By Sheryl Dion, RN
The American Recovery and Reinvestment Act of 2009 (ARRA) set aside nearly $20 billion in federal incentive payments to healthcare providers and organizations who adopt electronic health record (EHR) technology. To qualify, healthcare providers and organizations must be using certified EHR technology in a "meaningful manner."
"Meaningful use" refers to a set of healthcare quality measures providers need to capture based upon their patient population, using EHR software. An example of one such measure would be tobacco usage. Meaningful use certification means you are working towards improving quality, safety, efficiency, care coordination, and public health; engaging patients and their families; and ensuring privacy and security for personal health information. Meaningful use, in its initial stages encompasses 15 core measures with at least five optional measures, ranging from e-prescribing, providing patients with electronic copies of their health information, to electronic insurance claims.
To successfully develop an EHR program that meets meaningful use requirements, IT professionals should work with a healthcare organization to determine the program scope, the best approach, and develop a remediation roadmap. Below is a five-step program that helps healthcare IT professionals implement an EHR best practices approach to achieving, monitoring, and refining meaningful use.
The Five-Step Program
Step 1: Program Development
Program development starts with assembling a pilot group. The scope of the program must take into account the provider types (specialty care or primary care), determine the correct assessment areas, map proper timeframes to complete the program rollout, and determine if the healthcare organization needs to roll this program out to other associated physician organizations.
Determining the best approach requires assessing and agreeing on the methodology.
- Assess whether you'll use interviews and observation or a reporting system that is on-site or remote.
- Use benchmarks to determine adoption levels.
- Implement pilots to ensure appropriate stopgaps are in place and that the proper course is being followed, allowing for course correction to keep program development on track.
- Educate through awareness programs to ensure understanding of agreed-upon best approach methodology.
Step 2: Create Assessment
Creating a proper assessment process requires that you define what the key indicators of adoption will be on a detailed level. Then you perform a "map and gap" for system functionality to ensure accurate data capture at the point of care by utilizing clinical best practices.
The "map and gap" process examines the inner processes of operational and provider proficiency, system optimization, clinical utilization and best practices approach, clinical staff and providers, and meaningful use criteria (structured data entry elements, patient care reporting, practice management functionality, patient access coordination of care, EHR system capability, and quality measures).
Step 3: Create Tools
Implementing a successful EHR adoption program relies heavily on creating the right tools and ensuring that health information entered into the EHR system follows ARRA meaningful use guidelines. Proper tools take into account data input (ensuring health information accuracy), rules (requiring proper procedures are followed), remediation (stopgaps to review and institute change to methods, resulting in a fine-tuned set of procedures), findings (determine if remediation achieved the desired results), and reporting (present results to key stakeholders).
Step 4: Remediation
The remediation process organizes and presents findings, identifies and recruits organizational or practice champions, and reaches out to colleagues and industry experts. Practice champions then identify and implement solutions based on the findings. Implementing IT solutions ensures that accurate data capture at the point of care is in place. Healthcare organizations can redesign the workflow -- if necessary -- to maximize efficiency, create practice policies and procedures for uniform clinical data capture and documentation, standardize and build templates and diagnostic-specific order sets, and reconfigure and standardize existing order sets for all visit types.
Step 5: Education and Awareness Sessions
Any program launch can fail without proper follow-up education and awareness sessions. It's critical that clinician volunteers talk about the process for EHR implementation. The basics of meaningful use and related quality programs should be reviewed with key personnel within your organization because many providers are not properly informed about these programs. Findings from the pilot and remediation processes should be shared to enhance knowledge and understanding of what did and didn't work, how some points were corrected or improved upon, and what were the successful outcomes of remediation. It is important that next steps are shared with the organization to provide a forward-looking vision of continual improvement.
Meaningful use, a driving factor to achieve full-scale EHR adoption, is a combination of quality data collection, use of clinical best practices, and the attention to the day-to-day operations of a practice that will maximize adoption. Real clinical transformation occurs when this combination is balanced in a full-scale effort for the providers. Following the necessary steps in reviewing all the data needed -- and the means by which the data can be optimized in EHR for the ease of the providers -- is what will lead to an increase in the use of technology and create true clinical integration.
Sheryl Dion, RN, is a Clinical Consultant at Concordant, which provides healthcare IT consulting services, specializing in ambulatory EHR adoption and implementation.