ARRA, HITECH Meaningful Use

ARRA, HITECH & Meaningful Use

Congress’ passage of the American Recovery and Reinvestment Act of 2009 (ARRA or more commonly, “the Stimulus”) created the Health Information Technology for Economic and Clinical Health (HITECH) Act. Half of HITECH’s $38 billion funding created Meaningful Use (MU), a program to shift paper-based medical records to digital electronic medical records (EMR; the platform). Collectively we now call these electronic health records (EHR; the content).

The MU program provided financial incentives to doctors and hospitals to shift to EHRs, followed by subsequent financial penalties for those who did not “voluntarily” get on board.  We are now in the penalty stage of that initiative[1] for hospitals and physicians who have not yet met these standards.

My Summary Analysis of ARRA, HITECH & Meaningful Use (MU)

The GOOD:

  • Today we have legible medical records rather than illegible handwritten ones.
  • ePrescribing has eliminated hand-written prescriptions that were occasionally misinterpreted.
  • Computerized provider order entry (CPOE) has reduced transcription errors and improved medication administration in the hospital environment.
  • Multiple healthcare workers can access the EHR simultaneously.
  • Opportunity with digital clinical data to have meaningful near-real-time analytics augmented by machine learning and artificial intelligence to create improved decision-making.
  • We have a growing number of hospitals that have a mature EMR adoption[2] (as assessed by HIMSS Analytics).

The BAD:

  • Note bloat: occurs when physician documentation results in pages of data rather than a succinct and concise document in which we describe the story of the patient.
  • WNL errors: “We never looked” errors.  Too much data in the EHR and not enough information.  In other words we have automated to the point that we don’t take the time to fully evaluate what is going on with the patient.
  • Alert fatigue: So many clinical decision support alerts that are false alarms that we tend to ignore the ones that we should be noting.
  • Perception that physicians may be spending more time with the computer than with the patient.
  • Communication last year by CMS that MU was going away, when in fact it is still in effect for inpatient care and outpatient Medicaid. Outpatient Medicare providers now address MU under the new MACRA QPP (see below).
  • With more EHR implementations we see/hear more complaints.

 

 

Footnotes:

[1] By the end of 2015, it has been estimated that 88% of hospitals and 65% of doctors had met MU standards.  However, subsequent audits may not support those numbers. As of March 2017, almost 397,000 Medicare-eligible providers, 231,569 Medicaid-eligible providers and 4,932 hospitals have attested to MU. (source:  http://CMS.gov/EHRincentiveprograms download)

[2] As of Q4 2016, 35.4% of hospitals and 28.1% of outpatient offices in the U.S. have reached HIMSS stage 6-7 on the EMR Adoption Model(SM). Source: HIMSS Analytics.[1] As of Q4 2016, 35.4% of hospitals and 28.1% of outpatient offices in the U.S. have reached HIMSS stage 6-7 on the EMR Adoption Model(SM). Source: HIMSS Analytics.

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