Laboratory and Radiology Orders with the CPOE System

Since the Centers for Medicare and Medicaid Services (CMS) issued a final rule permitting “credentialed medical assistants” to enter medication orders into the computerized provider order entry (CPOE) system as directed by an eligible professional (e.g., a physician or osteopath), many questions have followed. The issue of whether this final rule permits credentialed medical assistants to enter laboratory and radiology orders into the CPOE is one of particular interest.

The wording of the final rule, although open to some debate, supports the conclusion that credentialed medical assistants are authorized to enter medication, laboratory, and radiology orders into the CPOE. Please note the following:

1. On page 53985 of the Federal Register, the following CMS Proposed Objective is presented:

Use computerized provider order entry (CPOE) for medication, laboratory, and radiology orders directly entered by any licensed health care professional who can enter orders into the medical record per state, local, and professional guidelines to create the first record of the order.  [Emphasis added.]

2. The CMS receives feedback and narrows the decision down to a few different options (described in the previous entry on this blog).

3. The CMS essentially chooses the third option and concludes on page 53986 that “credentialed medical assistants” should be permitted to enter orders into the CPOE (as described in the previous entry on this blog).

4. CMS issues its modified objective on page 53987:

After consideration of the public comments received, we are modifying this objective for EPs as § 495.6(j)(1)(i) and for eligible hospitals and CAHs [critical access hospitals] at § 495.6(l)(1)(i) to use the same language as Stage 1 (with the addition of laboratory and radiology orders), as we did not finalize our proposed changes to when the order must be entered: “Use computerized provider order entry (CPOE) for medication, laboratory, and radiology orders directly entered by any licensed health care professional who can enter orders into the medical record per state, local, and professional guidelines.”  [Emphasis added.]

The CMS objective clearly expands CPOE to laboratory and radiology orders, as well as medication orders. However, it seems as though the wording of this finalized order contradicts the excerpts quoted above and the wider context of the comments and the CMS responses.

A fundamental rule of reconciling conflicting statements in a legal document is that the specific supersedes the general. Based on this principle, it is apparent that the general wording of the modified CMS objective contradicts the specific findings and conclusions in the body of the final rule. Therefore, a correct rendering of the final rule would be as follows:

“Use computerized provider order entry (CPOE) for medication, laboratory, and radiology orders directly entered by an licensed health care professional or credentialed medical assistant who can enter orders into the medical record per state, local, and professional guidelines.”  [Emphasis added.]

About Donald A. Balasa

Donald A. Balasa, JD, MBA, chief executive officer and legal counsel for the American Association of Medical Assistants, keeps his eye on what is happening in the profession.
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11 Responses to Laboratory and Radiology Orders with the CPOE System

  1. Brewer, Sherry says:

    I couldn’t be happier about this. Thanks Don!

    Sherry Brewer, BS, CMA-AC(AAMA)

    Medical Assistant Program Manager/Coordinator

    Cuyahoga Community College

    2900 Community College Avenue

    MHCS-124E

    Cleveland, Ohio 44115-3196

    Phone: 216-987-4439

    Fax: 216-987-4285

  2. jennifer says:

    At the location of where I work I am still being told that I as a CMA-AAMA still can not enter or order radiology or laboratory or medications into the patients charts. For example: I work in the orthopedic department, the day before the patients comes in I am looking at the last office notes to see if they need x-rays, if it states in the dictation I will enter the x-ray order, so the patient can have the x-ray done before the doctor comes in so this can keep a good flow. If it is a new patient the doctor has requested that I order certain images for what ever the patient’s chief complaint. They are saying that if I order these x-ray’s that the physician actually has to sign the orders that day and the physician needs to be in the same room when I order these x-rays. This is told to me by my supervisor who tells me it is because of the Joint Commission states that all physicians by 2014 will need to enter there own orders. Please advise what i can do?

    Thank you for all the work you are doing for the CMA-AAMA’s and for keeping everyone very informed.

    • Thank you for your question. I understand the issues.

      I am not aware of a requirement that physicians enter their own orders as of 2014. I also am not aware of any Joint Commission requirements on this matter.

      Would you be kind enough to send me any written documentation of what you have been told? I would be happy to review it and provide you some specific direction.

      Thank you again.

      Donald A. Balasa, JD, MBA
      Executive Director, Legal Counsel

      American Association of Medical Assistants
      Ph: 800/228-2262 | Fax: 312/899-1259 | http://www.aama-ntl.org

      Visit us on Facebook! http://www.aama-ntl.org/facebook

      The CMA (AAMA): Health Care’s Most Versatile Professional

  3. lauren says:

    I am a CMA and frequently put in lab orders, mammogram orders, and medication refills at our busy OB/GYN practice. My question is one of my co-workers obtained all of her experience on the job and is not certified or licensed. Is she legally allowed to do so?

    • Thank you for your question.

      Based on the CMS final rule for stage 2 of the Medicare and Medicaid Electronic Health Record Incentive Program, only “credentialed medical assistants” are permitted to enter orders into the computerized provider order entry system (CPOE) for purposes of having such entry count toward “meaningful use” under the program. Your fellow medical assistant who is not credentialed may not enter such orders into the CPOE system for meaningful use under the EHR incentive program.

      I hope this is helpful.

      Donald A. Balasa, JD, MBA
      Executive Director, Legal Counsel

      American Association of Medical Assistants
      Ph: 800/228-2262 | Fax: 312/899-1259 | http://www.aama-ntl.org

      Visit us on Facebook! http://www.aama-ntl.org/facebook

      The CMA (AAMA): Health Care’s Most Versatile Professional

  4. Rosie says:

    I have been a medical assistant for over ten years, I was a certified M.A for 5 years. I just need a clarafication when you talk about a credentialed medical assistant are we talking about a certified or someone that has meet the requirements.

    • Thank you for your question.

      In my opinion, “credentialed medical assistant” referred to in the CMS final rule is a medical assistant who has passed a standardized medical assisting examination given by a third party, such as a CMA (AAMA). According to CMS, only credentialed medical assistants are permitted to enter orders into the electronic health record for meaningful use purposes under the Medicare & Medicaid Electronic Health Record Incentive Program.

      I hope this is helpful. Please let me know whether you would like further clarification.

      Donald A. Balasa, JD, MBA
      Executive Director, Legal Counsel

      American Association of Medical Assistants
      Ph: 800/228-2262 | Fax: 312/899-1259 | http://www.aama-ntl.org

      Visit us on Facebook! http://www.aama-ntl.org/facebook

      The CMA (AAMA): Health Care’s Most Versatile Professional

  5. When I worked for a physican, I was told as part of my job was to call in prescriptions to the patients pharmacy. Is this permissable with the AAMA standards. For Dr. Balasa.

  6. Pingback: North Carolina Medical Society - Doctor to Doctor » Blog Archive » CMA Changes For Stage 2 Meaningful Use

  7. Tiffany Green says:

    If you are a CNA,are you allowed to enter orders in the CPOE?

    • Thank you for your question. Note the following CMS FAQ:
      [EHR Incentive Programs] When meeting the meaningful use measure for computerized provider order entry (CPOE) in the Electronic Health Records (EHR) Incentive Programs, does an individual need to have the job title of medical assistant in order to use the CPOE function of Certified EHR Technology (CEHRT) for the entry to count toward the measure, or can they have other titles as long as their job functions are those of medical assistants?
      If a staff member of the eligible provider is appropriately credentialed and performs similar assistive services as a medical assistant but carries a more specific title due to either specialization of their duties or to the specialty of the medical professional they assist, he or she can use the CPOE function of CEHRT and have it count towards the measure. This determination must be made by the eligible provider based on individual workflow and the duties performed by the staff member in question. Whether a staff member carries the title of medical assistant or another job title, he or she must be credentialed to perform the medical assistant services by an organization other than the employing organization. Also, each provider must evaluate his or her own ordering workflow, including the use of CPOE, to ensure compliance with all applicable federal, state, and local law and professional guidelines. Created: 08/20/2013 (FAQ9058)

      Certified Nursing Assistants are indeed credentialed. However, the question is whether they are “appropriately credentialed to perform medical assistant services.” In my opinion, the language of the CMS rule and of the above FAQ does not resolve this question. It is up to each employer to determine whether the CNA is indeed competent and knowledgeable in electronic order entry. If the nursing assistant is, then it appears that the CNA is permitted to enter orders and have such entry count toward meaningful use.

      I hope this is helpful.

      Donald A. Balasa, JD, MBA
      Executive Director, Legal Counsel

      American Association of Medical Assistants
      Ph: 800/228-2262 | Fax: 312/899-1259 | http://www.aama-ntl.org

      Visit us on Facebook! http://www.aama-ntl.org/facebook

      The CMA (AAMA): Health Care’s Most Versatile Professional

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