Stage 3 Meaningful Use Regs Add Pressure to Get Imaging Studies Into EHRs

In a draft version of the stage 3 meaningful use criteria, the goal of having at least 10 percent of imaging studies be accessible through certified electronic health record (EHR) systems gets some teeth. In addition, the draft suggests doubling the requirement for computerized provider order entry (CPOE) use from 30% of radiology orders to 60% of such orders, and pushes for greater use of clinical decision support (CDS) in EHRs to curb inappropriate testing. The draft regulations were presented last week at the Office of the National Coordinator (ONC) Health IT Policy Committee meeting in Washington D.C. Once the draft regulation is published in the Federal Register, the Department of Health and Human Services will accept comments on the proposed changes for 45 days.

Making Imaging Studies More Accessible

In the stage 2 definition of meaningful use of EHR systems, eligible providers could pick the objective of having access to radiology reports and images though their EHR systems from a menu of different objectives. As long as they met the criteria for a certain number of the menu objectives, they could collect their EHR incentive payments. In the draft of the stage 3 criteria, the ONC is proposing switching the objective of access to imaging studies in EHRs from an optional menu objective to a core objective that all providers would need to meet in order to collect their incentive payments. It is seeking comments on the feasibility of making this switch. The ONC had noted when it released the Stage 2 definition of Meaningful Use that the information exchange infrastructure necessary to meet this objective was at different stages in different areas of the country. The ONC may be hoping that by the time the stage 3 definition of meaningful use becomes effective, the infrastructure challenge will be less of a hurdle as more and better systems for exchanging radiology reports and images electronically will have been set up.

Curbing Inappropriate Imaging and Lost Reports

The doubling of use of CPOE relates to the ONC’s goal of greater use of CDS to protect patients from too inappropriate testing. The draft proposes increasing the number of implemented CDS interventions or guidance from five to 15 and says that the 15 CDS interventions should include one or more interventions in the appropriateness of lab and radiology orders. Finally, the Stage 3 draft definition seeks to enlist EHR systems in solving the problem of lost reports, which can lead to a missed diagnosis or having to redo an imaging procedure. The ONC is proposing a requirement that EHR systems be set up to track when test results are available and note if results are not available by a certain time. In addition, the EHR system must record the date and time results are viewed and by whom. The EHR system should also be set up with the ability to identify abnormal test results, presumably so that the ordering physician does not miss acting on this information. View the draft here. Meaningful use and its impact on radiology is covered in depth in the latest issue of Radinformatics.