I name this post The Implementation Headaches of Meaningful Use Part 1 not necessarily because I plan a Part 2, 3, etc., but instead because I believe those Parts are inevitable in this process. Whether you like it or not, America is going to an Electronic Health Record. Not only are we going to an Electronic Health Record, but by gosh it is going to be Meaningful! Hence, the Meaningful Use requirements of the HITECH act. The Federal Government not only wants providers to adopt Electronic Health Records, but they want that adoption to lead to significant improvements in care.
It is an admirable goal, and in theory, it seems like a decent idea. However, as with all good ideas in theory, there is always reality to be faced, and reality is not always as rosy. We are currently on the eve of Stage 1 Meaningful Use Implementation. That means for eligible hospitals there are 24 Meaningful Use objectives to implement. There are 14 Required Core Objectives, and 10 additional objectives for which the eligible hospital must choose 5. This makes for a total of 19 objectives to implement.
I am going to focus this post on the difficulties and confusion surrounding one sub part of one required objective. Hospital Core Objective #6 is the capture of Demographic information. Easy enough, right? Part 6 (C) and 6 (D) request the capture of Race and Ethnicity Information. Which begs the first question, what is the difference and why do we need both? I did a little unofficial research on the difference between Race and Ethnicity. As a general definition, ethnicity is more about perceived genealogy, shared history, and culture. Race describes shared biological or genetic traits and physical characteristics.
The second question is how does the Federal Government classify what could be endless Ethnicities and Races? They refer to the Standards of the Office of Management and Budget. Under those standards, there are two classes for Ethnicity and five classes for Race. They are as follows: Ethnicity choices 1) Hispanic or Latino 2) Not Hispanic or Latino, Race choices 1) American Indian or Alaska Native 2) Asian 3) Black or African American 4) Native Hawaiian or Other Pacific Islander 5) White.
Now to the final and more difficult question, how do you train your staff to ask your patients this fragile social question without offending anyone? My suggestion is that you prepare a very delicate script for your staff that explains why the information is being requested. Something to the effect of the government tracking disparities in healthcare- that is why they think it is meaningful isn’t it? The Office of Management and Budget suggests self reporting on behalf of the individual, so in no event should your staff guess as to someone’s ethnicity or race.
CMS does say that you do not have to ask the question if asking is violation of a State or Federal Law. To that effect, I would make sure no one is asking patients their Race or Ethnicity until they have had there EMTALA required Triage exam. CMS also states that the documentation of a patient refusing to provide their Ethnicity or Race information counts for reporting purposes. Lastly, you only have to have documented information on 50% of unique patients, to receive credit for this requirement. Therefore, your staff can be trained to go for substantial compliance, and not to push situations where it is clear the individual is irritated by the questions.
Does anyone have any ideas? How is the implementation of this and other Meaningful Use Requirements going at your facility or your client’s facility?