How does Meaningful Use impact health IT for oral health?
In order to qualify for Meaningful Use incentive payments, EPs, including dentists, must use an EHR that is certified and that meets the criteria established under the final EHR certification rule. A certified EHR is defined as a qualified EHR that meets criteria developed by ONC to ascertain that the technology meets standards and implementation specifications. Subsequently, a qualified EHR is defined as an electronic record of health-related information on an individual that includes patient demographic and clinical health information, such as medical history and problem lists; and has the capacity to do the following: 1. Provide clinical decision support; 2. Support physician order entry; 3. Capture and query information relevant to health care quality; and 4. Exchange electronic health information with, and integrate such information from other sources. For dentists, finding a certified dental EHR is particularly challenging, as there is a limited number of either certified dental EHRs or certified EHRs which offer dental modules. The available certified products are discussed further here. In addition, EPs must be able to report on performance measures that have been identified by CMS to support the achievement of Meaningful Use Stage 1 under the Medicare and Medicaid EHR Incentive Programs.
In order to qualify as a meaningful user for purposes of Medicaid EHR incentive payments, dentists would need to collect patient information, such as vital signs, that currently is not routinely collected during most dental visits. As stated in the Meaningful Use Final Rule, to account for the possibility that these measures are not applicable to EPs, such as dentists, there is an option to report that specific objective measures do not apply to these providers. However, exclusion of this type (based on specific objective measures) will subsequently reduce the number of core measures that apply for these providers. While only certain quality measures will apply to dentists to sufficiently meet Stage 1 of Meaningful Use, subsequent stages of Meaningful Use requirements may be more relevant to certain provider groups, including dentists.
Despite these challenges, an oral health provider who is eligible for the EHR Incentive Programs as detailed by the CMS eligibility requirements, and who meets the Medicaid 30% criterion discussed above can use the Medicare and Medicaid EHR Incentive Program Attestation and Registration System to register and attest to Meaningful Use. To assist with this process, CMS provides details on registering for the EHR Incentive Programs, including step-by-step guides to attestation.
There are other challenges associated with the adoption of health IT among oral health providers, including lack of dental specific diagnostic codes, which is discussed in the Institute of Medicine’s April 2011 Report Advancing Oral Health In America. Although there are several diagnostic code sets available for oral health (such as the ADA’s SNODENT), the IOM report points out that they have not been put into general use or are not yet available to the general public. Many of these and other challenges faced by oral health providers when it comes to Meaningful Use are discussed in detail in a 2011 Background and Final Report from the Agency for Healthcare Research and Quality that focus on Quality Oral Health Care in Medicaid.
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