Records Privacy Blog

“Meaningful use” is the term used in the Health Information Technology for Economic and Clinical Health (HITECH) section of ARRA (aka the

stimulus bill).  It refers to a set of criteria required to receive incentive payments from either Medicare or Medicaid.  The notion is that over the five years of incentive payments, physicians will need to meet a series of benchmarks to demonstrate their meaningful use of an EHR.  The benchmarks will get more challenging in succeeding years.

It is up to the Centers for Medicare and Medicaid Services (CMS) to finalize these benchmarks for meaningful use.  In this task, they will be guided by recommendations from the HIT Policy Committee.  The Committee issued their preliminary recommendations last July (see http://healthit.hhs.gov/portal/server.pt/gateway/PTARGS_0_10741_888532_0_0_18/FINAL%20MU%20RECOMMENDATIONS%20TABLE.pdf ).  CMS will now prepare the final recommendations for public comment and formal issuance, but it does not look like that will occur until the first quarter of 2010.

The recommendations for the 2011 meaningful use criteria will be likely to involve reporting on certain chronic health problems (diabetes, hypertension, and smoking).  Physicians will also be expected to use e-prescribing and computerized physician order entry (CPOE).  CMS will probably require physicians be able to provide patients with an electronic copy of their medical record.

Hospitals are also eligible for incentive payments and the recommendations include benchmarks for how to achieve meaningful use at the institution level.

The incentive payments are scheduled to start in 2011, so there is little time to prepare.  The vendor community is aware of these proposed measures, but given the timing, you should already be discussing how this functionality will be supported by your EHR.  For some systems, the functionality will come with a new release.  Preparing for that will require time and resources, and both are in short supply.

Don’t guess; your vendor’s got a list. 

The stimulus funding, also known as the American Recovery and Reinvestment Act (ARRA) is starting to flow.  Or if not flow, the feds have at least connected the pipes without actually turning on the spigot.  So what does this mean to CIO’s in the health arena?

One funding opportunity (https://www.grantsolutions.gov/gs/preaward/previewPublicAnnouncement.do?id=10534 ) will support the creation and operation of health information exchanges.  If you haven’t already connected with the exchange in your state, it is time to do so.  The exchange will likely be run by state government, a private entity, or some combination.  Although there may be multiple regional exchanges in your state, the HIE grant opportunity is targeted to the “state designated entity (SDE).”  This will be the exchange that the state’s Governor names as the statewide exchange.

Your job will be to ensure that your electronic medical record system is able to supply information through the exchange to requestors.  Typically this exchange will be brokered through interfaces maintained by the exchange to your EMR software and with the requesting site.  The kinds of information exchanged will include eligibility and claims transactions, eprescribing transactions, laboratory orders and results, public health reportable conditions, clinical information, and quality measures.  Each state exchange will then connect to the National Health Information Network, allowing interstate transfers of information.

There are a host of policy and privacy issues around this exchange, so you should also be talking to your legal advisors.

Enabling the electronic exchange of health information is a key component in making hospitals and physicians eligible to receive incentive payments from Medicaid and Medicare starting in 2011.  The implicit promise behind funding this infrastructure is lowered healthcare costs through the avoidance of duplicative testing, more complete and timely patient information, and, ultimately, better outcomes.