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Requirements to Achieve the 2011, Stage 1, Meaningful Use

Posted Jun 22 2010 8:00am

The Centers for Medicare & Medicaid Services (CMS) have proposed rules to encourage the implementation and practice of superior health information technology (HIT) and meaningful use of electronic records (EHR). This incentive is in accordance with the American Recovery and Reinvestment Act (ARRA) and is established so that physicians and clinicians who are able to meet these rules by 2011 can receive incentive payments, beginning 2011.

The CMS HIT rules specify and also define the eligibility requirements for professionals and hospitals, criteria to be adopted by physicians for Stage 1 (by 2011), reporting methodology and timings, payment details, payment procedures, and penalties for those unable to meet the criteria. In Stage 2, to be implemented in 2013 and 2014, and Stage 4 (after 2015), CMS proposes to elaborate and expand the continuous quality health care and information exchange, the criteria for which is yet to be determined in the future regulations.

To achieve the 2011 CMS HIT rules, hospitals must certify that the 23 EHR objectives have been met and that their EHR system is equipped to support them; all the required functionality measures have been established and met for the each of the 23 points; EHR system is used to generate data to calculate the 35 new quality measures accurately. A few of the quality measures are already present in the existing Medicare quality reporting programs, though most of them have not been specified.

EHR Objectives

The major EHR objectives that must be implemented by hospitals are as follows:

· Availability of patient demographics data

· Drug-drug interaction and drug-allergy levels at the time of prescribing

· Medication lists

· Medication reconciliation

· Discharge summary

· Exchange clinical information

· Quality reporting

· CPOE (computerized provider order entry)

· Clinical decision support

· Syndromic surveillance of public health

· Patient access to data

· Use of electronic exchange between physicians and pharmacy

· Improving population health outcomes

Measures of Meaningful Use

The measures of meaningful use are categorized into two groups - one that measures the use of an EHR technology and the other that measures the clinical quality of the system. Quality measures include efficient measure systems for heart failure, pneumonia, stroke, and surgical care.

Limitations in Achieving CMS Rules

According to the American Hospital Association (ASA), the rules proposed by the CMS are ambitious goals that may be difficult to achieve in the specified time frame. It will be difficult, especially for smaller hospitals, to be able to implement the EHR standards by 2011. Furthermore, this process is inflexible. Also, there are some measures, such as the certification or measurement of the EHR systems that are not under the hospital control and have to be procured from external vendors.

The AHA proposes an alternative and step-by-step approach to achieve the ultimate goal. However, only a limited number of objectives will be achieved by 2011, but it is expected that these goals will be fully achieved by 2017.

REMINDER:  The final rule for Meaningful Use is not out yet.  We expect to see it by the end of the month, but will likely be the end of July 2010

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