As President Trump seeks to overhaul Obamacare, many health care officials are urging the president to ditch Meaningful Use (MU) and other technical regulations that will require them large sums of money to comply with, while pushing for measures that continue to advance technology in medicine and allow for more flexibility in national Electronic Health Record (EHR) incentive programs.
The widespread adoption of EHR technology in recent years has been encouraged largely due to government mandates outlined in the former President Obama’s Affordable Care Act (ACA). The American Recovery and Reinvestment Act of 2009 went further, authorizing the Centers for Medicare & Medicaid Services (CMS) to provide incentive payments to eligible professionals and hospitals that adopt, implement, upgrade or demonstrate “meaningful use” of certified EHR technology.
This national movement from paper to pixels not only put the onus on practitioners to implement and perform, but it also tasked nurse educators with instructing nursing students on how to use various forms of EHRs, so that they are more proficient on the technology when they get to the workforce, and so that they can provide hospitals with much-needed feedback on implementation.
Meaningful Use referred to the EHR Incentive Programs established in the ACA to encourage eligible professionals and eligible hospitals to adopt, implement, upgrade (AIU), and demonstrate meaningful use of certified EHR technology. Government officials made “meaningful use” of EHRs one of the factors that determines a provider’s Medicare reimbursement, but many in the field considered the MU standards too rigid.
"Stop MU and redirect resources focused on the program," said Marc Probst, CIO of Intermountain Healthcare in Salt Lake City, and an original member of the Health IT Policy Committee of the Office of the National Coordinator. "Any value that potentially came from MU is now over."
Probst added that "the check-the-box approach to HIT [health information technology] is severely limiting innovation, frustrating caregivers and increasing costs. [It's] time to let providers and other HIT organizations figure out for themselves how to best utilize the EMR technology and get value from their investments."
The College of Healthcare Information Management Executives, of which Probst is current chair, is drafting a bill for Congress that would create a semantic interoperability of EHR systems and data.
Meaningful Use refers to using certified EHR technology to:
Sounds good, right? But critics say the MU requirement was way too rigid and placed onerous and expensive regulations on practitioners and threatened their Medicare reimbursements. The Merit-Based Incentive Payment System (MIPS) is a Medicare payment system that aims to factor value into provider reimbursement. It, along with a separate Advanced Alternative Payment Models program, was mandated by the federal Medicare Access and CHIP Reauthorization Act (MACRA) of 2015.
MIPS takes into account four performance categories that will affect a provider’s Medicare reimbursement: cost, quality, clinical practice improvement activities and, previously, Meaningful Use. But in April 2016, “Meaningful Use” was restructured into what’s known as “Advancing Care Information.” ACI will account for 25 percent of your total MIPS score beginning in 2017 for reimbursement in 2019; the final score earned by a clinician for a given performance year then determines MIPS payment adjustments in the next calendar year.
The CMS says the major benefit to housing EHR technology requirements under ACI instead of MU is that it now provides a measure of partial credit to any clinician or practice that makes progress in implementing new technology, instead of treating it as “all or nothing.”
To earn the ACI category’s full 25%, providers must score 100 points or higher. Fifty points are available as a “base score” for providers who simply answer a series of “yes/no” questions about whether they have completed the requirements of the ACI, which are similar to the measures for Meaningful Use Stage 3.
In another win for practitioners, last November, CMS said it would only require doctors and hospitals to track and report meaningful use data for 90 continuous days in 2017.
Beyond participation, providers can earn points for things such as patient electronic access and health information exchange. Additionally, predicting hospital readmissions is currently very important as reimbursement is dependent upon reducing readmissions. Predictive analytics, based on interpreting data collected and properly documented, can improve patient care while avoiding financial and reimbursement penalties for hospitals and health care facilities.
A number of international medical organizations, including the Quality and Safety Education for Nurses and the Institute of Medicine, recommend restructuring the way health professionals are educated to ensure they are equipped with the knowledge, skills, and attitudes needed to embrace EHR technology.
And with the growing usage of technology and mobile clinical decision support, there is also a growing emphasis on the importance of nursing informatics competencies in nursing schools. Nursing informatics combines nursing science with computer science, as well as information processing theory and technology. And with the proliferation of so much technology in the medical field, the roles of the clinical nurse, informatics nurse and informatics nurse specialist are complementary. The American Nurses Association states that clinical nurses must be involved in the selection, design, development, implementation, evaluation and improvement of EHRs and electronic patient-care devices used in patient-care settings.
The need to train nursing students on the various EHR platforms available is greater than ever before, in order to reduce medical errors and increase their input into implementation of the most effective systems in the workplace.
Nurse educators need to partner with curriculum experts who have a keen understanding of the leading academic and commercial tools that will most benefit nursing students and will provide ready solutions to enable student mastery of EHR processes and procedures.
EHR education should be provided through several approaches and flexible to meet individual and class-wide needs.
Lippincott’s DocuCare is a cutting-edge EHR training solution designed to prepare students for the technology demands of practice, so they can not only keep up with EHR tech, but they can be valuable contributors to EHR implementation processes. DocuCare integrates more than 200 patient scenarios with web-based EHR software to provide real-world practice with patient care documentation, ensuring your students are competent and practice ready.Learn more