Apologies to all my international readers. This US specific post may make your head spin.
Over the past two years, I’ve discussed the problems associated with trying to force the trauma flow sheet into an electronic form (see links below). It just doesn’t work yet. In 2009, the US government Centers for Medicare & Medicare Services (CMS) designed a set of financial incentives to move healthcare providers and hospitals toward using an electronic health record (EHR). This incentive program is called “meaningful use." Could this force trauma centers to use it for their trauma flow sheet?
The answer is a resounding NO. Meaningful Use seeks to reduce errors, improve the availability of patient information for providers, help develop best practices, and automate processes such as filling prescriptions. Hospitals have until the end of 2012 to complete Stage 1, in which they establish a baseline for EHR use. Stages 2 and 3 will follow in 2013 and 2015, where EHR usage will be further integrated by expanding the usage requirements. The exact guidelines for Stages 2 and 3 have not been determined yet.
So what is actually required in Stage 1? A list of 24 objectives (for hospitals) as been developed. A slightly different list has been developed for healthcare providers. The hospital list consists of 14 core objectives which must be met, and another list of 10 objectives, and the hospital can pick any 5 to meet.
Here is a summary of the core list. All must be implemented:
- Use computerized order entry
- Perform drug allergy and interaction checks
- Maintain an active problem list
- Maintain an active drug list
- Maintain an active drug allergy list
- Record certain demographic info
- Record certain vital signs
- Record smoking for patients age > 13
- Report required clinical quality measures to CMS
- Implement one clinical decision support rule
- Provide an electronic copy of the patient’s health information if requested
- Provide an electronic copy of any discharge instructions
- Be able to exchange key health information between providers
- Protect all of this EHR information
Here’s the non-core list. Any five of 10 must be implemented:
- Implement drug formulary checks
- Record advance directives
- Incorporate lab tests
- Be able to generate lists of patients
- Identify patient education resources
- Perform medication reconciliation
- Help transition the patient to another setting of care
- Submit data to immunization registries
- Be able to report data to state registries
- Be able to submit surveillance data to public health systems
Bottom line: Did you see any mention of the trauma flow sheet here? NO. There is no language requiring specific portions of the record to be in electronic form. And since technology still has not advanced to the point where meaningful data input or report output can be generated by an EHR version of the trauma flow sheet, it should not be used for this purpose. A paper trauma flow sheet that has been scanned into the EHR is still the gold standard.