EHRs in Health Care
In 2009, the Health Information Technology for Economic and Clinical Health Act (HITECH) was passed into law mandating interoperable Electronic Health Record (EHR) adoption throughout the United States health care system for all providers who serve Medicare or Medicaid patients. The HITECH Act sets “meaningful use” requirements, goals, and objectives, and gives specific timelines for which to achieve them. As an incentive to expedite the process, the Centers for Medicare and Medicaid Services (CMS) has offered monetary rewards for those facilities and physicians who are taking steps to implement an EHR system by 2015. Beginning in 2015, CMS will penalize facilities and physicians who have not implemented an EHR system. One of the stipulations of receiving the incentive money is demonstrating “meaningful use”, or utilizing EHR technology in a meaningful way that improves patient care. Meaningful use has three stages, each focusing on different areas of patient care. There are several advantages and disadvantages of implementing an EHR system, but the benefits greatly outweigh the risks. The HITECH Act is one of the most important pieces of health care legislation to date and has been called the “foundation for health care reform” (Blavin & Ormond, 2011).
In 2004, the Bush administration introduced a plan to ensure that the medical profession completely converts to electronic health records (EHR). This plan was passed into law by the Obama administration in 2009 under the Health Information Technology for Economic and Clinical Health Act (HITECH), which is a provision of the American Recovery and Reinvestment Act (ARRA) (Kwami, n.d.). This Act is essentially a $27 billion stimulus package meant to accelerate health care information technology in the United States. It allows the Centers for Medicare and Medicaid Services (CMS) to offer financial incentives (up to $44,000 from Medicare and $63,750 from Medicaid per physician or up to $2 million per hospital) for implementing an Electronic Health Record (EHR) system in their facility by 2015 (Murphy, 2012). Not only do they have to implement it, they must also meet the “meaningful use” requirements set forth by CMS for successful utilization of the EHR system. To receive the maximum incentive payment, physicians/facilities must begin participation by April 1, 2013. Starting in 2015, physicians and facilities who have not met those requirements will be penalized.
What is Meaningful Use?
Meaningful use is an umbrella term for the rules and regulations that hospitals and physicians must meet to qualify for the federal incentive funding under ARRA. There are three stages of meaningful use; each has different goals and objectives. For example, stage one focuses on data capture and sharing, and is grouped into five patient-driven areas related to patient health outcomes: 1.) Improve quality, safety, and efficiency, 2.) Engage patients and families, 3.) Improve care coordination, 4.) Improve public and population health, and 5.) Ensure privacy and security for personal health information (“Meaningful Use 101,” n.d.). Step two focuses on the advanced clinical processes involved in patient care and stage three will focus on improving actual patient outcomes. Requirements for meaningful use include the ability to e-prescribe, electronically exchange patient health information, and report on clinical data. The eventual goal is a national health information network. Facilities and physicians must achieve stage three of meaningful use by 2015.
Traditionally, physicians have been reimbursed based on how many services they provide (fee for service). Meaningful use shifts this paradigm to a more patient centered process and concentrates on performance-based initiatives like pay for performance (P4P) reimbursement. CMS recently introduced three P4P programs mandated...
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