Meaningful Use Stage 2 Simplified for Us Pharmacy Folk: Part 3

In Part 1 we covered basic timelines and goals, in Part 2 we reviewed Core Objectives.  Welcome to the third installment, where we will outline the Menu Objectives.  

Stage 2 Meaningful Use provides a large update to the Menu Objectives when compared to Stage 1.  In Stage 1, we only saw Advanced Directives as an objective.  In Stage 2 we have a number of new additions, including a few relevant to Pharmacy Informatics.  As mentioned in Part 2, Eligible Hospitals must meet 3 out of 6 for Meaningful Use.  Those relevant to pharmacy include:

Progress Notes for more than 30 % of unique patients.  While this might primarily be an objective for providers, pharmacists are also writing notes related to medication therapy.  Common examples include anticoagulation or pharmacokinetic consults, as well as a number of items we will cover in Part 4 on Clinical Quality Measures.  Informatics Pharmacists may be asked to help provide contextual tools to aid the clinical pharmacist in writing notes.  The more targeted and meaningful notes we can write, the more likely we are to be accepted as members of the healthcare team.  Informatics is an important platform for pharmacists to show others the benefits of an EHR. 

ePrescribing in more than 10 % of discharge prescriptions.   Informatics Pharmacists play a role in configuring and maintaining the medication database used by providers to create electronic prescriptions.  Depending on the facility, they may own it entirely, or support it indirectly with another team.  A more comprehensive and accurate medication ordering database will translate to safer prescriptions and better physician acceptance.  Don't underestimate the importance of maintaining your medication libraries for prescribing use.  It is the linchpin in the connection to the continuity of care and will come full circle if a patient comes back to your hospital.  

Other objectives more unrelated to pharmacy include:

• Imaging results:  more than 20 % are accessible using certified EHR technology
• Family histories are recorded in more than 20 % of patients
• Advanced directives are recorded for more than 50 % of patients 65 years or older
• Lab results are provided to providers for more than 20 % of patients

If you like charts, CMS provides a nifty comparison table for both core and menu objectives. 

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ONC Dashboard on Health IT Adoption

The Office of the National Coordinator for Health IT has released a dashboard showing various adoption statistics.  Lots of fun to play with, I recommend you give it a try.  

Of note:

• Provider adoption is anywhere from 12 to 40 %.   Rural providers have adopted quicker than small practices in general.  
• Hospital adoption of Basic EHR (I will explain this in a future post) went from around 20% in 2010 to 35% in 2011.  
• About 93% of community pharmacies are in the Surescripts network for ePrescribing.  

Data based on Feb 2012 ONC Brief.  

With ONC clarifying layers of certified EHR technology and requiring implementation by the end of 2014, how much of a jump will we have in Basic EHR adoption in 2012?   

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Meaningful Use Stage 2 Simplified for Us Pharmacy Folk: Part 2

In Part 1 we discussed the intent of Meaningful Use Stage 2 Final Rule, as well as the timelines for implementation and attestation.  

Welcome to Part 2, where we bite off a chunk of core objectives, and how they relate to the Informatics Pharmacist.  

Starting out with what has changed, we see the have added a few core objectives for both Eligible Professionals (private doctor's offices) and Eligible Hospitals (and health systems).  We will primarily focus on the Eligible Hospital (EH) objectives, as these involve most Informatics practices.  

CMS added 2 additional core objectives, and is requiring all 16 be met.  The measures directly relevant to pharmacy include:

CPOE used for more than 60 % of medication orders.  This is a slight bump from Stage 1, but the impact on Pharmacy remains important.  Pharmacists play an integral role in order verification and perfection.  Informatics Pharmacists may build and design medication ordering systems EHRs, creating a unique opportunity to help providers make the 60 % threshold.  Spend as much time as possible with IT and provider groups to help bridge the gap between IT implementation and physician acceptance.  

Interventions:  implement 5 clinical decision support tools plus drug/drug and drug allergy support systems.   As a red hot topic in the world of Pharmacy Informatics, Stage 2 puts us to task and requires these tools to be in place.  Naturally the issue of alert fatigue and truly "meaningful" medication warnings surfaces as the gorilla in the room.   We could talk about this topic for hours, but let's cut to the real issue:  health systems are relying on Informatics teams to reduce noise and only show actionable warnings.  We will continue to beat on drug data vendors to streamline their content for clinical use, but until the legal ramifications as worked out we have to rely on each other.  Now that we have the backing of CMS the real question: as a profession what can we do to revolutionize this critical content?

eMAR implemented and used for more than 10 % of medication orders.  If you have eMAR in place, chances are you meet this objective easily.  If you have yet to implement, start buying your nurse colleagues donuts and coffee now.  It will be an interesting journey!  My main recommendation here is to really get to know your nurses.  Meet with them as often as you do pharmacy and you will discover some amazing new workflows.  Some you will want to change, others you might implement.  Success at eMAR is dependent on cooperation, and it is up to us to extend the hand. 

Immunization data transmitted successfully to external systems.  Many EHRs place immunizations within the purvue of databases designed mainly for medications, so Informatics Pharmacists may inherit some responsibilities for this objective.  It would most likely be pertaining to adequate documentation and codification of orders to allow transmission to third parties.  If you are not familiar with immunization workflows within your EHR it might be a good time to find a nurse colleague and transfer some knowledge.  

The remaining core objectives are not considered to have direct impact on Pharmacy Informatics, but as a member of the EHR team they are important to review.  

• Demographics:  Record for more than 80 % of patients
• Vitals:  Record for more than 80 % of patients
• Smoking Status:  Record for more than 80 % of patients
• Labs:  Incorporate lab results for more than 55 %
• Patient List:  generate patient list by specific conditions
• Patient Access:  Provide online access to health information for more than 50% with more than 5 % actually accessing. (if broadband available in community)
• Education Resources:  Use EHR to identify and provide education resources more than 10 %
• RX Reconciliation:  Medication Reconciliation at more than 50 % of transitions of care
• Summary of Care:  Provide summary of care document for more than 50 % of transitions of care and referrals with 10 % sent electronically and at least 1 sent to a recipient with a different EHR vendor or successfully testing with CMS test EHR
• Labs:  successful ongoing transmission of reportable laboratory data
• Syndromic Surveillance:  Successful ongoing transmission of electronic syndromic surveillance data
• Security Analysis:  Conduct or review security analysis and incorporate in risk management process

You can review the information directly at the CMS website as well.  

In Part 3 we will discuss Menu Objectives, and Part 4 will cover Clinical Quality Measures.  The 5th installment will break down ONC criteria certified EHR technology.  

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