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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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What clinical management capabilities (e.g., patient lists) will I need to implement?

The core objectives for Stage 1 require the implementation of certified technology to maintain up-to-date patient lists.  The three required patient lists are:  

1. Problem lists

  • Core Objective for Eligible Professionals and Eligible Hospitals:  Maintain an up-to-date problem list of current and active diagnoses.
  • Measure:  More than 80 percent of all unique patients seen by an eligible professional or admitted to an eligible hospital’s inpatient or emergency department have at least one entry (or an indication that no problems are known for the patient) recorded as structured data.  

2. Medication lists

  • Core Objective for Eligible Professionals and Eligible Hospitals:  Maintain an active medication list.
  • Measure:  More than 80 percent of all unique patients seen by an eligible professional or admitted to an eligible hospital’s inpatient or emergency department have at least one entry (or an indication that the patient is not currently prescribed any medication) recorded as structured data.  

3. Medication allergy lists

  • Core Objective for Eligible Professionals and Eligible Hospitals:  Maintain active medication allergy list.
  • Measure:  More than 80 percent of all unique patients seen by an eligible professional or admitted to an eligible hospital’s inpatient or emergency department have at least one entry or (or an indication that the patient has no known medication allergies) recorded as structured data.  

All certified EHRs will enable a user to electronically select, sort, retrieve, and generate lists of patients according to, at a minimum, the data elements included in your: (1) problem lists; (2) medication lists; (3) demographics; and (4) laboratory test results.  

To fulfill these objectives, at least 80 percent of all unique patients must have at least one entry.  If there is no entry, there should be an indication that the patient has no known problem, medications, or medication allergies.  This entry or indication must be recorded as structured data.  Your EHR should provide you with the ability to enter this information in a format that can be recognized electronically and correctly categorized.  For example, if the patient is on aspirin, then that information should be in the EHR so that it can be automatically identified as a medication and not as an order, note, or anything else.  Typically, the name of the medication is entered from a pull-down menu or typed in or converted to a standardized spelling or abbreviation.  This ensures that the data can be useful and clearly understood by other providers and can be used to target individual patients or disease populations.  

Also, the menu set includes one objective that pertains to patient lists.  

Menu Objective for Eligible Professionals and Eligible Hospitals:  

  • Generate lists of patients by specific conditions to use for quality improvement, disparity reduction efforts, research or outreach.  

Measure:  

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

These clinical management capabilities support a practice-based population health (PBPH) approach to care.  PBPH uses information on a group of patients within a practice (or group of practices) to improve the care and outcomes of patients within that practice.  Providers could generate lists of patients with depression, diabetes, or obesity, for example.  The list could then be used by the provider to better manage their patient population.  Although it is not required that providers use these list to manage their patient population, the ability to generate patient lists according to specific patient characteristics is critical to the practice-based population health approach.  Module 5 provides more information on public health and population-based health objectives.

Related Resources:

Quality Improvement and Disparities Data – AHRQ presentation outlining health disparity issues and methods of addressing these issues.
2009 National Healthcare Quality and Disparities Reports – AHRQ’s 2009 report on healthcare quality and disparities: the report looks at quality, effectiveness of healthcare, timeliness of care and several other variables.
Roadmaps for Clinical Practice: A Primer on Population-Based Medicine go to exit disclaimer– This report by the American Medical Association (AMA) introduces the concept of population-based medicine as a strategy to reduce health disparities and support disease prevention and health promotion.
Practice-Based Population Health: Information Technology to Support Transformation to Proactive Primary Care – This AHRQ report produced by NORC discusses how improvements in information technology can improve patient care.
The Next Step in Population Health: The Indian Health Service’s iCare Program go to exit disclaimer– This presentation provides an overview of the Indian Health Service’s resource and patient management system, iCare.
Who is at Risk? Patient Identification and Outreach go to exit disclaimer– Presentation by Kwame Kitson, Institute for Family Health, on Meaningful Use of Health IT data, patient identification, and outreach.

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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