Question: We’ve participated in Stage 1, and will participate in Stage 2, of the Electronic Health Record Incentive Program regarding meaningful use. We’ve had registered nurses enter medication orders using Computerized Provider Order Entry in Stage 1 (“CPOE”), and plan on using them to enter orders in Stage 2. However, there is a disagreement in the hospital about whether registered nurses are allowed to enter orders using CPOE. Can you clear this up?
Answer: Registered nurses can enter orders using CPOE.
The American Recovery and Reinvestment Act of 2009 (“ARRA”) was enacted on February 17, 2009. The ARRA contained provisions known as the Health Information Technology for Economic and Clinical Health Act (“HITECH Act”). The HITECH Act established incentive payments to eligible professionals to promote the adoption of the meaningful use of health information technology (“HIT”) and qualified electronic health records (“EHR”). The incentive payments are part of a broader effort under the HITECH Act to accelerate the adoption of HIT and the utilization of EHR.
The EHR incentive programs consist of three stages of meaningful use. Each stage has its own set of requirements to meet in order to demonstrate meaningful use, with the objectives being known as Core Measures. Stage 1 focused on providers capturing patient data and sharing that data either with the patient or with other health care professionals, and consisted of 15 Core Measures, including, as Measure 1, using CPOE for medication orders. Stage 2, which becomes effective in 2014, will consist of 17 Core Measures, including, as Measure 1, using CPOE for medication, laboratory or radiology orders. Stage 3 has yet to be released.
Whether registered nurses could enter orders using CPOE was a point of much confusion. However, the Centers for Medicare & Medicaid Services (“CMS”) cleared up the confusion when it released the final regulations in the Federal Register on September 4, 2012:
Comment: We have received many comments on who can enter the order into CEHRT for it to count as CPOE. Four possibilities received comment support. First, only the ordering provider be able to enter the order into CEHRT. Second, any licensed healthcare professional who can enter orders into the medical record per state, local and professional guidelines can enter the order into CEHRT. This is the current policy which was proposed to continue. Third, an expansion to any licensed, certified or appropriately credentialed healthcare professional (some commenters replaced medical assistant with healthcare professional) who can enter orders into the medical record per state, local and professional guidelines. Fourth, an expansion to allow anyone, including those commonly referred to as scribes, enter the orders into the medical record per state, local and professional guidelines. We also note that there was some confusion among commenters as to our current limitation and proposal of any licensed healthcare professional using CPOE to create the first entry of the order into the patient’s medical record as we received many comments suggesting that nurses should be able to enter the orders. We clarify that nurses who are licensed and can enter orders into the medical record per state, local and professional guidelines may enter the order into CEHRT and have it count as CPOE. (Emphasis added.)
The last sentence of the Comment makes clear that registered nurses can enter orders if permitted to in accordance with state, local and professional guidelines.