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Stage 1 Core Measure 11

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Measure at a Glance

Type: enabled function

Denominator: none

Duration: enabled during the entire reporting period

Objective: Implement one clinical decision support rule relevant to specialty or high clinical priority along with the ability to track compliance with that rule.
Measure: Implement one clinical decision support rule.
Exclusion: No exclusion.
There are no changes to this objective and measure regardless of when EPs attest to Stage 1 Meaningful Use.

CMS Technical Specification

TennCare Notes
Clinical decision support (CDS) in electronic health records continues to be a topic widely discussed with far-ranging applications, but the best guidance for this measure focuses on the practice-level and is stated in the considerations listed in the technical specification, "workflow, patient population, and quality improvement efforts."

As the technical specification mentions, the clinical decision support rule should be implemented for the length of the reporting period. For the first year of Stage 1 Meaningful Use, EPs should have their CDS selected and working in the EHR system by the first day of the 90 day reporting period.

The attestation portal will require the EP to choose yes or no to having enabled this functionality. Additionally, the EP will answer which CDS rule he implemented and can indicate the answer is a rule or intervention by briefly listing the patient population targeted, alert prompted, and relevance to the EP’s practice.

Here are a few examples of CDS from meaningful use attestations:

  • One provider uses CDS "to monitor diabetic patients for A1C and diabetic nutritional counseling using the Health Maintenance Care guidelines in EHS to refer pts for counseling and to run A1C every 3 months."
  • A pediatric practice has implemented a "clinical alert enabled to alert staff to patients who are under 1 year of age, have been diagnosed with a UTI and have NOT had a VCUG."
  • Another provider focuses on patients diagnosed with Chronic Obstructive Pulmonary Disease, "to alert provider of Alpha-1 blood test that needs to be performed upon diagnosis."

Relevant CMS FAQs

  • 10077: clarifying the non-applicability of Core Measure 2 to this measure

Additional Resources
A short overview of the findings of Clinical Decision Support 2011: Understanding the Impact reveals surveyed providers’ evaluations of the ability of CDS to influence clinical decisions and standardize care to improve quality outcomes. Vendor performances are graphed.

Federal Regulations Governing This Measure

CMS' Final Rule

§ 495.6(d)(11) see objective and measure above

Standards and Certification Final Rule

§ 170.304(e)Clinical decision support

  1. Implement rules. Implement automated electronic clinical decision support rules (in addition to drug-drug and drug-allergy contraindication checking) based on the data elements included in: problem list; medication list; demographics; and laboratory test results.
  2. Notifications. Automatically and electronically generate and indicate in real-time, notifications and care suggestions based upon clinical decision support rules.