Meaningful Use and Medication
- By: Kathy Vieson, PharmD, BCOP
- 22 Comments
So much has been written, and so much angst suffered, regarding meaningful use incentives, requirements, and attestation that it is easy to lose sight of the objective that the rule is intended to accomplish. So, as a brief reminder, meaningful use (MU) is a rule established by the Centers for Medicare and Medicaid (CMS) to facilitate “the exchange and use of health information to best inform clinical decisions at the point of care,” as specified by the American Recovery and Reinvestment Act of 2009 (ARRA).
Requirements
“Use” refers specifically to the use of EHR or EMR systems. Hospitals and healthcare professionals (at the individual level) can receive incentive payments for the adoption of EHR’s/EMR’s if those systems meet the criteria established for meaningful use. Those criteria are many and all can be viewed at the CMS website. Unsurprisingly, a good number of the core requirements for both hospitals and healthcare professionals are related to medication. In short, in order to qualify for incentive payments during Stage 1 of implementation, eligible hospitals and healthcare professionals both must:
- Use CPOE for medication orders directly entered by any licensed healthcare professional who can enter orders into the medical record per state, local and professional guidelines.
- Implement drug-drug and drug-allergy interaction checks.
- Maintain active medication list.
- Maintain active medication allergy list.
- Implement one clinical decision support rule related to a high priority condition (hospital) or relevant specialty (professional) in addition to drug-drug and drug allergy interactions.
- Have capability to exchange key clinical information (such as problem list, medication list, medication allergies, diagnostic test results) among providers of patient care and patient authorized entities electronically.
In addition, eligible healthcare professionals must:
- Generate and transmit permissible prescriptions electronically.
And there are a couple of key “menu” measures, from which eligible hospitals and professionals can choose that relate to medication, most notably:
- Implement drug formulary checks.
- The eligible hospital or professional who receives a patient from another setting of care or provider of care, or believes an encounter is relevant, should perform medication reconciliation.
CMS, as well as many helpful colleagues in the media and throughout the industry, have taken great pains over the last year to define terms and further explain these requirements. For the purpose of this discussion, we will assume that they are largely understood. Whatever the nuances, it is clear that effective interaction with pharmacists and interoperability with drug data is essential for those who wish to meet meaningful use standards. The requirement that EHR/EMR software companies have a drug database already installed to be certified confirms this point. And yet, we see or hear little about how pharmacists and pharmacy businesses will be affected as meaningful use requirements are implemented.
Impact on Pharmacy?
We would like to hear from you about the impact of medication-related MU requirements on pharmacists and pharmacy systems. Some questions to consider:
- Are hospital and/or retail pharmacies in a position to help institutions and practitioners meet MU requirements?
- How will existing processes and workflows within pharmacies be affected?
- Which of the above core requirements will have most benefit for pharmacies?
- Which of the above core requirements will have most negative impact on pharmacies?
- Considering all of the medication-related core and menu requirements for meaningful use, which will have the greatest impact on improving patient care?
- Will greater adoption of EHR/EMR systems increase or reduce costs for pharmacies?
Please feel free to make any relevant comments, ask questions, and provide suggestions for additional information. Drug information technology specialists from Elsevier / Gold Standard will monitor and facilitate the discussion.
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Retail pharmacies and pharmacists will be required only for dispensing of drugs (with or without automation of dispensing). The above noted requirements of EHR can be very well taken care off using computer algorithms, developed in conjunction with one (or few) pharmacists or using published literature. So many pharmacists are not needed in the healthcare force.
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