Meaningful Use

Meaningful use is using certified electronic health record (EHR) technology to: Improve quality, safety, efficiency, and reduce health disparities. Engage patients and family. Improve care coordination, and population and public health.

Meaningful use, which CMS changed to "advancing care information" and rolled out under the Medicare Merit-based Incentive Payment System, will now be called "promoting interoperability."

Meaningful Use Proposals: An Opportunity To Provide Comment

Public comment is open for three recently published notices of proposed rulemaking that intend to restructure the Electronic Health Record Incentive Program (aka meaningful use) requirements starting this year through 2017, as well as define Stage 3 meaningful use, set to begin in 2018.

CMS and the Office of the National Coordinator for Health IT's NPRMs will affect more than 538,000 active program registrants, including eligible hospitals (EHs), critical access hospitals (CAHs), eligible professionals (EPs) and the developers of more than 2,600 health IT products currently used to meet meaningful use. Most importantly, the meaningful use program will continue to affect care delivery in the U.S. health care system as a whole with the potential to improve patient outcomes.

All three NPRMs propose significant changes to the program in different ways, yet align with each other to redefine meaningful use. The most important takeaway for providers and health IT developers alike is that now is the chance to influence program changes based on their hands-on, frontline experiences.

Providers and health IT developers should provide comments on both the favorable and challenging proposals. CMS and ONC will review and evaluate all comments they receive. Thus, the more support they receive for a proposal, the more likely they will finalize it as is.  

Top Three Stage 3 Takeaways and Ideas for Public Comment -- Due May 29, 2015

The sum of the CMS Stage 3 NPRM and meaningful use-related components of the ONC 2015 Certified EHR Technology NPRM are that Stage 3 will be more challenging and complex than Stage 2, with ambitious thresholds, opportunities to upgrade and innovate with new technologies and/or require new workflows for providers. Our top three takeaways reflect the fundamental tenets of the meaningful use program that remain intact.

  1. Unclear CEHRT upgrade timing. All providers must implement 2015 Edition certified EHR technology for the 2018 reporting year. CMS' proposed timeline is such that providers must meet year-long performance requirements in consecutive years (i.e., 2016, 2017 and 2018). As a result, it is difficult for providers to identify the optimal timing for the CEHRT upgrade, even with a shorter reporting period proposed for 2015. For example, a CEHRT upgrade that occurs in the first quarter of 2016 may not be fully implemented until mid-year. That timing could impede a provider's ability to meet year-long meaningful use performance metrics. Readying current technology to meet the aggressive Jan. 1, 2018, deadline may lead to development challenges for health IT developers.
  2. High thresholds proposed. CMS proposes eight objectives with 16 measures for EPs and 17 for EHs, the majority of which set higher thresholds than those finalized in the existing Stage 2 regulation. Providers may disagree with those new bars for performance. We suggest that they offer concrete case examples that support their positions. For example, the Secure Electronic Messaging measure increases from 5% to 35%, which assumes a high patient portal or personal health record adoption level among patients. Providers may wish to provide comment regarding the difficulties in their patient engagement efforts, especially the challenges among the majority of patient populations to whom the providers render care.  
  3. Electronic clinical quality measure reporting mandated in 2018. CMS proposes to mandate electronic clinical quality measure reporting starting in 2018. This proposal continues CMS' efforts to align quality reporting requirements across programs. CMS will specify the required measures providers report in separate, future rulemakings (i.e., the Medicare Physician Fee Schedule and Inpatient Prospective Payment Systems rules). Providers and health IT developers alike may want to describe to CMS the significant efforts required to develop and implement updated electronic CQM specifications. Providers may require new data capture workflows in multiple settings across their care delivery process to ensure completion of data. In addition, providers have to perform data validation to ensure the accuracy of their performance. Based on our anecdotal evidence, we understand the process is extremely resource intensive for both sets of stakeholders.

Top Three 2015‒2017 Meaningful Use Modification Takeaways and Ideas for Public Comment -- Due June 15, 2015

The 2015‒2017 Modifications NPRM  proposes to drastically modify meaningful use requirements for providers. The proposal aims to simplify program requirements, reduce reporting burdens and align with the Stage 3 NPRMs. 

  1. Program year and reporting periods changed. CMS proposes to modify the program year for EHs from a fiscal year to a calendar year to align with the program year schedule that EPs follow. In addition, it offers a shortened reporting period of any consecutive 90 days for all providers in 2015. This is the last proposed 90-day reporting period for providers past their first year of meaningful use in the program's foreseeable future. Providers may wish to commend CMS on these changes and encourage them to finalize them exactly as proposed. 
  2. Removed measures, reduced thresholds. Many providers will welcome the surprising policy changes that CMS made to reduce thresholds and remove about 40% of core measures. On the other hand, they may be unpleasantly surprised to see no change to a measure many providers struggle with: Patient Electronic Access, or the View, Download and Transmit [VDT] Measure 1 (i.e., electronic access to health information provided for more than 50% of patients seen/discharged). Our anecdotal evidence suggests providers struggle to meet this requirement because of challenges in providing access to patient information when their systems require an email address to do so and/or provider intervention to authenticate a patient's identity. As mentioned in the Stage 3 information above, providers should offer frontline case examples to support their standpoint on the lessened measure thresholds proposed for VDT Measure 2 (i.e., patients who view, download or transmit their health information) and Secure Electronic Messaging. However, they may want to suggest to CMS that other measures, such as VDT Measure 1, also deserve lessened thresholds.
  3. Potential "Modified Stage 2" complications. Some of the changes that CMS proposes may complicate a provider's ability to successfully demonstrate meaningful use. We encourage providers to explain whether or not they would be able to successfully (or not successfully) demonstrate meaningful use based on the modified policies. Here are a few examples that may warrant special attention: 
  • Public health reporting. Changes to public health reporting may complicate the attestation options available to providers because they may now be required to meet a measure they did not originally intend to report. CMS also proposes to require bidirectional data exchange to meet the Immunization Registry measure. Providers may want to note whether bidirectional immunization data exchange is currently available through their public health agencies and if they would incur additional fees to reconfigure their systems to accommodate bidirectional exchange. 
  • Electronic prescribing. CMS intends to make e-prescribing a required measure for EHs in 2015. While there is an exclusion available for those that did not intend to report this measure from the original Stage 2 menu options this year, the measure would be mandatory for the year-long 2016 reporting period. Some providers have not been able to implement e-prescribing due to complex inpatient workflows and implementation challenges, including those that plan to migrate from one EHR vendor to another.

Individuals or groups can submit comment and may do so in several ways, including via electronic submission or mail. To electronically submit, visit and follow the "Submit a comment" instructions.

Source: iHealthBeat, Monday, May 18, 2015

Patient Engagement, Usability, and Meaningful Use Stage 3

Patient Engagement

Patient engagement was a very hot topic at the recent HIMSS conference in Chicago. There was no shortage of exhibitors promoting their patient engagement tools and there were also several presentations that contained suggestions for better engaging patients. Some exhibitors that we spoke to were not aware of the proposed patient engagement rules (described below) and were very excited at the prospect of greater use of their tools.

Interoperability, Usability, and the ONC 2015 Edition Certification

"Satisfaction and usability ratings for certified electronic health records (EHRs) have decreased since 2010 among clinicians across a range of indicators.”

This announcement was made 5 years ago the 2013 Healthcare Information and Management Systems Society (HIMSS) Conference & Exhibition by Michael S. Barr, MD, MBA, FACP.

Study Shows Divide Over How Meaningful Use Meets Pediatric Needs

Children's hospitals appear split on whether meaningful use requirements address their specific pediatric care needs, according to a study published Monday in the Journal of the American Medical Informatics Association, EHR Intelligence reports.

Under the 2009 economic stimulus package, providers who demonstrate meaningful use of certified electronic health records can qualify for Medicaid and Medicare incentive payments.

Study Details

For the study, researchers surveyed 164 general acute care children's hospitals between September 2011 and May 2012. The survey yielded responses from 61% of facilities.


Overall, the survey found that EHR adoption rates across all surveyed children's hospitals fluctuated between 37% and 87%. Further, nearly 60% of respondents said they had not implemented an EHR system with comprehensive capabilities.

Meanwhile, 57% of hospitals said their EHR systems did not have the necessary functions for pediatric care, while more than 33% said that commercial EHR technology also did not have the necessary functionalities for such care.

In addition, the survey found that hospitals were split about how meaningful use requirements served to address pediatric care needs. For example, 54% of respondents said the program criteria met the needs of children's hospitals, while 46% of respondents said they did not (Gruessner, EHR Intelligence, 3/10).

The study concluded that "a sizable proportion [of children's hospitals] still finds their systems suboptimal for pediatric care," adding, "The meaningful use incentive program is failing to promote and in some cases [is] delaying uptake of pediatric-oriented features" (Nakamura et al., JAMIA, 3/9).

Source: iHealthBeat, Wednesday, March 11, 2015