For many practicing physicians, Electronic Health Records computer software has become part and parcel of the organizational processes behind the delivery of high-quality patient care. EHR/EMR technology has made has made the administrative side of medical treatment easier and more efficient for both the doctor and the patient.
With that in mind, the 2009 American Recovery and Reinvestment Act (ARRA) – a multi-billion dollar stimulus package designed to help the U.S. recover from the most recent great recession – introduced official guidelines to foster “meaningful use” of EHR among eligible healthcare professionals.
What does Meaningful Use mean for healthcare professionals?
As per law, eligible physicians (as well as eligible hospitals and critical access hospitals) register for the Medicare and Medicaid EHR Incentive Programs to receive incentive payments for integrating EHR software systems into their practices or medical centers. “Integration” in this case means the adoption, implementation, demonstration, and regular upgrade of their EHR software systems to meet specific Meaningful Use guidelines and objectives.
Physicians and other healthcare professionals may use EHR technology to record patient information electronically rather than fill out paper records. Further, EHR have other technological capabilities besides electronic patient records. Meaningful Use guidelines encourage healthcare providers to use the full functionality of EHR to meet certain objectives for improved patient care.
The Center for Medicare Services (CMS) run the Medicare EHR Incentive Program in the United States, whereas every state runs its own Medicaid EHR Incentive Program. A Medicare eligible healthcare provider is able to receive up to $44,000 in incentive payments over five consecutive years of participation in the Medicare EHR Incentive Program. A Medicaid eligible healthcare provider is able to receive up to $63,750 in incentive payments over 6 years of consecutive participation in the Medicaid EHR Incentive Program.
A doctor who is eligible for Medicare Incentives but chooses not to demonstrate Meaningful Use will get a payment penalty (more on that later) on his or her Physician’s Medicare Fee Schedule. However, doctors eligible for Medicaid Incentives will not get penalized by the Medicaid EHR Incentive Program if they choose not to participate.
Since Meaningful Use is such a vast subject, we will focus on Meaningful Use and its challenges as they apply to Medicare eligible healthcare professionals in this blog series.
Eligible physicians must demonstrate to CMS that they have met all Meaningful Use Stage I requirements in order to receive incentive payments (and avoid penalties). For the first year of participation, they must show Meaningful Use through the measures established by CMS for at least a 90-day consecutive period and then report compliance to CMS. For the second, third, and the following years, eligible healthcare providers must fulfill the Meaningful Use requirements for the entire calendar year – every year. The first year’s 90-day period and every subsequent year are considered reporting periods for the demonstration of compliance to Meaningful Use.
There are three distinct stages of Meaningful Use.
Meaningful Use Stage I
According to cms.gov, eligible healthcare professionals must meet:
- 13 core objectives
- 5 menu objectives from a list of 10
- A total of 18 objectives
The following is a brief outline of Meaningful Use Stage I’s 13 core objectives, intend to provide a general sense of what to expect in terms of action and compliance. For a full description of Meaningful Use Stage I, please consult cms.gov.
1. Use EHR software to directly input medical orders via a desktop computer or mobile device.
2. If and when eligible healthcare providers find a drug-drug and drug-allergy contraindication related to a particular patient, they must immediately generate an electronic notification in real time based on medication and allergy records and computerized provider order entry.
3. Keep an updated record of current and active diagnoses.
4. Create and transmit medical prescriptions via EHR technology.
5 & 6. Maintain up-to-date electronic medication and medication allergy lists for every patient.
7. Record the demographics of patients, such as language, gender, race, ethnicity, and date of birth.
8. Changes in vital signs such as height, weight, blood pressure, Body Mass Index (BMI), and growth must be recorded and charted electronically.
9. Record if patients 13 years or older are smokers or non-smokers.
10. Electronically calculate all CMS core clinical measures and at least three clinical quality measures, and then report them to CMS.
11. Implement one clinical decision support rule that pertains to your medical specialization. (More information on this can be found at cms.gov.)
12. Upon patients’ request, healthcare providers should be able to provide patients with electronic copies of their health information, including diagnostic test results, problem and medication lists, medication allergies, and other pertinent data.
13. Generate electronic clinical summaries that include diagnostic test results, problem lists, medication lists, and medication allergy lists on patients.
Meaningful Use Stage I’s Menu Objectives
Some of Meaningful Use Stage I’s menu objectives include:
- Use EHR to record clinical lab-test results
- Send electronic notifications reminding patients about their preventive or follow-up medical care
- Use EHR technology to find education resources for patients based on their specific situations
In The Challenges of Meaningful Use Part II, we will discuss Meaningful Use Stage II as it applies to Medicare eligible healthcare professionals, the associated payment penalties, and what Practice Forces can do to help you with your compliance to Meaningful Use.