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Chiropractic News

September 2010

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Objectives, measures, and exclusions at-a-glance

This chart is a supplement to Steven J. Kraus' article "Spell it out," which appeared in Issue 13, 2010.

By Steven J. Kraus, DC, DIBCN, CCSP, FASA, FICC

Most DCs must meet 13 of the 15 core objectives to demonstrate meaningful use of their EHR

 

 

Core Objective

Measure

Exclusions

1

Use computerized provider order entry for medication orders directly entered by any licensed healthcare professional who can enter orders into the medical record per state, local, and professional guidelines.

More than 30 percent of all unique patients with at least one medication in their medication list seen by the EP have at least one medication order entered using CPOE.

MOST DCs EXEMPT

 
Any EP who writes fewer than 100 prescriptions during the EHR reporting period.

2

Drug-drug and drug-allergy interaction checks.

Enable this functionality for the entire EHR reporting period.

NA

3

Maintain up-to-date problem list of current and active diagnoses.

More than 80 percent of all unique patients seen by the EP have at least one entry or an indication that no problems are known for the patient recorded as structured data.

NA

4

Generate and transmit permissible prescriptions electronically (eRx).

More than 40 percent of all permissible prescriptions written by the EP are transmitted electronically using certified EHR technology.

MOST DCs EXEMPT

 
Any EP who writes fewer than 100 Rx during the EHR reporting period.

5

Maintain active medication list.

 

More than 80 percent of all unique patients seen by the EP have at least one entry (or an indication that the patient is not currently prescribed any medication) recorded as structured data.

NA

6

Maintain active medication allergy list.

 

More than 80 percent of all unique patients seen by the EP have at least one entry (or an indication that the patient has no known medication allergies) recorded as structured data.

NA

7

Record all of the following: Preferred language, gender, race, ethnicity, date of birth.

More than 50 percent of all unique patients seen by the EP have demographics recorded as structured data.

NA

8

Record and chart changes in the following vital signs: height, weight, blood pressure, calculate and display body mass index (BMI), plot and display growth charts for children 2 - 20 years, including BMI.

More than 50 percent of all unique patients age 2 and older seen by the EP, height, weight, and blood pressure are recorded as structured data.

Any EP who believes that all three vital signs of height, weight, and blood pressure of their patients have no relevance to their scope of practice.

9

Record smoking status for patients 13 years old or older.

More than 50 percent of all unique patients 13 yrs + seen by the EP have smoking status recorded as structured data.

Any EP who sees no patients 13 yrs +.

10

Report ambulatory clinical quality measures to CMS or, in the case of Medicaid EPs, the states.

Successfully report to CMS ambulatory clinical quality measures selected by CMS in the manner specified by CMS

NA

11

Implement one clinical decision support rule relevant to specialty or high clinical priority along with the ability to track compliance with that rule.

Implement one clinical decision support rule.

An example for DCs would be the NCQA LBP Guideline

NA

12

Provide patients with an electronic copy of their health information (including diagnostics test results, problem list, medication lists, and medication allergies) upon request.

More than 50 percent of all patients who request an electronic copy of their health information are provided it within three business days.

Any EP with no requests during the EHR reporting period.

13

Clinical summaries provided to patients for more than 50 percent of all office visits within three business days.

 

Any EP with no office visits during the EHR reporting period.

14

Capability to exchange key clinical info (e.g., problem list, medication list, allergies, and diagnostic test results), among providers of care and patient-authorized entities electronically.

Performed at least one test of certified EHR technology's capacity to electronically exchange key clinical information.

NA

15

Protect electronic health information created or maintained by the certified EHR technology through the implementation of appropriate technical capabilities.

Conduct or review a security risk analysis in accordance

with the requirements under 45 CFR 164.308(a)(1) and implement security updates as necessary and correct identified security deficiencies as part of its risk management process.

NA

 

© 2010 Future Health, Inc.

 

In addition to the core measures, eligible providers must also choose five of the following 10 “menu set” objectives to demonstrate meaningful use; but since most DCs have exclusions from three of the 10, DCs only need to choose four of the remaining seven items.

 

Menu Set Objective

Measure

Exclusions

1

Implement drug-formulary checks.

The EP has enabled this functionality and has access to at least one internal or external formulary for the entire EHR reporting period.

NA

2

Incorporate clinical lab-test results into EHR as structured data.

More than 40 percent of all clinical lab tests results ordered by the EP 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.

An EP who orders no lab tests whose results are either in a positive/ negative or numeric format during the EHR reporting period.

3

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 of the EP with a specific condition.

NA

4

Send reminders to patients per patient preference for preventive/follow-up care.

 

More than 20 percent of all patients 65 yrs + or 5 years old or younger were sent an appropriate reminder during the EHR reporting period.

An EP who has no patients 65 yrs + or 5 years old or younger with records maintained using certified EHR technology.

5

Provide patients with timely electronic access to their health information (including lab results, problem list, medication lists and allergies) within four business days of the information being available to the EP.

At least 10 percent of all unique patients seen by the EP are provided timely (available to the patient within four business days of being updated in the certified EHR technology) electronic access to their health information subject to the EP’s discretion to withhold certain information.

Any EP that neither orders nor creates any of the information listed at 45 CFR 170.304(g) during the EHR reporting period.

6

Use certified EHR technology to identify patient-specific education resources and provide those resources to the patient if appropriate.

More than 10 percent of all unique patients seen by the EP are provided patient-specific education resources.

NA

7

The EP who receives a patient from another setting of care or provider of care or believes an encounter is relevant should perform medication reconciliation.

The EP performs medication reconciliation for more than 50 percent of transitions of care in which the patient is transitioned into the care of the EP.

 

MOST DCs EXEMPT

 
An EP who was not the recipient of any transitions of care during the EHR reporting period.

8

The EP who transitions their patient to another setting of care or provider of care or refers their patient to another provider of care should provide summary care record for each transition of care or referral.

Subject to paragraph (c) of this section, the EP who transitions or refers their patient to another setting of care or provider of care provides a summary of care record for more than 50 percent of transitions of care and referrals.

EP who neither transfers a patient to another setting nor refers a patient to another provider during the EHR reporting period.

9

Capability to submit electronic data to immunization registries or immunization information systems and actual submission according to applicable law and practice.

Performed at least one test of certified EHR technology's capacity to submit electronic data to immunization registries and follow up submission if the test is successful (unless none of the immunization registries to which the EP submits such information has the capacity to receive the information electronically).

MOST DCs EXEMPT

 
An EP who administers no immunizations during the EHR reporting period or where no immunization registry has the capacity to receive the information electronically.

10

Capability to submit electronic syndromic surveillance data to public health agencies and actual submission according to applicable law and practice.

Performed at least one test of certified EHR technology's capacity to provide electronic syndromic surveillance data to public health agencies and follow-up submission if the test is successful (unless none of the public health agencies to which an EP submits such information has the capacity to receive the information electronically).

 

MOST DCs EXEMPT

 
An EP who does not collect any reportable syndromic information on their patients during the EHR reporting period or does not submit such information to any public health agency that has the capacity to receive the information electronically.

 

© 2010 Future Health, Inc.

 

 

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