What Is Meaningful Use and How Will It Affect HIV/AIDS Patient Care?
“Meaningful use” is a term derived from the American Recovery and Reinvestment Act (ARRA) of 2009 that created the EHR Incentive Program for eligible healthcare professionals and hospitals. This program provides a financial incentive to providers who become “meaningful EHR users” by effectively adopting, utilizing and implementing EHRs. Meaningful use revolves around the concept that users of health IT should use electronic health record technology in a meaningful way—so that the benefits of health IT are realized through improvements in quality, safety, and efficiency of patient health care. There are specific criteria, as announced in the July 2010 EHR Incentive Program Final Rule. This rule defines Meaningful Use, eligible providers, and related objectives and measures.
In order to demonstrate Meaningful Use of EHRs, providers must use certified EHR technologies and adhere to specific criteria when using EHRs. The following describes Stage 1 Meaningful Use objectives, as organized by the programs’ health outcome policy priorities:
Improve care coordination. The Stage 1 Meaningful Use core function under this priority area is the capability to electronically exchange key clinical information among care providers and patients (or other authorized entities). Because HIV/AIDS patients often require care from a number of different providers and in various care settings, coordination of care is especially important for this population group. This is especially true of HIV/AIDS care in rural areas , as a patient’s providers may be located in distant cities and towns. Meaningful use of health IT can facilitate care coordination by enabling providers to exchange important clinical information. This includes the electronic exchange of health information between providers and authorized entities. Coordination is also enhanced through medication reconciliation, which is especially relevant for HIV/AIDS patients who may take multiple medications at one time.
Improve quality, safety, efficiency, and reduce health disparities. Stage 1 Meaningful Use core functions under this priority area are: 1) Computerized Provider Order Entry (CPOE); 2) drug-drug interaction and drug-allergy checks; 3) e-Prescribing; 4) record demographics; 5) maintain an up-to-date problem list of current and active diagnoses; 6) maintain active medication list; 7) maintain active medication allergy list; 8) record and chart changes in vital signs; 9) record smoking status for patients 13 years or older; 10) implement one clinical decision support rule; and 11) report ambulatory clinical quality measures to CMS or the States.
There are unique issues of the HIV/AIDS population that necessitate careful, population-specific use of health IT to improve quality, safety, and efficiency and reduce disparities. The implementation and use of an EHR and its specific functionalities can facilitate high-quality care. In addition, Clinical Decision Support (CDS) systems can help providers diagnose patients and form treatment plans. When multiple health IT tools are used together, the results can be more impressive. For example, CPOE coupled with a CDS system can reduce the occurrence of preventable adverse drug events, which is especially important for HIV/AIDS patients taking multiple medications. The Veterans Health Administration (VHA) is utilizing CDS tailored for HIV/AIDS patients to assist providers in recognizing and treating symptoms that may otherwise be overlooked. Incorporating patient demographics into the CDS system can also improve quality while reducing health disparities.
Engage Patients and Families. Stage 1 Meaningful Use core functions under this priority area are the ability to provide patients with an electronic copy or electronic access to clinical information, and to give clinical summaries to patients following each office visit. Because the treatment of HIV/AIDS is complex, providing patients with access to their health information quickly, comprehensively, and securely is key to addressing the multiple symptoms and health issues affecting HIV/AIDS patients. In addition to the patients themselves, family members often play a central role in the patient’s support system and can be actively involved in assisting the patient through the care process. Active participation by patients and families can promote adherence to complicated medication regimens and can encourage an awareness of disease progression or medication side-effects that require prompt medical attention.
Improve Population and Public Health. Stage 1 Meaningful Use menu set functions under this priority area are the ability to submit electronic data to immunization registries and to submit them as required and accepted, and the ability to submit electronic syndrome surveillance data to public health agencies and to submit them according to applicable law and practice. Having an EHR that is able to transmit reports directly to public health agencies is important to providers who diagnose HIV/AIDS, as providers must report the detection of these conditions to the local public health agencies . The Adult HIV/AIDS Confidential Case Report resource is a sample of a confidential HIV/AIDS case report for CDC.
Ensure Adequate Privacy and Security Protections for Personal Health Information. The Stage 1 Meaningful Use function required under this priority area is the protection of electronic health information created or maintained by the EHR through the implementation of appropriate technical capabilities. Maintaining privacy and security of personal health information in an EHR is a requirement for achieving Meaningful Use. The confidentially of HIV/AIDS status is very important to patients. When handling personal health information, including HIV/AIDS test results and other information that can be traced to HIV status (e.g., medications, referrals, other labs), health care personnel must follow HIPAA and any other required privacy and security guidelines.
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