Meaningful Use: Overview and Implications
Healthcare information technology is increasingly being recognized by healthcare providers and policymakers as a tool for providing high-quality and efficient care (American Hospital Association, 2010). Electronic health records have in particular received attention from policymakers. This attention is in the form of economic stimulus legislation and healthcare reforms: targeted information technology regulations have been introduced that incentivize adoption of electronic health records by hospitals and professional healthcare providers to enhance the well-being of Americans (Sensmeier, 2010). The impact of the adoption and meaningful use of electronic health records has been experienced on multiple fronts.
Overview of Meaningful Use
The Centers for Medicare and Medicaid (CMS) defines meaningful use as the use of health information technology that increases the interoperability of exchange of information amongst healthcare professionals (American Hospital Association, 2010). The term is also used in reference to a set of standards that were developed by the CMS that focus on paying healthcare providers incentives for attaining designated criteria on the meaningful use of information technology to enhance patient care. The origins of Meaningful Use are traced to the American Recovery and Reinvestment Act (ARRA) of 2009. The congress, on recognizing the potential merits of the use of electronic health records, authorized through the ARRA substantial funding to support widespread adoption of health information technology. A section of the act, Health Information Technology for Economic and Clinical Health (HITECH) allocates $19 billion to healthcare providers (hospitals and physicians) who demonstrate “meaningful use” of electronic health records (Ferris, 2010). A significant proportion of the funds will be disbursed as incentive payments to eligible healthcare providers who use electronic health records systems. The incentive payments are distributed via the Medicare and Medicaid programs. The formula used to determine hospital incentive payments embodies a base payment of $ 2 million. Other factors considered include total discharge volume, level of charity care, proportion of inpatient days reimbursed by the Medicare and Medicaid programs, and a yearly transition factor. The latter factor scales back payments over time. Hospitals started receiving the Medicare incentive payments in the year 2011. This period is expected to extend up to 2016. Penalties for failing to demonstrate meaningful use will commence in 2015. They will be introduced in phases and are expected to become permanent in 2017. Incentives from the Medicaid program are expected to commence from the year 2016 and extend up to 2021. No penalties will be imposed for the latter program (American Hospital Association, 2010).
The ARRA specifies 3 components of meaningful use: use of electronic health records in a meaningful way and certified electronic health records technology to exchange health information electronically with the aim of improving quality of care. The last component is use of certified electronic health records technology to submit measures selected for reporting such as clinical quality measures. The meaningful use program has 3 main goals: to promote standardization of the electronic capture of information for instance patient demographics and provider orders; enhance quality of healthcare at care points; and to promote the use of clinical decision support as well as patient self-management tools as tools for improving quality, safety, and efficiency (American Hospital Association, 2010).
Meaningful use was to be implemented in 3 stages over a five-year period. Stage one ended back in 2012. It focused on the capture of data in a consistent format, coordination and communication of care information in a structured format, and analysis of health trends. Other areas focused on in stage 1 were the use of information to enhance the engagement of patients and families in care and implementation of clinical decision support tools to aid the management of diseases and medications. Stage two begun in 2013 and ends in 2014. It emphasizes advanced sharing for instance electronic exchange of patient/client care summaries between healthcare providers. Stage three will commence in 2015. It will focus on improving quality, safety, and efficiency outcomes, providing access to self-care tools for patients, improving population health, providing clinical decision support for high priority conditions, and improving access to comprehensive patient data. The incentive payments for meaningful use will end in 2016 once stage 3 is completed (Ferris, 2010).
Implications of the Collection and Use of Meaningful Use Core Criteria
Some of the meaningful use requirements are aimed at helping healthcare providers nurses included make better informed decisions, be more efficient, and deliver higher quality and safer care. These tools include clinical decision support tools and enhanced access to comprehensive patient information through exchange of information between providers. They can help to eliminate adverse drug reactions, duplicative testing, and improve provider collaboration. Enhancement of the ability of electronic health records systems to capture and facilitate sharing of clinical will in addition support more robust and rigorous quality measurement and improvement. The information collected from patients and documented electronically can be analyzed and used to optimize decision making and in the identification of more effective care processes. This will help to reduce duplication of work, optimize health outcomes, streamline workflows, and decrease costs (Sensmeir, 2010).
Achievement of the benefits of implementation of health technology requires clinicians to play a critical role in the leveraging of information technology systems. They do this by acting as project champions and conducting systems training for other clinicians. Implementation of the electronic health record systems will thus have significant ramifications for nurses and nursing. Nurses will be involved in decision making on the usefulness and efficiency of these systems. To achieve this, they must be supported to effectively play their roles as leaders in the design and use of electronic health record systems, care coordinators across multidisciplinary teams, integrators of patient data, researchers on quality, safe, and efficient patient care, and advocates for engagement of patients and families (Sensmeir, 2010).
The first stage criteria aimed at the electronic capture of clinical data in a consistent format at point-of-care had serious implications for nurses. Nurses were instrumental in the identification and standardization of the data elements needed for this foundational element. This step was complex due to existence of a wide range of nursing documentation forms, workflows, and processes in healthcare set ups. Nurse leaders worked with frontline nurses in defining order sets, developing standardized care pathways, and the selection of terminologies that precisely and consistently describe the essence of nursing (Sensmeir, 2010).
Another implication of the Meaningful Use core criteria on nursing is the evolution of the role of nursing informatics. Healthcare organizations have created the position of chief nursing informatics officer. Nurses in these positions play strategic and tactical/operational roles. These roles include guiding the selection process for electronic health record systems, advising on the sequencing of system modules, assisting in the identification of appropriate value propositions, and providing oversight during the design and implementation of systems. Nurses in this position also act as project champion leaders. They additionally advocate for redesign of workflow processes in a manner that supports adoption of novel technologies. They also help to measure performance using clinical and financial indicators (Murphy, 2011).
With regards to patients, enhanced sharing of clinical information between healthcare providers helps to enhance the quality, safety, and effectiveness of care provided, eliminate duplication of investigations, reduce costs, and to decrease the occurrence of adverse events. Use of clinical decision support tools by healthcare providers, on the other hand, helps to optimize decision making and patient outcomes. Expanded access of their health information will hopefully help to motivate patients to adopt positive behaviors and increase their engagement in self-care and clinical decision making. Lastly, enhanced communication between healthcare providers and patients provides opportunities for early management of disease conditions and provision of follow up care (Dimick, 2011).
Regarding the impact of Meaningful Use on population health and national health policy, the menu objectives for Stage encourage healthcare providers to send data to public health agencies and immunization registries. Stage 2 also encourages the transmission of information to registries as well as public health agencies. This information is essential as it drives best practices, informs health care policy decisions, and improves the nation’s public health. Meaningful Use core criteria will enhance data interoperability and exchange. Collected standardized clinical data can be reused for the following purposes quality and practice improvement, outcomes research, identification of national priorities with reference to disease conditions and other health issues, and decision support. All these processes will contribute to increased healthcare quality and improved population health (Chute, 2010).
Regarding the issue of addition of extra Meaningful Use core criteria, I do not at this stage recommend addition of any criteria. My decision is informed by statistics suggesting that achievement of the already set up criteria by hospitals and eligible professionals has been slow. For instance, a report by the Government Accountability Office noted that in 2011, only 9% of all eligible professionals were successful in attesting Meaningful Use. Concern has also been expressed that the 75 % threshold set for eligible professionals to attest to meaningful use is too high (American Academy of Otolaryngology-Head and Neck Surgery, 2012).
Conclusion
In summary, this paper has provided an overview of the Meaningful Use program. To this end, it has described the legislative changes that enabled creation of the program, its components, goals, and phases. The paper has also examined the implications of the collection of data and use of the program on nurses, nursing, patients, population health, and national health policy. It has established that the program has multiple impacts on all the above fronts.
References
American Academy of Otolaryngology-Head and Neck Surgery (2012). Electronic health records meaningful use stage 2 final rule summary.
American Hospital Association (2010). The road to Meaningful Use: What it takes to implement electronic health records systems in hospitals.
Chute, C. G. (2010). Interoperability review: The journey of Meaningful Use. AMIA, 1(1).
Dimick, C. (2011). First Steps to Patient-Centered Care: Meaningful Use Focuses Industry on Baby Steps. Journal of AHIMA, 82(2), 20-24.
Ferris, N. (2010). ‘Meaningful Use’ of electronic health records. Health Policy Briefs, 33(11).
Murphy, J. (2011). The nursing informatics workforce: Who are they and what do they do? Nurse Econ., 29(3), 150-152.
Sensmeier, J. (2010). Meaningful use: Making IT matter. Nursing Management, 41(9), 2-6.
