Meaningful Use Gaining Traction
By Ivan Michaels

The Centers for Medicaid and Medicare Services (CMS) Incentive Program for Meaningful Use (MU) is gaining traction as the first year for full incentive payments ended with the beginning of 2012. The MU program requires the compliance of 20 of 25 measures, which includes 15 Core measures and 10 Menu measures. All 15 Core measures must be met.

All but one of these core measures can be successfully reported by customers building or running NextGen Crystal Reports and various customer efforts, such as exchanging key clinical information electronically with providers, immunization registries, and public health agencies. However, the one mandatory core measure which cannot be readily satisfied by customers on their own effort is MU measure #10, the reporting of Clinical Quality Measures (CQMs).

CQMs can be reported for customers via the NextGen^® Health Quality Measures (HQM) facility via a form of a scorecard report. These CQM and HQM measures are robust implementations of complex Structured Query Language (SQL)/Server stored procedures run against the NextGen HQM database. The HQM database is data-mined from the NextGen^®Electronic Health Record (EHR) database. Much effort has been given by NextGen to developing these facilities and for achieving CMS MU certification (CCHIT), a requirement which must be completed to be valid for MU reporting. As a result, we want to encourage our customers to understand the benefits of becoming familiar with the NextGen HQM facilities, as this will help them to increase their successful use of facilities for MU reporting. Furthermore, we need to encourage them because there are potential issues which can arise to slow their progress in using the HQM reporting facilities.

First and foremost of the potential issues is the customer’s understanding of the published specs for each measure’s denominator, numerator, and possible exclusion conditions. Chief among the remaining issues is the need for an audit of the customer workflow and EHR database, checking that the required MU measure data points are available and reasonably populated with data documented during patient encounters. There are hundreds of MU measure data points across the EHR templates. Some are well understood, such as “BP Vital signs” or “Lab Orders/Results.” But, others are less obvious, such as the “meds_reviewed” checkbox on the master_im template or “Lab Exclusion” checkboxes implemented in the various flowsheet protocol templates. All are important data points used by the HQM measures.

Experience has shown that EHR MU data points can be and have been missing or lacking expected data. Why? A major reason is that the necessary workflow has not been fully understood from the point of view of the CQM measure requirement, so that documentation of a data point during a patient office visit is therefore less than expected. This is a possible condition which would not necessarily be noticed during go-live implementation and day to day operation. Also, because NextGen is a highly customer modified template environment, it is possible to have a modified template without all the “out of the box” data points being maintained in the EHR database. It’s often a concern expressed by existing NextGen customers.

As a result, since missing MU data point information might not be noticed during daily operations, an audit is advised to find these issues and to take corrective actions ASAP. Otherwise, the MU CQM measures, which will be shown in the HQM scorecard, could be reporting less than the anticipated measure results. To achieve successful MU attestation by NextGen customers, the customer needs to utilize the HQM facilities as well as all of the customer’s own efforts to report 20 of 25 required measures.

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