Today we’re going to focus on medications. There was some attention on medications in stage 1, and that grows in stage 2. There are eight tests that focus on medications. These span five core objectives (one of the objectives only applies to an inpatient setting certification). The five core objectives are:
- Use computerized provider order entry (CPOE) for medication, laboratory and radiology orders.
- 170.314(a)(1) Computerized Provider Order Entry
- 170.314(a)(2) Drug-drug, drug-allergy interactions
- Generate and transmit permissible prescriptions electronically (eRx)
- 170.314(b)(3) Electronic Prescribing
- 170.314(a)(10) Drug formulary checks
- Generate lists of patients by specific conditions to use for quality improvement, reduction of disparities, research or outreach
- 170.314(a)(6) Medication List
- 170.314(a)(7) Medication allergy list
- Perform Medication Reconciliation.
- 170.314(b)(4) Clinical information reconciliation
- Automatically track medications from order to administration
- 170.313(a)(16) Electronic Medication Administration Record
CPOE, one of the requirements of stage 1 turned out to be a very low bar. If you look at the original denominator for this measure, it was based upon the number of unique clients with at least one medication order. If you were a provider who placed one of the 10 medications for a complex client through your CPOE system, you would have met the requirements…AND you only had to do that one med for 30% of unique clients served.
In stage 2 the denominator changed to the total number of orders (ALL) entered during the EHR reporting period. If an organization had 100 clients, totaling 1000 medications for stage 1 they would have only had to enter 30 medications to be compliant – out of 1000 total meds. Using the same 100 clients and 1000 meds for stage 2, they would need to enter 600 medications to be compliant. If you look at percentages (30% to 60%) and don’t look at the change in how the denominator is calculated, you miss the significance of this change.
Why this focus? Expensive error reduction. Healthcare costs caused by improper and unnecessary use of medicines exceeded $200 billion in 2012, according to IMS Institute for Healthcare Informatics estimates. This amount is equal to 8% of the nation’s healthcare spending in 2012 and would be sufficient to pay for healthcare for more than 24 million currently uninsured citizens. These avoidable costs arise when clients fail to receive the right medications at the right time or in the right way, or receive them but fail to take them.
While entering medication orders real-time, doing drug-drug, drug-allergy and formulary checking, you:
- Reduce errors at the time of ordering
- Reduce the chance of selecting medications for which the client has a known allergy (stopping an adverse reaction)
- Reduce drugs that are off formulary for the clients health plan
- Reduce duplicating a prescription for a medication the client is already receiving from another provider
Prescribing a medication that’s formulary makes it affordable for the client, thus they are more likely to pick up the medication. Having real-time clinical decision support tools can guide or educate during the prescribing process, bringing in critical information from other parts of the clients health record. Additionally the medications are updated in the clients record and easily accessible for follow-up visits or data exchange. The cost saving potential surrounding medications is huge.
In an inpatient setting they added a test for electronic medication administration. This test is laser focused on the five medication rights: Right Client. Right Medication. Right Dose. Right Route. Right Time.
Why the focus on medication lists and allergy lists? It is no longer enough to have information/data within your EHR. Data needs to be accessible and usable. Having the electronic list of active medications helps streamline encounters, allows for the more efficient use of your clinicians, and makes on-call coverage safer and easier
Lastly, clinical reconciliation focuses on three components of the health record:
Electronically receiving information in the form of an electronic referral, accepting and incorporating that data is huge in error prevention. Rekeying data is error prone.
The focus on medications as part of meaningful use is both reduced costs ($200 billion per year) and better outcomes. ARRA, Meaningful Use Funding is available for a short time (10 years). The benefits of meaningfully using the system, however, is long lasting. In February 2009, the American Recovery and Reinvestment Act set aside $27 billion to foster increased use of EHRs. Money was to be paid to providers over an extended period of time (10 years). It is a minimal investment to attempt some leaps in health care. In one year alone, with focus just on the medication piece of MUS2, we could save $200 billion. The $27 billion they might pay out spans a 10-year time line. In that 10-year timeline we could save $2 trillion just on medications.