Meaningful Use

Good news, Stage 2 meaningful use has been postponed until 2014. Based on the slow adaptation of meaningful use and the technology challenges that meaningful use represent this portion of meaningful use has been pushed back one year. The reality is that even meaningful use stage 1 has been difficult to obtain and many Practices that have completed attestation are not meeting meaningful use requirements. For simplicity sake, meaningful use has three basic components: Use of certified EHR in a meaningful manner, such as electronic prescriptions; Use of certified EHR technology to exchange patient information; Use of certified EHR to submit quality measures. Sounds simple but the devil is in the details. Meaningful use stage 1 requires eligible professionals (EP’s) to meet and comply with 20 objectives out of a possible of 25 meaningful use objectives. There are 15 core objectives that everyone has to meet and then EP’s may choose 5 more from a list of 10 potential objectives. The mandatory/required core objectives are as follows: (1) Use CPOE for medication orders directly entered by any licensed healthcare professional who can enter orders into the medical record per state, local and professional guidelines. (2) Implement drug-drug and drug-allergy interaction checks. (3) Maintain an up-to-date problem list of current and active diagnoses. (4) Generate and transmit permissible prescriptions electronically (eRx). (5) Maintain active medication list. (6) Maintain active medication allergy list. (7) Record all of the following demographics: (A) Preferred language. (B) Gender. (C) Race. (D) Ethnicity. (E) Date of birth. (8) Record and chart changes in the following vital signs: (A) Height. (B) Weight. (C) Blood pressure. (D) Calculate and display body mass index (BMI). (E) Plot and display growth charts for children 2–20 years, including BMI. (9) Record smoking status for patients 13 years old or older. (10) Report ambulatory clinical quality measures to CMS or, in the case of Medicaid EPs, the States. (11) Implement one clinical decision support rule relevant to specialty or high clinical priority along with the ability to track compliance with that rule. (12) Provide patients with an electronic copy of their health information (including diagnostics test results, problem list, medication lists, medication allergies) upon request. (13) Provide clinical summaries for patients for each office visit. (14) Capability to exchange key clinical information (for example, problem list, medication list, allergies, and diagnostic test results), among providers of care and patient authorized entities electronically. (15) Protect electronic health information created or maintained by the certified EHR technology through the implementation of appropriate technical capabilities. Notice that core objective number 10 requires the reporting of quality measures. This is another list of measures that must be reported. Out of a list of 6 total clinical quality measures , EPs must select 3 required core measures to report on. Then there is a list of 38 clinical quality measures alternatives from which the providers must select 3 additional measures. Another important core objective is number 13 which requires patients be given clinical summaries after each office visit. Then we have our list of 10 menu set objectives. You must pick 5 of these in order to meet meaningful use. (1) Implement drug formulary checks (2) Incorporate clinical lab-test results into EHR as structured data. (3) Generate lists of patients by specific conditions to use for quality improvement, reduction of disparities, research, or outreach. (4) Send patient reminders per patient preference for preventive/follow-up care. (5) Provide patients with timely electronic access to their health information (including lab results, problem list, medication lists, and allergies) within 4 business days of the information being available to the EP. (6) Use certified EHR technology to identify patient-specific education resources and provide those resources to the patient if appropriate. (7) The EP who receives a patient from another setting of care or provider of care or believes an encounter is relevant should perform medication reconciliation. (8) The EP who transitions their patient to another setting of care or provider of care or refers their patient to another provider of care should provide summary care record for each transition of care or referral. (9) Capability to submit electronic data to immunization registries or immunization information systems and actual submission according to applicable law and practice. (10) Capability to submit electronic syndromic surveillance data to public health agencies and actual submission according to applicable law and practice. So let’s concentrate on the good news, we have until 2014 to meet meaningful use stage 2 so hopefully by then you will have taken care of the above requirements, HIPAA 5010, ICD10, Healthcare reform and all the other legislations that are becoming in effect or has become effective in the last couple of years.