Meaningful use and clinical decision support

The meaningful use program is entering stage 3, which focuses a great deal on advanced clinical support. Now that electronic health records have been adopted on a large scale across the U.S., many doctors are looking to use these tools for patient care optimization. After all, the No. 1 reason the meaningful use program was developed in the first place was to give patients more streamlined and holistic care.

How EHRs fit into clinical decision support
Before the HITECH spurred widespread growth in the adoption of EHRs, many doctors thought that these records would house patient information much more easily than paper records.

"Based on stage 3, preventative care is a clear focus."

Additionally, once the program began to advance, an EHR became less like an "electronic filing cabinet, and more of an indispensable tool by which to deliver better healthcare," said former ONC coordinator Dr. Farzad Mostashari, according to the American Health Information Management Association.

Stage 2 took these steps a bit further, stating that eligible providers and professionals had to demonstrate five key clinical support guidelines outlined by the Centers for Medicare & Medicaid Services. For instance, AHIMA used the example of a senior man who is a candidate for colorectal cancer screening. Once the EHR allows the physician to see that the patient is due for a screening, and then the patient has the colonoscopy, this would qualify as an instance of clinical decision support.

With stage 2 in the rear-view mirror, many physicians are now looking to stage 3 requirements. One of the key provisions of stage 3 includes updates to clinical decision support, but the recommendations take it a step further than stage 2 did. The CMS states that all eligible providers and professionals must "implement 15 clinical decision support interventions or guidance related to five or more clinical quality measures." In addition, two or more of these 15 interventions must relate to the management of chronic diseases, lab and radiology ordering, preventative care and support related to advanced medications.

Based on stage 3's robust initiatives, it's clear that the CMS is making preventative care a clear focus. According to Healthcare IT News, this decision is "long overdue," especially given the rise of many chronic diseases in the U.S., including diabetes and heart disease.

Meaningful use stage 3 aims at making clinical interventions possible via EHRs.
Meaningful use stage 3 aims at making clinical interventions possible via EHRs.

Tools to help providers with meaningful use clinical decision support
Patient portals and EHR modules that allow doctors to enable clinical decision support will certainly become more important moving forward. During HIMSS15 in Chicago last month, the CMS announced the progression of open APIs on EHRs for stage 3 purposes. It seems that the U.S. government truly wants patient engagement to become the future purpose of the EHR, and it makes sense.

Patients are already very involved with online presence when it comes to healthcare, especially given the popularity of wearable technology and healthcare and wellness apps. If stage 3 is adopted on a wide-reaching scale, it could make coordination of care and value-based services a reality in the U.S. medical system.

Additionally, according to Healthcare IT News, doctors will have access to a "behavior change" formulary for e-prescribing, which can further efforts for prevention and reduce the amount of prescription drug overuse. This is a major goal for the CMS, as preventative efforts can reduce an estimated 80 percent of the nation's healthcare costs.

Of course, interoperability is going to play a major role in making stage 3 successful. EHRs need to become more advanced in order for doctors to be able to deliver the care strategies needed to adopt this platform. With stage 3 already happening across the U.S., doctors need to think about implementing advanced intelligent medical software in order to stay on track with regulatory demands. 

An overview of MU stage 3

Ever since the Centers for Medicare & Medicaid Services launched the meaningful use program through the HITECH Act in 2009, there have been significant strides to help the U.S. health care system implement electronic health records. The first round of implementation, stage 1, began in 2011, while stage 2 started last year in 2014. With the first two stages in the rear-view mirror, many hospitals and health systems are looking to advance their medical software and other technology for stage 3, which is set for 2017.

Although the CMS has developed an overview of how the organization would like stage 3 to operate, the rule has not yet been finalized. However, based on what the CMS has outlined so far, stage 3 might be the most comprehensive of the platforms outlined in the MU program, as it affects many topics, areas of care and demographics.  

"Stage 3 is the most comprehensive platform outlined in the MU program."

"Even though we're talking about Stage 3," Robert Anthony, deputy director of the quality measurement and health assessment group at the CMS, said at HIMSS15 in Chicago last month, according to Healthcare IT News, "what we're really talking about is what everybody will be doing – or we're proposing that everyone will do – in 2018 and beyond."

A vision laid out for MU stage 3
Many health care professionals let the CMS know that with the first two stages, there were significant growing pains that need to be addressed, specifically with workflow issues. Stage 3 initiatives hope to correct these problems by making the implementation and health information exchange process much more streamlined and simple.

One of the more notable "upgrades" with stage 3 is the fact that the CMS has narrowed down the more than 20 objectives to eight simple and straightforward topics that provide internal flexibility for many kinds of eligible providers and professionals.

Also at HIMSS15, Elisabeth Myers, the policy and outreach lead in CMS' division of health IT, further explained these eight objectives to a packed crowd at Chicago's McCormick Place, which are as follows:

  • Protecting patient data in EHRs
  • E-prescribing
  • Public health reporting
  • Patients obtaining electronic access to their health data
  • Computerized provider order entry
  • Clinical decision support
  • Patient engagement through care coordination
  • Health information exchange

Many of these eight initiatives expand upon features in stage 2. For example, providers can now use APIs to meet criteria as part of the patient access objective. This could be particularly useful given the rise of mobile health devices and wearables that have become very popular with the general public.

Optimizing your medical software is important to meet stage 3 requirements.
Optimizing your medical software is important to meet stage 3 requirements.

Additionally, stage 3 MU requirements have a renewed focus on making EHR systems more interoperable. In stage 1 and 2, it was apparent that in many cases, a majority of patient data was getting locked up in departmental or organizational silos, which created problems for both patients and providers and wasted costs.

The goal of stage 3 would be to remove these barriers so that providers can achieve operational goals, better engage with patients and reduce costs at the same time. Managing chronic conditions like diabetes and coronary heart disease, managing high-cost radiological orders and focusing on preventative care were also outlined in the stage 3 proposals.

Although stage 3 isn't finalized until 2017, now is the time for eligible providers and professionals to ensure that their organizations are ready for the changes. Make sure your EHR system's functionality will not only keep the organization in line with these federal requirements, but will also allow you to provide better care for your patients and drive down operational costs within your practice.