EHRs Benefits and Drawbacks
As discussed in the lesson and assigned reading for this week, EHRs provide both benefits and drawbacks. Create a “Pros†versus “Cons†table and include at least 3 items for each list. Next to each item, provide a brief rationale as to why you selected to include it on the respective list.
Refer to the Stage 3 objectives for Meaningful Use located in this week’s lesson under the heading Meaningful Use and the HITECH Act. Select two objectives to research further. In your own words, provide a brief discussion as to how the objective may impact your role as an APN in clinical practice
Work Product of the HITPC Meaningful Use Workgroup – Meaningful Use Stage 3 Recommendations
Improving quality and safety
Topic Stage 2 Final Rule Updated Stage 3 Objective Discussion Focus Area Type Provider
use effort
Standards
Maturity
Development
Effort
Clinical
Decision
Support
Eligible Professionals
(EPs)/Eligible Hospitals (EH)
Core Objective: Use CDS to
improve performance on high-
priority health conditions
Measure:
1. Implement 5 CDS
interventions related to
four or more CQMs at a
relevant point in patient
care for the entire EHR
reporting period. Absent
four clinical quality
measures related to an EP,
eligible hospital or CAH’s
scope of practice or
patient population, the
clinical decision support
interventions must be
related to high-priority
health conditions. It is
suggested that one of the
five CDS interventions be
related to improving
healthcare efficiency.
2. Functionality for drug-drug
and drug-allergy interaction
checks enabled for the
entire EHR reporting period.
Core: Eligible Professionals/Eligible Hospitals/Critical Access
Hospitals demonstrate use of multiple CDS interventions that
apply to quality measures in at least 4 of the 6 National
Quality Strategy priorities. Recommended intervention areas:
1. Preventive care
2. Chronic condition management (e.g., diabetes, coronary
artery disease)
3. Appropriateness of lab and radiology orders (e.g., medical
appropriateness, cost-effectiveness – high cost radiology)
4. Advanced medication-related decision support* (e.g.,
renal drug dosing, condition-specific recommendations).
5. Improving the accuracy/completeness of the problem list,
medication list, drug allergies
6. Drug-drug and drug-allergy interaction checks
CEHRT should have the functionality to enable intervention tools
(the intention is not to be overly prescriptive, but to encourage
innovation in these areas):
1. Ability to track “actionable” (i.e., suggested action is
embedded in the alert) CDS interventions and user
responses to interventions, such as:
a) How often an alert has fired
b) What immediate actions the user took (when those
options are presented in the context of the alert)
c) Optional reason for overriding alert
2. Perform age-appropriate maximum daily-dose weight
based calculation
*Kuperman, GJ. (2007)Medication-related clinical decision support
in computerized provider order entry systems a review. Journal of
the American Medical Informatics Association: JAMIA, 14(1):29-40.
• CDS
• Population
management
• Care
coordination
Primary
care
Specialty
(selectively)
Relation to
CQMs will
be more
difficult for
specialists
(less
measures
available)
Medium Emerging
– Accuracy
of
allergies:
Emerging
Highblank
Work Product of the HITPC Meaningful Use Workgroup – Meaningful Use Stage 3 Recommendations
Topic Stage 2 Final Rule Updated Stage 3 Objective Discussion Focus Area Type Provider
use effort
Standards
Maturity
Development
Effort
Care
Planning –
Advance
Directive
Menu EH Objective: Record
whether a patient 65 years old
or older has an advance
directive.
Measure: More than 50
percent of all unique patients
65 years old or older admitted
to the eligible hospital’s or
CAH’s inpatient department
(POS 21) during the EHR
reporting period have an
indication of an advance
directive status recorded as
structured data.
• Core for Eligible Hospitals, introduce as Menu for Eligible
Professionals
• Record whether a patient 65 years old or older has an advance
directive
• Threshold: Medium
• Certification Criteria: CEHRT has the functionality to store the
document in the record and / or include more information
about the document (e.g., link to document or instructions
regarding where to find the document or where to find more
information about it).
• Patient
engagement
• Care
coordination
Primary
Care
Specialty
(selectively)
Low
May be
administered
by care team
members
Approved Low
Electronic
Notes
Objective: Record electronic
notes in patient records.
Measure: Enter at least one
electronic progress note
created, edited and signed by
an EP for more than 30 percent
of unique patients with at least
one office visit during the EHR
Measure reporting period. The
text of the electronic note
must be text searchable and
may contain drawings and
other content
• Core: Eligible Professionals record an electronic progress
note, authored by the eligible professional.
• Electronic progress notes (excluding the discharge summary)
should be authored by an authorized provider of the Eligible
Hospital or CAH
– Notes must be text-searchable
– Non-searchable scanned notes do not qualify but this
does not mean that all of the content has to be character
text. Drawings and other content can be included with
text notes under this measure
• Threshold: High
• CDS
• Care
coordination
Primary
Care
Specialty
Medium Adopted Low
2
blank
blank