While hospitals are required to do so under Stage 1 of Meaningful Use, "EPs were not included in this area, and this is something of concern because many do in-office testing, which will probably grow," said Arthur Davidson, M.D., director of public health informatics at Denver Health and a member of the Meaningful Use Workgroup. "There would be a missed opportunity to report those in the near term if we don't include EPs in this criteria."
He also wanted to expand the criteria so EPs would have to communicate reportable conditions for which no clearly associated lab value existed. "Maybe we can't do this in Stage 2, but we should signal it for Stage 3," Davidson said.
Paul Tang, M.D., VP and CMIO at Palo Alto Medical Foundation and chair of the Meaningful Use workgroup, said he liked the value-add that would incur if certain conditions triggered EHRs to bring forth the appropriate public health reporting form, even if electronic communication of that form was not possible. "This would be a little like our CPOE requirement, where you want to have the interaction, even if it goes by paper for a period of time," he said.
Up for debate was which electronic system would have to issue the information--the EHR or the LIS (laboratory information system) and the role of certification in the entire dynamic.
"Here is the challenge," said Charlene Underwood, director of Government and Industry Affairs, Siemens Medical Solutions, and a member of the Meaningful Use workgroup, "you have a clinical system which is your EHR, and then you have the lab system that feeds it. The lab system does the reporting and that's managed and separate, but there's overlap sometimes when this criteria comes in which says the EHR also has to do that reporting. It seems like the EHR should do condition reporting and alerting, and we should let the lab system do what it does."
James Daniel, public health coordinator with the Office of the National Coordinator for Health IT, said he didn't want Meaningful Use to get ahead of the industry by requiring providers to send electronic reports that public health agencies are not ready to receive. "This causes confusion with health departments. We need to do our homework and define this in a way that is useful for public health."
The issue of LIS certification also reared its head.
"This is a real problem because … today, in the law, it says you have to have a certified EHR. If you then expand that, it means we have to certify all the LISs in the nation--I just don't think we want to go there. There's a lot of overhead with that," said Underwood.
After Daniel said that is currently happening, Underwood responded, "I don't think that was ever the intent."
Despite the urge for caution, Davidson said the issue required action. "This is our window and our opportunity to make sure there is good reporting through Meaningful Use, and we should not dictate which method is used."
The Meaningful Use Workgroup will next meet on May 3 to reconcile its draft recommendations with other Health and Human Services programs, such as the National Quality Strategy and the Affordable Care Act's Accountable Care Organization provision.
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