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Meaningful Use Quality Reporting Haunts CIOs

Capturing and submitting data to CMS directly from an EHR remains a big concern, according to a recent CHIME survey.

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While the vast majority of CIOs expect that their organizations will achieve Meaningful Use (MU) within Stage 1 of the program, nearly 90% said they still had concerns about meeting the requirements and, of those, 28% cited capturing and submitting data for quality measures as their largest concern, according to a recent survey by CHIME.

"Quality measures is the sticky wicket for everyone. These measures have to be created directly from your EHR versus having them abstracted and entered into the CMS Web site as we do today, so this is going to be very challenging," said Pam McNutt, SVP/CIO, Methodist Health System, and chair, CHIME Policy Steering Committee. "I think people were surprised [at how difficult this is going to be] because many of us are already reporting some of these same quality measures to CMS through various programs--such as Core Measures and Pay for Performance--so we thought, We have this data. But the thing is, a lot of this data is captured through abstractions where someone is reading through the chart or notes and pulling the data out and keeping tabs on who had what, but the thing here is this has to be generated from the EHR."

She continued, "Automated physician notes are not required [as part of Meaningful Use] until Stage 2, so you don’t have physicians recording some of the data that you need in granular fashion. So how are you going to record some of these items that are currently captured by abstraction? That is difficult. We don’t have our physicians on e-documentation yet, in most cases."

But that's not all. McNutt also noted that hospitals will have to map some of their tests, procedures, and results to codes like SNOMED, LOINC, and rxNorm because the calculation CMS wants requires it to be done using those codes. "This is not something many of us had in place before," she added.

In addition to concerns about quality measures, survey respondents voiced concerns about CPOE, with 26% finding that requirement most disconcerting. Responding to a question that asked if the emergency department's inclusion in a hospital's CPOE metric was helpful in reaching its 30% threshold, McNutt responded, "For some people, being able to count the orders entered while the patient is still in the ED is very helpful to reach that 30%, but for others who had no CPOE initiative of any kind going, they are still struggling--within nine months to a year--to get a lot of their physicians up and running."

Almost as an aside, McNutt touched on one of the issues that is giving CIOs the most grief of all--the lack of clinical informatics specialists in the workforce. "All of us are experiencing a shortage of qualified staff to help us with all these endeavors right now," she added.

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