CPOE and Meaningful Use

The American Recovery and Reinvestment Act of 2009 authorized the Centers for Medicare & Medicaid Services (CMS)to provide financial incentives to providers and hospitals for adopting meaningful use of certified electronic health record (EHR) technology. [1]

Under this authority the Office of the National Coordinator for Health Information Technology (ONC) has begun to setup standards, implementation specifications, and certification criteria for EHR technology. The final rules should be completed by the end of 2010.

The ONC has listed the following goals as a guide:

1. Promote interoperability and where necessary be specific about certain content exchange and vocabulary standards to establish a path forward toward semantic interoperability. 2. Support the evolution and timely maintenance of adopted standards 3. Promote technical innovation using adopted standards 4. Encourage participation and adoption by all vendors, including small businesses 5. Keep implementation costs as low as reasonably possible 6. Consider best practices, experiences, policies, frameworks, and the input of the HIT Policy Committee and HIT Standards Committee in current and future standards 7. Enable mechanisms such as the Nationwide Health Information Networ (NHIN) to serve as a test-bed for innovation and as an open-source reference implementation of best practices 8. To the extent possible, adopt standard that are modular and not interdepenent.

The standards to be adopted are based on current industry practices and rely on the following: Health Level 7, Inc (HL-7); National Institute of Standards and Technology (NIST) and Integrating the Healthcare Enterprise (IHE); SNOMED CT; ICD-9 and 10; X12, LOINC, NCPDP and RxNorm.

The Centers for Medicare & Medicaid Services (CMS) has stated Meaningful Use is "one piece of a broader Helth Information Technology infrastructure needed to reform the health care system and improve health care quality, efficiency, and patient safety." This has been proposed to be accomplished in three stages:

 Stage 1 (2011):  Electronic capture of health information in a coded format
                  Tracking key clinical conditions
                  Effective communication and care coordination
                  Reporting of clinical quality measures
                  Reporting public health information
 Stage 2:  will expand on the above by focusing on disease management, clinical decision support, medication management, support for patient access to their health information, transitions in care quality measurement and research and direct communication with public health agencies.

Stage 3 would focus on achieving improvement in quality, safety and efficiency, focusing on decision support for national priority conditions, patient access to self management tools, acces to comprehensive patient data and improving health outcomes.

[2]

As of August 2009 the HIT Policy Council has provided a Matrix defining the time-line and recommendations of Meaningful Use. [3]

All of this is not without controversy. There are studies emerging that indicate that CPOE may actually increase medical errors especially if not implemented correctly. There is evidence that the current CCHIT-certified EHR technology is challenging to use for physicians and hospitals and takes years of training. Dr. Rick Weinhaus has observed that CCHIT certification model is "fatally flawed because it mandates hundreds of required features and functions, which take precedence over good software design."