Meaningful Use Program
The adoption of electronic health records (EHRs) is continuously stretching globally. This can be attributed to the overwhelming benefits when compared with traditional paper-based systems. According to Alammari et al. (2021), the rates of EHR adoption increased from 42% to 89% between 2008 and 2015. Consequently, EHRs have become a fundamental element in the patient care delivery process. However, in the US, the adoption of EHR came along with several incentive programs such as the meaningful use program. This is a program established through the Centers for Medicare and Medicaid Services EHR Incentive Programs that ensures that eligible healthcare providers and hospitals exhibit meaningful use of an electronic health record to qualify for reimbursement. According to Alammari et al. (2021), the term meaningful use refers to a slew of minimum US government standards for HER use to improve collaboration, patient-centered care, and support progressive development as well as standardized clinical data exchanges. Nevertheless, it is important to highlight that the term is currently outdated.
The program originated following the signing of the American Recovery and Reinvestment Act (ARRA) into law by President Obama on February 17, 2009. The US Congress later passed the Health Information Technology for Economic and Clinical Health (HITECH) Act which allowed federal subsidies for healthcare facilities and eligible physicians to adopt certified EHR systems. According to Lite et al. (2020), the meaningful use incentive program was necessary to improve the efficiency, coordination, and quality of patient care by leveraging certified EHR technologies efficiently and securely.
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An EHR is a comprehensive systematized collection of health-related information about a patient stored in a digital format while electronic medical records (EMR) refer to digital versions of a chart with patient information stored on a computer (Alsahafi & Gay, 2018). Meanwhile, an electronic personal health record (ePHR) relates to an electronic application that allows individuals to access, manage and share their health-related information in a secure and private environment (Alsahafi & Gay, 2018). The EHR provides a cross-link between EMR and ePHR that allows networking with many computer systems using a designed information system. The Meaningful Use program significantly impacts the nursing profession and primary care physicians. It forms the guiding principle to ensure the implementation of certified EHR improves patient safety, care, and efficiency. The subsequent sections of the paper will explore the analysis, core requirements, challenges, and recommendations of the meaningful use program.
Analysis of the Meaningful Use Program
The meaningful use program consisted of three evolving stages with increasingly comprehensive EHR adoption standards. Stage 1(2011-2012) aimed at data capturing and sharing. Clinicians were expected to fulfill a set of 13 core objectives during this stage. These objectives included the use of computerized order entry, recording of demographics, maintenance of allergy list, and recording of vital signs among others which collectively supported healthcare. This stage also focused on creating an electronic database, learning how to use and ensuring its security. Stage 2 (2012) focused on advanced clinical processes and comprised 17 necessary requirements and 6 menu objectives. Finally, stage 3 (2016) refined the meaningful use standards to focus on improving health outcomes. This stage consisted of menu objectives including submitting electronic immunization information, recording patient notes electronically, sending patient reminders for preventive and follow-up care, using clinical lab test results in EHR as structured data, implementing drug formulary checks, reporting cancer cases to public health, and recording family history data. A vast majority of these objectives have been met at the workplace.
The meaningful use incentive elaborates a consistent technique of inaugurating electronic data management into daily practice to optimize healthcare outcomes. The program was generally affordable as the US government allocated $20.6 billion to ensure its adoption (Lite et al., 2020). Meaningful program when carefully executed works and considerably enhances quality patient care, coordination, and safety. The program also enhances efficiency in healthcare by providing a safe and secure method of collecting, storing, and sharing health-related information. Strengths related to meaningful use include; the promotion of adoption and effective use of EHRs, improvement of access for Medicare and Medicaid beneficiaries, the transformation of health information technology, and an increase in PCP participation (Holman et al., 2018). However, weaknesses associated with this program include; the program pertaining only to Medicare beneficiaries, too many criteria, a lack of substantial evidence that the program is related to the overall quality of healthcare, cost expensive to implement, security threats, and training as a prerequisite (Holman et al., 2018).
Core Requirements of the Meaningful Use Program
The core requirements are beneficial to many healthcare stakeholders including patients, providers, nurses, and population health. Meaningful use enhances the utilization of patient reminders, e-Prescribing, and electronic access to healthcare information which reduces medical errors and improves the quality of patient care. Trout et al. (2022) in their research demonstrated an 8% decrease in composites for mortality for selected procedures and an 18% decrease in composite mortality for selected conditions as well as a positive impact on quality associated with EHRs that attested to meaningful use. Similarly, the program enables healthcare providers to make informed clinical decisions, enhance their efficiency and deliver better healthcare since it directly affects their reimbursements (Holman et al., 2018). The meaningful use program further impacts nursing. It facilitates proper documentation, avoidance of medication errors such as adverse drug reactions, reduces duplicative testing, and enhances provider collaboration. The program also equips nurses with technological skills and expertise. Consequently, nursing care and patient satisfaction are both enhanced. Additionally, the general population benefits from increased surveillance and implementation of prevention programs through the continuous reporting of cancer cases and immunization data to public health registries.
Challenges and Recommendations
The implementation of certified EHR faces several challenges including a lack of a clear plan, cost, lack of oversight, privacy risks, and concerns about sustainability. The EHR utilizes complicated and sophisticated software that is expensive to install and maintain. Similarly, health-related information is valuable and is targeted by several perpetrators of cybersecurity attacks (Colicchio et al., 2019). Patient information contained in the EHR is very sensitive and at risk of data security breaches due to unauthorized access. Additionally, the meaningful use program lacked a clear insight into the diversity of the several primary healthcare providers and their specialties. These adversely affected the implementation of the program leading to failed expectations and physician burnout (Colicchio et al., 2019). The meaningful use program further became unsustainable resulting in its transformation to the Promoting Interoperability program (Alammari et al., 2021).
Following the aforementioned challenges, the recommendations include; adequate training, better communication, adequate time for implementation, and ensuring a realistic, scalable, and flexible starting point for the adoption of EHR. The components of technology are complex and require expertise that can only be obtained through adequate training. Likewise, the healthcare industry is diverse and hence the adoption of EHR should be scalable, flexible, realistic, and tailored to the specific facility. Finally, adequate time should be allowed given the dozens of standards and criteria.
The Meaningful use program is a US government-sponsored program aimed at establishing certified electronic health records. It is composed of three evolving stages. Careful implementation of the program is beneficial to patients, providers, nurses, and the general population. However, the program faces a slew of challenges and weaknesses which ought to be addressed via several strategies including the aforementioned strategies. Finally, the Promoting Interoperability program has currently replaced the meaningful use program.
Alammari, D., Banta, J. E., Shah, H., Reibling, E., & Ramadan, M. (2021). Meaningful use of electronic health records and ambulatory healthcare quality measures. Cureus, 13(1), e13036. https://doi.org/10.7759/cureus.13036
Alsahafi, Y. A., & Gay, V. (2018). An overview of electronic personal health records. Health Policy and Technology, 7(4), 427–432. https://doi.org/10.1016/j.hlpt.2018.10.004
Colicchio, T. K., Cimino, J. J., & Del Fiol, G. (2019). Unintended consequences of nationwide electronic health record adoption: Challenges and opportunities in the post-Meaningful Use era. Journal of Medical Internet Research, 21(6), e13313. https://doi.org/10.2196/13313
Holman, G. T., Waldren, S. E., Beasley, J. W., Cohen, D. J., Dardick, L. D., Fox, C. H., Marquard, J., Mullins, R., North, C. Q., Rafalski, M., Rivera, A. J., & Wetterneck, T. B. (2018). Meaningful use’s benefits and burdens for US family physicians. Journal of the American Medical Informatics Association: JAMIA, 25(6), 694–701. https://doi.org/10.1093/jamia/ocx158
Lite, S., Gordon, W. J., & Stern, A. D. (2020). Association of the meaningful use electronic health record incentive program with Health Information Technology venture capital funding. JAMA Network Open, 3(3), e201402. https://doi.org/10.1001/jamanetworkopen.2020.1402
Trout, K. E., Chen, L.-W., Wilson, F. A., Tak, H. J., & Palm, D. (2022). The impact of electronic health records and Meaningful Use on inpatient quality. Journal for Healthcare Quality: Official Publication of the National Association for Healthcare Quality, 44(2), e15–e23. https://doi.org/10.1097/JHQ.0000000000000314
Meaningful use for nurses
You will select (2) Core objectives to enable EHRs to support healthcare from Stage 1. You will select (2) Menu objectives that provide flexibility for providers to choose from Stage 1 or Stage 2.
To earn full credit, your paper must include the following components:
A. Introduction and overview of the Meaningful Use Program – provide an overview of the Meaningful Use Program. Describe its significance to advanced practice registered nursing and the impact it has on the nursing profession.
1. What is it?
2. When did it originate? Why is it needed?
3. What are the relationships between EMR, EHR, and ePHR to clinical information systems?
4. What is the significance to the nursing profession, especially to the PCP?
The EHR is a transportable subset of the EMR designed for use by healthcare organizations and physician practices and other providers. It provides a bridge connecting the EMR and the ePHR. â€œThe EHR is a longitudinal record of patient health information generated by one or more encounters in any care delivery settingâ€ (Health Information and Management Systems Society [HIMSS], 2014, para. 1). The patient owns the data.
B. Discussion and analysis of the Meaningful Use Program (MUP) – describe and analyze the goals and objectives of meaningful use as well as its implications for nurses, nursing, national health policy, patient outcomes, and population health associated with the collection and use of meaningful use core criteria.
1. Review the goals and objectives and discuss them. Is this something you see or deal within your workplace?
2. Discuss the implications â€“ is the program effective? Is it affordable? Does it work? Does it really improve quality and efficiency of care?
3. What are the strengths and weaknesses of MUP?
4. Support your ideas with evidence-based practice.
C. Core Requirements of the Meaningful Use Program – analyze how the core requirements are beneficial for advanced nurses, nursing, monitoring population health, setting national health policies, and/or improvements in patient outcomes or population health.
1. Patients â€“ discuss impact of MUP on the use of patient reminders, ePrescribing, electronic access, etc.
2. Providers â€“ does MUP assist providers in making more informed decisions, deliver better care, and create greater efficiencies?
3. Nursing â€“ does MUP help to prevent duplicative testing, eliminate adverse drug reactions, and enhance provider collaboration?
4. Population health â€“ does MUP encourage providers to send data to immunization registries and public health agencies?
D. Challenges and recommendations – discuss current challenges with meaningful use seen in practice today and provide recommendations using evidence-based rationale.
1. Challenges â€“ lack of clear plan, cost, lack of oversight, privacy risks, concerns about sustainability
2. Recommendations â€“ realistic, scalable, and flexible starting point for adopting EHR, allow reasonable time for robust EHR use, ensure adequate training, better communication with physicians and providers
E. Conclusion – summarize your findings and conclude by providing insights gained from your analysis.
1. Do not introduce new concepts
2. Summarize the highlights of your findings
3. Offer your insights
THE ELECTRONIC RECORD AND MEANINGFUL USE
The number of EHR adopters continues to grow, which is necessary to meet care new outcome knowledge spurred by meaningful use, an initiative that uses EHRs to improve patient care. Meaningful use originated with the American Recovery and Reinvestment Act (ARRA) (Recovery.gov, 2014), signed into law by President Obama on February 17, 2009. ARRA and the Health Information Technology for Economic and Clinical Health (HITECH) Act, a part of ARRA, were milestones in the history of HIT. The HITECH Act outlined four purposes:
The HITECH Act provided monetary incentives to hospitals and eligible providers that met â€œmeaningful useâ€ requirements. The term meaningful use refers to the use of information from EHRs to make improvements in the delivery of healthcare (Blumenthal & Tavenner, 2010). Meaningful use requires an interoperable HIS for data exchange. A full-text summary of the meaningful use objectives and measures is online in a New England Journal of Medicine article, â€œThe â€˜Meaningful Useâ€™ Regulation for Electronic Health Recordsâ€ (http://www.nejm.org/doi/full/10.1056/NEJMp1006114).
According to research done by Mathematica Policy Research, Harvard School of Public Health, and Robert Woods Johnson Foundation (2013), 44% of hospitals in the United States had adopted a basic EHR as of 2012. The adoption rate by smaller and rural hospitals was slower than larger, private, and urban hospitals. The meaningful use definition, finalized in July 2010, allowed hospitals and providers to qualify for incentive payments beginning in 2011. It provided a two-tiered implementation plan. The CMS website at http://www.cms.gov/Regulations-and-Guidance/Legislation/EHRIncentivePrograms/Meaningful_Use.html has additional information about meaningful use.
Meaningful use has three stages. Stage 1 focuses on data capturing and sharing. Stage 2 focuses on advanced clinical processes. Finally, Stage 3 focuses on improved clinical outcomes. Eligible providers, hospital, and critical access hospitals must meet the thresholds for the first stage prior to meeting ones for the second stage. Meaningful use requires that all EHRs be certified to verify the interoperability for sending and receiving health data. An overview of Stages 1 and 2 meaningful use objectives for eligible providers is displayed in Table 17-1.
Core objectives to enable EHRs to support healthcare
1. Use computerized provider order entry (CPOE).
2. Use drugâ€“drug and drugâ€“allergy interaction checks.
3. Maintain an up-to-date list of diagnoses.
4. Create and transmit prescriptions electronically.
5. Maintain an active medication list.
6. Maintain an allergy list.
7. Record demographics.
8. Record vital signs.
9. Record smoking status for patients 13 years and older.
10. Use one clinical decision support rule.
11. Provide patients the ability to view online, and transmit information within 4 days after information is available to the provider.
12. Provide clinical summaries for each office visit.
13. Protect electronic health information.
Stage 2â€”Meet all 13 objectives above plus 4 additional ones.
1. Include clinical lab test results in the EHR.
2. Perform medication reconciliation.
3. Submit electronic data to immunization registries.
4. Use secure electronic messaging to communicate with patients on relevant health information.
Menu objectives that provide flexibility for providers to choose
Stage 1â€”Select 5 of the following menu objectives; at least 1 is a public health measure.
1. Implement drug formulary checks.
2. Use clinical lab test results in the EHR as structured data.
3. Create patient lists by condition for quality improvement, reduction of disparities, research, or outreach.
4. Send patient reminders for preventive and follow-up care.
5. Use certified EHR technology to provide patient education resources.
6. Perform medication reconciliation for patients received from another setting/provider.
7. Provide a summary of care for patients referred to another setting/provider.
8. Able to submit electronic immunization information.
9. Able to submit electronic syndromic surveillance data to public health agencies.
Stage 2â€”Select 3 of the following menu objectives.
1. Submit electronic syndromic surveillance data to public health agencies.
2. Record patient notes electronically.
3. Have imaging results accessible in the EHR.
4. Record family history data.
5. Report cancer cases to public health cancer registry.
6. Report specific cases to a specialized registry.
Source: The Eligible Professional Meaningful Use Table of Contents Core and Menu Set Objectives at http://www.cms.gov/Regulations-and-Guidance/Legislation/EHRIncentivePrograms/Downloads/Stage2_MeaningfulUseSpecSheet_TableContents_EPs.pdf; the Eligible Professionalâ€™s Guide to Stage of the EHR Incentive Program at http://www.cms.gov/Regulations-and-Guidance/Legislation/EHRIncentivePrograms/Downloads/Stage2_Guide_EPs_9_23_13.pdf
In 2014, as a part of meaningful use Stages 1 and 2, eligible providers were required to select and report 9 of 64 clinical quality measures in three of the following six domains: patient and family engagement, patient safety, care coordination, population and public health, efficient use of health-care resources, and clinical processes/effectiveness. Note that the ability to report electronic syndromic surveillance data to public health agencies could assist with identifying and containing disease outbreaks, such as the Ebola hemorrhagic fever virus that erupted in 2014 across the world. Additional information about the clinical quality measures is online at http://www.cms.gov/Regulations-and-Guidance/Legislation/EHRIncentivePrograms/ClinicalQualityMeasures.html.
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