Meaningful Use
In the context of health IT, meaningful use is a term used to define minimum U.S. government standards for electronic health records (EHR), outlining how clinical patient data should be exchanged between healthcare providers, between providers and insurers and between providers and patients.
Although the meaningful use program in the U.S. was part of a successful effort to usher in EHRs, it was also unpopular with providers, who had to meet a slew of requirements to prove meaningful use. In 2018, the program was overhauled and renamed the Medicare and Medicaid Promoting Interoperability Programs by the Centers for Medicare and Medicaid Services (CMS). The term meaningful use is now largely outdated.
The general intent of meaningful use was to improve the collaboration between clinical and public healthcare, improve patient-centric preventative care and support the continued development of robust, standardized data exchanges.
In an effort led by both CMS and the Office of the National Coordinator for Health IT (ONC), meaningful use was phased into practice and divided into three stages, spanning from 2011 to 2015. In addition, CMS and ONC created incentive programs to encourage eligible professionals or eligible hospitals to adopt, implement and upgrade to certified EHR technologies (CEHRT) and demonstrate meaningful use in compliance with their criteria.
Meaningful use stages
When they were introduced, the Medicare and Medicaid EHR Incentive Programs were designed to measure the meaningful use of CEHRT in three stages:
- Stage 1 focused on promoting the adoption of certified EHR technologies. This initial stage established requirements for the electronic capture of clinical data and giving patients access to electronic copies of their own health information.
- Stage 2 expanded upon stage 1 criteria by encouraging the meaningful use of CEHRT. This stage emphasized care coordination and the exchange of patient information. It increased the thresholds of criteria compliance and introduced more clinical decision support, care coordination requirements and patient engagement rules.
- Stage 3 focused on using CEHRT to improve health outcomes by implementing protected health information, e-prescribing, clinical decision support, computerized provider order entry, patient provider access, coordinated care through patient engagement, health information exchange, clinical data registry and case reporting.
Breaking down the process into stages made it more feasible to implement and lessened the likelihood of overwhelming providers, although hospitals remained critical of the program.
Requirements
Meaningful use was based on five main objectives, according to the Centers for Disease Control and Prevention. They were:
- Improve quality, safety, efficiency, and reduce health disparities.
- Increase patient engagement.
- Improve care coordination.
- Expand population and public health.
- Ensure adequate privacy and security protection for personal health information.
With these priorities in mind, CMS and ONC established meaningful use standards that EHRs needed to meet. These standards promoted the use of CEHRT. If CMS determined that a successful demonstration of meaningful use applied, the parties were then considered eligible for federal funds.
Because the meaningful use program was technically voluntary, meaningful use criteria were considered guidelines, not regulations. Still, failure to adhere to meaningful use resulted in reimbursement-related penalties.
History of meaningful use
The Health Information Technology for Economic and Clinical Health (HITECH) Act of 2009 promoted the adoption of meaningful use. Per the U.S. Department of Health and Human Services, Subtitle D of the HITECH Act addresses the privacy and security concerns associated with the electronic transmission of health information, in part, through several provisions that strengthen the civil and criminal enforcement of the HIPAA rules.
Eligible organizations for the Medicare EHR Incentive Program were required to achieve stage 1 meaningful use by 2014 in order to receive incentive payments. Deadlines were established and at times extended for stages 2 and 3. During this process, CMS established the Medicare and Medicaid EHR Incentive Programs to encourage clinicians, hospitals and clinics to implement meaningful use of CEHRT.
In April 2018, CMS renamed meaningful use from the EHR Incentive Programs to the Promoting Interoperability Programs, with the intent of reflecting a focus on improving interoperability, flexibility and patient access to health information.
In CMS' new rule, the agency noted that beginning with an EHR reporting period in 2019, all eligible hospitals under the Medicare and Medicaid Promoting Interoperability Programs are required to use the 2015 Edition of CEHRT. CMS also finalized changes to measures, including removing certain measures that do not emphasize interoperability and the electronic exchange of health information.
These changes had been heralded for several years. According to ONC, meaningful use shifted into the Merit-Based Incentive Payment System, or MIPS, in part due to the introduction of the Medicare Access and CHIP Reauthorization Act (MACRA) of 2015. MACRA is one of the four components of MIPS, which combines existing CMS quality programs (including meaningful use), the Physician Quality Reporting System and value-based payment modifiers. The consolidation was intended to improve quality of care.
