D.C. Report: Clarification on CPOE, Maryland HIE Goes Live

Clarification on CPOE. As part of Stage 1 Meaningful Use requirements for computerized physician order entry (CPOE), there is continuing confusion around who is authorized to enter information in the electronic health record (EHR) in order to qualify for the Medicare and Medicaid EHR Incentive Programs. Is the physician the only person who can enter such information? The Centers for Medicare & Medicaid Services clarified its earlier answer (Updated 08/17/2010, Answer ID 10071) as follows:

“Any licensed healthcare professional can enter orders into the medical record for purposes of including the order in the numerator for the objective of CPOE if they can originate the order per state, local, and professional guidelines. The order must be entered by someone who could exercise clinical judgment in the case that the entry generates any alerts about possible interactions or other clinical decision support aides. This necessitates that the CPOE occurs when the order first becomes part of the patient’s medical record and before any action can be taken on the order.”

The “provider” in CPOE means the person authorized to initiate in the medical record. Hence, if a physician or physician assistant writes a written order he/she is the initiator and hence is the one who must use CPOE. A pharmacist or nurse who transcribes a written order into the system does not count. A pharmacist doing a clinical intervention or a nurse taking a verbal order might count, though the physician must countersign eventually.

Health Information Exchange in Maryland Now Live. With eight health care institutions in one county currently using the exchange and all 48 hospitals in the state expected to participate in the network, the not-for-profit Chesapeake Regional Information System for our Patients (CRISP) officially launched this week. Federally qualified health clinics that primarily serve Medicaid, uninsured and other underserved patients, are also included. Participant groups agreeing to exchange information include clinics, hospitals, laboratories, physician practices, radiology centers and other health care entities. CRISP received $10 million in incentive funding from the Office of the National Coordinator.

CHIME StateNet continues to track health information exchange (HIE) developments through StateNet and the StateNet Workgroups on HIEs and regional extension centers (RECs). Doug Abel, Anne Arundel Health System in Annapolis, serves as Maryland’s State CIO Coordinator. To guide HIE development, StateNet is developing principles for best practices in technical, business and governance areas. Examples include statements such as the following:Chesapeake Regional Information System for our Patients (CRISP) officially launched this week. Federally qualified health clinics that primarily serve Medicaid, uninsured and other underserved patients, are also included. Participant groups agreeing to exchange information include clinics, hospitals, laboratories, physician practices, radiology centers and other health care entities. CRISP received $10 million in incentive funding from the Office of the National Coordinator.

CHIME StateNet continues to track health information exchange (HIE) developments through StateNet and the StateNet Workgroups on HIEs and regional extension centers (RECs). Doug Abel, Anne Arundel Health System in Annapolis, serves as Maryland’s State CIO Coordinator. To guide HIE development, StateNet is developing principles for best practices in technical, business and governance areas. Examples include statements such as the following:Chesapeake Regional Information System for our Patients (CRISP) officially launched this week. Federally qualified health clinics that primarily serve Medicaid, uninsured and other underserved patients, are also included. Participant groups agreeing to exchange information include clinics, hospitals, laboratories, physician practices, radiology centers and other health care entities. CRISP received $10 million in incentive funding from the Office of the National Coordinator.

CHIME StateNet continues to track health information exchange (HIE) developments through StateNet and the StateNet Workgroups on HIEs and regional extension centers (RECs). Doug Abel, Anne Arundel Health System in Annapolis, serves as Maryland’s State CIO Coordinator. To guide HIE development, StateNet is developing principles for best practices in technical, business and governance areas. Examples include statements such as the following:Chesapeake Regional Information System for our Patients (CRISP) officially launched this week. Federally qualified health clinics that primarily serve Medicaid, uninsured and other underserved patients, are also included. Participant groups agreeing to exchange information include clinics, hospitals, laboratories, physician practices, radiology centers and other health care entities. CRISP received $10 million in incentive funding from the Office of the National Coordinator.

CHIME StateNet continues to track health information exchange (HIE) developments through StateNet and the StateNet Workgroups on HIEs and regional extension centers (RECs). Doug Abel, Anne Arundel Health System in Annapolis, serves as Maryland’s State CIO Coordinator. To guide HIE development, StateNet is developing principles for best practices in technical, business and governance areas. Examples include statements such as the following:

• HIEs must have a clear and sustainable business model for ongoing operation that does not put an undue hardship on participants.
• HIEs should not face competition from other government sponsored entities such as RECs.
• All participants in the HIE should have representation in the governance of the HIE.

StateNet Coordinators and all CHIME members will be asked to share these principles with colleagues, State health IT officials and others in the state with the goal of recognizing the important role of CIOs and promoting coordination among all HIE participants. Watch for more information to come.