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'Meaningful Use' of Electronic Health Records

Country: 
USA
Partner Institute: 
Johns Hopkins Bloomberg School of Public Health, Department of Health Policy and Management
Survey no: 
(16)2010
Author(s): 
Krista Harrison, Emily Adrion and Gerard Anderson
Health Policy Issues: 
New Technology, System Organisation/ Integration, Remuneration / Payment, Responsiveness, HR Training/Capacities
Current Process Stages
Idea Pilot Policy Paper Legislation Implementation Evaluation Change
Implemented in this survey? yes yes yes yes yes no no

Abstract

By mid-2011, providers and hospitals that adopt electronic health records systems and can demonstrate "meaningful use" of those systems will be eligible to receive bonus payments from the federal government. The Department of Health and Human Services recently released regulations outlining what constitutes "meaningful use".

Purpose of health policy or idea

Financial incentives in the form of bonus payments for providers and hospitals will be introduced in May of 2011 with the goal of achieving nationwide adoption of electronic health records (EHRs). It is argued that extensive adoption of EHRs could reduce paperwork, improve sharing of patient medical records, reduce health care costs and improve quality.

 

Main points

Main objectives

In an effort to encourage the widespread adoption of EHRs, Congress passed the Health Information Technology for Economic and Clinical Health ("HITECH") Act as part of the American Recovery and Reinvestment Act (ARRA) of 2009. The legislation included financial incentives in the form of bonus payments aimed at achieving extensive adoption of EHRs by 2014. The legislation also included penalties, particularly reductions in Medicare and Medicaid reimbursement rates for those providers and hospitals that do not adopt EHRs by 2015. The belief was that EHRs would not only reduce paperwork in health care, but that "meaningful use" of EHRs could lead to improved access to, and sharing of, patient medical records, improved ability to track trends in health care and could potentially lead to reductions in the cost of care as well as improvements in quality.

The HITECH legislation did not define "meaningful use" of EHRs but instead tasked the Department of Health and Human Services with drafting regulations to establish what would constitute meaningful use. Within the Department of Health and Human Services, the Office of the National Coordinator for Health Information Technology and the Centers for Medicare and Medicaid Services have been the primary agencies responsible for drafting the regulations. The final regulations were released in July 2010.

These regulations lay out technical standards and a certification process for EHR systems and outline basic requirements for what constitutes "meaningful use" of EHRs for providers and hospitals. 

Both hospitals and providers must store at least 80 percent of patient records in a certified EHR system. Providers must then meet at least 20 "meaningful use objectives" which include requirements such as the ability to prescribe medications electronically and the ability to provide patients with copies of their record. Hospitals must meet at least 19 "meaningful use objectives" which include system capabilities such as computerized physician order entry, ability to record and store advance directives for adults over age 65, and the ability to transmit quality of care information to the Centers for Medicare and Medicaid Services and others.

Providers that meet the above objectives will be eligible to receive bonus payments of up to $44,000-$63,750 each and hospitals that meet the above objectives could potentially earn bonuses that amount to millions of dollars. The total cost of providing these incentives has been projected at $27 billion over 6 years.    

Type of incentives

 Financial

Groups affected

Hospitals, Providers, Patients

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Characteristics of this policy

Degree of Innovation traditional rather innovative innovative
Degree of Controversy consensual controversial highly controversial
Structural or Systemic Impact marginal rather fundamental fundamental
Public Visibility very low low very high
Transferability strongly system-dependent rather system-neutral system-neutral

 At this time, it is too early to predict the potential outcomes of this policy.

Political and economic background

As part of the 2008 presidential election, President Obama espoused a broad national health policy to restructure health care delivery. The definition of "meaningful use" was a fundamental aspect of the initiative to stimulate providers and hospitals to adopt electronic health systems, by establishing a measure of quality that could be used to award financial incentives.

Change of government

The Obama Administration has strongly supported EHR adoption.

Change based on an overall national health policy statement

The 'meaningful use' definition is crucial to establish a uniform measure of quality to which EHRs can be compared across the US.

Purpose and process analysis

Current Process Stages

Idea Pilot Policy Paper Legislation Implementation Evaluation Change
Implemented in this survey? yes yes yes yes yes no no

Origins of health policy idea

Congress passed the Health Information Technology for Economic and Clinical Health ("HITECH") Act as part of the American Recovery and Reinvestment Act (ARRA) of 2009. The HITECH legislation did not define "meaningful use" of EHRs but instead tasked the Department of Health and Human Services with drafting regulations to establish what would constitute meaningful use. Within the Department of Health and Human Services, the Office of the National Coordinator for Health Information Technology and the Centers for Medicare and Medicaid Services have been the primary agencies responsible for drafting the regulations. The final regulations were released in July 2010. These regulations lay out technical standards and a certification process for EHR systems and outline basic requirements for what constitutes "meaningful use" of EHRs for providers and hospitals. 

 

Initiators of idea/main actors

  • Government: The US Congress enacted the HITECH Act, which required the Centers for Medicare and Medicaid Services to define meaningful use.
  • Providers: Providers and hospitals are required to implement electronic health records systems and demonstrate their ability to meet the meaningful use objectives set out by CMS in order to receive incentive payments.
  • Payers: nsurance companies will be affected by provider efforts to adopt EHS and demonstrate meaningful use.
  • Patients, Consumers: Widespread adoption of EHR and demonstration of 'meaningful use' could improve coordination and quality of care for patients.
  • Private Sector or Industry

Approach of idea

The approach of the idea is described as:
new: The U.S. has not previously had a national-level initiative to promote the adoption of EHRs or a definition by which to standardize and measure their quality and utilization.

Stakeholder positions

Republicans oppose the meaningful use definition, saying that the standard it sets is not high enough to justify the money invested in the systems. Proponents counter that the definition as issued allows a wide variety of systems to work toward implementing EHRs, and that future rulemaking can mandate a more robust definition. 

 

Actors and positions

Description of actors and their positions
Government
Congressvery supportivevery supportive strongly opposed
Centers for Medicare and Medicaid Services (CMS)very supportivevery supportive strongly opposed
The Obama Administrationvery supportivevery supportive strongly opposed
Providers
Cliniciansvery supportiveneutral strongly opposed
Hospitalsvery supportiveneutral strongly opposed
Payers
Insurersvery supportivesupportive strongly opposed
Patients, Consumers
Patientsvery supportivesupportive strongly opposed
Private Sector or Industry
EHR technology manufacturersvery supportivevery supportive strongly opposed

Influences in policy making and legislation

Because the HITECH legislation did not define meaningful use of EHRs but instead tasked the Department of Health and Human Services with drafting regulations to establish what would constitute meaningful use, the Office of the National Coordinator for Health Information Technology and CMS had extensive control over how meaningful use was ultimately defined.  

 

Legislative outcome

success

Actors and influence

Description of actors and their influence

Government
Congressvery strongvery strong none
Centers for Medicare and Medicaid Services (CMS)very strongvery strong none
The Obama Administrationvery strongvery strong none
Providers
Cliniciansvery strongstrong none
Hospitalsvery strongstrong none
Payers
Insurersvery strongstrong none
Patients, Consumers
Patientsvery strongweak none
Private Sector or Industry
EHR technology manufacturersvery strongstrong none
EHR technology manufacturersCongress, Centers for Medicare and Medicaid Services (CMS), The Obama AdministrationPatientsInsurersClinicians, Hospitals

Positions and Influences at a glance

Graphical actors vs. influence map representing the above actors vs. influences table.

Adoption and implementation

The Department of Health and Human Services has been, and will continue to be, closely involved in implementation.  This role will likely involve tracking progress, awarding financial incentives (bonuses), imposing penalties on those who have not adopted EHRs, and potentially may involve revisions to the "meaningful use" regulations over time. Provider groups and hospitals will be involved in implementation of the EHR systems and will need to meet the established criteria in order to receive the implementation bonuses. Manufacturers of EHR technology will also likely play a role in implementation, as the EHR systems may need to be modified to meet regulations.  

Monitoring and evaluation

The Department of Health and Human Services, particularly the Office of the National Coordinator for Health Information Technology and the Centers for Medicare and Medicaid Services will likely be closely involved in monitoring and evaluating progress towards EHR adoption. 

Results of evaluation

 n/a

Expected outcome

Given the large financial incentives available to providers and hospitals that adopt EHRs, it is likely that there will be widespread adoption of EHRs over time. It is unclear whether the definitions of "meaningful use" will be strong enough to lead to improvements in patient safety and quality and/or reductions in cost.

Impact of this policy

Quality of Health Care Services marginal rather fundamental fundamental
Level of Equity system less equitable neutral system more equitable
Cost Efficiency very low high very high

 At this time, it is too early to assess the ultimate impact of this policy.

References

Sources of Information

 Official documents on 'meaningful use':

Other articles on 'meaningful use':

Author/s and/or contributors to this survey

Krista Harrison, Emily Adrion and Gerard Anderson

 Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health

Suggested citation for this online article

Krista Harrison, Emily Adrion and Gerard Anderson. "'Meaningful Use' of Electronic Health Records". Health Policy Monitor, October 2010. Available at http://www.hpm.org/survey/us/b16/3