Posted September 26, 2017 by admin in articles
 
 

Meaningful Use: all three stages overview

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Article written by Alexandra Riabtsun, Marketing Manager for Glorium Technologies (https://gloriumtech.com), a custom software development company with a focus on healthcare

The MU Stage 1

The MU Stage 2

The MU Stage 3

Electronic Health Records Incentive Programs promote meaningful use of certified EHR technology (CEHRT) among eligible hospitals (EHs), eligible professionals (EPs), and critical access hospitals (CEHRT). They were established by the Centers for Medicare & Medicaid Services (CMS).

If EPs achieve all the Meaningful Use (MU) objectives, they can qualify for the EHR Incentive Programs. There are three stages of the MU. The first Stage covers the electronic data capture. The second Stage outlines the CEHRT use for continuous point of care  improvement and structural formatted information exchange. The third Stage modifies the second one and is focused on the health outcomes improvement.

There are five patient-driven objectives in the MU.

  1. Quality, safety, and efficiency improvement.
  2. Patients and their families engagement.
  3. Care coordination improvement.
  4. Public and population health improvement.
  5. Privacy and security for personal health information assurance.

The main goal is to achieve better clinical outcomes, improve population health outcomes, increase transparency and efficiency, empower individuals, and promote more robust research data on health systems.
The MU Stage 1

Core Objectives:

  • to employ computerized provider order entry (CPOE) for medication orders (more than 30 percent of unique patients with at least one medication and at least one medication order entered through CPOE);
  • to conduct drug-drug and drug-allergy check ;
  • to lead a continuously updated problem list of current and active diagnoses (minimum 80 percent of unique patients with corresponding notes recorded as structured data);

to produce and transfer electronic permissible prescriptions (eRx) (more than 40 percent of permissible prescriptions electronically transmitted);

  • to sustain active medication and medication allergy list (minimum 80 percent of unique patients with medication info and allergy info recorded as structured data);
  • to register demographics information, like preferred language, gender, race, ethnicity, and date of birth (more than 50 percent of unique patients with demographic records as structured data);
  • to track and register vital signs changes, like height, weight, blood pressure, body mass index, growth charts for children 2-20 years (more than 50 percent of unique patients with vital signs records as structured data);
  • to register smoking status for patients older than 13 years (more than 50 percent of unique patients with smoking status recorded as structured data);
  • to state ambulatory clinical measurements to CMS;
  • to perform one clinical decision support rule;
  • to arrange electronic copy of their health information upon request for patients (more than 50 unique patients requested get such a copy within three business days);
  • to arrange clinical summary of their office visits for patients (clinical summaries provided for over 50 percent of office visits);
  • to secure EHR information by conducting security risk analysis under 45 CFR 164.308(a)(1);

Menu Objectives

  • to employ drug formulary checks
  • to include lab test results into EHR as structured data (more than 40 percent of lab results);
  • to create lists of patients according to their specific conditions;
  • to provide patients with reminders (65 years or older or 5 years of younger) for preventive/follow-up care (more than 20 percent of appropriate patients);

to arrange access to their health information within 4 business days for patients (at least than 10 percent of unique patients);

  • to define patient-specific education resources through certified EHR and provide patients with it if necessary (more that 10 percent of all unique users);
  • to employ medication reconciliation if a patient comes from another point of care (for more than 50 percent of care transitions);
  • to arrange care record summary when transiting a patient (more than 50 percent of transitions and follow-up submission if successful);
  • to submit electronic data to immunization information systems and perform it when applicable by law and practice (at least one test performed);
  • to transfer electronic syndromic surveillance data to public health agencies and perform it when applicable by law and practice (at least one test performed and follow-up submission if successful).

The MU Stage 2

Core Objectives:

  • to employ computerized provider order entry (CPOE) for medication, laboratory, and radiology orders (more than 60 percent of medication, 30 percent of laboratory, and 20 percent of radiology order entries);
  • to produce and transfer electronic permissible prescriptions (eRx) (more than 50 percent of permissible prescriptions electronically transmitted are compared to at least one formulary);
  • to register demographics information, like preferred language, sex, race, ethnicity, and date of birth (more than 80 percent of unique patients with demographic records as structured data)
  • to track and register vital signs changes, like height/length and weight (no age limit), blood pressure (years 3 and older), body mass index, growth charts for children 0-20 years (more than 80 percent of unique patients with vital signs records as structured data);
  • to register smoking status for patients older than 13 years (more than 80 percent of unique patients with smoking status recorded as structured data);
  • to perform clinical decision support rules (5 clinical support interventions related to 4 or more clinical quality measures; the EP has drug-drug and drug-allergy interaction functionality enabled);
  • to arrange ability to electronically view, download, and transmit health information within 4 business days for patients (more than 50 percent of unique patients are timely provided with access to health information; more than 5 percent of unique patients can view, download, or transmit their health information);
  • to arrange clinical summary of their office visits for patients (clinical summaries provided for over 50 percent of office visits within one business day);
  • to secure EHR information by conducting security risk analysis under 45 CFR 164.308(a)(1), including addressing the encryption/security of data at rest
  • to include lab test results into EHR as structured data (more than 55 percent of lab results);
  • to create lists of patients according to their specific conditions (became the core objective);
  • to define patients using clinically relevant info who should get reminders for preventive/follow-up care (more than 10 percent of all unique patients who have had 2 or more office visits within the EP within 24 month before the beginning of EHR reporting period);
  • to define patient-specific education resources through certified EHR and provide patients with it if necessary (more that 10 percent of all unique users) (became the core objective);
  • to employ medication reconciliation if a patient comes from another point of care (for more than 50 percent of care transitions) (became the core objective);
  • to arrange care record summary when transitioning a patient (more than 50 percent of transitions and follow-up submission if successful; more than 10 percent of such transitions are electronically transmitted with CEHRT; the recipient receives a summary record via exchange facilitated by organization participating in NwHIN Exchange or in a way consistent with the governance mechanism ONC establishes for the NwHIN) (became the core objective);
  • to submit electronic data to immunization information systems and perform it when applicable by law and practice (successful ongoing submission of electronic immunization data from CEHRT to immunization information system for the entire EHR reporting period) (became the core objective);
  • to employ secure electronic messaging (more than 5 percent of unique patients sent a secure message using CEHRT);

Menu Objectives:

  • to submit electronic syndromic surveillance data to public health agencies and perform it when applicable by law and practice (successful ongoing submission for the entire EHR reporting period);

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  • to track electronic notes in patient records (at least one created, edited, signed electronic note for more than 30 percent of unique patients; the text sent must be searchable and may contain drawings and other content);
  • to attach imaging results with image and supporting and explaining content to the CEHRT (more than 10 percent of tests with image results accessible through CEHRT);
  • to track patient family health history as structured data (more than 20 percent of unique patients have a structured data entry for one or more first-degree relatives);
  • to define and track cancer cases and transfer them to a public health central cancer registry (successful ongoing submission for the entire EHR reporting period);
  • to define and track specific cases and transfer them to a specialized registry (successful ongoing submission for the entire EHR reporting period).

The MU Stage 3

  • to secure electronic protected health information in CEHRT with technical, administrative, physical safeguards (a security risk analysis in accordance with the requirements under 45 CFR 164.308(a)(1), 45 CFR 164.312(a)(2)(iv) and 45 CFR 164.306(d)(3));
  • to create and transfer permissible prescriptions electronically (eRx) (more than 60 percent of prescriptions queried for a drug formulary and transmitted electronically using CEHRT);
  • to employ clinical decision support rules (5 clinical support interventions related to 4 or more clinical quality measures; if less than four — support intervention must be related to high-priority health conditions the EP has drug-drug and drug-allergy interaction functionality enabled);
  • to employ CPOE for medication, laboratory, and diagnostic imaging orders (more than 60 percent of medication, laboratory, diagnostic imaging orders);
  • to arrange timely electronic access to their health information and patient-centric education for patients (more than 80 percent of unique patients are timely provided with access to health information; the information must be available on any application of patient choice if it meets technical configurations of CEHRT API;
    more than 35 percent of unique patients must get access to patient-specific educational resources identified by relevant information from CEHRT);
  • to employ CEHRT to engage with patients about their care (more than 5 percent of unique patients can view/download/transmit their health information, access health information through API with application of their choice; for 2018 – more than 10 percent;
  • to provide more than 5 percent of unique patients with secure messaging through corresponding function in CEHRT for 2018 – more than 25 percent;
    more than 5 percent of unique patients have  patient generated health data or data from a nonclinical setting included to CEHRT);
  • to arrange care record summary when transitioning a patient and receive and incorporate a summary of care record after receipt of new patient (more than 50 percent of transitions and follow-up submission if successful;
    more than 40 percent of transitions and new patients have their electronic summary of care document incorporated into EHR;
    more than 80 percent of transitions and new patients have their clinical information reconciled, such as medication, medication allergy, and current problem list.

to get actively involved to a public health agency or clinical data registry to submit electronic public health data in a meaningful way using certified EHR technology.
Public health agencies and clinical data registries: immunization registry, syndromic surveillance, electronic case reporting, public health registry, clinical data registry.

 

 



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