A couple of weeks ago we examined three of the five core stage 1 meaningful use objectives with a target threshold of 50%. Today we will finish up with the last two objectives on that list. Those two are:
• Clinical summary
• Patient request for an electronic copy of their health information
Clinical Summary
The clinical summary core meaningful use objective essentially states that a summary of the office encounter must be provided to the patient within 3 business days for at least 50% of the provider’s office-based encounters. What exactly is a clinical summary? Quoting from the final rule: “The after-visit clinical summary contains an updated medication list, laboratory and other diagnostic test orders, procedures and other instructions based on clinical discussions that took place during the office visit.”
In my opinion, the clinical summary will be the meaningful use objective that provides the greatest utility to our patients. How many times do your patients walk out of the office and within 10 minutes are unable to recall the majority of what transpired during the visit with you? I suspect this occurs more often than we imagine. Printing the clinical summary and handing it to the patient (or providing it electronically) truly has the potential to facilitate patient care.
While there is great utility with this measure, I also believe it will be one of the most disruptive objectives for the practice to meet from a work flow perspective. Note this measure applies to patient encounters within the office—the concept of unique patient encounters discussed last time does not apply to the clinical summary. You must distribute the clinical summary after at least half of your office-based encounters in order to meet this objective.
One final point to consider: you can deliver the clinical summary in a wide range of formats and still satisfy this objective. Printing the clinical summary is likely to be the most common method of delivering it to the patient, but this measure permits you to provide the clinical summary electronically as well (patient portal, secure email, or on electronic media such as a CD of USB fob for example). Providers without an office encounter during the reporting period are excluded from reporting this measure.
Patient Request for Electronic Copy of Health Information
The final measure on the 5 at 50% list deals with patients who request an electronic copy of their health information. To satisfy this measure, more than 50 percent of the provider’s patients who request an electronic copy of their health information must receive a copy within 3 business days. As with the clinical summary described above, this measure does not look at unique patient encounters and in fact the denominator for this measure is the patient request. This measure is not encounter based.
What does the phrase “copy of their health information” include? Quoting again from the final rule: “Provide patients with an electronic copy of their health information (including diagnostics test results, problem list, medication lists, medication allergies) upon request.”
As with the clinical summary, this objective provides substantial latitude in terms of the type of electronic format utilized to convey this information to the patient. The media could be any electronic form such as patient portal, PHR, CD, USB fob, etc. Providers are excluded from this measure if they have no patient requests for an electronic copy of health information during the reporting period.
The “Middle of the Order” will provide substantial challenges as the provider works to demonstrate meaningful use. The target for each of these five core measures is 50% of the eligible population. Remember, for demographics, vital signs and tobacco the measures look at unique patient encounters during the reporting period. The two measures reviewed today take a different approach—for the clinical summary, each office encounter during the reporting period is in the denominator, where as for the last measure, only patient requests for health information are captured. Pay close attention to the work flow within your practice and you will be successful in the Middle of the Order.
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