CMS revises EHR meaningful-use


2014 is proving to be challenging year for demonstrating meaningful use. As the deadline to attest to meaningful use (MU)
quickly approaches, many providers are trying to make sense of the goals they face in the transition from Stage 1 to Stage 2. Th EHR (Electronic Health Record) incentive program has changed and evolved since inception in 2010 following the Health Information Technology for Economic and Clinical Health (HITECH) Act. The HITECH act was enacted as part of the American Recovery and Reinvestment Act of 2009, to help promote the adoption and meaningful use of health information technology, with the end goal of improved health systems.

With the creation of the EHR incentive program, CMS would help providers begin their journey to becoming meaningful users. Previously providers found the transition from paper to EHR to be costly as their inefficiency often resulted in loss of productivity. With the incentive program, providers are rewarded for taking steps towards the adoption of an EHR system.

Moving and Consolidating 

Early adopters of MU were challenged with the requirements of meeting 15 core measures and five of the 10 menu measures along with reporting on CQM’s (Clinical Quality Measures). The number of measures has not changed considerably over the years, but with the progression from Stage 1 to Stage 2 we see that some measures have been consolidated or moved from menu to core.

Additionally, the thresholds core measures have increased significantly. This year Stage 2 incorporates many changes addressing patient engagement, efficient use of healthcare resources and collaboration between providers and healthcare communities. It is believed that engaging a patient and their family as active participants in their healthcare will help to increase the effectiveness and efficiency of healthcare.
Center for Medicaid and Medicare Services (CMS) has charged providers with improving patient involvement. This speaks to the patient portal measure(s) as well as the secure messaging measure.

New to Stage 2
Here we see the shift of responsibility for achieving MU from resting solely on the shoulders of the EP’s and clinical staff to including the provider’s patients. Secure messaging is the only new core measure for Stage 2. This measure requires that more than five percent of a provider’s patients, seen during the reporting period, use the CHERT (Certified EHR Technology) to communicate securely with their provider
on relevant health information; thus requiring that the patient take action. Because patients will now be able to access all of their health records via a patient portal, there is no longer a separate measure requiring providers to furnish patients with an electronic copy of the PHI (Personal Health Information) upon request. The portal allows patients online access to view their PHI.

From Menu to Core
Several measures, including family health history, medication reconciliation and summary of care, have been moved from menu to core. This history is crucial in providing a complete patient history, allowing for the most accurate diagnosis possible. This year, transitions of care require that the referring provider issue a summary of care document for more than 50 percent of all transitions in care. Additionally, more than 10 percent of these summaries of care documents must be transmitted electronically using CHERT, with at least one being transmitted to a distinct CHERT.

Lastly, immunization registry moves from menu to core in Stage 2. Which along with Syndromic surveillance and cancer registry (found in the menu measures), allow for better collaboration between providers and healthcare communities.

It’s about Better Care 
We know that it can be very difficult and challenging at times to keep the focus on the end goal of providing better care to patients while also reducing the costs. The measures we see in Stage 2 strengthen the groundwork, so that as we proceed towards our end goal of better and more efficient healthcare we have a stronger foundation. Each measure independently provides an added benefit to the patient or the provider; together they allow for a comprehensive overhaul to our healthcare system. We are in no way saying that this process will be simple. However, as the MU measures become part of your workflow, the hope is that performing these acts will take less time, require less funding and ultimately provide a better service.

Kelly Fountain is a health IT advisor with Kentucky Regional Extension Center, a part of UK HealthCare.