Vendor Selection Criteria: Certification and meaningful use

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Selecting an EMR is like buying a house where it needs thorough inspection/evaluation and making sure that every component is functional and meeting all the related requirements prior to approval and signing of contract. Based on experience, some of the significant criteria that must be considered during the selection process are the following:

Product Requirements

  • Is the EHR system HIE certified? The organization might need an EHR system that meets the national interoperability standards; a system with the capability of transferring health information within and across organizational and state boundaries. Implementing an HIE certified system will eliminate the need to create a custom interface in the future that may be very costly to the organization. An HIE certified system will "reduce adoption barriers due to high interface costs, low reliability, and unknown development costs for the vendor". [1]

Resources for Healthcare Facilites

During the process of EHR selection, healthcare facilities should use the Comprehensive List of Certified Health Information Technology (CHPL) to identify certified EHR systems. Products listed on the CHPL have been successfully tested and certified. [2] Also, healthcare facilities can generate the CMS EHR Certification ID required for meaningful use attestation which is different from the CHPL Product Number. Steps on how to obtain the CMS EHR Certification ID are outlined on the CMS website. [3]

Meaningful Use (MU)

Meaningful use is using certified electronic health record (EHR) technology to: Improve quality, safety, efficiency, and reduce health disparities. Engage patients and family. Improve care coordination, and population and public health. [4] A gap analysis can be performed:

  • ONC‐ATCB certification (Six certifying bodies ) [1]
  • HIPAA privacy and security compliant [2]
  • Meaningful use reporting [5]
    • Stage 1 (2011-2012) Data Capture and Sharing
    • Stage 2 (2014) Advance Clinical Processes
    • Stage 3 (2016) Improved Outcomes
  • Ability to generate county, state, and federal reports
  • Support HL7 messaging standard [3]
  • Support Secure Sockets (SSL) digital certificate
  • Audit trail capabilities[6]

Meaningful Use Stages

Stage 1 core objectives include: [7]

  • Computer provider medication orders
  • Medication Lists
  • Allergies
  • Problem Lists
  • Discharge Instructions
  • Decision Support Tools
  • Growth charts for children
  • Providing patients with electronic copy of health information upon request

Stage 1 Stage 1 menu objectives include:

  • Immunizations
  • Preventive care reminders
  • Public health data submission
  • Patient access to health information

Stage 1 Maternal-child health CQMs for healthcare providers include:

  • Blood pressure
  • Smoking cessation
  • Childhood weight counseling
  • Childhood immunizations
  • HIV prenatal screening
  • Screening for cervical and breast cancer

Stage 2 objectives build upon Stage 1 by raising some performance thresholds, yet provide some flexibility. Also included: [8]

  • At this stage patients should have online access to health information.
  • Automatic electronic tracking of medications from order through administration for hospitals
  • Secure electronic messaging to communicate with patients for healthcare providers

Stage 2 menu additions include:

  • Electronic outpatient lab reporting
  • Discharge prescriptions for hospitals
  • Recording clinical notes
  • Patient family history for both hospitals and providers
  • To promote interoperability and health information exchange, users will be expected to exchange health information with providers using a different EHR vendor product.

Stage 3 Proposed Objectives and Measures (for 2017 and subsequent years) include: [9]

  • Protect Patient Health Information.
  • Electronic Prescribing (eRx)
  • Clinical Decision Support (CDS)
  • Computerized Provider Order Entry (CPOE)
  • Patient Electronic Access to Health Information
  • Coordination of Care through Patient
  • Health Information Exchange (HIE)
  • Public Health and Clinical Data Registry Reporting

Stage 3 proposed rules further builds on Stage 1 & 2, to help further simplify and provide more flexibility for providers by:[10]

  • Decreasing the number of objectives requirement to eight.
  • Allowing EHR reporting in 2017 to be optional, for providers to adjust to current regulation, before the mandatory EHR reporting in 2018.
  • Creating a same calendar year single reporting period for all providers.
  • Decreasing the number of redundant measures and avoiding duplicative reporting.
  • Streamlining clinical quality measurement reporting mechanisms and alignment with other CMS programs.

Meaningful Use Gap Analysis

  • Is it ONC Certified? [4]
  • Does it meet all Meaningful Use objectives?
  • Does it provide automated MU & Clinical Quality Measure Reports?
  • Does the vendor provide MU Training Guides/Resources?
  • MU may be a base functionality, but the vendor may provide "concierge" MU assistance for a fee. Will a "hand-holding" solution be needed, if so does the projected benefit (in both labor and avoiding MU penalties) justify the cost?
  • Does the system facilitate easy MU Data capture such as required data fields? If the capture of MU data is not well-integrated into natural workflow, the practice runs a high risk of failing to meet criteria. This may be difficult to evaluate accurately outside of a live demonstration.
  • Does it provide audit logs, usage monitoring, etc?
  • Does it allow/include data migration from previous EMR?
  • Does it contain CDS Rules to improve performance on high priority health conditions?
  • Does it have capability to electronically submit Clinical Quality Measures to CMS?
  • Does it have Public/Cancer Registry Reporting Capabilities?
  • Does it provide 24/7 technical support?
  • Does it include Pt Portal, CCD Transmission & Direct Messaging with no extra/minimal cost? [11]
  • Is the ONC certification current or does the product require inherited certification/ gap certification?[12]

Meaningful Use Reporting Accuracy

When selecting a vendor for EHR implementation, the accuracy of the reported data must be investigated. It has been found that although clinicians may document the care they deliver and maintain the data in the EHR, the documentation must be usable for reporting, that is, structured data versus textual data. If data is captured in non-structured forms, then it is essentially missing from the automated reporting. There was substantial variability in the accuracy of 11 electronically reported meaningful use quality measures. In selecting an EHR vendor, it is important each demonstrate the accuracy of meaningful use reports. [13]

Medicare and Medicaid EHRs

In order to qualify for incentive payment, first an EHR must be certified. In 2014, the Office of the National Coordinator for Health IT (ONC) and the Centers for Medicare and Medicaid Services (CMS) established two new standards and criteria for certified EHRs . These criteria outlined requirements that Medicaid and Medicare EHRs need to meet in order to continue receiving incentives. The requirements are:

  1. Publicly Accessible Certification Test Results
  2. Price Transparency

These new requirements provide additional clarity and openness to the EHR systems that handled data for millions of Medicaid and Medicare recipients. [14] [15]

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  1. EHR/HIE: Interoperability
  4. Meaningful Use Definition and Objectives
  5. How to Attain Meaningful Use.
  6. HITECLA.Org Selecting the Right EHR.
  7. McCartney, P. (2013). Meaningful uses stages 1 and 2. American Journal of Maternal Child Nursing, 38(1), 56. doi. 10.1097/NMC.0b013e31827401f6
  8. McCartney, P. (2013). Meaningful uses stages 1 and 2. American Journal of Maternal Child Nursing, 38(1), 56. doi. 10.1097/NMC.0b013e31827401f6
  9. Medicare and Medicaid Programs; Electronic Health Record Incentive Program—Stage 3
  13. Kern,L.M, Malhotra, S, Barron, Y, Quaresimo,J, Dhopeshwarkar, R., et. al. (2013).Accuracy of electronically reported “meaningful use” clinical quality measures: A cross-sectional study. Annals of internal medicine, 158(2), 77-83.