Becker's Hospital Review

92 THOUGHT LEADERSHIP CMIO Musings: Is Meaningful Use Still Meaningful? By Maulik P. Purohit, MD, MPH, Senior Vice President and CMIO, University Health System A s we step farther into 2018, reflecting on the past will be important to move forward in a truly meaningful way — not just in name. Meaningful use, as it is called, is one of those programs we should reflect on. e program began in 2009 with the enact- ment of the American Reinvestment and Re- covery Act and its accompanying Health Infor- mation Technology for Economic and Clinical Health Act — laws that drastically changed the way hospitals use IT. Specifically, the HITECH Act authorized nearly $36 billion in incentive payments for the use of health IT, leading pro- viders to scramble to implement new technol- ogies and opening the floodgates for EHR and IT vendors to develop them. Healthcare providers could see monetary gains by demonstrating "meaningful" use of their IT by submitting select data to CMS. ose who didn't or couldn't demonstrate meaningful use faced penalties. CMS split the meaningful use program into three stages. Although reporting requirements vary slightly for providers in outpatient and inpatient set- tings, Stage 1 emphasized adoption, as well as data capture and sharing, and covered a period from 2011 to 2013. Stage 2 targeted advanced clinical processes such as interoperability and health information exchange, and ran from 2014 to 2016. In Stage 3, the program focuses on optimizing outcomes with the EHR, and requires meeting eight criteria with a certified EHR technology (CEHRT), including: • security assessments of vulnerabilities to protected health information • electronic prescriptions • clinical decision support • certain requirements of computerized physician order entry • patients' electronic access to their data • care coordination via patient engage- ment • interoperability through HIE • submission of public health and clinical data to select registries Stage 3 is optional for 2017, but mandatory for 2018. e program now called "advancing care information" and is part of the Medicare Merit-based Incentive Payment System. It's important to note that MIPS only applies to of- fice-based physicians or other clinicians reim- bursed by Medicare, so ACI attestation is only required for those physicians participating in MIPS. Since its implementation, a number of rules have been modified. For example, physi- cians used to earn payments under meaning- ful use, but that portion was phased out. Now physicians who submit meaningful use data incorporate it to comprise 15 to 25 percent of their MIPS score. In its early days, healthcare providers rushed to sign up for the incentives. By January 2011, the year incentive payments began, 118,819 el- igible providers and 2,320 eligible hospitals re- ceived approximately $5.4 billion in payments — or $18,600 and $1.37 million per participat- ing provider and hospital, respectively. As the years went on, incentive payments and participating providers increased. In fact, in just that first year the total number of EPs receiving payments climbed from 79,642 to 268,461 between 2011 and 2012 — an increase of just over 337 percent. However, in 2013 — the final year providers could attest for Stage 1 — participation slowed, as did the payments. In 2015, when stage 2 started, EHR vendors struggled to grapple with the changes, in part fu- eled by a delayed release of ICD-10. CMS adjust- ed its attestation period from 365 days down to 90 (as an alternative option), but despite the re- structuring, participation and payments contin- ued to diminish. e number of EPs receiving payments in 2014 dropped roughly 70 percent, compared to the hospitals receiving payments, which saw a 15 percent dip. In October 2015, CMS modified Stage 2 to ease reporting requirements and align them with other quality reporting programs. e final rule also set Stage 3 in 2017 and honed in on using advanced use of CEHRT to sup- port clinical effectiveness, health information exchange and quality improvement. Stage 3 is intended to align the timelines and require- ments for clinical quality measure reporting in the Medicare and Medicaid EHR Incentive Programs with other CMS quality reporting programs that use CEHRT to reduce provider burden associated with reporting on multiple CMS programs and enhance CMS operation- al efficiency. Meaningful use was initially viewed as a potential positive step forward. However, meaningful use requirements have become checkboxes and hospitals expend significant resources into meeting the requirements that may or may not improve patient outcomes. While policymakers' original intent for mean- ingful use was for the program to accelerate EHR adoption and optimization — goals that have, for the most part, been met by nearly 99 percent of U.S. hospitals using EHRs — mean- ingful use has been disjointed since Stage 1. It may have fostered fewer errors and advanced prescription drug monitoring, but meaningful use requirements have increased the time and effort physicians and nurses put into their med- ical charting — hence the term "EMR care" instead of patient care. Healthcare providers are le asking, "Is there a connection between meaningful use and the delivery of high-quali- ty care, or is this just another checklist?" Now, nearly nine years aer its implemen- tation, hospitals are looking for what's next. Here are my recommendations for the direc- tion meaningful use should take. Reward patients for their engagement. Get- ting patients interested and engaged with their care can be a challenge. What if the meaningful use program encouraged insur- ance companies to incentivize patients to log onto their portals? at way, patients would potentially stay educated about their care. In a portable society like ours, patients should be taking their data with them anyway. At the end of the day, incentivizing patient signup could not only foster higher engagement, but also relieve physicians of some stress. Incentivize the vendors as well as the hos- pitals. Hospitals have to take on the burden of developing their own application pro- gramming interfaces so patient portals can communicate with their customized EHR. However, if vendors would prioritize interop- erability of their products for the society at large, more acceptable products — including portals — could be created. When individual hospitals are incentivized, a mix of challenges ensues relating to ease of use and data shar- ing — and customized solutions with the least dollars spent as everyone will try to meet the minimum requirements possible. is path- way is setting us up for more IT headaches. Instead, the government could incentivize cooperation among vendors in addition to hospitals to make these collaborations feasible from a business standpoint, as well as increas- ing convenience for all consumers — primar- ily patients. Take, for example, Apple's latest announce- ment. e technology company is rolling out a health records feature tucked in its Health app as part of the latest iOS update. Apple is collaborating with EHR vendors like Epic and

• Cover