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— Susan B. Bergman, MD, Framingham, MA
Although EHRs have been around for well over a decade, they have not been widely adopted because poor usability and inflated pricing.
To encourage faster adoption, the government decided to incentivize healthcare providers using the carrot and stick approach of incentive payments initially, followed later by penalties.
While there is evidence that market forces alone were already pushing lower pricing and more usable solutions through competition, the government was looking for ways to spend taxpayer money to kick-start and stimulate the imploding economy.
Ironically, pouring over half-a-billion dollars of taxpayer money into encouraging EHR adoption has hampered competitive forces, and is keeping EHR prices falsely elevated while encouraging unscrupulous vendors to spend money on slick marketing rather than developing usable products.
So the Office of the National Coordinator (ONC) within the Department of Health and Human Services (HHS) decided that to encourage EHR adoption, providers would be incentivized monetarily to not only purchase an EHR, but also make "meaningful use" of it.
To ensure EHRs can be used in a "meaningful way" (as defined by the ONC), you first have to ensure an EHR has the features that can allow it to be used in a "meaningful way." For example, an EHR that simply scans your handwritten notes doesn't really offer much benefit over a paper note.
Therefore, only EHRs that have been certified by an ONC-authorized testing and certification body (ONC-ATCB) to contain the required features, are eligible for the stimulus incentives.
What defines "meaningful use," and how can providers prove they are using their EHR meaningfully? The brief answer is to require documenting within the EHR certain population health information, and then generating and submitting reports to the Centers for Medicare and Medicaid Services (CMS). While the ONC is in charge of the whole program, CMS is the organization that will be paying out the money.
For example, asking if a patient uses tobacco is the first step in encouraging them to stop. "Meaningful use" of your EHR requires you to document their smoking status within the EHR in a certain way, and then provide CMS a tally of the percentage of patients that were asked and have the documentation that proves it. Hence, the EHR must be able to document the smoking status in a specific way, as well as provide specific reports that show what percentage of your patients you asked and documented in this way. Smoking status is just one of 25 criteria that make up the first stage of Meaningful use. The ONC plans to build on meaningful use over the next five years in three consecutive stages, as shown.
It is anticipated that each stage will require a higher overall percentage of patients that you asked (or performed) the required measures. A list of the current measures and requirements is here.