Magazine article Clinical Psychiatry News

Meaningful Use Criteria: What's Missing?

Magazine article Clinical Psychiatry News

Meaningful Use Criteria: What's Missing?

Article excerpt

Since the passage of the Health Information Technology for Economic and Clinical Health (HITECH) Act in February 2009, there has been a tremendous amount of discussion about the idea of "meaningful use." Associated with the meaningful use criteria are financial incentives for those who adopt an electronic health record and care for Medicare and Medicaid patients. Such incentives might total more than $40,000-$60,000 per provider. Those who fail to meet the criteria will find their reimbursements reduced beginning in 2016.

Despite the abundance of commentary and speculation over meaningful use, until recently the term had not actually been defined. And now that the full set of rules for meaningful use is available, it might surprise some to know what has actually been excluded from the criteria.

In explaining the meaningful use concept at the beginning of this year, the U.S. Department of Health and Human Services laid out several objectives and priorities centered on improving the quality, safety, efficiency, and accessibility of care. Any aspects of electronic health record (EHR) implementation that do not meet those goals have been specifically left out of the criteria. In doing so, the intent is to challenge health care providers to move forward toward the goal of EHR implementation, while acknowledging the limitations of the technology currently available.

The first and most fascinating exclusion is any requirement for encounter note generation. While most EHR products emphasize electronic note generation, the authors do not think this provides a significant benefit over handwritten charting in meeting the goals of HITECH (Federal Register 2010;75:1843-2010). Still, it might be difficult to implement an EHR without this piece, as once an office becomes dependent on the technology, workflow can be significantly hindered by searching for documentation that is not in the electronic record.

To address this, some practices have chosen to scan in handwritten notes. Unfortunately, this might preclude critical data points from being captured by the system, and make it impossible to meet some of the quality reporting goals laid out elsewhere in HITECH.

A second intentional omission in the criteria is the requirement that providers make educational resources available to patients. Although the authors admit that proper information and education are critical, they are reluctant to make this a necessity, saying "there is currently a paucity of knowledge resources that are integrated within EHRs, that are widely available, and that meet [our] criteria, particularly in multiple languages. …

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