Meaningful Use was created in order to create infrastructure for the health information system in American medical industry today.

The various stages were thought out and decided upon in order to ensure successful EHR use to establish an electronic health information network in the United States.

• Stage 1 - this stage was established for data capture and sharing to start taking place

• Stage 2 - this stage, began in January 2014, and intends to advance processes

• Stage 3 - this stage leads to improved outcomes

Requirements for Providers:

When looking at requirements for providers, these must be broken down into Medicare program requirements and Medicaid program requirements.

• Medicare program meaningful use requirements include 13 core measures that must be met and 5 of 9 optional measures. A 90 day reporting period to execute against goals of the program is also required.

• Medicaid program requirements include showing proof that the practice has purchased and installed a government certified EHR and after 1 year the practice must then meet the medicare requirements also with the 13 core measures.

Meaningful Use and its requirements intend to allow for progress tracking and more connectivity.

While using EHR will improve connectivity and is the way of the future, it is a lot of work for practices and physicians. But, it doesn't have to be! Scribes can help.

• Our medical scribes here at Scribe Solutions perform all the data entry work but also can assist in other services such as tracking labs, transcribing radiology reports, attending to patient needs, and helping physicians organize data.

• Scribe Solutions understands the demands that physicians face and offers a low cost, innovative approach to significantly improve the process of patient care.

As most of you probably know, Meaningful Use is rooted in the HITECH act. If you don't already know or understand the HITECH act, here is a "snippet" from Health and Human Services website:

The Health Information Technology for Economic and Clinical Health (HITECH) Act, enacted as part of the American Recovery and Reinvestment Act of 2009, was signed into law on February 17, 2009, to promote the adoption and meaningful use of health information technology.  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.  

HITECH act allows for financial incentives for EHR use. The goals behind these incentives include the desire by the U.S. Government to have an efficient and centralized National Health Information Network and better quality care for patients. 

To qualify for government's financial incentives, the practices need to demonstrate meaningful use and purchase and use of a government certified EHR system. Physicians must meet all meaningful use requirements to qualify for incentives from the government. 

See more info here at CMS.gov 

You may be surprised to learn that the majority of U.S. medical records are not available electronically. Despite this alarming fact, the U.S. medical industry is increasingly switching to EHR. According to the American Journal of Managed Care (AJMC), in 2008, fewer than 10% of hospitals utilized a basic EHR system.

But, by 2009, doctors and hospitals were starting to adapt and began to switch to EMR due to funding from the stimulus from Medicare and Medicaid payments. 

The EMR switch is sweeping the U.S. medical space, with 60% of hospitals having adopted at least a basic EHR system today, according to AJMC. 

Health IT is becoming more important each and every day. As doctors and hospitals become more and more accountable to the quality of the care they provide to patients, high-tech, high-performing electronic medical records will be key to successful treatment and management of patients.  

EMR On Rise, But Still Obstacles to Overcome in Overall Health IT

While EHR use is clearly on the rise, there are still some general challenges related to Health IT. The rise in EHR use is clear, with around 26 percent of hospitals having a comprehensive EHR system - and this number is quintuple that of the figure from 2010, according to an AHA report. So, yes, EHR is being used more, but most hospitals are using basic EHR systems.

With this, it brings up the question of when and how will hospitals start using more advanced systems, but in an efficient and reasonable way. The AHA has conducted studies on this issue, and has found that 59 percent of hospitals have a basic or comprehensive EHR system (quadruple the figure from 2010) but while the majority of these hospitals meet most of Stage 2 meaningful  use requirements, only 5.8 percent are able to meet all of the standards.

According to eWeek’s article, “Stage 2 Meaningful Use includes 16 core objectives, such as the ability to view and download their health information, as well as the ability of hospitals to transmit health information between facilities, such as a skilled nursing center and a hospital.”

While critical access hospitals (CAHs) appear to be behind, hopefully they can bridge the gap and adapt to Stage 2 Meaningful Use.

Stay tuned for updates on Stage 2 Meaningful Use and how to overcome obstacles related to Health IT and EHR.

EHR Benefits are Visible

It is now becoming even more apparent that EHR as a whole is positively impacting the healthcare industry.

Specifically, when it comes to EHR alerts, these benefits are highly visible. Now, with new EHR alert systems in place, results are being seen in a variety of areas. One area is HIV testing. The implementation of EHR alert and documentation has increased regular HIV testing rates at multiple facilities. Two places that have seen astounding results from EHR alerts are New Orleans and New York City. This news of increased HIV testing rates due to EHR alerts can only bolster the health IT industry and lead to more screening of this disease, but also others. There is a clear, strong, future for the use of EHR alerts in modern health care.

See some results from the use of alerts in New Orleans and New York:

• LSU Hospital - in the emergency dept. rise from 17% in 2012 to 26% in Dec. 2013 for HIV screening 

• In New Orleans urgent care center - rise from 3% in 2012 to 17% in Dec. 2013

• Urban Health Plan with 16 facilities in New York City saw an increase in HIV testing from 8% to 56% over a three year period 

Revenue Cycles and Hospital Management

Often times one might not associate revenue cycles with hospitals, because hospitals are many times understaffed and lacking resources, thus making revenue cycle management difficult.

But this is constantly changing and hospitals are becoming, and have become, more efficient.

Yes, hospitals are places where patients receive treatment - pretty clear definition. But, when it comes to managing hospitals, one thing always arises and is a key component to most, if not all, decisions made when operating hospitals.

With the new federal mandates, comes more and more EHR implementations, and coming from this is meaningful use and ICD-10 and their associated changes. Some see these changes as burdensome, but with the help of medical scribes, these new changes can actually lead to more streamlining and efficiency, and to better doctor patient interaction.

Despite some hospitals viewing EHRs and electronic charting in general as a hassle, some hospitals are actually profiting more from these changes. Revenue cycle management and financial metrics are important to hospital administrators, and though new changes may lead to new organization and management of health care, as seen in analysis, using EHRs and medical scribes can lead to growing profits. EHRs can clearly be productivity-boosting and especially so when viewing EHR through the lens of patient coordination.

For more info on this click here to see an article by EHR Intelligence.

Patient Satisfaction & Thoughts on Improvement

Hospitals can always improve when it comes to patient satisfaction.

Administrators and consultants are always looking for ways to become an even better provider to their patients. With ever changing technology and new requirements for documentation, it can make it even more difficult to achieve high patient satisfaction. As a writer for MedCity News put it, “ I’ve felt that there’s not been enough next-generation tech being applied to the low margin, high volume business of hospital supply management.” Supply chain automation is important to gain higher patient satisfaction, and even though it is often viewed as being the responsibility of the administration, it is directly tied to patient and nursing satisfaction.

• Supply chain expert Harold Richards explains that thinking about patient satisfaction and supply chain can be compared to ant hill management:“You may have had an ant farm as a child and marveled at the cooperative efforts and precisions of the ants as they went about their daily activities...so it is with the hospital supply chain, full of hard working individuals who run into daily challenges just as ants do. Both rely on excellent systems of communication to get things accomplished. However, ants do not have to deal with bureaucracy, integrating of mismatched systems, missing supplies, and other time-wasting system failures (at least not as far as we can tell).”

The ant farm comparison seems to be on point when it comes to managing busy ER departments and the like. Today more than ever, patients are converging on emergency rooms across the country seeking treatment for their ailments. Resulting from this is - you guessed it- overcrowded ERs filled to capacity and short staffed in many cases. According to the USA TODAY, some hospitals are faced with spikes as high as 12%.

It is apparent that an increase in volume can cause problems, and without proper planning and supply chain management, there could be inefficiencies such as shortage of staff and medical supplies in emergency situations. So, look at hospital management from the ant farm perspective if you will...it might just make it a little clearer...and little more fun to analyze efficiency. Make sure you know what is happening in your ant hill.

Meaningful Use & Dealing With Technicalities

Meaningful use is using certified electronic health record technology for a number of tasks in health care. Technology plays a clear role not only in day-to-day life, but also in the way business is done. In terms of healthcare, this means that technology and the medical world are intrinsically linked. EMRs and EHRs are more popular and readily available.

But just having these systems in place is not the only piece to the puzzle. Providers need to take control of their Health IT plans to ensure that data is reported properly. Correct reporting to the Centers for Medicare & Medicaid Services (CMS) is key in order in order to collect incentive payments. This could be complicated if proper planning and management isn’t in place.

Without proper planning and management, a breakdown in coordination could lead to failure to properly report data. This is particularly important for critical access hospitals. Health IT consultant Marcia Cheadle, who is Senior Director of Meaningful Use and Advanced Clinicals for Engage, explains “The CAHs in particular are challenged there because of the way the government views their cost accounting...They also have to go to the fiscal intermediary related to the depreciation of assets required for each of the stages.

The landscape of the Health IT industry is constantly changing and thus it is important to keep up with meaningful use news and maintain planning and coordination efforts at your organization.

Technology is strongly present in meaningful use, and it is imperative that it be properly administered to allow for efficiency in reimbursement.

Stage 2 Meaningful Use has made it obvious that the administrative function of your organization must flow in an organized manner in order to flourish in the current healthcare environment.

Emergency Preparedness and Health IT Systems  

The Department of Health and Human Services (HHS) has been increasing its initiatives to help providers prepare their IT systems for emergencies. These initiatives are important because there is always a chance for natural or man-made disasters to strike. A National Coordinator, Karen DeSalvo, MD, MPH, Msc and Greg S. Margolis, PhD NREMT-P explain that HHS is making an effort to help providers prepare for potential disasters and to protect data and patients in the event of an emergency: “The question isn’t whether or not we will have another disaster - it is just a matter of when, where, and how severe it will be.”

Natural disasters can be devastating events, and hurricanes, earthquakes and other storms can cut off electricity and internet connection which can lead to crisis situations in hospitals. That is why it is key to follow HHS activity and initiatives to prepare for emergencies.

Examples of HHS efforts of preparation are detailed below:

• First project is a single website that aggregates real-time data from Twitter to identify trends related to public health and incidences of disaster.
• Second project is another website that is still being developed, and it will include an interactive map to highlight the number of Medicare beneficiaries reliant on electricity on a given zip code level. This map will tie directly to data from the NOAA to warn hospitals and other providers about storms approaching that may cut power at their locations. 

To see more information on HHS efforts to take on EHR and data disaster planning click here.

Shifting to ICD-10

ICD-10 will be replacing ICD-9 as the medical classification set forth by the International Statistical Classification of Diseases and Related Health Problems (ICD), a medical classification list by the World Health Organization (WHO). ICD-10 includes codes for diseases, signs and symptoms, abnormal findings, complaints, social circumstances, and external causes of injury or diseases.

What Does This Mean?

ICD-10 is a new change, but stay informed about what it means.

Here are some key facts to know about ICD-10 compliance:

• Transition to ICD-10 is required for everyone covered by the Health Insurance Portability Accountability Act (HIPAA), and this is explained in depth on cms.gov.

• The ICD-10 change does not affect CPT coding for outpatient procedures and physician services.

• The deadline for ICD-10 compliance is set for October 1, 2015 to replace ICD-9, as established by the Department of Health and Human Services (HHS) on August 4, 2014.

• ICD-9 will continue to be required until September 30, 2015.

                                   Response to the Change and More Info.

In response to the new compliance date, American Medical Association (AMA) president elect Steven J. Stack stated,“While the AMA appreciates that physicians have additional time to comply with ICD-10, we continue to have fundamental concerns about ICD-10 and its implementation, which will not be resolved by the extra time.”

Testing for ICD-10 will take place by Centers for Medicare and Medicaid Services (CMS) during November 2014 and March and June 2015. Further end-to-end testing will also take place on a rolling basis. Moving to ICD-10 is most likely going to affect all physicians.

Due to increased number of codes, change in number of characters per code and increased code specificity, the transition to ICD-10 will require adequate planning and training.

For even more information, see this article on AMA website.