Meaningful Use – Page 11 – RISC Management and Consulting

News Release

The United States Department of Health and Human Services (HHS) announced on August 23, 2012, the next steps to promote the use of electronic health records and expand health information exchange. According to Kathleen Sebelius, the change will lead to enhanced patient care via the elimination of duplicate screening and tests, as well as the reduction of medical errors.

Under the Health Information Technology for Economic and Clinical Health (HITECH) Act, physicians, health care professionals and hospitals can qualify for Medicare and Medicaid incentive payments when they adopt and meaningfully use certified electronic health record (EHR) technology.

More than 120,000 eligible health care professionals and more than 3,300 hospitals have qualified to participate in the program and receive an incentive payment since it began in January 2011. That exceeds the goal set earlier this year of 100,000.

That includes more than half of all eligible hospitals and critical access hospitals and one out of every five eligible health care professionals. The program is divided into three stages:

Stage 1 sets the basic functionalities electronic health records must include such as capturing data electronically and providing patients with electronic copies of health information.
Stage 2 (which will begin as early as 2014) increases health information exchange between providers and promotes patient engagement by giving patients secure online access to their health information.
Stage 3 will continue to expand meaningful use objectives to improve health care outcomes.

These are the Stage 2 requirements announced on August 23, 2012:

Make clear that stage two of the program will begin as early as 2014. No providers will be required to follow the Stage 2 requirements outlined today before 2014.
Outline the certification criteria for the certification of EHR technology, so eligible professionals and hospitals may be assured that the systems they use will work, help them meaningfully use health information technology, and qualify for incentive payments.
Modify the certification program to cut red tape and make the certification process more efficient.
Allow current “2011 Edition Certified EHR Technology” to be used until 2014.

The CMS final rule also provides a flexible reporting period for 2014 to give providers sufficient time to adopt or upgrade to the latest EHR technology certified for 2014.

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Clinical Decision Support System (CDSS)

What is a CDSS?

A CDSS is an interactive decision support system software that can assist clinicians in decision making processes when ascertaining diagnosis on patient data. CDSS products have the ability to connect health observations with a knowledge information network to control alternative treatments to enhance medical practice and judgment. Some products are capable of reviewing and filtering preliminary diagnoses and deducing links between patients with their medical history and forecast events.

A question we have been asked here at RISC is: The Meaningful Use (MU) incentive rule requires that we implement one CDS rule. What is the meaningful use CDS rule requirement for Stage 1 meaningful use?

Answer: The requirement is, “Implement one clinical decision support rule relevant to specialty or high clinical priority along with the ability to track compliance to that rule.” [1. See References below]

Physicians, nurses and other health care professionals use a CDSS to prepare a diagnosis and to review the diagnosis as a means of improving the final result. Data mining may be conducted to examine the patient’s medical history in conjunction with relevant clinical research. Such analysis can help predict potential events, which can range from drug interactions to disease symptoms.

What is Data Mining?

Data mining is sorting through data to identify patterns and establish relationships.

Data mining parameters include:

Association – looking for patterns where one event is connected to another event
Sequence or path analysis – looking for patterns where one event leads to another later event
Classification – looking for new patterns (May result in a change in the way the data is organized but that’s ok)
Clustering – finding and visually documenting groups of facts not previously known
Forecasting – discovering patterns in data that can lead to reasonable predictions about the future

What is Evidence-Based Practice (EBP)?

EBP is the practice of applying research to promote quality care and enhanced clinical practice based upon the best evidence from the most recent systematic reviews and meta analyses of randomized controlled trials (RCTs) for clinical information on a stated problem.

Meta-analyses are reviews of literature related to a particular intervention, culminating in the calculation of the effect size of an intervention. Systematic reviews of research (SRRs) are either summaries of the research on an intervention or summaries of what is known about a phenomenon. A rigorous process is used to identify appropriate studies, based on criteria developed by the researcher. The results of studies are synthesized, but no statistics are calculated. Meta-syntheses are systematic reviews of qualitative studies, often resulting in theoretical propositions that can later be tested in practice.

Meta-analyses, SRRs, RCTs, and even meta-syntheses are used to develop clinical practice guidelines (CPGs). Clinical practice guidelines are translated into care protocols, care maps, procedure manuals, and algorithms that are then implemented within institutions. The developers of CPGs consider all of the studies related to a clinical problem.

These evidence-based CDSS facilitate care before, during, and post diagnoses on patients. In addition, CDSS products have capabilities such as monitoring medication orders, preventing duplications, and providing analysis/diagnosis/treatment plan processes, with condition-specific clinical guidelines promoting best practices to improve patient outcomes.

The Health Information Technology for Economic and Clinical Health (HITECH) Act (Meaningful Use) stipulates that healthcare providers must demonstrate MU by 2015 or face reduced Medicare reimbursement in 2016. In addition, Providers are now in the final months to qualify for Stage 1 funds. Eligible Providers (EPs) that have not yet attested have only a brief period left to do so, in order to capture the full amount of incentive funding.

References:

1. http://www.himss.org/content/files/CDS_MU_FAQ.pdf and http://www.cms.gov/Regulations-and-Guidance/Legislation/EHRIncentivePrograms/downloads/EP-Attestation-Worksheet.pdf

2. Melnyk, B. M., & Fineout-Overholt, E. (2011). Evidence-based practice in nursing and healthcare: A guide to best practice (2nd ed.). Philadelphia, PA: Wolters Kluwer/Lippincott Williams & Wilkins.

3. Centers for Medicare & Medicaid Services. (2012). Electronic Health Records Incentive Programs. Retrieved from http://www.cms.gov/Regulations-and-Guidance/Legislation/EHRIncentivePrograms/index.html?redirect=/ehrincentiveprograms

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