Time to revisit meaningful use and to see what we have to do get there. We have this nice quote from http://motorcycleguy.blogspot.com/2010/07/meaningful-use-standards-summary.html Yeah, right!
This is a summary of the requirements for MU http://mycourses.med.harvard.edu/ec_res/nt/26F568D6-E6F3-418A-96B9-497666DEF5C0/MUQuick.pdf Let's look thru them to see what we need to allow you to achieve MU with Synapse without spending $4,800,000! 1. CPOE No excuses here. Synapse has CPOE of medications since year 0. And the recent addition of RxTerms should make it even easier. 2. Implement drug-drug and drug allergy interaction checks We used to have this but dropped it a long time ago. This is really part of eRx 3. ePrescribing The core code has been written. Just waiting for Surescripts to play ball here so we can do testing 4. Demographics ONC want preferred language, and race which we do not have. Actually our ethnicity appears to be race, so in reality we don't have what they call ethnicity. And ethnicity is not even that, but whether the patient is Latino or not! But this can be inferred from the race, so I don't think we need add anything here except language preference. 5. Problem List - covered 6. Medication List - covered 7. Vital Signs/Growth Charts - covered 8. Smoking Status - covered 9. Clinical Decision Support - You only have to implement one rule. Can use one of the DM rules 10. Calculate and Transmit CMS Quality Measures This is through attestation in 2011, and electronically in 2012. Not sure what is required here. Percentage of DMs on an ACE inhibitor? DM with HbA1c below 7% ?? 11. Electronic Copy of Health Information Provide patients with an electronic copy of their health information (including diagnostic test results, problem .... They can do this via the patient portal. 12. Clinical Summaries Just print off using [Docs] button 13.Exchange Key Clinical Information Capability to exchange key clinical information (for example, problem list, medication list, medication allergies, .... ) this is a single test. I presume it means effectively being able to generate a CCR and consume a CCR. We can currently consume a CCR, and generating a CCR is fairly trivial. 14. Privacy / Security Protect electronic health information created or maintained by the certified EHR technology through the .... Currently all communication to the server is encrypted in transit. Have to investigate what else is required And you have to select 5 measures including one from population health. We can do of these right now 1. Lab Results into EHR 2. Patient List 3. Patient Reminders 4. Timely Electronic Access to Health Records - via Portal 5. Patient Specific Education
Here's the list of tests required for EHR certification and compliance http://xw2k.nist.gov/healthcare/use_testing/finalized_requirements.html
http://xw2k.nist.gov/healthcare/docs/170.302.d_medicationlist_v1.0.pdf This is the NIST test for maintaining an active medication list, and to view changes. No issues I can see here.
http://xw2k.nist.gov/healthcare/docs/170.302.e_allergylist_v1.0.pdf This is the test for maintaining an allergy list. It looks like they want to maintain a list of Inactive allergies! I would ordinary just delete .. but it appears that I have to create in Inactive Allergy class.
http://xw2k.nist.gov/healthcare/docs/170.302.f.1_vitalsigns_v1.0.pdf The vitals signs are okay, since newer versions of Synapse allow you to change recorded vitals.
http://healthcare.nist.gov/docs/170.302.g_smokingstatus_v1.0.pdf Updated Synapse to include extra smoking status categories of unknown, current some days, current daily and current unknown.
http://healthcare.nist.gov/docs/170.302.c_problemlist_v1.0.pdf Synapse has been updated so that it can display only inactive, active problems.
http://healthcare.nist.gov/docs/170.302.f.3_growthcharts_v1.0.pdf Synapse has no issues with the growth charts test.
http://healthcare.nist.gov/docs/170.302.h_IncorpLabTest_v1.0.pdf This appears to be the ability to import HL7 results and to display them. Should be no issues here.
http://xw2k.nist.gov/healthcare/docs/170.302.i_GeneratePatientLists_v1.0.pdf This is a reporting function based on demographics, problem lists, medications, and lab results. Build 37 will be able to do all of these, but will need to be able to specify more demographic fields to search on apart from the current dob, and gender.
http://xw2k.nist.gov/healthcare/docs/170.302.j_ MedicationReconciliation_v1.0.pdf This seems to require that the user can display the patient's medication list electronically, and a separate list electronically to compare them, and then reconcile in a manner the user chooses. Synapse 37 now imports a medication list from a supplied CCR and will display the two lists simultaneously, and will allow the import of medications from the CCR list.
http://xw2k.nist.gov/healthcare/docs/170.304.c_RecordDemographicsAmb_v1.0.pdf The demographics test requires preferred language, and race/ethnicity. This is done for the next release.
I just noticed that the test requires one to record date of death, and preliminary cause of death. We can do this already so no change here.
And just noticed that the immunization test suite requires recording of the country as part of the demographics, so I have now added in Country. I will make it a non required field so you can leave it blank. It is just there to pass the tests. PS: This apparently was an error in the part of NIST and the revised scripts 1.1 have the country removed from the addresses now. However, I can still leave the country in as it is too much effort to remove it now.
http://xw2k.nist.gov/healthcare/docs/170.302.k_Immunizations_v1.0.pdf This is the ability to create a HL7 immunization record, and is now done for HL7 2.5.1. The user can now record VIS data, doses and units of the adminstered vaccine.
NIST have released an updated and corrected set of tests http://xw2k.nist.gov/healthcare/use_testing/effective_requirements.html active from October 24. If you look at the list, the relevant tests for ambulatory EMRs are §170.302 (a) - §170.302 (w) where §170.302 (w) is optional, and §170.304 (a) - §170.304 (j) The *.306 apply to hospital EHRs.
