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In this example, MU has met the 5 "why it matters" objectives which have contributed to Tyler's positive health outcomes.
1. Tyler's efficient portal application has safely alerted him to schedule an annual check-up and flu shot, which engaged Tyler to make a decision to schedule an appointment.
2.  The physician has access to Tyler's standardized health information and sees that his information is updated and can proceed with his appointment. The physician notices that Tyler has an abnormal heart rhythm and he promptly orders a referral for Tyler to see a cardiologist. The cardiologist reviews Tyler's information from his physician and diagnoses Tyler with a-fib. The cardiologist schedules Tyler for an implementation of a pacemaker. After the procedure, Tyler is prescribed an antibiotic, however the EHR alerts the staff that Tyler has a severe allergy. Tyler's care is safely communicated and coordinated amongst the providers.
3. The physician administers Tyler's flu shot and uploads this information into Tyler's EHR. This information is immediately entered into a state immunization registry, which contributes to protecting population and public health.
4. Tyler receives home health where he updates and keeps in contact with his physician and cardiologist via secure messaging on his EHR portal.
(Cerner Corporation, 2017)

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I believe that MU will continue to act as the original foundation and framework to modernizing and improving quality healthcare for patient and provider use and exchange. Though MU has made its exit, it has started a movement. The recent controversies of MU including poor reimbursement, lost productivity, frustration, and penalties has created a shift toward value rather than volume (Bendix, 2016). Medicare Access and CHIP Reauthorization Act (MACRA) offers customization features tailored to how you want to participate, supports interoperability, and and a quality payment program (Health IT, 2018).

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Certified EHR Technology (CHERT): to be meet the criteria for MU and its incentives, the professional or hospital must use a certified EHR (CMS, 2018a). A certified EHR meets a specific structure and standards outlines by CMS and ONC.

Hospitals and professionals must be considered eligible for medicare and medicaid MU incentive programs (CMS, 2018b. Visit the link below to view your hospital or professional eligibility:

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CMS is renaming the EHR Incentive Programs to the Promoting Interoperability (PI) Programs to continue the agency's focus on improving patients' access to health information and reducing the time and cost required of providers to comply with the programs' requirements. CMS is also in the process of finalizing updates to the programs through rulemaking. For more information, visit the landing page where CMS will publish updates and additional resources as soon as they are available.

CMS is continuing efforts to reduce burden by easing reporting requirements and streamlining data submission methods for eligible hospitals and CAHs attesting to CMS for the PI Programs (formerly named the EHR Incentive Programs).

For the 2018 reporting period:

Medicare eligible hospitals and CAHs will use the QNet system to submit meaningful use attestations.

The Registration and Attestation System will continue to be available for Medicaid-only hospitals and CAHs. These hospitals should contact their state Medicaid agencies for specific information on how to attest.

Eligible hospitals and CAHs attesting to CMS for both the Medicare and Medicaid PI Programs as dually eligible hospitals or CAHs will register and attest for the Medicare program in the QNet system.

Dually eligible hospitals new to the PI Programs must register in the Registration and Attestation system and register in QNet.

The goal of this change is to make it more simple for facilities to report data to CMS. Instead of reporting CQMs and meaningful use attestations in two separate systems, eligible hospitals and CAHs will be able to report this information through one portal.

Hospitals will not need to do anything differently to prepare for this transition. Instead, they can continue to collect data the way they normally would.

For information on QNet account registration, please review the QNet User Guide. The User Guide includes step-by-step instructions for creating an account on QNet.
Medicare Eligible Hospitals and CAHs
The following hospitals are eligible to participate in the Medicare PI Program:

"Subsection (d) hospitals" in the 50 states or DC that are paid under the Inpatient Prospective Payment System (IPPS)

CAHs

Medicare Advantage (MA-Affiliated) Hospitals

Medicaid Eligible Hospitals and CAHs
The following hospitals are eligible to participate in the Medicaid PI Program:

Acute care hospitals (including CAHs and cancer hospitals) with at least a 10 percent Medicaid patient volume

Children's hospitals (no Medicaid patient volume requirements)

Dually Eligible Hospitals and CAHs
Eligible hospitals and CAHs that are eligible to participate in both the Medicare and Medicaid PI Programs as dually eligible hospitals and CAHs:

May be subject to the Medicare payment reduction for failing to demonstrate meaningful use.

May be eligible to earn a Medicaid incentive payment for demonstrating meaningful use successfully.

Dually eligible hospitals that successfully attest to CMS will avoid a Medicare payment adjustment and satisfy the Medicaid PI Program requirements.

Medicare and Medicaid Eligible Hospital and CAHs PI Program

In meeting the PI Programs' requirements for 2015 through 2017 (Modified Stage 2) and Stage 3, eligible hospitals and CAHs will focus on advanced use of certified EHR technology (CEHRT) to support health information exchange and interoperability, advanced quality measurement, and maximizing clinical effectiveness and efficiencies.
Objectives and Measures

All eligible hospitals and CAHs are required to report to a single set of:

Hospitals have the option of reporting to Stage 3 in 2017. In 2018, all new and returning participants attesting to CMS or their State Medicaid agency have the option to attest to the Modified Stage 2 objectives and measures.

Clinical Quality Measures
Eligible hospitals and CAHs must report to 16 clinical quality measures (CQMs). Visit the eCQM Library page for more information.
Reporting Period
The PI reporting period is a minimum of any continuous 90 days between January 1 and December 31, 2018.
Payment Information

The last year for Medicare eligible hospitals and CAHs to earn an incentive payment was 2016, except hospitals in Puerto Rico.

Medicaid incentive payments continue through 2021.

Eligible hospitals and CAHs that do not successfully demonstrate meaningful use of CEHRT are subject to Medicare payment adjustments.

There are no payment adjustments under the Medicaid PI Program.

Resources
EHR Hospital Presentations

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CMS is continuing efforts to reduce burden by easing reporting requirements and streamlining data submission methods for eligible hospitals and CAHs attesting to CMS for the PI Programs (formerly named the EHR Incentive Programs). For the 2018 reporting period: Medicare eligible hospitals and CAHs will use the QNet system to submit meaningful use attestations.

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Watch the video to meet Tyler and learn how MU has contributed to his health outcomes....

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

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Interoperability supports professionals' and hospitals' abilities to achieve MU specific objectives by removing the barriers of care (Office of the National Coordinator for Health IT, 2013). Removing the barriers builds a clear path for care coordination and communication. To remove the barriers, interoperability ensures:

Patient information is available when and where they need it

Health information is standardized so that it can be understood and shared across various settings and people

Health information is archived, accessible, and secure

(Office of the National Coordinator for Health IT, 2013)

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Office of the National Coordinator for Health IT

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Interoperability involves health information technology that ensures communication of standardized health information, health information accessibility, and safe and secure information exchange across various settings and people (Office of the National Coordinator for Health IT, 2013).

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Protect patient health information

Electronic prescribing

Standardizing health information

Computerized provider order entry

Pateint elctronic access

Coordination of care through patient engagement

Health information exchange

Public health & clinical data registry reporting

(Waldren, & Solis, 2016, p. 19)

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In order to achieve MU, professionals and hospitals are required to adapt, implement, & prove specific objectives defined across 3 different stages (CDC, 2017). These stages are flexible and continue to evolve. CMS provides a resource [below] to determine where professionals and hospitals are on the MU implementation timeline.

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CMSGOV Home >Regulations and Guidance >EHR Incentive Programs > My EHR Participation Timeline

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On February 17, 2009, The American Reinvestment & Recovery Act (ARRA) proposed a plan to “modernize our nation’s infrastructure” (CDC, 2017, para. 1). The ARRA introduced the Health Information Technology for Economic and Clinical Health (HITECH) Act which inspired the partnership of ARRA, CMS, and ONC (CDC, 2017). As a result of the partnership, “HITECH proposes the meaningful use of interoperable electronic health records throughout the United States health care delivery system as a critical national goal" (CDC, 2017, para. 1).

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1. Improves quality, safety, efficiency, & reduces health disparities
2. Engages patients & families in their health.
3. Improves care coordination
4. Improves population & public health
5. Ensures adequate privacy & security
(CDC, 2017, para. 2)

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In order to attract eligible healthcare industries to adopt, implement, and practice meaningful use and relieve the expenses, CMS introduced Medicare & Medicaid EHR Incentive Programs (CDC, 2017).

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Meaningful Use (MU) is an incentive program utilizing certified electronic health records (EHRs) to improve the quality, safety, and effectiveness of health care (Blumenthal, 2011). MU includes 3 stages that define specific objectives and goals and support the deployment and beneficial use of the program (CDC, 2017).

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Centers for Medicare & Medicaid Services (CMS)

National Coordinator for Health IT (ONC)