Meaningful Use Measures: CPOE – Meaningful Use Monday

CPOE (Computerized Provider Order Entry), is the direct entering of orders into a computer (or mobile device), so that the order is documented in a digital, structured, and computable format.

Meaningful Use Core Measure: CPOE
More than 30% of unique patients with at least one medication in their medication list seen by the EP have at least one medication order entered using CPOE.
Exclusion: providers who write fewer than 100 prescriptions during the reporting period.

CPOE is one of the measures that elicited quite an animated response from the provider community. When initially proposed, this measure required 80% of all orders to be directly entered by the provider. To overcome objections to the scope of the requirement and the burden it would impose, CMS ultimately limited the measure to medication orders and reduced the threshold to 30%. (The proposal for Stage 2 reinstitutes lab and radiology orders, but the requirements have not yet been finalized.)

There was also a great deal of conversation about who has to enter the order into the EHR—does it have to be the authorizing physician him/herself? This is the only measure in the Final Rule in which CMS addresses who can perform the function, identifying “…any licensed healthcare professional who can enter orders into the medical record per state, local and professional guidelines.” While some providers are unsure about where these specific guidelines can be found, CMS does provide further guidance, stating that CPOE should be done by someone who can exercise clinical judgment and take action based on the alerts and/or clinical decision support information that the order might generate.

Because for now CPOE is limited to medication orders, it is accomplished either in the course of ePrescribing or by using the same workflow but not transmitting the prescription electronically, (e.g., when prescribing controlled substances or prescribing for patients who request a printed prescription.) All of these prescriptions count in the numerator of this meaningful use measure because they are entered into the EHR.

Lynn Scheps is Vice President, Government Affairs at EHR vendor SRSsoft. In this role, Lynn has been a Voice of Physicians and SRSsoft users in Washington during the formulation of the meaningful use criteria. Lynn is currently working to assist SRSsoft users interested in showing meaningful use and receiving the EHR incentive money. Check out Lynn’s previous Meaningful Use Monday posts.

About the author

Lynn Scheps

Lynn Scheps

Lynn Scheps is Vice President, Government Affairs at EHR vendor SRSsoft. In this role, Lynn has been a Voice of Physicians and SRSsoft users in Washington during the formulation of the meaningful use criteria. Lynn is currently working to assist SRSsoft users interested in showing meaningful use and receiving the EHR incentive money.

5 Comments

  • Has anyone discussed EMR/EHI systems that do not have customizable templates. My attorney goes to UCLA, he’s in his 80s. When we met for dinner the other night he mention he had seen his doctor that afternoon. I asked him what the doctor said about the stye in the corner of his left eye. He said the doctor never picked his head off the computer so he never saw it.

    Sunday I was with a group of people discussing health care. Two different people mentioned since their doctor got an EMR system, he never looks at them any more. One woman actually changed doctors because of that.

    Some of these Companies selling EMR systems are making their dashboards really nice with images. This slows down the time the page populates. Most doctors I have interview can not finish an encounter while the patient is present. They do what they can and then go back to fill in the details.. not to mention how many are increasing their cost of translation and typing.

    What good is a system that makes more work for you?

    I would love to hear what the group has to say about this.

    Roseann Boffa
    A.L.Russell & Assoc.

  • I understand where you are coming from. However, If a doctor is using a pen and paper he/she is still looking down at the tablet to write and may only be taking short notes until the patient leaves, then they finish the reporting the information. I agree the EMR systems should not have images that slow the process down. It should be basic maybe similar to old dos blue screens. Straight to the point no frills.

    I guess there are good and bad to all things, but going digital is a positive step to the future of healthcare.

  • Great topic of discussion. While CPOE is of great value as are EHR AND EMR’S I think the dr must learn to use them & at the same time be present with the patient. Screens should be simple as to not distract the dr..User friendly screens with quick input is key

    More important is educating physicians on the effective use of CPOE /EMR/EHR . Enter the data and be present with the patient..look at them listen to them. I have worked with good drs who do both.
    These are the ones I stay with because they truly care and work with the system and LISTEN TO THE PATIENT. Multitasking & listening is key. The fine art of automated medical care..automating it is wonderful and essential. Dr’s need to learn how to use it effectively -input and listen. Its a talent.
    I find seasoned DR”s have a great talent for this…younger new commers purely rely on entering data..Thats not their main job..They have 2 tasks to manage. and ones that are critical to good healthcare management.

    I offer training sessions to physicians on this. Contact me for more info..The more support the better..The more knowledge and skill I can teach the drs the more effective health care they can give the patient. Being present with the patient is key I cannot emphasize that enough. It takes the desire, will and commitment.
    Carol

  • I agree that all of these issues can be dealt with. At least dealt with to the same level or better than the paper world. Training and commitment are keys to solving the problem. Although, not all EMRs are created equal and so the right EMR can help get you their quicker as well.

  • While some providers are unsure about where these specific guidelines can be found, CMS does provide further guidance, stating that CPOE should be done by someone who can exercise clinical judgment and take action based on the alerts and/or clinical decision support information that the order might generate.

    Answer:
    Use computerized provider order entry (CPOE) for medication orders directly entered by any licensed
    healthcare professional who can enter orders into the medical record per state, local and professional
    guidelines.

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