Putting the Meaningful in Meaningful Use Meeting current criteria while preparing for the future The Centers for Medicare & Medicaid Services designed Meaningful Use (MU) requirements to encourage healthcare organizations to adopt electronic health records (EHRs) and use them in a meaningful way to improve patient care. Yet the question remains: What does it really mean to use technology in a meaningful way? Some would say it involves leveraging technology to integrate and share information seamlessly across the care continuum. Others might mention that accurate reporting is key to enabling providers to use comprehensive data when making critical care decisions. While both of these components are important, the true realization of meaningful use comes when technology is used in a way that fundamentally enhances patient care and improves the patient experience. Reaching this goal requires organizations to keep patients top-of-mind throughout technology implementation and beyond. Rather than focusing on adopting technologies that check the boxes for MU Stage 1, organizations must keep their emphasis on the patient. Think years down the road, when MU incentive dollars are no longer on the table. Will the technology in place best serve the long-term needs of the organization and the patient? To that end, this white paper offers strategies for taking a patient-centered approach to Stage 1 and Stage 2 MU efforts. More specifically, it discusses how the use of robust technology including data-enriched patient portals can help organizations successfully meet MU requirements now and in the future, while still keeping focus squarely on what is important: sustaining meaningful relationships with patients. Meeting MU Objectives and Reporting Requirements MU criteria are staged in three progressive levels that aim to move a healthcare organization from: 1) initial data capture; to 2) consistent and seamless information sharing; to 3) clinical process enhancement and outcomes improvement. Stage 1 sets the baseline for electronic data capture and information sharing, while Stages 2 and 3 expand on that baseline and push providers to exchange information to further drive continuous quality improvement. (See Sidebar 1 for an overview of MU requirements.) Although most organizations are focused on meeting only the MU Stage 1 requirements directly in front of them, it is imperative to understand the window of opportunity currently open in regard to technology implementation. Organizations now have the power to put systems in place that not only meet existing MU requirements, but also anticipate and satisfy criteria coming down the line. Keep in mind that each successive stage of MU raises the capability bar substantially. (See Sidebar 2 for a timeline of the three phases of MU criteria.) For example, MU Stage 1 largely asks organizations to show that they have adopted technology capable of capturing and exchanging patient data. In other words, at this stage, the mere implementation of technology is the primary goal. By contrast, those looking ahead will notice the distinct emphasis on e-reporting found in Stage 2 and beyond. More specifically, the reporting requirements in Stage 2 call for certified technology capable of output reporting that can measure when patients receive, download and view information sent to them. Furthermore, an organization must be able to quantify the percentage of its patient population that receives healthcare information electronically plus achieve a designated percentage of patients using the technology. Later MU stages require providers to further leverage technology to facilitate communication between providers and patients. While this kind of communication and reporting might sound simple, an organization s ability to meet the increased requirements could be challenging to manage and maintain. The difficulty increases when technologies are only used to meet immediate criteria, rather than considering the long-term resources needed to achieve all stages of Meaningful Use.
Benefits of Leveraging Patient Portals for MU Now and in the Future To effectively meet MU requirements at any stage, an organization must use certified technology. Typically, this takes the form of an EHR. However, many vendors solutions are not currently able to fully meet the advanced stages of MU. An EHR on its own, for example, will seldom be able to satisfy the patient engagement requirements that make up an important component of the later stages of MU. These technology gaps could be challenging to close, and may slow down a healthcare organization s progress toward achieving MU Stage 2 or Stage 3. Selecting technology, such as a patient portal that is ONC-certified as an Ambulatory EHR module, can help an organization meet the current requirements of Stage 1 and position itself to meet more demanding long-term needs. Unfortunately, the platform is at times overlooked as a technology capable of helping with all stages of MU compliance. Often, portals are viewed merely as a nice to have tool used only for enhancing direct patient-to-provider communication. Even among those organizations that do have portals, few take full advantage of their full capabilities. In fact, estimates reveal that most healthcare organizations only use about 15 percent of the capabilities of their portals or EHRs, despite investing millions of dollars in the technologies. The situation is much like that involving ubiquitous Word or Excel applications; many people use the technologies, yet few truly understand how they work or know how to access the sophisticated components that can help take performance to the next level. Built on top of a foundational platform, a small segment of patient portals can act as a comprehensive data repository and therefore can perform many different tasks to fulfill MU requirements. These portals are able to collect, standardize, normalize and store data supplied by patients or by any EHR system, allowing easy receipt and exchange of health information among patients and providers with different technology. These select portals can help meet several core measures in MU Stage 1. For example, Core Measure 5 requires an organization to provide patients with an electronic copy of their health information upon request. Using a portal, a patient can view their Continuity of Care Document (CCD) on demand and download it, thus meeting the requirement. In Core Measure 6, clinical summaries for each visit must be provided. This information also can readily be available and accessible via a patient portal. In MU Stage 2, a portal can help meet criteria such as Core Measure 7, which requires that patients have the ability to view online, download and transmit their health information. Core Measure 8 involves providing clinical summaries for each patient visit, while Core Measure 15 stipulates that the provider supply a summary of care record for each transition of care or referral. Each of these measures can be met and the required information provided to the patient via a portal. When patients provide information through a portal, they often are simultaneously satisfying other MU criteria, as well. For example, patients who update their health history information via a portal or who complete and submit an interactive form found on a portal may help an organization meet MU Stage 1 Core Measure 9, which requires providers to maintain an up-to-date problem list of current and active diagnoses, or the Core Measure 10 stipulation of an active allergy list. Similarly, in MU Stage 2, the patient may help meet the Core Measure 3 requirement to record demographic information or the Core Measure 5 call to record smoking status of patients age 13 years or older.
Achieving Real Meaningful Use Even more important than meeting specific MU criteria, a portal that sits atop a data repository allows an organization to fully leverage data to improve patient care the ultimate goal of Meaningful Use. For instance, a portal that acts as a data repository allows an organization to share information while also supporting data exchange which in turn enables true care coordination. A portal can give each provider involved in a patient s care access to an up-to-date view of the patient s condition, procedures, medications and other clinical information to smooth continuity of care across all providers. Portal technology allows various applications to be connected to one accurate data source, meeting today s MU requirements while also fostering more interactive care. A certified patient portal can also facilitate dynamic two-way interactions between providers and patients, such as through: Reminders. Portals can offer everything from appointment reminders, to individualized alerts to pick up or take medications as prescribed. These reminders drive better patient compliance and, ultimately, better care. Requests. Simple requests for appointments or questions to providers can be handled more efficiently via a portal. Patients get responses faster, adding to their overall satisfaction. Results. Test results including normal results easily can be made available to patients at their convenience, without burden to administrative staff. Patients appreciate timely notification and the ability to see results. Forms. Providing patients with the ability to complete forms electronically before or after a visit rather than filling in paper forms at the time of a visit increases data accuracy and elim inates the need for scanning. By completing the forms online at their convenience, patients avoid the frustration of trying to recall health history details in the waiting area. Education. Providers can ensure the delivery of appropriate patient education via a portal whether to individual patients or to all patients in a target group (such as those scheduled for the same kind of surgery, or those with the same diagnosis). Patients can read through the information at their leisure and share it with others who may be involved in their care out side the healthcare organization. Offering patients these resources redefines their role in care decisions, empowering them through easy access to information and an effective means of communication. Mobile health applications for portals further allow patients to conveniently monitor and manage health on-the-go. Patients can update forms, obtain test results, send secure messages and pay bills all of which bolster patient satisfaction while also supporting Stage 2 MU objectives related to greater patient involvement and information access. All Portals Aren t Created Equal While a patient portal can play an integral role in helping organizations meet MU requirements and enhance patient care, not all portals are the same. Many are designed as add-ons to other technologies, and these tend to be driven more by the needs of the parent IT system rather than the needs of the organization s users. They typically work solely with the particular systems for which they were designed, forcing patients to turn to multiple portals with varying interfaces to interact with different providers. A patient who sees a primary care provider (PCP) and several specialists, for example, typically is only able to communicate with one provider at a time via these kinds of portals. Now, newer portal solutions are emerging to help check the box for MU2 requirements. So while they may have received some level of ONC certification, they often do not have robust API platforms to facilitate integration with multiple EHR vendors and often they continue to be simple web technologies that are tethered to a single database, requiring patients to manage their health through several portals. As we venture down the path of connected health starting with the MU2 requirements, it s important that organizations align themselves with solutions that fulfill the requirements for today (MU2), and equally as important, provide the runway to facilitate things like population health, care coordination, and DirectTrust which will be required in later stages of meaningful use as well as being relevant components for ACOs and PCHMs.
All Portals Aren t Created Equal Because it is not a one-time, isolated or independent solution, there is no need to change infrastructure as an organization s needs change. A portal that sits on top of a data repository remains separate from EHR platforms and offers a total implementation package thus saving time and money establishing connectivity among multiple stakeholders. With these solutions, a patient can use one portal not only to communicate with a PCP and all specialists, but also to link information from those providers together. Beyond Meaningful Use By effectively capturing and exchanging health information across the continuum of care, portal technology provides more than just what an organization needs to meet today s MU requirements; it can shepherd an organization through the entire MU process to achieve the ultimate objective of better patient care. Keeping the meaningful in Meaningful Use requires a progressive strategy to deliver comprehensive, data-driven care that centers on patients and empowers them to be more actively engaged. Portals can serve as a foundation for that strategy through efficient data capture and sharing, which in turn contributes to better and more effective clinical processes. Indeed, the greatest benefit of a patient portal is its role in improved outcomes. That is the ultimate goal of Meaningful Use and healthcare at any stage. This whitepaper is based on standards published August 2013. [SIDEBAR 1] Overview of MU Requirements Requirements for hospitals/critical access hospitals (acute care) Stage 1: Acute care organizations must meet 23 objectives (18 core set objective requirements and five of 10 from a menu set of objectives). Additionally, they must report on all 15 clinical quality measures. Stage 2: Meet 16 core set objectives; six menu set objectives; 16 of the 29 clinical quality measures 1. Use computerized provider order entry (CPOE) for medication, laboratory, and radiology orders directly entered by any licensed healthcare professional who can enter orders into the medical record per state, local, and professional guidelines. 2. Record all of the following demographics: preferred language, sex, race, ethnicity, date of birth, date and preliminary cause of death in the event of mortality in the eligible hospital or CAH. 3. Record and chart changes in the following vital signs: height/length and weight (no age limit); blood pressure (ages 3 and over); calculate and display body mass index (BMI); and plot and display growth charts for patients 0-20 years, including BMI. 4. Record smoking status for patients 13 years old or older. 5. Use clinical decision support to improve performance on high-priority health conditions. 6. Provide patients the ability to view online, download, and transmit information about a hospital admission. 7. Protect electronic health information created or maintained by the Certified EHR Technology through the implementation of appropriate technical capabilities. 8. Incorporate clinical lab test results into Certified EHR Technology as structured data. 9. Generate lists of patients by specific conditions to use for quality improvement, reduction of disparities, research, or outreach. 10. Use clinically relevant information from Certified EHR Technology to identify patientspecific
11. The eligible hospital or CAH who receives a patient from another setting of care or provider of care or believes an encounter is relevant should perform medication reconciliation. 12. The eligible hospital or CAH who transitions their patient to another setting of care or pro vider of care or refers their patient to another provider of care provides a summary care record for each transition of care or referral. 13. Capability to submit electronic data to immunization registries or immunization information systems except where prohibited, and in accordance with applicable law and practice. 14. Capability to submit electronic reportable laboratory results to public health agencies, where except where prohibited, and in accordance with applicable law and practice. 15. Capability to submit electronic syndromic surveillance data to public health agencies, except where prohibited, and in accordance with applicable law and practice. 16. Automatically track medications from order to administration using assistive technologies in conjunction with an electronic medication administration record (emar). Six menu set objectives: 1. Record whether a patient 65 years old or older has an advance directive. 2. Record electronic notes in patient records. 3. Imaging results consisting of the image itself and any explanation or other accompanying information are accessible through CEHRT. 4. Record patient family health history as structured data. 5. Generate and transmit permissible discharge prescriptions electronically (erx). 6. Provide structured electronic lab results to ambulatory providers. Stage 3: Requirements are not yet fully established as of this publish date Requirements for providers/ambulatory practices Stage 1: Providers must meet 24 objectives (19 core set objective requirements and five of 10 from a menu set of objectives). Additionally, providers must report on six clinical quality measures (3 required core measures or three alternative core measures and three additional measures selected from a set of 38 clinical quality measures). Stage 2: Meet 17 core set objectives; six menu set objectives; and 9 of the 64 clinical quality measures. 1. Use computerized provider order entry (CPOE) for medication, laboratory, and radiology orders directly entered by any licensed healthcare professional who can enter orders into the medical record per state, local, and professional guidelines. 2. Generate and transmit permissible prescriptions electronically (erx). 3. Record the following demographics: preferred language, sex, race, ethnicity, date of birth. 4. Record and chart changes in the following vital signs: height/length and weight (no age limit); blood pressure (ages 3 and over); calculate and display body mass index (BMI); and plot and display growth charts for patients 0-20 years, including BMI.
5. Record smoking status for patients 13 years old or older. 6. Use clinical decision support to improve performance on high-priority health conditions. 7. Provide patients the ability to view online, download and transmit their health information within four business days of the information being available to the EP. 8. Provide clinical summaries for patients for each office visit. 9. Protect electronic health information created or maintained by the Certified EHR Technology through the implementation of appropriate technical capabilities. 10. Incorporate clinical lab test results into Certified EHR Technology as structured data. 11. Generate lists of patients by specific conditions to use for quality improvement, reduction of disparities, research, or outreach. 12. Use clinically relevant information to identify patients who should receive reminders for preventive/follow-up care and send these patients the reminders, per patient preference. 13. Use clinically relevant information from Certified EHR Technology to identify patientspecific education resources and provide those resources to the patient. 14. The EP who receives a patient from another setting of care or provider of care or believes an encounter is relevant should perform medication reconciliation. 15. The EP who transitions their patient to another setting of care or provider of care or refers their patient to another provider of care should provide a summary care record for each transition of care or referral. 16. Capability to submit electronic data to immunization registries or immunization information systems except where prohibited, and in accordance with applicable law and practice. 17. Use secure electronic messaging to communicate with patients on relevant health information Six menu set objectives: 1. Capability to submit electronic syndromic surveillance data to public health agencies except where prohibited, and in accordance with applicable law and practice. 2. Record electronic notes in patient records. 3. Imaging results consisting of the image itself and any explanation or other accompanying information are accessible through CEHRT. 4. Record patient family health history as structured data. 5. Capability to identify and report cancer cases to a public health central cancer registry, except where prohibited, and in accordance with applicable law and practice. 6. Capability to identify and report specific cases to a specialized registry (other than a cancer registry), except where prohibited, and in accordance with applicable law and practice.
Stage 3: TBD Source: Centers for Medicare and Medicaid. Accessed July 2, 2013 http://www.cms.gov/regulations-and-guidance/legislation/ehrincentiveprograms/meaningful_use.html [END SIDEBAR] [SIDEBAR 2] Timeline for meeting Meaningful Use requirements After submitting data for MU Stage 1 for two or three years (depending on the healthcare entity s first year of Stage 1), an organization is eligible to attest for MU Stage 2. Early adopters of MU Stage 1 criteria could move into Stage 2 as soon as October 2013 for acute care organizations, or January 2014 for ambulatory practices and other providers. Stage 1: During the first year, MU requirements must be met for a 90-day period; the second year, MU requirements must be met the entire year Providers begin each year of MU based on calendar years (Jan. 1 Dec. 31) Orgs begin each year of MU based on the federal fiscal year (Oct. 1 Sept. 30) Orgs/providers that began Stage 1 in 2011 will be in Stage 1 for three years Orgs/providers have until 2014 to begin attesting for Stage 1 MU incentives Stage 2: Organizations begin entering Stage 2 in fiscal year 2014; providers in calendar year 2014. In order to qualify for MU Stage 2 incentives, providers must meet MU objective requirements for 2 full years. Stage 3: Organizations begin entering Stage 3 in fiscal year 2016; providers in calendar year 2016. [END SIDEBAR] This white paper was provided by. About is a leading provider of connected health solutions that facilitate patient engagement, health information exchange, and the coordination of patient care. The platform is deployed by physician practices, hospitals, IDNs, and HIT vendors to provide a flexible technology infrastructure that enables the progression from secure patient communication/collaboration to data exchange and analysis as more organizations transition to value-based care and delegated risk management. The Patient Portal is a 2014 ONC certified EHR module for both Inpatient and Ambulatory domains, designed to deliver extensive EHR integration via its robust application programming interface (API). Industry leading EHR vendors continue to select as their patient engagement platform, collectively representing over 25,000 client organizations and over 350,000 care providers.