Meaningful Use has been a hot topic in the healthcare industry recently and after a long wait and deliberation, the Office of the National Coordinator for Health IT (ONC), together with the Centers for Medicare and Medicaid Services (CMS) released the final rules for Meaningful Use earlier this week.
The goals of Meaningful Use, at least for this first stage, are to provide incentives for healthcare providers to convert from their paper based medical records to electronic health records (EHRs). This is accomplished through establishing rules for what constitutes meaningful use of an EHR system and then providing incentive payments to those organizations that implement an EHR system meeting the rules.
As of July 13th, we now know the rules and they aren’t an all or nothing proposition. Instead, there are 15 “core” rules that must be implemented, and then 10 other optional or “a la carte” rules of which 5 must be implemented as part of stage 1, with the remaining required for stage 2 (2013).
The 15 core rules, extracted from a nice summary from the New England Journal of Medicine, are:
- 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 event of mortality) at least 50% of the time
- Record vital signs and chart changes (height, weight, blood pressure,
body-mass index, growth charts for children) at least 50% of the time
- Maintain up-to-date problem list of current and active diagnoses at least 80% of the time
- Maintain active medication lists at least 80% of the time
- Maintain active medication allergy lists at least 80% of the time
- Record smoking status for patients 13 years of age or older at least 50% of the time
- Provide patients with a clinical summary for each office visit within 3 business days, at least 50% of the time
- On request, provide patients with an electronic copy of their health information (including test results, problem lists, meds lists, allergies) within 3 business days, at least 50% of the time
- Generate electronic prescriptions at least 40% of the time
- Use Computerized Physician Order Entry (CPOE) for medication orders at least 30% of the time
- Implement drug-drug and drug-allergy interaction checks
- Be able to exchange key clinical information among providers by performing at least one test of the EHR’s ability to do this
- Implement one clinical decision support rule, and ability to track compliance with the rule
- Implement systems that protect privacy and security of patient data in the EHR, by conducting or reviewing a security risk analysis, and taking corrective step if needed
- Report clinical quality measures to CMS or states
The optional 10 rules of which 5 must be demonstrated are:
- Implement drug-formulary checking
- Incorporate lab test data into the EHR as structured data
- Generate lists of patients by specific conditions to use for quality
improvement, reduction of disparities, research, or outreach
- Use EHR technology to identify patient-specific education resources, and provide those to the patient as appropriate – and do this at least 10% of the time
- Provide medication reconciliation between care settings, at least 50% of the time
- Provide summary of care record for patients transferred to another provider or setting, at least 50% of the time
- Submit electronic immunization data to local registries (performing at least one test of data submission, where registries can accept them)
- Submit electronic syndromic surveillance to public health agencies (perform at least one test, where local agencies can accept them)
- Medical Professionals: Send reminders to patients (per patient preference) for preventive and follow-up care, at least 20% of the time, or for over-65 year-olds or under=5 year-olds)
- Medical Professionals: Provide patients with timely electronic access to their health information, at least 10% of the time
- Hospitals: Record advance directives for patients 65 years of age or older at least 50% of the time
- Hospitals: Submit of electronic data on reportable laboratory results to public health agencies
The challenge with many EHR systems is that they are implemented for a single provider or hospital, but patients visit many different doctors and hospitals, and thus an individual EHR can’t provide a complete view of the patient.
A solution to this is to implement or be part of an HIE that implements an Enterprise Master Patient Index or EMPI. An EMPI helps provide a single view of a patient giving a complete view which can help provide better patient care and help implement the Meaningful Use rules.
The rules that could benefit in some way from an EMPI are bolded in the lists above and we can expect that rules in future stages of initiative will further benefit from or require an EMPI to be easily or effectively implemented. Whether it is avoiding re-entry of information, being able to safely prescribe the right medicines, avoiding unnecessary duplicate tests, or being able to provide patients with a complete copy of their health information, an EMPI can help.
So if you are a hospital or professional looking to implement the meaningful use rules, make sure you consider the benefits of an EMPI and include one in your plans. If you are an EHR provider or building an HIE solution, you should consider bundling an EMPI or EMPI capabilities in your offering. In both cases, NextGate can help with the MatchMetrix EMPI Suite, contact us to learn how.
