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HITECH/ARRA
Stage 3: New Objectives and Measures

Meaningful Use Objectives and Measures: New Objectives and Measures

Recommended for Adoption in Stage 3

The recommendations identify a number of new objectives in each of the four meaningful use subgroups for adoption in Stage 3. Generally, the recommendations do not identify when a new objective would be “menu” or “core,” but those that do are designated as such below. To improve quality, safety and reduce disparities:

  • 20% of referrals or transitions of care orders created using CPOE;  and
  • EHRT enabled to assist with follow-up on test results.

To strengthen patient engagement:

  • Add a menu objective for providers and hospitals: 10% of patients submit patient-generated health information, for use in improving performance on high-priority health conditions and/or improving patient engagement in care. The committee seeks input on how to better define and support this objective;
  • Patients are able to request an amendment to their record online through the view/download/transmit function; and
  • EHRT enabled to query research enrollment systems to identify available clinical trials, with implementation of a use requirement postponed until future stages.

To improve care coordination:

  • Providers and hospitals to which a patient is referred acknowledge receipt of external information and provide 50% of referral results to the requesting provider (10% returned electronically). The committee seeks input on returning test results; and
  • Hospitals send electronic notification of a significant healthcare event for 10% of patients to at least one key member of the patient’s care team, within two hours of the occurrence.

To support population and public health improvements:

  • Enable providers and hospitals to receive an appropriate age-, gender- and immunization history-based recommendation for 20% of patients from an immunization recommendation system, with an exclusion available for providers and hospitals that do not administer immunizations; and
  • Hospitals must send 10% of Healthcare Associated Infection (HAI) reports electronically to the National Healthcare Safety Network.

The committee also identifies possible ways to improve and expand information exchange in Stage 3 through new objectives, measures, and certification criteria:

  • Add a menu objective requiring practices to query an outside entity when a patient is transitioned without a care summary. EHRT must be able to query another entity for outside records and respond to such queries, with other added functionality. The committee questions how to measure this objective, and requests feedback on the best way to identify patients.
  • Add certification criteria enabling EHRT to query an external Provider Directory for entity-level addressing information.  The committee questions whether existing standards are mature enough to support this criterion and seeks input on implementation.

The committee also seeks input on expanding EHRT certification criteria to facilitate data portability.

Proposed for Future Stage

The committee identifies a number of objectives to be considered for future stages, and includes possible certification criteria to support many new objectives. The new objectives include:

  • Electronically sending adverse event reports to the FDA and/or the CDC;
  • Submission of vaccine contraindications and reasons for substance refusal;
  • Creation and provision of care plan information when transitioning or referring a patient, to include a number of specific elements;
  • Requiring an acknowledgement of order receipt and tracking for completion;
  • Advanced medication reconciliation to check for formulary compliance;
  • Reconciliation of contraindications;
  • Provider review and acceptance of patient-transmitted information into EHR; and
  • Provider submission of case reports on reportable diseases/conditions to public health agencies.

The committee also asks for input on how to advance the concept of a shared care planning and collaboration tool.

The committee also identifies a number of existing objectives to which certification criteria should be added or expanded in the future. These new functionalities include:

  • Greater specificity for food-drug interactions;
  • Standardized electronic procedures for prior authorization;
  • Capacity for electronic episodes of care;
  • Ability to maintain an up-to-date interdisciplinary problem list;
  • Support of streamlined access to prescription drug monitoring programs data;
  • Use of other EHR data to support maintenance of up-to-date and accurate problem lists;
  • Functionality to code medication allergy contraindications; and
  • Use of patient input to reconcile problems.

As noted previously, the committee requests feedback on six broad questions related to meaningful use. The most significant question is whether there should be flexibility for some providers or hospitals to achieve a close percentage of objectives but not all of them. The committee also asks how to balance ease of clinical documentation with practice management efficiency, whether providers should be required to conduct a health IT safety assessment, how to deal with several patient consent issues, how to foster innovation to share information and receive intelligence from other, non-EHR applications and services, and how to give providers evidence that a capability was in use for measures that are not percentage-based.