As I previously mentioned, there are 15 core objectives that every eligible provider (EP) must report on.  In continuation of my last post, below are the next five objectives:  
 
6. Maintain an active allergy list on more than 80% of all unique patients. See #5. Maintaining an allergy list is a requirement, just as maintaining the medication list is required.  Users will record that the medication list and allergy list has been reviewed by "reconciling" it (i.e. stamping it with a date).
  
7. Record the following demographics: preferred language, gender, race and ethnicity, and date of birth on more than 50% of unique patients. This one is pretty straightforward as well. These demographics are captured by most offices on patient paperwork. The biggest challenge will be making sure that all the information is entered into the computer at each visit.

8. Record and chart vital signs on more than 50% of unique patients age 2 and over. As with #7, most offices already capture this information; however, CMS requires that BMI be calculated and displayed in the chart, as well as the plotting of growth charts (with BMI) for patients ages 2-20.

9. Record smoking status for more than 50% of unique patients 13 and over. Providers must remember to use CMS-acceptable terminology when documenting the smoking status of their patients. These options include
        · Current every day smoker 
        · Current some day smoker 
        · Former smoker 
        · Never smoker
        · Smoker, current status unknown
        · Unknown if ever smoked
Once Quillen users upgrade to the 11.2 version of Allscripts, these will all be designated with MU for acceptable documentation.

10. Report ambulatory clinical quality measures (CQMs) to CMS (or to the State, if Medicaid). These include such measures as adult weight screening, hypertension, and tobacco use intervention. For providers who see pediatric patients, they can choose from immunization status or weight assessment. Another alternate is flu vaccination in patients 50 or older. The list of 38 additional CQMs is available for download at the CMS website. 

In my next post, I'll list the last 5 core objectives, as well as the 10 optional objectives, from which EPs must choose 5.

So exactly how does one define "meaningful use"?
While not everyone who uses EHR may agree on the exact definition, the government hasn't been hesitant to chime in. And why shouldn't they? The whole program has been established to monitor how EHR is improving patient care delivery. 
During each year of participation in the EHR Meaningful Use Incentive Program, eligible providers must report on 20 of 25 specific measures if they want to receive incentive payments for meaningful use of their EHR. These include 15 required core objectives and 5 objectives from a list of 10 optional objectives. They must also report on 6 clinical quality measures from a list of 3 required, 3 alternate, and 38 additional measures.

Confused yet?
This is where meaningful use can get a bit complicated. Some of the measures and objectives can be difficult to understand, and reporting on them is even more complicated. I'll try to explain, but don't be discouraged if they seem a little unclear. Like I mentioned in my previous post, we could all benefit from a class on meaningful use.

Below are the first 5 of 15 core objectives--those that every EP must report on:
1. Use CPOE (computerized physician order entry) for greater than 30% of unique patients with at least one medication in the medication list. So, "CPOE" threw me for a loop. Simply put, the provider should use a computer or mobile device to order a medication or other order (imaging, lab) and record it for more than 30% of his/her patients (and 'unique' means you can't count the patient more than once). It's not exactly the same thing as e-prescribing, which requires sending the script to a pharmacy. See #4.
2. Implement drug-drug and drug-allergy checks. This one's pretty straight forward. Whichever EHR system the provider uses, it must alert the provider regarding drug-to-drug and drug-to-allergy interactions. As long as it's in place for the entire reporting period, then this objective is satisfied.
3. Maintain an up-to-date problem list of current and active diagnoses for more than 80% of unique patients. Basically, this objective requires that the provider enter active and past problems into the patient's medical record. The information can be obtained either from the previous record, a transferred record, the EP's diagnosis, or from asking the patient. Probably the most important thing to remember about this objective is that SOMETHING has to be documented, even if the patient doesn't have any active problems. When our system is upgraded in March, our providers will be able to easily document "no active problems."  Also of note, 'unique', like in #1 above, means a patient can't be counted more than once.
4.  More than 40% of permissible prescriptions written by the provider are generated and transmitted electronically. Very similar to #1, but still unique in that these are actually prescriptions that are sent and received electronically, not just ordered and recorded in the system. Keep in mind, depending on state law, scheduled drugs cannot be sent electronically, so these would not count toward the requirement.
5. Maintain an active medication list on 80% of all unique patients. As with #3, something has to be recorded, even if the patient has no active meds, and remember the definition of 'unique'--CMS isn't talking encounters, they mean individual patients.  

In my next post, I'll list and define the next five objectives...stay tuned.  

Meaningful Use...If you haven't heard this buzz word around the office, then you've probably been hiding out. Providers and administrators have been frantically trying to prepare for it, but exactly what "it" is can be a bit confusing. A matter of fact, I almost titled this entry "Meaningful Use for Dummies" because it can be so complicated. I decided against the title because, frankly, even the most intelligent of "meaningful" users can be totally confused by all the requirements; frankly, we all need a class on it,thus, my cliche' title. Since taking a class isn't practical for most of us, I'm dedicating my first few posts to educating EHR users on meaningful use and it's impact on healthcare organizations.
Defining Meaningful Use
Think back a few years ago. Remember the American Recovery and Reinvestment Act of 2009? You may not remember it by its exact name; just think Healthcare Reform. Basically, the Act provides for payments to be made to eligible providers, hospitals, and critical access centers (participating in Medicare and Medicaid programs) that "adopt and successfully demonstrate meaningful use of certified electronic health records."  The documentation for the incentive program is 276 pages, like most government programs, so sorting through it can be a bit combersome.
As for defining meaningful use, there are three parts to the definition:
1. Providers should use a certified EHR in a "meaningful" or useful way, such as e-prescribing;
2. Providers should be able to connect and exchange patient health information through the certified EHR to improve the quality of patient care (i.e. provider to hospital, provider to provider); and
3. Providers using certified EHR technology should report to the U.S. Health and Human Services Secretary, clinical quality measures (selected by the Secretary) that demonstrate the use of their EHR technology in a meaningful way.
What it all boils down to...if you see Medicare or Medicaid patients and you want incentive payments for using EHR, then you have to report to the government on how you're using it. 
As mentioned above, the clincal quality measures that providers must report on are clearly defined by the Secretary. In my next post, I'll explain what those measures are.