Meaningful Use Made Easy - Understanding Core Objectives

Meeting "meaningful use" is the key to receiving up to $63,750 in Medicaid stimulus money or $44,000 in Medicare money. Many small practices may already be using a certified electronic medical/health record (EMR/EHR) system. But, here's the problem. There's no road map! The vendors of the software merely guarantee the "Capability" of meeting meaningful use. It's up to the practice to actually accomplish it. Unfortunately, it's not easy.

Many practices have the software and aren't fully using it. Others, keep putting off implementation because they didn't believe the checks would come - and now they are. Yes, doctors are getting paid. So, basically, meaningful use is attainable. And, seriously, it's not as hard as you would think. This article will give you a break down on what you need to do.

First, find a 2011 certified EHR. You may contact me for a list of good ones: http://technologymanagementpros.com I'll be happy to steer you in the right direction. But, before you make a decision, you need to ask the vendor a lot of questions about the numerous objectives and how they deal with each one.

Once you do that, you need to purchase it, install it, get trained by the vendor and start using it. This is the hard part and can take months for larger practices, so if you want to get paid the full stimulus money, now would be a great time to start. But, once you're actually using it, the good news starts. To meet all the Meaningful Use objectives, the following tips will help:

Core Objectives:

1. Privacy and Security: By using certified solution, you meet measure one.

2. Maintain an up-to-date problem list: The physician must add a problem to the Patient Problem List. Or, note that the patient has no problems.

3. Maintain Active Medication List: 80% - of all Unique Patients - Add active Drug to Chart using eprescribing (eRX), moving drug from claims history to Active Meds, or go to indicate Patient has no Known Active Meds.

4. Perform Drug/Drug and Drug/Allergy Checking: This is automatic when using the eRX function. All good EHR's will do this automatically. (No measurable patient volume needs to be attested by a Yes/No answer.)

5. Maintain Active Medication Allergy List: 80% of all Unique patients - Add a drug allergy for each patient or indicate patient has No Known Allergies. Food allergies are not a requirement.

6. Record Demographics: 50% of all Unique patients: Must include: gender, date of birth, race, ethnicity, language. These are the only demographics that are required.

7. Use CPOE - 30% of Unique patients - Using eRX satisfies this requirement, even if the meds are entered as sample/handwritten.

8. Generate and transmit Permissible Prescriptions electronically: 40% of permissible prescriptions - Most EMR's merely track every prescription written within system. If you are using the eprescribing function of your EMR, this will be automatic.

9. Record and Chart Vitals: 50% of all unique patients greater than 2 years old - must include Height, Weight, and Blood Pressure - The system will calculate BMI. Enter vitals in SOAP note.

10. Record smoking status: for 13 years old or greater: 50% of unique patients - taken during demographics. This one is easy. Just add this to your workflow if it is not there.

11. Clinical Decision Support: Most EMR's will have a reporting function that tracks reports for numerous quality measures. Ask your vendor and make sure they are certified. If so, this is covered.

12. Provide patients with an electronic copy of their health information within 3 days of request: More than 50% of patients requesting data - Your EMR must have the ability to send info to USB, CD or a patient portal. If your patient has internet access, activate their patient portal. If not, use one of the other methods.

13. Provide clinical summaries: 50% of all SOAP Notes - Can be printed, done on USB, CD or sent to the patient portal. Basically, you must provide a visit summary. If they have the patient portal active, you don't need to do this. They can read it there. If not, you can print this at the end of the visit. You will need to adjust your workflow accordingly.

14. Report Quality Measures - Your EMR will have reports for this. For 2011, no target percentages are needed. Ask your vendor about quality measure reporting. As long as it is there, you merely need to attest to this for 2011.

15. Exchange Clinical Information Among Providers: The ONC requirements for this are simple. Your system has to be capable of it and have some way to test it. You don't have to actually do it. Your vendor will explain, and the certified EHR will have this capability. There's nothing you have to do in 2011.

Menu Set Objectives (You only need to meet five)

1. Drug Formulary Checking - If you are eprescribing, this one is automatic.

2. Medication Reconciliation: Done in ePrescribing - Dependent on claims history information - Done each time physician receives a patient referral. Basically, you check claims history and update your chart. This one takes effort and workflow change.

3. Incorporate Clinical Lab Results into a Patient Chart: 40% of lab test results: Quest automatically sends the lab into patient chart. If you use Quest, you meet this objective. This requires a lab interface (which you will pay for - or have Quest pay for). But, once this is in place it is automatic. So far, two of the first three are automatic.

4. Submit Data to Immunization Registries: Check with your vendor and find out how this is done. There should be a report that you can send to the Immunization Registries. It's a simple task and should probably be one of your menu set objectives.

5. Public Health Syndromic Surveillance: Physician would add a problem to Problem list - then flag problem as a reportable condition. Clinic would then fax form or send electronically to Public Health Entity. The problem with this one is the physician has to do some extra work, slowing down the flow. Maybe one you should initially skip.

6. Generate lists by specific Conditions: This is another report you need to ask your vendor about. Find out how easy this is done in each software package you look at. If it's easy, then you have another objective complete.

7. Supply with referral a Summary of Care record: 50% of referrals. Physician must choose the reason for sending the record as "referral." The record will be counted toward this measure.

8. Provide Patients with Timely, Online Access: Most EMR/EHR's have a patient portal. If they don't, and they are certified, then they have an interface with one of the available online Portals such as Google Health or Healthvault. Ask your vendor about this before you purchase. This should be an easy objective.

9. Provide Patient Education Materials: More than 10% of unique patients - Physician must mark in SOAP note (there is a prompt) that patient was supplied with educational material. Every EMR has some way of noting this. Your practice needs to insure this happens in your workflow.

10. Generate Patient Reminder Lists: 20% of population - Staff must enter patient reminders. There should be something in your EMR that does this. Most EMR's are very concerned with helping you improve our quality care with reminders. Have a discussion with your vendor about this.

As you can see, many of the objectives are automatic. Some require your front office or medical assistants workflow to change slightly. Some objectives are reports you have to send off. If your software is good, these will be easy. The tough ones are when your providers have to change their workflow. When choosing "Menu Set" objectives, keep that in mind.

If you have any questions, feel free to email me at jbricky @ technologymanagementpros.com.