As per a study, usage of EHR systems amongst the U.S physicians has surged from 18 percent in 2001 to 92 percent in 2018. The adoption rate of EHR is higher amongst specialized physicians.
The use of EHR is high because patients’ data is acquired easily for better care and to maintain standards for public health. Read this piece to understand what is EHR and Meaningful Use, and how healthcare can achieve Meaningful Use.
What is EHR (Electronic Health Records)?
EHR is a digital health record of patients. It consists of information that is listed on a patients’ medical sheet. EHR includes vital signs, medical history, medications, diagnosis, progress reports, allergies, immunizations, imaging reports, and laboratory data. It also consists information about demographics, medical insurance, and data acquired from wearable health devices.
EHR ensures that data is shared with the healthcare facilities and practitioners for better coordination and patient care. Health information is transmitted to laboratories, pharmacies, imaging centers, emergency units, workplaces, and schools via EHR.
Electronic health records enhances patient care due to availability of accurate medical data. Digital records prevents duplication of data and delays in treatment procedures.
Records are used for public health management. For example, number of people suffering from diabetes in 2021 or number of people diagnosed with tuberculosis last year.
EHRs are HIPAA and HITRUST compliant to avoid disclosure of Patient Health Information (PHI) due to cyberattacks. Breach of PHI harms patients’ reputation, privacy, and data can be misused as well.
Popular EHR systems in the USA are Allscripts, AmkaiSolutions, Angel Systems, athenahealth, Askesis Development Group, Cerner Corporation, Credible, CGI, and many more on the list.
What is Meaningful Use (MU)?
in 2018, CMS (Centers for Medicare & Medicaid Services) rebranded the EHR Incentive Program, which is commonly known as the Meaningful Use. The program was called as ‘Promoting Interoperability‘ that will include requirements which concentrates on increasing the adoption of APIs (Application Programming Interfaces), and decreasing administrative burdens.
The HHS (Health and Human Services) Department has funded the Meaningful Use program. This program offers incentives and monetary help to the healthcare professionals to adopt certified electronic health records.
Certified EHR are those that meet the standards defined by the certification and testing body. Certified EHR has to be used meaningfully. This includes exchanging EHR with healthcare workers for improving care and for issuing e-prescriptions. The objective of Meaningful Use program is to improve care, decrease medical costs, build efficiency, assure security, and privacy of data.
MU includes engagement of patients and healthcare providers in uplifting their own health. The aim of MU program is to improve public health.
Every year, monetary incentives increase and novel requirements are added at each stage of Meaningful Use. If failed to meet the requirements at each stage, then it results in financial penalty.
Therefore, to qualify for funds the healthcare providers need to adopt EHR and exhibit Meaningful Use of certified electronic health records. Moreover, HIPAA compliance and Privacy Rules are to be included while exhibiting Meaningful Use.
MU was imbibed in the HITECH (Health Information Technology for Economic and Clinical Health) Act and was a part of ARRA (The American Reinvestment and Recovery) Act, 2009. The objective of HITECH Act is to improve the US healthcare system, which is carried out through the adoption of EHR by the healthcare professionals.
What Healthcare Can Do to Achieve Meaningful Use?
Healthcare facilities and providers can achieve MU by implementing the following steps.
For Healthcare Organizations and Providers Who Haven’t Used EHR
1. Begin by calculating investment returns and financial assessments, and assign an EHR team amongst the staff members.
2. Determine your current position by evaluating staff’s computer skills. Scrutinize workflow along with hardware and software requirements.
3. Plan EHR goals, so as to draft a project plan for implementation.
4. Check for certified vendors for EHR systems that meets healthcare facility’s needs.
5. Install EHR system by coordinating with vendors.
6. Review Meaningful Use, phase plans, and clinical measures by evaluating EHR system.
For Healthcare Organizations and Providers Who Use EHR
1. Check for ARRA certification with the vendors and when their upgrades will be available.
2. Try to incorporate lab interface and a patient portal because this provides complete patient information.
3. Use CPOE (Computerized Physician Order Entry) because this rids of paper based patient ordering system.
4. Do a gap analysis of allergies, vitals, documentation, medications, and health problems, thus creating an organized data.
5. Check for HIPAA compliance in the system, thus addressing privacy concerns.
3 Stages of Meaningful Use
The Meaningful Use program is classified into three stages and every stage is build over the previous one. Thus, expanding EHR usage amongst the healthcare providers and patients.
Stage 1 – Storing and Gathering Data
In 2010, stage one of the MU program was declared by the Office of the National Coordinator for Health IT (ONC) and Centers for Medicare and Medicade Services (CMS). This stage focuses on sharing and gathering of EHR data.
Healthcare providers eligible for Medicaid EHR incentive program (the one who implement meaningfully use certified EHR) are nurses, physicians, midwives (certified nurses), physician assistants, and dentists.
Hospitals are eligible if 10 percent of patients in the acute care facilities have Medicaid, and children’s hospitals. The U.S. government provided financial incentives to those who met certain criteria and standards.
These Criteria Includes
1. How many years participated?
2. Enrolled for Medicare and Medicaid incentive or not.
3. How many patients were discharged?
4. Total percent of inpatient bed days.
MU stage one consists of 25 criteria that must be met by the healthcare organizations, so that they can qualify for either Medicare EHR or Medicaid incentive program. These criteria are divided into 10 menu requirements and 15 core requirements. The providers must meet all 15 core objectives and five out of 10 menu objectives.
The Core Requirements are as Follows
1. Minimum 30 percent of patients with a medication list, should have one medication order entry by using CPOE (Computerized Provider Order Entry).
2. At least 40 percent of the prescriptions must be rendered electronically.
3. Keep a track of drug allergies.
4. Document demographics of at least 50 percent of patients. It includes gender, language, race, birth date, or ethnicity.
5. Note vital signs such as weight, height, or blood pressure of minimum 50 percent of patients.
6. Maintain patients’ active problem list (at least 80 percent of patients).
7. Keep medication list of at least 80 percent of patients.
8. Note down allergies of at least 80 percent of patients.
9. Utilize EHR for care suggestions, as per patients’ clinical chart.
10. Note smoking status of patients’ over 13 years age.
11. Do security and risk analysis to safeguard PHI.
12. Prepare aggregate medical data of patients.
13. Allow patients to access their healthcare data, so they can download it electronically.
14. Give visit summary to at least 50 percent of patients within three business days.
15. Exchange medical data with third party healthcare providers.
The Menu Requirements Include
1. Incorporate drug formulary checks such that there’s at least one external or internal formulary for the reporting phase.
2. Implement results of clinical tests in patients’ EHR.
3. Create list of patients diagnosed with specific condition, thus aiding to decrease health disparities in population.
4. Send alerts to patients for follow-ups or preventive care.
5. Give health information to patients electronically within a few days upon request.
6. Provide education resources to patients based on their health conditions.
7. Note advanced aspects for patients above 65 years old.
8. Reconcile with patients and verify whether medical list is updated.
9. Prepare a summary of care for patients transferred or referred to another facility.
10. Submit electronic data on vaccinations.
11. Share laboratory results to public healthcare facilities.
A Medicare eligible healthcare professional must meet these requirements within 90 days time in the first year and the entire subsequent year. The provider must upgrade, adopt, or incorporate a certified EHR in the first year, wrap up 90 days reporting phase in second year, and report for entire the subsequent year.
Stage 2 – Advanced Clinical Process
Stage two of MU program was launched in 2014. The usage of EHR software was expanded for exchanging medical data between healthcare providers. This stage aims to enhance integration for lab results and e-prescriptions.
Some core requirements mentioned in stage one have been altered in stage two.
The Altered Core Requirements Include
1. Instead of requesting health data, patients can acquire medical information online.
2. The timeline for providing healthcare data for EPs (Eligible Professionals) is within four working days. EHs (Eligible hospitals) and CAHs (Critical Access Hospitals) must provide online data under 36 hours post discharge. In all these cases, patients must be able to view, access, or download health data.
3. Instead of providing clinical data to providers during transfers of 50 percent of patients, give summary of care electronically for more than 10 percent referrals or transfers.
4. Conduct minimum one electronic exchange of healthcare data with a recipient, by using EHR technology created by a different developer (Not to use EHR of the sender).
5. Run one successful test with CMS designated test within reporting period.
Menu Requirements Include
1. Submission of electronic syndromic surveillance information to public healthcare facilities.
2. Note digital records of patients.
3. Imaging results can be accessed via CEHRT.
4. Note down medical history of patients’ family.
5. Detect and report cancer patients to the State cancer registry.
6. Locate and report particular cases to specialized registry, other than cancer.
7. Record advance directives for patients’ older than 65 years.
8. Provide electronic prescriptions.
9. Give electronic laboratory results to the ambulatory providers.
Stage 3 – Implementation or Improved Outcomes
In 2015, the rules of stage three were announced publicly. The rules includes protection of all ePHI (Electronic Patient Health Information) maintained by CEHRT (Certified Electronic Health Record Technology). Generating e-prescriptions and improving health conditions also falls under this stage.
Stage 3 comprises of providing timely access to patients’ medical data and boosting patient engagement with their health. This stage consists of eight objectives that must be met by the healthcare professionals or institutions.
Key Objectives of Stage Three Includes
1. Incorporating HIPAA to safeguard PHI.
2. EPs must provide 80 percent of their treatment plans or drug prescriptions electronically via certified EHR. Hospital discharge medications of at least 25 percent of patients must be provided electronically.
3. Incorporating clinical decision support for improving outcomes and performance of high-risk health conditions.
4. Mandatory usage of CPOE for recording labs, medications, and radiology requests. EPs must use CPOE for at least 80 percent of orders.
5. Share patients’ health data within 24 hours.
6. Coordinate care through patient engagement, thus enhancing involvement of patients in healthcare.
7. Exchange medical data within the healthcare system for better coordination, care, and to make informed health decisions.
8. Report clinical and public health data meaningfully to the registry.
How to Prepare for MU Audits?
Any healthcare provider who is receiving MU EHR incentives payments are eligible for audits for six years. The healthcare professionals and facilities must prove that meet the MU requirements during the reporting phase.
Medicaid coordinates with an auditing agency called the Figliozzi and Co. for conducting MU audits.
Practices for Successful MU Audits Include
1. To have a MU coordinator.
2. Document everything and save it.
3. Get read for an audit before attesting.
4. Make an electronic audit file.
5. Don’t depend entirely on software vendors for compliance proof.
6. Print the reports on the day of attestation.
7. Pay attention to minute details.
8. Give documents that are requested.
Documents Needed for MU Audits
1. ONC certification
2. Menu and core measure reports
3. Reports on clinical quality measure
4. Proof of compliance for Yes or No objectives
5. Evidence for compliance during the reporting phase
6. Procedures and policies
Relationship Between Meaningful Use and EHR
In 2009, President Barack Obama signed the ARRA (American Recovery and Reinvestment Act) law. This Act was a package for rendering investments for America’s employment, infrastructure, education, transportation, and other fields.
ARRA consists of the HITECH Act that targets the healthcare sector. This Act offers a way to organize the digital health network of the USA. The ARRA HIT Policy Committee put forth ‘Meaningful Use’ as the main criteria for healthcare providers. This criteria must be met to acquire monetary support under ARRA.
For funding, healthcare providers must record essential aspects of patient such as medications and smoking status. Documenting each medical record of patient is essential for Meaningful Use and EHR.
Almost 95 percent of healthcare institutions are eligible for Medicare and Medicaid EHR program. Through Meaningful Use and EHR certification, one can aim to achieve 100 percent digital health record of patients. This can be an ideal way to improve public health and patient care in the upcoming years.