Introduction
With the advancement of healthcare IT and the emergence of various accessible EHR solutions, the Meaningful Use (MU) incentive program became necessary. As per the Centers for Disease Control and Prevention (2020), the concept of MU refers to the selection and adoption of certified EHR technology that supports the electronic exchange of data for the purpose of augmenting patient safety. Another critical point of MU is providers’ obligation to submit information on care quality to the U.S. Department of Health and Human Services (CDC, 2020). This paper seeks to discuss MU by exploring issues that it might contribute to, related barriers to legislation implementation, implications for EHR investment decisions, and examples of MU at an inpatient psychiatric facility.
MU Legislation and Related Issues
Legal Issues
MU legislation, including the MU compliance rule, is inextricably linked with the risks of legal challenges for healthcare organizations. Compared to the traditional paper-based data storage practices, EHR files create conditions for documenting and storing huge amounts of data peculiar to patient care, and these information overloads could contribute to the threats of care mistakes and following medical malpractice claims (Graber et al., 2019). As current research indicates, healthcare providers, especially physicians, face tremendous risks of EHR-related mistakes and subsequent legal action during transitioning from traditional data storage measures to EBP software (Graber et al., 2019). Particularly, there have been cases of delayed diagnoses of life-threatening conditions, such as sepsis and cancer, due to difficulties in accessing other providers’ notes or the practice of storing different pieces of information peculiar to one patient in more than one location (Graber et al., 2019). Therefore, attempts to encourage ubiquitous EHR adoption and MU might create the risks of malpractice in the absence of adequate staff training.
Financial Issues
Some theoretical models predict substantial savings at the provider level due to demonstrating MU through the implementation of certified EHR solutions, but healthcare providers continue to report enormous expenses during the transition stage. For instance, initial EHR costs can exceed $60,000 in certain cases, which is not always followed by equally high financial and care quality gains (Gesulga et al., 2017). Actually, switching to EHR systems with proven safety and effectiveness requires well-considered budget allocation decisions for various areas of expenditure, including computer equipment, EHR software, end-user training programs, implementation, and maintenance (Gesulga et al., 2017). Basically, although the MU of EHRs is accepted as a promising part of healthcare quality improvement at the national level, healthcare facilities’ concerns about EHR solutions’ return on investment remain prominent (Gesulga et al., 2017). Thus, switching to EHR systems and following MU requirements might also be challenging from a financial perspective due to the need for significant investments.
Ethical Considerations
MU legislation can also create a series of ethical challenges related to privacy and trust-based communication. The third stage of the MU process is concerned with the facilitation of EHR interoperability and client-centered data management (Heath et al., 2020). As per this part of the MU program, providers are encouraged to implement secure messaging solutions for patients accessing their EHR data through patient portals and ensure clients’ uninterrupted access to patient teaching materials and healthcare data generation functions (Heath et al., 2020). Despite strengthening patient engagement, these recommendations enhance healthcare clients’ self-sufficiency in information-related matters, which could lead to patients’ incorrect interpretation of their medical test results and broken trust in their doctors because of misunderstanding. Another possible ethical challenge refers to clients’ imperfect password storage practices. Users’ irresponsibility can promote the unintended disclosure of their medical information, including data on stigmatized mental health disorders, addictions, sexual preference pathologies, or STDs, to other users of their personal computers.
Issues and Barriers to Legislation Implementation within Healthcare Organizations
The abovementioned issues can give rise to a series of barriers to full EHR integration and following the MU process. The legal challenges described above can contribute to physicians’ fear of responsibility for inadvertent errors that stem from EHR systems’ insufficient or non-existent bug-tracking features and limited user-friendliness (Samhan & Joshi, 2017). This fear gives rise to the phenomenon of EHR resistance, including physicians’ intentional avoidance of specific EHR-related activities and the tendency to delegate patient assessment data entering to other professionals (Samhan & Joshi, 2017). Regarding financial challenges, the willingness to reduce expenses might hinder the organization’s decision-making when it comes to vendor assessment, thus shifting its focus from software’s compatibility with the facility’s strategic goals and service type to its affordability. This could result in relatively large organizations’ failure to implement advanced EHR systems tailored to their clinical needs and patient volumes. Finally, the threat of ethical challenges might discourage providers from promoting patient portal utilization among their clients, thus hindering the implementation of stage two and three MU requirements regarding increasing the proportion of active portal users.
Making EHR Investments in Light of MU
Making EHR investments that would maximize the organization’s ability to meet multiple MU criteria is pivotal. To start with, these criteria, including the application of clinical decision support features and EHR use for optimal patient engagement, should be considered during the vendor assessment process (Heath et al., 2020; Office of the National Coordinator for Health Information Technology, 2019). Having studied various EHR features available today, the organization should determine the features of interest that would be aligned with MU in its individual case (ONCHIT, 2019). Therefore, copying other hospitals’ EHR choices is not the best option for promoting MU. After setting clear EHR-related goals, for instance, by using the SMART mnemonic, the organization is encouraged to rely on national information resources, such as the lists of HIT products and EHR modules that have undergone the certification process, to choose between high-quality software options (ONCHIT, 2019). Thus, the use of analytical skills and software vendor ratings can support EHR investments that would be beneficial in the long term.
MU and My Current Organization
My current workplace is an inpatient psychiatric facility that offers treatment and nursing care services to adult and geriatric patients with a variety of mental health diagnoses. As per the American Recovery and Reinvestment Act, mental health inpatient settings were exempt from the responsibility to meet specific MU criteria (Schacht et al., 2019). Between 2014 and 2018, hospitals participating in the Inpatient Psychiatry Facility Quality Reporting Program, including my workplace, submitted quality-related data, including information on their EHR implementation progress (Schacht et al., 2019). As of now, reporting EHR-related quality indicators is not required, but my organization continues using the EHR solution produced by Epic Systems Corporation that it purchased a few years ago. Some elements peculiar to MU requirements find reflection in the organization’s patient data management practices, including the sporadic use of clinical decision support features by psychiatrists and patient/family engagement practices (Gesulga et al., 2017). Particularly, engagement is maximized by using a web-based patient portal to facilitate post-discharge care, whereas data privacy is protected thanks to secure password resetting policies.
Conclusion
Finally, MU requirements establish that efforts involving EHR use should work toward maximizing care quality, safety, efficiency, patient engagement, and other indicators of success. Strict requirements related to EHR adoption and the utilization of its features might involve liability considerations, concerns linked with cost-effectiveness, and privacy threats. Despite these barriers, organizations that are eligible for EHR incentive programs can utilize analytical tools and the lists of approved software solutions for success in decision-making.
References
Centers for Disease Control and Prevention. (2020). Public health and promoting interoperability programs (formerly, known as electronic health records meaningful use). Web.
Gesulga, J. M., Berjame, A., Moquiala, K. S., & Galido, A. (2017). Barriers to electronic health record system implementation and information systems resources: A structured review. Procedia Computer Science, 124, 544-551.
Graber, M. L., Siegal, D., Riah, H., Johnston, D., & Kenyon, K. (2019). Electronic health record-related events in medical malpractice claims. Journal of Patient Safety, 15(2), 77-85.
Heath, M., Porter, T. H., & Dunegan, K. (2020). Obstacles to continued use of personal health records. Behaviour & Information Technology, 1-14. Web.
Office of the National Coordinator for Health Information Technology. (2019). How do I select a vendor? Web.
Samhan, B., & Joshi, K. D. (2017). Understanding electronic health records resistance: A revealed causal mapping approach. International Journal of Electronic Healthcare, 9(2-3), 100-128.
Schacht, L., Ortiz, G., & Shaw, R. (2019). Implementation status of electronic health record (EHR) systems in state psychiatric hospitals: Research report. National Association of State Mental Health Program Directors Research Institute. Web.