What is Meaningful Use?
Interview topic: What is Meaningful Use?
Interviewee: Michael Dieter, MLIS, MBA, Clinical Assistant Professor
Currently, the topic of meaningful use is garnering quite a bit of attention in the press, but people who are not involved in the healthcare IT industry may not know the objectives of meaningful use, or the meaning of the term.
Today, I have with me, University of Illinois at Chicago’s Clinical Assistant Professor, Michael Dieter, who I will interview on the topic of meaningful use. Michael has worked at UIC for 21 years, and has been in the Department of Biomedical and Health Information Sciences since 1997. Michael acted as course developer for the transition of UIC’s online health informatics and health information management curriculum to its current online format.Currently, the topic of “meaningful use” is garnering a lot of attention in the press, but people who are not involved in the healthcare IT industry may not know the objectives of meaningful use, or the meaning of the term. Today I have with me University of Illinois at Chicago’s clinical assistant professor Michael Dieter, who I will interview on the topic of meaningful use. Michael has worked at UIC for twenty-one years, and has been involved with the Department of Biomedical and Health Information Sciences since 1997. Michael acted as a course developer for the transition from the Health Informatics and Health Information Management onsite curriculum to its online format. Good afternoon, Michael. How are you today?
0:48 MD: Great, Keira. Thank you for inviting me to participate in this dialog.
0:51 KS: Not a problem, Michael. I’d like to turn it over to you at this time to discuss the topic of meaningful use.
0:59 MD: OK. Well, I think the best way to begin is really to start by providing a brief overview that situates meaningful use as one of a series of events that has paved the way for the transformation of health care delivery. We can look back to 1999 with the publication of the Institute of Medicine’s To Err Is Human: Building a Safer Health System report, which laid out a comprehensive strategy that healthcare stakeholders could use to reduce preventable medical errors. The report concluded that the know-how already exists to prevent many of these mistakes. The report set a minimum goal of 50% reduction in errors over the next five years.
2:00 MD: The second major event on this timeline was when President George W. Bush in 2004 demonstrated his commitment to improving the nation’s healthcare information technology by calling for a widespread adoption of electronic health records in ten years, doubling funding to $100 million for demonstration projects, and creating a new subcabinet position of National Health Information Coordinator. That brings us to 2009 with the implementation of the American Recovery and Reinvestment Act, or ARRA, and its component act HITECH, Health Information Technology for Economic and Clinical Health. This legislation provides that eligible professionals and eligible hospitals who demonstrate meaningful use of certified electronic health records technology are eligible for incentive payments. The adoption of EHR and health information technology in high priority areas, such as electronic prescribing, clinical physician order entry, interoperable electronic health records and quality measures reporting can improve patient safety as called for in the IOM report, and also improve the effectiveness, efficiency, , and the quality of healthcare delivery.
3:39 MD: Now, HITECH set several priorities for as goals to be achieved. One is to improve the quality, safety and efficiency of care while reducing disparities. A second is engage patients and families in their own care. A third is to promote public and population health. A fourth is to improve care coordination. A fifth is to promote the privacy and security of electronic health records. And finally, each of these priorities includes eligible hospitals and eligible professionals meeting specific criteria defined for meaningful use in three stages.
4:26 MD: So meaningful use criteria are what break down from these priorities as definable goals that have to be met to be eligible to receive the incentives. The Act uses Medicare and Medicaid payments allocated by the Centers for Medicare and Medicaid Services, also known as CMS, to incentivize and penalize participating providers based upon their attainment of these key objectives for meaningful use of a certified EHR. And this is an important distinction that just not any EHR is qualified for eligible providers or hospitals to receive these incentives, but it must be certified. The bottom line is that HITECH provides incentives not just for simple adoption of EHR technology, but meaningful use of certified EHR technology. And we have to keep in mind that it’s a work in progress, and it is a beginning, not an end, where the goal is a nationwide Health Information Technology infrastructure, where health information can be exchanged and accessed.
5:46 MD: Now the initial phase of the infrastructure was the creation of several regulatory bodies – The Office of the National Coordinator of Health Information Technology, and also the existing body of CMS, who are the primary agencies responsible for meaningful use and HITECH. So, you know, our timeline here, as of January 2010, the meaningful use interim rule was first released for public comment. And so later in July, after all these comments were received and considered CMS and ONC announced the meaningful use final rule to implement the EHR incentive program under HITECH. Just as an aside, some figures that I pulled from HIMS estimated the potential scope of impact to affect/impact roughly 624,000 eligible hospitals and eligible providers. An estimate from the Congressional Budget Office estimated that the average benefit to eligible providers would be $54,000 dollars to purchase and implement certified EHR technology, and then $10,000 dollars annually to maintain it over the five-year period. For eligible hospitals, obviously the figures are much larger, and it’s approximately $5 million dollars, with a range from one to one hundred million to purchase and implement the technology that’s been certified, and one million annually for maintenance.
8:00 MD: Now the government has provided a plan for navigating this change that consists of three stages over a five-year period in which eligible hospitals and eligible providers must demonstrate appropriate use of a certified EHR to meet both quality of care metrics and system adoption metrics. Stage 1, which we are already in as of July, as I mentioned, involves the electronic capture of health information in a coded format, using electronic information to track key clinical conditions communication of information for care coordination, implementing decision support to facilitate disease and medication management, and reporting clinical quality measures and public health information. So Stage 1 is basically to get eligible hospitals and eligible providers into the game using technology that’s recognized as certified. It’s oriented toward the development and use of electronic health records.
9:24 MD: In Stage 1, there are a total of 25 criteria for meaningful use. Fifteen core criteria and ten menu criteria. To meet Stage 1 requirements, eligible professionals, which are basically physicians, need to satisfy the fifteen core criteria, and five self-selected menu criteria. Eligible hospitals are required to satisfy fourteen core and five self-selected menu criteria. And then there’s a timeline for implementing the criteria that determines the amount of the incentive. So, in addition to reporting on the utilization of the EHR technology, based on the criteria, there’s also reporting requirements based upon quality measures. And eligible providers are required to report on three required core measures… I believe, um… hypertension and blood pressure management, tobacco use assessment and cessation, and adult weight screening and follow-up, whereas eligible hospitals are required to report on all fifteen of the required core measures, plus three others chosen from a list of thirty-eight requirements.
10:53 MD: Now, in terms of Stage 2, the criteria should begin in 2013. I think that’s when they’re scheduled to be ready. And basically they’re using clued criteria involving the use of health information for continuous quality improvement at the point of care. Much of the Stage 2 requirements simply expand the threshold for Stage 1 and requirements and it also is intended to improve the level of continuous quality improvement at the point of care. Stage 2 includes electronic transmission of orders entered upon EHR systems and order entry systems, and the electronic transmission of diagnostic test results.
11:52 MD: Stage 3 requirements criteria begin in 2015 and basically promote improvement in quality, safety and efficiency. And in Stage 3, we see a greater role for patient access to self-management tools involving comprehensive data, and intended to… efforts intended to improve the population… the health of the population in general. It’s important to realize that these criteria are intended to provide a pathway for the introduction of health care information technology into the healthcare delivery process. And there’s a degree of flexibility intended so that it takes into account health care’s current level of technology adoption and expected returns from increased technology adoption, resulting in a sequence of stages, and the timing of incentives and penalties. The design of this strategy encourages early adoption of certified technology to maximize your incentives and minimize penalties; and increasing your depth of usage over time.
13:20 MD: So basically, to fulfill these criteria, a provider’s attainment of a stage’s requirements equates to meaningful use of an EHR, and that qualifies them for this bonus. And failure to meet the required stage for a given year will result in a provider incurring a monetary penalty or possibly losing their full Medicaid or Medicare reimbursement. And so, just recently, as of January 3rd, registration for Medicare and Medicaid meaningful use incentive programs has opened and there’s an online Web site where organizations can start the process.
14:04 MD: On January 12th, the proposed Stage 2 and Stage 3 recommendations were published for public comment, and probably next summer, if things follow the pattern that Stage 1 followed, the Stage 2 requirements will become effective. The bottom line here is to think about meaningful use as a means to an end, and not an end in itself. It’s the beginning of a process to transform health care delivery to improve its effectiveness and efficiency. I think in terms of the specific criteria, much of that material is available on the ONC and CMS Web sites, and there’s also a lot available at professional organizations’ Web sites, such as HIMS and AHIMA. So, there’s a great deal of information out there, and at this point in time, we’re kind of waiting to see what happens. You know, there’s been some resistance to the early, interim criteria that were proposed which resulted in them being slightly modified, and if… we’re at the point of really waiting to see what happens next.
15:38 KS: Wonderful. Thank you, Michael. Your explanation has been both insightful and comprehensive. Thank you for your time today.
