How does meaningful use affect emr software

Notice of Funding Opportunities. Practice Facilitation Handbook Module Previous Page. EHR Implementation Regardless of which EHR a practice uses, the practice facilitator should immediately determine how hardware and software are supported and by whom. Conducting a comprehensive workflow analysis is a critical step to health IT implementation. Stages of Meaningful Use In primary care, meaningful use consists of three stages: Stage 1: transferring data to EHRs and being able to share information Stage 2: includes new standards such as online access for patients to their health information and electronic health information exchange between providers Stage 3: implementation.

Stage 1 Stage 1 began in and remains the starting point for all providers. An additional menu set of 24 measures of which 19 must be met through structured data entry, including patient-specific education resources, medication reconciliation, and patient electronic access. Generate and transmit permissible prescriptions electronically eRX. Maintain active medication list.

Record smoking status for patients age 15 years or older. Stage 2 Stage 2 to be implemented in includes new standards such as online access for patients to their health information and electronic health information exchange between providers. Generate lists of patients by specific conditions to use for quality improvement, reduction of disparities, research, or outreach. Generate at least one report listing patients with a specific condition.

Automatically track medications from order to administration using assistive technologies in conjunction with an electronic medication administration record eMAR. Record smoking status for patients age 13 years or older. Stage 3 Stage 3 implementation is expected in and includes demonstrating that the quality of health care has been improved for the population served.

Examples of two States that have made significant progress in connecting providers electronically can serve as exemplars for the State you work in: The NY eHealth eHealth Collaborative serves as a model for coordinating all exchange efforts throughout the State of New York.

As an increasing number of private practices, nursing homes, clinics, and hospitals implement EHRs, these providers have the option to connect to information hubs in their region of the State for sharing patient data. Consider a pregnant patient who receives her primary care in her hometown of Buffalo and travels to the Bronx to visit relatives. While there she goes into labor prematurely. Thanks to the eHealth network, her prenatal records from her patient care team at the community health center she visits in Buffalo are available online to the Bronx hospital where she is being treated The Massachusetts eHealth Institute MeHI at the MassTech Collaborative is improving health care for the Massachusetts population through the use of IT.

It also serves as the REC for helping providers achieve meaningful use goals. This program supports the goal for all providers to have access to a federally certified EHR that communicates with other certified EHRs by Meaningful Use Funding Funding for meaningful use is the key to succeeding.

Run by your State Medicaid agency. Payments over 5 consecutive years. Payments over 6 years; does not have to be consecutive. Payment adjustments will begin in for providers who are eligible but decide not to participate. No Medicaid payment adjustments. Providers must demonstrate meaningful use every year to receive incentive payments.

In the first year providers can receive an incentive payment for adopting, implementing, or upgrading EHR technology. Providers must demonstrate meaningful use in the remaining years to receive incentive payments.

For stage 1, attestation pertains to: 15 core objectives. Meaningful Use and Quality Improvement Meaningful use reinforces the concept of meeting patient needs as outlined in the landmark Institute of Medicine study Crossing the Quality Chasm: A New System for the 21 st Century IOM, : care that is safe, efficient, effective, timely, person centered, and equitable. Recording vital signs electronically. Maintaining up-to-date problem list. Maintaining active medication list. Maintaining active allergy list.

Recording smoking status. Providing patients with clinical summaries for each office visit. Checking for drug-drug and drug-allergy interactions. Exchanging electronic information with other sites of care.

Implementing a decision support rule and tracking compliance with the rule. Maintaining systems to protect privacy and security of patient data. Reporting clinical quality measures to CMS or States. Generating lists of patients for QI or outreach. Providing electronic health education resources.

Content exchange standards, including HL7 version 2. Standards for protecting the exchange of electronic health information, including encryption standards The deemed standards are in turn referenced as part of specific certification requirements and implementation specifications. Another example is the requirement for inpatient EHR systems to submit reportable lab results to public health agencies It is worth reiterating here that neither the current ONC certification criteria and implementation specifications nor the Stage 1 CMS meaningful use requirements require laboratories to transmit results using LOINC codes.

The temporary certification program will be replaced eventually by a permanent certification program. As of this writing, 62 RECs for practitioners have had funding announced and an additional 46 RECs have been funding to help critical access and rural hospitals adopt certified EHR technology. The RECs will focus mostly on clinicians providing primary care services, with an emphasis on individual and small group practices fewer than 10 providers.

The RECs aim to provide assistance in EHRs product selection and implementation as well as guidance on improving clinical administrative workloads to use EHRs most effectively, and meeting legal, regulatory, and other requirements. The relevance of RECs to laboratories is that understanding RECs efforts in their area may provide an opportunity for laboratories to work with the RECs, physician offices, and EHR vendors to improve success in implementing laboratory interfaces.

HIEs are groups of organizations working together with a goal of improving the quality of health care delivery in a region, typically a state, by focusing on standards-based interoperability of healthcare information and healthcare information systems.

The goals, capabilities, and participants in HIEs will vary across states, and participants in HIEs will vary across states. Reflecting a priority for the electronic exchange of laboratory results in HIEs. In July , the ONC issued a Program Information Notice PIN [ 9 ] that directed HIE efforts and award grantees to focus their efforts on receipt of structured laboratory results as one of three priorities for HIEs for the others being e-prescribing and sharing patient care summaries across organizations.

Greater implementation of EHRs has important clinical, operational, and business implications for laboratories, particularly those that serve physician practices. Laboratories can expect to see a dramatic increase in the expectations for LIS-EHR electronic interfaces for test results and laboratory test orders eventually if not immediately , as physicians implement EHRs more widely.

The increase in expectations for electronic interfaces will stem from 1 the fact that laboratory result interfaces will facilitate meeting meaningful use requirements see above for incorporation of laboratory data in an EHR and 2 the fact that implementing an EHR generally will lead to the desire to have laboratory results delivered electronically.

Further to the latter point, once a physician practice has an EHR in place, the expectation will understandably follow that laboratory results will be electronically incorporated into the electronic record instead of being entered manually or instead of being viewed on separate laboratory web portal sites or the like.

Meaningful use requirements and the expected increase in EHR implementation offer some opportunities for laboratories. At minimum, eligible providers will likely want to receive test result data in a way that will automatically populate information into their EHRs and in turn facilitate CQM reporting to meet meaningful use criteria. For laboratories, more widespread and time-sensitive expectations for LIS-EHR interfaces present substantial challenges and bring with them considerations that go beyond the specific requirements mentioned in the Final Rules.

In addition, there may be considerable expenses involved in implementing interfaces and maintaining interfaces. There may be lack of control or involvement available to the laboratory for EHR management at physician sites.

Poor process design resulting in problems with laboratory testing may be blamed inappropriately on the laboratory. Primary among the challenges is that the laboratory has the responsibility for the accuracy of test result data that are transmitted from the laboratory to receiving systems.

This includes the following:… 2 Results and patient-specific data electronically reported to network or interfaced systems. As part of its stated goal to promote the electronic exchange of health information and in recognition of the fact that laboratory information is an integral part of EHRs, CMS recently issued a revised guidance related to interpretation and compliance with CLIA requirements for laboratory result reporting and laboratory information exchange.

In the document, the CMS indicates that this is the first of a series of forthcoming memoranda from CMS on electronic exchange of laboratory information. The document provides important direction to laboratories on meeting CLIA requirements and includes revisions in requirements related to the electronic exchange of laboratory information, data retention, and management of corrected laboratory reports in EHRs.

Guidance is also offered related to the definition of individuals who are authorized to receive laboratory results and how others may be designated by the authorized individuals to receive laboratory information. When meeting such requirements as the above, as well as in pursuit of a stewardship role for the quality of laboratory data in medical practice, laboratories need to be aware that EHRs may vary in their effectiveness of result display.

Laboratory report elements that may be subject to variation in EHRs include:. EHR certification requirements dictate only that the CLIA-mandated elements see previous section that constitute a test report must be displayed in the EHRs and have no further requirements as to format, readability, or display.

The issues related to the above items as well as other aspects of more complex laboratory result display commonly arise during the course of interface implementation. Failure to address these issues might have negative consequences, which include misinterpretation of laboratory results and the perception however inappropriate it might be that the laboratory is responsible for less than optimal display of laboratory results in EHRs and interpretive errors that might arise from such display.

Whether laboratories interface directly from their LIS to EHRs interfaces or interface through some type of integration services provider or interface engine, the capability will be necessary to interface with a wide variety of EHRs and vendors that are available.

Laboratories will need to establish a network connectivity model e. Laboratories will need to secure the availability of technical support expertise for implementing and supporting the interfaces.

Compatibility with ONC-mandated interoperability standards is important, perhaps not as much in the current requirements, but certainly with an eye toward the future. Attention to the operational aspects of LIS-EHR results reporting interfaces is necessary for successful implementation and ongoing support. Some of the more important factors are summarized here:. The importance of and methods for maintenance of the laboratory test definitions in the EHR must be understood, particularly when it comes to change control.

For instance, will clients be changing their laboratory test definitions settings in the EHR, which in turn will affect the correct filing in the EHR of test results that are received in interface transmissions? Laboratory procedures should address change control and communication that should occur when the laboratory makes to the test definition in its own LIS.

Ongoing troubleshooting of interfaces and interface-related client support issues will grow as the number of interfaces grow, and must be accounted for in laboratory management planning. Overall client site contact and engagement will be important to be able to have successful communication of laboratory results electronically on an ongoing basis and to manage changes.

Implementing EHRs interfaces requires some involvement by support personnel at the client site; however, getting access to and attention of such people at client sites can be challenging and frustrating if such personnel resources at any particular site even exist. There may be a need to train EHR interface clients as to how laboratory results are viewed. A process for handling and communicating corrected results must be implemented and validated.

Depending on the practice setting, the establishment of procedures may be necessary for the communication of laboratory test results in situations in downtime situations when the interface is not available. LIS upgrades or updates must also take into account any effects on interfaced systems and sites. As mentioned, CPOE as a requirement for laboratory test orders was removed from Stage 1, but is expected to be present in Stage 2. Laboratories should expect to have processes in place to handle electronic transmission of orders from interfaced clients in advance and expectation of these requirements.

CPOE systems must be configured correctly for laboratory test ordering in terms of menus, order tests, and the options for how test order choices are presented to the ordering physician. Depending on the clinical setting, the CPOE process for laboratory tests may need to account for future orders, duplicate order handling, and canceled order handling. Billing problems may arise as well if not factored into planning. In line with the HHS-stated goals, broadly speaking, there will be greater expectations for exchange of healthcare data with unaffiliated entities and more decision support in general, both of which can be expected to involve laboratory tests.

Meaningful use criteria dictate how eligible providers and hospitals must use EHRs technology, while certification standards specify what capabilities that EHR must possess in order to support meaningful use. Some of these criteria and requirements are directly applicable to laboratory testing currently, and more promise to be applicable to laboratory testing in the future. As EHR uptake expands, there will be greater expectations for electronic interchange of laboratory information, and laboratories must prepare now to meet the needs of the future environment.

Implementation of LIS-EHR interfaces promises to be a major priority in the future and a challenge for laboratories serving outreach clients. In addition, some of the new and future requirements and programs may provide other opportunities for ways that laboratories can better serve their provider community.

National Center for Biotechnology Information , U. Journal List J Pathol Inform v. J Pathol Inform. Published online Feb Walter H. Author information Article notes Copyright and License information Disclaimer. Henricks: gro. Received Dec 8; Accepted Dec This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

This article has been cited by other articles in PMC. Keywords: Electronic health records, federal regulations, laboratory information management, laboratory information systems, meaningful use. EHRs are central to the goals that the federal government has identified for improving healthcare:[ 1 ] Improve quality, safety, and efficiency of healthcare and reduce health disparities.

Participants must report the required measures under each of the four objectives below, or claim exclusions if applicable: ePrescribing, Health Information Exchange Provider to Patient Exchange Public Health and Clinical Data Exchange As noted, these objectives are similar to the requirements for the Meaningful Use program.

Meaningful Use Stage 1 For Meaningful Use Stage 1 , the 15 core objectives for Eligible Professionals EPs were: 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.

Implement drug-drug and drug-allergy checks. Maintain an up-to-date problem of current and active diagnoses Maintain active medication list Maintain active medication allergy list Generate and transmit permissible prescriptions electronically eRx. Record patient demographics: sex, preferred language, race, ethnicity, and date of birth. Record vital signs and chart changes in the following: height, weight, blood pressure, body mass index BMI , growth charts for children.

Record smoking status for patients 13 years old or older. On request, provide patients with an electronic copy of their health information including diagnostics test results, problem list, medication lists, medication allergies.

Provide clinical summaries for patients for each office visit. Implement capability to exchange key clinical information among providers and patient authorized entities electronically. Implement one clinical decision support rule along with the ability to track compliance with the rule. The 10 Menu Set Objectives for EPs, which they must report at least 5 of, were: Generate lists of patients by specific conditions to use for quality improvement, reduction of disparities, research, and outreach.

Patient preference refers to the patient's choice of delivery method between internet based delivery or delivery not requiring internet access. Incorporate clinical lab-test results into EHR as structured data. Implement drug-formulary checks Provide patients with timely electronic access to their health information including lab results, problem list, medication lists, allergies within 4 business days of the information being available to the EP either through the receipt of final lab results or a patient interaction that updates the EP's knowledge of the patient's health.