Meaningful Use for Nurses, Research Paper Example

The Health Information Technology for Economic and Clinical Health (HITECH) Act is a part of the American Recovery and Reinvestment Act (ARRA) of 2009 that was signed into law on February 17, 2009. This law identifies stage 1 Meaningful Use criteria that eligible professionals and eligible hospitals must implement in order to ensure proper payment from Medicare and the Electronic Health Record (EHR) program. It is essential for nurses to be knowledgeable of these requirements because their firsthand knowledge of the program will allow hospital operations to run smoothly. Meaningful Use includes a core set of requirements in which all standards must be met in addition to an optional set of requirements in which at least five standards must be met.

It is essential for the nursing staff to have a thorough understanding of the core criteria required by HITECH and ARRA in addition to ways that these standards are measured. Although there are many important core criteria listed in both stage 1 and stage 2 of Meaningful Use, the most important factors will be discussed. Furthermore, potential gaps in healthcare evaluation will be examined and additional core requirements will be suggested if this is found necessary. Many of the core criteria listen in stage 1 of Meaningful Use reflect medical practices that should be incorporated in all healthcare situations. Several of these include practices that monitor patient diagnosis and treatment, including implementation of drug-drug and drug-allergy interaction checks, maintenance of a list of current and active diagnoses, maintenance of an allergy list, recording patient demographics, and keeping track of patient smoking status. Many of these requirements are covered in the nurse or physician’s initial interview with his or her patient. Repetition of these and similar tasks is necessary because it allows the healthcare professional to understand whether any factors regarding the patient’s health and treatment has changed significantly since the last visit.

While these stage 1 Meaningful Use standards are important to gain a greater understanding of the patient’s health, it is important to understand that much of this information could be used for additional purposes. In particular, this form of data collection has implications in public health because it will allow researchers to determine the distribution and prevalence of individuals with certain diagnoses and medications according to demographic status. This can lead to a greater understanding of what areas and groups of people should be recommended for health screenings, or to suggest lifestyle changes that will allow individuals to avoid disease risk factors. This health information is useful at the city, state, and federal scale. Furthermore, analysis of this data could contribute to significant change in nursing and medical practices. For example, this data may demonstrate that certain treatment techniques are more beneficial than others in specific cases, which may lead to an abandonment of current standard of care in favor of a new procedure.

The stage 1 Meaningful Use standards include several optional requirements, which ensure patient safety but aren’t always necessary depending on the specific setting of the institution. Therefore, hospitals and private practices are asked to implement at least five of these policies, although meeting all of the requirements listed is beneficial to both the hospital and its patients. Some of these practices include the implementation of drug-formulary checks, the recording of advanced directives for patients aged 65 or older, and the incorporation of clinical laboratory test results into certified EHR technology as structured data. In each of these cases, if a hospital or healthcare practice were to avoid implementation of these policies, it wouldn’t cause extreme detriment to the patient population. However, implementation would enable the hospital or healthcare practice to run more smoothly, and provided that the institution has the education and manpower to do so, effort should be extended to carry out these policies to improve the patient experience.

Stage 2 Meaningful Use policies were designed primarily to save the healthcare system money, to save both doctors and hospitals time, and to save lives (EHR, 2013). Ultimately, these policies build upon the requirements set out in stage 1, which simply required the healthcare team to follow expected regulations when interviewing their patients and tracking progress. Stage 2 core objectives require increased use of the EHR system. These policies include submission of electronic data to immunization registries, providing summaries of care and referrals, using clinically relevant information to determine who should receive reminders about follow-up care, and to perform medication reconciliation. The implications of this program’s success relies in part on the role of nurses. Since nurses have a great deal of interaction with patient’s in the hospital compared to the other healthcare professionals, it will become necessary for all nurses to be properly trained to use the EHR system. This will allow patient information to be tracked to determine progress and alternative treatment methods and contribute to public health because de-identified patient information will become easier to access.

While stage 1 and 2 of Meaningful Use is helpful in ensuring that both hospitals and private healthcare practices meet minimum requirements concerning EHR implementation, it may be necessary to consider the hospitals that have not yet implemented electronic record systems. A multitude of nursing studies have demonstrated that these processes have many functions and save valuable time in clinical settings. However, even though these systems are useful, they are not legally required, and do not have to uphold meaningful use requirements. It may be useful to require EHR systems in both hospitals and private healthcare settings that see large patient volumes.

“Meaningful Use of Electronic Health Records: The Road Ahead” explains that approximately 700,000 clinicians and 5,000 acute care hospitals use EHRs and that these numbers are growing (Jha, 2010). However, violations of Meaningful Use results in hefty fines and may be discouraging many healthcare facilities from implementing these systems. Therefore, it may be useful for the federal government to implement additional legislation that encourages implementation of EHR in order to supplement the success of Meaningful Use.

An additional gap that is present in Meaningful Use includes definition of proper procedures that nursing staff and healthcare professionals should utilize when patients are on research protocols. While it is sometimes expected that these patients receive at least the standard of care, other protocols may need to deviate from this requirement. Therefore, there is a need to implement Meaningful Use procedures that apply to these special situations. Although EHR regulation of patients on protocol is usually necessary for the completion of a successful clinical trial, tracking this information is also necessary in order to ensure patient health. While stage 1 Meaningful Use requirements involve tracking patient medications and drug interactions, blinding processes that occur in research studies may prohibit knowledge of a specific drug that is being taken. Therefore, nurses and other practitioners should at minimum, be aware that the patient is on study before making additional clinical decisions. In order to ensure that research is regulated in this matter, it would be necessary for the federal government to offer funding incentives for this purpose (Adler-Milstein et al., 2011).

In conclusion, the Meaningful Use guidelines are a useful extension of healthcare practices that are already expected from hospitals and private health offices. However, this policy encourages implementation of the EHR system, which will be awarded by government incentives. However, failure to achieve all policy objectives and several optional objectives may result in fines. Therefore, although the program appears to be attractive for many healthcare organizations, it may be deterring several agencies on this basis. In addition, the program fails to consider what should be done in situations where the patient is on a research protocol. Therefore, there should be several changes made to the current meaningful use policy. Firstly, there is a need to either increase financial incentives or to require EHR implementation in large scale healthcare institutions. Second, it is essential for the Meaningful Use policy to be extended to patients on research protocols who are taken unknown drugs or cannot be offered treatments that interfere with the purpose of the research study. As the policy ages, it is likely that many changes will be made in order to ensure perfection.

References

Adler-Milstein et al. (2011). A Survey of Health Information Exchange Organizations in the United States: Implications for Meaningful Use. Ann Intern Med, 154(10):666-671.

EHR Incentive Program. (2013). Stage 2. Retrieved from http://www.cms.gov/Regulations-and-            Guidance/Legislation/EHRIncentivePrograms/Downloads/Stage2_Guide_EPs_9_23_13.pdf

Jha A. (2010). Meaningful Use of Electronic Health Records: The Road Ahead. JAMA, 304(15):1709-1710.