OK, no comments on how difficult, stupid or whatever the incentive are. If we take that as a given, does anyone know when all of this starts?

When are we supposed to start following the Core and Menu sets? Is it January 1, 2011?

How will it work? Who will monitor it? Will we send in reports, etc.?

TIA for keeping it informational and not being critical of the process. There are plenty of other threads for that.

Please double check - after skimming 800 + pages- my gross understanding at this point is

1. all EMRs will have to be certified - this time by the ???-ONC - which begins sometime in Aug 2010.
2. Providers can "register" beginning Jan 2011
3. Awards will be based on meeting requirements for 90 days
4. Reporting (attestations) can begin as early as April 2011
5. Monetary awards can be distributed as early as May 2011

seems simple enough?

Gino

Thanks.

I also think you have until July 2011 to start using it to get the 2011 money. It will be interesting to see how they check this to assure you're meeting the requirements. It may simply be that we sign a letter saying we're doing it but rarely is the government that simple.

I upgrade to v5 this week for several reasons but one is to get my staff in the groove for eRX, entering meds to check interactions, and all that jazz.

Travis,

At first, when I saw the requirements it looked overwhelming. But, taking them one by one, especially the way they grade it: Will follow a disease state over time and show how it affects outcome. Need to do: Show this with one patient. (something like that)

As for the ability to electronically connect with other physicians, that's a little weird. I am looking at an easy way to do that. Technically, one could use DropBox, although I don't like the way you cannot actually delete information off there.

Travis,

ePrescribe is awesome. But, forget out interactions. I turned that off within an hour. Hell, it has Bactroban cream interacting with Bactroban ointment. I exaggerate (although I should check), but the yellow and red just overwhelms the senses. If you could choose warn at D level or warn at C level, it would be nice. Plus, you can't separate interactions from allergies so it is all or nothing. It's definitely an area that needs a huge improvement.

Odd Bert. I just posted a question about CCR and how to electronically communicate that with other docs. Not sure how to do it. I would suspect shipping it in an email as a big no-no. Giving a patient a CD with their health info also sounds a bit pricey and plus, as a consultant, I prefer to have all the info about the patient before the day of their appt so I can review it all and assure I have everything I need.

eRX checks will get annoying if it tells me everything on the planet. I'm waiting on SureScripts to send me whatever they send me to get eRX official.

Another thing. I'm reviewing the criteria and I realize that these are primary care issues through and through. I don't do immunizations, rarely do too much labwork, don't order preventive exams/tests, don't order a ton of medications, don't send patients preventive or f/u care reminders, don't even know what a clinical-decision support rule is.

The main 15 are reasonable and doable. The additional 10 that I have to pick 5 of are not a specialists use but I can do 5 of them just because v5 has the ability (not that I would need to do them)

Agreed, that I do not have to do that many, but only would to qualify. I read somewher (I thought) about different criteria for surgeons. Can't recall.

I honestly think it's the government's responsibility to come up with a way to communicate with other doctors. However, 3rd party programs such as Certified Mail would probably work since all of the correspondence stays on a secure server. I used to use it to meet HIPAA requirements, but too many doctors refused to use it.

As far s eRx, it should be rathe quick and seamless to get set up with SureScripts. If you aren't getting it set up, I would ping support and get someone to help. I did it that way, and I was set up in less than an hour.

I just read over a summary of the "Meaningful Use" hoops we will have to jump through in order to qualify.

http://healthcarereform.nejm.org?p=3732

Like others have said, some criteria are easy and some are not.

Much of the data, for example smoking status of patient, is already in my notes, but not in the required structured format.

I hope that Amazing Charts will phase in these criteria over the next 5 or so releases. It would be nice to go ahead and start working on codifying some of the data. It would also be nice if the program had an option (perhaps a checkbox in administrative options) that could be turned on to force me (or one of my staff members) to answer the smoking question during a patient visit if it is blank.

Lots of work ahead of us.

How are we going to get that smoking data in the right format in AC? Seems like these criteria begin to pigeonhole the EMR companies a bit. Now instead of an open box for social history with templates, we will probably have to click a drop down menu or click a button like the Allergies to have another box come up to pick out the smoking status. I guess it would be nice if we could just right click in the box and that would bring up our normal templates as well as an area with radio buttons like "Doesn't smoke", "Smokes 1ppd", "Smokes 2ppd", etc

Also, with the new requirements of a problem list being "structured data", does the "right click/template" use become useless in the Assessment area? Essentially, we have to enter the Problem through the Diagnosis box which adds it to the Problem List. This makes the right click templates useless.

What would be nice is to right click and use templates just like we do now. When you click on those templated items, the enter in the Assessment exactly like the Diagnosis list or Problem List.

I tried to format my templates exactly like AC puts the diagnosis in the assessment box but they don't register. Shucks

work in progress - i am looking at using the social history health maintenance/intervention options to capture smoking data. unfortunately it seems limited to "current smoker" or "former smoker" options only. These are structured and can be reported. MU requires >50% of pts > age 13 to have smoking status assessed. Knowing that in 3 months 20 people admitted to either smoking or having smoked is an incomplete numerator. I am looking for other ways to collect "no hxo smoking" - perhaps it is an easy programming fix?

gino

There is an ICD 9M code for "Tobacco Use" (several, actually), which could be used in the assessment section. This would be searchable, structured data.

That's a great idea. Thanks John.