Difference between revisions of "Impact of meaningful use"

Revision as of 12:57, 23 May 2011

The Impact of Meaningful Use on Healthcare Support Services

Many eligible healthcare professionals are scrambling to meet the meaningful use criteria and deadlines for many reasons; primarily to maximize Medicare and Medicaid reimbursements, leverage technology to provide better patient care and create efficiencies in prescribing, registry reporting, transition of care and medical records management.4

Knowing full well that implementing an electronic health record system and consequently proving meaningful use will require resources to accomplish, with the focus on the implementation factor, the impact to healthcare support services such as the medical records department, has been overlooked or, if known, ignored.

Meaningful use definition “Meaningful use is ultimately linked to achieving measurable outcomes in patient engagement, care coordination, and population health.”1 Meaningful use is being defined by the Centers for Medicare and Medicaid Services as “how to best frame (these) measures including measurement of key public health conditions, measuring health care efficiency, and measuring the avoidance of certain adverse events.” 1

Meaningful use measures with impact on support services Measure: Record Advance Health Care Directive (AHCD) Stage 1: 50% (hospital requirement only). Make core requirement. For EP and EH: 50% of patients >=65 years old have recorded in the electronic health record (EHR) the result of an advance directive discussion and the directive itself if it exists. 2

Impact: Advance health care directives are legal documents, which allow the patient to chose his or her end-of-life decisions ahead of time.3 50% of all admitted patients 65+ should have documented in their health record that there was a discussion about, or documentation of, an advance directive. Hospitals have been actively pursuing this meaningful use criteria as it is seems to be an easy goal to accomplish because the time and effort to implement this procedure electronically appears minimal with low impact to the workflow. However, the unexpected consequence of implementing this criterion without full workflow process analysis proved to negatively impact clinical support services at healthcare facilities. Colleena Kirby, the legal documents processor in the medical records administration department at a large health maintenance organization in Hawaii reports that there was an average of 10 AHCD per day pre-meaningful use. Post-meaningful use implementation about 60 AHCD per day arrives for processing.5 The AHCD workflow consists of filtering for errors, rejecting erroneous AHCD, sending out rejection letters, scanning, indexing and documenting the AHCD. This process took approximately two hours a day for 10 AHCD. With the number increasing to 60 per day, the processing of AHCD was creating a backlog of all other documentation processing and was requiring resources which were not available to the medical records administration department. Consequently all legal documents processing started backlogging, which impacted patient care, revenue cycle and legal departments.5

How clinical information systems can help: The use of the EHR can be used by healthcare providers to document that a conversation regarding AHCD was discussed with the patient, which also qualifies as part of the 50% of AHCD for meaningful use. However, many providers and facilities will accept the paper document and send to the medical records administration, or scanning department, to process and scan in the document itself as proof of discussion of the AHCD. Document management systems which utilize a scan-on-demand function, which can feed scans into the EHR via fax or PDF, can help integrate the paper and electronic records, alleviating the impact to support services departments while not requiring more full-time resources to complete the work and also fulfilling meaningful use criteria.

References: 1. U.S. Department of Health and Human Services The Office of the National Coordinator for Health Information Technology. Meaningful use: a definition. 2009. Available from URL: http://healthit.hhs.gov/portal/server.pt?open=512&objID=1325&mode=2. Accessed 2011 May 21. 2. U.S. Department of Health and Human Services The Office of the National Coordinator for Health Information Technology. Meaningful use matrix. 2009. Available from URL: http://healthit.hhs.gov/portal/server.pt/document/872719/meaningful_use_matrix_pdf. Accessed 2011 May 21. 3. Medline Plus. Advance directives. Available from URL: http://www.nlm.nih.gov/medlineplus/advancedirectives.html. Accessed 2011 May 21. 4. Healthcare Information and Management Systems Society. The consequences of not pursuing meaningful use. 2010. Available from URL: http://www.himss.org/ASP/topics_News_item.asp?cid=74732&tid=9. Accessed 2011 May 21. 5. Kirby C. [Personal interview, 15 May] Honolulu; 2011 (unpublished).

Submitted by: Lari Anne Kamei