First, what is meaningful use? For me it has two definitions.
A couple of months ago I was explaining to my wife the definition of EHR “meaningful use” over dinner. She was nodding her head and seemingly listening more intently than normal to my work-related subject. As soon as I was done talking, she quickly said she really liked the phrase “meaningful use.” Then she advised me to make “meaningful use” of the lawnmower and cut the grass. Not only do I hear this phrase consistently at work, it now follows me home.
However CMS defines meaningful use as a method to prove that providers are using an EHR to the CMS standards. Until recently the government was very unclear on these standards. CMS was telling the healthcare industry to get moving now, but they failed to list what the objectives are. I equate it to someone telling you to get in your car and drive without telling you the destination or the direction. Then on July 13, 2010, CMS released its final rule which clarified the vast realm of questions on the incentive program.
In typical government fashion, the final rule document released consisted of 864 pages. Unless reading encyclopedias is your thing, I would skip to the fact sheets versions on the CMS website. Below are some links to the fact sheets that I am referring to:
- CMS FINALIZES DEFINITION OF MEANINGFUL USE OF CERTIFIED ELECTRONIC HEALTH RECORDS (EHR) TECHNOLOGY
- CMS FINALIZES REQUIREMENTS FOR THE MEDICARE ELECTRONIC HEALTH RECORDS (EHR) INCENTIVE PROGRAM
- CMS FINALIZES REQUIREMENTS FOR THE MEDICAID ELECTRONIC HEALTH RECORDS (EHR) INCENTIVE PROGRAM
- MEANINGFUL USE
An important side note is that the measures that you see are just stage 1 measures. There are a total of 3 stages and each stage is increasingly more difficult. You have to meet all three stages if you want a full stimulus payment.
The final rule on EHR meaningful use is broken down into 2 sections. The first category is for core measurements that every eligible provider must demonstrate and report. These core measurements consist of 15 items. I have categorized these core items into the sections of “no brainers,” “some work may be required,” and “what was CMS thinking?”
The “no brainers” are core measurements that any decent EHR should do automatically for you, or things I am sure that you are already doing. These include things like drug allergy checking, recording demographics, maintaining medication list, smoking status, maintaining problem lists, and maintaining allergy lists. With very little work you should be able to cross these off your list.
Other measures might require some new tools or processes to be put into place. These include things like clinical decision support rules, reporting of quality measures (PQI ), providing clinical summaries to patients in 3 days, IT security risk analysis, and using CPOE for medications.
Lastly “what was CMS thinking?” measures might be more difficult for your practice. Measures such as recording vitals in the EHR are not hard for any software application, but many specialists don’t take every vital. For example, dermatology practices who see a lot of teenagers would be required to do things like growth charts and BMI charting. This could affect the efficiency of a specialty practice. I also think it is interesting that doctors of dental medicine and surgery are eligible providers, but it is almost impossible with these core measures for them to meet the meaningful use standards. The focus of these measures is clearly on primary care.
Another difficult measure requires patients to be provided with their record electronically when requested. This will require something like a patient web portal, or at a minimum burning CDs for patients. Also one of the core measures is to exchange clinical information electronically. This will be a valuable function, but you will have to rely on what your software vendor and state can do. How difficult these items are will depend heavily on your software vendor, budget, and specialty.
The second CMS category is titled menu measurements which consist of 10 items. A provider must pick 5 of the measurements to report on .The flexibility of picking 5 out of the 10 was a nice surprise from the initial model of all or nothing. The menu measurements on average are more difficult than the core measures so choose wisely. I will save the menu measure for a later discussion.
In the first reporting year (which is 2011) you have 90 days to attest and report these measures. You can pick any 90 day window in 2011 for the reporting. In the following years you will be required to report on the entire year.
Now that practices have the final Stage 1 measures you need to make the decision if you are going after this money or not. For me I have decided to make “meaning use” of the lawnmower and cut the grass.
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