EHRs Benefits and Drawbacks Health, Medicine, Nursing Essay

Purpose
The ideas and beliefs underpinning the discussions guide students through engaging dialogues as they achieve the desired learning outcomes/competencies associated with their course in a manner that empowers them to organize, integrate, apply and critically appraise their knowledge to their selected field of practice. The ebb and flow of a discussion is based upon the composition of student and faculty interaction in the quest for relevant scholarship.
Activity Learning Outcomes
Through this discussion, the student will demonstrate the ability to:
Contribute level-appropriate knowledge and experience to the topic in a discussion environment that models professional and social interaction (CO4)
Actively engage in the written ideas of others by carefully reading, researching, reflecting, and responding to the contributions of their peers and course faculty (CO5)

Due Date:
Students must post a minimum of two times in each graded discussion. The two posts in each individual discussion must be on separate days. Posting twice on two different days meets the minimum requirement however for full credit, the student must post at least three substantive posts on three different days. The student must provide an initial post to each graded discussion topic posted by the course instructor, by Wednesday, 11:59 p.m. MT of Week 3. Subsequent posts, including essential responses to peers, must occur no later than the Sunday, 11:59 p.m. MT at the end of Week 3. Students are expected to submit assignments by the time they are due. Threaded discussions are not considered assignments and are not part of the late assignment policy.

A 10% late penalty will be imposed for discussions posted after the deadline on Wednesday regardless of the number of days late. NOTHING will be accepted after 11:59pm MT on Sunday (i.e. student will receive an automatic 0).
Total Points Possible: 150 Points
Requirements:
Post a written response in the discussion forum to EACH threaded discussion topic:

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.

Adhere to the following guidelines regarding quality for the threaded discussions in Canvas:
Application of Course Knowledge: Demonstrate the ability to analyze, synthesize, and/or apply principles and concepts learned in the course lesson and outside readings.
Scholarliness and Scholarly Sources: Demonstrates achievement of scholarly inquiry for professional and academic decisions using valid, relevant, and reliable outside scholarly source to contribute to the discussion thread.
Writing Mechanics: Grammar, spelling, syntax, and punctuation are accurate. In-text and reference citations should be formatted using correct APA guidelines.
Direct Quotes: Good writing calls for the limited use of direct quotes. Direct quotes in discussions are to be limited to one short quotation (not to exceed 15 words). The quote must add substantively to the discussion. Points will be deducted under the grammar, syntax, APA category.
For each threaded discussion per week, the student will select no less than TWO scholarly sources to support the initial discussion post.
Scholarly Sources: Only scholarly sources are acceptable for citation and reference in this course. These include peer-reviewed publications, government reports, or sources written by a professional or scholar in the field. The textbooks and lessons are NOT considered to be outside scholarly sources. For the threaded discussions and reflection posts, reputable internet sources such as websites by government agencies (URL ends in .gov) and respected organizations (often ends in .org) can be counted as scholarly sources. The best outside scholarly source to use is a peer-reviewed nursing journal. You are encouraged to use the Chamberlain library and search one of the available databases for a peer-reviewed journal article. The following sources should not be used: Wikipedia, Wikis, or blogs. These websites are not considered scholarly as anyone can add to these. Please be aware that .com websites can vary in scholarship and quality. For example, the American Heart Association is a .com site with scholarship and quality. It is the responsibility of the student to determine the scholarship and quality of any .com site. Ask your instructor before using any site if you are unsure. Points will be deducted from the rubric if the site does not demonstrate scholarship or quality. Current outside scholarly sources must be published with the last 5 years. Instructor permission must be obtained BEFORE the assignment is due if using a source that is older than 5 years.

DISCUSSION CONTENT
Category

Points

%

Description
Application of Course Knowledge


50

33%

The quality for this category is determined by the ability to analyze, synthesize, and/or apply principles and concepts learned in the course lessons and outside readings and relate them to real-life professional situations.
Scholarliness and Scholarly Resources


40

27%

This category is evaluated on the quality of the student’s ability to: Support writing with appropriate, scholarly sources; provide relevant evidence of scholarly inquiry clearly stating how the evidence informed or changed professional or academic decisions; evaluate literature resources to develop a comprehensive analysis or synthesis; use sources published within the last 5 years; match reference list and in-text citations match, and minimize or appropriately format direct quotations.

Interactive Dialogue

40

27%

The quality for this category is determined by substantive written responses to a peer and faculty member’s questions in the threaded discussion. Substantive posts add importance, depth, and meaningfulness to the discussion. Students must respond to least one peer in the threaded discussion. If no question asked directly from faculty, student must respond to questions posed to the entire class. Post must include at least one scholarly source.







Total CONTENT Points= 130
DISCUSSION FORMAT
Category

Points

%

Description
Grammar, Spelling, Syntax, Mechanics and APA Format

20

13%

Reflection post has minimal grammar, spelling, syntax, punctuation and APA* errors. Direct quotes (if used) is limited to 1 short statement** which adds substantively to the post.
* APA style references and in text citations are required; however, there are no deductions for errors in indentation or spacing of references. All elements of the reference otherwise must be included.
**Direct quote should not to exceed 15 words & must add substantively to the discussion






Total FORMAT Points= 20






DISCUSSION TOTAL= 150 Points

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 highpriority 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 High blank 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 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 Hospital Labs EH MENU Objective: Provide structured electronic lab results to ambulatory providers EH MENU Measure: Hospital labs send structured electronic clinical lab results to the ordering provider for more than 20 percent of electronic lab orders received • Eligible Hospitals provide structured electronic lab results using LOINC to ordering providers • Threshold: Low • Care coordination Hospitals Low Patient matching issues, but can ease EP workflow Adopted Low (High cost for interfaces though) Order Tracking **New** • New • Menu: Eligible Professionals • The EHR is able to assist with follow-up on orders to improve the management of results. • Results of specialty consult requests are returned to the ordering provider [pertains to specialists] • Threshold: Low • Certification requirements: o EHR should display the abnormal flags for test results if it is indicated in the lab-result message o Provide ability for ordering provider to optionally indicate a date that the order should be completed by when entering the order, which triggers notification to the ordering provider if the results are not returned by the indicated date o Notify ordering provider when results are available or not completed by a certain time o Record date and time that results are reviewed and by whom o CEHRT should provide the capability to match results (e.g., lab tests, consultation results) with the order in order to accurately results each order or to detect when an order has not been completed • Patient engagement • Care coordination Primary Care Specialty Medium Involves entire care team Adopted High (matching results) 3 blank blank 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 Unique Device Identifier (UDI) **New** • New • Menu: Eligible Professionals and Eligible Hospitals record the FDA Unique Device Identifier (UDI) when patients have devices implanted for each newly implanted device • Threshold: High Primary Care Specialty (selectively) Low Emerging Medium Demographics EP Objective: Record the following demographic • Preferred language • Sex • Race • Ethnicity • Date of birth EH Objective: Record the following demographics • Preferred language • Sex • Race • Ethnicity • Date of birth • Date and preliminary cause of death in the event of mortality in the eligible hospital or CAH Measure: More than 80 percent of all unique patients seen by the EP or admitted to the eligible hospital's or CAH's inpatient or emergency department (POS 21 or 23) during the EHR reporting period have demographics recorded as structured data. • Certification criteria • CEHRT provides the functionality to capture o Patient preferred method of communication (e.g., online, telephone, letter) o Occupation and Industry codes o Sexual orientation, gender identity o Disability status • CDS • Patient engagement Primary Care Specialty (selectively) Medium Other members of care team probably will enter. Level of granularity could add additional effort for care team. Emerging High 4 blank blank blank Work Product of the HITPC Meaningful Use Workgroup – Meaningful Use Stage 3 Recommendations Engaging patients and families in their care Topic Stage 2 Final Rule Updated Stage 3 Objective Discussion Focus Area Type Provider use effort Standards Maturity Development Effort View, Download, Transmit (VDT) Objective: Provide patients the ability to view online, download and transmit their health information within four business days of the information being available to the EP. Measure 1: More than 50 percent of all unique patients seen by the EP during the EHR reporting period are provided timely (available to the patient within 4 business days after the information is available to the EP) online access to their health information. Measure 2: More than 5 percent of all unique patients seen by the EP during the EHR reporting period (or their authorized representatives) view, download, or transmit to a third party their health information. 1. More than 50 percent of all unique patients discharged from the inpatient or emergency departments of the eligible hospital or CAH (POS 21 or 23) during the EHR reporting period have their information available online within 36 hours of discharge. 2. More than 5 percent of all unique patients (or their authorized representatives) who are discharged from the inpatient or emergency department (POS 21 or 23) of an eligible hospital or CAH view, download or transmit to a third party their information during the EHR reporting period • Core: Eligible Professionals/Eligible Hospitals provide patients with the ability to view online, download, and transmit (VDT) their health information within 24 hours if generated during the course of a visit and ensure the functionality is in use by patients. • Threshold for availability: High (i.e., the functionality is available to the majority of patients; it does not require patients to view information online, if they chose not to) • Threshold for use: low – Labs or other types of information not generated within the course of the visit should be made available to patients within four (4) business days of information becoming available • Add family history to data available through VDT Preamble: Mobile access to VDT may improve access to underserved populations who do not have access to broadband. Information is not released to the patient until it is signed by the author. Letter of Transmittal: Open Notes discussion • Patient engagement • Care coordination Primary Care Specialty High Emerging Medium 5 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 Patient Generated Health Data **New** • New • Menu: Eligible Professionals and Eligible Hospitals receive providerrequested, electronically submitted patient-generated health information through either (at the discretion of the provider): – structured or semi-structured questionnaires (e.g., screening questionnaires, medication adherence surveys, intake forms, risk assessment, functional status) – or secure messaging. • Threshold: Low FAQ: Although not a part of the certification criteria, if an organization's EHR accepts patientgenerated information using interfaces to remote devices, then receipt of such data will satisfy this objective. • Patient engagement • Care coordination Primary Care Specialty High Immature (devices) Mature (secure messaging) High Visit Summary/ Clinical Summary EP Objective: Provide clinical summaries for patients for each office visit EP Measure: Clinical summaries provided to patients or patient-authorized representatives within 1 business day for more than 50 percent of office visits. • Core: Eligible Professionals provide office-visit summaries to patients or patient-authorized representatives with relevant, actionable information, and instructions pertaining to the visit in the form/media preferred by the patient • Summaries should be shared with the patient according to their preference (e.g., online, printed handout), if the provider has implemented the technical capability to meet the patient preference • Threshold: Medium • Certification Criteria: CEHRT allows provider organizations to configure the summary reports to provide relevant, actionable information related to a visit. HITSC to identify what the communication preferences options should be. Providers should have the ability to select options that are technically feasible, these could include: Email, patient portal, regular mail, etc… • Patient engagement • Care coordination Primary Care Specialty Medium Adopted Medium 6 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 Patient Education EP/EH Objective: Use Certified EHR Technology to identify patient-specific education resources and provide those resources to the patient EP CORE Measure: Patient specific education resources identified by CEHRT are provided to patients for more than 10 percent of all unique patients with office visits seen by the EP during the EHR reporting period EH CORE Measure: More than 10 percent of all unique patients admitted to the eligible hospital's or CAH's inpatient or emergency departments (POS 21 or 23) are provided patient- specific education resources identified by Certified EHR Technology • Continue educational material objective from stage 2 for Eligible Professionals and Hospitals – Threshold: Low • Additionally, Eligible Providers and Hospitals use CEHRT capability to provide patient-specific educational material in non-English speaking patient's preferred language, if material is publically available, using preferred media (e.g., online, print-out from CEHRT). – Threshold: Low, this should be a number and not a percentage • Certification criteria: EHRs are capable of providing patient-specific educational materials in at least one non-English language Additional information: Expand the InfoButton standard to include disability status. CDS may be used to remind providers about relevant patient-specific education for shared decision making • Patient engagement Primary Care Specialty Medium Adopted Medium Secure Messaging EP Core Objective: Use secure electronic messaging to communicate with patients on relevant health information EP Core Measure: A secure message was sent using the electronic messaging function of Certified EHR Technology by more than 5 percent of unique patients (or their authorized representatives) seen by the EP during the EHR reporting period • No Change in objective • Core: Eligible Professionals • Patients use secure electronic messaging to communicate with EPs on clinical matters. • Threshold: Low (e.g. 5% of patients send secure messages) • Certification criteria: EHRs have the capability to: – Indicate whether the patient is expecting a response to a message they initiate – Track the response to a patient-generated message (e.g., no response, secure message reply, telephone reply) • Patient engagement Primary Care Specialty Medium Approved High (tracking) 7 blank Work Product of the HITPC Meaningful Use Workgroup – Meaningful Use Stage 3 Recommendations Improving Care Coordination Topic Stage 2 Final Rule Updated Stage 3 Objective Discussion Focus Area Type Provider use effort Standards Maturity Development Effort Medication Reconciliation EP/EH CORE Objective: The EP/EH who receives a patient from another setting of care or provider of care or believes an encounter is relevant should perform medication reconciliation. EP/EH CORE Measure: The EP, eligible hospital or CAH performs medication reconciliation for more than 50% of transitions of care in which the patient is transitioned into the care of the EP or admitted to the eligible hospital’s or CAH’s inpatient or emergency department (POS 21 or 23) • No Change • Core: Eligible Professionals, Hospitals, and CAHs who receive patients from another setting of care perform medication reconciliation. • Threshold: No Change FAQ: Reconciliation may also be performed for all encounters (instead of just transitions of care) • Care coordination Primary Care Specialty Low Adopted Low 8 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 Summary of care for transfers of care EP/EH CORE Objective: The EP/EH/CAH who transitions their patient to another setting of care or provider of care or refers their patient to another provider of care provides summary care record for each transition of care or referral. CORE Measure: 1. The EP, eligible hospital, or CAH that transitions or refers their patient to another setting of care or provider of care provides a summary of care record for more than 50 percent of transitions of care and referrals. 2. The EP, eligible hospital or CAH that transitions or refers their patient to another setting of care or provider of care provides a summary of care record for more than 10% of such transitions and referrals either (a) electronically transmitted using CEHRT to a recipient or (b) where the recipient receives the summary of care record via exchange facilitated by an organization that is a NwHIN Exchange participant or in a manner that is consistent with the governance mechanism ONC establishes for the nationwide health information network. Eligible Professionals/Eligible Hospitals/Critical Access Hospitals provide a summary of care record during transitions of care. Types of transitions: • Transfers of care from one site of care to another (e.g., Hospital to: PCP, hospital, SNF, HHA, home, etc.) • Consult (referral) request (e.g., PCP to Specialist; PCP, SNF to ED) [pertains to EPs only] • Consult result note (e.g. consult note, ER note) Summary of care may (at the discretion of the provider organization) include, as relevant: • A narrative that includes a synopsis of current care and expectations for consult/transition or the results of a consult [required for all transitions] • Overarching patient goals and/or problem-specific goals • Patient instructions, suggested interventions for care during transition • Information about known care team members (including a designated caregiver) Threshold: No Change Although structured data is helpful, use of free text in the summary of care document is acceptable • Care Coordination Primary Care Specialty High Adopted Capability listed here is adopted, because only asking for free text. Would like to push further where standards are emerging. High 9 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 Notifications **New** • New • Menu: Eligible Hospitals and CAHs send electronic notifications of significant healthcare events within 4 hours to known members of the patient’s care team (e.g., the primary care provider, referring provider, or care coordinator) with the patient’s consent, if required • Significant events include: – Arrival at an Emergency Department (ED) – Admission to a hospital – Discharge from an ED or hospital – Death • Low threshold FAQ: Modular certification is encouraged; this does not need to be an EHR function • Care coordination Primary Care Specialty High Approved High 10 Work Product of the HITPC Meaningful Use Workgroup – Meaningful Use Stage 3 Recommendations Population and public health Topic Stage 2 Final Rule Updated Stage 3 Objective Discussion Focus Area Type Provider use effort Standards Maturity Development Effort Immunization history Eligible Professionals, Hospitals, and CAHs receive a patient’s immunization history supplied by an immunization registry or immunization information system, allowing healthcare professionals to use structured historical immunization information in the clinical workflow • Threshold: Low, a simple use case Certification Criteria: • CEHRT functionality provides ability to receive and present a standard set of structured, externally-generated immunization history and capture the act and date of review within the EP/EH practice. • Ability to receive results of external CDS pertaining to a patient’s immunization • Population management • CDS Primary Care Specialty (selectively) Medium Emerging High 11 blank blank 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 Registries MENU EP: Capability to identify and report cancer cases to a public health central cancer registry, except where prohibited, and in accordance with applicable law and practice MENU EP: Capability to identify and report specific cases to a specialized registry (other than a cancer registry), except where prohibited, and in accordance with applicable law and practice. • Menu: Eligible Hospitals / Eligible Professionals • Purpose: Electronically transmit data from CEHRT in standardized form (i.e., data elements, structure and transport mechanisms) to one registry • Reporting should use one of the following mechanisms: 1. Upload information from EHR to registry using standard c-CDA 2. Leverage national or local networks using federated query technologies CEHRT is capable (certification criteria only) of allowing enduser to configure standard c-CDA file to determine which data will be sent to the registries. Registries are important to population management, but there are concerns that this objective will be difficult to implement • Population management Primary Care Specialty (selectively) High Emerging High Electronic lab reporting Core Objective: Capability to submit electronic reportable laboratory results to public health agencies, except where prohibited, and in accordance with applicable law and practice. Core Measure: Successful ongoing submission of electronic reportable laboratory results from Certified EHR Technology to a public health agency for the entire EHR reporting period. • No Change • Core: Eligible Hospitals and CAHs submit electronic reportable laboratory results, for the entire reporting period, to public health agencies, except where prohibited, and in accordance with applicable law and practice Hospital Low Adopted Medium 12 blank blank 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 Syndromic Surveillance EP MENU Objective: Capability to submit electronic syndromic surveillance data to public health agencies, except where prohibited, and in accordance with applicable law and practice EH CORE Objective: Capability to submit electronic syndromic surveillance data to public health agencies, except where prohibited, and in accordance with applicable law and practice EP/EH Measure: Successful ongoing submission of electronic syndromic surveillance data from Certified EHR Technology to a public health agency for the entire EHR reporting period • Eligible Hospitals and CAHs (core) submit syndromic surveillance data for the entire reporting period from CEHRT to public health agencies, except where prohibited, and in accordance with applicable law and practice • Patient engagement • Care coordination Hospital Primary Care Specialty (selectively) Medium Adopted Low 13 blank Work Product of the HITPC Meaningful Use Workgroup – Meaningful Use Stage 3 Recommendations Items Removed from Recommendations Topic Stage 2 Final Rule Updated Stage 3 Objective Discussion Focus Area Type Provider use effort Standards Maturity Development Effort eMAR Objective: Automatically track medications from order to administration using assistive technologies in conjunction with an electronic medication administration record (eMAR). Measure: More than 10 percent of medication orders created by authorized providers of the eligible hospital's or CAH's inpatient or emergency department (POS 21 or 23) during the EHR reporting period for which all doses are tracked using eMAR. • Core: Eligible Hospitals automatically track medications from order to administration using assistive technologies in conjunction with an electronic medication administration record (eMAR) • Threshold: Medium • Certification criteria: CEHRT provides the ability to generate report on discrepancies between what was ordered and what/when/how the medication was actually administered to use for quality improvement • CDS Hospital Low Adopted High (for additional functionality to track discrepancies) 14 blank 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 Reminders Objective: Use clinically relevant information to identify patients who should receive reminders for preventive/followup care and send these patients the reminders, per patient preference. Measure: More than 10 percent of all unique patients who have had 2 or more office visits with the EP within the 24 months before the beginning of the EHR reporting period were sent a reminder, per patient preference when available. • No Change • Core: Eligible Professionals use relevant data to identify patients who should receive reminders for preventive/follow-up care • Threshold: Low • Reminders should be shared with the patient according to their preference (e.g., online, printed handout), if the provider has implemented the technical capability to meet the patient’s preference • Patient engagement • Population management Primary Care Specialty Medium Adopted Low 15 blank 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 Imaging Objective: Imaging results consisting of the image itself and any explanation or other accompanying information are accessible through CEHRT. Measure: More than 10 percent of all tests whose result is one or more images ordered by the EP during the EHR reporting period are accessible through CEHRT. Objective: Imaging results consisting of the image itself and any explanation or other accompanying information are accessible through CEHRT. • Measure: More than 10 percent of all tests whose result is one or more images ordered by the EP during the EHR reporting period are accessible through CEHRT. • Care coordination Primary Care Specialty Low Adopted Low Family History Objective: Record patient family health history as structured data. Measure: More than 20 percent of all unique patients seen by the EP during the EHR reporting period have a structured data entry for one or more first-degree relatives. • No Change in objective • Menu: Eligible Professionals and Hospitals record patient family health history as structured data for one or more first-degree relatives • Threshold: Low • Certification criteria: CEHRT have the capability to take family history into account for CDS interventions • CDS • Population management Primary Care Specialty Low Adopted (for structured data capture) Low 16 blank blank 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 Medication Adherence **New** • New • Certification Criteria: CEHRT has the ability to: 1. Access medication fill information from pharmacy benefit manager (PBM) 2. Access PDMP data in a streamlined way (e.g., signin to PDMP system) • CDS • Patient engagement Primary Care Specialty High Immature High Amendments **New** • New • Certification Criteria: Provide patients with an easy way to request an amendment to their record online (e.g., offer corrections, additions, or updates to the record) • Patient engagement • Care coordination Primary Care Specialty Low Immature High Case Reports **New** • New • Certification Criteria: – CEHRT is capable of using external knowledge (i.e., CDC/CSTE Reportable Conditions Knowledge Management System) to prompt an end-user when criteria are met for case reporting. – When case reporting criteria are met, CEHRT is capable of recording and maintaining an audit for the date and time of prompt. – CEHRT is capable of using external knowledge to collect standardized case reports (e.g., structured data capture) and preparing a standardized case report (e.g., consolidated CDA) that may be submitted to the state/local jurisdiction and the data/time of submission is available for audit. • CDS • Population management Primary Care Specialty (selectively) High Immature High 17 blank blank blank