The authors found that even hospitals with core systems, such as registration and laboratory software, that have met the explicit data capture requirements for Stage 1 (for example, CPOE for medications and problem lists) will only have 35% of the data needed for the 15 required hospital measures. The remaining 65% are classified as the hidden requirements of meaningful use.
According to the report, the most difficult challenge of the hidden requirements is the need for additional physician documentation in the EHR and for electronic medication administration. In addition, the report shows that 30% of data elements from physician documentation and 10% of those from medication administration may come from the emergency department (ED) or surgical suite, areas where many hospitals have limited clinical IT.
Metzger said, "One of the big additions to meaningful use in the July release was inclusion of the ED."
The report noted, "Only two of the required hospital quality measures deal exclusively with care delivered in the ED to patients ultimately admitted to the hospital for inpatient care. However, in many hospitals a large number of admitted patients are first seen in the ED, and a number of the measures include data elements likely to be captured at that time."
The report continued, "In addition, several measures require information about care during a patient's stay in the surgical suite. Many hospitals use standalone clinical software in these care areas or may lack clinical IT altogether."
Metzger said, "The basic message is that a minimalist approach to Stage 1 meaningful use will not position any hospital for a future that includes healthcare reform, value-based purchasing, and increased cost pressures and transparency. In short, meeting the quality reporting requirements for meaningful use isn't just a project aimed at the HITECH incentives. It is the future."