In 2009, President Obama signed the HITECH Act into law, creating a roadmap for a nationwide health information infrastructure. The goal was to have every healthcare provider in America using electronic health records (EHRs) in such a way as to improve care quality and efficiency of care delivery.
The Act included $30 billion in incentives for providers meeting "Meaningful Use" Criteria, which were to be deployed in three stages. Stages 1 and 2 are already out of the gate, and EHRs have been widely adopted. Criteria for Stage 3 was released in March.
Meaningful Use, managed by the Center for Medicare & Medicaid Services (CMS) offers financial incentives that pay providers to achieve specific results. Eligibility requirements for professionals varies depending on the incentive program that is chosen for participation. Demonstrating Meaningful Use requires achieving compliance objectives at each stage. By 2012, around three-quarters of office-based primary care physicians had EHR systems, and most providers implementing them said that financial incentives and penalties were big influences in their adoption.
Meaningful Use Stages 1 and 2
The Meaningful Use Stages can be thought of like an escalator. The first stage focused on getting people on board, and subsequent stages involve higher levels of use. The higher levels of use focus on delivering better care through more advanced EHR use. For Stage 1, participants had to meet 19 out of 24 measurable goals that included things like electronic checking for drug interactions, and EHR maintenance including demographics, hospital electronic discharge records, and a security risk analysis.
In Stage 2, more is required for eligible professionals. For example, patient vital signs are to be electronically collected, charted, and stored as structured data. Perhaps most importantly, Stage 2 requires online availability of patient information so patients can view information online, as well as download and transmit it to other healthcare providers. Stage 2 has been harder for providers than Stage 1, and software and IT issues have hampered some Stage 2 efforts.
Meaningful Use Stage 3
The goal of EHRs and Meaningful Use are ultimately better and more efficient healthcare with a lower price tag. Stage 3 of Meaningful Use, which has been delayed until 2017, revolves more around data interoperability between EHR softwares. Problems have arisen when it comes to integrating third party vendors with legacy healthcare information systems. Many EHR systems are "closed" systems, which makes it harder to integrate third-party solutions for things like electronic prescribing and sharing of data.
The reasoning behind having EHR software with data sharing capabilities is to give patients and caregivers a holistic view of the health record. Therefore empowering patients to take better control of their health and allow caregivers to make better decisions. It is hoped that ultimately sharing requirements will push toward greater standardization of electronic health data and EHR systems.
Doctors See Potential for Benefits, But Many Aren't Impressed
Many doctors have found complying with Meaningful Use difficult and costly, and a number have remained "stuck" in Stage 1. Smaller practices in particular have struggled to comply with the first two stages of Meaningful Use, and many doctors simply aren't seeing benefits of Meaningful Use in terms of better or more efficient healthcare delivery yet.
Ultimately, EHRs and Meaningful Use should offer tremendously valuable insights, but making the systems easy to adopt while still able to gather Meaningful Use data is proving to be a challenge for many vendors.
In 2008, only 17% of doctors in the US used EHRs, and only 9% of US hospitals used them. The data tha has developed because of EHR usage is becoming available and showing that when well-implemented and managed, EHRs can improve healthcare safety, effectiveness, and efficiency.
Likewise, Meaningful Use compliance should result in better health outcomes, more involvement of patients in their own care, and lower healthcare costs. While there are still numerous problems to be worked out with EHRs and Meaningful Use, the end goal is positive and attainable.