Meaningful Use In Health Care
Introduction
Technology has limitless potential in this day and age and utilizing it to increase patient safety has become a priority in the United States. The passage of ARRA was a way to encourage health care providers to utilize electronic health records in a meaningful way. This paper will analyze the impact of meaningful use on nurses, nursing, national policy, patient outcomes and population health followed by recommendations for additional criteria that could be added for the improvement of Meaningful Use.
Overview of Meaningful Use
According to an Institute of Medicine (IOM) report as many as 98,000 people die each year from medical errors (IOM, 1999). Meaningful use of EHRs was implemented with the goal of decreasing this number. …show more content…
In 2004, President George Bush began the push for every American to have an electronic health record by 2014. To this end, an idea that began during the Bush administration reached culmination on February 17, 2009 when the American Recovery and Reinvestment Act (ARRA) was signed into law by the President of the United States. ARRA included a measure called the Health Information Technology for Economic and Clinical Health (HITECH) Act. As one of its components Meaningful Use (MU) is intended to improve not only patient care, but the delivery of that care through the use of technology. According to Swanson, Cowan, and Blake (2011), “MU is most easily defined as the successful demonstration of implementing, adopting, and meaningfully using electronic health record technology of by providers of medical care” (p.10).
The main ideas behind MU are a reduction in health disparities by improving quality, safety and efficiency; engagement of patients and families in their health; an improvement in coordination of care, population health, and public health; provision of privacy and security protection for personal health information (“HealthIT.gov,” n.d.). Financial payments are made available from Centers for Medicare & Medicaid Services (CMS) to providers and facilities that are able to demonstrate the use of the electronic health record in a meaningful way. MU was to be implemented in a phased approach so as to not overwhelm providers. The three stages were originally to be put into place between the years 2011-2015 with Stage I to include data capture and sharing; Stage II included advancement of clinical processes; while Stage III is concerned with improving outcomes by simplification of MU requirements and reducing provider burden.
The following competencies must be met to achieve MU: clinical data collection, clinical decision support, computerized provider order entry (CPOE), health information exchange (HIE), privacy and security, healthcare quality, organizational and project management, standards and interoperability. Clinical data collection includes items such as vital signs, medications and problems list. Clinical decision support provides for drug-drug interaction checks and medical reconciliation. Computerized provider order entry allows patient orders to be input electronically thereby reducing the chance of error related to illegible handwriting.
Health information exchange allows patient information to be exchanged by various hospitals and within an organization itself to facilitate continuity of care.
Providers must show that they have taken certain measures to protect the privacy and security of patient’s health information and that they have improved the quality of health care they deliver. Organizational and project management is needed to adequately implement MU in a health care organization. Standards and interoperability include HL-7, SNOMED and ICD-10 codes; this includes technical standards and specifications that must be in place for the organization to achieve successful …show more content…
attestation.
Implications of Meaningful Use for Nurses and Nursing
Implications for nursing include working closely with IT and championing EHR usage to ensure system optimization and while nurses view the implementation of EHR and MU as beneficial because it provides a mechanism for safer patient care they also find it frustrating as well.
Implementation of an EHR and demonstration of meaningful use should not make a nurse's job more difficult. According to Mihalko (2012), “a well-designed EHR should support the nurse by streamlining processes and workflows, assisting with intelligent decision support at the point of care, standardizing documentation, and making data entry and data retrieval faster and more accurate” (p.2). The focus should include medication administration safety, transparency of the nursing process, diagnosis prioritization, and electronic workflow development should standardize and improve communication. By using their voice nurses must begin to expect solutions that improve electronic documentation, communication, patient safety and care (Lavin, Harper, & Barr, 2015).
Implications for National Health Policy
National health policies play an important role in a countries effort to improve and maintain the health of its citizens. In the United States MU is a tool that works to engage patients and families in their health while improving safety, efficiency, and reducing health disparities. Other goals include improved care coordination, population and public health and lastly ensuring privacy and security protection
for personal health information. Implications of Meaningful Use on Patient Outcomes Currently studies that show the effects of MU on health care utilization are few in number. Those that have been published have shown a positive association between the two. In a study by Jones, Rudin, Perry, and Shekelle (2014), CPOE automated dose calculation decreased medication dosage errors from 37% to 80% and the addition of the patient’s picture on the order verification screen eliminated 100% of incorrect patient orders. MU has also been associated with more efficient care including fewer primary care visits and lab tests.
Implications of Meaningful Use on Population Health
Population health is defined as the “health outcomes of a group of individuals, including the distribution of such outcomes within the group” (Kindig & Stoddart, 2003 pp. 381). Some of the positive effects of requiring health care providers to show meaningful use of EHRs include increased communication between public health officials and providers; improved data gathering capabilities allowing an improvement in public health reporting for items such as immunizations, the ability to track patterns that may emerge allows officials to act quickly to stop threats to the public’s health, MU creates an opportunity for organizations to provide better care for their patients, for example, when allergies are put in the system any medication that is ordered is automatically cross-checked for any adverse reactions thereby preventing patient harm (Friedman, Parrish & Ross, 2013).
Recommendations
Socioeconomic status (SES) cannot be overlooked when treating patients therefore the provider must be aware of any barriers that may potentially derail a patient’s treatment plan. Many studies have indicated that income and economic status are among some of the strongest predictors of health. Patients with lower socioeconomic status are less likely to seek preventive medical care, have a higher incidence of chronic diseases and a lower life expectancy rate than those that enjoy a higher socioeconomic status. Adding SES indicators to data that is collected will help decrease the health disparities that MU is working to eliminate. Inclusion of an income question can be set up to trigger further dialogue between provider and patient on financial risk factors while revealing any barriers to care that need to be overcome to provide best patient outcomes (Chen, Weider, Konopka & Danis, 2014).
Summary I have personal experience of working with MU as an informatics nurse and while I do understand what the government is trying to accomplish with it I also believe it leaves much to be desired. Many of the competencies were vague requiring us to attend meeting after meeting in an attempt to try and understand what was needed to be able to attest. I am not sure the average person realizes that there are so many other costs involved in MU implementation besides just the purchase of the EHR product itself. I have heard of private practices willing to pay the penalty because it would be cheaper than trying to purchase an EHR product and then implement MU on top of that.
As I left my position before we began Stage 3 implementation I was interested to read that many of the complaints that providers had about the first two stages were not only heard but being acted upon by the government. In Stage III, which is optional in 2017, the government seems to be allowing providers to slow down and regroup before requiring them to move on the next stage which I think is an excellent idea.
Technology has limitless potential in this day and age and utilizing it to increase patient safety has become a priority in the United States. The passage of ARRA was a way to encourage health care providers to utilize electronic health records in a meaningful way. This paper will analyze the impact of meaningful use on nurses, nursing, national policy, patient outcomes and population health followed by recommendations for additional criteria that could be added for the improvement of Meaningful Use.
Overview of Meaningful Use
According to an Institute of Medicine (IOM) report as many as 98,000 people die each year from medical errors (IOM, 1999). Meaningful use of EHRs was implemented with the goal of decreasing this number. …show more content…
In 2004, President George Bush began the push for every American to have an electronic health record by 2014. To this end, an idea that began during the Bush administration reached culmination on February 17, 2009 when the American Recovery and Reinvestment Act (ARRA) was signed into law by the President of the United States. ARRA included a measure called the Health Information Technology for Economic and Clinical Health (HITECH) Act. As one of its components Meaningful Use (MU) is intended to improve not only patient care, but the delivery of that care through the use of technology. According to Swanson, Cowan, and Blake (2011), “MU is most easily defined as the successful demonstration of implementing, adopting, and meaningfully using electronic health record technology of by providers of medical care” (p.10).
The main ideas behind MU are a reduction in health disparities by improving quality, safety and efficiency; engagement of patients and families in their health; an improvement in coordination of care, population health, and public health; provision of privacy and security protection for personal health information (“HealthIT.gov,” n.d.). Financial payments are made available from Centers for Medicare & Medicaid Services (CMS) to providers and facilities that are able to demonstrate the use of the electronic health record in a meaningful way. MU was to be implemented in a phased approach so as to not overwhelm providers. The three stages were originally to be put into place between the years 2011-2015 with Stage I to include data capture and sharing; Stage II included advancement of clinical processes; while Stage III is concerned with improving outcomes by simplification of MU requirements and reducing provider burden.
The following competencies must be met to achieve MU: clinical data collection, clinical decision support, computerized provider order entry (CPOE), health information exchange (HIE), privacy and security, healthcare quality, organizational and project management, standards and interoperability. Clinical data collection includes items such as vital signs, medications and problems list. Clinical decision support provides for drug-drug interaction checks and medical reconciliation. Computerized provider order entry allows patient orders to be input electronically thereby reducing the chance of error related to illegible handwriting.
Health information exchange allows patient information to be exchanged by various hospitals and within an organization itself to facilitate continuity of care.
Providers must show that they have taken certain measures to protect the privacy and security of patient’s health information and that they have improved the quality of health care they deliver. Organizational and project management is needed to adequately implement MU in a health care organization. Standards and interoperability include HL-7, SNOMED and ICD-10 codes; this includes technical standards and specifications that must be in place for the organization to achieve successful …show more content…
attestation.
Implications of Meaningful Use for Nurses and Nursing
Implications for nursing include working closely with IT and championing EHR usage to ensure system optimization and while nurses view the implementation of EHR and MU as beneficial because it provides a mechanism for safer patient care they also find it frustrating as well.
Implementation of an EHR and demonstration of meaningful use should not make a nurse's job more difficult. According to Mihalko (2012), “a well-designed EHR should support the nurse by streamlining processes and workflows, assisting with intelligent decision support at the point of care, standardizing documentation, and making data entry and data retrieval faster and more accurate” (p.2). The focus should include medication administration safety, transparency of the nursing process, diagnosis prioritization, and electronic workflow development should standardize and improve communication. By using their voice nurses must begin to expect solutions that improve electronic documentation, communication, patient safety and care (Lavin, Harper, & Barr, 2015).
Implications for National Health Policy
National health policies play an important role in a countries effort to improve and maintain the health of its citizens. In the United States MU is a tool that works to engage patients and families in their health while improving safety, efficiency, and reducing health disparities. Other goals include improved care coordination, population and public health and lastly ensuring privacy and security protection
for personal health information. Implications of Meaningful Use on Patient Outcomes Currently studies that show the effects of MU on health care utilization are few in number. Those that have been published have shown a positive association between the two. In a study by Jones, Rudin, Perry, and Shekelle (2014), CPOE automated dose calculation decreased medication dosage errors from 37% to 80% and the addition of the patient’s picture on the order verification screen eliminated 100% of incorrect patient orders. MU has also been associated with more efficient care including fewer primary care visits and lab tests.
Implications of Meaningful Use on Population Health
Population health is defined as the “health outcomes of a group of individuals, including the distribution of such outcomes within the group” (Kindig & Stoddart, 2003 pp. 381). Some of the positive effects of requiring health care providers to show meaningful use of EHRs include increased communication between public health officials and providers; improved data gathering capabilities allowing an improvement in public health reporting for items such as immunizations, the ability to track patterns that may emerge allows officials to act quickly to stop threats to the public’s health, MU creates an opportunity for organizations to provide better care for their patients, for example, when allergies are put in the system any medication that is ordered is automatically cross-checked for any adverse reactions thereby preventing patient harm (Friedman, Parrish & Ross, 2013).
Recommendations
Socioeconomic status (SES) cannot be overlooked when treating patients therefore the provider must be aware of any barriers that may potentially derail a patient’s treatment plan. Many studies have indicated that income and economic status are among some of the strongest predictors of health. Patients with lower socioeconomic status are less likely to seek preventive medical care, have a higher incidence of chronic diseases and a lower life expectancy rate than those that enjoy a higher socioeconomic status. Adding SES indicators to data that is collected will help decrease the health disparities that MU is working to eliminate. Inclusion of an income question can be set up to trigger further dialogue between provider and patient on financial risk factors while revealing any barriers to care that need to be overcome to provide best patient outcomes (Chen, Weider, Konopka & Danis, 2014).
Summary I have personal experience of working with MU as an informatics nurse and while I do understand what the government is trying to accomplish with it I also believe it leaves much to be desired. Many of the competencies were vague requiring us to attend meeting after meeting in an attempt to try and understand what was needed to be able to attest. I am not sure the average person realizes that there are so many other costs involved in MU implementation besides just the purchase of the EHR product itself. I have heard of private practices willing to pay the penalty because it would be cheaper than trying to purchase an EHR product and then implement MU on top of that.
As I left my position before we began Stage 3 implementation I was interested to read that many of the complaints that providers had about the first two stages were not only heard but being acted upon by the government. In Stage III, which is optional in 2017, the government seems to be allowing providers to slow down and regroup before requiring them to move on the next stage which I think is an excellent idea.