By Mike Lowe, Project Manager, PMO
On July 13, 2010, the Centers for Medicare and Medicaid Services (CMS) announced the final rules for Stage 1 regarding Meaningful Use of the Electronic Health Record (EHR) incentive program. As healthcare providers begin implementing new EHR solutions, these rules must be followed in order to qualify for slices of a $34 billion incentive pie.
The two critical and most challenging criteria to satisfy Stage 1 Meaningful Use qualifications are the following:
1. 80% of the provider/hospital patients must have records in the EHR solution.
2. Eligible professionals must meet 20 of 25 objectives (and eligible hospitals 19 of 24) to achieve Meaningful Use and qualify for incentives.
Among these objectives are the following:
a. Computerized Physician Order Entry (CPOE)
b. E-Prescribing
c. Drug-drug and drug-allergy interaction checks
d. Maintaining up to date problem lists of current and active diagnoses
e. Maintaining active medication list
f. Maintaining active medication allergy list
g. Drug formulary checks
h. Medication reconciliation
Many providers for whom we have helped implement solutions would not have met these objectives because of a slow migration toward any EHR solution. Designating only 3 – 4 patients each day for electronic documentation demonstrated this reticent embrace of EHR technology. All other patient documentation would be recorded on paper. EHR numbers would increase glacially until the majority of patients were documented.
However, established, aggressive MU incentive deadlines mean that the providers will now need to adapt EHR solutions with more immediacy. To assist clients in satisfying MU criteria and meeting deadlines you should address three key initiatives within a project.
1. Fully engage physicians and clinical staff during the project– Because they will be using the clinical portion of the application, physicians and clinicians need to provide input and otherwise collaborate during the build process since this will impact their daily work. Lines of communication must stay open. Unengaged physicians are unreceptive physicians when new applications go live. Such needless aversion could delay achieving milestones.
2. Backload patient clinical data – One of the common canards of EHR is that the patient data is going to “magically appear” from within the application on the patient’s first visit. This is rarely the case. A complete patient EHR takes time and effort; thus, scanning documents into an application would help populate a patient’s EHR, but those scanned documents could not trigger any of the drug interactions when prescribing medications. To better prepare for imminent patient visits (and to start working toward satisfying MU criteria), begin back loading prior patient information such as previous medications, allergies, and diagnoses. The inclusion of past medications, allergies and diagnoses will allow the drug-drug and drug-allergy interactions to be active when prescribing medications during real-time treatment. In addition, including this information establishes the up-to-date problem and medications lists. Devoting time now to input patients’ medical histories will complement bed-side, real-time input and begin contributing to the 80% patient documentation objective.
From an ambulatory perspective, such proactive input will enable remote clinicians utilizing the application within the same organization to access this documentation, eliminating the need for unnecessary phone calls, faxes and medical record requests.
3. Begin utilizing specific modules of the EHR – As the application is built, certain components such as ePrescribing, CPOE, and recording of vital signs can be utilized immediately. Early adoption of these items will afford the provider more time to become acclimated with the application. This also initiates the building of patient records, further contributing to achieving the 80% EHR documentation core goal as well as addressing the ePrescribing and CPOE objectives. The ambulatory benefit of using specific EHR modules mimics that noted in back loading patient data.
CMS has recently approved CCHIT and Drummond as certifying bodies, thus loosening the logjam for MU-certified applications. And while a backlog will remain, by no means should EHR implementations come to a grinding halt; after all, not even glaciers stop. If anything, especially in the ambulatory space, implementations should move forward and providers should start using the various components of EHR immediately.
If you would like more information on achieving MU compliance with your Cerner, Eclipsys, Epic, McKesson, MEDITECH, Siemens applications, VCS can help. Please contact us at 610.444.1233 or vcs@getvitalized.com. Helpful information also resides on our website.