Published: 2010-07-17 15:23:10
Author: Steven Kraus | Dynamic Chiropractic | April 22, 2010
We are at the start of five critical years of electronic health record (EHR) adoption and health information technology (HIT) expansion. $44,000 of federal stimulus money is on the line for qualifying providers with certified EHR systems.
Confusion is growing about what a certified EHR is, and chiropractors are wondering where they fit in. Through the HITECH Act, meaningful use of EHRs is now being defined, and its definition will determine who qualifies for incentive payments from CMS.
This is part two of a three-part part series on the meaningful use of health information technology. Last month I explained the eight goals behind HIT standards and how your practice has been primed for these standards. Next month we'll continue with an explanation of how incentives will be paid out over the next five years and what milestones your practice will need to achieve to qualify. Before we get there, however, we need to know how chiropractors are going to accomplish meaningful use of a certified EHR system. For our purposes, I've broken the proposed rule down into three categories encompassing 25 total requirements: (1) improving technology; (2) improving outcomes; and (3) objectives which may not relate to chiropractic practice.
Category 1: Rules to Bring Your Technology Up to Speed
Of the 25 proposed rules or "objectives," a large portion define what kinds of capabilities health care providers or eligible professionals need to have once an EHR system is adopted. CMS and the Office of the National Coordinator for Health Information Technology (ONC) paint with a broad brush, as they're writing both for hospitals and private practice providers. These are the keystones your EHR system is going to need to guarantee if you want to qualify for stimulus funds. Your software provider should handle the ability to perform these items.
1. Computerized Physician Order Entry (CPOE) is used for management of medications, lab results, imaging, provider referrals, and patient visits. The term CPOE is tech-speak for "a doctor who stores and manages his or her patient orders electronically." If you have a true EHR, then you should have this objective fulfilled. To meet CMS standards, 80 percent of your orders must be fulfilled with such a system. For the DC, these orders will include active care PT/rehab orders, radiology, and lab testing if such testing is ordered in your clinic.
2. Incorporate lab test results into the patient's electronic health record as structured data. Offices able to meet the above objectives should have no problem accepting and storing lab tests with the patient's other data in the EHR. To meet CMS standards, this must be done in 50 percent of patient files with whom you have ordered such tests.
3. Maintain a current patient problem list based on ICD-9 or SNOWMED CT. This isn't anything that you don't already do, but just as in the first objective, you'll be doing it strictly via EHR management. To meet CMS standards, this must be accomplished on 80 percent of unique patient visits.
4. Record patient demographics. This function is easily met through most EHRs. Keep in mind, however, that in-clinic data retrieval and analysis are also going to be important. If you're going to collect this information for the government, then you might as well be able to mine it for insights into your practice. To meet CMS standards, 80 percent of all patients must have demographics recorded. These include race, language preference, gender, ethnicity, and date of birth.
5. To exchange patient health information among providers and
authorized third parties. What good is it to have completely
digital clinic data if that data isn't portable across multiple systems?
Problems lists, and radiology results, etc., all need to be able to be
sent out by your clinic, as well as be retrieved by your clinic via your
state's health information exchanges. To meet CMS standards, you have
to demonstrate this capability for at least one piece of patient health
information, with the ability to send and receive information on 80
percent of all patients referred in or referred out.