Introduction to Health Care and Public Health in the US: Meaningful Use of
Health Information Technology
Audio Transcript
Slide 1
Welcome to Introduction to Health Care and Public Health in the
US: Meaningful Use of Health Information Technology . This is
Lecture (a).
The component, Introduction to Health Care and Public Health in the US, is a
survey of how health care and public health are organized and services are
delivered in the US.
Slide 2
The objectives for Meaningful Use of Health Information Technology are:
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Define meaningful use of health information technology in the context of
the Health Information Technology for Economic and Clinical Health
(HITECH) Act.
Describe the major goals of meaningful use.
Define the criteria for Stage 1 of meaningful use for eligible professionals
and eligible hospitals.
Describe the standards specified for Stage 1 of meaningful use, including
those devoted to privacy and security.
Discuss the likely criteria for Stages 2-3 of meaningful use.
Slide 3
This lecture will discuss the implementation of meaningful use of health
information technology in the context of the Health Information Technology for
Economic and Clinical Health (HITECH) [high-tech] Act.
With the American Recovery and Reinvestment Act (ARRA, air-uh), also known
as the economic stimulus bill, the United States entered a new “era” for health
information technology. The portions of ARRA addressing health information
technology are known as the Health Information Technology for Economic and
Clinical Health, or HITECH, Act. HITECH provides incentives for adoption of the
electronic health record (EHR) by physicians and hospitals, for which it will fund
up to $27 billion. HITECH also provides direct grants administered by federal
agencies, up to $2 billion, to develop the infrastructure to support the program.
Other provisions in other areas of ARRA will indirectly benefit health information
technology. These include comparative effectiveness research, research funding
Health IT Workforce Curriculum
Version 3.0 / Spring 2012
Introduction to Health Care and Public Health in the US
Meaningful Use of Health Information Technology
Lecture a
1
This material (Comp1_Unit10a) was developed by Oregon Health & Science University, funded by the Department of
Health and Human Services, Office of the National Coordinator for Health Information Technology under Award
Number IU24OC000015.
for the National Institutes of Health (NIH) and other federal agencies, and
investments for broadband and other telecommunications network infrastructure.
Slide 4
The HITECH program is predicated on financial incentives for the meaningful use
(MU, emm-you) of health information technology. It is administered by the Office
of the National Coordinator for Health Information Technology, often called ONC
[oh-enn-see].
Slide 5
Meaningful use is driven by the underlying goals for the health care system. That
is, any specific technology criteria must be related to one or more of five goals for
the health care system. This reflects the notion that meaningful use is not
fundamentally about technology, but rather is intended for improving health and
health care. The five goals for the health care system under meaningful use are:
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Improving quality, safety, and efficiency of care
Engaging patients in their care
Increasing coordination of care
Improving the health status of the population, and
Ensuring privacy and security
Meaningful-use criteria will be detailed later in this lecture, but for now, two
examples will illustrate how criteria map back to the meaningful-use goals.
One of the criteria is implementing checks for drug-drug interactions in the EHR;
that is, seeing whether prescribed drugs have any serious clinical interactions
that could harm patients. This pertains to the goal of improving quality, safety,
and efficiency. Quality is improved because clinicians may prevent the
administration of a drug that causes adverse effects or some sort of interaction.
A second example is providing a summary of care to patients. This activity
pertains to the goal of engaging patients in their care.
Slide 6
This slide spells out the overall requirements for meaningful use from the
HITECH legislation. There are essentially three requirements. The first is that
those eligible for incentives must use certified EHR technology in a meaningful
manner (that is, meaningful use). Furthermore, this certified EHR technology
must be connected in a manner that allows the exchange of health information
about the patient across different care settings. Finally, the health care provider
or organization must use this certified EHR technology to submit information on
clinical quality indices that allow measurement and ultimately improvement in the
quality of care.
Health IT Workforce Curriculum
Version 3.0 / Spring 2012
Introduction to Health Care and Public Health in the US
Meaningful Use of Health Information Technology
Lecture a
2
This material (Comp1_Unit10a) was developed by Oregon Health & Science University, funded by the Department of
Health and Human Services, Office of the National Coordinator for Health Information Technology under Award
Number IU24OC000015.
Slide 7
For eligible professionals and hospitals to receive funding under HITECH, they
must use an EHR that is qualified, or certified, through the process established
by ONC. Therefore, a qualified EHR is one that has been certified and has the
following functionality. It must include patient demographic and clinical health
information, such as medical history and problem lists. It must also have the
capacity to provide clinical decision support, support physician and provider order
entry, capture and query information relevant to health care quality, exchange
electronic health information with other sources, and integrate such information.
Slide 8
The HITECH program will implement meaningful use in three stages. Each stage
aims for higher functionality and improvement of care as part of an effort
originally called “health information technology-enabled health reform.” The
program began in 2009 when the HITECH policies were developed. The Stage 1
rules were finalized in 2011, while Stage 2 is slated to begin in 2013 and Stage 3
in 2015.
Stage 1 is focused on capturing and sharing of data. Stage 2 will raise the bar
and focus more on advanced care processes with decision support. Stage 3 will
focus on improving outcomes of care. The Stage 2 rules will likely be announced
in 2012.
Slide 9
How are HITECH and meaningful use implemented? Basically, those who
achieve meaningful use will receive the incentive funding through increased
reimbursement from Medicare or Medicaid, the government-funded health care
payment systems in the US. The rules differ slightly for funding through Medicare
or Medicaid, but they have the same general concept.
One group that will receive funding is eligible professionals. Different types of
professionals are eligible under Medicare or Medicaid. Physicians, osteopaths,
and dentists will qualify under both. Podiatrists, optometrists, and chiropractors
will be eligible under Medicare. Those eligible under Medicaid include certified
nurse-midwives, nurse practitioners, and physician assistants who work at
certain types of health centers (federally qualified health centers). One of the
initial controversies involved hospital-based eligible professionals, in particular
physicians who work in hospitals. In the original legislation, they were not eligible,
although the hospitals that they work for were eligible. Some additional legislation
has greatly narrowed the definition of hospital-based eligible professionals, so
that now, these individuals are not eligible if they provide more than 90% of their
service in the hospital (such as a pathologist or emergency physician). Those
who work less time in the hospital are eligible.
Health IT Workforce Curriculum
Version 3.0 / Spring 2012
Introduction to Health Care and Public Health in the US
Meaningful Use of Health Information Technology
Lecture a
3
This material (Comp1_Unit10a) was developed by Oregon Health & Science University, funded by the Department of
Health and Human Services, Office of the National Coordinator for Health Information Technology under Award
Number IU24OC000015.
Eligible hospitals under Medicare and Medicaid include acute-care hospitals and
critical-access hospitals. Children's hospitals are eligible under Medicaid. Eligible
hospitals need to be located in the 50 states of the US or the District of
Columbia.
The coming slides will show that there are various differences in procedure
depending on whether one obtains incentive funding under Medicare or
Medicaid.
Slide 10
As mentioned earlier, eligible professionals and hospitals will be paid by
increased reimbursement under Medicare and Medicaid. The rules differ,
however, depending on whether one qualifies for funding under Medicare or
Medicaid.
Eligible professionals who achieve meaningful use under the Medicare rules will
receive $44,000. The amount of money depends on which year meaningful use
has been achieved. To receive the maximum amount of money, the eligible
professional must start either in 2011 or 2012. If meaningful use is not achieved
until later, such as 2013 or 2014, the reimbursement amount decreases, and if it
is not achieved until 2015 or later, no funds are received.
Medicare-eligible professionals who work in health-professional shortage areas
can receive an additional 10% payment ($4400) if they achieve meaningful use.
Therefore, eligible professionals can receive up to a total of $48,400 over the life
of the program.
Eligible professionals receiving incentive payments under Medicaid are eligible
for even more money. They can receive $21,250 in the first year they achieve
meaningful use, and then further amounts for up to an additional five years if they
maintain meaningful use. They can qualify for a total of $63,750. These
professionals can receive the funding in the first year without achieving all the
criteria of meaningful use, as long as they implement or upgrade to a qualified
EHR.
Slide 11
Payment for eligible hospitals is somewhat complex. The amount depends on
whether meaningful use is achieved through Medicare or Medicaid. It also
depends on the hospital type and on the share of patients who receive care
through Medicare or Medicaid. There has also been a debate about hospitals
that have multiple campuses. The Centers for Medicare & Medicaid Services
(CMS) has determined that multi-campus hospitals count as one eligible hospital,
although legislation may change this in the future.
The general formula for payment is a multiplication of three factors. The initial
amount is a base of $2 million and then $200 per discharge, starting at the
Health IT Workforce Curriculum
Version 3.0 / Spring 2012
Introduction to Health Care and Public Health in the US
Meaningful Use of Health Information Technology
Lecture a
4
This material (Comp1_Unit10a) was developed by Oregon Health & Science University, funded by the Department of
Health and Human Services, Office of the National Coordinator for Health Information Technology under Award
Number IU24OC000015.
1150th discharge up to the 23,000th discharge. This means that the hospital can
receive $200 per discharge for a maximum of 21,850 patients, for a total of $6.37
million. There is also a factor that accounts for the share of Medicare and
Medicaid patients, and a transition factor that decreases the money over time
depending on when the hospital became eligible.
Slide 12
Eligible professionals may well wonder how they can receive this money.
Basically, they need to meet the meaningful-use criteria and report that they have
met them. In 2011, eligible professionals and hospitals must achieve meaningful
use for some period of 90 consecutive days. After 2011, it has to be achieved
throughout the year. The first-year reporting will be attestation only, mainly
because CMS does not yet have systems in place to receive the information.
Eligible professionals and hospitals will have to report numbers on their
measures of the various criteria for meaningful use. In subsequent years, they
will be required to provide all the data for these calculations to CMS.
There are some important exceptions in the funding for Medicaid. One is that in
the first year, Medicaid-eligible professionals and hospitals do not need to
achieve complete meaningful use. They only need to demonstrate that they have
adopted, implemented, or upgraded a certified EHR. Some call this the A/I/U [ayeye-you] criterion. Those receiving funding under Medicaid (but not Medicare)
can also skip years; for example, if they do not meet the criteria in the second or
third year, they can receive funding in the next year that they achieve meaningful
use. The reimbursement rules went into effect for eligible professionals on
January 1, 2011 and for eligible hospitals on October 1, 2010.
Slide 13
The final rules for Stage 1 of meaningful use were published in the Federal
Register on July 28, 2010. One rule came from CMS, basically describing the
program that would provide incentives for EHR adoption, to be paid for by
increased Medicare and Medicaid reimbursement. The second rule came from
ONC and provided the initial set of standards, implementation specifications, and
certification criteria for EHR technology. There has been a great deal written on
the rules, and they are easy to find on the Web. Some of the better-known
organizations that have produced freely available materials are the Department
of Health and Human Services, Computer Sciences Corporation (which has a
series of highly readable and relatively short documents), and John Halamka’s
Geek Doctor blog. The official CMS Web site for the incentive programs, given
on the slide, includes instructions and forms that enable an eligible professional
or eligible hospital to sign up.
The certification process in Stage 1 will be guided by the Temporary Certification
Rule, which was released on June 24, 2010. This will be superseded starting in
Health IT Workforce Curriculum
Version 3.0 / Spring 2012
Introduction to Health Care and Public Health in the US
Meaningful Use of Health Information Technology
Lecture a
5
This material (Comp1_Unit10a) was developed by Oregon Health & Science University, funded by the Department of
Health and Human Services, Office of the National Coordinator for Health Information Technology under Award
Number IU24OC000015.
2012 by the Permanent Certification Rule, which was released in January 2011.
More information on EHR certification is available on the ONC Web site.
Slide 14
The two sets of rules -- from CMS and ONC -- are connected in a straightforward
manner. HITECH ties the standards, implementation specifications, and
certification criteria adopted in the ONC rules to the incentives that are then
covered in the CMS rule. The ONC rule focuses more on informatics by
specifying standards in four areas: vocabulary, content exchange, transporting of
information, and privacy and security. These will be described in more detail in
the next lecture.
Slide 15
As already noted, the temporary certification rule will cover the certification of
EHRs for Stage 1 meaningful use, but this will be replaced by the permanent rule
that has already been released and will start taking effect in 2012. The
certification program now is a clear departure from the previous program funded
by the government but run by the private, nonprofit Certification Commission for
Health Information Technology (CCHIT; see-see-aych-eye-tee). The original
CCHIT process focused on functionality and usability, whereas the new
certification process essentially focuses on the ability of systems to meet the
meaningful-use criteria.
This slide outlines some highlights of the temporary and permanent rules. First,
they cover all inpatient and outpatient systems, and they cover all vendorsupplied as well as self-developed systems. The certification process can certify
complete systems or modules that meet at least one criterion for meaningful use.
Therefore, the user can buy a system that covers all the criteria or can
demonstrate that a combination of modules meets the criteria. ONC designates
authorized testing and certification bodies, also known as ATCBs [ay-tee-seebees], and these bodies use tools and techniques developed by the National
Institute for Standards and Technologies, or NIST [nisst]. This process is
described at the URL listed on the slide. Essentially, the testing process validates
that the EHR can meet the meaningful-use criteria for the organization using it.
Slide 16
This concludes Lecture (a) of Meaningful Use of Health Information
Technology. In summary, the HITECH Act of ARRA legislated incentives for the
“meaningful use” of health information technology. Meaningful use means that
criteria for the use of information technology are tied back to the goals of the
health care system. These criteria are met by eligible professionals and eligible
hospitals to receive incentive payments for the use of EHRs.
Health IT Workforce Curriculum
Version 3.0 / Spring 2012
Introduction to Health Care and Public Health in the US
Meaningful Use of Health Information Technology
Lecture a
6
This material (Comp1_Unit10a) was developed by Oregon Health & Science University, funded by the Department of
Health and Human Services, Office of the National Coordinator for Health Information Technology under Award
Number IU24OC000015.
Slide 17
References slide. No audio.
Health IT Workforce Curriculum
Version 3.0 / Spring 2012
Introduction to Health Care and Public Health in the US
Meaningful Use of Health Information Technology
Lecture a
7
This material (Comp1_Unit10a) was developed by Oregon Health & Science University, funded by the Department of
Health and Human Services, Office of the National Coordinator for Health Information Technology under Award
Number IU24OC000015.