The transition to electronic health records (EHRs) has been a major focus of health care reform over the past several years. To drive the switch, the 2009 stimulus package’s Health Information Technology for Economic and Clinical Health Act (HITECH) created an incentive program to reward meaningful use of EHRs through Medicaid and Medicare funding. The requirements of the program have come to be known as meaningful use.

Medicare offers up to $43,720 over five years for each “eligible professional” (doctor, nurse practitioner, chiropractor…) who started the program in 2011, with incrementally smaller totals for those starting in later years. Medicaid offers up to $63,750 over six years for adopting a certified EHR and demonstrating meaningful use. However, doctors who do not meet the criteria by 2015 will face a penalty of 1% of Medicare payments, increasing by an additional 1% each year, up to 5%.

The rules and requirements for hospitals vary only slightly from those for independent professionals, so we’ll stick with the rules for professionals.

The Goals of Meaningful Use

Administrators of the program defined meaningful use as  “use by providers to achieve significant improvements in care.” The objectives of meaningful use are divided into the following domains:

  1. Improve Quality, Safety, Efficiency

  2. Engage Patients & Families

  3. Improve Care Coordination

  4. Improve Public & Population Health

  5. Ensure Privacy & Security for Personal Health Information

The program includes three stages over a five year period, with each stage requiring increasing meaningful use. The requirements for stages one and two have changed over the course of the program’s implementation, in response to the unexpected difficulty medical providers have found in meeting the requirements.

Stage 1

Stage 1 includes specific core objectives and menu objectives under each of the above domains. All 13 of the core objectives must be met (as an example of the difference between the requirements for professionals and hospitals, hospitals have only 11 core objectives). These include issuing prescriptions electronically, checking drug interactions, recording medication allergies, providing patients with clinical summaries after each visit, and ensuring privacy and security.

In addition, professionals must meet five other objectives from a menu of nine options. The menu objectives include creating electronic patient reminders, submitting data to public immunization registries, and making records available to patients electronically.

Stage 2

Stage 2 builds on Stage 1, upping the list of core objectives to 17. Several menu items from Stage 1 are transferred into the core requirements, including immunization registry submission and structured incorporation of lab results into EHRs.

An additional 3 items from a menu of 6 are also required. New menu items are added including making imaging results accessible through the EHR and reporting cancer information to a public health registry.

Delays and Changes

Originally, the earliest adopters would have completed Stage 1 in 2012 (after starting in 2011) and attested to meeting Stage 2 requirements in 2013. Due to widespread difficulties, the first year for Stage 2 pushed back to 2014.

The schedule and requirements have again been delayed in a Final Rule released on September 4th. The new rule loosens the requirements on software certification, delaying the required implementation of 2014 certified software. It also pushed back the beginning of Stage 3 to 2017 for the earliest adopters.

While the new rule appears to make it easier to meet requirements by increasing flexibility, it has not been received with widespread enthusiasm. CHIME (The College of Healthcare Information Management Executives), which represents chief information officers of hospitals, released a scathing reply criticizing the full year of reporting required in 2015. By delaying the process but retaining full-year reporting periods, the rule has increased the total period in which professionals and hospitals will be required to report meaningful use, a process that requires significant investment of time and resources.

Check back for a post further exploring the difficulties of meeting Meaningful Use requirements soon.

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