Meaningful Use Program for Nurses: Implications and Recommendations

When in usable format, electronic health records-EHRs provide nurses with critical information that informs patient care, thus being critical in the success of implementing nursing informatics in hospitals. “Meaningful Use” program comprise rules/regulations designed by Center for Medicare and Medicaid to govern the use of EHRs to improve service delivery to patients. Nonetheless, while the Meaningful Use program tends to spur progress, it also raised concerns. Considerably, because of the attributed concerns raised by the public, primarily healthcare organizations, the Centers for Medicare & Medicaid Services has delayed stage III implementation, which will now take place in year 2017 so that it can change the program by incorporating public feedback and experts’ opinion. This is intended to address the program’s shortcomings by realigning Meaningful Use program to its core goal, which is proper implementation of EHRs to improve healthcare delivery (Federal Advisory Committees, 2015).

The challenge in addressing the shortcomings lies in knowing the specifics that should be altered in the program to improve EHRs implementation in its current state. In this light, this paper seeks to provide an overview of the Meaningful Use and analyze the implications of the program, both negative and positive to help identify the specifics that need change, which will be included in the recommendation section. The paper concludes with insights garnered regarding the programs and changes needed to allow Meaningful Use program facilitate the implementation of EHRs effectively and improve patient outcomes (Federal Advisory Committees, 2015).

Overview of Meaningful Use

Meaningful Use comprises of three stages. The first stage, which was initiated in year 2010 was meant to promote EHRs adoption. The second stage finalized in year 2012 to increase criteria compliance threshold, as well as, introduce more care-coordination requirements, patient engagement rules and criteria compliance. The third stage, which is predicted to commence in year 2017 is expected to pay special attention to the exchange of health information and meaningful guidelines found in the other two stages (Centers for Medicare & Medicaid Services, 2010).

To meet Meaningful Use objectives, hospitals and healthcare professionals, including the nurses have to adopt EHR technology that has been certified, as well as, employ the EHR in achieving specific objectives. These objectives include improved safety, efficiency, quality, as well as, eliminate health disparities. This also goes for engaging families and patients in healthcare, improving public and population health, improving coordination and maintaining security and privacy. Stage 1 promotes EHR adoption by capturing and sharing data. This is attained by capturing data electronically using a standardized format, using data to keep track of major clinical conditions, communicating the information to enable care coordination processes, reporting public health information and clinical quality measures, as well as, using information garnered to involve patients and families in the care process (Centers for Medicare & Medicaid Services, 2010).

Criteria for stage 2, leads to advanced clinical processes, which are evident in rigorous exchange of information, increased lab results and e-prescribing requirements and increased patient-controlled data. Criteria for stage three, which leads to improved outcomes comprise of improving safety, efficiency and quality to facilitate improved health outcomes, decision support needed for high-priority conditions at the national level and access of self-management tools for patients. This also goes for access of comprehensive data for all patients through health information exchange that is patient focused and improving the overall population health (Centers for Medicare & Medicaid Services, 2010).

The Meaningful Use program comprise of measures that help ascertain that specific objectives in every criteria have been met. For eligible professionals, attainment of Meaningful Use is determined by meeting 15 core objectives, half of menu set objectives and 6 clinical quality measures where three are core measures and 3 from the additional set. For hospitals, they must attain 14 core objectives, half of the menu set objectives and 15 measures of clinical quality. Eligible hospitals and healthcare professional are mandated to report performance on clinical quality measures to receive incentive payment and ascertain implementation of the Meaningful Use program (Federal Advisory Committees, 2015).

Analysis

The core criteria of Meaningful Use – MU have both positive and negative implications for nursing, patient outcomes, national health policies, nurses and the health population.

Implications for Nursing Field and Nurses

Positive implications for nurses and nursing field range from professional growth to a change in the way nursing is practiced to improve patient care. Meeting the core criteria of MU will require healthcare organization to hire informatics specialists, thus creating a high demand of nursing informatics. Hay Group survey showed 96% of hospitals interviewed had already started creating nurse IT positions, as well as, departments. This will require nursing professional to make nursing informatics mandatory rather than just a specialty if nurses are to help healthcare organizations meet the MU objectives. The MU core criteria build on nursing through certification and standardization of nursing profession, specifically in nursing informatics. This is because they core criteria is the basis, on which standards for EHRs certification that ensures nurses select EHRs that perform well to meet MU needs are selected. The core criteria help create certification criteria, technical requirements and standards, which allow successful implementation of MU to improve patient outcome, a critical goal in nursing field. In addition, Adler-Milstein and Huckman (2013) indicates that Meaningful Use core criteria could improve nurse productivity because of ease in making decisions using EHRs, thus positively impacting quality and efficiency of care.

Nurses, as in the case of other healthcare professionals and organizations will be eligible for the $27 billion incentives offered for meeting the MU core criteria. This implies more capital to improve patient care and nursing profession. Nonetheless, non-compliance to MU core criteria also carries with it heavy penalties. The failure of a nursing professional in meeting the core criterion just by 1% subjects the nurse to the financial penalties and ineligible when it comes to getting any incentives. As Angi (2013) indicates, the 100% pass rate that the core criteria requires is unachievable and unreasonable. Capturing data electronically in the hybrid environment, where manual processes are used to record patient data coupled with the increased costs of implementing EHRs is a huge impediment to 100% compliance. DesRoches, Audet, Painter, and Donelan (2013) show that to meet the MU core criteria, nurses will need better training in using EHRs to improve of their capacity to use EHRs effectively by improving efficiency and accuracy in order entry and documentation.

Implications Patient Outcomes

In the case of patient outcomes, the core criteria help in ensuring patients’ security and privacy. Nurses in the field of informatics have to ensure security and privacy when exchanging healthcare information. This is guided by the criteria, which mandates encryption of private information, as well as, destruction of health information, when deemed necessary. According to Goel (2011), the core criteria highlight the adaption of patient portal in stage 2 as critical to meeting MU objectives. Nonetheless, the challenge lies in patients’ inability to have the capacity to download, transmit and view data from system within stipulations, which is critical for communicating their concerns, getting feedback and improving health outcomes. Kruse, Bolton and Freriks (2015) research findings show patient portals help in disease monitoring and management. However, to make this possible, this will require nurses to conduct patient education to inform patients on the portal benefits to encourage patient enrollments or else, the portal will have no benefit in improving patient outcome.

The Agency for Healthcare Research and Quality review of several reports show the MU core criteria facilitate the effective use of computerized-physician order entry that significantly reduce medical errors and adverse drug events by up to 50%. MU core criteria enables nurses and physicians to garner comprehensive patient and health data that informs patient care and health practices aimed at improving patient outcomes. At US Davis, using EHRs information, researchers have managed to improve practice by designing an algorithm that employs temperature, respiratory rate, white blood cell count and blood pressure to identify the likelihood on sepsis onset, thus enabling them to reduce sepsis complications in patents (Gultepe, 2014).

Implications for National Health Policy and Population Health

The core criteria of MU will help in improving population health, as the mandated communication and documentation of key data, including that of lab results and immunization could help identify populations that cannot access healthcare or are not compliant to healthcare. This will help devise strategies to reach such populations and ensure overall improvement in population health. More so, through EHRs alerts, providers, including nurses can receive alerts, as well as, provides data such as the one regarding near misuse, adverse events and disease outbreaks to improve population surveillance and health (Jacobsen & Juste, 2010). Nonetheless, inherent errors in technological systems, such as delivering falsifying alerts or conclusions still remain a challenge in adapting technologies on a wider scale to attain the benefits relating to population health.

In creating the MU, HITECH Act saw the need to authorize government funding to enhance care by collaborating with the private sector. Nonetheless, the huge challenge in implementing the core criteria lies in lack of funding to implement EHRs systems. The government has made considerable efforts in disbursing up to 70 million dollars by year 2010 but more money, up to 700 million dollars is needed to make the program a success. In this case, the government has a role to amend national health policy to allow more funding to be directed towards IT health infrastructure (Lenert & Sundwall, 2012).

Meaningful Use Recommendations

The implications of MU core criteria reveal several shortcomings with the core criteria used. One of them is that it fails to account for barriers that exist in implementing MU successfully including those relating to training, patient education and IT infrastructure barriers. In this light, it creates a criterion which requires nurses, the nursing field and healthcare organization to have a 100% success in attaining what is stipulated in the core criteria else, there will be penalties.

In light of what is aforementioned, as implications that raise concerns over the application of MU, primarily, its core criteria, the inclusion of several additional criteria is necessary. There should be two criteria, where one requires the provider to offer educational resources and incentives to patients to facilitate critical empowerment and engagement of patients. As noted before, a major challenge is the patients’ inability to understand or use the patient portal as needed to improve patient outcomes. In this light, as Bolton and Freriks (2015) indicates, such as criteria would ensure that patients have all the information they need to learn more about EHRs and their benefits, thus being empowered to adapt them with ease. In addition, another core criterion should mandate that providers provide sufficient training on the use of EHRs effectively to nurses to facilitate the implementation of EHRs in a manner aligned to MU program. Notably, as DesRoches, Audet, Painter, and Donelan (2013) research shows and as previously discussed, a barrier to MU adaptability is lack of sufficient training on nurses, thus leading to increased medical errors and ineffectiveness. Nurses need to learn how to use EHRs efficiently to improve patient outcome

Considerably, a core criteria with a pass rate below 100% and which is based on research to identify the average pass rate needed for eligibility, as guided by achievability and reasonability is needed. This would encouraged more nurses and healthcare organizations who find the 100% pass rate intimidating join MU and work hard towards building IT infrastructure to improve patient outcomes and get the incentives provided. Notable, as previously mentioned, IT barriers are major impediment to MU implementation yet the core criteria makes infrastructure that necessitate secured and efficient electronic information exchange a priority. In this light, a range of percentage for example, 50%-65% or 65%-80%, based on the capacity that healthcare organizations and professionals can attain amidst the challenges should be used for a start to allow the adaptation of MU program on a national scale and realization of MU benefits (Jacobse & Juste, 2010).

Conclusion

From the implications of the MU program, what can be deduced is that MU has remarkable potential benefits as seen in population health, patient outcome, nursing and nursing profession. Nonetheless, concerns also emerge as part of the implications of MU program in relation to nurse training, patient education, IT infrastructure, as well as, the inability to attain the 100% pas rate needed be eligible for MU program and associated incentives. In addition, the impact of the core criteria on national policy is negative in reference to the need to increase the funding. Recommendations are drafted based on the specific shortcoming identified for the program in the analysis bit in reference to concerns raised. The recommendations include modification of core criteria; a range of percentage for infrastructure’s capacity to meet the stipulated goals of efficiency that accounts for IT barriers and a pass rate below 100% guided by research to identify the average pass rate needed for eligibility. In addition, additional new core criteria recommended include the idea that provider must provide patient education resources and training for nurses. These changes will contribute in addressing the shortcoming in MU program to help it achieve its main objectives.

References

Adler-Milstein, J., & Huckman, R. (2013). The impact of electronic health record use on physician productivity. American Journal of Managed Care, 19(11), SP345-SP352.

Angi, P. D. (2013). The challenges of capturing meaningful use data. For The Record, 25(15), 30- 36.

Centers for Medicare & Medicaid Services. (2010). Medicare & Medicaid EHR incentive program meaningful use stage 1 requirements overview. Retrieved from http://www.cms.gov/Regulations-and-Guidance/Legislation/EHRIncentivePrograms/downloads/MU_Stage1_ReqOverview.pdf

DesRoches, C. M., Audet, A., Painter, M., & Donelan, K. (2013). Meeting meaningful use criteria and managing patient populations. Annuals of Internal Medicine, 158(11), 791-799

Federal Advisory Committees. (2015). How to attain meaningful use. Retrieved from http://www.healthit.gov/providers-professionals/how-attain-meaningful-use

Geol., M.S., Brown, T.L., Williams, A., Cooper. A.J., Hsnain-Wynia, R., Baker, D. W. (2011). Patient reported barriers to enrolling in a patient portal. Journal of the American Medical Informatics Association, 18(Suppl 1), i8-i12. Doi: 10.1136/amiajnl-2011-000473

Gultepe, E., Green, J. P., Nguyen, H., Adams, J., Albertson, T., & Tagkopoulos, I. (2014). From vital signs to clinical outcomes for patients with sepsis: A machine learning basis for a clinical decision support system. Journal of the American Medical Informatics Association, 21(2):315-25. Doi: 10.1136/amiajnl-2013-001815.

Jacobsen, T., & Juste, F. (2010). Information technology: Nursing in the era of meaningful use. Nursing Management, 41(1), 11-13.

Kruse, C. S., Bolton, K., & Freriks, G. (2015). The effect of patient portals on quality outcomes and its implications to meaningful use: A systematic review. J Med Internet Res, 17(2), e44. Doi:10.2196/jmir.3171

Lenert, L., & Sundwall, D. N. (2012). Public health surveillance and meaningful use regulations: A crisis of opportunity. Am J Public Health, 102(3), e1–e7. Doi: 10.2105/AJPH.2011.300542
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