Update on Meaningful Use and Contracting

What constitutes “meaningful use” of an electronic health record system has been updated by the Centers for Medicare and Medicaid (CMS) and the Department of Health and Human Services (HHS) in volume 75, number 144 of the Federal Register, page 44565, as of July 28, 2010.  These new definitions for stage 1 meaningful use are to go into effect as of September 27, 2010.  Under the original rule that was published at the end of 2009, there were a total of 25 standards that needed to be met by an EHR user to qualify as a meaningful user.  Under the final rule published July 28, the list has ben somewhat shortened, so that there are 15 “core” standards that must be met, under § 495.6(d), and an additional 5 standards from the list of 10 found in § 495.6(e) for those who qualify as eligible professionals under the regulation.  In parallel, eligible hospitals and critical access hospitals must meet the core standards in § 495.6(f), and 5 additional standards in § 495.6(g).

Under § 495.6(d), the following are the fifteen mandatory standards for eligible professionals:

(d)(1) use computerized provider order entry for medication orders for at least 30% of patients seen

(d)(2) implement drug-drug and drug-allergy interaction checking

(d)(3) main an up to date problem list

(d)(4) e-prescribing for at least 40% of all permissible prescriptions

(d)(5) maintain active medication list

(d)(6) maintain active allergy list

(d)(7) record particular demographics

(d)(8) record specific vital signs, including BMI and capability for growth charts

(d)(9) record smoking status

(d)(10) report ambulatory clinical quality measures to CMS or your State Medicaid EP (though the specifics are not provided here)

(d)(11) implement a clinical decision support rule

(d)(12) provide an electronic copy of health information to patient on request

(d)(13) provide patient clinical summaries at each patient visit

(d)(14) prove capability to exchange key clinical information electronically by performing at least one test of this capability

(d)(15) protect protected health information by complying with the risk assessment and risk reduction guidance in the HIPAA security rule, at 45 CFR § 164.308.

Eligible professionals also must pick and implement five of the following:

(e)(1) implement drug-formulary checking

(e)(2) incorporate lab test results into EHR

(e)(3) generate patient lists by specific conditions for quality improvement, research, outreach

(e)(4) patient preventive care reminders

(e)(5) provide patients with timely access to their health information

(e)(6) provide patients with patient-specific education resources

(e)(7) perform medication reconciliation when a patient is received from another setting of care

(e)(8) provide summary of care for patients referred or transitioned to another care setting

(e)(9) prove ability to exchange immunization data with an electronic registry

(e)(1) prove ability to exchange surveillance data with an electronic registry.

Some of the above are new, and some of the previous draft standards were dropped (such as a requirement to use electronic insurance eligibility or submit claims electroncially, which are typically under the purview of a practice management system, but not typical of an EHR).

Prospective EHR vendors should be able to show you how they will aid you in complying with these requirements, and a reputable EHR vendor should be willing to put its compliance efforts into its contract for sale and implementation.  If you already have an EHR vendor that you use today, now is the time to start the conversation on compliance with these requirements.  Expect more news on this very important regulatory topic soon.

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Maryland technology attorney and college professor.

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