1. Capture the Data
Almost all data needed for Stage 1 has to be entered as structured data elements or entered using specific coding systems or vocabularies. In order to meet Stage 1 criteria, data capture has to focus on the specific data elements associated with Stage 1, including field entries specific to the provider, such as CDS rule parameters and specialty performance measure metrics. This will require an EHR system that has structured fields needed for each criteria, acquiring and loading content databases, configuring data-entry templates that assist and remind users to enter the correct data, and designing/developing methods to download eligibility, test results and other data from other systems. It will also require training the physicians or other users on how to accurately enter patient data.
2. Establish Effective Workflows to Reinforce Data Entry (Including Medication Reconciliation)
The key to the success of many workflow redesigns is developing teams and assigning roles. Data entered by medical assistants or nurses should be checked by a provider, who can then confirm findings and signs off on them as patient record entries. Medical assistants and nurses can also play roles in medication reconciliation by questioning patients about medications and queuing up medication information from patient transition records and notifications. Workflows should always include the provider taking the final responsibility for patient record entries made as a result of workflows and in some cases may need to manage the workflow alone.
3. Drive Provider Involvement in Adoption of the EHR
Providers must become committed EHR users to realize meaningful use. In order to have EHR data that is consistent and comprehensive every provider must use (and consistently uses) the system. The same is true of the success of functions and features such as CPOE, CDS and healthcare maintenance. Provider commitment requires at least training and some kind of discipline (such as peer pressure or upper management decree).
An even more effective level will be realized if providers are involved with system planning and rollout (the earlier the better), and when they are prepared for and then see the value they can get from using system features.
4. Computer-Based Provider Order Entry (CPOE)
There are two facts eligible professionals and practices need to understand about CPOE meaningful use criteria: The first is that the measure for all stages (including Stage 1: 80 percent) applies to all orders, including laboratory, radiology, referral, medication, physical therapy and other services. The second is that to satisfy Stage 1 (and subsequent Stage 2 and Stage 3) rates, each qualified order has to be directly entered by the authorizing provider. (This does not mean that for Stage 1, 80 percent of each type of order has to be entered via CPOE, but it does mean that 80 percent of cumulative orders must be entered via CPOE.) The key to meeting this challenge is getting authorized providers to use CPOE, which workflows can help. Nurses and other users can queue some orders to relieve providers of unnecessary "clerical" work without relieving them of their responsibility for actually placing the order. Standard orders and order sets associated with specific problems and visit types can also make it easier. Every ordering provider should gain an understanding of how CPOE works and how to use it, and enforce its use. Practices are also encouraged to integrate order transmittal and tracking when implementing CPOE. It is not specifically required for Stage 1, but the resulting provider convenience (of being able to track order status and link to results) goes a long way toward reinforcing CPOE use.
5. Start E-Prescribing — as Soon as Possible
The Stage 1 e-prescribing criteria requires provider to e-prescribe at least 75 percent of permissible prescriptions. Part of what is necessary to overcome the challenge is under the direct control of eligible professional practices: configure the EHR with an e-prescribing module, subscribe to networks that facilitate transmittal, and train users in and enforce use of the systems. Other challenges outside providers direct control that they need to track and pressure other stakeholders to resolve are: a) pharmacies that are still not equipped to receive and process e-prescriptions (40 percent of independents), and b) current Drug Enforcement Agency (DEA) prohibitions of e-prescribing controlled substances.