How to make Meaningful Use Meaningful

What does it mean to achieve meaningful use?  Is the true intent of meaningful use to improve and facilitate patietnt care?  Is it possible that the EMR has dual purposes, that may in fact be conflicting?  One of the major pushes is to push billing codes into the documentation done by both physicians and nursing.  While this makes the billing process more efficient, it does not necessarily make the EMR easier to navigate for providers and nurses and therefore, may not contribute to increased patient safety and improved patient care.  This subject matter is further explained by Dr. Chaiken.





One of the ways to make EMRs meaningful is the implementation of clinical decision support systems.  While a provider is entering orders or a nurse is documenting, a clinical decision support system can warn, alert, and even make suggestions based on patient data already in the system and new data being entered.  For example, providers can be alerted if they order a medication that the patient may be alergic to or may interact negatively with a medication the patient is already taking.  For nurses, the clinical decision support system may alert nurses to suggested interventions based on documentation of a wound or pressure ulcer.  OpenLink.org gives an overview of what CDSS is and how it works.

Stage One of Achieving Meaningful Use

The goal of the Office of the National Coordinator (ONC)  is for each person to have an electronic health record (EHR) by 2014.  The ONC has also established the goal of a nationwide infrastructure that would support individual EHRs.  This is obviously a lofty goal.  In order to make it more manageable, the development, implementation, and adoption goals have been spread out over three stages.  The first stage of meaningful use must be achieved and reportable to the Centers for Medicare and Medicaid Services (CMS) by 2011.  For hospitals to take full advantage of incentive payment progrrams, they must demonstrate stage one meaningful use criteria beginning January 1, 2011.     The sooner stage one and then subsequent stages are met, the more financial incentives the hospital will receive, as you can see from the chart below.

Stage one requires that hospitals meet 20 of 25 objectives established by CMS. Each objective has a specific measure that has to be met.  Some objectives need to meet a certain percentage of use and others only need to be available for use. CMS will audit these objectives to determine the amount of money each eligible provider and eligible hospital.

Another imporatnt piece of meaningful use is being able to speak the language.  The language of informatics and information technology has almost as many acronyms as nursing.  To truly understand the language and requirements of meaningful use you must know the meanings of the alphabet soup that is splattered throughout the technical writing.

The following is another simple video relating meaningful use to tennis.

Bringing Meaningful Use to the Bedside

It is one thing to think conceptually about the meaningful use of technology and quite another to apply those conceptions to the reality of the bedside.  Will meaningful use change the way care is delivered?  Will the change be for the better or for worse?  As the objectives required by CMS are implemented, it is important for nurses in informatics to anticipate how the new onslaught of technology will effect the care that is provided by those at the bedside.

The Cleveland Clinic presents a clear vision of how nurses in informatics will work to bring the expanding technlolgy and demands of meaningful use to the nursing profession, both at the bedside and in informatics. The TIGER Initiative, part of the Alliance for Nursing Informatics, is another way of ensuring that nursing care remains at the bedside while integrating technology. 



Although the following is a commercial for a certified EMR company, it smartly points out where nursing has come from and where it should be.  Integrating technology into practice should not cause nursing to spend less time with patients.

Basics of Meaningful Use

Anyone working in the health care industry should be familiar with the term "meaningful use."  Meaningful use will have many implications for all health care professionals including nursees.  Because of the impact to nursing, it is important for nurses to have a basic understanding of what meaningful use is, the plan for adoption,  the ways it will impact nursing and health care, and the ramifications for health care organizations who do not meet meaningful use criteria.  The purpose of this and the following blogs will be to provide basic information about meaningful use.



Meaningful Use: Where Did It Come From?

 In February, 2009, President Obama signed the American Recovery and Reinvestment Act.  Contained in this bill is the Health IT for Economic Health Act (HITECH).  The main purpose of HITECH is to provide resources, tools, and incentives for the adoption of electronic health records.  One incentive comes in the form of $19.2 billion allocated to development and implementation of health IT.  The Department of Health and Human Services has a complete website devoted to the HITECH Act.  The HITECH Act includes eight seperate programs designed to work together become the foundation of how the electronic medical record (EMR) can function to benefit all Americans. 

The creation of the EMR is the basis for meaningful use and the HITECH Act.  The Centers for Medicare and Medicaid Services (CMS) is tasked with overseeing and providing incentive payments to eligible providers, hospitals, and critical access hospitals.  The eligible party must demonstrate adoption, implemetation, and meaningful use of the EMR to CMS by providing specific core competencies. Meaningful use entails three main components according to ARRA: The EMR should be capable of e-presccribing, exchanging information with other systems, and submit clinical quality and other measures to agencies.  Additionally, CMS defines the dates and criteria for the three stages of implementation of the EMR for meaningful use.

The following video provides a quick, high level overview of meaningful use.

Over the next few weeks, the requirements needed to meet meaningful use in each of the three stages will be discussed.