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Definition

Meaningful Use

In the context of health IT, meaningful use is a term used to define minimum U.S. government standards for electronic health records (EHR), outlining how clinical patient data should be exchanged between healthcare providers, between providers and insurers and between providers and patients.

Although the meaningful use program in the U.S. was part of a successful effort to usher in EHRs, it was also unpopular with providers, who had to meet a slew of requirements to prove meaningful use. In 2018, the program was overhauled and renamed the Medicare and Medicaid Promoting Interoperability Programs by the Centers for Medicare and Medicaid Services (CMS). The term meaningful use is now largely outdated.

The general intent of meaningful use was to improve the collaboration between clinical and public healthcare, improve patient-centric preventative care and support the continued development of robust, standardized data exchanges.

In an effort led by both CMS and the Office of the National Coordinator for Health IT (ONC), meaningful use was phased into practice and divided into three stages, spanning from 2011 to 2015. In addition, CMS and ONC created incentive programs to encourage eligible professionals or eligible hospitals to adopt, implement and upgrade to certified EHR technologies (CEHRT) and demonstrate meaningful use in compliance with their criteria.

Meaningful use stages

When they were introduced, the Medicare and Medicaid EHR Incentive Programs were designed to measure the meaningful use of CEHRT in three stages:

  • Stage 1 focused on promoting the adoption of certified EHR technologies. This initial stage established requirements for the electronic capture of clinical data and giving patients access to electronic copies of their own health information.
  • Stage 2 expanded upon stage 1 criteria by encouraging the meaningful use of CEHRT. This stage emphasized care coordination and the exchange of patient information. It increased the thresholds of criteria compliance and introduced more clinical decision support, care coordination requirements and patient engagement rules. 
  • Stage 3 focused on using CEHRT to improve health outcomes by implementing protected health information, e-prescribing, clinical decision support, computerized provider order entry, patient provider access, coordinated care through patient engagement, health information exchange, clinical data registry and case reporting.

Breaking down the process into stages made it more feasible to implement and lessened the likelihood of overwhelming providers, although hospitals remained critical of the program.

Requirements

Meaningful use was based on five main objectives, according to the Centers for Disease Control and Prevention. They were:

  • Improve quality, safety, efficiency, and reduce health disparities.
  • Increase patient engagement.
  • Improve care coordination.
  • Expand population and public health.
  • Ensure adequate privacy and security protection for personal health information.

With these priorities in mind, CMS and ONC established meaningful use standards that EHRs needed to meet. These standards promoted the use of CEHRT. If CMS determined that a successful demonstration of meaningful use applied, the parties were then considered eligible for federal funds.

Because the meaningful use program was technically voluntary, meaningful use criteria were considered guidelines, not regulations. Still, failure to adhere to meaningful use resulted in reimbursement-related penalties.

History of meaningful use

The Health Information Technology for Economic and Clinical Health (HITECH) Act of 2009 promoted the adoption of meaningful use. Per the U.S. Department of Health and Human Services, Subtitle D of the HITECH Act addresses the privacy and security concerns associated with the electronic transmission of health information, in part, through several provisions that strengthen the civil and criminal enforcement of the HIPAA rules.

Eligible organizations for the Medicare EHR Incentive Program were required to achieve stage 1 meaningful use by 2014 in order to receive incentive payments. Deadlines were established and at times extended for stages 2 and 3. During this process, CMS established the Medicare and Medicaid EHR Incentive Programs to encourage clinicians, hospitals and clinics to implement meaningful use of CEHRT.

In April 2018, CMS renamed meaningful use from the EHR Incentive Programs to the Promoting Interoperability Programs, with the intent of reflecting a focus on improving interoperability, flexibility and patient access to health information.

In CMS' new rule, the agency noted that beginning with an EHR reporting period in 2019, all eligible hospitals under the Medicare and Medicaid Promoting Interoperability Programs are required to use the 2015 Edition of CEHRT. CMS also finalized changes to measures, including removing certain measures that do not emphasize interoperability and the electronic exchange of health information.

These changes had been heralded for several years. According to ONC, meaningful use shifted into the Merit-Based Incentive Payment System, or MIPS, in part due to the introduction of the Medicare Access and CHIP Reauthorization Act (MACRA) of 2015. MACRA is one of the four components of MIPS, which combines existing CMS quality programs (including meaningful use), the Physician Quality Reporting System and value-based payment modifiers. The consolidation was intended to improve quality of care.

This was last updated in December 2018

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How has meaningful use affected your organization's adoption of certified EHR technology?
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This article is well-written but useless in the grand scheme of how to provide great health care to sick and poor Americans. I wonder if compensated content authors like Mrs. Rouse really think the American public believes health care providers and the government really care about the public's overall health. The health care system has too many laws as it is and just expands these laws when the initial ones fail. What is the point of changing the name of the meaningful use law and developing additional criteria when the first effort faced so many implementation barriers by the very providers and health care delivery systems that claim to care about patients' welfare and public health?

Start with lowering healthcare costs, not creating more policies that providers refuse to follow. The cost of health care is too high; providers are taking advantage of the ICD coding system by over-billing insurance companies for simple procedures and basic diagnostic tests; private insurance company premiums are too costly and basically unregulated; the list of factual complaints about the American health care system is long and largely ignored by providers and health care delivery systems. Health care providers and health care delivery systems are about making money. This is evident as sick and dying people can be turned away by hospitals simply due to a lack of insurance. Providers and health care systems should not have to be compensated to provide patient-centered care. This shows the health care delivery system is comprised of providers who do not care and only make beneficial changes if forced or compensated. The health care system is not failing due to lack of policies based on good ideas; it fails because the people working for it do not follow the  basic ethical principles of nursing and medicine. I guess the only reason providers learned these principles is to include them in class papers. One of the main reasons for the failure is due to the apathy of nurses. Maybe it is unfair to point the finger at nurses, but since the statistics state that nurses have the most interaction with patients, nurses should be ashamed about the statistics regarding patient morbidity and mortality. The sad part is that nursing educators, administrators, providers, and policy makers all know what nurses should be doing. My point is, all providers and health delivery systems need to provide better care and stop with all the policies, health care jargon and legalese. 

Nursing and medical schools teach how nurses, doctors, and health care delivery systems should practice patient-centered care. This concept or theory is published in nursing, medical, and health care journals; health lecturers make speeches about it, and the government creates policies to enforce it. Yet, it is still a relevant topic of conversation because it is not being done. Meaningful use is another aspect of the health care system that attempts to promote patient centered care but has failed the American people due to the lack of action by the primary stakeholders charged with caring for the American people. 

thank you
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this illegally interferes with the practice of medicine  42 USC 1395 by specifying how a physician must keep records a prerogative of the practitioner.

If the physician does not comply financial penalities are levied and the the physician is locked out of CCM code payments.


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Are CMS attestations - accurate provider directory listings - part of Meaningful use? Which stage would this be considered?    
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