ELECTRONIC HEALTH RECORD: "MEANINGFUL USE" NOTES

What is the meaning of "Meaningful Use" for EHR?

By Calvin Lee, MD General Surgeon
written 7/2/12

Yep, that's me.

I've been struggling a bit to understand the topic of "meaningful use". It's going to be important to my colleagues, but perhaps not as important to me as I am primarily a cash based practice. I'm putting together my notes online so I can refer to them later and perhaps others might find this useful. Below is my notes on this topic. This has become a big topic in healthcare. I've always been interested in computers in healthcare; thus my interest in this subject. Surgical Artistry (my medical group practice) adopted the use of Electronic Health Record (or Electronic Medical Record) in 2006. We have watched the software evolve and change to meet the requirements of what's believed to be Meaningful Use.

In 2009 Congress passed legislation as part of the American Recovery and Reinvestment Act authorizing the spending of billions of dollars (greater than 20 billion?) of incentive payments to clinicians and hospitals over a 10 year period. The payments are to help with adoption of approved Electronic Health Records (EHR). "Meaningful use" is a term used regarding meeting the requirements for the EHR incentive program. The payments are tied to Medicare and Medicaid health insurances and practitioners and hospitals need to demonstrate meaningful use every year that they participate in the program.

This legislation is known as the HITECH act. HITECH = Health Information Technology for Economic and Clinical Health Act. It states that beginning in 2011, healthcare providers and hospitals will be offered financial incentives for demonstrating meaningful use of electronic health records. The incentives will be offered until 2015. Providers stand to receive between $43,000 and $64,000 in their participation with Medicare and Medicaid (much much more for hospitals). After that time, penalties may be applied for failing to demonstrate such use. The act also establishes grants for training centers.

Surgical Artistry (my practice) at this time has decided not to participate in the HITECH act. We are mainly a private pay practice and the incentives are related to medicare and medicaid health insurances.

This can be complicated. I can see how entire careers can be built on this at this time. I wrote the below outline to clarify things for myself. Perhaps it will be of some use if you are just starting to looking into meaningful use (MU).

Overview of Meaningful Use

Providers/hospitals must use certified EHR programs.
Providers/hospitals must use their EHR to show measures of quality and quantity
American Recovery and Reinvestment Act of 2009 has 3 components of Meaningful Use:
- Use of EHR in a meaningful manner - such as ePrescribing
- Use EHR to exchange health information
- Use EHR to submit clinical quality and other measures

Providers and hospitals have different but similar requirements.

Core Set of Objectives Includes

CPOE = computerized provider order entry. For medications
Drug allergy and drug interaction checks
Maintain up to date problem list
Maintain active medication list
Maintain active allergy list
Record demographics including preferred language, and date/cause of death
Record and chart changes in vital signs (blood pressure, height, body mass index)
Record smoking status
Report hospital clinical quality measures to CMS (Centers for Medicare/Medicaid Services)
- Documentation of clinical quality measures
- Currently as of 7/2/12, there are no measures on infection types and rates.
- For hospitals, there are measures for ED (emergency department) admissions, ischemic stroke, and venous thromboembolism.
- For providers, there are measures for screening, obesity, back pain. More items are being added to the list.
Provide patients with an electronic copy of their health information upon request
Provide patient with an electronic copy of their discharge instructions at time of discharge upon request
Protect patient confidentiality

Objectives that need to be met

Hospitals need to meet a core set of 14 objectives (mainly listed above) along with 5 objectives from a menu set of 10 objectives (called Menu Set Objectives). Practitioners must meet a core set of 15 objectives along with the 5 out of 10 menu objectives.

Menu Set Objectives (pick 5)

Implement drug formulary checks
Record advance directives for patients 65 and older
Have lab data in EHR
Make patient lists by conditions - for data mining
Use the computer to find educational resources
Receiving hospital/clinician to perform medication reconciliation
Transferring hospital to provide summary
Submit immunization data electronically to immunization registries
Submit lab data to public health agencies
Submit syndromic surveillance data to public health agencies

The hopes of Meaningful Use of Electronic Health Record (EHR)

Increased efficiency
Improved communications between hospitals and clinicians
Error reduction
Improved quality of patient care
Computer to help with decision making
Computer to help with work flow

External Links for up to date information on Meaningful Use

American College of Rheumatology Health Information Technology - info regarding e-prescribing, HIT Webinar Library, "Meaningful Use"

Disclaimer: These are my notes and interpretation of what I've heard around me.

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This Surgical Artistry webpage is for information only, not medical advice.
www.surgerytoday.com homemade website by Calvin Lee, MD and Tzuying Tammy Wu, MD, Modesto, CA
Date of edit: 07/04/2012