There are lots of good reasons for chiropractors to transition to Electronic Healthcare Records (EHR) systems within their practices.
The biggest reason is, of course, patients benefit. Chiropractors can provide better care when they know more about patients’ medical histories. Another is organization. Paper records must be filed and stored.
However, even with all of the good reasons to implement EHR systems, the fact remains that there are difficulties as well: it can be expensive, the entire staff must be trained, and transitions of any kind can be bumpy. In order to speed up adoption, the 2009 Stimulus and Recovery Act included incentives for Eligible Professionals (EPs) and institutions who adopt EHR systems and meet particular guidelines, called Meaningful Use (MU) objectives, within set timeframes, described as stages. Chiropractors are among the EPs.
Meaningful Use Stage 1 is, obviously, the first set of objectives chiropractic practices (and other EPs) must meet in order to qualify for the incentive payment. A practice must meet Stage 1 objectives for 90 days during the first year, then for one year. EPs use the calendar year rather than the federal fiscal year to track meaningful use stages.
There are 24 stage 1 MU objectives in total. The objectives for stage 1 are designed to set the baseline for data capture and information sharing. They are divided into two groups: core objectives and menu set objectives. EPs must demonstrate that they have met 14 core objectives and 5 menu set objectives. Chiropractors are specifically exempt from several of the core objectives that simply do not apply to the treatment DCs provide. For example, because the vast majority of chiropractors don’t (and in 45 states, cannot) write prescriptions, they are exempt from the objective “Generate electronic prescriptions.”
Here are the 14 stage 1 core meaningful use objectives:
Use Computerized Provider Order Entry (CPOE) EPs who write fewer than 100 prescriptions during the reporting period are excluded from this requirement.
Implement drugdrug and drugallergy interaction checks.
Maintain an uptodate problem list of current and active diagnoses.
Generate and transmit permissible prescriptions electronically (eRx). EPs who write fewer than 100 prescriptions during the reporting period are exempt from this requirement.
Maintain active medication lists.
Maintain active medication allergy lists.
Record preferred language, gender, race, ethnicity, and date of birth.
Record and chart changes in the following vital signs:
Calculate and display body mass index (BMI).
Plot and display growth charts for children 2–20 years, including BMI
Record smoking status for patients 13 years old or older.
Report ambulatory clinical quality measures to CMS or, in the case of Medicaid EPs, the States.
Implement one clinical decision support rule relevant to specialty or high clinical priority along with the ability to track compliance with that rule.
Provide patients with an electronic copy of their health information (including diagnostics test results, problem list, medication lists, medication allergies) upon request.
Provide clinical summaries for patients for each office visit.
Protect electronic health information created or maintained by the certified EHR technology through the implementation of appropriate technical capabilities.
The Stage 1 Menu Set Objectives are:
Implement drug formulary checks.
Incorporate clinical labtest results into EHR as structured data.
Generate lists of patients by specific conditions to use for quality improvement, reduction of disparities, research, or outreach.
Send patient reminders per patient preference for preventive/followup care.
Provide patients with timely electronic access to their health information (including lab results, problem list, medication lists, and allergies) within 4 business days of the information being available to the EP.
Use certified EHR technology to identify patientspecific education resources and provide those resources to the patient if appropriate.
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 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.
Capability to submit electronic data to immunization registries or immunization information systems and actual submission according to applicable law and practice.
Capability to submit electronic syndromic surveillance data to public health agencies and actual submission according to applicable law and practice.
The CMS provides detailed instructions for how to demonstrate each objective, along with exclusions and frequently asked questions, and other useful information for each objective.