NCPDP SCRIPT ePrescribing Upgrade

NCPDP SCRIPT ePrescribing Upgrade – 12/10/2019

WHY?  CMS has adopted an update to the Medicare Part D electronic prescribing standards from NCPDP 10.6 to NCPDP 2017071 (NCPDP = National Council of Prescription Drug Programs). This requirement has a compliance date of 1/1/2020 and is impactful to any organization that conducts electronic transacting in any of the NCPDP standards in scope of the Part D requirement. UMC will update our ePrescribing standards to the new script on 12/10/2019.

What does this mean for you?  On 12/10, you will be asked to log out and back into PowerChart. When you log back in, the upgrade will be complete and you will see the enhancements listed below.

  • Transmitting Patient Height and Weight - PowerChart can now support sending a patient’s height and weight on prescriptions. Both pieces of information are always sent when they are available and valid for all patients. The NCPDP SCRIPT standard requires that this information be provided on prescriptions for patients under the age of 18 and the system prevents you from routing a prescription electronically if that information is not available and valid. If the information is not documented or is no longer valid, the system displays a notice on the order scratch pad and in the routing dialogue box. In this case, the height and weight will need to be entered prior to entering the prescription.
  • Pediatric physicians across the organization approved the following lookback time periods based on the patient age. For example, a documented weight for an 8-month-old child would only be clinically valid for 100 days. If a provider is trying to send a prescription and the patient has not been seen in the last 100 days, the system will give the error shown above and a weight will have to be entered before the script can be sent.
  • Measured height/weight and Estimated height/weight documentation are both acceptable.
  • 1000 Character SIG Support - You can enter a SIG with special instructions up to 1000 characters. If the combination of SIG elements combined with special instructions exceeds 1000 characters, then you cannot route the prescription on the review screen (shown below). If the pharmacy selected in the ordering conversation has not been upgraded, then the system prevents you from exceeding 140 characters on the prescription review screen to ensure the pharmacy can accept your order.
  • Enhanced Routing Error Messaging - If an error is present, the system displays an alert in the scratch pad banner and you can click See Details or open the Routing dialogue box to view the specific information. If the error is due to a missing or invalid height and or weight, the system displays that specific error in the scratch pad banner. The error messages encompass all the various reasons why you cannot route orders electronically, whether they be user, patient, facility, or medication specific.
  • Prescription Review Screen Updates - A new checkbox has been included at the bottom of the review screen if any free-text prescriptions are included in your ordering conversation. Free-text orders do not meet the DEA’s requirements for transmitting controlled substances and should never include a controlled substance. This box must be selected to indicate that none of your free-text orders contain controlled substances in order to sign the orderable items. If one of the free-text orders does contain a controlled substance then you can select cancel or modify and remove the order from your scratch pad to be ordered correctly with an NDC.

Recommendations: Annual Physical Exams

Annual Physical Exam recommendation is now live in Prod, and patients are slowly qualify, satisfying, and cancelling as the jobs finish processing all patients.

Recommendation:

Annual Physical Exam

Recommendation Qualifications:

Ages 3 to 64 years old

Recommendation Auto-Satisfiers:

New Patient, Preventative Visit, age 1 through 4 years

New Patient, Preventative Visit, age 5 through 11 years

New Patient, Preventative Visit, age 12 through 17 years

New Patient, Preventative Visit, age 18 through 39 years

New Patient, Preventative Visit, age 40 through 64 years

Established Patient, Preventative Visit, age 1 through 4 years

Established Patient, Preventative Visit, age 5 through 11 years

Established Patient, Preventative Visit, age 12 through 17 years

Established Patient, Preventative Visit, age 18 through 39 years

Established Patient, Preventative Visit, age 40 through 64 years

Medicare Annual Wellness Visit - Expectations

Medicare Wellness Visit Expectation

Go-Live Date: 6/12/19

 

Patients will qualify for Medicare Wellness Visit expectation based off the following criteria:

                65 years of age or older                      

Medicare Wellness Visit Satisfiers:

                G0402 Medicare Initial Preventative Exam/Welcome to Medicare

                G0438 Medicare Annual Wellness Visit Initial

                G0439 Medicare Annual Wellness Visit Subsequent

                Received Elsewhere

Expectation is satisfied for 366 days and overdue after 366 days

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Patient Portal: Updating Emancipation/Minor Age Break

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Updating Emancipation/Minor Age Break

What: Updating the emancipation/minor age break from 18 years of age to 13 years of age. Cerner will be breaking Self/Proxy access for all patients within this age range. This break will not be retroactive for patients that are older than 18 years of age.

When: June 24th 2019

Why: Aligning State regulation with the organizational patient portal policy for the adolescent population.

 

***Please follow the new PM conversation education that was previously distributed for all portal invites***

Social History Control: Updates

New Vaping Catgory and Tobacco Category Updates

New Vaping Category

To ensure we are capturing different forms of nicotine use, we are implementing a new Vaping Category within the Social History Control. The new Vaping Category will capture electronic cigarette use that contains nicotine or non-nicotine (flavorings only, marijuana, etc.) liquids/products.

  1. The new Vaping Category will be sequenced below the Tobacco Category
2. Within the Vaping Category will be new sections to document the following:
     a. Nicotine Use - Does the vaping device contain nicotine?
     b. Device Type - What type of e-cig/electronic cigarette device?
     c. Education Topics Nicotine
     d. Comment - Comment box for additional comments, if needed

Tobacco Category Updates

  1. “Pt under age 13” response will be removed from the Smoking Tobacco Use and Smokeless Tobacco Use sections within the Tobacco Category
  2. “E-Cig” response will be removed from the Type section within the Tobacco Category

During the Tobacco Category update, some end-users may experience a “Social History Error” error. This error will only occur if the “Pt under age 13” or “E-Cig” responses were previously selected within the Social History Control and will be resolved quickly.

To resolve this error, IT Clinical will inactivate the Tobacco Category for all patients where the “Pt under age of 13” or “E-Cig” responses were previously selected within the Social History Control. After the Tobacco Category has been inactivated, please re-document appropriate responses for the Tobacco Category and Vaping Category.

Click HERE for Handout

Dynamic Documentation: MSSP to Quality Measures

Name Change: MSSP Education to Quality Measures

PowerForm & Workflow MPage Component Update

  1. MSSP Education PowerForm will be updated to display “Quality Measures” instead of “MSSP Education”
  2. Regulatory Documentation Workflow MPage component will be updated to display “Quality Measures” instead of “Regulatory Documentation”
    1. Name change to the MSSP Education PowerForm located on the drop-down list for the “Quality Measures” component
Name change to the PowerForm located under AdHoc

PowerNotes Update

  1. MSSP Education section in PowerNotes will be updated to display “Quality Measures” instead of “MSSP Education”

Dynamic Documentation Update

  1. MSSP Education section in Dynamic Documentation will be updated to display “Quality Measures” instead of “MSSP Education”

Click HERE for Handout

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Patient Portal: MyTeamCare Updates

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MyTeamCare Updates

New Invitation Process

  •  The purpose of the new invitation process is to meet 2015 CEHRT and PIP (Promoting Interoperability Program) requirements by allowing a patient to receive an invitation and view their health record via FHIR (Fast Healthcare Interoperability Resource).
  • This new process will allow front office staff to review who has proxy access and send a proxy invitation to a patient's record within the new PM Conversation
  • Other benefits include allowing front office staff the ability to document a proxy user's relationship and demopraphics in relation to the patient     

Messaging Attachments

  • Re-enable on 4.8.19
  • Within the reactivation of messaging attachments in MyTeamCare, this will allow clinicians to save the message attaachments to the patient's chart to be reviewed at a later time
  • Save to Chart
    • Replying to a patient’s message with an attachment will not save the attachment to the patient’s chart
    • Replying will not send the attachment with the message to a provider
    • Forwarding a message has to be used in order to allow a provider the ability to save to chart
     
  • Supported Document Types:

Patient Health Questionnaire (PHQ-9) Screening and Remission

Changes to the Patient Health Questionnaire – 9 (PHQ-9) will be made to help providers meet the requirements for NQF 0418: Screening for Depression and Follow-Up Plan and NQF 0710: Depression Remission at Twelve Months.

When documenting an Ad Hoc form for PHQ-9 the person documenting must choose the reason for completing the questionnaire; Screening or Remission Evaluation (see Figure 1).

Depending on the choice 1 of 2 versions of the PHQ-9 will open. The PHQ-9 itself is unchanged. However, the reasons available for excluding the patient from the screening are different on the two forms.

Appropriate exclusion criteria for not completing a routine screening include (see Figure 2)-

  • Active diagnosis for depression or bipolar disorder
  • Patient refuses to participate
  • Patient is in an urgent or emergent situation where time is of the essence and to delay treatment would jeopardize the patient’s health status
  • Situations where the patient’s functional capacity or motivation to improve may impact the accuracy of results of standardized depression assessment tool. Example: certain court appointed case or cases of delirium.[i]

Appropriate exclusion criteria for not completing an evaluation for depression remission include (see Figure 3)-

  • Patients with a diagnosis of bipolar disorder
  • Patients with a diagnosis of personality disorder
  • Patients who were permanent nursing home residents[ii]

Figure 1 PHQ-9 Decision Tree

 

 Figure 2 PHQ-9 Screening

 

  

Figure 3 PHQ-9 Remission Assessment

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Social History Control Updates

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With new requirements for Promoting Interoperability Program (PIP), formerly Meaningful Use Stage 3, the Social History control with the Nursing Adhoc is being updated!

You will have the same options, just in a slightly different format. You will still be able to document the patient’s social history within the Intake form; it will just have a more updated appearance.  

The look of the Social Habits Ambulatory section currently looks something like this:

Mid-July, the updated look will roll out and revealing a more sleek appearance. Double-clicking on any of the key terms, will launch open the forms, making them available for you to document patient information:

SEXUAL HISTORY

TOBACCO USE

ALCOHOL USE

RECREATIONAL DRUG USE

Once the information has been documented, select OK to update the patient record. Once back on the Social History home screen, click on Mark All as Reviewed (take credit for your work!) to update the Last Reviewed date to today’s date and select Verified in the Social History Verification box to on the Left.

On subsequent encounters: Once the social history has been completed in this process, follow the following instructions to verify and update.

Verify with the patient that the information is accurate, if it IS correct, click on Mark All as Reviewed (take credit for your work!!) to update the Last Reviewed date to today’s date and select Verified in the required box. Moreover, you are finished with Social History.

If it IS NOT correct, select the control that needs to be updated and select Modify. 

In this example, we are going to modify the Tobacco control.

Make the necessary updates and select OK.

Reviewing the Tobacco Control, you are now able to see the updates to this control.

Right-clicking on the desired control, you can view more options that allow you to edit the controls. Note that this is where you can review the history of the control.

 

Social History Control

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Sexual Orientation - Gender Identity (SOGI)

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2015 CEHRT/Meaningful Use Stage 3/PIP: Sexual Orientation & Gender Identity

Sexual Orientation & Gender Identity (SOGI)

As a part of the 2015 CEHRT (Certified EHR Technology) requirements, our electronic health record (EHR) must have the capabilities to document sexual orientation and gender identity (SOGI). Utilizing this feature will allow us to improve our patient care by capturing a patient’s sexual orientation and preferred gender identity.

SOGI can be documented in Cerner using the Social History Control, and can be accessed via Histories on the Table of Contents/Menu or by documenting in the control via a PowerForm.

Sexual Orientation & Gender Identity (SOGI) – Transgender Alert

The new Social History Control has the Gender Identification field; similar to the one in the Sexuality History PowerForm. In order to maintain the Transgender Alert (patients that are transitioning from one gender to another and cannot yet legally change their name in the EHR), the Sexuality History form will be renamed and continued to be used for the purposes of adding documentation for the Transgender Alert.

Due to upcoming functionality for documenting Birth Sex, the Sex at Birth field will be removed in the near future.

For those allowed to update the birth sex or admin sex in PM Conversation:

Select PM Conversation from within a patient’s chart.

Select Admin/Birth Sex

Document the appropriate/legal admin or birth sex field.

Select OK.

SOGI Education

CMS Updates to Radiology Orders

New radiology orders will be implemented in 2018 per Centers for Medicare and Medicaid Services (CMS).

If more than 1 or 2 views are needed for DX Chest or DX Abdomen, please specify the views you are expecting and use appropriate order.

For example, any combination of views can be used for DX Chest 3 vws - such as PA, Lateral, Decub.  

All new orders can be used for both in-patient and out-patient.

Also, know that there will also be a few description changes for two US orders.

See below:

2018 New Radiology Orders:

      DX Chest 3 vws (must specify vws)

      DX Chest 4+ (must specify vws)

      DX Abdomen 3+ (must specify vws)

      CT Bone Marrow Biopsy

      NM Inj for Melanoma

      NM Inj Proc Sent Node (Breast)

 

2018 Description Changes to Radiology Orders:

      US Extremity Non-Vasc Complete will now be US Extremity Joint Complete

       US Extremity Non-Vasc Limited will now be US Extremity Limited Joint and Soft Tissue

 
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Secure Messaging: Data Reconciliation

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The documents received will be matched by the appropriate clinical staff, and located on the Data Reconciliation mPage.

If there are external documents available for viewing, the document name is displayed as a link when you position the pointer over it. Clicking the link displays the document in a pop-up box.

The Data Reconciliation page displays the problems, allergies, and medication identified on the external documents. Items in the patient’s current chart within PowerChart are displayed as active items.

If there are external documents available for viewing, the document name is displayed as a link when you position the pointer over it. Clicking the link displays the document in a pop-up box.

To reconcile, click the check mark in the first column, and then the reconcile button.

Medications can be reconciled by clicking the black triangle, then selecting the Summarization of episode note option, the blue arrow. For Medications, you can select Document Medication by Hx button, which will take you to the regular Medication History screen, where you can add/modify the medication details.