Saturday, April 7, 2012

Introduction to EMR Part II

In the last post I mentioned the government incentives for doctors who meaningfully use an EMR. For many, the term meaningful use is a bit confusing. Really, though, it is quite easy. Meaningful use simply refers to using the best features of an EMR.

Last year, 2011, was the first year of meaningful use. In that first year the bar was set pretty low insofar as usage requirements. Basically, doctors had to use an 'approved' (certified) EMR the right way for just three consecutive months. The EMR that the doctor chose to use had to be certified according to ONC-ATCB requirements. The ONC-ATCB requirements simply ensured that the EMR had the necessary features to accommodate doctors needs and government requirements.

As of 2011, there were two companies testing and certifying EMR for ONC-ATCB certification. These are The Drummond Group and the Certification Commission for Health information Technology (CCHIT). These two companies have great websites that help a physician find a certified EMR product. If you are in the market for an EMR these websites are the best place to start.

Once you are on the site(s) you will see that there are two types of certification, complete and modular. Complete means that the EMR has proven that they have all of the components a physician needs to achieve meaningful use. A modular certification simply means that the software satisfies part of the requirements. If a doctor chooses a modular EMR s/he will need to use other technologies to fulfill some of the requirements for meaningful use. 

In other words, with a complete EMR – you have everything you need in one place. With a modular system, you will need to use multiple modular systems to meet meaningful use. 
While systems with modular certification may seem to be less useful – that is not necessarily true. Modular give you the ability to mix and match according to your preferences. So, in my opinion, either modular or complete are great depending on your preference for all-in-one or mix-and-match.

Now, let’s jump back to meaningful use. As I said before meaningful use really is easy but it may require a change in workflow…. Even so, it is a change for the better in most cases. Here is what meaningful use requires the physician to do in an electronic medical record:

  • Prescribe electronically
  • Turn on the EMR’s drug interaction warnings
  • Report clinical quality measures to the Centers for Medicare and Medicaid Services (CMS)
  • Enter patient demographics in the EMR (name, gender, date of birth, etc.)
  • Keep an electronic record of patient’s diagnosis history
  • Record patient allergies
  • Record patient medications
  • Record patient vital signs (height, weight, blood pressure, etc)
  • Record whether a patient smokes
  • Implement clinical decision support rules (automated reminders about how to handle certain medical situations)
  • Provide medical records to patients within 3 days of their request
  • Provide patients with a summary of their office visit within 3 days of the visit
  • Test the EMR’s ability to electronically communicate with other medical providers
  • Conduct a security and privacy risk assessment
  • Turn on the EMR’s drug formulary system (checks if medications are covered by a patient’s insurance)
  • Enter (or receive) lab results in the EMR
  • Generate a list of patients by medical condition
  • Send patient reminders about preventative care and wellness
  • Give patient’s timely access to their medical information
  • Provide patient educational materials
  • Perform medication reconciliation when patient’s transition from other care providers (this means the provider must compare his/her list of medications to a list from the other provider)
  • Test the EMR’s ability to submit immunization information to the appropriate state agencies
  • Test the EMR’s ability to submit electronic disease information to a public health agency (health department, Centers for Disease Control , etc.)

See, there is nothing earth shattering in that list. These requirements will, however, get bigger as time goes by. But for now, meaningful use is simply a way to get doctors to get acquainted with using an EMR. Also, as you look over that list of requirements, it is pretty easy to see how useful these requirements are in patient care. 

To learn more about meaningful use and the EMR incentive programs, go to the Centers for Medicare and Medicaid website here: Overview of EHR Incentives


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