Meaningful Use (WG6)

Discussion of How VistA Meets, or Can Meet, Meaningful Use, Stage 1 45 CFR Part 170

Final Rule
 * Standards and Certification Criteria Final Rule http://edocket.access.gpo.gov/2010/pdf/2010-17210.pdf [PDF - 390 kb]  U.S. Department of Health & Human Services (Published on July 28, 2010)

Interim final rule documents (superseded by Final rule documents)
 * Official document published in the Federal Register
 * http://edocket.access.gpo.gov/2010/E9-31216.htm (HTML version of Official Document published in the Federal Register)
 * VistApedia copy of Official Document
 * CMS Topical Web Site

=Background discussion=
 * The texts discusses EHR's as being Certified. It is not yet clear how this certification status will be awarded.
 * The criteria herein are just for Stage 1 (beginning 2011). Further criteria are likely to be unveiled as the program progresses.
 * Stage 2 will begin in 2013; Stage 3 in 2015
 * Professionals must not only adopt/install a certified EHR, but must also demonstrate meaningful use. Thus just have a system capable of the features below will not be sufficient. They must be implemented and used.

=All-in-one vs. Composite systems=

Details from 45 CFR Part 170 describe the ability of a eligible system to be constructed from modules, and thus VistA doesn't have to meet all of the meaningful use criteria by itself.''

Discussion/Details Page

=Possible $ Bonus amounts=

Up to $65k, maximum amount available under Medicaid

Up to $44k, maximum amount available under Medicare

=Listing of Criteria for Stage 1 of Meaningful Use=

1. Use Computerised Provider Order Entry (CPOE)

 * VistA Status: [ ] Ready Now; [ ] Minor Work; [X] Moderate Work [ ] Major Work depending upon which item. Elements of this are handled in other Meaningful use items.
 * Discussion/Details Page

2. Implement drug-drug, drug-Allergy, drug-formulary checks

 * VistA Status: [ ] Ready Now; [ ] Minor Work; [X] Major Work 
 * Discussion/Details Page

3. Maintain an up-to-date problem list of current and active diagnoses based on ICD-9-CM or SNOWMED CT

 * VistA Status: [x] Ready Now; [ ] Minor Work; [ ] Major Work 
 * Discussion/Details Page

4. Generage and transmit permissible prescriptions electronically (eRx)

 * VistA Status: [ ] Ready Now; [ ] Minor Work; [ X] Major Work 
 * Discussion/Details Page

5. Maintain active medication list

 * VistA Status: [ ] Ready Now; [ ] Minor Work; [X] Major Work 
 * Discussion/Details Page

6. Maintain active medication Allergy list

 * VistA Status: [ ] Ready Now; [ ] Minor Work; [ ] Major Work [X] To be determined 
 * Discussion/Details Page

7. Record demographics

 * VistA Status: [ ] Ready Now; [ ] Minor Work; [ ] Major Work [X] To Be Determined 
 * Discussion/Details Page

8. Record and chart changes in vital signs

 * VistA Status: [ ] Ready Now; [X] Minor Work; [ ] Major Work 
 * Discussion/Details Page

9. Record smoking status for patients 13 yrs old or older

 * VistA Status: [ ] Ready Now; [X] Minor Work; [ ] Major Work 
 * Discussion/Details Page

10. Incomporate clinical lab-test results into EHR as structured data

 * VistA Status: [] Ready Now; [ ] Minor Work; [ ] Major Work [X] Depends upon specific requirements which are not yet available 
 * Discussion/Details Page

11. Generate lists of patients by specific conditions to use for quality improvement, reduction of disparities and outreach

 * VistA Status: [ ] Ready Now; [ ] Minor Work; [ ] Major Work 
 * Discussion/Details Page

12. Report quality measures to CMS or the States

 * VistA Status: [ ] Ready Now; [ ] Minor Work; [X] Major Work 
 * Discussion/Details Page

13. Send reminders to patients per patient preference for preventative/followup care

 * VistA Status: [ ] Ready Now; [ ] Minor Work; [ ] Major Work 
 * Discussion/Details Page

14. Implement 5 clinical decision support rules

 * VistA Status: [ ] Ready Now; [ ] Minor Work; [ ] Major Work 
 * Discussion/Details Page

15. Check insurance eligibility electronically from public and private payers

 * VistA Status: [ ] Ready Now; [ ] Minor Work; [ ] Major Work 
 * Discussion/Details Page

16. Submit claims electronically to public and private payers

 * VistA Status: [ ] Ready Now; [ ] Minor Work; [ ] Major Work <Please edit>
 * Discussion/Details Page

17. Provide patients with an electronic copy of their health information upon request

 * VistA Status: [ ] Ready Now; [ ] Minor Work; [ ] Major Work <Please edit>
 * Discussion/Details Page

18. Provide patients with an electronic copy of their discharge instructions and procedures at time of discharge, upon request

 * VistA Status: [ ] Ready Now; [ ] Minor Work; [ ] Major Work <Please edit>
 * Discussion/Details Page

==19. Provide patients with timely electronic access to their health information (including lab results, problem lists, medication lists, allergies) within 96 hours of the information being available to the eligible professional==
 * VistA Status: [ ] Ready Now; [ ] Minor Work; [ ] Major Work <Please edit>
 * Discussion/Details Page

20. Provide clinical summaries for patients for each office visit

 * VistA Status: [ ] Ready Now; [ ] Minor Work; [ ] Major Work <Please edit>
 * Discussion/Details Page

21. Capability to exchange key clinical information among providers of care and patient authorized entities electronically.

 * VistA Status: [ ] Ready Now; [ ] Minor Work; [ ] Major Work <Please edit>
 * Discussion/Details Page

22. Provide summary care Records for each transition of care and referral

 * VistA Status: [ ] Ready Now; [ ] Minor Work; [ ] Major Work <Please edit>
 * Discussion/Details Page

23. Perform medication reconciliation at relevant encounters and each transition of care

 * VistA Status: [ ] Ready Now; [ ] Minor Work; [ ] Major Work <Please edit>
 * Discussion/Details Page

24. Capability to submit electronic data to immunization registries and actual submission where required and accepted.

 * VistA Status: [ ] Ready Now; [ ] Minor Work; [ ] Major Work <Please edit>
 * Discussion/Details Page

25. Capability to provide electronic submission of reportable lab results (as required by state or local law) to public health agencies and actual submission where is can be received HOSPITALS ONLY

 * VistA Status: [ ] Ready Now; [ ] Minor Work; [ ] Major Work <Please edit>
 * Discussion/Details Page

26. Capability to provide electronic syndromic surveillance data to public health agencies and actual transmission according to applicable law and practice

 * VistA Status: [ ] Ready Now; [ ] Minor Work; [ ] Major Work <Please edit>
 * Discussion/Details Page

27. Protect electronic health information created or maintained by the certified EHR technology through the implementation of appropriate technical capabilities.

 * VistA Status: [ ] Ready Now; [ ] Minor Work; [ ] Major Work <Please edit>
 * Discussion/Details Page