Regulations & EHR Integration

It wasn’t long after Beers debuted the criteria that they gained the attention of federal rule makers. However, they were initially unsure how to employ them. Smith said, ”Turning the criteria into regulations was going to be very difficult because there is a ‘yes, but…’ for most situations and the exceptions were too nuanced and complex to be mastered by surveyors.” Ultimately, federal surveyors were mandated to use the Beers Criteria® as part of the Centers for Medicare & Medicaid Services (CMS) Guidance to Surveyors and refer to the criteria to determine if medications in a patient’s regimen are safe and appropriate.

Then in 2015, the National Committee for Quality Assurance (NCQA) and the Pharmacy Quality Alliance (PQA) began using the Beers Criteria® in the quality measure, Use of High-Risk Medications in the Elderly, one of the measures CMS uses to evaluate quality care. At the same time, NCQA uses the criteria in the quality measure Potentially Harmful Drug-Disease Interactions in the Elderly. These measures used the Beers Criteria® and an extensive literature review to prepare a list of evidence-based drug-therapy alternatives.

Even before the widespread use of technology in health care, Beers envisioned the criteria being computerized. Today, many electronic health records (EHRs) integrate the Beers® Criteria most commonly as part of clinical decision support tools to alert clinicians when they prescribe a potentially inappropriate medication for an older patient. These alerts may suggest therapeutic alternatives and help support conversations with patients and families about the risks and benefits of potentially inappropriate medications are used.

Steven Buslovich, MD, CMD, MSHCPM, chief medical officer, PointClickCare, noted that the Beers Criteria® can be integrated into workflows and used to support deprescribing and medication optimization efforts. However, he stressed that integrating the criteria into electronic health records is a valuable support tool but shouldn’t be used to drive care. “There are times when a medication on the list is the best or only choice for a patient, and prescribers need to be able to make those decisions,” he said.