How does Your EHR Calculate Meaningful Use Measures?

Ron Sterling
Sterling Solutions
Author: Keys to EMR/EHR Success

In order to support Meaningful Use  attestation, you need supporting documentation for each measure by Eligible Provider (EP). The reports from you EHR will be the reference point for documenting your compliance with many meaningful use measures. However, the MU measure calculations can dramatically differ from EHR to EHR.

If your printed meaningful use measure reports do not meet the required levels, then you should not assume that you can explain your way around the discrepancy. Convoluted explanations about not using the EHR as prescribed by the vendor will only complicate your efforts to meet the MU audit standards and could undermine the use of the EHR.

As examples:

• You may document a smoking discussion with the patient in a free form note, but if you do not check the appropriate smoking item in the EHR form, the EHR will not count the free form note.
• You may have specific patient education items for each major service area. But, if your EHR only calculates the patient education resource measure using a general item, your measure calculation will understate your actual efforts.
• A significant number of EHR products allow or, in some cases, require MU report customization to properly calculate MU based on your use of the EHR. You may have to identify the clinical variables that you use to document certain MU Measures.

You need to have a clear understanding about how your EHR calculates the measures. In some cases, EHRs logically calculate the measure from the EP’s activities. For example, a prescription entered for a patient can be clearly determined and counted. Other measures are more complex or impossible to count. For example, distribution of a clinical summary to a patient may be supported by printing the document, but it is not clear that every printed clinical summary fulfilled the meaningful use measure (some clinical summaries may be used for other purposes or never make it to the patient.) Similarly, if you use a patient portal to distribute the clinical summary, the EHR may never know if the document was ever accessed by the patient.

In order to produce the reporting results that you need for your Eligible Providers, you should have a clear understanding and strategy to accommodate the EHR’s Meaningful Use Measure calculation:

• Inventory how your EHR calculates the MU Measure for each measure and the appropriate findings and activities needed to meet the specific requirements of your EHR. For example, the specific clinical findings that trigger each MU Measure should be catalogued.
• Review how your doctors use the EHR and verify that they are using the EHR in a way that proper MU credit is counted for each measure.
• Understand how the EHR deals with measures that may not depend on the EP. For example, patient reminders may be determined by the EP recording the patient plan items in a certain way, but depend on the practice staff to issue the patient reminder.
• Monitor physician performance by physician using the EHR MU reports to verify the measure and the appropriate use by the Eligible Provider to trigger the count.

Note that the same issues that are encountered by many practices with general use of an EHR apply to Meaningful Use. If an EP records information without considering the inner workings of the EHR, the patient information may not be properly presented, tracked, or counted in the MU Measure.

This article was originally published on Avoid EHR Disasters and is used here with permission. Ron Sterling is author of the HIMSS Book of the Year Keys to EMR/EHR Success. He is a nationally recognized EHR expert with the information that you need to improve patient service and performance. For questions or if you are looking to engage him as a speaker, he can be contacted at rbsterling@sterling-solutions.com.