Meaningful Use Stage 3 Emphasizes Better Decision Support

5 Key Elements For Clinical Decision Support Systems

Even as federal officials are finalizing standards for Stage 2 of the Meaningful Use incentive program for adoption of electronic health records (EHRs), an advisory committee is busy planning for the third and final stage of the $27 billion initiative.

For Stage 3, the Health IT Policy Committee's Meaningful Use Workgroup wants physicians and hospitals to increase their use of clinical decision support; computerized physician order entry (CPOE); structured, machine-readable data; and medication reconciliation (the process of comparing a patient's medication orders to all the meds he or she has actually been taking). The plan also ramps up requirements for patient engagement.

In a plan recently unveiled in Washington, D.C., the workgroup made its preliminary recommendations for Stage 3.

New for Stage 3 would be requiring providers to enable at least 10% of their patients to submit their medical history electronically, to accept readings from home medical devices, and to update and correct information in EHRs. Providers also would need to supply electronic care plans to other providers and care sites when patients are referred or moved, and the referring site would be required to send a small percentage of results back, according to documents prepared by workgroup chair Dr. Paul Tang, chief innovation and technology officer at the Palo Alto (Calif.) Medical Foundation, and co-chair Dr. George Hripcsak, head of biomedical informatics at Columbia University in New York.

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Several of the optional "menu" items in Stage 2 would become "core" measures in Stage 3, just as optional items would be mandatory in Stage 2, pending the final rule for Stage 2. In February, the U.S. Department of Health and Human Services (HHS) proposed rules for Stage 2. The final rule is expected any day, and Stage 2 is set to begin with fiscal year 2014, one year later than the 2009 American Recovery and Reinvestment Act originally called for.

Based on the current timeline, Stage 3 would start two years after a provider first achieves Stage 2 Meaningful Use, which means no earlier than 2016. Any physician or hospital that has not met Stage 1 by 2015 faces Medicare penalties for noncompliance.

In Stage 3, the Meaningful Use workgroup calls for a tripling of the minimum number of clinical decision support rules from 5, as proposed for Stage 2, to 15. The group wants providers to compare a minimum of 30% of hospital discharge medication orders to insurance drug formularies, up from 10% in the proposed Stage 2 rules.

Providers would also need to record more demographic information, including potentially controversial information such as sexual orientation and gender identity. The panel also recommends eliminating some measures that have "topped out," such as the recording of patient smoking status.

In the area of improving population health, the workgroup also would like providers to use EHRs to generate lists of patients for multiple specific conditions and present clinicians with real-time dashboard views for quality improvement, reduction of health disparities, research, or outreach purposes.

Tang and Hripcsak expect to send their final Stage 3 recommendations to HHS by May 2013, regardless of whether the November election produces a change in administration next January.

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