Meaningful Use and the Emergency Department

From ACEP:

Highlights and revisions relevant to ACEP and emergency medicine include:

  • Hospital EDs included in CPOE requirement. ACEP asked that computerized provider order entry (CPOE) used for any type of orders that take place in the ED be included in the hospitals meaningful use requirements, as the proposed program did not provide for this.
  • ED throughput measures finalized. ACEP stressed the importance of ED throughput measures in the rule. The three measures around median time for ED arrival to ED departure, and admit decision time to ED departure time for admitted patient have been finalized for hospital and CAH reporting for payment years 2011 and 2012. These are among just 15 measures finalized in the CMS rule.
  • Syndromic surveillance measure remains in Stage 1. ACEP urged that this measure remain in the initial phase of the program as EDs will be a key collection point. The drafters agreed, noting the measure for this objective allows exceptions and allows for the possibility that such electronic exchange of syndromic data may not be possible.
  • “Hospital-based physicians” clarified (emergency physicians remain ineligible for direct incentives—control over hospital systems is at issue). Conforms with the Continuing Extension Act of 2010, which clarified a “hospital-based provider” as performing substantially all of his or her services in an inpatient hospital setting or emergency room only.
  • CAHs are included. Under Medicaid, the final rule includes critical access hospitals (CAHs) in the definition of acute care hospital for the purpose of incentive program eligibility.
  • Billions in incentives to be paid. The final rule’s economic analysis estimates that incentive payments under Medicare and Medicaid EHR programs for 2011 through 2019 will range from $9.7 billion to $27.4 billion.

Experts Debate Paramedic Intubation

From JEMS:

(Excerpt from a discussion about a case study)

For many years, we didn’t critically look at the success rates and outcomes related to prehospital endotracheal intubation (ETI). However, over the past decade or so, numerous studies have brought scrutiny to this long-established prehospital practice.
I know that there’s been some discussion as to whether paramedics should be allowed to continue to perform ETI in the prehospital setting. Any talk of limiting a paramedic’s skill set generates an emotional response from EMS providers and others. However, we must react to evolving science and change practices accordingly to ensure the safety and wellbeing of the patients we serve. Thus, this begs the question: Should prehospital ETI remain a core paramedic skill?