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Meaningful Use

 “Meaningful Use” is the term defined by the Medicare and Medicaid Electronic Health Record Incentive Programs as the ability to demonstrate meaningful use of certified Electronic Health Record Technology. Eligible providers, hospitals, and critical access hospitals may participate in the program. The incentive program provides payments to those who “adapt, implement, upgrade, or demonstrate meaningful use of certified Electronic Health Record Technology.”

Background:

Through the American Recovery and Reinvestment Act of 2009 and Health Information Technology for Economic and Clinical Health Act (HITECH) of 2009, funds were made available for the adaptation of the Electronic Healthcare Record (EHR). The intended result is “health care that is patient-centered, evidence-based, prevention-oriented, efficient, and equitable.” Steps have been taken since the HITECH was enacted to promote the use of the EHR, including:


 * Creating a process for “certifying” EHR technology to ensure the technology will meet the standards of meaningful use
 * Adapting laws to improve privacy and security of EHR’s
 * Defining “meaningful use” in terms of measured outcomes that must be met
 * Creating a support structure to assist with implementation such as Regional Extension Centers, training programs, and identifying early adaptors.

In 2009, according to DHHS and CMS (2010), designing the definition of meaningful use was a collaborative effort by the Office of the National Coordinator for HITECH, Centers for Medicare and Medicaid Services, National Committee on Vital and Health Statistics, Health Information Policy Committee, National Priorities Partnership, patient representatives, vendors, providers, consumers, payers, and certifying entities. With consideration to all parties, the final result was a three phase approach.


 * “Stage 1: '' The Stage 1 meaningful use criteria focuses on electronically capturing health information in a coded format; using that information to track key clinical conditions and communicating that information for care coordination purposes (whether that information is structured or unstructured, but in structured format whenever feasible); consistent with other provisions of Medicare and Medicaid law, implementing clinical decision support tools to facilitate disease and medication management; and reporting clinical quality measures and public health information.


 * Stage 2: Our goals for the Stage 2 meaningful use criteria, consistent with other provisions of Medicare and Medicaid law, expand upon the Stage 1 criteria to encourage the use of health IT for continuous quality improvement at the point of care and the exchange of information in the most structured format possible, such as the electronic transmission of orders entered using computerized provider order entry (CPOE) and the electronic transmission of diagnostic test results (such as blood tests, microbiology, urinalysis, pathology tests, radiology, cardiac imaging, nuclear medicine tests, pulmonary function tests and other such data needed to diagnose and treat disease). Additionally we may consider applying the criteria more broadly to both the inpatient and outpatient hospital settings.


 * Stage 3: Our goals for the Stage 3 meaningful use criteria are, consistent with other provisions of Medicare and Medicaid law, to focus on promoting improvements in quality, safety and efficiency, focusing on decision support for national high priority conditions, patient access to self management tools, access to comprehensive patient data and improving population health.” 

The three phase approach is intended to bring all eligible providers and hospitals to the same level of use by 2015. The collaboration raised concerns about penalizing early adapters with more stringent criteria; in response, the approach that was chosen would be as follows:


 * Stage I Criteria: Payment year 2011-2012


 * Stage II Criteria: Payment year 2013-2014


 * Stage III Criteria: Payment year 2015

When the eligible provider or hospital satisfies the requirements of adaptation, implementation or upgrade of certified EHR technology, the first payment year begins. The first payment year does not require proof of “meaningful use.” However, for the second year payment, all criteria must be met based on the stage criteria at that time.

Example:


 * Hospital “A” starts in the year 2011; the first year is implementation of a certified EHR. Then the second year (2012) payment will require criteria for Stage I to be met.


 * Hospital “B” starts in 2013, the first year is implementation of a certified EHR. Then the second year (2014) will require criteria for Stage I and Stage II to be met.

Purpose:

There are several reasons why meaningful use has become a priority in the United States health care system. First, it can promote patient-centered care. This includes easily accessible and updated information such as allergies, medications, and diagnostic information. Second, it promotes the practice of evidence-based care. Practice guidelines must be met including specific CMS and state requirements. Third, focus would be on prevention. This includes smoking cessation and immunizations. Fourth, the intent would be improvement of efficiency. Multiple health care providers can view the EHR at any given time, diagnostics and labs are easily available, and processes can be streamlined. Finally, the financial purpose is to make health care more equitable. The intent is to prevent waste due to duplication of services and fraud. The criteria are posted in “Electronic Health Records At a Glance” on the Center for Medicare and Medicaid Services website at [https://www.cms.gov/apps/media/press/factsheet.asp? www.cms.gov].

Concerns:

Meaningful use is not without flaws. A recent report “The 2012 HIMSS Analytics Report: Security of Patient Data,” from Kroll Cyber Security stated, “the third installment of the bi-annual survey of healthcare providers nationwide, shows a steady rise in data breaches over the last six years, despite increasingly stringent regulatory activity surrounding reporting and auditing procedures, and heightened levels of compliance.” Kroll found that compromising of information has increased since the implementation of Stage I.  Reasons vary from misuse by third party vendors to lost or stolen laptops. Lack of decisiveness regarding future criteria has left the health care industry with concerns of what might be expected in the future and how it will adapt. There are also growing concerns that private practice providers will not be able to meet the demands and cost required to implement a certified EHR.

Summary:

Meaningful use is a term used to describe the rules proposed by the federal government to implement the use of certified EHR technology. The Department of Health and Human Services and Centers for Medicare and Medicaid Services will continue to define the term “meaningful use” and the criteria that must be met with continued use of the three stage pathway.

References:

Electronic Health Records At A Glance. (2012, April 11). Retrieved April 13, 2012, from CMS.gov Centers for Medicare and Medicaid Services: https://www.cms.gov/apps/media/press/factsheet.asp?Counter=3788&intNumPerPage=10&checkDate=&checkKey=&srchType=1&numDays=3500&srchOpt=0&srchData=&keywordType=All&chkNewsType=6&intPage=&showAll=&pYear=&year=&desc=&cboOrder=date Kroll Cyber Security 2012 HIMSS Report. (2012, April). Retrieved April 13, 2012, from Kroll Advisory Solutions: http://www.krollcybersecurity.com/white-papers/himss-2012-report.aspx Overview of EHR Incentive Programs. (2012, April 11). Retrieved April 13, 2012, from CMS.Gov Centers for Medicare and Medicaid Services: https://www.cms.gov/Regulations-and-Guidance/Legislation/EHRIncentivePrograms/index.html?redirect=/EHRIncentivePrograms/ Torrieri, M. (2011, December 24). Dealing with Meaningful Use Attestation Aggravation. Retrieved April 13, 2012, from Physicians Practice Your Practice Your Way: http://www.physicianspractice.com/meaningful-use/content/article/1462168/2009082

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