A Chiropractor’s Guide
What exactly does Meaningful Use mean in the chiropractic world?
“Meaningful Use” means chiropractors must show they are using certified EMR/EHR technology in ways that can be measured significantly in quality and quantity. However, EHRs are often capable of doing much more than just recording information. The EHR Incentive Program asks providers to use the capabilities of their EHRs to achieve benchmarks that can lead to improved patient care. The bill was implemented in 2010. At that time, the Government laid out the transition from paper to electronic in 3 stages over 5 years.
-
Stage 1 – (2011 and 2012) Baseline for Electronic Data Capture and Information Sharing.
-
Stage 2 – (2013) Implements Advanced Clinical Processes
-
Stage 3 – (2015) Expands to Improved Outcomes.
There are objectives that must be met to show productive use of an EHR system. For eligible chiropractors, there are 23 total objectives. To qualify for a stimulus check, they must meet 18 of these objectives. There are 13 Core objectives that must be met. Of the remaining 10 objectives, 5 must be chosen and met by the recording provider.
Core Objectives
-
Record patient demographics (gender, race and ethnicity, date of birth, preferred language)
-
Record vital signs (height, weight, blood pressure, body mass index, and growth charts for children)
-
Maintain up-to-date problem lists
-
Maintain active medication lists
-
Maintain active medication allergy lists
-
Record smoking status for patients older than 13 years of age
-
Provide patients with a clinical summary for each office visit within 3 business days
-
On request, provide patients with an electronic copy of their health information (including test results, problem lists, meds lists, allergies) within 3 business days
-
Generate electronic prescriptions (note: Chiropractors exempt from criteria)
-
Use Computerized Physician Order Entry (CPOE) for medication orders at least 30% of the time.
(note: Chiropractors exempt from criteria) -
Implement drug-drug and drug-allergy interaction checks
-
Be able to exchange key clinical information among providers by performing at least one test of the EMR’s ability to do this.
-
Implement one clinical decision support rule, and ability to track compliance with the rule (this is reduced from the previous 5 rules to the final 1 rule)
-
Implement systems that protect privacy and security of patient data in the EMR, by conducting or reviewing a security risk analysis, and taking corrective step if needed
-
Report clinical quality measures to CMS or states – for 2011 provide aggregate numerator and denominator through attestation; for 2012, electronically submit measures (this refers to PQRI measures)
10 Menu Meaningful Use Criteria
(Must choose and demonstrate at least five)
-
Implement drug-formulary checking
-
Incorporate lab test data into the EMR as structured data
-
Generate lists of patients by specific conditions (to use for quality improvement, reduce disparities, research, or outreach)
-
Use EMR technology to identify patient-specific education resources, and provide those to the patient as appropriate
-
Provide medication reconciliation between care settings
-
Provide summary of care record for patients transferred to another provider or setting
-
Submit electronic immunization data to local registries (performing at least one test of data submission, where registries can accept them)
-
Submit electronic syndrome surveillance to public health agencies (perform at least one test, where local agencies can accept them)
-
Send reminders to patients (per patient preference) for preventive and follow-up care
-
Provide patients with timely electronic access to their health information
Of the 25 objectives listed above, 18 must be recorded per patient for chiropractors. Conquering these tasks without much knowledge can be lengthy and frustrating. The entire process can be tough and painful. Some doctors have chosen to bring on more staff to help record. Bringing more front desk help in your office is not really the answer. If you believe that you are too busy to tackle these objectives or are struggling to do so right now, you should go with a meaningful use expert through a chiropractic consulting company or your own EHR company. It makes more sense to hire a specialist in this area than to bring on more office help. These experts will help you get set up and guide you along the way when questions surface. They will make sure you are recording everything you need to meet the requirements set in the objectives listed above. They can assure that you will receive a quality stimulus check from the Government. Just think if you were to record all of these objectives and spend many man hours on this project, and you did not receive a reimbursement because you did not fully show meaningful use in your office. This is the tragedy you must avoid.
Conclusion
You must make a choice whether or not you are going to attempt to go for the stimulus check. Some chiropractors have chosen to just continue their practice instead of tackling the extra work… Some doctors chose to record the information themselves… Other providers hired a meaningful use consultant to guide them through the processes. You must decide if your practice will benefit from showing meaningful use or not. Do you even want to hassle with the extra documentation?
The stimulus is directly related to Medicare. If you run a cash practice or see very limited Medicare patients, showing meaningful use is NOT for you. The amount of your stimulus check will depend on the number of patients you see that are insured by Medicare… If you do not have a high volume of patients insured through Medicare, then DO NOT take on this project. The volume of your Medicare-insured patients is the single most important factor in deciding whether you should show meaningful use or not.
