Hospital Quality Reporting: The Hidden Requirements in Meaningful Use
The American Recovery and Reinvestment Act of 2009 includes incentive payments for hospitals and physician practices that can demonstrate “Meaningful Use” of certified electronic health record (EHR) technology. Given the orientation of the program as an investment in improving health care, the focus on using the EHR to enable performance monitoring, performance improvement and external reporting of performance measures is not surprising. In fact, quality reporting is one of a small number of specific EHR functions mentioned in the original legislation. The final rule for meaningful use incentives for 2011 and 2012 was released on July 13, 2010.
The Global Institute for Emerging Healthcare Practices is the applied research arm of CSC’s Healthcare Group.
The industry focus on HITECH meaningful use requirements has led many to not pay enough attention to what will be required to capture the data for the 15 quality measures for hospitals. Meaningful use criteria requires that every data element be available in the certified EHR, and measure specifications and data dictionaries are very clear about the type of documentation required, in particular when it is a physician order, a diagnosis, or a reason why a clinical intervention (such as a discharge medication or VTE prophylaxis) is not clinically appropriate for a particular patient.
We deconstructed the 15 hospital measures into the unique data elements and types and sources of electronic documentation needed. We found that even hospitals with core systems such as reg/ADT and laboratory who have met the explicit data capture requirements for HITECH meaningful use Stage 1 (CPOE for medications, problem list, etc.) will only have 35 percent of the data needed for the hospital measures. The remaining 65 percent are the hidden requirements of meaningful use.
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