What is meaningful use really? It is the use of certified EHR in a meaningful manner such as electronic prescription, e-Rx, the use of certified electronic health record technology for electronic exchange of health information to improve quality of health care and the use of certified EHR technology to submit clinical quality data and other measures. Read this expert healthcare training article for more.
It means that providers have to show they're using this certified technology in ways that can be measured significantly in quality and quantity.
So let's talk about the different stages. Well, all of this is for Stage 1 which began in 2011, the beginning of meaningful use. Stage 2 and 3 requirements are going to be forthcoming. They're going to have higher thresholds with greater emphasis on the exchange of health information.The HIT policy committee has proposed the delay for Stage 2 until 2014 because Stage 2 has been too hard to meet at this minute, at this particular time. So that may be delayed until 2014.
They made a recommendation but it hasn't been announced yet that Stage 2 is delayed until 2014 but they're talking about it. So let's go through the Stage 1 criteria. Well, if they use computerized provider order entry for medication orders directly entered by any licensed healthcare professional who can enter orders into the medical record per state, local and professional healthcare guidelines.
If they implement drug to drug and other drug allergy checks, you have to maintain an up to date problem list of current and active diagnoses for that patient if they generate and transmit permissible prescriptions electronically.
Maintain active medication list. Maintain active medication allergy list. Record all of these demographics, preferred language, gender, race, ethnicity, date of birth, record and chart changes in the following vital signs, height, weight, blood pressure. Calculate and display body mass index BMI and then plot and display growth charts for children ages 2 to 20 including their BMI.
It's records smoking status for patients 13 years or older, report ambulatory clinical quality measures to CMS or in the case of Medicaid eligible professionals to your state.
Implement one clinical decision support rule relevant to specialty or high clinical priority along with the ability to track medical compliance with that rule, provide patients with an electronic copy of their health information including diagnostic test, RCT test results, problem list, medication list, medication allergies and on request of the patient, provide clinical summaries for patients for each office visits.
Our expert stated in a health system conference that you have to have the capability to exchange key clinical information for example a problem list, a medication list, allergies, diagnostic test results, among providers of care and patient authorized entities electronically. So you have to do this electronically.
You have to protect electronic health information, created or maintained by the certified EHR technology through the implementation of appropriate technical capability to ensure healthcare compliance.
You have to meet 15 of the core objectives, all 15 that we already explained. And five can be chosen from the remaining ten objectives. Now, what are these remaining ten objectives? Well, implement drug formulatory tracks, incorporate clinical lab test results into your EHR as structured data, generate patient list by specific conditions to use for quality improvement, reduction of disparities, research and outreach.
Send patient reminders per patient preference for preventive follow-up visits. Provide patients with a timely electronic access to their health information, including lab results, problem list, medication lists and allergies. You have to do that within four days it being available to the eligible professional. Use certified EHR technology to identify patient specific education resources and provide those resources to the patient if appropriate.
The eligible professional who receives the patient from another setting of care or provider of care or believe in encounter as relevant should perform a medication reconciliation. So you have to do that as per healthcare rules.
Summary care records, if you, eligible professional transitions the patient to another setting of care or provider of care or referred the patient to another provider of care, you have to have provide a summary care record for each of those transitions of care.
You have to have the capability to submit electronic data to immunization registry or immunization information system and actual submission according to applicable law and practice.
Capability to submit electronic records, syndromic surveillance data to public health agencies and actual submission according to law and practice. So if there's some kind of community health crisis, you’d have to be able to submit a communicable disease, you'd have to submit that to the public health agencies that require it.
And so, you have to choose five of these ten that you implement now. So bottom line, you have to implement 20 objectives to qualify for the incentive payment, 15 core and 5 menu. Now, you can find this list of menu and core objectives on the CMS electronic health records website.
Now, in addition to the stated objective, there are clinical quality measures that also have to be reported on. There are six total clinical quality measures, three core or alternate core and then 3 out of 38 from an alternate set.
Our expert further mentioned n the same audio conference that there are going to be Stage 2 and three clinical quality measure reporting requirements as well. And some of those might be, you know, weight, prenatal, smoking cessation. There's a whole range of them. And you're going to have to report on three core or alternate core and then three of the total 38 from the alternate set.
Now, for Stage 1 requirement, the reporting period is 90 days for the first year and following subsequent year. It's done through a cessation to meet the objective measures 80% of your patients must have records in your certified EHR technology. And eligible professionals have to report on 20 of 25 of the meaningful use objectives.
Now, obviously, for Stage 1 requirements, some of the meaningful use objectives are not going to be applicable to every provider’s clinical practice such as dentists won't perform immunizations. Chiropractors won't prescribe medication. It's going to be dependent on the type of eligible professional.
But they wouldn't have any eligible patients or action for that measure as per CMS rules. And exclusion don’t count against the five deferred measures either. So if you're a chiropractor and you can't meet the e-prescribing requirement, you still have to meet five other objectives from the menu set.
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