On Medical Assisting
Below is a video of my presentation at the AAMA 58th Annual Conference in St. Louis, in which I discussed order entry into the computerized provider order entry (CPOE) system and answered questions about the Centers for Medicare and Medicaid (CMS) Stage 2 Meaningful Use requirements.
The video can also be accessed through the AAMA YouTube channel: https://www.youtube.com/watch?v=Hz4avFT3XZE
In the continuing discussion about computerized provider order entry (CPOE), a frequent question concerns whether a noncredentialed health care professional could circumvent any safeguards and perform order entry into an electronic health record (EHR) system. As Rob Antony of CMS stated last year, it is indeed possible to do this. However, that possibility is one of the primary reasons for CMS audits, which could identify and penalize such behaviors. A standard EHR system would maintain a log of which staff members enter orders. Any practice found violating the requirements for order entry could be subject to financial penalties. The full text and video of Mr. Anthony’s statement follows:
“There’s not a requirement as part of certification that your certified EHR has to identify you as [a] credentialed [medical assistant]; there’s actually not a requirement within certification that you have to be identified as anything. However, for purposes of entry, for purposes of workflow, the [eligible professional] and the practice [have] to make sure that’s who is entering that information. We realize that not every EHR may have that information, but certainly a large number of them do, and I can anticipate that an auditor would ask for that log.”
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“We don’t actually have any additional regulatory authority beyond what we have with incentive payments and payment adjustments, specific to this program for CPOE. It is possible for anyone to game the system here. That’s why an auditor might look at credentialing and would look at those audit logs to see whether or not that was likely to have happened. The authority here, or the clout, Is either if an auditor goes through and discovers that people were erroneously counted within a numerator and you did not actually meet meaningful use, you would forfeit an incentive payment, and then potentially [it would] be applied [to] the payment adjustments. So certainly if an auditor comes by afterward and discovered that your attestation was not correct, then it would be a forfeit of payment or a recoup of payment, and potentially things that are egregious fraud get sent for additional prosecution.”
We have detailed who can perform computerized provider order entry (CPOE) for meaningful use objectives, as well as the potential costs of improper CPOE. Naturally, the broader question in this discussion is why only licensed health care professionals or credentialed medical assistants are allowed to perform CPOE.
These rulings are made with patient protection as the primary goal. One way the limits on CPOE help ensure that protection involves a function of the CPOE system known as clinical decision support alerts.
Robert Anthony of the Centers for Medicare and Medicaid Services spoke about these alerts and their importance for patient safety in his presentation. The full text and video are below:
“The purpose of this really is to make sure that when information goes into a system, and it is done obviously prior to any action being taken on the orders … that somebody who has some clinical expertise or authority is able to see any of the clinical decision support alerts that pop up and say, ‘You may not want to prescribe this medication because of a contraindication.’ Then they can take action on that for patient safety, whereas I as a lay person might see a clinical decision alert, have no idea what that means, and ignore it completely. So that’s really the whole idea behind having a licensed health professional or a CMA (AAMA) to look at that.”
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