On July 13, 2010, the Centers for Medicare and Medicaid Services (CMS) and the Office of the National Coordinator for Health Information Technology (ONC) issued the final regulations required for the electronic health record (EHR) incentive programs contained in the American Recovery and Reinvestment Act of 2009 (ARRA). The Final Rule lists the requirements for meeting the meaningful use objectives for Stage One. Two additional updates for Stage Two and Stage Three will be announced in the future.
In the Final Rule, the objectives are divided into a Core Set and a Menu Set. Eligible Hospitals are required to meet the 14 Core Set requirements. From the Menu Set, the Eligible Hospitals can select 5 of the 10 objectives to meet with one of the five coming from the improve population and public health section.
ARRA INCENTIVE FOR ELIGIBLE HOSPITALS
ELIGIBLE HOSPITAL CORE SET (MUST MEET ALL CORE OBJECTIVES)
Stage 1 Objectives (Required Functionality) CPSI Application(s) needed Measurement
Use CPOE for medication orders directly entered by any licensed healthcare professional who can enter orders into the medical record per state, and professional guidelines
CPOE More than 30% of all unique patients with at
least one medication in their medication list admitted to the eligible hospital’s or CAH’s inpatient or emergency department (POS 21 or 23) have at least one medication order entered using CPOE
Implement drug, drug-allergy interactions checks
Clinical
Monitoring via Pharmacy, POC and CPOE
The eligible hospital/CAH has enabled the drug-drug and drug-allergy interaction check functionality for the entire EHR reporting period
Maintain an up-to-date Problem List of current and active diagnoses
POC, ChartLink and Clinical Vocabulary & Code Mapping
More than 80% of all unique patients admitted to the eligible hospital’s or CAH’s inpatient or emergency department (POS 21 or 23) have at least one entry or an indication that no problems are known for the patient recorded as structured data
Maintain active medication list
Pharmacy, POC and CPOE
Maintain active medication allergy list
Pharmacy, POC and Clinical Monitoring
More than 80% of all unique patients admitted to the eligible hospital’s or CAH’s inpatient or emergency department (POS 21 or 23) have at least one entry (or an indication that the patient has no known medication allergies) recorded as structured data
Record demographics: preferred language, gender, race, ethnicity, date of birth, date and cause for death in the event of mortality
Census Application
More than 50% of all unique patients admitted to the eligible hospital’s or CAH’s inpatient or emergency department (POS 21 or 23) have demographics recorded as structured data
Record and chart vital signs: height, weight, blood pressure, calculate and display BMI, plot and display growth charts for children 2-20 years, including BMI
POC and/or Electronic Forms
For more than 50% of all unique patients age 2 and over admitted to the eligible hospital’s or CAH’s inpatient or emergency department (POS 21 or 23) height, weight, and blood pressure are recorded as structured data Record smoking status for
patients 13 years old or older
Census, POC and/or Electronic Forms
For more than 50% of all unique patients 13 years old and older admitted to the eligible hospital’s or CAH’s inpatient or emergency department (POS 21 or 23) have smoking status recorded as structured data
Implement one clinical decision support rule relevant to specialty or high clinical priority along with the ability to track compliance to the rule
POC and/ or Electronic Forms, Census, CPOE, HIM, Lab, Radiology and Pharmacy
Implement one clinical decision support rule
Report hospital quality measures to CMS or the state Core Measures & Interface Management System
For 2011, provide aggregate numerator, denominator, and exclusions through
attestation as discussed in section II(A)(3) of this final rule. For 2012, electronically submit the clinical quality measures as discussed in section II(A)(3) of this final rule.
Provide patients with an electronic copy of their health information (including diagnostic test results, problem list, medication list, medication allergies) upon request
Lab, HIM, Electronic File Management, POC and/ or Electronic Forms, ChartLink, Pharmacy and Radiology
Provide patients with an electronic copy of their discharge instructions at the time of discharge upon request
HIM, POC and/or Electronic Forms
More than 50% of all patients who are discharged from an eligible hospital’s or CAH’s inpatient department or emergency department (POS 21 or 23) and who request an electronic copy of their discharge instructions are provided it
Capability to exchange key clinical information (for example, problem list, medication list, medication allergies and diagnostic test results) among providers of care and patient authorized entities electronically Interface Management System, POC, Lab, HIM, ChartLink, Radiology and Pharmacy
Perform at least one test of certified EHR technology’s capacity to electronically exchange key clinical information
Protect electronic health information created or maintained by the certified EHR technology through the implementation of appropriate technical capabilities
Linux Server and ClientWare
Conduct or review a security risk analysis per 45 CFR 164.308 (a)(1) and implement security updates as necessary and correct identified security deficiencies as part of its risk, management process
ELIGIBLE HOSPITAL MENU SET (MUST SELECT 5 OBJECTIVES)
Stage 1 Objectives (Required Functionality) CPSI Application(s) needed Measurement Implement drug-formulary checks Pharmacy, POC and CPOE
The eligible hospital/CAH has enabled this functionality and has access to at least one internal or external drug formulary for the entire EHR reporting period
Record advance directives for patients 65 years old or older
Census, POC and/or Electronic Forms
Hospitals must record at least 50% of inpatients 65 years old or older an indication of an
advance directive status recorded Incorporate clinical lab-test
results into EHR technology structured data Lab Application or Discrete Element Interface, Interface Management System
More than 40% of all clinical lab test results ordered by an authorized provider of the eligible hospital or CAH for patients admitted to its inpatient or emergency department (POS 21 or 23) during the EHR reporting period whose results are either in a positive/negative or numerical format are incorporated in certified EHR technology as structured data Generate lists of patients by
specific conditions to use for quality improvement, reduction of disparities and outreach
Use certified EHR technology to identify patient-specific education resources and provide those resources to the patient if appropriate
POC and Patient Education Documents
More than 10% of all unique patients admitted to the eligible hospital’s or CAH’s inpatient or emergency department (POS 21 or 23) are provided patient-specific education resources The eligible hospital who
receives a patient from another setting of care or provider of care, or believes an encounter is relevant should perform medication reconciliation
Pharmacy, POC and Medication Management
The eligible hospital or CAH performs medication reconciliation for more than 50% of transitions of care in which the patient is transitioned into the care of the EP or admitted to the eligible hospital’s or CAH’s inpatient or emergency department (POS 21 or 23)
The eligible hospital who transitions their patient to another setting of care or provider of care, or refers their patient to another provider of care should provide a summary of care record for each transition of care or referral POC and/or Electronic Forms, Lab, Radiology and Electronic File Management
The eligible hospital or CAH who transitions or refers their patient to another setting of care or provider of care provides a summary of care record for more than 50% of transitions of care and referrals
Capability to submit electronic data to
immunization registries or immunization information systems and actual submission in accordance with applicable law and practice
Interface Management System, HIM and POC
Perform at least one test of certified EHR technology’s capacity to submit electronic data to immunization registries and follow up submission if the test is successful (unless none of the immunization registries to which the eligible hospital or CAH submits such information have the capacity to received the information electronically)
Capability to submit electronic data on
reportable (as required by state or local law) lab results to public health agencies and actual submission in accordance with applicable law and practice
Interface Management System, Lab Application or Discrete Element Interface
Performed at least one test of certified EHR technology’s capacity to provide electronic submission of reportable lab results to public health agencies and follow-up submission if the test is successful (unless none of the public health agencies to which eligible hospital or CAH submits such information have the capacity to receive the information electronically)
Capability to submit electronic syndromic surveillance data to public health agencies and actual submission in accordance with applicable law and practice
Interface Management System, HIM, POC and/or Electronic Forms
January 2012
z Anticipated NPRM Stage 2July 2012
z Anticipated Final Rule Stage 22015
z Medicare payment adjustments begins for providers that are notmeeting Meaningful Use criteria
2016
z Last year to receive Medicare incentive paymentsz Last year to register for participation in Medicaid Incentive Program
2021
z Last year to receive Medicaid incentive paymentsMEANINGFUL USE INCENTIVE TIMELINE
CPSI PRODUCT REQUIREMENTS TO ACHIEVE MEANINGFUL USE
Products Required for Stage 1
Stage 1 requires the use of the following products within our integrated health information system. All components play an integral role in providing the key interactions to fulfill Meaningful Use objectives.
Future Requirements for Meaningful Use in Stage 2 and 3
Meaningful Use criteria for Stages 2 and 3 will continue to expand on the existing baseline. The remaining criteria will be staged over the next five years with Stage 2 expected by 2013, and Stage 3 by 2015. Some of the anticipated criteria for Stage 2 include:
z Optional Stage 1 criteria will be required
z Greater emphasis on interoperability among health care providers
z Criteria expanded to the entire outpatient hospital setting, not just the Emergency Department
z Increased use of e-Prescribing, CPOE and e-transmission of patient care summaries
z Incorporating lab results into EHR
z Linux Server
z ClientWare
z Interface Management System
z Ad Hoc Reporting
z Census Applications
z Electronic File Management
z Electronic Forms
z ChartLink
z Clinical Vocabulary & Code Mapping
z CPOE z Medication Management z Clinical Monitoring z Core Measures
z Health Information Management
z Patient Education Documents
z Pharmacy
z Point of Care
z Order Entry/Results Reporting
z Laboratory
The following are excerpts from the KLAS report “Meaningful Use Leading to Improved Outcomes” published May 2009*:
Computerized Physician Order Entry (CPOE):
z “CPSI has shown that community hospitals can implement CPOE.”
z “BRAVO: CPSI is the first vendor to compete with Meditech across all community hospital sizes in
delivering CPOE. The ability to do both chemotherapy orders and pediatric dosing is impressive. Nursing adoption is high and covers every aspect including BPOC for medications. The system works and is modeled to be cost effective in the under-200-bed community. Response time and uptime are considered excellent.”
z “CPSI has a solid number of early-adopting community hospitals working to surpass the threshold
of more than 50 percent of orders being entered electronically by doctors. Not one hospital (Over 200 Beds) has achieved this goal, based upon the recent CPOE data.”
Barcode at the Point of Care (BPOC):
z “BPOC at the time of medication administration is a strength for CPSI. CPSI has proven to have a
solid delivery of BPOC in the community hospital space.”
z “Nurses make solid use of the CPSI software, which includes BPOC for medications and nurse charting.”
Nursing Caregiver Charting:
z “Additional (competitor) products...were not included because providers did not consider them to be
