Clinical Decision Support and Meaningful Use

Meaningful Use Stage 2, Stage 3, and Clinical Decision Support

The CMS EHR Incentive Program (Meaningful Use) Stage 3 final rule requires that eligible professionals and eligible hospitals implement clinical decision support interventions. The CDS measures and objectives change from 2015-2017 and 2018.

  • 2015-2017 Clinical Decision Support Objective

     

    Use clinical decision support to improve performance on high-priority health conditions.

               

    2015-2017 CDS Measure 1

     

    Implement five clinical decision support interventions related to four or more clinical quality measures at a relevant point in patient care for the entire EHR reporting period. Absent four clinical quality measures related to an EP, eligible hospital, or

    CAH's scope of practice or patient population, the clinical decision support interventions must be related to high-priority health conditions.

     

    • 2015 Alternative Measure 1
      • For an EHR reporting period in 2015 only, an EP, EH, or CAH who is scheduled to participate in Stage 1 in 2015 may satisfy the following in place of Measure 1:
        • Implement one clinical decision support rule relevant to specialty or high clinical priority, or high priority hospital condition, along with the ability to track compliance with that rule.
      • Measure: Implement one clinical decision support rule

     

    2015-2017 CDS Measure 2

    The EP, EHs or CAH has enabled and implemented the functionality for drug-drug and drug allergy interaction checks for the entire EHR reporting period.

    • Exclusion: For the second measure, any EP who writes fewer than 100 medication orders during the EHR reporting period.

     

  • 2018 and Beyond Clinical Decision Support Objective

     

    Implement clinical decision support (CDS) interventions focused on improving performance on

    high-priority health conditions.

     

    CDS MU Measure 1

     

    Implement five CDS interventions related to four or more clinical quality measures (CQMs) at a relevant point in patient care for the entire EHR reporting period.  Absent four CQMs related to an EP, eligible hospital, or CAH's scope of practice or patient population, the clinical decision support interventions must be related to high-priority health conditions.

     

    CDS MU Measure 2

     

    The EP, eligible hospital, or CAH has enabled and implemented the functionality for drug-drug and drug-allergy interaction checks for the entire EHR reporting period.

     

    Exclusion:  For the second measure, any EP who writes fewer than 100 medication orders during the EHR reporting period is excluded

What are the important aspects that qualify a CDS rule for Stage 2 and Stage 3 of Meaningful Use?

  • CDS is not simply an alert, notification, or explicit care suggestion. CDS encompasses a variety of tools including, but not limited to: computerized alerts and reminders for providers and patients; clinical guidelines; condition-specific order sets; focused patient data reports and summaries; documentation templates; diagnostic support; and contextually relevant reference information. These functionalities may be deployed on a variety of platforms (e.g. mobile, cloud-based, installed).3 CDS is not intended to replace clinician judgment, but rather is a tool to assist care team members in making timely, informed, higher quality decisions. The “Five Rights” concept provides a best practice framework that providers may consider in considering CDS options appropriate for their practice. The Five Rights concept states that in order to provide these benefits, CDS interventions must provide:
    • the right information (evidence-based guidance, response to clinical need),

    • to the right people (entire care team – including the patient),

    • through the right channels (e.g., EHR, mobile device, patient portal),

    • in the right intervention formats (e.g., order sets, flow-sheets, dashboards, patient lists),

    • at the right points in workflow (for decision making or action).

 

Meaningful Use Resources

HIMSS Fact Sheet for Clinical Decision Support Objective Measures for Meaningful Use 2015-2018 for Elligible Professionals and Eligible Hospitals

Read the HIMSS fact sheet on the CDS Objective and Measures for the CMS EHR Incentive Program for 2015-2017 and 2018 and beyond for eligible hospitals, critical access hospitals, and eligible professionals.

CMS Fact Sheet on Clinical Decision Support

The Centers for Medicare and Medicaid Services has developed a fact sheet designed to define what constitutes one of the five CDS interventions that eligible providers must implement to meet the EHR Incentive Program objective measure for clinical decision support. Read the Fact Sheet

 

xHIMSS CDS Meaningful Use Stage 1 FAQ - Video - Donald Levick, MD, MBA, CPHIMS, Medical Director Clinical Informatics, Lehigh Valley Health Network, discusses the new HIMSS CDS Meaningful Use FAQ that was recently released.

Achieving Meaningful Meaningful Use: What it has to do with CDS and why failure is not an option
Jerry Osheroff, MD, TMIT Consulting, LLC, HIMSS Clinical Informatics Insights, 12/09