EHRs and Meaningful Use

by MDI Achieve

Posted on: January 29, 2010

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Electronic Health Records (EHRs) continue to be a hot topic in the long-term care industry. Now the discussion has begun to include issues such as government incentives, certification and "meaningful use." This leaves many wondering what all this means for long-term care providers.

Background
For more than two decades, health information technology vendors have been preaching about the efficiencies that can be realized by computerizing the process of providing health care, as well as the resulting quality of care improvements. As regulations increased, health care providers had no choice but to implement some type of software systems to comply with requirements such as electronic submission of MDS assessments in the 1990s and HIPAA-compliant electronic claims for Medicare and Medicaid in the 2000s. However, the full power of these systems remains untapped by providers who typically use only a fraction of the tools available in the software they already own.

In April 2004, President George W. Bush issued an executive order that empowered the Department of Health and Human Services to establish programs and regulations in order to "provide leadership for the development and nationwide implementation of an interoperable health information technology infrastructure to improve the quality and efficiency of health care."¹ The U.S. government understood the need for health care to utilize technology to allow the consumer's health information to follow that person through all care settings. With access to a patient's complete health record, better diagnosis and treatment decisions can be made by health care providers. Bush's Executive Order prompted the establishment of the Office of the National Coordinator (ONC), tasked with coordination of nationwide efforts to implement and use the most advanced health information technology and the electronic exchange of health information.

In December 2008, then President-Elect Barack Obama indicated this initiative would continue under his administration: "[T]he economic recovery plan I'm proposing will help modernize our health care system-and that won't just save jobs, it will save lives. We will make sure that every doctor's office and hospital in this country is using cutting edge technology and electronic medical records so that we can cut red tape, prevent medical mistakes, and help save billions of dollars each year." True to his word, President Obama signed The American Recovery and Reinvestment Act of 2009 (ARRA) which authorized the Centers for Medicare and Medicaid Services (CMS) to provide incentives to providers for the adoption and meaningful use of certified EHR technology, through provisions of the Health Information Technology for Economic and Clinical Health (HITECH) Act.

What is "Certified EHR Technology"?
The ONC has established specific goals for implementation specifications and certification criteria that are largely centered on developing standards so that all certified systems will speak the same language to allow the efficient exchange of information.²

Certification bodies, such as the Certification Commission on Health Information Technology (CCHIT), are working to develop certification criteria that will be based on the technology standards that are identified, as well as the criteria defined by CMS for meaningful use, specific to the care setting(s) targeted. When these standards and criteria are finalized, certification bodies will be able to guide technology vendors through the process of demonstrating compliance of their systems to become "certified EHR technology." The ONC plans to issue a separate rule relating to the testing and certification of complete EHRs and EHR modules in 2010.

What is "Meaningful Use"?
Meaningful Use is simply a legal term for determining whether an eligible party qualifies for incentives under ARRA. In December 2009, CMS announced a proposed rule that includes a definition of meaningful use criteria in stages, to begin in 2011. Stage 1 criteria include.
• Electronically capturing health information in a coded format,
• Using that information to track key clinical conditions,
• Communicating that information for care coordination purposes, and
• Initiating the reporting of clinical quality measures and public health information.

Under the proposed rule, "eligible professionals" (EPs) and eligible hospitals and critical access hospitals could qualify for monetary incentives for efforts to adopt implement, or upgrade certified EHR technology for meaningful use, based on 23-25 specific objectives/measures for each care setting.³ The incentive program will provide incentive payments for efforts to adopt, implement, or upgrade certified EHR technology, but they must also demonstrate meaningful use of this technology according to the specific objectives. Simply purchasing a certified system is not enough.

What does this mean for EHRs in Long-Term Care?
In the current proposed rule, LTC providers are not included in the groups who are eligible for incentive payments for implementation and meaningful use of certified EHR technology. However, under the original Executive Order of 2004, all care settings were included in the mandate of the use of EHRs by 2014.

CCHIT's Long Term and Post Acute Care (LTPAC) workgroup has been active in identifying criteria that apply to Skilled Nursing Facilities (SNFs), Medicare-certified Home Health agencies, inpatient and home Hospice programs, Inpatient Rehabilitation Facilities (IRFs) and Long-Term Acute Care settings. Under their design, the LTPAC certification program will include certain EHR functionalities required to support reimbursement. The LTPAC workgroup will publish their "roadmap" criteria to indicate expected requirements for the future, possibly as soon as 2013.

References

1. Executive Order 13335. Incentives for the Use of Health Information Technology and Establishing the Position of the National Health Information Technology Coordinator, Published in the Federal Register, April 30, 2004. Retrieved from http://edocket.access.gpo.gov/2004/pdf/04-10024.pdf.

2. Facts-at-a-Glance. Health Information Technology: Initial Set of Standards, Implementation Specifications, and Certification Criteria for Electronic Health Record Technology. Retrieved from http://healthit.hhs.gov/.

3. CMS Fact Sheet. CMS Proposes Definition of Meaningful Use of Certified Electronic Health Records (EHR) Technology, Released December 30, 2009. Retrieved from www.cms.hhs.gov/apps/media/press/factsheet.asp?Counter=3564.

MDI Achieve is the leading provider of software solutions for the eldercare continuum. Our Matrix software is a fully integrated, web-based solution with EHR capabilities designed to improve quality of care, documentation and administration of eldercare organizations.

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