Write a 1,200-1,500-word essay describing the electronic health records incentive programs, also known as meaningful use. It offers financial incentives and was designed to improve quality, safety, and efficiency of care through the use of electronic health records.
1.Describe the three stages of meaningful use and their measures.
2.Explain the challenges and barriers faced by facilities in implementing each stage of meaningful use.
Include three to five references, including your textbook.
Prepare this assignment according to the guidelines found in the 7th edition APA Style Guide, located in the Student Success Center. An abstract is not required.
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Implementing Meaningful Use (MU)
The Centers for Medicare and Medicaid Services or CMS is the body that came up with the terminology now commonly known as the Meaningful Use (MU). This is a federal program that sought to encourage providers to acquire and use certified electronic health records technology (CEHRT) systems in the care of their patients (AAP, 2021; Sweeney, 2017). In the year 1999, the Institute of Medicine (IOM in the United States published a landmark report after conducting surveys over a period of time. The report was aptly titled To Err Is Human and painted a depressing picture of the state of healthcare in the US. In the report, it was noted that at the time there were 98,000 preventable patient deaths annually caused by medical and medication errors by healthcare professionals. This IOM report recommended that the solution to this problem of pervasive medical errors would be resolved by applying innovative technological solutions in the delivery of healthcare (McGonigle & Mastrian, 2017). But at that time there was no legislative framework to entrench such a policy in practice. This was to be realized ten years later in the year 2009 when President Obama signed into law the American Recovery and Reinvestment Act or ARRA of 2009. This law also contained the Health Information Technology for Economic and Clinical Health Act (HITECH) which carried the Meaningful Use clause (AAP, 2021; Sweeney, 2017). The purpose of the HITECH and its Meaningful Use clause was to speed up the implementation and adoption into practice of health information technology (HIT). Specifically, this objective was to be achieved through the widespread use of federally certified electronic health records (EHRs) that are interoperable (AAP, 2021; Sweeney, 2017). The purpose of this paper is to outline the three stages of this EHR incentive program referred to as the Meaningful Use Program. Implementing Meaningful Use Essay Paper
The Three Stages of the Meaningful Use (MU) Program
According to the CMS, the MU Program was essentially a program that was aimed at promoting interoperability and therefore fostering care coordination. In the United States, healthcare is very expensive compared to the rest of the developed countries (Sultz & Kroth, 2018). This is because healthcare in the US is run as a private enterprise and there is no Universal Health Coverage (UHC). This has led to a situation in which there is rampant care fragmentation adding to the costliness of the healthcare services in the country. It was noted that each provider was operating in isolation and there was no way that they were sharing patient information. When patients moved from one provider to another, there was a new need to get new tests done and a new prescription made just because that provider did not have the patient’s past medical records. This is what the Promoting Interoperability Program (meaningful Use Program) sought to address through incentives anchored in the two acts – ARRA and HITECH. Interoperability means that the EHR systems off providers would be interlinked such that there is seamless interfacing (Reisman, 2017). With this, one provider can easily access information about a patient that is stored in the EHR system of the previous provider through permission. This prevents duplication of prescriptions and repeating of tests which is both costly and dangerous to patient safety.
The MU incentives are financial in nature and the payments are made to eligible providers and hospitals once they meet in their practice the specific standards for using federally certified EHR technology (CEHRT). The three stages of the MU program are as follows:
- The use of CEHRT to capture and share patient data starting in the year 2011
- The use of CEHRT in advancing and promoting clinical processes in practice beginning in the year 2014, and
- The use of CEHRT to improve the health outcomes of populations (AAP, 2021).
By the start of the year 2019, it was envisaged that all providers would have met the requirements of the MU and satisfied all the provisions outlined in the above three stages. As with any project, it was expected that there would be massive challenges in adopting technology in the healthcare system. This is partly due to the costs involved, but also due to the fact that there would be a need for mass training of healthcare professionals in the proper use of the CEHRT systems.
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- Stage I: The use of CEHRT to capture and share patient data
This is the first stage of the MU program and it entailed the acquisition of federally certified EHR systems which would then be installed in the healthcare setting. There would then be need to train the staff in the healthcare organization on how to transition from handwritten records to the more efficient electronic health records. Both of these two measures are resource intensive and hence there would be need for the healthcare organizations to plan ahead and set aside the required resources. It is at this stage that it was expected there would be teething problems but these would be dealt with as time went by. Te most important thing at this first stage was the acquisition of the EHR system from certified vendors and beginning to use it. Implementing Meaningful Use Essay Paper
The capturing of patient data using the CEHRT systems would occur at different stages. The very first would be the demographic data of the patient which would then be followed by physician or clinician notes, tests and investigations ordered, diagnosis made, prescribed medications, nursing care index (cardex), referrals, and other relevant medical notes. To facilitate this, the EHR systems would have different components or facets that interface with each other. These include Computerized Provider Order Entry (CPOE), bar Code Medication Administration (BCMA), Automated Medication Dispensing Cabinets (ADCs), Electronic Medication Administration Records (eMAR), Clinical Decision Support (CDS), Electronic Medical Record (EMR), and Patient Data Management Systems (PDMS) amongst others (Alotaibi & Federico, 2017). The totality of these system subcomponents would make the EHR system which would then be expected to be interoperable with (accessible to) other providers.
Some of the challenges and barriers that were expected in this first stage of the MU Program included the lack of technological competence in the majority of healthcare professionals, the high cost of acquiring the CEHRT systems, and loopholes in the security of patient data and information breaching the HIPAA (Health Insurance Portability and Accountability Act) rules.
- Stage II: The use of CEHRT in advancing and promoting clinical processes in practice
This second stage was premised on the expectation that by thus time, all healthcare institutions and organizations would have acquired the CEHRT systems and installed them. They would also have trained their staff on their use and started using them to capture, store, and manipulate patient data in an interoperable fashion. In this stage, the traditional clinical processes such as obtaining subjective and objective patient data (history taking and physical examination), investigating and testing, prescribing, and treatment (medicating, counseling, therapy, and so on) would be fostered by the CEHRT systems already in use in hospitals. This is the stage that was meant to entrench the use of technology in healthcare through coming up with evidence-based solutions to the barriers and challenges that were noted in the first stage. It was to be the stage of troubleshooting and perfection. By the end of this stage, the providers and healthcare professionals would be competent in the use of the electronic systems in advancing the efficacy and effectiveness of the various clinical processes as indicated above. Challenges and barriers in this stage included the need for a new specialty for a niche of healthcare professionals to manage and handle the technological aspect of healthcare. This was met by the introduction of the Nursing Informatics course in US universities. The other barriers were system breakdowns and unreliable Internet connectivity amongst others.
- Stage III: The use of CEHRT to improve the health outcomes of populations
The first of the 4 objectives of the Quadruple Aims by the Institute or Healthcare Improvement or IHI is the improvement of the health of populations (Sikka et al., 2015). This is the third and last stage of the MU Program and it is the consolidation phase. At this stage, the use of EHR systems in healthcare organizations is a normal and routine process. Challenges are expected to have been addressed and interoperability is expected to be in operation. The systems should now be working to foster care coordination amongst providers and to prevent care fragmentation. In all, patient outcomes are expected to be greatly improved through the use of EHR systems. The main challenge and barrier in this stage will be the rapid advancements in technology that necessitate the frequent upgrading of systems after every few years (Cohen & Adler-Milstein, 2016). This involves substantial financial expenditure.
The use of technology in healthcare has been one of the most meaningful changes to occur in the delivery of healthcare services. It was inspired by the IOM report in 1999 that stated that preventable medical errors were causing significant patient deaths and disability. Through the ARRA and HITECH Acts, the Meaningful Use program has been able to entrench the use of CEHRT systems in all healthcare settings and organizations.
Alotaibi, Y., & Federico, F. (2017). The impact of health information technology on patient safety. Saudi Medical Journal, 38(12), 1173–1180. https://doi.org/10.15537/smj.2017.12.20631
American Academy of Pediatrics [AAP] (2021). Meaningful use overview. https://www.aap.org/en-us/advocacy-and-policy/aap-health-initiatives/Informatics/Pages/Meaningful-Use-Overview.aspx
Cohen, G.R., & Adler-Milstein, J. (2016). Meaningful use care coordination criteria: Perceived barriers and benefits among primary care providers. Journal of the American Medical Informatics Association, 23(e1), e146–e151. https://doi.org/10.1093/jamia/ocv147
McGonigle, D., & Mastrian, K.G. (2017). Nursing informatics and the foundation of knowledge, 4th ed. Jones & Bartlett Learning.
Palatnik, A. (2016). To err is human. Nursing Critical Care, 11(5), 4. https://doi.org/10.1097/01.CCN.0000490961.44977.8d
Reisman, M. (2017). EHRs: The challenge of making electronic data usable and interoperable. Pharmacy and Therapeutics (P&T), 42(9), 572-575. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5565131/
Sikka, R., Morath, J.M., & Leape, L. (2015). The Quadruple Aim: Care, health, cost and meaning in work. BMJ Quality & Safety, 24(10), 608-610. http://dx.doi.org/10.1136/bmjqs-2015-004160
Sultz, H.A., & Kroth, P.J. (2018). Sultz and Young’s health care USA: Understanding its organization and delivery, 9th ed. Jones & Bartlett Learning.
Sweeney, J. (2017). Healthcare informatics. Online Journal of Nursing Informatics (OJNI), 21(1). https://www.himss.org/library/healthcare-informatics Implementing Meaningful Use Essay Paper