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Meaningful Health Care Informatics Blog

Oct 1 2012   9:30PM GMT

A preview of what’s being considered as part of meaningful use stage 3



Posted by: RedaChouffani
HHS, Meaningful use, Meaningful use stage 2, MU 3, ONC, Stage 3

The Office of National Coordinator for Health IT and the Center for Medicare & Medicaid Services released the final requirements for stage 2 EHR incentive programs in August 2012.

Among the items that have been identified as part of the requirements in stage 2 were information exchange, care coordination, patient engagement, data encryption, and content standardization.

The health IT policy committee released its preliminary recommendations for meaningful use stage 3 in September 2012. There have several adjustments made to stage 2 as part of the initial recommendations for stage 3. The following is a list of some of the proposed measures:

Under the quality safety improvements, and reduction in health disparities, there have been the following changes:

  • More than 20% of referrals/transition of care orders created by the emergency physician (EP) or authorized providers of the eligible hospital’s or critical access hospital’s (CAH) inpatient or emergency department (place of service (POS 21 or 23)) during the electronic health record (EHR) reporting period are recorded.
  • More than 60% of medication, laboratory, and radiology orders created by the EP or authorized providers of the eligible hospital’s or CAH’s inpatient or emergency department (POS 21 or 23) during the EHR reporting period are recorded using computerized physician order entry (CPOE)
  • More than 30% of hospital discharge medication orders for permissible prescriptions (for new or changed prescriptions) are compared to at least one drug formulary and transmitted electronically using certified EHR technology
  • Capture of additional data as part of patient registration: sex, occcupation and industry codes, sexual orientation, gender identity, disability status
  • Implement 15 clinical decision support interventions that are presented at a relevant point in patient care for the entire EHR reporting period.
  • More than 80% of all clinical lab tests results ordered by the EP or by authorized providers of the eligible hospital or CAH for patients admitted to its inpatient or emergency department (POS 21 or 23) 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
  • More than 20% of all unique patients who have had an office visit with the EP within the 24 months prior to the beginning of the EHR reporting period were sent a reminder, per patient preference
  • More than 30% of medication orders created by authorized providers of the eligible hospital’s or CAH’s inpatient or emergency department (POS 21 or 23) during the EHR reporting period are tracked using electronic medication administration records (eMAR).
  • Record electronic notes in patient records for more than 30% of office visits within four calendar days.

The subgroups of the committee proposed the following recommendations for patient and family engagements:

  • EPs should make info available within 24 hours if generated during the course of a visit
  • For labs or other types of info not generated within the course of a visit, it is made available to patients within four business days of info becoming available to EPs
  • Signal potential for increasing both thresholds (% offer and % use) based on experience in stage 2
  • Offer 10% of patients the ability to amend information (e.g., offer corrections, additions or updates to their records)
  • More than 10% of patients use secure electronic messaging to communicate with EPs
  • Record communication preferences for 20% of patients, based on how (e.g., the medium) patients would like to receive information for certain purposes (including appointment reminders, reminders for follow up and preventive care, referrals, after visit summaries and test results).

Patient Coordination recommendations:

  • EP/emergency hospital (EH)/CAH to whom a patient is referred acknowledges receipt of external information and provides referral results to the requesting provider, thereby beginning to close the loop.
  • Measure:  For 10% of patients referred during an EHR reporting period, referral results generated from the EHR are returned to the requestor (e.g. via scan, printout, fax, electronic clinical document architecture ((CDA) Care Summary and Consult Report)).
  • The EP, eligible hospital, or CAH that site transitions or refers their patient to another setting of care (including home) or provider of care provides a summary of care record for 65% of transitions of care and referrals (and at least 30% electronically).

Population and Public health recommendations:

  • Documentation of timely and successful electronic receipt by the certified EHR technology of vaccine history (including null results) from an immunization registry or immunization information system for 30% of patients who received immunizations from the EP/EH during the entire EHR reporting period.
  • Implement an immunization recommendation system that: 1) establishes baseline recommendations (e.g., Advisory Committee on Immunization Practices), and 2) allows for local/state variations. For 10% of patients receiving an immunization, the EP/EH practice receives the recommendation before giving an immunization.
  • Documentation of ongoing successful electronic transmission of standardized reports from the certified EHR technology to the jurisdictional registry.  Attestation of submission for at least 10% of all patients who meet registry inclusion criteria during the entire EHR reporting period as authorized, and in accordance with applicable state law and practice.
  • Documentation of successful ongoing electronic transmission of standardized (e.g., consolidated CDA) reports from the certified EHR technology to a jurisdictional, professional or other aggregating resource. Attestation of submission for at least 10% of all patients who meet registry inclusion criteria during the entire EHR reporting period as authorized, and in accordance with applicable state/local law and practice.
  • Documentation of successful electronic transmission of standardized health care acquired infection reports to the National Healthcare Safety Network (NHSN) from the certified EHR technology. Total numeric count of hospital-acquired infections (HAIs) in the hospital and attestation of certified EHR electronic submission of at least 20% of all reports during the entire EHR reporting period as authorized, and in accordance with applicable state law and practice.

The current plan is to transmit the final stage 3 recommendations to HHS during the month of May in 2013, but there are still several stages that the recommendations will undergo. Some of the content of the initial recommendations listed above will likely change through public comments and revisions.

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