This column addresses a specific meaningful use requirement each month, looking at how it connects to health care quality priorities and previewing possible updates to the measure in future stages of meaningful use.

Electronic Exchange of Clinical Information

Health Outcomes Policy Priority:	Improve care coordination.
Objective:	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.
Measure:	Performed at least one test of certified EHR technology's capacity to electronically exchange key clinical information.
Exclusion:	No exclusion.

Background: The HITECH Act itself specifically stipulates the use of health information exchange (HIE) in meaningful use for eligible providers. Widespread adoption of electronic health records, though a critical piece of the initiative, does not in itself guarantee that electronic patient information can always follow the patient to the point of care. For providers to deliver the highest quality of care to their patients it is likewise critical that they have easy access to information available to and originating with other providers who care for that patient. The objective to test the capability of one’s certified EHR technology to exchange information then is a simple but important step in achieving a larger network of healthcare providers who can gain access to the flow of patient related information.

The intent of the test is to demonstrate that key elements of clinical information can be shared.  Although the ONC rule for EHR certification stipulates a specific set of elements that vendors must be able to exchange, CMS allows providers to use their own clinical judgment in determining which elements they consider key for the purposes of diagnosis and treatment—and thus what information elements are actually exchanged. The exchange may be in either structured or unstructured (images, free text, scans) format and does not have to be successful in order to be considered valid for meeting this objective. Also, a “dummy” patient can be used for the test rather than a real patient. Finally, in addition to exchange with another provider, the test can also take place between the provider and a patient authorized entity, such as an insurance company, personal health record vendor, or other HIE exchange.

Stage 2 Proposals: In general, the robustness of HIE is expected to rise with Stage 2 meaningful use. Where the initial test of capability for exchange disappears after Stage 1, we see the gradual fruition of that capability in the more stringent requirements (structured date) and higher thresholds for exchanging patient data that are evidenced in revised and also new objectives. This includes moving the summary of care requirement to core, the exchange of care plans, and active submissions to immunization registries and so on.