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This is the week 6 essay for nursing informatics class in university of chamberlain.
Meaningful use for Nurses: Implications and Recommendations
Dan Martin
Chamberlain College of Nursing
NR512: Nursing Informatics
December 2015
President Obama worked with congress to pass the American Recovery and Reinvestment Act, which provides $19 billion for “meaningful use” to promote health care reform through the use of health information technology since 2011 (Murphy, 2010). The intent of the Meaningful Use is to have digitalized infrastructure so the systems can communicate with one and another and data can be exchanged among providers and researchers. In return, we can improve the quality and efficiency of patient care, reduce cost and minimize billing frauds.
This paper analyzes the implications of Meaningful Use for nurses, nursing, national health policy, patient outcomes, and population health. At last, paper discussed the proposal of adding the criteria of being able to send orders to lab, imaging center and other treatment facilities on the current stage 2 criteria list.
Overview of Meaningful Use
Meaningful Use (MU) is a volunteer government incentive program, where incentive dollars is provided to meaningful users to accelerate the adoption of electronic health records (EHR) in the USA. The implementation of Meaningful Use includes total three stages. Stage 1 occurred during 2011-2013 and focused on collecting identifications and health data. Stage 2 occurs in year 2014-2015, focuses on advance clinical processes, and stage 3 focuses on dealing with measuring clinical outcomes (Scherb, et al. 2013).
The Centers for Medicare and Medicaid Services (CMS) set a series of specific objectives and criteria for stage 1 and 2. If the eligible providers for Meaningful Use program meet required core measures then the eligible providers as “meaningful users” can receive the incentive dollars over a period of 5 years. There are ongoing discussions regarding Meaningful Use and the objectives and criteria that are set by CMS. Meaningful Use is still a relative new concept for healthcare providers and hospitals. No one is really sure if we have the appropriate criteria and how Meaningful Use impacts our practice. It is important to continue assessing the criteria and raise the bars to ensure the continuous improvement effort.
Implication of Meaningful Use Core Criteria
Meaningful Use sped up the adoption of electronic health records, but it also has its unique implications on nursing, national health policy, patient outcomes, and population health. According to CMS (2012), The core criteria for stage 2 includes that more than 60% of medication, 30% of laboratory, and 30% of radiology orders created by the eligible providers (EP) during the electronic health records (EHR) reporting period are recorded using computerized physician order entry (CPOE); implement drug-drug and drug-allergy interaction checks, more than 50% of all permissible prescriptions written by the EP are compared to at least one drug formulary and transmitted electronically using certified EHR Technology; more than 80% of all unique patients seen by the EP have demographics recorded as structured data; maintain an up-to-date problem list of current Criteria one is about orders; maintain active medication allergy list, record and chart vital sign changes, clinical decision making as well as offering after visit summary to patient etc. Nurses and nurse practitioners are the ones entering the verbal orders, updating vital signs, allergy list patient demographic information, pharmacy information, patients’ problem list and filling out the after visit summary or discharge summary, as well as many participating in core measures.
Base on above analysis, Meaningful Use will add extra pressure for nurses. Besides, nurses also document nursing process and other nursing information such nursing diagnosis and nursing notes. Many if not all clinical decisions are made based on nursing documentation. The quality of the clinical decision affects the quality and efficiency of patient care. The challenge that many hospitals are facing is the limited access, availability and visibility of electronically nursing data in the clinical informational system. With the implementation of Meaningful Use, there will be tremendous pressure from the hospitals to nurses to develop and implement clinical information system to ensure the “meaningful use” of nursing data and improve the core measure results of the entire organization (Scherb, et al. 2013). Secondly, in order for nursing to communicate with one another, or other disciplines such as CMS, nursing needs to use standardized terms. Once hospitals adopt the standard terms, CMS then can compare hospital performance to the Meaningful Use criteria.
Meaningful Use directly and indirectly affects patients in a positive way, whether through giving them greater access to their health information or through enhanced engagement and collaboration with their providers (Tagalicod, 2013). Patient will be now able to schedule and pay bills online, communicate with their providers online, and access their health data. Besides, there are many positive implications for public health and national health policy as well. Meaningful use recommended providers to send immunization data to public health agencies. In stage 2, provides are expected to share more data to public health agencies. Public health agency can translate the data into knowledge to support the health care policy decision process, which in return to improve public health as well (Tagalicod, 2013).
Recommendation for Meaningful Use
Meaningful Use is still relatively new. There is tremendous discussion on the criteria that were set by CMS. According to Dr. Kannry (2012), evidence showed that patients are interest in seeing laboratory test results, refilling medication, and sending securing messaging to physician care team in stage 1. Both stage 1 and 2 mentioned Personal health records, but there is no definition what is personal health records and what is personal health records mean to patient. During stage 1, the adoption rate of EHR has increased, and CMS defined the lab test release time. However, based on Dr. Kannry’s study (2012), patient were not giving the capability of seeing the lab test result, refill medication or sending a secure message to physician, so the benefits of meaningful use was not fully reflected in patient care. Based on above discussion, I believe we could add the criteria of being able to view test result, refill medication and send secure message to providers in stage 1.
In stage 2, the criterion that is missing is to differentiating the amount of incentive dollars that each hospital receives based on how far hospital is from achieving MU. Hospital does not have EHR will receive higher incentive than those that already have EHR system in placed (Diana, et al. 2014). Dr. Diana (2014) and her team analyzed the hospitals that are potentially eligible to receive MU. The result showed that hospital that implemented EHR system before 2010 is more likely to receive the incentive dollars. Hospitals who did not implement EHR system are less unlikely to receive the incentive dollars. So in order to truly achieving the goal of MU, which is to increase the adoption rate of EHR in US, the incentive dollars should go to the hospitals that do not have EHR system. So I believe we need to add criteria of how far each hospital is from achieving MU.
Conclusion
Obviously, incentive is always a tricky tactic to use. Meaningful Use will speed up the adoption of electronic health records. But in order to achieve long lasting change, government needs to carefully examine the criteria list for each stage and ensure we are setting challenging and tangible goals for eligible providers. And also ensure the incentive money goes to help the hospitals that do not have EHR system currently.
No one knows how Meaningful Use would impact our practice; it is clearly that Meaningful Use will directly and indirectly change nursing practice, which could be overwhelming for nursing. Leaders who are leading the implementation of Meaningful Use need to incorporate change management in the process. Remind providers and nurses the objective of the change is to improve the quality of patient care.
Overall Meaningful Use is a positive thing. It will lead to increased adoption of electronic health records in US, better quality of patient care with reduced cost.
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References:
1. Murphy, J. (2010). The journey to meaningful use of electronic health records. Nursing Economic$. 28 (4) , 283-286.
2. Scherb, C. A., Maas, M. L., Head, B. J., Johnson, M. R., Kozel, M., Reed, D., Swanson, E., & Moorhead, S. (2013). Implication of electronic health record meaningful use legislation for nursing clinical information system development and refinement. International Journal of Nursing Knowledge, 24 (2) , 93-100.
3. Tagalicod, R. (2013). The real world impact of meaningful use. CMS.gov. Retrieved
from http://www.cms.gov/eHealth/ListServ_RealWorldImpact_MeaningfulUse.html
4. Skolnik, N. (2010). Meaningful use criteria: what's missing? Rheumatology News. Retrieved from http://www.rheumatologynews.com/views/commentaries/single-article/meaningful-use-criteria-what-s-missing/2908d2343f417bcd98f7efcf226c4455.html
5. Diana M. L., Harle C.A., Huerta T. R., Ford E. W., Menachemi N. (2014). Hospital characteristics associated with achievement of meaningful use. Journal of Healthcare Management / American College of Healthcare Executives. 59. (4). 272.
6. Kannry J., Beuria P., Wang E., & Nissim J. (2012). Personal health records: meaningful use, but for whom? The Mount Sinai Journal of Medicine, 79. (5). 593-602.
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