Meaningful Use in the Emergency Department

When National Coordinator for Health Information Technology David Blumenthal, M.D., addresses the American College of Emergency Physicians (ACEP) annual meeting Sept. 28 in Las Vegas, he will be speaking to a group that had many concerns about the proposed electronic health record incentives but ended up pleased with the revisions in the meaningful use final rule.

Angela Franklin, ACEP’s director of quality and health IT, explained in a recent interview that concerning computerized provider order entry (CPOE), emergency department (ED) physicians were unpleasantly surprised to find that orders that take place in the ED were excluded from the proposed hospital meaningful use requirements. As ACEP wrote to the Centers for Medicare & Medicaid Services last March, the ED is often the most time- and resource-intensive care setting and is often the site of the largest volume of CPOE.

ACEP was pleased to find that CMS listened, and EDs were included in CPOE requirements, Franklin said.
She noted that ACEP also worked with the National Quality Forum to ensure that ED throughput was included in the 15 clinical quality measures for hospitals. The measures around median time for ED arrival to ED departure and admit decision time to ED departure time for admitted patient in the final rule “should help with the crowding issues in EDs,” Franklin said.

Because EDs will be a key collection point, ACEP had also argued that syndromic surveillance measures remain in Stage 1, which they did, on the menu of optional measures.

But Franklin says now the pressure is on ED physicians to work with hospital CIOs and software vendors to develop plans to implement the systemic changes such as drug-drug and drug-allergy interaction checks needed to meet the new requirements. “We think emergency physicians will have more input into systems that go into EDs,” she said, “because they will be the ones responsible for meeting implementation deadlines.”