‘Meaningful Use’ refers to the utilization of electronic health record (EHR) technology in a meaningful and beneficial way for both patients and healthcare providers. The term is primarily associated with the Medicare and Medicaid EHR Incentive Programs, which aim to improve the quality, safety, and efficiency of healthcare by providing financial incentives to healthcare providers who effectively use EHR technology.
Effective use means utilization of certified EHR technology by healthcare providers in a meaningful manner, such as through electronic prescribing, ensuring that it is connected in a way that facilitates the electronic exchange of health information. Providers are also required to submit information on the quality of care and other measures to the Secretary of Health & Human Services (HHS).
The introduction of the Medicare and CHIP Reauthorization Act of 2015, also known as MACRA, had a significant impact on meaningful use. It established the Quality Payment Program (QPP), which includes the Merit-based Incentive Payment System (MIPS). MIPS offers eligible professionals and hospitals a way to participate in the QPP and replaces meaningful use as one of its components. This consolidation of programs aims to shift from fee-for-service models to a fee-for-value approach.
The Medicare EHR Incentive Program, aka Meaningful Use, was transitioned to become one of the four components of the new MIPS. MIPS consolidates three fee-for-service programs – the Physician Quality Reporting System (PQRS), the Value-Based Payment Modifier Program (VBM) and the Medicare Electronic Health Records (EHR) Incentive Program which has been renamed as the Promoting Interoperability category in 2018 – into one fee-for-value program.
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With the MACRA Promoting Interoperability category came a stronger push for interoperability. Participants must report the required measures under each of the four objectives below, or claim exclusions if applicable:
As noted, these objectives are similar to the requirements for the Meaningful Use program.
The American Recovery and Reinvestment Act (ARRA) of 2009 was primarily intended to help the country recover from the Great Recession of 2008. However, it also contained measures aimed at providing investments in health and science technology, among others. As part of ARRA, the Health Information Technology for Economic and Clinical Health Act (HITECH) had a major impact on healthcare as it pushed for the nationwide adoption and “meaningful use” of electronic health records (EHRs).
According to the Centers for Disease Control (CDC), the concept of “meaningful” use or MU is anchored on five health outcomes pillars. These are:
Improving quality, safety, efficiency, and reducing health disparities
Engage patients and families in their health
Improve care coordination
Improve population and public health
Ensure adequate privacy and security protection for personal health information
The Centers for Medicare and Medicaid Services (CMS) and the Office of the National Coordinator (ONC) for Health IT have been leading MU’s phased implementation, which occurred in stages.
The ONC has noted on its website that the Advancing Care Information category (which in 2018 was renamed Promoting Interoperability or PI) within the Merit-Based Incentive Payment System or MIPS supplants meaningful use. However, it would still be extremely useful to have a familiarity with the background and evolution of MU to better understand what’s coming in the future.
According to the CDC’s MU website, “in order to encourage widespread EHR adoption, promote innovation and to avoid imposing excessive burden on healthcare providers, meaningful use was showcased as a phased approach, which is divided into three stages.”
This incremental implementation began with data capture and sharing in 2011 and moved up to advanced clinical processes in 2013 and then included improved outcomes in 2015.
For Meaningful Use Stage 1, the 15 core objectives for Eligible Professionals (EPs) were:
The items with asterisk (*) in both sets are public health objectives. EPs must select at least one of them to report on. Additionally, EPs needed to complete 6 Clinical Quality Measures (CQI).
For Medicaid, states were given flexibility to revise meaningful use after seeking approval from CMS.
For Stage 2 of Meaningful Use, the 17 Core Objectives for EPs were:
In October 2015, CMS released a final rule that established Stage 3 in 2017 and beyond, which focuses on using CEHRT to improve health outcomes. In addition, this rule modified Stage 2 to ease reporting requirements and align with other CMS programs.
To meet its commitment to promoting and prioritizing interoperability of health care data, CMS renamed the EHR Incentive Programs to the Promoting Interoperability Programs in April 2018. This change moved the programs beyond the existing requirements of meaningful use to a new phase of EHR measurement with an increased focus on interoperability and improving patient access to health information.
In her speech at the HIMSS19 Global Conference, CMS Administrator Seema Verma shared a strong message about the changes in the Meaningful Use program. According to Administrator Verma, “Last year, we finalized a significant overhaul of the Meaningful Use programs. In fact, the changes were so significant it warranted a name change. In our new Promoting Interoperability Programs, clinicians and hospitals are no longer incentivized or penalized based on just using an EHR. We eliminated thresholds and removed check-the-box measures in favor of scoring based on performance and results around interoperability and giving patients their data. We meant what we said about putting patients at the center of the system; nearly half of a hospital or clinician’s score in these programs is now based solely on sharing data with patients.”
The U.S. government’s journal, The Federal Register, echoes that message: “In April 2018, (CMS) renamed the EHR Incentive Programs and the MIPS Advancing Care Information performance category to the Promoting Interoperability (PI) Programs and Promoting Interoperability performance category, respectively (83 FR 41635). This refocusing and rebranding of the initiatives is just one part of the CMS strategic shift in focus to advancing health IT and interoperability.”
This law, signed by Congress in 2016, aims to “accelerate the discovery, development, and delivery of 21st century cures, and for other purposes.” The Office of the National Coordinator (ONC) of Health IT has been given the responsibility of “implementing those parts of Title IV, delivery, related to advancing interoperability, prohibiting information blocking, and enhancing the usability, accessibility, and privacy and security of health IT.“
The law includes definitions for “interoperability” and “information blocking”. Title IV also includes provisions for leveraging electronic health records to improve patient care and empowering patients and improving patient access to their electronic health information.
The proposed CMS-9115-P, submitted in March 2019, states that it “is intended to move the health care ecosystem in the direction of interoperability, and to signal our commitment to the vision set out in the 21st Century Cures Act and Executive Order 13813 to improve access to, and the quality of, information that Americans need to make informed health care decisions, including data about health care prices and outcomes, while minimizing reporting burdens on affected plans, health care providers, or payers.”
It further notes that this proposed rule is the “first phase of proposed policies centrally focused on advancing interoperability and patient access to health information using the authority available to (CMS).”
Additionally, this proposed rule includes initiatives that support Executive Order 13813 (Promoting Healthcare Choice and Competition Across the United States), such as:
In section 106(b) of MACRA, Congress declared it a national objective to achieve widespread exchange of health information through interoperable certified EHR technology nationwide by December 31, 2018.
In 2018, CMS began participating in the Da Vinci project, a private-sector initiative led by Health Level 7 (HL7), a standards development organization. For one of the use cases under this project—called “Coverage Requirements and Documentation Rules Discovery”—the Da Vinci project developed a draft Fast Healthcare Interoperability Resources (FHIR) standard during the summer and fall of 2018.
CMS also proposes to revise the conditions of participation for hospitals (including short-term acute care hospitals, long-term care hospitals (LTCHs), rehabilitation hospitals, psychiatric hospitals, children's hospitals, and cancer hospitals) and CAHs to “require that these entities send patient event notifications to another health care facility or to another community provider.”