Previously I reviewed the high-threshold meaningful use objectives. Today I want to explore the Core meaningful use objectives without a threshold. What is the difference between those objectives with a threshold and those without? Simply stated, the meaningful use objectives without a threshold are asking the provider to attest to the fact that a singular action was accomplished during the meaningful use reporting period. There are five core objectives that fall into this category:
1. Were drug-drug and drug-allergy checks turned on for the duration of the reporting period?
2. Was a clinical decision support (CDS) rule implemented during the reporting period?
3. Did the provider exchange clinical data with another EHR during the reporting period?
4. Was a security risk analysis plan in place during the reporting period?
5. Did the provider submit clinical quality measures to CMS during the reporting period?
None of these measures are accompanied by exclusion criteria. As these five are core objectives, the absence of exclusion means every provider demonstrating meaningful use is expected to answer these five questions. I have reviewed security risk analysis (objective #4)and clinical quality measure (objective #5) in previous posts. Let’s take a closer look at the other three.
Verify Drug-Drug and Drug-Allergy Checks are On
The first core objective on the list is perhaps one of the easiest objectives to meet within the entire EHR incentive program. The e-prescribing tools in every certified EHR (and every certified e-prescribing application for those of you taking the modular approach to meaningful use) possess robust drug-drug and drug-allergy checking features. Often cited as the source of “alert fatigue”, recent enhancements to this process include the ability to attenuate the severity at which these interactions are brought to the user’s attention. This meaningful use objective is asking the provider to attest to the fact that this feature of the eRx tool was “on” throughout the reporting period. It is important to note that “turning it down” (so that you are not pummeled with every known interaction described in nauseating detail in the PDR for example) is acceptable…just don’t turn it off.
Use a CDS Rule
The second measure on the list is asking if the provider used a single clinical decision support (CDS) rule during the reporting period. Of interest, the above mentioned drug-drug and drug-allergy checking tool, while actually a form of CDS, does not count for this measure—it is not possible to kill two birds with one stone here. In spite of this restriction, meeting this measure should provide very little trouble for the nephrologist. CDS is present in some form or another within every certified EHR, and several EHRs permit you to create your own. Remember, the measure simply is asking if you used a CDS rule during the reporting period…a very low hurdle to clear.
Show Success Sending Data
The last core objective on our list today is exchanging key clinical data. This is an interoperability measure, one of the fundamental components of meaningful use. The measure requires the provider to attest to the fact that at least one time during the reporting period they were able to send information to “another distinct certified EHR or other system that can accept the information and not between organizations that share certified EHR technology.” All certified EHRs are capable of exporting a standard data set that at a minimum includes a patient’s problem list, medication list, medication allergy list and diagnostic test results. This measure’s success does not require the transmission of actual patient data (provider’s may send data for a test patient for example). Finally, practices with more than one provider using the same certified EHR are only required to meet this measure for one provider. The practice may then report success for all other provider’s in the practice as long as they are using the same certified EHR.
Demonstrating meaningful use will be a challenging process for many nephrologists. However, the core measures without a threshold reviewed above should not be difficult to achieve. In the coming weeks, I will review some of the tougher hurdles to clear that stand between you and the successful demonstration of meaningful use. Happy Holidays.
Randy Gertner says
Today I learned a good one. I did not know that lisinopril and lithium can interact, and lead to elevated lithium levels. Althought we all deal with alert fatigue, I find the benefits of the drug-drug interaction in the ERx tool invaluable. I was also “caught” on cyclosporin and lipitor—-one has to lower the lipitor dose when starting cyclosporin. My only wish for the EMR programs would be to allow us to “turn off” a particular alert if we wanted. For example, I know about cardura and “caution with the elderly.” I wish I could click a button “do not show me this alert again.”
Randy Gertner says
I was on call and received a call to fill some potassium. The k was low, so I chose KDUR. Alas, I get an alert. It is not a minor one, but DrFirst stated it was a major interaction. That is new (for me) for a k supplement. Turns out the patient has COPD. He was on ipratropium. The latter can cause decreased gut motility, and cause a solid k pill to rest on the stomach lining. There is a high chance of gastric ulcers, bleeding, and perforation with this drug interaction. The blurb and reference from DrFirst was excellent. I changed the medication to KLOR (liquid) and everything was ok. I think we see here the power of the government incentive. They encouraged us to go electronic to prevent an error like this.
I have some follow up on the lisinopril/lithium interaction listed above. I placed the patient on a baby lisinopril dose (2.5mg). I checked a Li level, and it increased to 2 (normal is .6 to 1.2). The patient and I concluded that it would be too difficult to manage and DC’ed the lisinopril. Compare this to the old way: No Dr.Frist, and no drug drug warning. Then the patient gets admitted with Li toxicity and needs dialysis. Again, the incentive program by the government prevents this type of error and saves the system money.
I find these drug in interaction references very educational. Anyone else out there have educational drug-drug interaction stories?
Randy Gertner says
Can the practice I exchange information with be an Acumen user at another practice across the country (not in my group practice but a separate group practice). It sounds like the answer is no the way I read your blog, but on the CMS website it is a bit more ambiguous to my read. Thank, RG
Terry Ketchersid, Vice President and Medical Officer at HITSG says
That is correct Randy, our understanding is the exchange must be with a seperate instance of the application if it is between practices using the same EHR. Until CMS further clarifies this we are advising our customers to exchange with a practice using a seperate system. Given the specialty specific nature of our application, in most instances this would prove to be the real world situation.