Ask the Pros: Meaningful Use, CPOE and the ED
Posted by Anthony Guerra on March 8th, 2010From:
Stacey Akin, I.S. Director, SkyRidge Medical Center
QUESTION: My question has to do with the 2010 requirements for “Meaningful Use.” I have heard conflicting stories about Computerized Physician Order Entry (CPOE) adoption requirements for 2010. I know we have to have 10% of our orders completed via CPOE. The question is whether or not we can use the Emergency Department (ED) orders to comply with the 10% requirement?
Barry Mathis, Principal, H.I.S. Professionals
ANSWER: Good question! We are working at several hospitals that were depending on CPOE orders coming from the ED to meet their 10% adoption requirement for “Meaningful Use” in 2010 and researched this issue thoroughly for them.
Presently the answer is no. The reason centers on the Place of Service (POS) code. The POS code is a two-digit code defined by the Centers for Medicare & Medicaid Services (CMS) in their Transaction Code Set Rule. The Interim Final Rule (IFR) published January 2010 clearly reminds hospitals that POS code 21 is used for “Hospital” orders. POS code 21 states a hospital is a “facility, other than psychiatric, which provide primarily diagnostic, therapeutic (both surgical and nonsurgical), and rehabilitation services by, or under, the supervision of physicians to patients admitted for a variety of medical conditions.”
On page 184 of the IFR, we are reminded that the Emergency Department is identified with POS code 23 and therefore would not be considered “hospital” orders.
Barry Mathis, H.I.S. Professionals, Principal, (423) 827-7893, bmathis@hispros.com
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Although the CPOE metric for Meaningful Use does not apply to ED they have broadened the traditional definition of who is included. It reads in the regulation as Computerized Provider Order Entry (note the word Provider, not Physician). On page 474 it states:
“(1)(i) Objective. Use computerized provider order entry (CPOE) for orders (any type) directly entered by authorizing provider (for example, MD, DO, RN, PA, NP). (ii) Measure. CPOE is used for at least 10 percent of all orders.”
This has the effect of broadening the number of providers that contribute to the 10% by including mid-levels.