Week 4 601B Meaningful use for nurse
Meaningful use for nurses
You will select (2) Core objectives to enable EHRs to support healthcare from Stage 1. You will select (2) Menu objectives that provide flexibility for providers to choose from Stage 1 or Stage 2.
To earn full credit, your paper must include the following components:
A. Introduction and overview of the Meaningful Use Program – provide an overview of the Meaningful Use Program. Describe its significance to advanced practice registered nursing and the impact it has on the nursing profession.
1. What is it?
2. When did it originate? Why is it needed?
3. What are the relationships between EMR, EHR, and ePHR to clinical information systems?
4. What is the significance to the nursing profession, especially to the PCP?
The EHR is a transportable subset of the EMR designed for use by healthcare organizations and physician practices and other providers. It provides a bridge connecting the EMR and the ePHR. “The EHR is a longitudinal record of patient health information generated by one or more encounters in any care delivery setting” (Health Information and Management Systems Society [HIMSS], 2014, para. 1). The patient owns the data.
B. Discussion and analysis of the Meaningful Use Program (MUP) – describe and analyze the goals and objectives of meaningful use as well as its implications for nurses, nursing, national health policy, patient outcomes, and population health associated with the collection and use of meaningful use core criteria.
1. Review the goals and objectives and discuss them. Is this something you see or deal within your workplace?
2. Discuss the implications – is the program effective? Is it affordable? Does it work? Does it really improve quality and efficiency of care?
3. What are the strengths and weaknesses of MUP?
4. Support your ideas with evidence-based practice.
C. Core Requirements of the Meaningful Use Program – analyze how the core requirements are beneficial for advanced nurses, nursing, monitoring population health, setting national health policies, and/or improvements in patient outcomes or population health.
1. Patients – discuss impact of MUP on the use of patient reminders, ePrescribing, electronic access, etc.
2. Providers – does MUP assist providers in making more informed decisions, deliver better care, and create greater efficiencies?
3. Nursing – does MUP help to prevent duplicative testing, eliminate adverse drug reactions, and enhance provider collaboration?
4. Population health – does MUP encourage providers to send data to immunization registries and public health agencies?
D. Challenges and recommendations – discuss current challenges with meaningful use seen in practice today and provide recommendations using evidence-based rationale.
1. Challenges – lack of clear plan, cost, lack of oversight, privacy risks, concerns about sustainability
2. Recommendations – realistic, scalable, and flexible starting point for adopting EHR, allow reasonable time for robust EHR use, ensure adequate training, better communication with physicians and providers
E. Conclusion – summarize your findings and conclude by providing insights gained from your analysis.
1. Do not introduce new concepts
2. Summarize the highlights of your findings
3. Offer your insights
THE ELECTRONIC RECORD AND MEANINGFUL USE
The number of EHR adopters continues to grow, which is necessary to meet care new outcome knowledge spurred by meaningful use, an initiative that uses EHRs to improve patient care. Meaningful use originated with the American Recovery and Reinvestment Act (ARRA) (Recovery.gov, 2014), signed into law by President Obama on February 17, 2009. ARRA and the Health Information Technology for Economic and Clinical Health (HITECH) Act, a part of ARRA, were milestones in the history of HIT. The HITECH Act outlined four purposes:
The HITECH Act provided monetary incentives to hospitals and eligible providers that met “meaningful use” requirements. The term meaningful use refers to the use of information from EHRs to make improvements in the delivery of healthcare (Blumenthal & Tavenner, 2010). Meaningful use requires an interoperable HIS for data exchange. A full-text summary of the meaningful use objectives and measures is online in a New England Journal of Medicine article, “The ‘Meaningful Use’ Regulation for Electronic Health Records” (http://www.nejm.org/doi/full/10.1056/NEJMp1006114).
According to research done by Mathematica Policy Research, Harvard School of Public Health, and Robert Woods Johnson Foundation (2013), 44% of hospitals in the United States had adopted a basic EHR as of 2012. The adoption rate by smaller and rural hospitals was slower than larger, private, and urban hospitals. The meaningful use definition, finalized in July 2010, allowed hospitals and providers to qualify for incentive payments beginning in 2011. It provided a two-tiered implementation plan. The CMS website at http://www.cms.gov/Regulations-and-Guidance/Legislation/EHRIncentivePrograms/Meaningful_Use.html has additional information about meaningful use.
Meaningful use has three stages. Stage 1 focuses on data capturing and sharing. Stage 2 focuses on advanced clinical processes. Finally, Stage 3 focuses on improved clinical outcomes. Eligible providers, hospital, and critical access hospitals must meet the thresholds for the first stage prior to meeting ones for the second stage. Meaningful use requires that all EHRs be certified to verify the interoperability for sending and receiving health data. An overview of Stages 1 and 2 meaningful use objectives for eligible providers is displayed in Table 17-1.
Core objectives to enable EHRs to support healthcare
1. Use computerized provider order entry (CPOE).
2. Use drug–drug and drug–allergy interaction checks.
3. Maintain an up-to-date list of diagnoses.
4. Create and transmit prescriptions electronically.
5. Maintain an active medication list.
6. Maintain an allergy list.
7. Record demographics.
8. Record vital signs.
9. Record smoking status for patients 13 years and older.
10. Use one clinical decision support rule.
11. Provide patients the ability to view online, and transmit information within 4 days after information is available to the provider.
12. Provide clinical summaries for each office visit.
13. Protect electronic health information.
Stage 2—Meet all 13 objectives above plus 4 additional ones.
1. Include clinical lab test results in the EHR.
2. Perform medication reconciliation.
3. Submit electronic data to immunization registries.
4. Use secure electronic messaging to communicate with patients on relevant health information.
Menu objectives that provide flexibility for providers to choose
Stage 1—Select 5 of the following menu objectives; at least 1 is a public health measure.
1. Implement drug formulary checks.
2. Use clinical lab test results in the EHR as structured data.
3. Create patient lists by condition for quality improvement, reduction of disparities, research, or outreach.
4. Send patient reminders for preventive and follow-up care.
5. Use certified EHR technology to provide patient education resources.
6. Perform medication reconciliation for patients received from another setting/provider.
7. Provide a summary of care for patients referred to another setting/provider.
8. Able to submit electronic immunization information.
9. Able to submit electronic syndromic surveillance data to public health agencies.
Stage 2—Select 3 of the following menu objectives.
1. Submit electronic syndromic surveillance data to public health agencies.
2. Record patient notes electronically.
3. Have imaging results accessible in the EHR.
4. Record family history data.
5. Report cancer cases to public health cancer registry.
6. Report specific cases to a specialized registry.
Source: The Eligible Professional Meaningful Use Table of Contents Core and Menu Set Objectives at http://www.cms.gov/Regulations-and-Guidance/Legislation/EHRIncentivePrograms/Downloads/Stage2_MeaningfulUseSpecSheet_TableContents_EPs.pdf; the Eligible Professional’s Guide to Stage of the EHR Incentive Program at http://www.cms.gov/Regulations-and-Guidance/Legislation/EHRIncentivePrograms/Downloads/Stage2_Guide_EPs_9_23_13.pdf
In 2014, as a part of meaningful use Stages 1 and 2, eligible providers were required to select and report 9 of 64 clinical quality measures in three of the following six domains: patient and family engagement, patient safety, care coordination, population and public health, efficient use of health-care resources, and clinical processes/effectiveness. Note that the ability to report electronic syndromic surveillance data to public health agencies could assist with identifying and containing disease outbreaks, such as the Ebola hemorrhagic fever virus that erupted in 2014 across the world. Additional information about the clinical quality measures is online at http://www.cms.gov/Regulations-and-Guidance/Legislation/EHRIncentivePrograms/ClinicalQualityMeasures.html.