The U.S. Dept. of Health & Human Services issued long-anticipated rules governing "meaningful use" of electronic medical records systems, aiming to make it easier for healthcare providers to tap into $27 billion in federal incentives.
Doctors and hospitals hoping to pull in that cash must be able to prove "meaningful use" of EMR technology, but it wasn’t clear until now exactly what that meant.
A proposed set of criteria issued in January specified between 23 and 25 items providers would have been required to meet. That proposal met with criticism that it was too stringent and would prevent most providers from being able to meet MU requirements. For example, a survey of 120 chief information officers from various healthcare providers showed that most doubted their organizations’ ability to meet the criteria as proposed.
Aiming to lower the hurdles, the finalized rules require that providers meet 14 to 15 base requirements and choose five more from a menu of 10 options. Writing in the New England Journal of Medicine, national HIT coordinator Dr. David Blumenthal and principal deputy administrator of the Centers for Medicare and Medicaid Services Marilyn Tavenner said the core objectives are the "basic functions that enable EHRs to support improved healthcare."
“As a start, these include the tasks essential to creating any medical record, including the entry of basic data: Patients’ vital signs and demographics, active medications and allergies, up-to-date problem lists of current and active diagnoses and smoking status,” according to Blumenthal and Tavenner.
"Other core objectives include using several software applications that begin to realize the true potential of EHRs to improve the safety, quality, and efficiency of care. These features help clinicians to make better clinical decisions — and avoid preventable errors."
The menu of 10 additional tasks includes "capacities to perform drug-formulary checks, incorporate clinical laboratory results into EHRs, provide reminders to patients for needed care, identify and provide patient-specific health education resources, and employ EHRs to support the patient’s transitions between care settings or personnel," the pair wrote.
|Objective:||Record patient demographics (sex, race, ethnicity, date of birth, preferred language, and in the case of hospitals, date and preliminary cause of death in the the event of mortality)||Measure:||More than 50 percent of patients’ demographic data recorded as structured data.|
|Objective:||Record vital signs and chart changes (height, weight, blood pressure, body mass index, growth charts for children)||Measure:||More than 50 percent of patients two years of age or older have height, weight and blood pressure recorded as structured data|
|Objective:||Maintain up-to-date problem list of current and active diagnoses||Measure:||More than 80 percent of patients have at least one entry as structured data|
|Objective:||Maintain active medication allergy list||Measure:||More than 80 percent of patients have at least one entry recorded as structured data.|
|Objective:||Record smoking status for patients 13 years of age of older||Measure:||More than 50 percent of patients 13 years if age of older have smoking status recorded as structured data|
|Objective:||For individual professionals, provide patients with clinical summaries for each office visit; for hospitals, provide an electronic copy of hospital discharge instructions on request||Measure:||Clinical summaries provided to patients for more than 50 percent of all office vsits within three business days; more than 50 percent of all patients who are discharged from the inpatient department or emergency department of an eligible hospital or critical access hospital and who request an electronic copy of their discharge instructions are provided with it|
|Objective:||On request, provide patients with an electronic copy of their health information (including diagnostic test results, problem list, medication list, medication allergies, and for hospitals, discharge summary and procedures||Measure:||More than 50 percent of requesting patients receive electronic copy within three business days|
|Objective:||Generate and transmit permissible prescriptions electronically (does not apply to hospitals)||Measure:||More than 40 percent are transmitted electronically using certified EHR technology|
|Objective:||Computer provider order entry (CPOE) for medication orders||Measure:||More than 30 percent of patients with at least one medication in their medication ordered through CPOE|
|Objective:||Implement drug-drug and drug-allergy interaction checks||Measure:||Functionality is enable for these checks for the entire reporting period|
|Objective:||Implement capability to electronically exchange key clinical information among providers and patient-authorized entitities||Measure:||Perform at least one test of EHR’s capacity to electronically exchange information|
|Objective:||Implement one clinical decision support rule and ability to track compliance with the rule||Measure:||One clinical decision support rule implemented|
|Objective:||Implement systems to protect privacy and security of patient data in the EHR||Measure:||Conduct or review a security risk analysis, implement security updates as necessary and correct identified security deficiencies.|
|Objective:||Report clinical quality measure to CMS or states||Measure:||For 2011, provide aggregate numerator and denominator throught attestation; for 2012, electronically submit measures|
|Objective:||Implement drug formulary checks||Measure:||Drug formulary check system is implemented and has access to at least one internal or external drug formulary for the entire reporting period|
|Objective:||Incorporate clinical laboratory test results into EHRs as structured data||Measure:||More than 40 percent of clinical laboratory test results whose results are in positive/negative or numerical format are incorporated into EHRs as structured data|
|Objective:||Generate lists of patients by specific conditions to use for quality improvement, reduction of disparities, research or outreach||Measure:||Generate at least one listing of patients with specific condition|
|Objective:||Use EHR technology to identify patient-specific education resources and provide to the patient as appropriate||Measure:||More than 10 percent of patients are provided patient-specific education resources|
|Objective:||Perform medical reconciliation between care settings||Measure:||Medication reconciliation is performed for more than 50 percent of transitions of care|
|Objective:||Provide summary of care record for patients referred or transitioned to another provider or setting||Measure:||Summary of care record is provided for more than 50 percent of patient transitions or referrals|
|Objective:||Submit electronic immunization data to immunization registries or immunization information systems||Measure:||Perform at least one test of data submission and follow-up submission (where registries can accept electronic submission)|
|Objective:||Submit electronic syndromic surveillance data to public health agencies||Measure:||Perform at least one test of data submission and follow-up submission (where public health agencies can accept electronic submission)|
|Additional choices for hospitals and critical access hospitals|
|Objective:||Record advance directives for patients 65 years of age or older||Measure:||More than 50 percent of patients 65 years of age or older gave an indication of an advance directive status recorded|
|Objective:||Submit of electronic data on reportable laboratory results to public health agencies||Measure:||Perform at least one test of data submission and follow-up submission (where public health agencies can accept electronic data)|
|Additional choices for eligible professionals|
|Objective:||Send reminders to patients (per patient preference) for preventative and follow-up care.||Measure:||More than 20 percent of patients 65 years of age or older or five years if age or younger are sent appropriate reminders|
|Objective:||Provide patients with timely electronic access to their health information (including laboratory results, problem list, medication lists, medication allergies)||Measure:||More than 10 percent of patients are provided electronic access to information within four days of it being updated in the EHR.|