Understanding the “Meaningful Use” of EHR – Part II
In the first part of this article, we delved upon the benefits announced by the federal government as part of the HIPAA and HITECH act for the healthcare professionals who adopt certified electronic health records (EHR) technology and put it to meaningful use in healthcare. In the second and final part of this article, we will look at stage 1 proposed by the HITECH act for defining meaningful use of electronic health records.
Stage 1 of meaningful use comprises of two sets, namely the core set and menu set containing objectives that the healthcare provider must report in order to receive incentives. In addition to reporting on core set and menu set objectives, the healthcare professional must also report on clinical quality measures. Core set consists of 15 objectives while the menu set consists of 10 objectives.
Core Set
The 15 core set objectives define the tasks that are essential for creating any medical record.
1. Record patient demographics (gender, race, ethnicity, date of birth, and preferred language)
2. Maintain up-to-date problem list of current and active diagnoses
3. Record smoking status for patients 13 years of age or older
4. Maintain active medication list
5. Record vital signs and chart changes (height, weight, blood pressure, calculate and display body-mass index, plot and display growth charts for children 2-20 years)
6. Maintain active medication allergy list
7. On request, provide patients with an electronic copy of their health information (including diagnostic test results, problem list, medication lists, medication allergies, discharge summary, procedures)
8. For individual professionals, provide patients with clinical summaries of each office visit
9. Computer provider order entry (CPOE) for medication orders
10. Generate and transmit permissible prescriptions electronically (eRx)
11. Implement capability to exchange key clinical information (ex:problem list, medication list, medication allergies, diagnostic test results), among providers of care and patient authorized entities electronically
12. Implement drug–drug and drug–allergy interaction checks
13. Protect electronic health information created or maintained by certified EHR technology through the implementation of appropriate technical capabilities
14. Implement one clinical decision support rule and ability to track compliance with the rule
15. Report clinical quality measures to CMS or states
Menu Set
Of the 10 objectives, the healthcare professionals must choose at least 5, which they should meet within the 2011 and 2012 period.
1. Implement drug formulary checks
2. Generate lists of patients by specific conditions to use for quality improvement, reduction of disparities, research, or outreach
3. Incorporate clinical laboratory test results into EHRs as structured data
4. Use certified EHR technology to identify patient-specific education resources and provide those to the patient if appropriate
5. Provide summary of care record for patients for each transition of care/referrals
6. Perform medication reconciliation between care settings
7. Submit electronic syndromic surveillance data to public health agencies
8. Submit electronic immunization data to immunization registries or immunization information systems
9. Provide patients with timely electronic access to their health information(including laboratory results, problem list, medication lists, medication allergies)
10. Send reminders to patients (per patient preference) for preventive and follow-up care
Clinical Quality Measures
Centers for Medicare and Medicaid Services (CMS) defines clinical quality measures as “measures of processes, experience, and/or outcomes of patient care, observations or treatment that relate to one or more of the Institute of Medicine domains of health care quality (e.g., effective, safe, efficient, patient-centered, equitable and timely).” To demonstrate meaningful use, the healthcare professional must report on three core measures and three additional measures.
If the healthcare professionals meet all the above objectives, they would be eligible for Medicare and Medicaid benefits.
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