What Does “Meaningful Use” of EHR Mean?

In order to get incentive payments from the federal government under recent legislation, nurse practitioners (NPs) and other clinicians must make “meaningful use” of Electronic Health Records (EHR). There has been much headscratching over the meaning of meaningful use.

For those NPs who are not yet familiar with these terms, here is the background information. On February 17, 2009, President Obama signed the Health Information Technology for Economic and Clinical Health (HITECH) Act, as part of the American Recovery and Reinvestment Act (ARRA). Under HITECH, the government will financially reward physicians who purchase and make meaningful use of electronic medical records (EMRs).  Medicare may pay $44,000 in incentives to physicians, a term that includes doctors of medicine or osteopathy, doctors of dental medicine or surgery, doctors of podiatric medicine, doctors of optometry, and chiropractors. The incentive payments are scheduled to begin in 2011 and will gradually decrease over several years. Starting in 2015, providers are expected to have adopted and be actively utilizing a certified EHR in compliance with the meaningful use requirements.

NPs and other advanced-practice nurses were not included in the HITECH legislation. However, Medicaid will pay incentives to physicians, dentists, certified nurse-midwives, NPs, and physician assistants who are practicing in Federally Qualified Health Centers (FQHCs) or Rural Health Clinics (RHCs) led by a physician assistant.

Defining Meaningful Use
Meaningful use has now been defined. In a Proposed Rule (CMS-0033-P) dated January 13, 2010, the Centers for Medicare & Medicaid Services (CMS) published the criteria that can be used to justify that an eligible professional (EP) or hospital is making meaningful use of EHRs. CMS says that EPs or hospitals shall be considered a meaningful EHR user for a reporting period if they meet three requirements: (1) they demonstrate the use of certified EHR technology in a meaningful manner;  (2) they demonstrate to the satisfaction of the Secretary of Health and Human Services (HHS) that certified EHR technology is connected in a manner that provides for the electronic exchange of health information to improve the quality of healthcare (eg, promoting care coordination),  and (3) using their certified HER technology, they submit information on clinical quality measures to HHS and in a form and manner specified by HHS. HHS expects providers to adopt meaningful use in several stages.

Qualifying as a Meaningful User—Stage 1
Stage 1 of meaningful use focuses on electronically capturing health information in a coded format, using that information for care-coordination purposes, implementing clinical-decision support tools to facilitate the management of disease and medication, and reporting clinical quality measures and public health information. To qualify as a stage 1 meaningful user, an EP must meet certain objectives, which are based on five stated priorities and their subsequent goals.

PRIORITY 1: Improve quality, safety, and efficiency and reduce health disparities. 
Goals

Provide access to comprehensive patient health data for a patient’s healthcare team. 

Use evidence-based order sets and computerized provider order entry (CPOE).

Apply clinical decision support at the point of care.

Generate lists of patients who need care, and use the lists to reach out to those patients.

Report information for quality improvement and dissemination to the public.

Objectives

Use CPOE.

Implement drug-drug, drug-allergy, and drug-formulary checks.

Maintain an up-to-date problem list of active diagnoses based on ICD-9-CM or SNOMED CT®.

Electronically generate and transmit permissible prescriptions (eRx).

Maintain an active medication list.

Maintain an active medication-allergy list. 

Record the following demographics: preferred language, insurance type, gender, race, ethnicity, and date of birth.

Record and chart changes in height, weight, and blood pressure; calculate and display body mass index (BMI) for ages 2 and over; and plot and display growth charts, including BMI, for children and young adults 2–20 years of age.

Record smoking status for patients 13 years old or older.

Incorporate results of clinical lab tests into EHR as structured data (ie, data that have specified data type and response categories within an electronic record or file).

Generate lists of patients by specific conditions for use in quality improvement, reduction of disparities, research, and outreach.

Report ambulatory quality measures to CMS (or, for EPs seeking the Medicaid incentive payment, to the States).

Send reminders to patients for preventive/follow-up care, using each patient’s preferred method of notification.

Implement five clinical-decision support rules relevant to the specialty, including for ordering diagnostic tests, along with the ability to track compliance with those rules.

Check insurance eligibility from public and private payers electronically.

Submit claims electronically to public and private payers.

PRIORITY 2: Engage patients and their families in their health care.
Goal

Provide patients and families with timely access to data, knowledge, and tools so that they can make informed decisions and manage their health.
 

Objectives

Provide patients with an electronic copy of their health information (including diagnostic test results, the problem list, medication lists, and allergies) upon request.

Provide patients with timely electronic access to their health information (including lab results, the problem list, medication lists, and allergies) within 96 hours of the information being available to the EP.

Provide clinical summaries for patients for each office visit.

PRIORITY 3: Improve care coordination.
Goal

Exchange meaningful clinical information among members of the healthcare team.

Objectives

Develop the capability to electronically exchange key clinical information (eg, the  problem list, the medication list, allergies, and diagnostic test results) among providers of care and patient authorized entities.

Perform medication reconciliation at relevant encounters and with each transition of care.

Provide a summary care record for each transition of care or referral.

PRIORITY 4: Improve population and public health.
Goal

The patient’s health care team communicates with public health agencies.

Objectives

Develop the capability to submit electronic data to immunization registries and perform actual submission where possible and accepted.

Develop the capability to provide electronic syndromic surveillance data to public health agencies and perform actual transmission according to applicable law and practice.

PRIORITY 5: Ensure adequate privacy and security protections for personal health information.
Goals

Ensure privacy and security protections for confidential information through operating policies, procedures, and technologies and compliance with applicable law.

Provide transparency of data sharing to patients.

Objective

Protect electronic health information created or maintained by certified HER technology through the implementation of appropriate technical capabilities.

There is a measure for each of the objectives listed. These measures will be discussed in a future column. For access to the entire Proposed Rule, visit http://edocket.access.gpo.gov/2010/E9-31217.htm