Background
Technology has become increasingly integrated in health care in such activities as transfer of patient records, sharing of test results, as well as in communicating a plan of care between or among providers conventionally undertaken by phone, fax, or email. In the recent past, the United States has strived towards changing this state of affairs by offering support to hospitals, doctors, and clinics as they adopt Electronic Health Records (EHRs) through a three-stage 5-year federal incentive payments program, Meaningful Use (Feldman & Alexander, 2012). HITECH approved the establishment of the Medicare Electronic Health Care Incentive Program to spur the adoption of automation in healthcare. In implementing EHRs to improve not only clinical care but also patient health outcomes, American health institutions have invested considerable financial and human resources. The Meaningful Use follows a tiered approach that increase in complexity from one stage to the other in the manner the new technologies are utilized in the health care environment (Amatayakul, 2013). At each stage, the core competencies required of health practitioners will remain the same, while the requirements will increase at every stage.
Hospitals across the country have embraced the program with full belief that technology would substantially support the development of automated clinical quality as well as help in their local quality improvement efforts. Considering that EHR implementation is mainly focused on the end result of utilizing technology among clinicians, physicians and nurses are key players in the federal meaningful use concept (Amatayakul, 2013). Physicians are generally concerned with improving the clinical workflows as well as efficiency. On the other hand, nurses are focused on using the technology in improving patient experience and safety. In this regard, nurses have a special relation to the meaningful use program because they are tasked with such activities s navigating with the EHR to attain the set goals. While other clinicians are often interested in time savings and efficiency, nurses are concerned with the efficiency in addition to how it makes sense clinically, and they are approaching it from a patient’s perspective.
Meaningful Use
In an effort to fast-track the implementation of Health Information Technology (HIT) along with the usage of electronic health records (EHRs), Congress enacted the Health Information Technology for Economic and Clinical Health Act (HITECH) in February 2009 as a part of the broader American Recovery and Reinvestment Act (Feldman & Alexander, 2012). Meaningful Use refers to a set of standards designed by the Centers for Medicare and Medicaid Services (CMS) for the purpose of paying providers that achieve the set criteria pertaining to the meaningful use of technological resources in improving patient care. In this regard, the overall objective of adopting EHRs is reducing health disparities, engaging patients and families, and improving communication to realize better coordination of care.
Stage 1 of the program (2011-2012), focused on gathering data in a more consistent manner, analyze health trends, and use the information to better engage with patients and families. Stage 2, which ends in 2014, focuses on advanced sharing e.g. e-prescribing and electronic sharing of patient care summaries between or among providers (Amatayakul, 2013). The final stage (2015-2016), emphasizes on improved outcomes and provision of patient with easy access to self-management tools among others. Providers who implement EHRs and meet the goals of meaningful use criteria would receive at least $80,000 in incentive payments if they offer their services to Medicare and Medicaid patients. On the other hand, providers who would not have adopted and EHR by 2014 but continue treating Medicare patients would attract a 5% decrease in reimbursements (Feldman & Alexander, 2012).
It is worth noting that the goals of Meaningful Use are mainly about health care using technology. The following are the specific federal goals for Meaningful Use using HER technologies:
– Improving the quality, safety, and efficiency of patient care
– Reducing health disparities
– Engaging patients and families
– Improving care coordination
– Ensuring sufficient privacy and security of personal health information
– Improving public health.
A clear understanding and broader appreciation of Meaningful Use can be gained through the knowledge that the objective of engaging patients and families will be facilitated by technology through provision of electronic copies of health information to patients upon request (Amatayakul, 2013). Such information will detail their diagnostic test results, problem list, medication allergies, medication lists, etc.
Impact on Nurses and Patient Outcomes
Successful implementation of the EHRs together with making meaningful use of the technologies would require that much of the traditional workflow be redesigned and incorporated into the new normal. This automatically translates that nurses need to brace themselves for a potentially messy process and big changes that await them going forth. For instance, findings of the September 2012 study published in the Journal of American Medical Informatics Association (JAMIA) showed computer provider order entry (CPOE) requirements as the most challenging criteria in the entire meaningful use program for nurses (Hamric et al., 2014). This is because the electronic records of vital signs and most of the quality reporting requirements demanded in the CPOE system effectively become a nursing responsibility.
Similarly, adopting e-prescribing, which occurs in stages, nurses are facing the challenge of keeping track of both digital orders and paper orders on two different systems. This is bound to continue until the whole transition is achieved to the electronic system. This is exacerbated in instances where a hospitalized patient is being offered treatment by a number of specialists, of which some have implemented CPOE while others still make use of paper prescription pads. Nurses are always concerned with whether orders will be at great risk of getting lost in the system or getting duplicated into two forms in the course of transition to EHRs and meaningful use (Amatayakul, 2013). There are also questions relating to the kind of safeguards that nurses will need to put into place so as to take note of such transitional errors. As such, nurses are obliged to collaborate with technology departments in order to keep patient information safe and attain the goals of meaningful use.
In the years ahead, meaningful use will typically require more functionality, and the specifics relating to what the federal government will authorize remains unknown. As such nurses will have to push their institutions to install systems for improving efficiency, quality along with the patient experience not only for the sake of receiving incentives from the government. Nurses have an increased obligation to ensure safe and efficient care, which can be best accomplished by voluntary participation on implementation teams to make their voices heard. It is upon nurses to make the meaningful criteria works for them and patients.
As health institutions embrace the challenge of adopting EHRs, nurse are increasingly called upon to apply their nurse-based knowledge to achieve the following among others:
– Effectively manage the mandatory transition from the conventional paper system to new digital records all in way that ensures patients are free from error
– Design information systems tailored to capture present, evidence-oriented standards of nursing care.
– Contribute to initiatives which inform local and federal policy pertaining to health care IT.
– Develop and implement necessary technological tools which are outside the scope of EHR e.g. home care management services or remote patient monitoring, disease registries, quality tracking, reporting systems, etc (Hamric et al., 2014).
Recommendations for Stage 1 and 2
Stage 1 of meaningful use criteria was essentially too primary care-based and thus not very relevant to specialists. Most of the menu items were optional lacking such crucial requirements as patient engagement and need for medical groups to account for meaningful use where multiple providers are involved (Hamric et al., 2014). Unlike the mere 30% percent required of providers to enter medication orders electronically, this needed to be increased to almost double. Also, Stage 1 required reporting of demographics only for more than 50% of unique patients (i.e. patients seen a number of times in the course of a reporting period but counted only once) (Hamric et al., 2014). More reliable demographics would have realized if the requirement was put at 80% or more.
Also, it was unwise to place it as a separate objective in Stage 1 the requirement of more than 80% of unique patients seen to have at least one entry or an indication that the patient is no longer on any prescribed medication, which was recorded as structured data. This would be better treated as a single measure of care record. In the revised requirements, most of these recommendations have been integrated in Stage 2 but there is great potential of many providers falling victim of fines as the later stage is more demanding (Hamric et al., 2014).
Conclusion
The meaningful use criteria is moving towards rendering nurses more focused on improving patient experience and outcomes through the use of technological resources. However, more improvements are needed so as to make the entire program more research and evidence-oriented practices. As identification of key data elements is undertaken and quality measures fully incorporated, nurses will increasingly become tech-savvy and realize the impact of their care.
References:
Amatayakul, M. (2013). Process Improvement with Electronic Health Records: A Stepwise Approach to Workflow and Process Management. New York: CRS Press.
Feldman, H. R., & Alexander, G. R. (2012). Nursing leadership: A concise encyclopedia. New York: Springer.
Hamric, A. B., In Hanson, C. M., In Tracy, M. F., & In O’Grady, E. T. (2014). Advanced practice nursing: An integrative approach. New York: CRS Press.
