01-10A - Introduction To Healthcare and Public Health in The US - Unit 10 - Meaningful Use of Health Information Technology - Lecture A

Introduction to Healthcare and
Public Health in the US

Meaningful Use of Health
Information Technology
Lecture a
This material (Comp1_Unit10a) was developed by Oregon Health and Science University, funded by the Department of Health
and Human Services, Office of the National Coordinator for Health Information Technology under Award Number
IU24OC000015.
Meaningful Use (MU)
Of Health Information Technology
Learning Objectives
Define meaningful use of health information technology in the
context of the Health Information Technology for Economic
and Clinical Health (HITECH) Act (Lecture a)
Describe the major goals of meaningful use (Lecture a)
Define the criteria for Stages 1 and 2 of meaningful use for
eligible professionals and eligible hospitals (Lecture b)
Describe the standards specified for Stages 1 and 2 of
meaningful use, including those devoted to privacy and
security (Lecture c)
Define the clinical quality measures (CQMs) for the
meaningful use program (Lecture c)
2
Health IT Workforce Curriculum
Version 3.0/Spring 2012
Introduction to Healthcare and Public Health in the US
Meaningful Use of Health Information Technology
Lecture a
HITECH, ARRA and
Achieving Meaningful Use
Health Information Technology for Economic and Clinical
Health (HITECH) Act of the American Recovery and
Reinvestment Act (ARRA) (Blumenthal, 2010;
Blumenthal & Tavenner, 2010)
Incentives for meaningful use (MU) of the electronic
health record (EHR) by physicians and hospitals (up
to $27B)
Direct grants administered by federal agencies ($2B)
Enhancements to HIPAA Privacy and Security Rules

3
Lecture a
Meaningful Use (MU) Driven
By Underlying Goals
For Healthcare System
Conceptually originated in legislation by Congressman Rodney Pete
Stark in 2010
All MU criteria must map to one or more of five goals for the
healthcare system
Improving quality, safety, and efficiency
Engaging patients in their care
Increasing coordination of care
Improving the health status of the population
Ensuring privacy and security
Examples
Implement drug-drug interaction checks Improving quality,
safety, and efficiency
Provide summary of care to patients Engaging patients in
their care

4
Lecture a
Overall Requirements
For Meaningful Use
Use certified EHR technology in a meaningful
manner
Use certified EHR technology connected in a
manner that provides for health information
exchange to improve the quality of care
Using certified EHR technology, the provider
submits information on clinical quality measures

5
Lecture a
Three Stages of Meaningful Use
Implementation
(McGuire, 2011)
6
Lecture a
Certified Electronic Health Records
A qualified EHR certified by an approved certifying entity
A qualified EHR is an electronic record of health-related
information on an individual that
Includes patient demographic and clinical health
information, such as medical history and problem lists
Has the capacity to
Provide clinical decision support
Support physician/provider order entry
Capture and query information relevant to
healthcare quality
Exchange electronic health information with, and
integrate such information from, other sources

7
Lecture a
Implementation
Implemented through increased Medicare or Medicaid
reimbursement to
Eligible professionals (EPs)
Medicare: MD, DO, DDS/DMD, DPM, OD, DC
Medicaid: MD, DO, DDS/DMD, Certified Nurse Midwives,
Nurse Practitioners, Physicians Assistants operating at an
FQHC/RHC
Hospital-based EPs not eligible (>90% service in hospital,
e.g., pathologist, emergency physician)
Eligible hospitals (EHs)
Medicare: Acute Care Hospitals, Critical Access Hospitals
(CAHs)
Medicaid: Acute Care Hospitals , CAHs, Childrens Hospitals
Within the 50 states and DC
Various differences in Medicare vs. Medicaid for amount
reimbursed, rules, and other aspects
8
Lecture a
Payment for Medicare
Eligible Professionals
Limited to 75% of Medicare charges

10.1 Chart: CMS.gov; Medicare and Medicaid EHR Incentive Program Basics (2012)
.
9
Lecture a
Additional Payment for
Medicare Eligible Professionals
In Health Professional Shortage Areas
These EPs can receive up to $48,400


10
Lecture a
Payment for Medicaid
Eligible Professionals

.
11
Lecture a
Payment for Eligible Hospitals
More complex depending on Medicare vs.
Medicaid, hospital type, and share of patients
Multi-campus hospitals count as one EH
General formula is that payment is multiplication
of:
Initial amount $2M + $200 per discharge for
1,150
th
to 23,000
th
discharge (maximum for
21,850 discharges is $2M + $4.37M = $6.37M)
Medicare or Medicaid share
Transition factor 1.0, 0.75, 0.5, and 0.25 over
four years depending on when become eligible

12
Lecture a
Meaningful Use Rules
Stage 1 final rules published on July 28, 2010
CMS Medicare and Medicaid Programs; Electronic Health
Record Incentive Program; Final Rule
ONC Health Information Technology: Initial Set of Standards,
Implementation Specifications, and Certification Criteria for
Electronic Health Record Technology
For those without time to read hundreds of pages, there are
excellent summaries and other materials from HHS, HIMSS,
CSC, and Geek Doctor blog
CMS Web site for program
http://www.cms.gov/ehrincentiveprograms/
EHR certification process guided by Temporary Certification Rule
released on June 24, 2010, to be superseded by Permanent
Certification Rule released in January, 2011 to start in 2012
http://healthit.hhs.gov/certification/
13
Lecture a
Connecting CMS and ONC Rules
HITECH ties the standards, implementation
specifications, and certification criteria adopted in ONC
rules to the incentives under the CMS Medicare and
Medicaid EHR Incentive Programs by requiring the
meaningful use of certified EHR technology
ONC rules require specific standards in four areas
Vocabulary
Content exchange
Transporting of information
Privacy and security
http://www.cms.gov/ehrincentiveprograms/
http://healthit.hhs.gov/
14
Lecture a
Electronic Health Record
Certification
Description of ONC HIT Certification Program: http://www.healthit.gov/policy-researchers-implementers/certification-programs-policy
List of certified EHR products: http://www.healthit.gov/policy-researchers-implementers/certified-health-it-product-list-chpl-0

(Health IT.gov; Certification Programs and Policy, 2012)

15
Lecture a
Electronic Health Record
Certification Process
Test procedures for EHR certification - http://www.healthit.gov/policy-researchers-implementers/2014-edition-draft-test-methods

(Health IT.gov; Certification Programs and Policy, 2012)

16
Lecture a
How Eligible Professionals and
Hospitals Receive Incentive Money
Meet and report on the MU criteria
Medicaid exceptions
In first year, EP/EH can demonstrate they
adopted, implemented, or upgraded (A/I/U) a
certified EHR
Can skip years but must begin by 2016

17
Lecture a
(CMS.gov; EHR Incentive Programs, 2012)

Cost Of Economic Stimulus
CMS estimates of EPs and EHs at onset of program
477,500 eligible as Medicare EP
95,500 of these eligible as Medicaid EP
44,100 eligible as Medicaid-only EP
5,011 EHs
3,620 acute care
1,302 CAH
78 childrens
11 cancer
Estimated achievement of MU in ten years
Low 95.6% of EHs and 36% of EPs
High 100% of EHs and 70% of EPs
Total cost: $9.7B (low) to $27.4B (high)

18
Lecture a
Meaningful Use Of Health
Summary Lecture a

The HITECH Act of ARRA legislated incentives
for the meaningful use (MU) of health IT
MU means that criteria for use of IT are tied
back to goals of the health care system
These criteria are met by eligible professionals
and eligible hospitals to receive incentive
payments for use of EHRs in three stages
19
Lecture a
References Lecture a
References
Blumenthal, D. (2010). Launching HITECH. New England Journal of Medicine, 362, 382-385.
Blumenthal, D., & Tavenner, M. (2010). The meaningful use regulation for electronic health records. New England
Journal of Medicine, 363, 501-504.
Metzger, J. and Rhoads, J. (2012). Summary of Key Provisions in Final Rule for Stage 2 HITECH Meaningful Use. Falls
Church, VA, Computer Sciences Corp.
http://assets1.csc.com/health_services/downloads/CSC_Key_Provisions_of_Final_Rule_for_Stage_2.pdf.

Charts, Tables, Figures
10.1 Chart: CMS.gov; Medicare and Medicaid EHR Incentive Program Basics. (2012). Retrieved December 2012, from
Centers for Medicare & Medicaid Services website: http://www.cms.gov/Regulations-and-
Guidance/Legislation/EHRIncentivePrograms/Basics.html

20
Lecture a
References Lecture a
(continued)
21
Lecture a
Images
Slide 6: McGuire, E. (2011). Focus on Healthcare Blog. Retrieved December 2012, from
http://healthcarehis.files.wordpress.com/2011/02/meaningful-use.jpg
Slide 15: Health IT.gov; Certification Programs and Policy. (2012). Retrieved December 2012, from U.S. Department of
Health & Human Services website: http://www.healthit.gov/policy-researchers-implementers/onc-hit-certification-
program
Slide 16: Health IT.gov; Certification Programs and Policy. (2012). Retrieved December 2012, from U.S. Department of
Health & Human Services website: http://www.healthit.gov/policy-researchers-implementers/about-
certification#benefits_of_certification
Slide 17: CMS.gov; EHR Incentive Programs. (2012). Retrieved December 2012, from Centers for Medicare &
Medicaid Services website: http://www.cms.gov/Regulations-and-Guidance/Legislation/EHRIncentivePrograms

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