NUR-621 Implementing Meaningful Use

The meaningful use can be defined as the utilization of certified electronic health records (EHR) technology in a meaningful manner such as electronic prescribing for instance and ensuring that the certified EHR technology connect in a way that enables the electronic exchange of health information to enhance the quality of care (CDC, 2020). Essentially, the meaningful use is vital since the efficient exchange of data between health care professionals, patients, and insurers is crucial in improving patient care, security and safety of data, and the entire IT system in health care field. According to CDC (2020), the concept of meaningful use is anchored on five fundamental pillars of health outcomes policy main concerns that include enhancing quality of life, efficiency, safety, and reducing health disparities, involving patients and their families in their care, enhancing care coordination, enhancing population and public health, and guaranteeing sufficient privacy and security safeguards for personal health information. Therefore, the aim of this paper is to delve into implementation of meaningful use. Specifically, the paper will describe the three stages of meaningful use and their measures and explain the challenges and barriers that health care facilities encounter in implementing each stage of the meaningful use.

The Three Stages of Meaningful Use and their Measures

The Meaningful Use initiative by the Medicare is categorized into three stages. Every stage is building on the preceding one over some years in an effort to expand EHR usage to ever increasing large patient population with variety of health care processes. The first stage of the meaningful use involves emphasis on data capture and sharing on EHR technology. Here health care providers are needed to focus on keeping health information electronically in a consistent format that facilitates access to the information by the authorized persons. Moreover, this stage also concentrates on trailing clinical conditions through utilization of EHR for effective care coordination, using the information obtained to initiate assessment and reporting information on both public health and clinical quality, and utilizing EHR for better engagement of patients in their healthcare provision. Essentially, every stage in the meaningful use requires the providers to meet certain indentified core objectives and prearranged number of the menu objectives. Therefore, the measures needed to realize the requirements for stage 1 of the meaningful use include realization of all the required 13 core objectives and also five of the existing Menu Objectives. Besides, all eligible providers, irrespective of the stage should meet nine clinical quality measures to achieve meaningful use requirements.

The meaningful use stage 2, which began in the year 2014, is characterized by advanced clinical processes. This stage maintains the fundamental core and menu structure from stage 1. This stage brings new objectives and measures and also higher standards that require health care providers to expand EHR capabilities to a greater segment of their patient populations. The stage will involve further incorporation of lab results, e-prescribing, and elaborate sharing of summaries of patient care. Overall, the objectives of stage 2 of meaningful use are to enhance patient care through effective patient involvement, care coordination, and clinical decision support. At this point, it is clear that providers who seek incentives for meaningful use should encourage patients to take active role in their care (Health Catalyst, 2020). Regarding measures for stage 2 meaningful use, there are exist 19 measures for hospitals and 20 for professional. Consequently, hospitals must achieve 16 core objectives and three out of six menu objectives. For professionals, 17 core objectives and three out of six menu objectives must be achieved (Health Catalyst, 2020).

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On the other hand, meaningful use stage 3 involves improved outcomes. This stage began in 2016. Stage 3 seeks to advance clinical EHR practices of stage 2 and improve them. The objective in this stage is to enhance the quality of exchanged health information, which will ultimately result in enhanced patient health on a big scale. This stage will also help health providers by ensuring effectively and easily access comprehensive patient data. Moreover, the public health issues will also be minimized with help of EHR. Essentially, the stage 3 goal involves a more pool of information network ranging from lab reports to information on immunization. Taken together, the ultimate intention of meaningful use stage 3 is to simplify the program, enhance patient outcomes, and push for interoperability between EHRs.

Regarding measures, CMS (2020) postulate that stage 3 involves eight measures and objectives for eligible professionals and hospitals. All providers are needed to attest to one set of objectives and measures. To realize requirements of stage 3, providers are required to use technology approved to the 2015 Edition. However, providers with technology certified to a mix of the 2015 and 2014 Editions can only attest the requirements of stage 3 if the set of technologies would not prevent them from attaining stage 3 measures. Meaningful use stage 3 is characterized by flexibility with some objectives to enable providers to select measures that are more crucial to the patient population or practice they serve. The objectives and their measures include;

Health Information Exchange

Providers are required to attest to all the three measures and must realize the standards for a minimum of two measures to attain the objective.

Coordination of Care through Patient Engagement

It is mandatory for providers to attest to all three measures and attain the standards for a minimum of two measures to meet the objective.

Public Health Reporting

It is mandatory for eligible providers to report on two measures while eligible hospitals should report on four measures.

Challenges and Barriers Faced by Facilities in Implementing each Stage of Meaningful Use

The adoption and meaningful use of EHR systems is an essential national goal, which has substantially increased in the recent years. However, there are concerns about the unique challenges in the meaningful use of the EHR. Generally, the challenges may range from limited resources to poor infrastructure issues (Adler-Milstein et al., 2015). However, this section will describe barriers and challenges in implementing meaningful use in each of the three stages.

Stage 1

The focus on this stage is capturing and sharing data on EHR technology. However, the challenges and barriers in realizing the objectives is failure of meaningful use to operate as required because of poor integration of technologies required into existing systems, the technologies may also be immature. Moreover, the meaningful use can potentially interrupt patient care due to workflow modifications. The other possible challenge is that meaningful use expectation may go beyond the practice and healthcare setting making it difficult to effectively implement the existing needs. Furthermore, focus on capturing and sharing data on EHR technology will likely lead to consolidation of EHR market, which brings various concerns such as massive financial requirements in migration of data. Moreover, migrating EHRs at the time of meaningful use reporting presents a significant challenge where one EHR may tend to phase out the other that is being executed. Therefore, satisfying meaningful use needs may require sustaining both needs to achieve reporting obligations, which is extremely challenging.

Stage 2

This stage is characterized by advanced clinical processes. The stage stresses on providing the patients with greater access to their health information through electronic means. However, there is no standard for patient access, which is a significant challenge for many providers. Besides, this stage pushed sustaining more exchanges of health information but failed to provide how it will happen, which presents a challenge of financial sustainability. This stage also contained a proposal to incorporate core and menu objectives to motivate eligible providers to enhance transfer of data electronically to attain certain set thresholds. However, the intricacy of selling technology does not auger well with the compulsory public requirement on pricing information (Yen et al., 2017).

Stage 3

Although, the ultimate intention of meaningful use stage 3 is to simplify the program, enhance patient outcomes, and push for interoperability between EHRs, the interoperability is not found at a fair cost and practices. There are proprietary barriers, more costs, and seemingly lack of pressure to eliminate these barriers by relevant stakeholders. Moreover, Stage 3 seeks to advance clinical EHR practices of stage 2 and improve them. As such, there is need for more features or functions to help in achieving this objective. However, some of these features or functions are not properly tested before being implemented.

Conclusion

The meaningful use is vital in facilitating the efficient exchange of data between health care professionals, patients, and insurers is crucial in improving patient care, security and safety of data, and the entire IT system in health care field. Ultimately, the implementation of three stages will enable providers to deliver best possible care, better coordination of care, facilitate information sharing with patients and their families and also among the providers, facilitate communication between providers, easy access to information and data to foster faster diagnosis of health issue, minimize error, and provision of quality, safe, and cost-effective care.

References

Adler-Milstein, J., DesRoches, C. M., Kralovec, P., Foster, G., Worzala, C., Charles, D., … & Jha, A. K. (2015). Electronic health record adoption in US hospitals: progress continues, but challenges persist. Health affairs, 34(12), 2174-2180.

CDC. (2020). Introduction | Meaningful Use | CDC. Cdc.gov. Retrieved 22 July 2020, from https://www.cdc.gov/ehrmeaningfuluse/introduction.html.

CMS. (2020). Stage 3 Program Requirements for Providers Attesting to their State’s Medicaid Promoting Interoperability (PI) Programs | CMS. Cms.gov. Retrieved 23 July 2020, from https://www.cms.gov/Regulations-and-Guidance/Legislation/EHRIncentivePrograms/Stage3Medicaid_Require.

Health Catalyst. (2020). Stage 2 Meaningful Use Measures and Reporting Solutions. Health Catalyst. Retrieved 23 July 2020, from https://www.healthcatalyst.com/meaningful-use/.

Yen, P. Y., McAlearney, A. S., Sieck, C. J., Hefner, J. L., & Huerta, T. R. (2017). Health information technology (HIT) adaptation: refocusing on the journey to successful HIT implementation. JMIR medical informatics, 5(3), e28.

NUR-621 Implementing Meaningful Use