orders during the EHR reporting period may take an exclusion from Measure 2 only.

This measure is required to achieve a promoting interoperability score.

The following are suggested roles for completing this measure:

• Doctor
• Technician
• Scribe

Since this measure is not percentage based, it does not appear in the CMS Meaningful Use Reporting window. It requires only a Yes/No attestation.

The firm conducting the meaningful use audits has been known to ask for evidence documenting the presence of these features during the attestation period.

Documenting Clinical Decision Support, 24

Documenting Drug Interaction Checks, 25

Documenting Clinical Decision Support

To document that you invoked a clinical decision support rule, perform the following steps during your attestation period:

1. Close or finalize an exam that includes one of the clinical decision triggers.
2. Press the Print Scrn key.

   Alternatively, take a screenshot of each of the enabled clinical decision support rules.

3. Open a new Word document (or use another word processor or graphics program).
4. Hold the Ctrl key and press the V key.
5. A copy of the screen is pasted into your document.
6. Save the Word document with your other Promoting Interoperability documentation.

Documenting Drug-Interaction Checks

To document the presence of this feature, perform the following steps during your attestation period:

1. Open the ePrescribing interface window.
2. Click Additional Options.
3. Click Preferences - Location.
4. Press the Print Scrn key. Be sure to capture the drug-interaction settings at the bottom of the page.
5. Open a new Word document (or use another word processor or graphics program).
6. Hold the Ctrl key and press the V key.
7. A copy of the screen is pasted into your document.
8. Save the Word document with your other Promoting Interoperabilitydocumentation.

If you are not using the ExamWRITER ePrescribing interface, ensure that you have a copy of the contract indicating that you had subscribed to a service prior to your attestation period.