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What order entry capabilities will I need to implement?

The use of EHR technology for computerized physician order entry (CPOE) is included in the Meaningful Use objectives. CPOE is the process whereby medical providers enter instructions for the treatment of patients using a computer application rather than via paper, fax or telephone.  CPOE systems allow providers to electronically enter medication orders and other orders, such as laboratory, radiology, and procedures.  These systems are regarded as a key technology for reducing medical errors (e.g., eliminating transcribing errors due to poor handwriting) and for improving the safety and efficiency of patient care.  CPOE technology often includes built in clinical decision support tools to aid in providing appropriate care.  Such tools provide checks for drug-to-drug interactions, allergies, medication contraindications, and medication dosage.  

The Meaningful Use core set of objectives require that two order entry-related capabilities be implemented.  These objectives and measures are:

1. Computerized physician order entry (CPOE)

    • Core Objective for Eligible Professionals and Eligible Hospitals: 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.
    • Measure:  More than 30 percent of unique patients with at least one medication in their medication list seen by the eligible professional or admitted to the eligible hospitals’ inpatient or emergency department have at least one medication order entered using CPOE.
    • Exclusion:  Any eligible professional who writes fewer than 100 prescriptions during the EHR reporting period.

The objective and measure above applies to Stage 1.  CMS has indicated that the Stage 2 CPOE measure will require that additional medication orders be entered using CPOE.  Meeting Stage 1 requirements will help your transition to Stage 2.     

2. Drug-to-drug and drug-allergy interaction checks

    • Core Objective for Eligible Professionals and Eligible Hospitals: Implement drug-drug and drug-allergy interaction checks.
    • Measure:  The eligible professional or eligible hospital has enabled this functionality for the entire EHR reporting period.  

All certified EHRs will allow a user to electronically record, store, retrieve, and modify medication orders.  The EHR will automatically and electronically generate and indicate real-time notifications for drug-drug and drug-allergy contraindications based on medication list, medication allergy list, and CPOE.  Under normal circumstances, once a medication is ordered and deemed appropriate based on drug-drug and drug-allergy interaction checks, an electronic message is sent to a pharmacy.  However, this last stage of electronic transmission of the order is not required as part of the CPOE goal for Stage 1.  Requirements around the transmission of prescription orders are covered under an objective for electronic prescribing, which we discuss later in Module 2.  

To be deemed a meaningful user in Stage 1, eligible professionals and eligible hospitals must report on the measures for both these CPOE objectives.  For the first order entry capability objective described above, more than 30 percent of a provider’s unique patients who receive medication must have at least one medication order entered using CPOE.  For Objective 2, the functionality for drug-drug and drug-allergy interaction checks must be enabled for the entire EHR reporting period.  As stated above, your certified EHR will automatically generate reports of these checks.  

3. Drug-formulary checks

    • Menu Objective for Eligible Professionals and Eligible Hospitals: Implement drug-formulary checks.
    • Measure:  The eligible professional or eligible hospital has enabled this functionality and has access to at least one internal or external drug formulary for the entire EHR reporting period.  
    • Exclusion: Any eligible professional who writes fewer than 100 prescriptions during the EHR reporting period.

A drug-formulary check electronically determines if a drug is on a formulary or preferred drug list.  To meet this optional objective, providers must report that drug-formulary checks are being done (answering ”yes” or ”no”) and that they have access to at least one internal or external drug formulary for the entire EHR reporting period.  

Although the measures for Stage 2 have not been finalized, it is anticipated that the threshold measures will be more stringent.  For Stage 2, the minimum threshold for CPOE may increase and drug-formulary checks may be required.

Related Resources:

Meaningful Use Final Rule – Federal Register notice of EHR Incentive Program Final Rule.  See pages 44370-44375 for a complete listing of the core and menu set objectives.
ONC Standards and Certification for EHRs – Information on certification criteria and standards to support Meaningful Use.  This website includes links to the Final Rule, facts-at-a-glance, and frequently asked questions.
Computerized Provider Order Entry – AHRQ website provides background information and additional resources on CPOE and other Health IT topics.
Hearing on Meaningful Use of Health IT go to exit disclaimer– Statement of David Blumenthal, National Coordinator for Health IT, before the Committee on Ways and Means, Subcommittee on Health on July 20, 2010.

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