Electronic health records objectives

Article Outline

 

The U.S. Department of Health & Human Services (HHS) has established objectives for the utilization of electronic health records (EHRs) in health care practices. The American Optometric Association Health Information Technology and Telemedicine Committee urges optometrists to become familiar with them now.

The 2009 American Optometric Association (AOA) New Technology survey confirms that optometrists are becoming increasingly sophisticated in their use of technology (AOA: 2009 AOA New Technology Survey Highlights available at www.aoa.org/x13329.xml). The survey finds that three quarters of responding AOA member practitioners now issue patient appointment reminders electronically. More than two thirds of respondents order lenses online from ophthalmic labs. More than a third interface practice management software technologies with electronic health record (EHR) systems.

However, the survey also suggests that many optometrists are still not making use of all the features and functions today's health information technology (HIT) offers. For example, only about 1 in 5 optometrists use EHR systems to maintain complete patient health records. (In many cases, practitioners appear to be using the systems primarily to record basic patient name and address information for use in claim filing and recall notices.) Only about 10% prescribe pharmaceuticals electronically (e-prescribing).

However, with the government ready to begin providing substantial EHR incentives in 2011, new Medicare payment penalties to be imposed in 2015, and the Nationwide Health Information Network (NHIN) set for launch in 2014, optometrists and other health care practitioners will soon have good reason to make more extensive use of HIT (see Why optometrists should act on EHRs now. Optometry 2010;81:162-4).

As part of an overall program to improve the quality, safety, and efficiency of American health care while reducing health disparities among various segments of the population, the U.S. Department of Health & Human Services (HHS) is taking steps to encourage the “meaningful use” of EHR technology. To that end, in December 2009, the department proposed objectives for the utilization of EHRs in health care practices, listing ways practitioners could use EHR systems to enhance the quality and efficacy of care. Based on recommendations from the department's HIT Policy Committee, the objectives call for practitioners to utilize EHR technology for a range of functions, from the ordering and prescribing of health care products, to the electronic reporting of potential public health threats. Practitioners will have to achieve those objectives to qualify for EHR incentive payments, escape Medicare payment penalties for nonuse of EHRs, and, ultimately, participate in the NHIN (which could soon become necessary for any practitioner who wants to be a part of the American health care system). To be certified for use in the NHIN, or the government incentive programs, EHR software will have to provide practitioners the functions necessary to achieve those objectives.

The HHS's HIT Policy Committee has recommended a total of almost 60 EHR objectives. While EHR programs must immediately provide all of those functions to win certification, health care practitioners will, at least initially, have to achieve only certain specified objectives to demonstrate meaningful use. During 2011, the first year of the federal HITECH incentive program, health care practitioners will probably have to demonstrate they have achieved about 20 objectives, which will constitute “Stage 1” meaningful use of electronic health records. The HHS plans to define 3 advanced stages of EHR use in the coming months. Health care practitioners who achieve Stage 1 meaningful use will eventually be expected to graduate to higher stages of EHR use. (The HHS has also announced that it will periodically redefine the criteria for Stage 1, Stage 2, Stage 3, and Stage 4 EHR use, presumably increasing requirements for each stage. For that reason, the sooner practitioners demonstrate meaningful EHR use, the easier it will be.)

The HHS's 20 proposed Stage 1 EHR implementation objectives applicable in 2011 are listed in Box 1. The AOA Health Information Technology and Telemedicine Committee has categorized the objectives in line with the HHS's overall health enhancement goals (“Engaging patients and families in their health care,” “Improving care coordination,” etc.). The HHS has indicated that Medicare Physician Quality Reporting Initiative (PQRI) participation will eventually be considered an EHR meaningful use objective—although, initially, in only a very limited fashion. Eventually, however, greater reporting of health care quality measures will be required for the meaningful use of EHRs.

Box 1.

HHS electronic health records “meaningful use” objectives for 2011

Improving quality, safety, and efficiency and reducing health disparities


•Utilize Computerized Physician Order Entry (CPOE)




•Do drug–drug, drug–allergy, drug formulary check




•Maintain up-to-date patient primary problem and active diagnoses list (using ICD-9-CM or SNOMED CT®) (at least 1 entry or indication of no active problem)




•Use e-prescribing—Permissible pharmaceutical prescriptions (those not prohibited under U.S. Food and Drug Administration regulations on controlled substances) generated and transmitted electronically with certified EHR technology




•Maintain active medication list




•Maintain active medication allergy list (at least one entry or “none”)




•Record demographics (preferred language, insurance type, gender, race, ethnicity, date of birth)




•Record and chart changes in vital signs (height/weight, blood pressure, body mass index, growth chart [children 2 to 20])




•Record smoking status (patients over age 13)




•Incorporate clinical lab test results into EHR




•Generate at least 1 list of patients with a specific condition (for use in quality improvement, reduction of disparities, and outreach)




•Report ambulatory quality measures to the U.S. Centers for Medicare & Medical Services (or state Medicaid agency)




•Send reminders of preventive or follow-up care (patients age 50 or older).




•Maintain clinical decision support rules relevant to practice




•Check insurance (public and private) eligibility electronically




•Submit claims to public and private insurance plans electronically




Engaging patients and families in their health care


•Offer patients electronic copies of their health information (within 48 hours).




•Provide patients timely (within 96 hours) access to their health information (lab results, problem list, medication list, allergies)




Improving care coordination


•Maintain capability to exchange key clinical information (e.g., problem list, medication list, allergies, diagnostic test results)




•Perform medication reconciliation at relevant encounters and at each transition of care and referral




•Provide summary care record of each transition of care and referral




Improving population and public health


•Submit electronic data to an immunization registry




•Provide electronic syndromic surveillance data to public health agencies.




•Conduct a Health Insurance Portability and Accountability Act (HIPAA) security risk analysis (or review past analysis)




For each objective, the HHS is developing specific EHR implementation “measures,” not unlike the quality of care measures used under the Medicare PQRI. By reporting that those measures have been taken, a practitioner will be able to document that an EHR utilization objective has been met. Health care practitioners will have to take those specific measures for specified numbers or percentages of patients. In a few cases, at least during 2011, simply having the EHR capability to achieve the objective or providing an EHR function for a limited number of patients will be sufficient to demonstrate meaningful use. In most cases, however, practitioners will have to provide the EHR function for a substantial number of patients.

Specific measures and patient percentages (still being finalized as this article was prepared for press) will be reported in future Optometry articles as well as in AOA News on the AOA Web site Electronic Health Records page (www.aoa.org/EHR.xml). It should be emphasized that the HHS had not finished the objectives listed here as this article went to press. Some changes could be forthcoming. However, optometrists should start to be become familiar with the HHS's EHR meaningful use objectives now. Moreover, they should begin to consider how each function will be incorporated into their practices and used to enhance patient care. Taken together, the objectives provide an indication of the way HHS officials hope to see EHRs used to benefit individual patients and improve the health of the nation overall.