In October of 2015, PCC will release version 7.0.4 of our charting and practice management software to all PCC users.
PCC 7.0.4 is a special release. It includes the features from the optional September PCC 7.0 release as well as improvements and updates for ICD-10, referral output, and Meaningful Use reporting.
Read below to learn more!
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PCC 7.0, 7.0.4, and PCC 7.1: PCC released an optional PCC 7.0 release in September of 2015, which included most of the features described below. Originally, PCC planned to release these features to all PCC clients in PCC 7.1. However, your feedback led to some great ICD-10 and workflow-related features, so all PCC practices will receive PCC 7.0.4 on October 25th. If your practice is already running PCC 7.0, you can read the What’s New in PCC 7.0.4 If I Already Have PCC 7.0? article to learn about features that are new to you. If your practice is using PCC 6.29, and skipped the first PCC 7.0 release because you did not need 2015 data for the ARRA EHR Medicaid Incentive program or a PCMH program, read below to learn about all of the new features and improvements in PCC 7.0.4.
Contact PCC Support for information about the items below or about any PCC product or service.
- 1 New Patient Education Materials from the AAP
- 2 Search By ICD-10 Codes for Diagnosing and Problem Lists
- 3 Add ICD-10 Default Diagnoses to Your Electronic Encounter Form
- 4 Direct Secure Messaging
- 5 Receive Direct Secure Messages, Including Inbound C-CDA For Transition of Care
- 6 Create a C-CDA Summary of Care Record
- 7 MyKidsChart Users Can Transmit a Visit Summary in C-CDA Format with Direct Secure Messaging
- 8 Meaningful Use Measures Report Update
- 9 Clinical Quality Measures Report Update
- 10 Immunization Forecasting Logic Update
- 11 Other Feature Improvements and Bug Fixes in PCC 7.0.4
New Patient Education Materials from the AAP
You can now access AAP Pediatric Patient Education materials in PCC EHR, in addition to MedlinePlus materials.
When you wish to access handouts and other materials for a patient, click on the Reports menu and select Patient Education.
To find education materials, pick from a list of the patient’s problems and visit diagnoses, prescribed medications, and labs.
You can also use the “All Articles” navigation or the search field to find content.
One you’ve found a handout or other item you want to share with a patient, you can click “Print” under the article title or in the PCC EHR window. You can also select the PDF version of a handout.
PCC 7.0 includes other new features in the Patient Education window:
Select From All Patient Diagnoses (or Problems, Medications, or Lab Tests): The pull-down menu in the Patient Education window now provides access to all patient diagnoses, and not just the patient’s Problem List items. Visit diagnoses, as well as problems, prescriptions, and lab tests are available when retrieving both AAP and MedlinePlus educational materials.
Pediatric Red Book Access and Other AAP Features: As part of PCC’s agreement with the AAP, the Patient Education tool also provides access to the Pediatric Red Book and the AAP Pediatric Coding Newsletter.
You can also access these AAP resources by logging in to PCCTalk.
Switch Between AAP Materials and MedlinePlus Materials
By default, PCC EHR will display the AAP Pediatric Patient Education library first. You can select the MedLinePlus library instead, and PCC EHR will remember your preference.
Both MedlinePlus and the AAP Pediatric Patient Education site begin on an “All Handouts” library page, making it easy to find relevant materials.
AAP Text Search vs. MedlinePlus Codes: When you select patient criteria from the pull-down menu, PCC EHR searches for that criteria in the AAP library. When you select patient criteria to search the MedlinePlus library, PCC EHR submits the actual SNOMED codes for each item. For this reason, you may find more exact matches in MedlinePlus.
How to Track Patient Education for Meaningful Use
If your practice is tracking the distribution of educational materials in order to meet Meaningful Use, you must select an item from the patient criteria in the drop-down list.
Then, you can use the “Print” button in the PCC EHR window or the printer icon on the page. You can also select the PDF version of a document and print that.
By selecting from the pull-down list to find patient relevant materials and then printing a version of the document, PCC EHR will track that you provided the education materials according to Meaningful Use guidelines.
Search By ICD-10 Codes for Diagnosing and Problem Lists
You can now search by ICD-10 code or description when you add a diagnosis to a patient's chart, either in the Diagnoses component or on the Problem List.
When you can't find a SNOMED-CT diagnosis description, use your mouse to right-click on the field and select "Find Other Diagnosis...".
In the Find Other Diagnosis window, enter a search string. You can search for diagnosis descriptions using SNOMED terminology, and in PCC 7.0.4, you can also search by ICD-10 codes.
If a clinician knows the billing code but does not know the chart diagnosis description, they can now enter the billing code to search for matching results. This matching is reliant on the National Library of Medicine's assisted mapping between SNOMED-CT and ICD-10, or on your practice's custom billing configuration.
Add ICD-10 Default Diagnoses to Your Electronic Encounter Form
You can now add additional ICD-10 codes to your Electronic Encounter Form, also know as the PCC EHR “Bill” window. These codes will appear, ready for selection, whenever you click “Bill” from a chart note.
Diagnoses should always be recorded on the chart note, accompanying other assessment notes. However, there are a few unusual billing situations where you may need to add an ICD-10 billing code to an encounter:
- Some PCMH programs ask for BMI percentile coding on claims. There are ICD-10 codes for BMI percentiles that are not described by SNOMED-CT. Your practice could add the BMI percentiles to the electronic encounter form for easy selection during any visit.
- The ICD-10 codes for abnormal well visits do not have a set of clear 1-to-1 associations in SNOMED-CT.
You can use the Billing Configuration tool to add ICD-10 diagnoses to your billing screen.
As you add diagnosis codes, remember that these codes are for billing purposes only. They will not appear on the patient’s chart note or be part of a patient’s medical history or summary of care.
Direct Secure Messaging
PCC EHR 7.0 includes Direct Secure Messaging. Direct Secure Messaging is a communication technology for the transmission and exchange of private health information. Your practice can use Direct Secure Messaging for transitions of care, and patient portal users can use Direct Secure Messaging to send their visit information to other medical practitioners.
Direct Secure Messaging Pilot Test: Direct Secure Messaging features are in pilot testing with the PCC 7.0 release. That means that just a couple of offices are trying the features in a live environment. PCC will extend Direct Secure Messaging support to all practices once the pilot is complete.
Activate Direct Secure Messaging For Your Practice
When you are ready to activate Direct Messaging for your practice, contact PCC Support. We will create your practice’s Direct Secure Messaging connection. PCC partners with Updox to manage the back-end of the service.
Create Direct Secure Messaging Accounts for Users
After Direct Secure Messaging is turned on for your practice, use the User Administration tool to create Direct Secure Messaging accounts.
Open a user account in PCC EHR’s User Administration tool, and then use the “Direct Secure Messaging” tab to create their account.
Who Needs a Direct Secure Messaging Account?: Direct Secure Messaging is optional, and PCC recommends you only create accounts for users who will communicate using Direct Secure Messaging, such as clinicians who transmit and receive electronic transition of care documents. PCC EHR supports Direct Secure Messaging, which is part of making PCC EHR a Meaningful Use certified EHR using the 2014-edition standards. However, your physicians may decide they prefer not to manage an additional communication channel.
After you create the account, you can see the user’s Direct Secure Messaging address as well as options to deactivate their account or set directory preferences.
The user’s Direct Secure Messaging account address also appears in the user’s My Account tool.
You can provide your address to patients or other medical practices, and they can use the address to send you transition of care documents.
Get Your Practice Registered with the DirectTrust Network
Once your practice’s Direct Secure Messaging service is turned on, you can send and receive direct messages to other users within the Updox network. However, in order to communicate with the full range of medical practices, at least one Direct Messaging user at your practice needs to be your practice’s legal representative for Direct Secure Messaging.
Only one Direct Secure Messaging user at your practice needs to complete the registration with the DirectTrust Network. Click on the blue link to get started.
The Updox website will walk the user through the registration process. The user will need to enter identifying information and answer demographic questions to verify their identity.
Once the process is complete, you will see the result in the User Administration tool, or in the My Account tool.
Once one user on your system has registered your practice with the DirectTrust Network, all Direct Secure Message users will have access to the Direct Secure Messaging trust network.
Can a Practice Send and Receive Direct Secure Messages Without Registering?: Your practice can elect not to have a user register with the DirectTrust Network (a process also known as “vetting” your practice’s account). You will still be able to send and receive messages, but you will be limited to contacting other Direct Secure Messaging users who use the Updox service.
What if the Registered User Leaves Your Practice?: When you disable a user from PCC EHR, their Direct Secure Messaging account will be disabled. If the registered Direct Secure Messaging user is disabled, PCC EHR will send a message to Updox, the third-party vendor that manages Direct Messaging accounts. Your practice will no longer be registered. You will see the DirectTrust network information link in the User Administration tool as shown above. A different user can use the link in the User Administration tool or the My Account tool to re-register your practice.
Receive Direct Secure Messages, Including Inbound C-CDA For Transition of Care
Once your practice has activated Direct Secure Messaging, other medical practices can send Direct Secure Messages to users at your practice. Those messages can include transition of care C-CDA attachments and other documents.
When a Direct Secure Message arrives, it will appear on the Messaging queue. Double-click on a message to review it and associate it with a patient chart.
Similar to the process for importing an electronic lab result, you can review message information, including patient name, birthdate, and sex, and message details, if available. Use the panel on the right to associate the message with a patient’s chart. In most cases, PCC EHR does the work for you and suggests a matching patient. Otherwise, you can search for any patient.
Click “Select” to place the Direct Secure Message into the patient’s chart.
After you click “Select”, PCC EHR will open the Direct Secure Message as it appears in the patient chart. You can see the full message details and any attachments.
As you review a message, you can click to open message attachments and create and complete tasks. For example, you can click “View” to view a C-CDA document or other attachment.
You can also create a task for any user so they can follow up on the message.
Direct Secure Message Protocol: Your practice can customize the Direct Secure Message protocol in the Protocol Configuration tool. For example, you may want to add the patient’s Problem List, History, or Upcoming Appointments components to assist your workflow when you read and evaluate a Direct Secure Message.
For information about protocols in PCC EHR, you can read about Protocol Configuration.
Reconcile a C-CDA Document
If a Direct Secure Message includes a transition of care document in C-CDA format, you can import any Problems, Medication Allergies, and Medications from the C-CDA document into the patient’s chart record.
When you see an incoming C-CDA in a Direct Secure Message, you can click “Reconcile” to review and import patient data.
On the “Reconciliation – Import” screen, you will see three sections: Problems, Medication Allergies, and Medications. In each section, you will see both the information in the C-CDA and the information that is already in the patient’s chart. When you want to import information, select it in the “Add to EHR” column.
After you have reviewed each section (Problems, Medication Allergies, and Medications) and selected any items you wish to add to the patient’s chart in PCC EHR, click Next.
On the “Reconciliation – Review and Save” screen, you can review what the final result of the patient’s record will be. You will see what the patient’s new Problem List, PCC eRx Allergies, and Medication History will display after the import is complete.
Optionally, Click Edit: You can click “Edit” and modify the items on these lists before saving. If you have a duplicate entry, for example, you may want to edit and combine notes or delete an item.
Click “Save” to save your changes and import the data. You can also click “Cancel” to close the C-CDA without making any changes to the patient’s chart.
Last Reconciled: PCC EHR tracks when a user clicked the “Reconcile” button, whether or not they decided to import data to the chart. You will see a “Last Reconciled” attribution on the Direct Secure Message as well as in the patient’s Visit History. You can revisit the message and choose to reconcile the C-CDA data with the patient chart again at any time.
Match Medications and Medication Allergies in PCC eRx: After you reconcile and import Medications and Medication Allergies from a C-CDA, they are added to the patient’s chart record as free text. After three minutes, they are synced with PCC eRx, PCC’s ePrescribing system, found in the Prescriptions section of each patient’s chart. After the record has synced, you should open the patient’s Prescriptions screen and use the Find Match feature to associate the new records with actual drugs and drug allergies.
Create a C-CDA Summary of Care Record
The new Summary of Care Record report produces a C-CDA-formatted chart summary for a patient. Your practice can use the report as a transition of care document. Optionally, if your practice uses Direct Secure Messaging, you can transmit the report to another clinician or practice.
When you need to create a C-CDA summary of care, select “Summary of Care Record” from the Reports menu.
On the report screen, you can indicate whether or not you are creating the record for a referral or transition of care.
Use the options on the screen to print or save the record as a PDF or C-CDA document.
Transition of Care For Meaningful Use: If you have indicated that the record is being created for a referral or transition of care, PCC EHR will track that you have generated the C-CDA document and it will update your Meaningful Use reporting totals.
Health Information Summary Report Change: The PCC 7.0 update removed the outbound transition of care selection options from the Health Information Summary report. For a summary of care record, use the more complete and C-CDA formatted Summary of Care Record report. The Health Information Summary is a less formal chart summary for patient, family, and clinician use.
Format a Summary of Care Record for a Referral
When you generate a Summary of Care Record for a referral, you can select a specific referral and optionally limit the output to information from that referral encounter.
First, choose the specific referral order from the selection pull-down menu.
By default, the referral Summary of Care Record will limit procedures, orders, and vitals noted for that given encounter date. (The output also includes the patient’s Problem List and other chart information not specific to a particular encounter.)
Optionally, you can deselect the “Limit to referral encounter” check box, and the Summary of Care report will generate the patient’s complete C-CDA with all available patient information.
The Summary of Care report output includes the patient’s insurance policy information, making it a good solution for referrals.
Transmit a C-CDA Transition of Care Document Using Direct Secure Messaging
If your practice uses Direct Secure Messaging, and you have a Direct Address configured for your user account, you can transmit a Summary of Care Record directly to another Direct Secure Messaging user, such as a specialist for a referral or another pediatric practice.
Select “Send via Direct Secure Message” and fill out the fields for the message.
Optionally, you can enter text and click “Search” to find a clinician by name or practice name.
You will see more results if a user at your practice is registered with the DirectTrust network.
MyKidsChart Users Can Transmit a Visit Summary in C-CDA Format with Direct Secure Messaging
Parents and other MyKidsChart users can download a C-CDA-formatted visit summary. Optionally, they can use your practice’s Direct Secure Messaging connection to send the visit summary directly to another Direct Secure Messaging user, such as another physician or medical practice.
When users want to save or send a visit summary in C-CDA format, they first select the patient and visit from their history.
At the bottom of the visit, they can choose to download or send the visit summary.
On the Direct Secure Email screen, the user can enter the Direct Secure Messaging address provided by the recipient. For example, a specialist might provide a parent with an address for the purpose of sending a visit summary directly to them.
After they enter an address, the user can optionally edit the default subject and message. Next, the user can choose whether to attach a C-CDA or PDF, and click “Send” to send the message and visit summary.
Direct Secure Messaging Required: MyKidsChart users can only send Direct Secure Messages if your practice has activated Direct Secure Messaging. Additionally, until a user at your practice registers with the DirectTrust Network, parents and families can only send messages to physicians and other practices within the Updox network. For more information, read the Direct Secure Messaging sections above.
Meaningful Use Measures Report Update
The Meaningful Use Measures report can now calculate and report your practice’s numbers for both 2014 and 2011-edition Meaningful Use guidelines, for both Stage 1 and Stage 2 applications.
When you want to check how well your clinicians meet Meaningful Use requirements, select the Meaningful Use Measures report from the Reports menu.
You can select either the 2014 or 2011 Meaningful Use rules by clicking on a tab at the top of the screen. Note that the 2011 Meaningful Use rules have been retired and that practices can no longer apply for the Medicaid EHR Incentive Program using the 2011 rules.
On the 2014 tab, you can select whether you are applying for Stage 1 or Stage 2, pick a reporting period, exclude Visit Reasons (such as lab-only, weight checks, or other visits where the physician doesn’t see the patient), select which professionals to include, and decide on report layout.
2015 October Meaningful Use Updates: This report was developed before the 2015 MU Updates. These changes substantially decreased your practice’s Meaningful Use reporting burden for the EHR Medicaid Incentive program, making the earlier Stage 1 and Stage 2 distinction out-of-date. For more information, contact your state medicaid agency to learn what measures are appropriate for your application. PCC is also offering Meaningful Use Measures web labs. You can find PCC’s web lab schedule and register for web labs at pcc.com/weblabs.
Provider of Encounter: 2014 Meaningful Use calculations use the “Provider of Encounter” for each visit. By default, the PoE is the scheduled physician, but your practice may change the provider at the top of the chart note. The 2011 calculations were based on the clinician who signed the visit.
After you make your selections, click “Generate Report”. Because Meaningful Use calculations look at a lot of patient data, the report may take a long time to run.
The report will display either the per-professional or aggregate results, typically indicated by the number of patients who meet the requirements (the “Numerator”) and the number of patients who meet certain rules and were seen during the reporting period (the “Denominator”). The final two columns display the percentage met by the physician and the typical required percentage for the Meaningful Use Measure.
Formatting and Exceptions: The Meaningful Use Measures report is formatted to help you fill out the ARRA application worksheet. Measures appear in the same order as the application, and extra rows are added to illustrate your numbers for each available exception.
How Is Each Measure Calculated?: For more information on how each row of the Meaningful Use report is calculated, and what changes you can make in your PCC EHR workflow to improve your percentile scores, you can watch a recording of PCC’s 2015 Meaningful Use Web Lab, and use the accompanying handout. Detailed written documentation is coming to PCC Learn later this fall.
Optional: Drill-Down to Per-Patient Details
Click “Details” for any measure to review patient-level details for the results.
Details for the report and the selected measure appear at the top. Below, you can see a list of included patients. The table shows whether or not each patient was included in the numerator, along with any relevant patient details for the measure, such as an order, diagnosis, or other patient information.
By reviewing patient records to determine why they were or were not included in a measure’s calculation, you can address potential problems in your workflow or PCC configuration that may alter your final percentage.
Clinical Quality Measures Report Update
PCC EHR’s Clinical Quality Measures report now calculates and reports your percentages for the 2014 CQM version of the nine pediatric measures recommended by CMS.
When you want to check how well your clinicians meet Clinical Quality Measures, select the Clinical Quality Measures report from the Reports menu.
You can select either the 2014 or 2011 CQM rules by clicking on a tab at the top of the screen. Note that the 2011 CQM rules have been retired and that practices can no longer apply for the EHR Medicaid Incentive Program using the 2011 rules.
On the 2014 tab, you can limit the report to specific measures, pick a reporting period, select which professionals to include, and decide on report layout.
Provider of Encounter: 2014 Clinical Quality Measure calculations use the “Provider of Encounter” for each visit. By default, the PoE is the scheduled physician, but your practice may change the provider at the top of the chart note. The 2011 calculations were based on the clinician who signed the visit.
After you make your selections, click “Generate Report”. Because CQM calculations look at a lot of patient data, the report may take a long time to run.
The report will display either the per-professional or aggregate performance results, typically indicated by the number of patients who meet the requirements (the “Numerator”) and the number of patients who meet certain rules and were seen during the reporting period (the “Denominator”). The “Performance Rate” column displays your practice’s percentage for the measure. The final two columns display the total number of patients who met certain CQM-specific exceptions or exclusions.
How Is Each Row Calculated?: For more information on how each row of the Clinical Quality Measure report is calculated, and what changes you can make in your PCC EHR workflow to improve your percentile score, you can read the How to Chart For Each Clinical Quality Measure.
Optional: Drill-Down to Per-Patient Details
Click “Details” for any measure to review patient-level details for the results.
Details for the report and the selected measure appear at the top. On the left, you can specify what portion of the patient population you wish to review (Numerator, Denominator, or All patients).
Click on any patient on the left to review what occurred for them to be counted in the denominator or the numerator on the right.
By reviewing patient records to see why they were or were not included in a measure’s calculation, you can address potential problems in your patient workflow or PCC configuration that may alter your final percentage.
Immunization Forecasting Logic Update
PCC’s immunization logic partner, STC, is implementing several patches to the Immunization Forecasting features in PCC EHR. The new changes will bring Forecasting Results and Forecasting Warnings more in line with ACIP standards.
Age Restriction Adjustments: PCC’s configuration for age restrictions have been adjusted to the ACIP default. The previous configuration caused immunizations such as Hib and HPV to be ignored for patients within certain age ranges.
MSPV Forecasting: MSPV administered at 11 years of age will now result in an Immunization Forecasting Result for MCV at 16 yrs of age.
Hib Update: Dose 3 of Hib administered at 12 months of age or older, with less than an 8 week interval from previous dose, generated a Forecasting Warning, but was still shown as valid. Dose 3 Hib without the proper interval will now display as invalid as well as produce a warning.
2015-16 Seasonal Influenza Recommendations: For 2015–16, ACIP recommends that children aged 6 months through 8 years who have previously received 2 or more total doses of trivalent or quadrivalent influenza vaccine before July 1, 2015, require only 1 dose for 2015–16. The two previous doses need not have been given during the same season or consecutive seasons. Children in this age group who have not previously received two or more doses of trivalent or quadrivalent influenza vaccine before July 1, 2015 require 2 doses for 2015–16. The interval between the 2 doses should be at least 4 weeks. Immunization Forecasting Results will make recommendations in accordance with these new guidelines. (Visit CDC.gov for more information)
PPSV Forecasting: Immunization Forecasting Results and Warnings in PCC EHR will now match ACIP interval recommendations for PPSV and PCV-13 for patients 65 years or older.
Other Feature Improvements and Bug Fixes in PCC 7.0.4
In addition to the features described above, PCC 7.0.4 includes these smaller improvements and squashed bugs.
New SNOMED-CT Descriptions for Newborn Visits: PCC 7.0.4 adds three new requested newborn visit SNOMED-CT descriptions. The addition of these codes will help your practice code for specific visit types without unusual mapping work-arounds. PCC has added these codes to your practice’s “Favorites” list of common, easily searchable diagnoses.
TOS Bill (the Checkout Receipt) Now Displays More Characters of the ICD-10 Code: Some ICD-10 codes are much longer that ICD-9 codes. PCC software already accommodated that length on your computer screen, and the PCC 7.0.4. update widens the available room on the TOS Bill, also known as the “checkout reciept”, that your practice can print when you post charges.
Hospital Visits that Span the ICD-9 to ICD-10 Transition: Posting a charge that extended across the ICD-9/ICD-10 transition could sometimes result in validation errors. PCC has resolved these issues. For information on posting these visits, see the CMS's guide to visits that span October 1st.
Network Errors Could Cause DrFirst to Stop Working: At some PCC practices, under certain circumstances, network errors could cause the DrFirst interface to stop working. Those practices needed to contact PCC Support to manually restart the prescriptions interface. The PCC 7.0.4 update fixes this problem. Network or internet problems at your practice can still interrupt PCC EHR services, but will no longer cause the DrFirst prescriptions interface to stop working for your practice.
Diagnoses Not Appearing, Not Lining Up With Selection Boxes: If a user selected and then deselected multiple diagnoses while moving between the Bill window and the chart, diagnoses could sometimes not appear or appear misaligned on the screen. This no longer occurs.