11. Implement one clinical decision support rule relevant to specialty or high clinical importance, along with the ability to track compliance with the rule. I was a bit confused by the term ‘clinical decision support’ so I checked the CMS definition. Translation—it’s the ability of the EHR technology to provide healthcare personnel with organized, “intelligently” filtered information that improves patient care. For example, if a patient is due for a flu vaccine, the system alerts the provider that he/she should talk to the patient about getting vaccinated. To meet this objective, providers must decide what clinical decision support rule they want to implement, and then track its effectiveness. A couple of things the EP must keep in mind—the rule must be related to their specialty or of high priority to the clinic, and the rule has to be conditional on patient-specific information (i.e. A reminder to ask about the flu vaccine for every patient doesn’t count; the reminder should be generated based on the patient’s demographics and immunization record).
Examples of a clinical decision support rule that would meet the requirements of this objective:
--For diabetic patients, an alert to order a hemoglobin A1c test if there hasn’t been one ordered in the past six months.
--For men and women 50 and over who have never had a colonoscopy or haven’t had one in the last 5 years, an alert to remind the provider to discuss ordering one.
12. Provide patients with an electronic copy of their health information upon request within 3 business days. This objective is often confused with core objective #13 (see below); however, these two objectives are distinctly different. The biggest difference is that this objective applies to requests for the health information, which includes diagnostic test results, problem list, medication lists, and medication allergies. Most offices already have a policy in place for providing this information to patients in a timely manner upon request, as outlined by the HIPAA Privacy Rule.
13. Provide clinical summaries for patients for each office visit within 3 business days. Unlike Core Objective #12, this objective requires that clinical summaries be provided for greater than 50% of all patient visits, and the patient isn’t required to request it—they must be asked if they would like to receive one. One of the challenges related to this objective is determining the workflow for providing the summary. When our Quillen users upgrade to the new version of the EHR, clinical summaries will be automatically generated based on the information charted during the encounter. For the summary to be completely up-to-date, providers will need to finish charting before the patients leaves; otherwise, the summary will need to be mailed, which will increase postage costs for the office. As defined by CMS, the clinical summary most include the following information:
· patient name
· provider’s office contact information
· date and location of visit
· updated medication list
· updated vitals
· reason(s) for visit
· procedures and other instructions based on clinical discussions that took place during the office visit
· any updates to a problem list
· immunizations or medications administered during visit
· summary of topics covered/considered during visit
· time and location of next appointment/testing, if scheduled
· a recommended appointment time if, not scheduled
· list of other appointments and tests that the patient needs to schedule with contact information
· recommended patient decision aids
· laboratory and other diagnostic test orders, test/laboratory results (if received before 24 hours after visit)
14. Capability to exchange key clinical information among providers of care and patient authorized legal entities electronically. To meet this objective, the only requirement is to perform at least one test of the capability of the EHR system to exchange the information. However, there are two particulars that providers should keep in mind: (1) key clinical information that is “structured data” before it leaves the system should be received as “structured data.” Basically, the information that is received needs to stay formatted if it was sent formatted; and (2) “legal entities” above applies to providers that are not using the same EHR system and that are employed by two separate organizations. For instance, a Quillen doctor exchanging information with another Quillen provider would not count, but a Quillen doctor exchanging information with a HMG provider would count because Quillen and HMG are two different legal entities.
15. Protect electronic health information created or maintained by the certified EHR technology through the implementation of appropriate technical capabilities. This objective can get a bit technical and is best left to the IT folks to monitor. For the most part, though, protecting security involves controlling access to the system by assigning unique user names and passwords, ensuring that sessions automatically log-off after a predetermined time, encrypting health information, and maintaining audit logs.
So that covers the first 15 required core objectives.
Below is the list of 10 optional or menu objectives from which EPs must choose 5 to meet the meaningful use measures. One of the five must be a public health* objective.
1. Implement drug formulary checks.
2. Incorporate more than 40% of clinical lab-test results into the EHR as structured data.
3. Generate at least one report listing patients of the EP by specific conditions to use for quality improvement, reduction of disparities, research, or outreach.
4. Send patient reminders per patient preference for preventative/follow-up care. This requires more than 20 % of patients 65 or older or 5 years old or younger.
5. Provide patients with timely electronic access to their health information (including lab results, problem list, medication lists, and allergies) within 4 business days of the information being available to the EP. Think patient portal or personal health record.
6. Use certified EHR technology to identify patient-specific education resources and provide those resources to the patient if appropriate (most be more than 10%).
7. The EP who receives a patient from another setting of care or provider of care or believes an encounter is relevant should perform medication reconciliation. This applies to EPs who are on the receiving end of the transition. The requirement is for more than 50% of patients.
8. The EP who transitions their patient to another setting of care or provider of care or refers their patient to another provider of care should provide summary care record for each transition of care or referral. Like #8, but applies when the EP transition the patient to someone else. The requirement is for more than 50% of patients.
9. Capability to submit electronic data to immunization registries or immunization information systems and actual submission according to applicable law and practice.*
10. Capability to submit electronic syndromic surveillance data to public health agencies and actual submission according to applicable law and practice.* This objectives applies primarily to Emergency Departments and may be difficult for in-office physicians to implement.
Selecting Menu Objectives
The recommendations for selecting menu objectives are pretty straightforward. Do they apply to your scope of practice? If so, choose the five objectives that already fit into your present workflow, if possible. Some EPs may not qualify for all of the objectives, for which they may be excluded. However, they should still pick five unless they run out of options from which to choose.