Over the past several months I have reviewed a number of topics related to demonstrating meaningful use. As you may recall, the meaningful use framework is divided into core and menu objectives. There are 15 core objectives and 10 of these have a threshold that must be cleared. Previously I reviewed those measures with the highest threshold to clear. This week and next we will tackle the five core measures with a threshold of 50%:
1. Demographics
2. Vital signs
3. Tobacco use
4. Clinical summary
5. Patient request for health information
Today I’ll review the first three measures on the list. Remember, when discussing meaningful use measures with target thresholds, it is best to think of each measure as a fraction. The denominator of each fraction is the population eligible for the measure. For these three measures, the eligible population is defined as “unique” patient encounters during the reporting period. What’s a unique patient encounter? Effectively any patient seen outside of the hospital setting during the reporting period is a potential patient encounter. The word unique implies the patient is only counted once in the denominator regardless of how many times they see the provider during the reporting period. That is, if I see a particular patient every month during the reporting period, that patient only counts one time in the denominator. The numerator for these fractions is the number patients in the denominator who have achieved each measure. The requirements to achieve the three measures under discussion today are described below.
Demographics
The demographic objective requires the presence of five demographics during the encounter:
• Date of birth
• Gender
• Race
• Ethnicity
• Preferred language
All five demographic values must be available in the EHR at the time of the encounter in order for the provider to receive credit for this measure. As with all measures reviewed today, at least 50% of the provider’s unique patient encounters during the reporting period must have these five demographic fields recorded in the EHR. There are no exclusions for this measure.
Vital Signs
The vital signs objective requires the presence of three specific vital signs on the date of the encounter:
• Height
• Weight
• Blood Pressure
As mentioned above with demographics, meeting the vital signs measure requires all three vital signs to be present or viewable within the EHR on the date of service. For example, you will not receive partial credit if the patient’s height is not recorded. Note that as with demographics and tobacco use (described below), the vital signs may be entered by the provider or anyone else within the practice. The vital signs measure applies to patients ages 2 years old and older. If you do not see patients over the age of 2 or if you are willing to attest to the fact that recording these three vital signs is outside the scope of your practice, you are not required to report this measure.
Tobacco Use
Preventive health is a common thread throughout the meaningful use framework and tobacco use and its prevention are woven into its fabric. The tobacco core measure applies to unique patient encounters with patients who are 13 years of age or older. This objective measures the percentage of patients in this age range who have been asked if they use tobacco. As is the case with demographics and vital signs, the meaningful use framework does not require the tobacco data to be entered on the date of service—it simply must be viewable on the date of the encounter. If you do not see patients over the age of 12 you are not required to report this measure.
All three of the measures reviewed today are core measures. Adult nephrologists are unlikely to meet the exclusions that exist for vital signs and tobacco; therefore you will be required to report all three.
What are the challenges you will face with these three measures? Demographics will require your practice to capture data outside of the typical workflow (preferred language and the separation of race and ethnicity). In terms of vital signs, consider how often you measure height. Note that all three measures reviewed today can be captured by your staff and are not required to be captured at every visit. The middle of the order is where most of the heavy lifting occurs with meaningful use. Next week we will take a look at the other two core measures with a 50% threshold.
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