Are the Meaningful Use criteria set by the ONC too strict? Too complicated? Too… frustrating?
These are questions being asked by thousands of providers, hospitals, clinics, and healthcare networks across the country. I’m a big believer in reviewing the basics, both for the benefit of my readers and my own education. Meaningful Use was one of the big themes at this year’s HIMSS11 conference, but I think it’s a topic that’s worth re-examining in light of the recent criticism aimed at the complexity and strictness of the MU criteria.
Here are some of the core elements of of the Meaningful Use criteria. These are the elements that I think will give providers the most trouble.
Computerized Physician Order Entry
Criteria– More than 30% of unique patients with at least one medication in their medication list seen by the EP
have at least one medication order entered using CPOE.
Possible Issues– Many providers already use some form of CPOE, but the systems they currently use may not be ONC certified. For those not currently using a CPOE system, they will have to adapt to the workflow changes quickly, in ways that may not have been explained to them yet.
Access to Electronic Copies of Medical Records
Criteria– More than 50% of all patients of the EP who request an electronic copy of their health information are provided it within 3 business days.
Possible Issues– Many patients have records which span multiple volumes. The quickest way to make this information available is to scan the documents as images, and give the patient a CD with their records. However, this entire process will need to be re-done in order to integrate the patient data into their EHR in a useful way. The criteria requiring a summary of patient visits is much more reasonable, because that information can be taken directly from a newly implemented EHR system.
Criteria– Conduct or review a security risk analysis per 45 CFR 164.308 (a)(1) and implement security updates as necessary and correct identified security deficiencies as part of its risk management process.
Possible Issues– Even if an EHR system has been certified as secure, there may be additional security issues that arise. Many physicians access EHR/EMR systems from home, so even if the setup is secure in their practice, there may be additional risks involved. If the providers do not have a secure system in place on their home computers, your medical records might end up online.
Integrating Structured Data
- More than 40% of all clinical lab tests results ordered by the EP during the EHR reporting period whose results are either in a positive/negative or numerical format are incorporated in certified EHR technology as structured data.
- For more than 50% of all unique patients age 2 and over seen by the EP, height, weight and blood pressure are recorded as structured data
Possible Issues– I’m really excited about the integration of structured data into EHRs. I think this is an area that will really streamline workflows by eliminating redundant information. However, the transition from the unstructured data we currently have to structured data is going to be a challenge, but Dr. John Halamka provided some insight into what will be necessary to achieve this in his recent post, “Freeing The Data“:
“Today’s certified EHRs provided structured vocabularies and specific pulldowns/checkboxes for data entry, but what do we do about past data? Ideally, we’d use natural language processing, probability, and search to examine unstructured text in the patient record.”
In summary, there are many hurdles that must be overcome in order to achieve Meaningful Use, and we need to make sure that providers have the resources available to make it as easy and painless as possible. We should also be recognizing the great work being done by Physician Champions, providers leading the way in EHR adoption. The more superusers we have in the field, the quicker we can achieve the goals set out by the ONC and achieve Meaningful Use in a way that streamlines the healthcare industry and creates value for patients. Because, in the end, patient health and safety is what it’s all about.