Difference between revisions of "Meaningful Use (WG6)"

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(All-in-one vs. Composite systems)
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'''Discussion of How VistA Meets, or Can Meet, <BR>Meaningful Use, Stage 1<BR> ''45 CFR Part 170'''''
 
'''Discussion of How VistA Meets, or Can Meet, <BR>Meaningful Use, Stage 1<BR> ''45 CFR Part 170'''''
  
[http://edocket.access.gpo.gov/2010/pdf/E9-31216.pdf Official document published in the Federal Register]
+
Final Rule
 
+
* Standards and Certification Criteria Final Rule http://edocket.access.gpo.gov/2010/pdf/2010-17210.pdf [PDF - 390 kb] <br>U.S. Department of Health & Human Services (Published on July 28, 2010)
[http://www.cms.hhs.gov/Recovery/11_HealthIT.asp CMS Topical Web Site]
+
 
 +
Interim final rule documents (superseded by Final rule documents)
 +
* [http://edocket.access.gpo.gov/2010/pdf/E9-31216.pdf Official document published in the Federal Register]
 +
* http://edocket.access.gpo.gov/2010/E9-31216.htm (HTML version of Official Document published in the Federal Register)
 +
* [[E9-31216 | VistApedia copy of Official Document]]
 +
* [http://www.cms.hhs.gov/Recovery/11_HealthIT.asp CMS Topical Web Site]
  
 
=Background discussion=
 
=Background discussion=
Line 9: Line 14:
 
* The criteria herein are just for Stage 1 (beginning 2011).  Further criteria are likely to be unveiled as the program progresses.
 
* The criteria herein are just for Stage 1 (beginning 2011).  Further criteria are likely to be unveiled as the program progresses.
 
* Stage 2 will begin in 2013; Stage 3 in 2015
 
* Stage 2 will begin in 2013; Stage 3 in 2015
* Professionals must bot adopt a certified EHR, but must also demonstrate meaningful use.  Thus just have a system capable of the features below will not be sufficient. They must be implemented and used.
+
* Professionals must not only adopt/install a certified EHR, but must also demonstrate meaningful use.  Thus just have a system capable of the features below will not be sufficient. They must be implemented and used.
  
 
=All-in-one vs. Composite systems=
 
=All-in-one vs. Composite systems=
*The text defines several similar by different terms:
 
**Qualified EHR --
 
**EHR Module
 
**Complete EHR
 
**Certified EHR
 
  
Note: A composite system composed of individually certified modules, to make a complete system.
+
 
 +
Details from 45 CFR Part 170 describe the ability of a eligible system to be constructed from modules, and thus VistA doesn't have to meet all of the meaningful use criteria by itself.''
 +
 
 +
[[MU-CompositeSystems|Discussion/Details Page]]
  
 
=Possible $ Bonus amounts=
 
=Possible $ Bonus amounts=
  
 +
[https://questions.cms.hhs.gov/cgi-bin/cmshhs.cfg/php/enduser/std_adp.php?p_faqid=9810&p_created=1245700431&p_sid=GYgNF3Tj&p_accessibility=0&p_redirect=&p_lva=&p_sp=cF9zcmNoPSZwX3NvcnRfYnk9JnBfZ3JpZHNvcnQ9JnBfcm93X2NudD0yNCwyNCZwX3Byb2RzPTIxLDI2LDEwNTgmcF9jYXRzPSZwX3B2PTMuMTA1OCZwX2N2PSZwX3NlYXJjaF90eXBlPWFuc3dlcnMuc2VhcmNoX25sJnBfcGFnZT0x&p_li=&p_topview=1 Up to $65k, maximum amount available under Medicaid]
 +
 +
[https://questions.cms.hhs.gov/cgi-bin/cmshhs.cfg/php/enduser/std_adp.php?p_faqid=9811&p_created=1245700559&p_sid=ENVCG3Tj&p_accessibility=0&p_redirect=&p_lva=&p_sp=cF9zcmNoPSZwX3NvcnRfYnk9JnBfZ3JpZHNvcnQ9JnBfcm93X2NudD0yNCwyNCZwX3Byb2RzPTIxLDI2LDEwNTgmcF9jYXRzPSZwX3B2PTMuMTA1OCZwX2N2PSZwX3NlYXJjaF90eXBlPWFuc3dlcnMuc2VhcmNoX25sJnBfcGFnZT0x&p_li=&p_topview=1 Up to $44k, maximum amount available under Medicare]
  
 
=Listing of Criteria for Stage 1 of Meaningful Use=
 
=Listing of Criteria for Stage 1 of Meaningful Use=
  
==Use Computerised Provider Order Entry (CPOE)==
+
==1. Use Computerised Provider Order Entry (CPOE)==
Enable a user to electronically record, store, retrieve and manage, at a minimum, the following order types:
+
; VistA Status: [ ] '''Ready Now'''; [ ] Minor Work; [X] Moderate Work  [ ] Major Work depending upon which item. Elements of this are handled in other Meaningful use items.
*# Medications
+
; [[MU-CPOE|Discussion/Details Page]]
*# Laboratory
+
 
*# Radiology/Imaging
+
==2. Implement drug-drug, drug-[[allergy~|Allergy]], drug-formulary checks==
*# Provider referrals
+
; VistA Status: [ ] Ready Now; [ ] Minor Work;  [X] Major Work <Please edit>
 +
; [[MU-RxCheck|Discussion/Details Page]]
 +
 
 +
==3. Maintain an up-to-date problem list of current and active diagnoses based on ICD-9-CM or SNOWMED CT==
 +
; VistA Status: [x] '''Ready Now'''; [ ] Minor Work;  [ ] Major Work <Please edit>
 +
; [[MU-ProbList|Discussion/Details Page]]
  
==Implement drug-drug, drug-allergy, drug-formulary checks==
+
==4. Generage and transmit permissible prescriptions electronically (eRx)==
; VistA
+
; VistA Status: [ ] Ready Now; [ ] Minor Work;  [ X] Major Work <Please edit>
:
+
; [[MU-ERx|Discussion/Details Page]]
==Maintain an up-to-date problem list of current and active diagnoses based on ICD-9-CM or SNOWMED CT==
 
; VistA
 
:
 
==Generage and transmit permissible prescriptions electronically (eRx)==
 
  
==Maintain active medication list==
+
==5. Maintain active medication list==
 +
; VistA Status: [ ] Ready Now; [ ] Minor Work;  [X] Major Work <Please edit>
 +
; [[MU-MedList|Discussion/Details Page]]
  
==Maintain active medication allergy list==
+
==6. Maintain active medication [[allergy~|Allergy]] list==
 +
; VistA Status: [ ] Ready Now; [ ] Minor Work;  [ ] Major Work [X] To be determined <Please edit>
 +
; [[MU-AllergyList|Discussion/Details Page]]
  
==Record demographics==
+
==7. [[Record~|Record]] demographics==
 +
; VistA Status: [ ] Ready Now; [ ] Minor Work;  [ ] Major Work [X] To Be Determined <Please edit>
 +
; [[MU-Demographics|Discussion/Details Page]]
  
==Record and chart changes in vital signs==
+
==8. [[Record~|Record]] and chart changes in vital signs==
 +
; VistA Status: [ ] Ready Now; [X] Minor Work;  [ ] Major Work <Please edit>
 +
; [[MU-Vitals|Discussion/Details Page]]
  
==Record smoking status for patients 13 yrs old or older==
+
==9. [[Record~|Record]] smoking status for patients 13 yrs old or older==
 +
; VistA Status: [ ] Ready Now; [X] Minor Work;  [ ] Major Work <Please edit>
 +
; [[MU-SmokeStatus|Discussion/Details Page]]
  
==Incomporate clinical lab-test results into EHR as structured data==
+
==10. Incomporate clinical lab-test results into EHR as structured data==
 +
; VistA Status: [] '''Ready Now'''; [ ] Minor Work;  [ ] Major Work [X] Depends upon specific requirements which are not yet available <Please edit>
 +
; [[MU-LabIntegrate|Discussion/Details Page]]
  
==Generate lists of patients by specific conditions to use for quality improvement, reduction of disparities and outreach==
+
==11. Generate lists of patients by specific conditions to use for quality improvement, reduction of disparities and outreach==
 +
; VistA Status: [ ] Ready Now; [ ] Minor Work;  [ ] Major Work <Please edit>
 +
; [[MU-PtLists|Discussion/Details Page]]
  
==Report quality measures to CMS or the States==
+
==12. Report quality measures to CMS or the States==
 +
; VistA Status: [ ] Ready Now; [ ] Minor Work;  [X] Major Work <Please edit>
 +
; [[MU-ReportQuality|Discussion/Details Page]]
  
==Send reminders to patients per patient preference for preventative/followup care==
+
==13. Send reminders to patients per patient preference for preventative/followup care==
 +
; VistA Status: [ ] Ready Now; [ ] Minor Work;  [ ] Major Work <Please edit>
 +
; [[MU-PtReminders|Discussion/Details Page]]
  
==Implement 5 clinical decision support rules==
+
==14. Implement 5 clinical decision support rules==
 +
; VistA Status: [ ] Ready Now; [ ] Minor Work;  [ ] Major Work <Please edit>
 +
; [[MU-SupportRules|Discussion/Details Page]]
  
==Check insurance eligibility electronically frompublic and private payers==
+
==15. Check insurance eligibility electronically from public and private payers==
 +
; VistA Status: [ ] Ready Now; [ ] Minor Work;  [ ] Major Work <Please edit>
 +
; [[MU-eInsurElig|Discussion/Details Page]]
  
==Submit claims electronically to public and private payers==
+
==16. Submit claims electronically to public and private payers==
 +
; VistA Status: [ ] Ready Now; [ ] Minor Work;  [ ] Major Work <Please edit>
 +
; [[MU-eClaims|Discussion/Details Page]]
  
==Provide patients with an electronic copy of their health information upon request==
+
==17. Provide patients with an electronic copy of their health information upon request==
 +
; VistA Status: [ ] Ready Now; [ ] Minor Work;  [ ] Major Work <Please edit>
 +
; [[MU-eCopyInfo|Discussion/Details Page]]
  
==Provide patients with an electronic copy of their discharge instructions and procedures at time of discharge, upon request==
+
==18. Provide patients with an electronic copy of their discharge instructions and procedures at time of discharge, upon request==
 +
; VistA Status: [ ] Ready Now; [ ] Minor Work;  [ ] Major Work <Please edit>
 +
; [[MU-Discharge|Discussion/Details Page]]
  
==Provide patients with timely electronic access to their health information (including lab results, problem lists, medication lists, allergies) within 96 hours of the information being available to the eligible professional==
+
==19. Provide patients with timely electronic access to their health information (including lab results, problem lists, medication lists, allergies) within 96 hours of the information being available to the eligible professional==
 +
; VistA Status: [ ] Ready Now; [ ] Minor Work;  [ ] Major Work <Please edit>
 +
; [[MU-eAccess|Discussion/Details Page]]
  
==Provide clinical summaries for patients for each office visit==
+
==20. Provide clinical summaries for patients for each office visit==
 +
; VistA Status: [ ] Ready Now; [ ] Minor Work;  [ ] Major Work <Please edit>
 +
; [[MU-Summaries|Discussion/Details Page]]
  
==Capability to exchange key clinical information among providers of care and patient authorized entities electronically.==
+
==21. Capability to exchange key clinical information among providers of care and patient authorized entities electronically.==
 +
; VistA Status: [ ] Ready Now; [ ] Minor Work;  [ ] Major Work <Please edit>
 +
; [[MU-eExchange|Discussion/Details Page]]
  
==Provide summary care records for each transition of care and referral==
+
==22. Provide summary care [[record~|Record]]s for each transition of care and referral==
 +
; VistA Status: [ ] Ready Now; [ ] Minor Work;  [ ] Major Work <Please edit>
 +
; [[MU-TransSummary|Discussion/Details Page]]
  
==Perform medication reconciliation at relevant encounters and each transition of care==
+
==23. Perform medication reconciliation at relevant encounters and each transition of care==
 +
; VistA Status: [ ] Ready Now; [ ] Minor Work;  [ ] Major Work <Please edit>
 +
; [[MU-eMedRec|Discussion/Details Page]]
  
==Capability to submit electronic data to immunization registries and actual submission where required and accepted.==
+
==24. Capability to submit electronic data to immunization registries and actual submission where required and accepted.==
 +
; VistA Status: [ ] Ready Now; [ ] Minor Work;  [ ] Major Work <Please edit>
 +
; [[MU-ImmReg|Discussion/Details Page]]
  
==Capability to provide electronic submission of reportable lab results (as required by state or local law) to public health agencies and actual submission where is can be received==
+
==25. Capability to provide electronic submission of reportable lab results (as required by state or local law) to public health agencies and actual submission where is can be received HOSPITALS ONLY==
 +
; VistA Status: [ ] Ready Now; [ ] Minor Work;  [ ] Major Work <Please edit>
 +
; [[MU-eSubReportable|Discussion/Details Page]]
  
==Capability to provide electronic syndromic surveillance data to public health agencies and actual transmission according to applicable law and practice==
+
==26. Capability to provide electronic syndromic surveillance data to public health agencies and actual transmission according to applicable law and practice==
 +
; VistA Status: [ ] Ready Now; [ ] Minor Work;  [ ] Major Work <Please edit>
 +
; [[MU-eSyndromic|Discussion/Details Page]]
  
==Protect electronic health information created or maintained by the certified EHR technology through the implementation of appropriate technical capabilities.==
+
==27. Protect electronic health information created or maintained by the certified EHR technology through the implementation of appropriate technical capabilities.==
 +
; VistA Status: [ ] Ready Now; [ ] Minor Work;  [ ] Major Work <Please edit>
 +
; [[MU-Security|Discussion/Details Page]]

Latest revision as of 19:54, 21 March 2012

Discussion of How VistA Meets, or Can Meet,
Meaningful Use, Stage 1
45 CFR Part 170

Final Rule

Interim final rule documents (superseded by Final rule documents)

Contents

Background discussion

  • The texts discusses EHR's as being Certified. It is not yet clear how this certification status will be awarded.
  • The criteria herein are just for Stage 1 (beginning 2011). Further criteria are likely to be unveiled as the program progresses.
  • Stage 2 will begin in 2013; Stage 3 in 2015
  • Professionals must not only adopt/install a certified EHR, but must also demonstrate meaningful use. Thus just have a system capable of the features below will not be sufficient. They must be implemented and used.

All-in-one vs. Composite systems

Details from 45 CFR Part 170 describe the ability of a eligible system to be constructed from modules, and thus VistA doesn't have to meet all of the meaningful use criteria by itself.

Discussion/Details Page

Possible $ Bonus amounts

Up to $65k, maximum amount available under Medicaid

Up to $44k, maximum amount available under Medicare

Listing of Criteria for Stage 1 of Meaningful Use

1. Use Computerised Provider Order Entry (CPOE)

VistA Status
[ ] Ready Now; [ ] Minor Work; [X] Moderate Work [ ] Major Work depending upon which item. Elements of this are handled in other Meaningful use items.
Discussion/Details Page

2. Implement drug-drug, drug-Allergy, drug-formulary checks

VistA Status
[ ] Ready Now; [ ] Minor Work; [X] Major Work <Please edit>
Discussion/Details Page

3. Maintain an up-to-date problem list of current and active diagnoses based on ICD-9-CM or SNOWMED CT

VistA Status
[x] Ready Now; [ ] Minor Work; [ ] Major Work <Please edit>
Discussion/Details Page

4. Generage and transmit permissible prescriptions electronically (eRx)

VistA Status
[ ] Ready Now; [ ] Minor Work; [ X] Major Work <Please edit>
Discussion/Details Page

5. Maintain active medication list

VistA Status
[ ] Ready Now; [ ] Minor Work; [X] Major Work <Please edit>
Discussion/Details Page

6. Maintain active medication Allergy list

VistA Status
[ ] Ready Now; [ ] Minor Work; [ ] Major Work [X] To be determined <Please edit>
Discussion/Details Page

7. Record demographics

VistA Status
[ ] Ready Now; [ ] Minor Work; [ ] Major Work [X] To Be Determined <Please edit>
Discussion/Details Page

8. Record and chart changes in vital signs

VistA Status
[ ] Ready Now; [X] Minor Work; [ ] Major Work <Please edit>
Discussion/Details Page

9. Record smoking status for patients 13 yrs old or older

VistA Status
[ ] Ready Now; [X] Minor Work; [ ] Major Work <Please edit>
Discussion/Details Page

10. Incomporate clinical lab-test results into EHR as structured data

VistA Status
[] Ready Now; [ ] Minor Work; [ ] Major Work [X] Depends upon specific requirements which are not yet available <Please edit>
Discussion/Details Page

11. Generate lists of patients by specific conditions to use for quality improvement, reduction of disparities and outreach

VistA Status
[ ] Ready Now; [ ] Minor Work; [ ] Major Work <Please edit>
Discussion/Details Page

12. Report quality measures to CMS or the States

VistA Status
[ ] Ready Now; [ ] Minor Work; [X] Major Work <Please edit>
Discussion/Details Page

13. Send reminders to patients per patient preference for preventative/followup care

VistA Status
[ ] Ready Now; [ ] Minor Work; [ ] Major Work <Please edit>
Discussion/Details Page

14. Implement 5 clinical decision support rules

VistA Status
[ ] Ready Now; [ ] Minor Work; [ ] Major Work <Please edit>
Discussion/Details Page

15. Check insurance eligibility electronically from public and private payers

VistA Status
[ ] Ready Now; [ ] Minor Work; [ ] Major Work <Please edit>
Discussion/Details Page

16. Submit claims electronically to public and private payers

VistA Status
[ ] Ready Now; [ ] Minor Work; [ ] Major Work <Please edit>
Discussion/Details Page

17. Provide patients with an electronic copy of their health information upon request

VistA Status
[ ] Ready Now; [ ] Minor Work; [ ] Major Work <Please edit>
Discussion/Details Page

18. Provide patients with an electronic copy of their discharge instructions and procedures at time of discharge, upon request

VistA Status
[ ] Ready Now; [ ] Minor Work; [ ] Major Work <Please edit>
Discussion/Details Page

19. Provide patients with timely electronic access to their health information (including lab results, problem lists, medication lists, allergies) within 96 hours of the information being available to the eligible professional

VistA Status
[ ] Ready Now; [ ] Minor Work; [ ] Major Work <Please edit>
Discussion/Details Page

20. Provide clinical summaries for patients for each office visit

VistA Status
[ ] Ready Now; [ ] Minor Work; [ ] Major Work <Please edit>
Discussion/Details Page

21. Capability to exchange key clinical information among providers of care and patient authorized entities electronically.

VistA Status
[ ] Ready Now; [ ] Minor Work; [ ] Major Work <Please edit>
Discussion/Details Page

22. Provide summary care Records for each transition of care and referral

VistA Status
[ ] Ready Now; [ ] Minor Work; [ ] Major Work <Please edit>
Discussion/Details Page

23. Perform medication reconciliation at relevant encounters and each transition of care

VistA Status
[ ] Ready Now; [ ] Minor Work; [ ] Major Work <Please edit>
Discussion/Details Page

24. Capability to submit electronic data to immunization registries and actual submission where required and accepted.

VistA Status
[ ] Ready Now; [ ] Minor Work; [ ] Major Work <Please edit>
Discussion/Details Page

25. Capability to provide electronic submission of reportable lab results (as required by state or local law) to public health agencies and actual submission where is can be received HOSPITALS ONLY

VistA Status
[ ] Ready Now; [ ] Minor Work; [ ] Major Work <Please edit>
Discussion/Details Page

26. Capability to provide electronic syndromic surveillance data to public health agencies and actual transmission according to applicable law and practice

VistA Status
[ ] Ready Now; [ ] Minor Work; [ ] Major Work <Please edit>
Discussion/Details Page

27. Protect electronic health information created or maintained by the certified EHR technology through the implementation of appropriate technical capabilities.

VistA Status
[ ] Ready Now; [ ] Minor Work; [ ] Major Work <Please edit>
Discussion/Details Page