Meaningful Use and ACO Reporting: Why an EMR Is Only a Partial Solution

Medicare and Medicaid electronic health record (EHR) financial incentive programs are available for eligible professionals (EPs), eligible hospitals (EHs) and critical access hospitals (CAHs) who can show they are “meaningfully using” their EHRs technology by meeting thresholds for specific objectives. The programs have three stages with increasing requirements for meaningful use that must be met.

As a businesswoman and an R.N. who works with meaningful use, patient safety and quality, and clinical improvement teams, I am constantly asking myself two questions:

  • Why are so many meaningful use programs run as silo initiatives versus being integrated into overall patient safety and quality, clinical improvement and transformation programs?
  • Why haven’t more healthcare organizations developed a strategy for streamlining their internal and external reporting?

The History of Meaningful Use

The HITECH provisions of the American Recovery and Reinvestment Act of 2009 enabled the federal government to establish the EHR programs with the objectives of improved healthcare quality and efficiency, promoting exchange of healthcare information and enabling patients to engage in their own healthcare.  Meaningful use Stage 1 began in 2011 with data capture.  Stage 2 will become effective in 2014 with an emphasis on exchange of information and patient engagement.  Stage 3 is in design phase and will focus on outcomes, clinical decision support (CDS), patient self-management and access to all relevant data.

Meaningful Use is Just One of Many Reporting Requirements

When I ask clients and colleagues in patient safety and quality, and clinical departments about their healthcare meaningful use program, the typical response I receive is that they know a meaningful use program exists. However, meaningful use is led by IT, and IT only reaches out to them if there’s an issue with a measure that isn’t being met.

In addition, most patient safety and quality departments say they are concerned about the growing number of reporting requirements – to name just a few – Meaningful use, Accountable Care Organization (ACO), Physician Quality Reporting System (PQRS), TCJ (The Joint Commission), Centers for Medicare and Medicaid Services (CMS) Core Measures, Financial and Operational KPIs, etc.  To meet the rising demands, these departments have -or are looking -for ways to expand their staff. The result can often be increased healthcare costs without an improvement in quality.

Why an EMR Is Only a Partial Solution

Sometimes used interchangeably with EHR, an Electronic Medical Record (EMR) is a digital version of paper charts. Will an EMR alone solve your meaningful use, ACO and healthcare internal and external reporting needs? The answer is likely to be no for three reasons:

1.      Meaningful information requires near-real time data to monitor, diagnose and treat the root causes before you report.

Meaningful Use Eligible Hospital (EH) Summary

EMR reports are typically provided weekly or monthly; they are static and one-dimensional, like the sample above.

What happens if you want to drill into the data and view trends related to a measure, say for example, an ED measure, where you might want to look at differences in the day of the week or time, differences by providers, etc.?  You could request another EMR report be built.  However, if you’re like many clients, your request would be in the EMR report queue for 120 days or more.  Then you would end up with multiple reports that you’re trying to cobble together to make sense of the data.

You may also want to look at data from other source systems such as operations, patient satisfaction and finance to analyze ED throughput and disposition of departure related to staffing ratio, department census/capacity, inpatient length of stay (LOS) and the impact on patient satisfaction. An Enterprise Data Warehouse (EDW) enables the integration of

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