MU2 – #4 A Focus on Orders and Results
Stage 2 of Meaningful Use will require many practices to significantly enhance their processes around orders and results. A lab interface will be a requirement for virtually all practices and many practices will need a bi-directional interface. Plan on significant changes in workflows and additional provider or staff time to meet these additional requirements.
Order Entry (CPOE): In Stage 1, providers were required to enter medications into the certified EHR at least 30% of the time. With Stage 2, that measure has been expanded to 60%, AND providers are now required to also enter lab studies and radiology studies 30% of the time. Providers who place fewer than 100 orders of a specific type (meds, labs, radiology) during the reporting period are excluded for that order type. Remember that the reporting period for 2014 is a calendar quarter, so some of your providers may qualify for an exclusion in 2014 but not in future years when the reporting period expands to 12 months.
Providers who have been listing the labs and radiology studies as text within their clinical notes will now need to select the orders from a picklist at least 30% of the time. You will need to understand where within the program the orders must be entered in order to be counted on the EHR’s Meaningful Use report. In many practices, staff enter the lab and radiology orders directly into another computer system (provided by the lab, hospital, or radiologist). To avoid having to enter the orders twice (once into your EHR and again into the lab or radiology system), you will want to explore a bi-directional interface where orders entered into your EHR are automatically sent to the lab and results from the lab system automatically feed into the EHR. We expect to see long queues for interface orders.
Who Can Enter the Orders: CMS specifications indicate that licensed healthcare professionals and “credentialed medical assistants” are allowed to enter the order. The rationale is that the certified EHR provides alerts to the user when orders are entered and that the person standing at the computer needs to have sufficient clinical knowledge to review and respond to these important quality concerns. Any individual who holds a medical assistant position in your organization and has a credential from a source outside your practice can be used. A specific credential has not been specified. Some options to consider:
- Carefully define the role of your medical assistants with written job descriptions and delineation of the credentials that are acceptable to your organization.
- Implement an operational policy that all alerts that are presented to a lower level medical assistant who is entering orders into the EHR are reviewed and approved with a supervisor or physician/mid-level prior to being finalized.
- Verify whether the MU reports generated by your EHR exclude orders entered by certain (non-credentialed) users from counting in the numerator.
Lab Results: The optional (Menu) measure in Stage 1 has become required (Core) and has increased to 55% of lab results being incorporated in the EHR as discrete data. There is no exclusion based on volume of labs ordered. There are no limitations regarding the type of lab or type of lab test, so positive/negative results from pathology studies as well as clinical labs are included. Results may be entered manually, scanned to discrete data fields, or received through an interface. There is currently no requirement that the lab result link back to the order, although we expect to see this type of requirement in Stage 3.
In addition, a separate Core Measure (Patient Electronic Access) requires that at least 50% of patients have online access to their health information, including lab results, within 4 business days. In the next MU 2 Blog Post, we’ll discuss this Measure further and provide tips for implementing and using a Patient Portal.
Get the CMS Specification Sheet for each Stage 2 Measure here.
Need help unraveling the complexities of Meaningful Use? MSOC Health can help! Contact Jeanne Chamberlin, Director of EMR Consulting at 919-442-2422 or firstname.lastname@example.org.