The Requirement of Meaningful Use - Essay Example

? Electronic Health Records (EHR) Electronic Health Records (EHR) Meaningful Use Meaningful Use is a new legislation that was enacted in the US under the ARRA Act and it was formalized into law in 2010. It affects the use of an EHR (Electronic Health Record) and its implications are long-term. It is also evident that with the effective advent of the requirement of meaningful use by the US government, the implementation and adoption of the EHR are compulsory and mandatory. Thus, the roadmap that was government-mandated for the EHR elaborately signifies serious implications to the definition and success critical factors of the EHR implementation. This study will comprehensively and extensively outline the conceptual framework which models the on the meaningful use since the study examines the context, intent and content factors that are involved in its outcome generation. Despite all the merits associated with the EHR roadmap which includes the introduction of a content and definitional order to an initial chaos in literature, EHR since possesses challenges that are inherent to its future (Department of Health and Human Services, HHS Press Office, 2010). The US government on July 13, 2010, put into action an ambitious 5-year transition plan which changed from the paper health record system to the electronic health record (EHR) system. The journey had initially started in 2004 when it was mentioned by President Bush during the address known as the State of the Union and there was a successive adoption of a 10-year plan through the HITECH (Health Information Technology for Economic and Clinical Health) Act of 2009. This was a momentous landmark for the US health care system. This signified a clear roadmap commitment to a paperless health record era and this policy reforms have led to a shift in health care practice as well as vested interests from each stakeholder in the healthcare system. This milestone evidently affects everyone including the policy-makers, policy-enforcers, and professionals in the healthcare system, Health IT software vendors as well as health researchers (Department of Health and Human Services, HHS Press Office, 2010). The ISO (Organization for Standardization) has effectively defined the Electronic Health Records (EHR) as a repository of data from the patients in digital form, that is exchanged securely and stored and can be accessible to a number of authorized users. Thus, it contains concurrent, prospective, and retrospective information and its major function is to support efficient, continuing and quality integrated health care. EHR has various definitions among them the computerized patient records (CPR) and also the electronic medical records (EMR) (Amatayakul, 2004). It is evident that through the advent of the US State Department of HHS (Health and Human Services) ruling in regard to the meaningful use of the EHR, it thus set forth the standards and the definition by which the EHR system was judged. In accordance to these regulations, the vendors will ensure that their efficient systems match up according to the required capabilities as well as assuring the providers that the systems they are acquiring from them will assist them in achieving meaningful use objectives as well as the 5-year national plan initiative in order to adopt and use the electronic health records (Department of Health and Human Services, HHS Press Office, 2010). A meaningful Use Overview There are namely two definitions of meaningful use which are user-related definition and the technology-related definition. In regard to the upgrade, implement and adopt certified EHR technology rule, the providers who meet this particular standard of measure during the first participation year are adequately compensated. Subsequently, in the years that follow in the participation, the providers must demonstrate certified EHR technology meaningful use through a means which is approved by the State as well as acceptable to the Secretary of DHHS (Department Health and Human Services). Thus, the first year targets various efforts that are geared towards adoption and the subsequent years are targeted on the actual implementation. In this scenario, implementation is properly defined as upgrading, implementing or adopting certified EHR technology which is capable of achieving meaningful requirement use; or expands the functionality that is available and commences utilization of EHR technology that is certified and is capable of meeting and achieving meaningful use requirements normally at the practice site which includes training, maintenance and staffing. The Department of Health and Human stipulates further deliverables by expounding that clinicians and health institutions should in subsequent years portray meaningful usage through attesting that they have adopted (that is installed and acquired) or commenced utilization of ( that is, implemented) EHR technology that is certified; or upgraded ( that is expanded) the functionality available of the EHR technology that is certified and therefore commenced with the utilization at the practice site (Department of Health and Human Services, HHS Press Office, 2010). EHR Terminologies Qualified EHR There are various terminologies that are associated with the EHR technology among them being a qualified EHR which means that it is an electronic record of information namely health-related on an individual and it includes the clinical health information for example the problem list and the medical history and the patient demographics. A qualified EHR has the immense capacity to offer clinical decision support, provide support in the physician order entry, to query and capture information that is relevant to the health care quality and also to exchange electronic health information (Amatayakul, 2004). EHR Module EHR Module refers to any component, service or combination thereof which can effectively meet the required standard of one certification criterion that is adopted by the Secretary of Secretary of DHHS (Department Health and Human Services). EHR modules examples include an interface or software program which provides the capacity to exchange carious electronic health information. Another example of an EHR module is a software program that is used in submitting public health information to various public health authorities or it can also be a quality measure of reporting software or service program (American Medical Association, 2010). Complete EHR A complete EHR encompasses EHR technology which can perform every applicable capability that is required by the certification criteria and it can be distinguished from the other EHR technology which cannot perform such capabilities. Complete EHRs are supposed to have capacities and capabilities that are beyond those addressed in the certification criteria (American Medical Association, 2010). Certified EHR Technology A certified EHR technology is a complete EHR or is a combination of EHR Modules and each of which effectively meets the required standards which include the Qualified EHR definition and it has been certified and tested in accordance to the certification program which is established by the national Coordinator (Amatayakul, 2004). Meaningful Use This is the use of the certified EHR technology mainly in the health practice in order to achieve the set goals of an improved health care efficiency, quality and patient safety (American Medical Association, 2010). Meaningful user A meaningful user is a qualified and certified health practitioner who uses certified EHR technology in order to achieve health care which is evidence-based, equitable, efficient, and patient centered and prevention-oriented (American Medical Association, 2010). Standardization/Certification stipulations The standardization aspect is the most important factor in the meaningful use requirement. It is worth mentioning that the meaningful use Stage 1 deals principally with data retrieval, data storage, data capture and reports generation from various multiple departments that are within the health facility. Stage 1 is achievable through the CPOE system (Computerized Patient Order Entry). Meaningful use Stage 2 criteria build on Stage 1 in order to exchange summaries of the patient care to other support transitions that are across unaffiliated settings, providers and EHR systems. Lastly, meaningful use Stage 3 deals on primarily on decision support for conditions that are of national high priority, access to various comprehensive patient data by way of patient-centered, robust health information exchange, access to the self management tools by the patient as well as improving population health (Amatayakul, 2004). The Department of HHS (Health and Human Services) adopted also standards that are closely related to the four recommended categories by the HITS (Health Information Technology Standards) Committee. This comprised of the vocabulary standards which include code sets and standardized nomenclatures that are used in describing clinical problems, the context exchange standards which involves standards that are used to share clinical information. The third category is the transport standards which are the standards that are used in establishing a predictable, common and communication protocol across the system. Finally, the security and privacy standards are concerned with the security transmission, access control and, authentication (Department of Health and Human Services, HHS Press Office, 2010). The evolution of EHR The notion of EHR began in the 80s in the disguise of the name CPR (computer-based records) that became to be referred to as the EMR (electronic medical records) in the 90s and then changed to electronic health records. Sometimes EHR and EMR are used interchangeably though there is a huge difference among the two. EMRs are not interoperable with other EMRs mainly outside their home enterprise. Ideally the term EHR elaborately implies an interoperability level with the other EMRs. The strong emphasis of health rather than the emphasis of medical record in EHR is mainly to stress on its longitudinal nature which is mainly across providers and time. The Institute of Medicine made a landmark report in 1991 which called for the achievement and establishment of paperless records in 10 years and this can be argued as the main foundation to the 2010 government roadmap (American Medical Association, 2010). The EHR vision was achievable due to the undying desire to have an elaborate system which could offer longitudinal data which is available to various clinicians in enabling ways so that they could make or arrive at informed decisions. Through this achievement, the health professionals would achieve workflow efficiencies and also lead to heath delivery cost reduction. The overarching EHR vision has been evidently been echoed over time since the inception of the noble idea and thus, the goal or the intent of the EHR technology has been stable since time immemorial (American Medical Association, 2010). In the 80s, the feeder system was developed whereby it functioned similarly to clinical workstations and it was capable of handling various clinical issues which included results reporting, telemedicine applications, decision support, order entry and access to transcribed reports. In addition, these workstations handled financial and administrative information such as the payroll, personnel and material management; research findings such as quality assurance, clinical trials and analyses; scholarly information which included digital libraries; as well as office automation such as word processes and spreadsheets. It is paramount to note that the paper system was inefficient and error-plagued. Eventually, these clinical work stations evolved into electronic medical records which are secure, confidential, accessible and acceptable to patients and health care professionals. It also contains other information that is non-patient-specific. Thus, the EHR terminology evolution began with the CPR (computer-based patient records) which were popular in the 80s and this term was replaced progressively in the 90s by the term known as electronic medical records which has evidently evolved to what is known today as the EHR (electronic health records) (Amatayakul, 2004). The EHR Meaningful Use Roadmap The framework for meaningful use consists of three fundamental stages which are Stage 1 that began in 2011, Stage 2 that began in 2013 and Stage 3 that is supposed to begin in 2015. Stage 1 focuses primarily on the electronic capturing of a number of health information. This is mainly in a coded format and at the same time using that information to tracking vital clinical conditions. It then communicates this information in order for the purposes of care coordination. Stage 2 effectively builds on Stage 1 criteria in order to encourage the utilization of health IT for the purposes of continuous quality improvement mainly at the point of care as well as the exchange of vital information in different health care units. Stage 3 focuses primarily on promoting improvements on safety, quality and efficiency as well as aiding in decision support on various national priority conditions (Amatayakul, 2004). In accordance to the US Department of HHS (Health and Human Services), meaningful use is defined as using EHR technology that is certified in order to improve efficiency, safety, quality and reduce health disparities. In addition, it purpose also involves engaging families and patients in their health care; improve public and population health and care coordination at the same time maintaining security and privacy. Therefore, meaningful use has three main components which include the use of EHR that is certified in a consequential manner for example e-prescribing; the utilization of EHR technology that is certified in order to submit clinical quality measures as well as achieve other mandated measures; and the exchange of health information electronically in order to improve the health care quality (Department of Health and Human Services, HHS Press Office, 2010). HER Strategy and Outcomes The framework for EHR is for a descriptive purpose and it contains three major elements which include the content, context and intent. By intent, it refers to the EHR technology goals while context outlines the environment which carries the technology. Content refers to the capacity and capabilities of the EHR system itself. It is worth noting that three stages in the US government road map towards achieving its set objectives which include Stage 1 which performs the main task of data capture; Stage 2 effectively deals with sharing of information; and Stage 3 deals with decision support (American Medical Association, 2010). EHR Strategy The specified EHR strategy in the meaningful use is elaborately summarized as to comprise of content, context and intent. Prior to the advent of meaningful use, the context and intent were fairly clear and the vision was to establish a system which would achieve particular common goals. These goals are referred as intent. Intent in regard to EHR refers to the legibility and availability of patient data which can be stored effectively secure and can be retrieved in a manner that is longitudinal in order to allow quality health care decisions. Context has evidently not changed over the years and in EHR technology, context is described as tertiary, secondary and primary health care facilities. Presently, EHR context is viewed as in-patient facilities, hospitals, emergency and ambulatory practice. The greatest transformation in the current framework is notable in the EHR content. Meaningful use has effectively stipulated the standardization criteria as well as the required standard, databases and networking (American Medical Association, 2010). Assessment Modeling In regards to the assessment modeling component, it deals with the various outcomes of the intent-context-content strategy which asses if the strategy is effective and successful by analyzing the outputs. The fundamentals of EHR are very clear: lowered costs, improved health care reduction, increased efficiency and enhanced security and privacy. Recent research has comprehensively shown that the benefits of the implementation of a computer-based patient record far outweigh the administrative, clinical, workflow as well as the revenue challenges. The transition of the present day EHR system has been a journey from un-standardized and disjointed desperate systems by way of a government mandated roadmap to the more effective and efficient present day and improved EHR system and strategy (Smith & Kalra, 2008). Model Assessment The model assessment is the component which measures the impact and the effects of the EHR roadmap implementation. This component elaborately reveals the point of evaluation of the whole model. The ultimate success of any particular information system can only be measured by the use of six vital dimensions. These are information quality, system quality, usage, impact on organization, impact on individual and user satisfaction. System quality refers to the information system processes including their attributes whereas information quality ideally measures the information output/input attributes. The information use dimensions quantify the end-user system consumption whereas the individual impact outlines the behavior of the end-user and is based on the information attributes and effects. The organizational impact checks on the performance of the organization in regard to the information attributes and output (Smith & Kalra, 2008). Conclusion The framework of meaningful use effectively presents the advantage of a less confounding; more defined; more standardized system and terminology; and also an incentive for the various EHR implementation and adoption. Meaningful use specifies the system standard at all the four levels mainly the content exchange standard which is the standard that is used in sharing clinical information, vocabulary standards which consist of standardized code sets and nomenclatures that are used in describing clinical problems, and transport standards which are concerned with establishing a predictable, common and communication protocol across the systems. The other standard is the security and privacy standard which involves transmission security, access control and authentication (American Medical Association, 2010). References Amatayakul, M.K. (2004, 2nd Ed.), Electronic Medical Records: A practical Approach for Professionals and Organizations. Chicago, Illinois: American Health Information Management Association. American Medical Association (2010): Health Information Technology (Health IT) Terminology. Retrieved from http://www..ama-assn.org/ama/pub/physicianresources/ Solutions/solutions-managing-your’s-practice/... on 04/05/2013. Department of Health and Human Services, HHS Press Office. (2010). Secretary Sebelius announces final rules to support ‘Meaningful Use’ of electronic health records [Press Release]. Retrieved on 04/05/2013 from http://www.hhs.gov/news/press/2010pres/07/20100713a.html Smith, K., & Kalra, D. (2008). Electronic health Records in Complementary and Alternative Medecine. International Journal of Medical Informatics, 77, 576-588. Read More