Pharmacists play a key role in helping to advance safe and effective medication use as hospitals scramble to meet new Stage 2 requirements for the “meaningful use” of electronic health records by 2014, according to informatics and quality assurance pharmacists.
The new requirements from the Centers for Medicare & Medicaid Services (CMS) are the latest phase in the government’s multiyear push to improve the quality and efficiency of medical care by evolving to an all-digital national system that aggregates accurate, up-to-date patient data across transitions of care.
Much of Stage 2 relates directly or indirectly to medication use, including new requirements for computerized provider order entry, clinical decision support, patient access to personal health records, medication order tracking, and compliance with 16 clinical quality measures (CQMs), including the provision of venous thromboembolism anticoagulation overlap therapy (sidebar, page 13).
“I see the move toward meeting these Stage 2 requirements as another great opportunity for pharmacy to get out and offer services and possibly expand the services they’re currently providing,” said Benjamin Anderson, PharmD, MPH, an informatics pharmacist at HealthEast Care System in St. Paul, Minn. Those efforts, he noted, could be geared toward providing medication reconciliation for a substantial portion of the transitions-of-care opportunities that crop up when patients are admitted to the inpatient or emergency departments of eligible or critical-access hospitals. By doing so, Dr. Anderson noted, “pharmacists can help meet the clinical quality measures [CQM] that are part of the [Stage 2] goals.”
The Stage 2 final rule requires that beginning in 2014, eligible hospitals and critical-access hospitals must report on 16 of 29 CQMs, selecting at least one in three of the six national quality strategy domains. Included in the 29 are measures relating to timeliness of emergency department care and to appropriate therapy for hemorrhagic and ischemic stroke, venous thromboembolism and acute myocardial infarction. Three other CQMs focus on appropriate antibiotic selection.
A lot is at stake for health systems. In addition to the $20 billion in incentive payments that CMS already has begun to distribute to providers that have met Stage 1 requirements, there are the looming Medicare payment cuts for those that fail to begin meeting meaningful use measures by 2015.
Dr. Anderson said HealthEast’s three acute care hospitals were well on their way to complying with Stage 2 measures. “Our leadership team took a very proactive role,” he said. “The goal was very much to stay at the front of deadlines for meeting Stage 1 and Stage 2. We’ve attested to Stage 1 and are putting the final upgrade into place that will allow us to finish our Stage 2 work.”
One important new Stage 2 core objective calls for automatic medication tracking from order to administration using assistive technologies in conjunction with electronic medication administration records (eMARs). Anne M. Bobb, RPh, CPHIMS, the administrator of clinical quality excellence at Ann & Robert H. Lurie Children’s Hospital of Chicago, said that she believes the provision will have a “significant impact” on hospitals.
By “assistive technologies,” Ms. Bobb said, CMS was referring to point-of-care bar coding or radiofrequency identification. She noted that meeting the Stage 2 measure requiring 10% of medication orders to be tracked by an eMAR system with bedside bar coding or radiofrequency identification may be challenging for the more than half of U.S. hospitals that have not yet deployed bar-code medication administration technology.
A Core of Contention
Perhaps the most contentious new core objective focuses on patient access to medical records. It requires that more than half of patients discharged from hospital emergency departments or inpatient settings be given online access to their medical records within 36 hours, and that more than 5% of them “view, download or transmit” their health information to a third party.
Meeting the 5%-plus measure may be difficult for many hospitals. “Some hospitals haven’t even started down the path to a patient portal,” Ms. Bobb said. “Once you have one, you have to actively encourage patients to access and use it. And then on top of that, Stage 2 is forcing us to [ensure] that patients proactively message their providers.”
Rachelle “Shelly” Spiro, RPh, FASCP, the executive director of the Pharmacy e-Health Information Technology Collaborative, said that the effort to involve patients in managing their personal health records was just beginning. “There are real campaigns that are being pushed at the grassroots level,” she said, noting that Farzad Mostashari, MD, ScM, the national coordinator for health information technology, and his deputy, Judy Murphy, RN, “have taken this personally and are really trying to make sure that patients are engaged.”
Ms. Spiro also said that the patient access was an important issue for hospital pharmacists, pointing out that “as patients leave the hospital, they’re going to be asking for their medical records, and included in the medical record, as one of the most important pieces, is the medication record.”
She added: “As pharmacists, we have this very important role in making sure that the active medication list that we’re putting out there upon discharge is accurate and something that patients can use.”