EDITOR’S NOTE: This is the first in of a series of articles addressing the facts, adoption, implementation and the interconnectivity of ICD-10 and Meaningful Use
Meaningful use is a topic being discussed everywhere in healthcare today. The Medicare and Medicaid electronic health record (EHR) incentive programs are providing major financial incentives for hospitals and providers to implement the “meaningful use” of certified EHR technology to achieve health and efficiency goals put forth by HITECH. Consequently, hospitals and providers are in the throes of putting meaningful use into practice.
There are many reasons why facilities and providers alike are working on meaningful use. But how many are looking at meaningful use in relation to the other big change that is coming? (You know: ICD-10.) Many large facilities are looking at both, and there is a strong correlation between the two. Interestingly, many opponents of ICD-10 are looking at meaningful use as the vehicle through which to justify shutting down or postponing the planned adoption of the new code set. In order to understand the value that ICD-10 adoption will add to meaningful use, first we need to break down meaningful use to its first-phase components.
In this series of articles we are going to explain the components of meaningful use on a basic level, without discussion of timelines, incentives and altruistic goals. The next step will be to expand your understanding to encompass ICD-10-CM adoption and integration, and to look for the areas in which they complement each other. For now, let’s perform a quick review of the current incentives and rules that comprise meaningful use:
- Participation starts in 2011.
- Possible incentives of $44,000 over five years exist.
- Providers must start in 2012.
- Important! For 2015 and later, Medicare-eligible professionals, eligible hospitals and CAHs that do not successfully demonstrate meaningful use will have a payment adjustment in their Medicare reimbursement.
The big goal of meaningful use is to ensure full use as the ultimate vision in which all patients are fully engaged in their healthcare and providers have real-time access to all medical information and tools to ensure the quality and safety of care while also affording improved access and elimination of healthcare disparities. So, what must get done first?
1. Use CPOE
Use CPOE for orders involving medications, laboratory, radiology and referrals.
Orders do not have to be sent electronically to labs, pharmacy or diagnostic imaging centers in 2011 or 2012. Practices must enter 80 percent of their total orders directly by the clinician into the CPOE system.
2. Implement Drug-Drug, Drug-Allergy, Drug-Formulary Checks
Enable this functionality.
3. Maintain an Up-to-Date Problem List
Current and active diagnoses should be based on ICD-9-CM or SNOMED CT®.
Eighty percent of unique patients must have at least one coded problem/diagnosis, with “none” being an allowed entry.
4. Generate and Transmit Prescriptions Electronically
Providers must send 75 percent of all permissible prescriptions electronically.
5. Maintain an Active Medication List
Eighty percent of unique patients must have at least one coded entry, with “none” being an allowed entry.
6. Maintain an Active Medication Allergy List Again – 80 percent of unique patients must have at least one coded entry, with “none” being an allowed entry.
7. Record Demographics
Document preferred language, insurance type, gender, race, ethnicity and date of birth.
Eighty percent of patients must have demographics recorded as structured data.
8. Record and Chart Changes in Vital Signs
Track weight, weight and BP; calculate and display BMI; record growth charts for patients age two and over.
Eighty percent of patients ages 2 and over must have blood pressure and BMI entered.
Children ranging in age from 2 to 20 must have a growth chart plotted and displayed.
9. Record Smoking Status
Record whether patients are current smokers, former smokers or never smoked. This must be recorded for 80 percent of patients 13 or older.
So, as you can see, hospitals and providers have a lot of work to do. In the next article we are going to look at each of these tasks and its correlation with ICD-10-CM, workflow changes and opportunities, and the most important changes that will need to made in the delivery of healthcare.
About the Author
Sandra Draper, RHIT, CCS, is the director of education and development for Precyse and an experienced health information professional with more than 20 years of HIM management experience. She has a record of consistent success in advancing health information management departments’ participation in revenue cycle performance, improvement in accounts receivables and DNFB reduction through project management.
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