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H H S Department of Health and Human Services
U.S. Department of Health and Human Services
Health Information Technology and Quality
Improvement

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Introduction

Meaningful use of electronic health records (EHRs) can help improve the quality, as well as the safety and efficiency of care.  Meaningful use of EHRs can help providers and hospitals to improve the diagnosis and treatment of acute and chronic conditions, eliminate unnecessary testing, generate reminders, and reduce medical errors.  EHR technologies can also support the recording of patient health information in a structured electronic format, which allows the information to be shared among providers and the data to support patient management by disease status or demographic characteristics.  EHRs that are certified for the Medicare and Medicaid EHR Incentive Programs (also called ”Meaningful Use” throughout this toolkit) are also be capable of computerized physician order entry (CPOE), electronic prescribing (e-Rx), and clinical decision support, all of which should bolster providers’ clinical capabilities, promote evidence-based decision making, and reduce health disparities.  Lastly, Meaningful Use of EHRs can promote effective and efficient communication between providers and patients and reduce the administrative time providers spend on paperwork.  

This module, addresses the requirements for Priority #1, “Improving quality, safety, efficiency and reducing health disparities.”  Of the five Meaningful Use health policy priorities, this policy priority is the broadest.  It has the largest number of objectives and measures, with 11 core functional measures for eligible professionals and 10 for eligible hospitals.  In addition, four of the menu set objectives and measures (out of ten that providers may select from) pertain to this health policy priority.  The table below lists the objectives and measures specific to this priority.  The first and introductory module of this toolkit explains the types of measures and the number of measures that must be reported to demonstrate Meaningful Use.    

Health Policy Priority:  Improve quality, safety, efficiency, and reducing health disparities Stage 1 Objectives and Measures

Objective

 

Eligible Professional

Eligible Hospital

Measure

Core Set

Use CPOE for medication orders directly entered by any licensed healthcare professional who can enter orders into the medical record per state, local and professional guidelines

 

Use CPOE for medication orders directly entered by any licensed healthcare professional who can enter orders into the medical record per state, local and professional guidelines

 

More than 30% of unique patients with at least one medication in their medication list seen by the eligible professional or admitted to the eligible hospital's inpatient or emergency department have at least one medication order entered using CPOE

 

Implement drug-drug and drug-allergy interaction checks

 

Implement drug-drug and drug-allergy interaction checks

 

This functionality has been enabled

 

 

Generate and transmit permissible prescriptions electronically (eRx)

 

 

More than 40% of all permissible prescriptions written by the eligible professional are transmitted electronically using certified EHR technology

 

Record demographics

  • preferred language
  • gender
  • race
  • ethnicity
  • date of birth

Record demographics

  • preferred language
  • gender
  • race
  • ethnicity
  • date of birth
  • date and preliminary cause of death in the event of mortality in the eligible hospital or CAH

More than 50% of all unique patients seen by the eligible professional or admitted to the eligible hospital's emergency department have demographics recorded as structured data

 

Maintain an up-to-date problem list of current and active diagnoses

 

Maintain an up-to-date problem list of current and active diagnoses

 

More than 80% of all unique patients seen have at least one entry or an indication that no problems are known for the patient recorded as structured data

 

Maintain active medication list

 

Maintain active medication list

 

More than 80% of all unique patients seen have at least one entry (or an indication that the patient is not currently prescribed any medication) recorded as structured data

 

Maintain active medication allergy list

 

Maintain active medication allergy list

 

More than 80% of all unique patients seen have at least one entry (or an indication that the patient has no known medication allergies) recorded as structured data

 

Record and chart changes in vital signs:

  • Height
  • Weight
  • Blood pressure
  • Calculate and display BMI
  • Plot and display growth charts for children 2-20 years, including BMI

Record and chart changes in vital signs:

  • Height
  • Weight
  • Blood pressure
  • Calculate and display BMI
  • Plot and display growth charts for children 2-20 years, including BMI

More than 50% of all unique patients age 2 and over seen have height, weight and blood pressure are recorded as structured data

 

 

Record smoking status for patients 13 years old or older

 

Record smoking status for patients 13 years old or older

 

More than 50% of all unique patients 13 years old or older seen have smoking status recorded as structured data

 

Implement one clinical decision support rule relevant to specialty or high clinical priority along with the ability to track compliance that that rule

 

Implement one clinical decision support rule related to a high priority hospital condition along with the ability to track compliance with that rule

 

One clinical decision support rule is implemented

 

Report ambulatory clinical quality measures to CMS or the States

 

Report hospital clinical quality measures to CMS or the States

 

For 2011, provide aggregate numerator and denominator, and exclusions through attestation

 

For 2012, electronically submit the clinical quality measures

 

Menu Set

Implement drug-formulary checks

 

Implement drug-formulary checks

 

This functionality is enabled and provides access to at least one internal or external drug formulary

 

 

Record advance directives for patients 65 years old or older

 

More than 50% of all unique patients 65 years old or older have an indication of an advance directive status recorded

 

Incorporate clinical lab-test results into certified EHR technology as structured data

 

Incorporate clinical lab-test results into certified EHR technology as structured data

 

More than 40% of all clinical lab tests results ordered for patients 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

 

Generate lists of patients by specific conditions to use for quality improvement, reduction of disparities, research or outreach

 

Generate lists of patients by specific conditions to use for quality improvement, reduction of disparities, research or outreach

 

At least one report listing patients with a specific condition is generated.

 

Send reminders to patients per patient preference for preventive/ follow up care

 

 

More than 20% of all unique patients 65 years or older or 5 years old or younger were sent an appropriate reminder during the EHR reporting period

 

Excluded is any eligible professional who has no patients 65 years old or older or 5 years old or younger

 

     

To meet and report these objectives and measures, providers must use EHR technologies that meet the certification standards set by the Office of the National Coordinator for Health IT (ONC).  As some of the objectives and measures require that 80 percent of unique patients have records in the EHR, providers should strive to use their EHR for all of their patients.  Most of these objectives and measures require that you report on only those patients that have a record in the EHR; only two allow to you to report on patients that do not a have an electronic record.  

It is important to note that information that is recorded in the EHR for the purpose of stage 1 Meaningful Use objectives must be formatted as structured data.  Structured data is information that is organized by a standardized vocabulary and can be reported into discrete chunks (as opposed to unstructured data, also called “free text,” which cannot be manipulated and is difficult to share with others electronically).  For example, so that a diagnosis is entered the same way each visit and for each patient, it should be typed in a consistent way, converted by the system to a standard term, or entered from a pull-down menu.  Structured data is necessary to meet the goals of Meaningful Use, Stage 1, which is to capture electronic data and share information.  Structured data is also a prerequisite for advanced functionalities (like clinical decision support and clinical quality measurement) that may be necessary for Meaningful Use Stages 2 and 3.  

The objectives of Priority #1, “Improving quality, safety, efficiency and reducing health disparities,” include initiatives to maintain up-to-date patient information, such as current diagnoses, drug regimens, demographics, allergies, and smoking status.  They also promote the electronic transfer of this information to other medical providers and to state government health agencies.  Each of the questions in this module addresses a Priority #1 objective and measure.  An additional question provides information on how to calculate and report on these objectives and measures.  Links to related resources follow this introduction and responses to the questions.  

This module discusses the quality related functional objectives and clinical quality measures required for Meaningful Use.  It poses and answers questions related to the Meaningful Use requirements for computerized physician order entry, clinical decision support, clinical management, electronic prescribing, patient demographics and reminders, clinical documentation, and electronic lab exchange.  Also addressed are the required clinical quality measures.  How to calculate and report these objectives and measures is also included.

Related Resources:

EHR Incentive Program – CMS’ official website for Meaningful Use.  Includes background information, eligibility criteria, and requirements for demonstrating Meaningful Use.
Standards and Certification for EHRs – Office of National Coordinator for Health IT’s website on certification criteria and standards to support Meaningful Use.  Includes links to the Final Rule, facts-at-a-glance, and frequently asked questions.
Crossing the Quality Chasm: A New Health System for the 21st Century go to exit disclaimer– Institute of Medicine study that documents the causes of the quality gap, identifies current practices that impede quality care, and explores how health IT approaches can be used to implement change.
Quality Improvement with an Electronic Health Record: Achievable but Not Automatic go to exit disclaimer– Annals of Internal Medicine article that highlights critical elements for success beyond the adoption of the EHR, including physician appreciation of structured data, the need for widespread adoption of standards, and a restructuring of the primary team with additional resources.
Systematic Review: Impact of Health Information Technology on Quality, Efficiency, and Costs of Medical Care go to exit disclaimer– Annals of Internal Medicine article on the experiences of four benchmark institutions that demonstrated the efficacy of health IT in improving quality and efficiency.
Health Information Technology for Improving Quality of Care in Primary Care Settings – Agency for Healthcare Research and Quality (AHRQ) publication examining the link between health information technology and quality improvement in a range of primary care settings.
The Underserved and Health Information Technology: Issues and Opportunities go to exit disclaimer– Analysis of the opportunities for use of health IT to improve underserved populations’ health outcomes and barriers to health IT’s implementation.
Identifying and Addressing Health Disparities go to exit disclaimer– Presentation by Geniene Wilson, ECRIP Fellow of the Institute for Family Health, discusses electronic demographic data collection and the use of these data to comply with Meaningful Use objectives to reduce health disparities.  

Developed by the Health Resources and Services Administration as a resource for health centers and other safety net and ambulatory care providers who are seeking to implement health IT.
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