This is Part One of a two-part series. Watch for the next section, which will cover EHR implementation from a nursing perspective.
By now, everyone knows that electronic health records (EHRs) are the next big thing in health care. Likewise, just about everyone has seen or heard the term “meaningful use” used in conjunction with EHRs. But if you’re not quite sure what the term means, or how it will affect you as a nurse, you’re not alone. Hospitals everywhere are struggling to make sense of meaningful use requirements and apply them to their information technology (IT) initiatives. This two-part series will provide a big-picture look at the upcoming transition to electronic records, with a spotlight on the nursing perspective.
The basics of the HITECH act
EHRs have existed for more than three decades now, although hospitals have been slow to adopt them – mainly because of the expense and logistical issues surrounding their implementation. In 2009, Congress passed the Health Information Technology for Economic and Clinical Health Act (HITECH), as part of a larger economic stimulus package. This mandate gave the health care industry a transformational opportunity to break through the barriers that had been impeding EHR adoption, and committed unprecedented resources to deploying them widely.
HITECH made the stakes for hospitals and care providers very high, by authorizing incentive payments (through Medicare reimbursements) to clinicians and hospitals that use EHRs in a manner that improves certain health care efficiencies and outcomes. In other words, hospitals can no longer afford to delay the move to electronic records. What’s more, it’s not enough to simply convert paper records to a digital format – the technologies must actually provide tangible benefits to patients and providers. That’s where the concept of meaningful use comes into play. Basically, meaningful use is the set of standards and benchmarks defined by the Centers for Medicare & Medicaid Services (CMS) that allows hospitals and providers to earn incentive payments when they meet specific criteria.
A tiered approach to meaningful use
Meaningful use guidelines have been issued in stages, with a tiered approach to increasing complexity in the way the new technologies are used. Hospitals and providers are currently looking ahead to 2014, when stage two requirements take effect. During this stage, the core competencies will remain the same in all stages, but the requirements will become more rigorous. For example, let’s look at the requirements for e-prescribing, most often referred to as computerized provider order entry (CPOE):
- Stage One: mandated that CPOE be used for prescribing in 30 percent of all unique patients taking at least one medication.
- Stage Two: mandates that CPOE be used to issue least 60 percent of medication orders, 30 percent of laboratory orders, and 30 percent of radiology orders issued.
Hospitals have a lot of work to meet stage two requirements. A complete comparison of stage one and two requirements in all other areas, from transitions of care to making scans and tests available through the EHR is available.
Defining the goals of meaningful use
It’s important to remember that meaningful use sets goals that are about health care, not about technology. So even though the use of CPOE is mandated at a certain level, the idea is that electronic prescribing will make patients safer by preventing medical errors and adverse drug interactions.
Federal goals for meaningful use are to use EHR technologies to:
- Improve the quality, safety, and efficiency of patient care
- Reduce health disparities
- Engage patients and families
- Improve care coordination
- Ensure adequate privacy and security for personal health information
- Improve public health
A brief and very useful table breaks down each of these goals into specific activities. Meaningful use becomes a bit more clear when you see that the goal of “engaging patients and families” will be furthered through technology by “providing patients with an electronic copy of their health information (including diagnostic test results, problem list, medication lists, medication allergies), upon request.”
How does meaningful use affect nurses?
Obviously, a lot has to happen before all providers and hospitals have fully implemented their EHRs and are making meaningful use of them. It’s likely to be a messy process, as workflow processes are redesigned and integrated into the new normal. At the very least, nurses should recognize that big changes are just ahead. It’s likely they’ll experience some frustration at the bedside as imperfect implementations are rolled out.
For example, according to a study published in the September 2012 issue of the Journal of American Medical Informatics Association (JAMIA), CPOE requirement is more challenging than any of the other criteria. As e-prescribing is adopted in stages, what will the affect be on nurses? Will they have to keep track of both paper orders and digital orders, on two different systems, until the entire transition is made to the electronic system? What if a hospitalized patient is being treated by multiple specialists, some of whom have adopted CPOE and others that still use paper prescription pads? Will orders be more likely to get lost in the system, or duplicated in two forms, during the transitional phase? What safeguards will nurses have to put in place to detect these transitional errors?
When questions like this arise, it becomes obvious that nurses must collaborate with technology departments to keep patients safe and meet the goals of meaningful use.
Stay tuned for part 2 of this series which will take a look at the ways this collaboration is occurring, and how nurses can get involved with their hospital’s EHR implementation. Part 2 also will detail some of the new roles that are emerging for tech-savvy nurses, and how nursing informatics can become an exciting career specialty.
Health care is in need of nurses who can analyze technologies from both the bedside and IT perspectives. An online MSN degree in nursing informatics is the perfect way to improve your knowledge, skills, and value to your organization. American Sentinel University is an innovative, accredited provider of online nursing degrees, including programs that prepare nurses for a specialty in case management, infection prevention and control, and executive leadership.