August 2010 Radiation Oncology News

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Guidelines on EHR Meaningful Use

Tamara Syverson, BSRT(T)

On July 13, 2010, the Centers for Medicare and Medicaid Services (CMS) published the final rule regarding EHR technology and qualifications for meaningful use taking into account over 2000 comments received.  It was determined a phased approach for implementation best encompasses the intent of meaningful use of current technology, while allowing for future adjustments based on technological advances and increased provider understanding.  As a result, measures have been outlined for the initial phase, while more stringent requirements will be detailed through future rulemaking, resulting in a total of 3 stages.  Requirements for Stage 1 were released on July 13, 2010, with expectations that Stage 2 and Stage 3 will be released in 2011 and 2013, respectively. 

At the current time, the Stage 1 criteria consists of a total of 25 meaningful use objectives within two categories; a core set of 15 objectives and a menu set of 10 objectives, each with associated measures to determine if the EMR was used in the appropriate number of opportunities.  In order to qualify for meaningful use, the eligible provider (EP), eligible hospital (EH) or critical access hospital (CAH) must meet each objective within the core set, as well as five of the objectives from the menu set, which allows for further flexibility while ensuring minimum standards are met.  The core set of objectives includes:

  • Use computerized physician order entry (CPOE) for all drug orders
  • Implement drug to drug and drug allergy interaction checks
  • E-Prescribing (EP only)
  • Record demographics
  • Maintain an up-to-date problem list
  • Maintain active medication list
  • Maintain active medication allergy list
  • Record and chart changes in vital signs
  • Record smoking status
  • Implement one clinical decision support rule
  • Report clinical quality measures (CQM)
  • Electronically exchange key clinical information
  • Provide patients with an electronic copy of their health information
  • Provide patients with an electronic copy of their discharge instructions (EH/CAH Only)
  • Provide clinical summaries for patients for each office visit (EP Only)
  • Protect electronic health information created or maintained by certified EHR

In addition to these core set of measurements, the menu set of objectives require a total of 5 be completed within 2011-2012, which allows for the deferment of the remaining 5 to later phases of the incentive program.  The menu set of objectives includes: 

  • Implement drug formulary checks
  • Incorporate clinical lab test results into certified EHR technology as structured data
  • Generate patient lists by condition
  • Identify patient-specific education resources and provide to patient as appropriate
  • Perform medication reconciliation between care settings
  • Provide summary of care record for referred or transitioned patients
  • Submit electronic immunization data to registries
  • Submit electronic syndromic surveillance data to public health agencies
  • Send care reminders to patients per patient preference (EP only)
  • Provide timely patient electronic access to health information (EP only)
  • Record advance directives for patients 65 years and older (EH/CAH only)
  • Submit electronic data on reportable laboratory results to public health agencies (EH/CAH only)

The CMS final rule including the requirements and measures for these objectives, as well as payment rates and necessities for the EHR incentive program can be found on the CMS website at: