The ethical/legal issues arising in NI practice

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 2014. 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, 2010).

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, 64(10),106-12.