Meaningful Use Information and Resources

Any discussion of Health Information Technology as used by community health centers (CHCs) must address the concept of Meaningful Use (MU). Therefore, CHAMPS has gathered the following MU information and resources as a general overview of the concept and included links to additional resources to provide more in-depth details about the ongoing development of this initiative.

Please click or scroll down for:
Definition and Importance of Meaningful Use
History/Background of Meaningful Use
Three Stages of Meaningful Use
Support for Implementing Meaningful Use
Other Online Resources

DEFINITION AND IMPORTANCE OF MEANINGFUL USE

Meaningful Use refers to the adoption and use of certified Electronic Health Record (EHR) technology to achieve specified objectives. It is a term that developed out of the Health Information Technology for Economic and Clinical Health (HITECH) Act of 2009 and its related efforts (see the History/Background of MU section below for more HITECH Act details).

  • There are three main components of Meaningful Use:
    • The use of a certified Electronic Health Record (EHR) in a meaningful manner, such as e-prescribing.
    • The use of certified EHR technology for electronic exchange of health information to improve quality of health care.
    • The use of certified EHR technology to submit clinical quality and other measures.
  • Meaningful Use is important for its role in:
    • Helping build the foundation for a reformed and improved health care system;
    • Capturing and sharing data, monitoring quality, and improving patient health outcomes; and
    • Emphasizing a patient’s involvement in their own health care and the ability to access their own information and to feel secure in its use and exchange.

HISTORY/BACKGROUND OF MEANINGFUL USE

  • The concept of Meaningful Use grew out of efforts by the National Quality Forum (NQF) to identify a set of national priorities to help focus performance improvement efforts in health care settings.
    • NQF released a report in 2008 identifying these priorities, which included: patient engagement, reduction of racial disparities, improved safety, increased efficiency, coordination of care, and improved population health. These were used to create a framework for the Meaningful Use of an EHR. Since that time, ‘Privacy and Security’ has been added to this list of priorities.
  • The American Recovery & Reinvestment Act (ARRA) of 2009 has also contributed to the development of the Meaningful Use concept by establishing a focus on preserving and improving affordable health care (other ARRA provisions included modernizing our nation’s infrastructure, enhancing energy independence, expanding educational opportunities, and providing tax relief.)  ARRA’s focus on preserving and improving affordable health care was expressed in the HITECH Act. This act addresses:
    • The promotion of Health Information Technology (HIT), including improving health care quality, safety, and efficiency, and the application and use of HIT standards
    • HIT testing, including pilot testing of standards, implementation specifications, a voluntary testing program, and research and development programs
    • Grants and loans funding and demonstration programs, including incentives for the use of HIT, funding to strengthen HIT infrastructure, and HIT implementation assistance (including Regional Extension Centers; see below) and other grant support for HIT
    • Privacy, with a focus on both privacy/security and the act’s relationship to other laws and reporting requirements
    • Provisions for monetary incentives through Medicaid and Medicare for eligible health care professionals and hospitals when they adopt certified EHR technology and use it to achieve specified objectives (i.e., use this EHR technology meaningfully).
      • Click HERE for more information about the Medicare and Medicaid Electronic Health Records (EHR) Incentive Program.

THREE STAGES OF MEANINGFUL USE

Meaningful Use will be implemented in three stages, allowing health care providers to address necessary objectives over time.

Meaningful Use Stage 1:

  • Stage 1 begins in 2011 and sets the baseline for electronic data capture and information sharing. In this stage, health care organizations will implement a certified electronic health record (EHR) and be able to demonstrate that it is being used to meet Stage 1 requirements. Providers and hospitals will report their performance on Stage 1 in two areas: Health IT Functionality measures and Clinical Quality measures.
    • Click HERE for a list of Stage 1 objectives and measures as tied to the following health outcomes policy priorities:
      • Improving Quality, Safety, Efficiency, and Reducing Disparities
      • Engaging Patients & Families in Their Health Care
      • Improving Care Coordination
      • Ensuring Adequate Privacy & Security
  • In January of 2010, the Department of Health and Human Services (HHS) released an Interim Final Rule to represent the first step in an incremental approach to adopting standards, implementation specifications, and certification criteria to enhance the interoperability, functionality, utility, and security of health information technology and to support its meaningful use.
    • Click HERE to download the HHS Health Information Technology: Initial Set of Standards, Implementation Specifications, and Certification Criteria for Electronic Health Record Technology; Interim Final Rule
  • In July of 2010, the Centers for Medicaid and Medicare Services (CMS) released the Final Rule for Meaningful Use Stage 1, which specifies: the initial criteria that must be in order to qualify for an incentive payment; calculation of incentive payment amounts; payment adjustments under Medicare for covered professional services and inpatient hospital services provided by eligible providers (EPs), eligible hospitals, and Critical Access Hospitals (CAHs) failing to demonstrate meaningful use of certified EHR technology; and other program participation requirements.
    • For eligible providers to demonstrate Meaningful Use and qualify for an incentive payment in Stage 1, 20 of 25 MU objectives must be met (including 15 required core objectives), and they must report on six clinical quality measures (including three required core measures).
    • Click HERE to download the CMS Medicare and Medicaid Programs; Electronic Health Record Incentive Program; Final Rule
    • Click HERE for a Medicaid EHR Incentives Overview
  • For more information about Meaningful Use Stage 1, visit the Office of the National Coordinator for Health Information Technology’s Standards & Certification Criteria Final Rule webpage. This site includes links to facts-at-a-glance and frequently asked questions.
  • Click HERE for a Meaningful Use Project Document developed by Colorado Community Managed Care Network (CCMCN); this multi-sheet Excel file provides a resource for community health centers (which may be working with a supporting organization like CCMCN) to document progress on Meaningful Use achievement, including:
    • Practice level gap analysis
    • Implementation of core clinical quality measures
    • Clinic action items (e.g., upgrading EMR to certified product)
    • Support organization action items (e.g., EMR meaningful use evaluation)
    • Site incentive payment schedule
    • Project charter
    • RAID (Risks, Assumptions, Issues, and Definitions)

Meaningful Use Stage 2:

  • Stage 2 begins in 2014 and expands guidelines for electronic data capture and information sharing. The basic framework for Stage 2 is similar to Stage 1 by being organized with core and menu objectives. In this stage, new measures include increased patient engagement through a patient’s ability to view online, download, and transmit their health information. Stage 2 also places emphasis on health information exchange and improved care coordination. Providers will report clinical quality measures (CQMs) either individually or as a group.
    • Click HERE for the Office of the National Coordinator for Health Information Technology (ONC) list of Stage 2 objectives and measures.
    • Click HERE for the Centers for Medicare & Medicaid Services (CMS) Stage 2 Overview Tipsheet.
    • Click HERE for the CMS Stage 2 Timeline.
  • In February of 2012, the Department of Health and Human Services (HHS) distributed a preliminary set of standards (proposed rules from CMS and ONC).
    • Click HERE to download the proposed rule, HHS Health Information Technology: Initial Set of Standards, Implementation Specifications, and Certification Criteria for Electronic Health Record Technology, 2014 Edition; Revisions to the Permanent Certification Program for Health Information Technology.
  • In September of 2012, the Centers for Medicaid and Medicare Services (CMS) released the Final Rule for Meaningful Use Stage 2, which specifies the criteria that eligible professionals (EPs), eligible hospitals, and critical assess hospitals (CAHs) must meet in order to continue to participate in the Medicare and Medicaid Electronic Health Record (EHR) Incentive Program.  All providers must achieve Meaningful Use under Stage 1 criteria before moving to Stage 2.
    • For eligible providers to demonstrate Meaningful Use (MU) and qualify for an incentive payment in Stage 2, 20 of 23 MU objectives must be met (including 17 required core objectives), and they must report on nine clinical quality measures (including one measure in three National Quality Strategy Domains).
    • Click HERE to download the CMS Medicare and Medicaid Programs; Electronic Health Record Incentive Program-Stage 2; Final Rule
    • Click HERE for a Clinical Quality Measures in 2014 and Beyond Comparison Chart.
    • Click HERE to learn about payment adjustments and hardship exceptions.
  • For more information about Meaningful Use Stage 2, visit the Office of the National Coordinator (ONC) for Health Information Technology’s Meaningful Use Regulations webpage and the CMS Stage 2 webpage. Also visit ONC’s Health Information Exchange (HIE) Interoperability Training Courses website to help explain to providers and staff the process of meeting the Stage 2 Meaningful Use data exchange.

Meaningful Use Stage 3:

  • Stage 3 is scheduled to begin in 2016. This stage will include demonstrating that the quality of health care has been improved.
  • In March of 2015, CMS released a Proposed Rule for Meaningful Use Stage 3.
    • Click HERE to download the HHS CMS Medicare and Medicaid Programs; Electronic Health Record Incentive Program – Stage 3 Proposed Rules.

SUPPORT FOR IMPLEMENTING MEANINGFUL USE

Regional Extension Centers
The HITECH Act also authorized a Health Information Technology Extension Program to support these efforts; this program includes a national Health Information Technology Research Center (HITRC) as well as Health Information Technology Regional Extension Centers (RECs).

  • Health Information Technology Research Center (HITRC): gathers information on effective practices while helping RECs work together and with other stakeholders to identify and share best practices in EHR adoption, meaningful use, and provider support.
  • Regional Extension Centers (RECs): organizations across the country funded to support providers with the goal of helping them quickly become meaningful users of EHRs.

For more information, including a list of RECs across the country, please visit the Office of the National Coordinator for Health Information Technology webpage for the Health Information Technology Extension Program.  Visit the HealthIT Regional Extension Center Dashboard to review the REC program’s progress toward helping providers adopt EHR and demonstrate meaningful use.

Primary Care Associations (PCAs)
State and Regional Primary Care Associations are required to provide some level of training and/or technical assistance to federally-qualified health centers (FQHCs) around the area of Meaningful Use.  For a list of Primary Care Associations nationwide, please click HERE.

OTHER ONLINE RESOURCES

Centers for Medicare & Medicaid Services
EHR Incentive Programs Overview Page

Healthcare Information and Management Systems (HIMSS)
Transforming Healthcare through IT

Integrating the Healthcare Enterprise
Changing the Way Healthcare Connects

SuccessEHS
2010 CHAMPS/NWRPCA Annual Conference session presentation slides and materials
Meaningful Use Reference Information
Meaningful Use and Health IT

US Department of Commerce
National Institute of Standards and Technology

US Department of Health and Human Services
Office of the National Coordinator (ONC) for Health Information Technology (HealthIT.gov)
HealthIT.gov Meaningful Use Dashboard
HRSA Directory of Health Center Networks