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Alice Pavlak Meaningful Use Topic Summary 9-2019

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Stage 1 Meaningful Use Explanation

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The HITECH Act: Electronic Health Records and Meaningful Use

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Meaningful Use Stage 3 Implementation

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A Patient's Journey: Meaningful Use Stage 3 and MIPS

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2019 MIPS Criteria

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1.  What has your experience been with EHRs?  Have you seen quality improvements?  Do they balance out any difficulties you have encountered?

2. Do you feel like your organization has truly attained "meaningful use" of its computer system? Describe how you think your organization is or is not meeting the criteria.

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Current State of Meaningful Use

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In the context of health IT, meaningful use is a term used to define minimum U.S. government standards for electronic health records ( EHR), outlining how clinical patient data should be exchanged between healthcare providers, between providers and insurers and between providers and patients.

Although the meaningful use program in the U.S. was part of a successful effort to usher in EHRs, it was also unpopular with providers, who had to meet a slew of requirements to prove meaningful use. In 2018, the program was overhauled and renamed the Medicare and Medicaid Promoting Interoperability Programs by the Centers for Medicare and Medicaid Services (CMS). The term meaningful use is now largely outdated.

The general intent of meaningful use was to improve the collaboration between clinical and public healthcare, improve patient-centric preventative care and support the continued development of robust, standardized data exchanges.

In an effort led by both CMS and the Office of the National Coordinator for Health IT ( ONC), meaningful use was phased into practice and divided into three stages, spanning from 2011 to 2015. In addition, CMS and ONC created incentive programs to encourage eligible professionals or eligible hospitals to adopt, implement and upgrade to certified EHR technologies (CEHRT) and demonstrate meaningful use in compliance with their criteria.

Meaningful use stages

When they were introduced, the Medicare and Medicaid EHR Incentive Programs were designed to measure the meaningful use of CEHRT in three stages:

Stage 1 focused on promoting the adoption of certified EHR technologies. This initial stage established requirements for the electronic capture of clinical data and giving patients access to electronic copies of their own health information.

Stage 2 expanded upon stage 1 criteria by encouraging the meaningful use of CEHRT. This stage emphasized care coordination and the exchange of patient information. It increased the thresholds of criteria compliance and introduced more clinical decision support, care coordination requirements and patient engagement rules.

Stage 3 focused on using CEHRT to improve health outcomes by implementing protected health information, e-prescribing, clinical decision support, computerized provider order entry, patient provider access, coordinated care through patient engagement, health information exchange, clinical data registry and case reporting.

Breaking down the process into stages made it more feasible to implement and lessened the likelihood of overwhelming providers, although hospitals remained critical of the program.

Requirements

Meaningful use was based on five main objectives, according to the Centers for Disease Control and Prevention. They were:

Improve quality, safety, efficiency, and reduce health disparities.

Increase patient engagement.

Improve care coordination.

Expand population and public health.

Ensure adequate privacy and security protection for personal health information.

With these priorities in mind, CMS and ONC established meaningful use standards that EHRs needed to meet. These standards promoted the use of CEHRT. If CMS determined that a successful demonstration of meaningful use applied, the parties were then considered eligible for federal funds.

Because the meaningful use program was technically voluntary, meaningful use criteria were considered guidelines, not regulations. Still, failure to adhere to meaningful use resulted in reimbursement-related penalties.

History of meaningful use

The Health Information Technology for Economic and Clinical Health ( HITECH) Act of 2009 promoted the adoption of meaningful use. Per the U.S. Department of Health and Human Services, Subtitle D of the HITECH Act addresses the privacy and security concerns associated with the electronic transmission of health information, in part, through several provisions that strengthen the civil and criminal enforcement of the HIPAA rules.

Eligible organizations for the Medicare EHR Incentive Program were required to achieve stage 1 meaningful use by 2014 in order to receive incentive payments. Deadlines were established and at times extended for stages 2 and 3. During this process, CMS established the Medicare and Medicaid EHR Incentive Programs to encourage clinicians, hospitals and clinics to implement meaningful use of CEHRT.

In April 2018, CMS renamed meaningful use from the EHR Incentive Programs to the Promoting Interoperability Programs, with the intent of reflecting a focus on improving interoperability, flexibility and patient access to health information.

In CMS' new rule, the agency noted that beginning with an EHR reporting period in 2019, all eligible hospitals under the Medicare and Medicaid Promoting Interoperability Programs are required to use the 2015 Edition of CEHRT. CMS also finalized changes to measures, including removing certain measures that do not emphasize interoperability and the electronic exchange of health information.

These changes had been heralded for several years. According to ONC, meaningful use shifted into the Merit-Based Incentive Payment System, or MIPS, in part due to the introduction of the Medicare Access and CHIP Reauthorization Act ( MACRA) of 2015. MACRA is one of the four components of MIPS, which combines existing CMS quality programs (including meaningful use), the Physician Quality Reporting System and value-based payment modifiers. The consolidation was intended to improve quality of care.

Continue Reading About Meaningful Use

Margaret Rouse asks:

How has meaningful use affected your organization's adoption of certified EHR technology?

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What is Meaningful Use? - Definition from WhatIs.com

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In the context of health IT, meaningful use is a term used to define minimum U.S. government standards for electronic health records ( EHR), outlining how clinical patient data should be exchanged between healthcare providers, between providers and insurers and between providers and patients. Although the meaningful use program in the U.S.

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Meaningful Use - Its Importance to Nurses

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September 2015 Vol. 10 No. 9

Author(s): Lillee Gelinas, MSN, RN, FAAN

As you're probably aware, meaningful use refers to use of electronic health record (EHR) technology to improve the quality and effectiveness of patient care. The Centers for Medicare & Medicaid Services (CMS) pays eligible hospitals and physician providers if they meet specific objectives in documenting care. Three stages of increasingly complex metrics exist for the information that must be documented.

Some nurses view meaningful use largely as an organization's responsibility and problem. Many see it as a physicians' issue because they are the targeted group responsible for meeting meaningful use requirements. Unfortunately, nurses don't see a role for themselves in the program.

But not so fast: A reputable consultant described meaningful use to me as an attempt to get physicians to document basic healthcare information and practices more consistent-
ly and thoroughly (Medical Records Completion 101, so to speak). But much of the basic documentation is done or guided by nurses. National nursing organizations made a concerted effort to include nursing's role in meaningful use legislation. The effort failed because the federal government feared the changes would dilute the focus on improving physician
behaviors.

Meaningful use appears to be all about documenting that the physician is doing everything necessary to ensure the patient is being treated as a whole person and not just for his or her presenting complaint. In fact, more demands are being placed on nurses to provide more patient care and education, particularly on the inpatient side. In stages 2 and 3 of the meaningful use incentive program, nurses are influencing and doing more of the documentation. Increasingly, nurses are saying that meaningful use is taking meaningful time away from essential patient care and contact. This makes meaningful use a nursing issue.

To ensure best outcomes for patient care, the nurse and physician must do everything appropriately. Unfortunately, a longstanding legal axiom is becoming a reimbursement axiom: If you didn't document it (in the EHR), you didn't do it. Across inpatient and ambulatory settings, nurses spend more time with patients than any other professionals. If we don't find better ways to document that we're applying all the appropriate clinical protocols and best practices, the increasing transparency demanded by CMS could tarnish nursing's reputation.

How can we spend meaningful time with our patients and still achieve meaningful documentation in the EHR? How can we keep nurses from burning out due to the increasing documentation requirements that take nurses' time away from patient contact?
We need support from management and information technology (IT). We need to take the lead in identifying documentation workflow deficiencies in EHR programs. EHR vendors and IT departments need to learn how we gather and document information efficiently so they can improve the tools we're required to use. Nurses live the documentation journey every day. We have the best perspective on how information could flow more efficiently into the EHR.

This isn't a time for nurses to sit on the sidelines. This is a time for us to demand improvements in EHR design-and to lead the effort. Nurses are doing meaningful work. Making EHRs more care-friendly is a meaningful must for nurses and the entire healthcare team.

Lillee Gelinas, MSN, RN, FAAN
Editor-in-Chief
lgelinas@healthcommedia.com

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Meaningful use is a workforce issue - American Nurse Today

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September 2015 Vol. 10 No. 9 Author(s): Lillee Gelinas, MSN, RN, FAAN As you're probably aware, meaningful use refers to use of electronic health record (EHR) technology to improve the quality and effectiveness of patient care. The Centers for Medicare & Medicaid Services (CMS) pays eligible hospitals and physician providers if they meet specific objectives in documenting care.

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The Downside of EHRs?

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EHR State of Mind | An Electronic Medical Records Parody