Meaningful use program

Examine the ethical/legal issues arising in NI practice while using, designing, managing,
upgrading, and building information systems. (POs 4, 6)Meaningful use program


Meaningful use is the application of electronic health record (EHR) technology with the
aim of improving safety, efficiency, quality and reducing health disparities. Other objectives of
using EHR include engagement of patients and families, improvement in care coordination and
population health, and maintaining security and privacy of health data obtained from patients
(Thompson 2010). The federal government has come up with a combination of voluntary
incentives and ultimate penalties to promote the meaningful use of EHRs. This initiative was
aimed at stimulation of investment and application of health information technology (HIT) in
order to ensure provision of quality health care. Effective implementation of the EHRs will
warrant dramatic improvements in the systems or models used in health care delivery. HIT has
the potential of transforming the process of delivery of health care services (Optum, Ferrari and
Heller, 2014). The congresses efforts to realize this potential in Health Information Technology
for Economic and Clinical Health Act of 2009 (HITECH), a part of the American Recovery and
Reinvestment Act of 2009 (ARRA) involved inclusion of $34 billion in financial incentives for
providers Medicare and Medicaid services including health care professionals and hospitals. The
HITECH legislation entailed a broad framework of what will be involved in the meaningful use.
According to the congress`s intent, respective health care service providers will be required to
adopt the meaningful use of EHRs in service provision in order for them to receive the stated
incentives and avoid possible payment reductions in future. The idea of meaningful use is
supported by users because it supports fundamental goals of improved health care provision

(Centers for Medicare and Medicaid Services, 2014). This paper will focus its discussion on the
overview of meaningful use program, analysis of the implications of meaningful use core criteria
and possible recommendations for the meaningful use criteria in stage two.

Overview of meaningful use program

Meaningful use is authorized by law to receive incentives. These incentives specify three
components associated with meaningful use including application of a certified EHR in a
meaningful manner, for instance e-prescribing, application of certified EHR technology for
exchange of heath data electronically in order to improve health care quality and application of
certified EHR technology to submit clinical quality as well as other measures (Blumenthal and
Tavenner, 2010). There are three stages involved in application of meaningful use. The initial
stage was implemented in the years 2011 and 2012. This stage focuses on four specific areas.
These include electronic capturing of health data using codes, use of electronically captured
health data to track crucial clinical conditions and share information for the purpose of
coordinated care provision, implementation of support tools for clinical decisions to facilitate
management of disease and reporting of information for improvement of quality. During the first
stage, two sets of objectives must be achieved. All core objectives are necessary. Nevertheless,
eligible providers may select the objective they wish to follow. Eligible providers (EPs) should
be credentialed with Medicate and may be, for example, a doctor of medicine. Medicaid EPs
may include, for instance, dentists, physicians, or nurse practitioners. According to the
meaningful use criteria, providers are required to satisfy 14 core objectives, five out of ten menu
set objectives and six measures of clinical quality. The second stage was implemented in the year

  1. The stage focuses on expansion of the initial stage criteria in order to encourage
    application of health information technology (HIT) for continued enhancement of quality at the

point of care and the exchange of health data in an efficiently formatted structure. The criteria for
these state include a more thorough health information exchange (HIE), increased requirements
for incorporation of lab results and e-prescribing, transmission of patient care information across
various settings electronically and more patient-controlled information. EPs are required to
satisfy 17 core objectives and three out of six menu set objectives. Implementation of the final
stage is expected to be fulfilled by the year 2017. This stage will involve the promotion of
improvements in efficiency, quality and safety, clinical decision support for high-priority
conditions at the national level, access by patients to self-management tools, and improvement of
population health (Optum, Ferrari and Heller, 2014).

Implications for nursing

The Medicare and Medic aid program HER incentive programs have a detailed outline of
the objectives and measures that highlight how health professionals are required to use EHRs to
enhance the quality of care and patient safety. To be recognized as making use of technology
meaningfully in the initial stage, for instance, a health care provide must satisfy the requirements
highlighted previously. Regarding the years of experience in operationalization of the EHR
systems, experts believe that adoption of meaningful use will have a large impact on nursing
practice linked to computerized provider order entry (CPOE), management of medication and
patient education, but less impact on documentation of demographics and offering patients with a
summarized information about their visit. When physicians make use of CPOE, nurses will be
able to check the EHR for fresh orders instead of checking the new orders from a paper chart.
Electronic documentation systems will provide nurses with the ability to document the care they
offer, generating new efficiencies with the application of templates and bedside medical
equipment interfaces like a wall mounted-tablet. The data captured in the wall-mounted tablet

can be transferred into the EHR via nurse verification instead of the traditional nurse
transcription (Kossman and Scheidenhelm, 2008).

Meaningful use in the perioperative setting is also worth considering regarding nurse
practice. In order to make sure that compliance is realized with several objectives of meaningful
use in perioperative services, nurses are required to make use of the comprehensive perioperative
form. This form may include the necessary documentation for preadmission screening and
testing, and data requirements for the day in which surgery will take place, and inpatients. For
instance, the form can have three sections including preadmission testing, surgery day, and
inpatient, and each section completed at different points of care. Capturing of meaningful
objectives including medication list, allergies, smoking status, weight and height documentation,
and directives made in advance can be done concurrently with preadmission testing visit or
phone call. Patient education and vital signs can be captured during surgery day. Patient data on
immunization histories can be can be captured at the time of inpatient encounters. This type of a
comprehensive form is of relevance to nurses in terms of capturing the data required for
excellent medical care, and fulfilling a number of the requirements of meaningful use (Kossman
and Scheidenhelm, 2008).

Implication for nurses

A review of various reports, which focused on the attitude of nurses, showed varied
responses from nurses. Some of the nurses reported that the use of EHR was cumbersome, and
consumed time away from direct care of patients. Other groups of nurses from Sweden revealed
a positive response. These group of nurses claimed that implementation of EHRs resulted in
increased use of a standardized plan of care. As evident from this report, there are several

factors, which may appear to affect the nurses` opinions, include the usability of EHRs, the
perceived importance, and the length of time following its implementation (Optum, Ferrari and
Heller, 2014). A report released in the year 2010 by the Institute of Medicine, stressed that
nurses should be involved in the selection, operationalization and execution of the technological
advancements for patient care. According to this report, nurses will be exposed to new
technologies, which will entail creation of new practice milieu, through which every health
professional will have access to electronic and individual health records as well as shared support
systems. This system will improve the level of interaction among multidisciplinary health care
professionals. Nurses are among the largest workforce in the health care industry, and therefore,
they are be required to be at the forefront of any redesigning efforts in health care industry based
on the meaningful use of fresh technologies. It is the responsibility of health care professionals to
rethink continuously about the way health data can be recorded using HIT, as this ensures
creation of patient-centered care processes (Kossman and Scheidenhelm, 2008).

Implications for national health policy

Health information technology systems (HIT) has been touted as a means of promotion of
free exchange of health data while ensuring patient privacy as well as ensuring improved
efficacy, safety and quality of care. However, these advantages are yet to be fully achieved, in
large part since there has been no widespread use of the necessary infrastructure to allow
achievement of these goals. HIT supporters argue that, if implemented in a correct way, it may
prove valuable in addressing challenging issues like the steadily rising costs of health care,
increasing size of uninsured population with inadequate access to health care services, and
problems related to safety of patients and quality of care. A national wide infrastructure
establishment, as envisioned, would facilitate information exchange across different clinical

settings and would offer tools for clinical support, which will be embedded in EHRs. This would
allow improvements in terms of safety of patients and care quality while reducing expenses from
reduced utilization (Optum, Ferrari and Heller, 2014).

Implications for population health

Regarding population health, the stage two objectives focused on population health
purpose to enhance population health via encouraging health care providers and professionals to
employ use of electronic health records in terms of transmission of health information to state
and local public health agencies (PHAs) and registries. Achievement of stage two objectives will
lead to improvement in quality of care offered to the community, and the nation at large. More
specifically, there will be an improvement in local and state public health management of
emergency response, recognition of outbreaks and situation awareness. There will also be
improvements in cancer surveillance and screening as well as guide planning and assessment of
prevention programs designed for cancer. Additionally, the local and state PHAs will be able to
develop immunization communications targeted for high-risk populations. Lastly, realization of
the objectives will enable empowerment and education of the community regarding population
health issues such as environmental health hazards (Fogelberg and Wadensten, 2009; Thompson,

Possible recommendations

Considerations for possible recommendations on the meaningful use criteria for stages
one and two may also be worth. Centers for Medicare & Medicaid Services (CMS), for instance,

has accepted comments from the public on the meaningful use criteria for stages two and three.
So far, from the comments, professionals of health information technology are pleading with the
policymakers to progress at a slower pace with stage two. In this regard, addition of criteria of
forwarding electronic reminders to the patient per patient preference for follow-up care or
preventive care on stage two criteria of meaningful use. This will represent a holistic type of care
where patient information is monitored outside hospital settings until full recovery (Centers for
Medicare and Medicaid Services, 2014).


EHRs have the potentiality of promoting the delivery of cost-effective, high-quality
health care services. More specifically, this can be achieved via support for clinicians` decisions
and improvement on patient outcomes. The role of nurses in the implementation and
achievement of meaningful application of EHRs is very crucial. Since nurses spend more time
with their patients, it is a requirement for them to identify novel ways in which technology can
be employed to make a difference in health care service industry. If HIT systems are envisioned
for rigorous improvements in health care service provision, nurse’s information starting from
influencing various policies to provision of feedback to their facility and departmental heads
regarding what works best for clinicians and patients must be sought.



Blumenthal, D., & Tavenner, M. (2010). The “meaningful use” regulation for electronic health
records. England Journal of Medicine, 363(6), 501-504.

Centers for Medicare and Medicaid Services. (2014). Medicare and Medicaid Programs;
Electronic Health Record Incentive Program; Final Rule. Washington, DC: Federal
Register 2010 44314-588.

Fogelberg, D.M., & Wadensten, B. (2009). Nurses’ experiences of and opinions about using
standardized care plans in electronic health records. Studies in Health Technology and
Informatics, 146, 763-764.

Kossman, S.P., & Scheidenhelm, S.L. (2008). Nurses’ perceptions of the impact of electronic
health records on work and patient outcomes. Computers, Informatics, Nursing-LWW
Journals, 26(2), 69-77.

Optum, Ferrari, V., & Heller, M. (2014). The paperless Medical Office: Using Optum PM and
Physician EMR. New York: Cengage Learning.

Thompson D (2010). Reducing clinical costs with an EHR. Healthcare Financial Management,

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