The next five years will be vital in the adoption of electronic health records and the expansion of health information technology. The meaningful use of EHR’s is now being defined through the HITECH Act, and its definition will determine who qualifies for incentive payments from CMS.
This is part two in a three-part part series on the meaningful use of health information technology.
• Part 1: Eight goals behind HIT Standards and how your clinic is prepared
• Part 2: How chiropractors will accomplish meaningful use of a certified EHR system
• Part 3: How incentives will be paid out over the next five years and what you will need to achieve to qualify
Using this article
Some comments are speculative. CMS and the Office of the National Coordinator for Health Information Technology (ONC) have published a proposed rule for what defines meaningful use of EHR’s. There are 25 major items in this proposed rule. There may be a few details below which have changed due to continuous CMS collection.
Refer to the full publication while reading this summary: http://www.futurehealthsoftware.com/quickFacts.html.
The proposed rule is broken into 3 Categories:
1) Improving technology
2) Improving outcomes
3) Objectives which may not relate to chiropractic practice
Category 1: Improving Technology 1. Computerized Physician Order Entry (CPOE) is used for management of medications, lab results, imaging, provider referrals, and patient visits. CPOE is a term used to describe doctors who store and manage their patient records electronically. CMS Standards: EHR must fulfill 80% of a doctor’s orders.
2. Incorporate lab test results into the patient's electronic health record as structured data. CMS Standards: 50% of patient files in the EHR must include the patient’s data along with accepted and performed lab tests.
3. Maintain a current patient problem list based on ICD9 or SNOWMED CT. CMS Standards: 80% of unique patient visits must be listed via EHR.
4. Record patient demographics. These include race, language preference, gender, ethnicity, and date of birth. CMS standards: 80% of all patients must have demographics recorded.
5. To exchange patient health information among providers and authorized third parties. Your clinic must have the capabilities to send and receive all patient health information via your state’s health information exchange. CMS Standards: demonstrate this capability for at least one piece of patient health information, with the ability to send and receive information on 80% of all patients referred in or referred out.
6. Submit claims electronically to public and private payers for at least 80 percent of all claims filed electronically by the eligible professional.
7. Provide patients with an electronic copy of health information. CMS standards: the ability to deliver secure, encrypted, functional electronic copies of records to at least 80% of your practice who request such a record.
8. Offer patients electronic access to health information. According to CMS, at least 10% of your unique patient visits should have access to their information, primarily via the internet to their PHR.
9. Protect all patient information through necessary security and best practices. This includes data encryption, secure off-site storage, unique users and passwords, tracking of deletions and additions to the record, automatic log-outs, and recording of health information disclosures.
10. Other capabilities include: being able to check insurance eligibility electronically from public and private payers on 80% or more of unique patients and being able to submit claims electronically.
Category 2: Improving Outcomes
11. Create lists of patients identified by conditions. Storing patient demographics and maintaining an electronic problem list. This data will help improve outcomes and will prove the effectiveness of chiropractic care with more reliable data sets. CMS Standards: your clinic will have to generate one patient list based on a condition.
12. Electronically record vital signs, including BMI, and growth and development charts (for patients age 2 through 20.) Rather than just weighing in, EHR’s offer an interactive component to the patient, where they can see their Body Mass Index tabulated immediately, and eventually show how their weight is increasing their risk for chronic disease. 13. Provide summary care record for each transition of care and referral for at least 80 percent of the transitions.
14. Record smoking status for patients ages 13 and older. CMS Standards: smoking status data on at least 80% of patients. As smoking is closely linked to increased morbidity and mortality, there is going to be a new emphasis on smoking cessation in primary care settings, and that includes chiropractic offices.
15. Send care reminders to patients age 50 and over according to patient preference. Your EHR should be able to generate a list of patients who are 50+, their schedule of visits, and how they want to be reminded. CMS Standards: this must be accomplished on at least 50% of unique patients.
16. Provide clinical summaries to patients after an office visit. This will clarify patient instructions and summarize what happened in the office—two factors that may improve patient compliance. CMS Standards: summaries must be offered in 80% of all patient visits.
17. Report ambulatory quality measures to CMS. Improved reimbursement for care of Medicare patients has been available for providers offering voluntary reports of quality outcomes in their offices according to published care guidelines. CMS standards: information would need to be calculated and submitted electronically.
18. Implement and respond to five clinical decision-making support rules. Specialties within health care are encouraged to use their own particular care guidelines during the clinical decision-making process, which should appear in the EHR as care alerts. The practitioners’ agreement or disagreement with the alert is recorded in that particular case. 19. Maintain an active medication list.
20. Maintain an active medication allergy list.
21. Perform one test of EHR's ability to submit data to vaccine registries.
22. Alert public health surveillance systems for disease. While you might be asked to make sure your system can communicate with state registries, chiropractors don't offer vaccinations nor often provide primary care for infectious disease, so these two objectives (numbers 21 and 22) may not be seen as critical and are only required if you performed them.
Category 3: Objectives which may not relate to chiropractic practices 23. Generate and transmit prescription medications electronically in 75% of cases. Chiropractors will most likely be exempt.
24. Perform medication reconciliation at care transitions. It is important to know what medications your patient is on to understand what effects it might be having on their problem list. However, advising on medications other providers have prescribed is outside our scope of practice in most states.
25. The eligible professional has enabled functionality to implement drug-drug, drug-allergy, drug-formulary checks.
Putting it all together
Part 1 covered the why behind health information technology expansion, and now we've covered the 25 meaningful use items that determine if the use of your EHR is considered meaningful. Part 3 will outline what you need to achieve to get the highest reimbursement.
Steven J. Kraus, DC, is founder and CEO of Future Health¯the nation’s #1 provider of chiropractic-specific EHR/practice management software. He has more than 22 years’ experience in practice management and is an acknowledged expert in Heath IT, including EHR and the up-to-$44,000 ARRA government incentive. Dr. Kraus serves on numerous committees and frequently travels to Washington D.C. to represent chiropractic physicians in healthcare discussions and policymaking. To see a no-obligation Future Health software demo, call Toll Free 1-888-434-7347.