Current Stage 1 criteria under the program, which is funded through the American Recovery and Reinvestment Act of 2009, call for 30% of "unique patients" who have at least one medication in their medication list to have at least one medication order entered using CPOE.
Providers must attest they have met the Stage 1 criteria for 90 consecutive days to receive federal reimbursements for their EHRs during their first year of eligibility under the Medicare portion of the incentive payment program.
The start date of the program was Oct. 1 for hospitals and will be Jan. 1, 2011, for office-based physicians and other so-called eligible providers. Stage 1 criteria will be in effect for the first two years of the program. Stage 2 criteria will go into effect in 2013; Stage 3 in 2015. The work group is now considering recommendations for those two later stages as well as longer-term goals with unspecified deadlines and timelines.
During their two-hour meeting Tuesday, work-group members settled on Stage 2 criteria recommendations that call for 60% of orders not only for prescriptions but also for laboratory tests and radiological procedures to be entered by licensed professionals using CPOE.
Stage 3 criteria would require 80% of these orders to come through CPOE, and in the future, 90% of those orders would be sent via CPOE, with bi-directional communication to electronically receive confirmation and order results both within an organization and externally with other providers.
Achieving such high levels of interoperability between provider IT systems has been a much-ballyhooed goal of federal authorities pushing for health information technology adoption, dating back to the executive order President George W. Bush issued in 2004 creating the Office of the National Coordinator for Health Information Technology at HHS.
Work-group members expressed reservations, however, about tying interoperability to CPOE criteria, even though prescription and lab orders, in particular in the outpatient environment, cry out for interoperability to maximize the efficiency of EHRs.
The problem is halting efforts to create and sustain regional and statewide health information exchange organizations—organizations that initially were seen as vital to achieving interoperability.
The work group also agreed to dial up the requirements on having EHRs alert providers automatically when they attempt to order or prescribe medications that would interact adversely with other drugs a patient may already be taking or to which a patient has a known allergy.
Systems that have these drug-drug and drug-allergy alerts are to be implemented as part of Stage 1 meaningful use.