Health Information Technology: A Guide to Meaningful Use

The American Recovery and Reinvestment Act of 2009 included a provision known as the Health Information Technology for Economic and Clinical Health (HITECH) Act. The HITECH Act provides funds for hospitals and clinicians to create and utilize electronic health record (EHR) systems. It also provides incentives for healthcare professionals to become meaningful users of certified health information technology (HIT).

Based on evidence that EHRs can aid in improving quality of care, the HITECH Act is designed to increase use of HIT to enhance the quality and efficiency of care, increase the involvement of patients in their care, and create an infrastructure to enable the digital exchange of health information.

In a special article in Archives of Internal Medicine [2012;172(9):731-736], experts provided an overview of the Medicare and Medicaid HER incentive programs and a guide for physicians involved in the process of demonstrating meaningful use of HIT.

According to the authors, >30,000 clinicians have qualified to receive initial incentive payments from the Centers for Medicare & Medicaid Services (CMS) for the meaningful use of EHRs. They note, however, that many physicians are uncertain about the EHR incentives program, including how to register for, report, and attest to meaningful use.

The first step toward receiving the incentive payment is determining eligibility. The CMS website helps physicians make the eligibility determination using an automated eligibility wizard (https://cms.gov/EHRIncentivePrograms/15_Eligibility.asp). Following use of the algorithm to identify eligibility, physicians must attest to fulfilling meaningful use criteria using certified EHR technology. There are several criteria for meaningful use defined by CMS (see Sidebar); certification indicates the clinician can achieve at least 1 of those criteria.

To be eligible for the maximum amount of incentive payments, physicians need to enter the Medicare program by 2012 and the Medicaid program by 2016. The Medicare program allows for up to $44,000 in incentive payments to physicians who achieve meaningful use for 5 consecutive years, beginning in either 2011 or 2012. Physicians who enter the program in 2013 or 2014 will be eligible for incentive payments, but the amount of the incentives will be lower. Beginning in 2015, physicians who opt not to participate in the Medicare program will incur a 1% decrease in Medicare reimbursements, with an additional 1% decrease in each successive year (maximum reimbursement decreases not to exceed 5%).

For the Medicaid program, physicians can be eligible for a greater maximum payment—up to $63,750 over 6 years—between 2011 and 2012. Physicians must enter the program in time to receive their first payment no later than 2016; however, the payment for the first year of participation is $21,250 regardless of the year joined, followed by $8500 for each subsequent year of participation. There are no penalties or reduction in reimbursement rates for nonparticipation in the Medicaid program.

For physicians adopting EHRs, the Office of the National Coordinator for Health Information Technology has established 62 not-for-profit Regional Extension Centers (RECs) to provide technical expertise and support. The RECs can assist clinicians in EHR product selection, offer help during the transition from paper records to EHRs, provide assessment of meaningful use objectives, and aid in the reporting and attestation process. The services are free or low cost to small practice primary care physicians and critical access hospitals and to other providers who service vulnerable populations.

In conclusion, the authors acknowledge that the adoption of EHRs creates “significant changes for physicians, with attendant dislocations in workflows, investments, and habits of practice…Meeting stage 1 objectives is the initial step; however, it will likely be the most difficult one, especially for those physicians transitioning from paper medical charts. Subsequent stages of meaningful use will serve as a glide path from stage 1 toward improved quality, efficiency, and patient-centeredness of care with effects extending far beyond the availability of incentive payments.”