The Health Information Technology for Economic and Clinical Health Act of 2009 requires healthcare professionals to use electronic health records in a meaningful manner, which is legally known as meaningful use. The primary goal of meaningful use is to significantly improve healthcare in the United States. The HITECH Act specifies the implementation of meaningful use in three stages from 2011 to 2015, with implementation of Stage 1 beginning in 2011. The federal government finalized the requirements for Stage 2 in August 2012, which became effective in 2013. Implementation of meaningful use Stage 2 involves the following components:
- Reporting Methods
- Reporting Criteria
- Code Sets
The HITECH Act establishes quality healthcare as a priority for the U.S. Department of Health and Human Services, the Centers for Medicare & Medicaid Services and the Office of the National Coordinator of Health Information Technology. The CMS implements meaningful use with a variety of clinical quality measures such as public reporting and quality improvement. ONC is responsible for certifying EHR technology that can perform calculations of CQMs.
Stage 1 has 44 CQMs that Eligible Professionals must continue to report as part of Stage 2. Eligible Hospitals and Critical Access Hospitals must continue to report 15 CQMs as required by Stage 1. Attestation is the primary method of reporting CQMs as of 2013. A pilot program for reporting CQMs electronically is also available for EPs, EHs and CAHs. This program is the EHR Incentive Program known as the Physician Quality Reporting System.
All healthcare providers must report CQMs in the same manner beginning in 2014. This requirement applies to all individuals and organizations, and for all stages of meaningful use. EPs will need to report on nine of the 64 CQMs for these individuals, while EHs and CAHs will need to report on 16 of the 29 CQMs for healthcare organizations.
All healthcare providers must report CQMs for at least three of six key policy domains in healthcare as recommended by HHS. These policy domains include the following:
- Patient Safety
- Clinical Processes
- Care Coordination
- Population and Public Health
- Patient and Family Engagement
- Efficient Use of Healthcare Resources
THE EHR Incentive Program uses value sets that are comprised of definitions, measure logic and data elements. These components are provided by federal agencies such as CMS, ONC, the Agency for Healthcare Research and Quality and the National Library of Medicine. These organizations must use various formats to be understandable by different audiences such as the general public, technical personnel and healthcare providers. The formats for CQM value sets include Excel, PDF, SVS and XML.
CQM value sets define clinical concepts with descriptions that use standard vocabularies and numerical values. The NLM maintains these value sets with the Value Set Authority Center. Each data element represents an attribute or state of the patient, which includes diagnoses and laboratory values. The VSAC is also responsible for providing online access to the CQM value sets that support Stage 2 meaningful use. This access requires the user to obtain a Unified Medical Language System Metathesaurus License, which is free of charge.
Healthcare providers must use certified EHR technology to receive incentive payments from the Medicare and Medicaid EHR Incentive Programs. The ONC Certification Program defines the steps needed to ensure that an EHR technology meets the standards needed to provide meaningful use. These steps generally test the appropriateness and accuracy of the technology in calculating CQM results. The ONC Certification Program is currently testing the Cypress certification tool, which is intended to standardize the certification process for EHR technology.
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