Electronic health records can provide many benefits for providers and their patients, but the benefits depend on how they’re used. Meaningful use is the set of standards defined by the Centers for Medicare & Medicaid Services (CMS) Incentive Programs that governs the use of electronic health records and allows eligible providers and hospitals to earn incentive payments by meeting specific criteria. The goal of meaningful use is to promote the spread of electronic health records to improve health care in the United States. The Health Information Technology for Economic and Clinical Health (HITECH) Act provides the Department of Health & Human Services (HHS) with the authority to establish programs to improve health care quality, safety, and efficiency through the promotion of health IT, including electronic health records and private and secure electronic health information exchange. Under HITECH, eligible health care professionals and hospitals can qualify for Medicare and Medicaid incentive payments when they adopt certified EHR technology and use it to achieve specified objectives.
The benefits of EHR meaningful use include: Complete and accurate information. With electronic health records, providers have the information they need to provide the best possible care. Providers will know more about their patients and their health history before they walk into the examination room; Better access to information. Electronic health records facilitate greater access to the information providers need to diagnose health problems earlier and improve the health outcomes of their patients. Electronic health records also allow information to be shared more easily among doctors’ offices, hospitals, and across health systems, leading to better coordination of care; and Patient empowerment. Electronic health records will help empower patients to take a more active role in their health and in the health of their families. Patients can receive electronic copies of their medical records and share their health information securely over the Internet with their families. In order to achieve meaningful use, eligible providers and hospitals must adopt certified EHR technology and use it to achieve specific objectives. These meaningful use objectives and measures will evolve in three stages over the next five years. Meaningful Use Stage I
Meaningful use stage 1 is the first phase of the United States federal government’s meaningful use incentive program, which details the requirements for the use of electronic health record (EHR) systems by hospitals and eligible health care professionals. The list of criteria and regulations was established by the Centers for Medicare & Medicaid Services (CMS) and the Office of the National Coordinator for Health IT (ONC) in July 2010. Consisting of 25 total criteria, the list for meaningful use stage 1 is broken into 15 core requirements and 10 menu requirements. All core requirements are mandatory, while health care providers can choose five of the 10 menu requirements to meet. Within the confines of meaningful use stage 1, all eligible parties must adopt an EHR that meets the listed criteria by the end of 2014 in order to be eligible for government incentives. In order to receive the maximum incentive, providers must have achieved meaningful use for at least 90 days by the end of the 2012 federal fiscal year (September 30, 2012). Below are the 15 core objectives, of which all 15 must be met and the 10 menu objectives, of which five must be met in stage 1. I have only listed the objectives for eligible professionals; the hospital list is similar and can be found online. Eligible Professionals –15 Core Objectives
1. Computerized provider order entry (CPOE)
2. E-Prescribing (eRx)
3. Report ambulatory clinical quality measures to CMS/States 4. Implement one clinical decision support rule
5. Provide patients with an electronic copy of their health information, upon request 6. Provide clinical summaries for patients for each office visit 7. Drug-drug and drug-allergy interaction checks
8. Record demographics
9. Maintain an up-to-date problem list of current and active diagnoses 10. Maintain active medication list
11. Maintain active medication allergy list
12. Record and chart changes in vital signs
13. Record smoking status for patients 13 years or older
14. Capability to exchange key clinical information among providers of
care and patient-authorized entities electronically 15. Protect electronic health information
Eligible Professionals –10 Menu Objectives (may defer 5 of 10) 1. Drug-formulary checks
2. Incorporate clinical lab test results as structured data 3. Generate lists of patients by specific conditions
4. Send reminders to patients per patient preference for preventive/follow up care 5. Provide patients with timely electronic access to their health information 6. Use certified EHR technology to identify patient-specific education resources and provide to patient, if appropriate 7. Medication reconciliation
8. Summary of care record for each transition of care/referrals 9. Capability to submit electronic data to immunization registries/systems* 10. Capability to provide electronic syndromic surveillance data to public health agencies* * At least 1 public health objective must be selected.
Providers needed to complete attestation of stage I by February 28, 2013. During the last three weeks of February over 2200 providers were attesting each day. There was some fear regarding attestation, but overall the process was simple to use as long as the provider had all of the information necessary to complete the process handy. Attestation has changed from the beginning of the program until now and will continue to do so into stage II. At first the process was heavily text based, but has changed to become easier and more visually stimulating. Meaningful Use Stage II
Meaningful use stage 2 is the second phase of the meaningful use incentive program that details the second phase of requirements for the use of electronic health record (EHR) systems by hospitals and eligible health care providers. As with the stage 1 requirements, meaningful use stage 2 will have a menu section and a core section of requirements, with core requirements mandatory and menu requirements chosen from a larger list. Meaningful use stage 2 will consist of continuations of stage 1 requirements, with heightened demands for the number of electronic transactions. In addition, some stage 1 menu list items will move to the stage 2 core list — meaning that optional choices from stage 1, such as submitting data to public health agencies and adding lab results to EHR systems, will be required in stage 2. Finally, stage 2 will likely incorporate a group of new requirements, many related to providing patients with access to their own medical records. Meaningful use stage 2 is scheduled to begin in 2014. Below are the 15 core objectives for stage 2 for eligible professionals, again I have only listed the eligible professional objectives; the hospital objectives are very similar and can be found online. Eligible Professional- 15 Core Objectives (Stage 2)
1. Use computerized provider order entry (CPOE) for medication, laboratory and radiology orders directly entered by any licensed healthcare professional who can enter orders into the medical record per state, local and professional guidelines. 2. Generate and transmit permissible prescriptions electronically (eRx). 3. Record the following demographics: preferred language, sex, race, ethnicity, date of birth. 4. Record and chart changes in the following vital signs: height/length and weight (no age limit); blood pressure (ages 3 and over); calculate and display body mass index (BMI); and plot and display growth charts for patients 0-20 years, including BMI. 5. Record smoking status for patients 13 years old or older. 6. Use clinical decision support to improve performance on high-priority health conditions. 7. Provide patients the ability to view online, download and transmit their health information within four business days of the information being available to the EP. 8. Provide clinical summaries for patients for each office visit. 9. Protect electronic health information created or maintained by the Certified EHR Technology through the implementation of appropriate technical capabilities. 10. Incorporate clinical lab-test results into Certified EHR Technology as structured data.
11. Generate lists of patients by specific conditions to use for quality improvement, reduction of disparities, research, or outreach. 12. Use clinically relevant information to identify patients who should receive reminders for preventive/follow-up care and send these patients the reminders, per patient preference. 13. Use clinically relevant information from Certified EHR Technology to identify patient-specific education resources and provide those resources to the patient. 14. The EP who receives a patient from another setting of care or provider of care or believes an encounter is relevant should perform medication reconciliation. 15. The EP who transitions their patient to another setting of care or provider of care or refers their patient to another provider of care should provide a summary care record for each transition of care or referral. 16. Capability to submit electronic data to immunization registries or immunization information systems except where prohibited, and in accordance with applicable law and practice. 17. Use secure electronic messaging to communicate with patients on relevant health information. Eligible Professional Menu Objectives
1. Capability to submit electronic syndromic surveillance data to public health agencies except where prohibited, and in accordance with applicable law and practice. 2. Record electronic notes in patient records.
3. Imaging results consisting of the image itself and any explanation or other accompanying information are accessible through CEHRT. 4. Record patient family health history as structured data. 5. Capability to identify and report cancer cases to a public health central cancer registry, except where prohibited, and in accordance with applicable law and practice. 6. Capability to identify and report specific cases to a specialized registry (other than a cancer registry), except where prohibited, and in accordance with applicable law and practice. In closing, meaningful use is something that is here and now. All providers and hospitals should begin the process of switching to qualified EHR if they have not already done so. They will lose the $5000.00 first year incentive, but they may be eligible for future incentives through CMS. It is not only a good business decision for a provider or hospital, but it is also the way of the future, patients will come to expect electronic medical records and throughout the process it will become easier and safer for both patients and health care providers.
Search Health IT. (2008-2012). Retrieved July 5, 2013, from Tech Target:
http://searchhealthit.techtarget.com/definition/HITECH-Act CMS.gov. (2012, November 9). Retrieved July 7, 2013, from https://www.cms.gov/Regulations-and-Guidance/Legislation/EHRIncentivePrograms/Stage_2.html Electronic Health Record. (n.d.). Retrieved June 26, 2013, from HIMSS: http://www.himss.org/ASP/topics_ehr.asp Health IT.gov. (n.d.). Retrieved June 30, 2013, from Meaningful Use: http://www.healthit.gov/policy-researchers-implementers/meaningful-use HRSA. (n.d.). Retrieved June 27, 2013, from http://www.hrsa.gov/healthit/toolbox/HealthITAdoptiontoolbox/PrivacyandSecurity/compliancereqs.html Murphy, K. (2012, August 27). EHR Intelligenc. Retrieved July 20, 2013, from Reporting periods, attestation in stage 2 meaningful use: http://ehrintelligence.com/2012/08/27/reporting-periods-attestation-in-stage-2-meaningful-use/