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ENTERPRISE ACCOUNTING AND MANAGEMENT

The ultimate criteria for achieving Meaningful Use are divided into five objectives:

  1. Improve quality, safety, and efficiency, while reducing health disparities.
  2. Engage patients and their families.
  3. Improve care coordination.
  4. Improve population and public health.
  5. Ensure adequate privacy and security protection for personal health information. (Murphy & Johnson, 2011)

Meaningful Use objectives are implemented in stages. MU requires access to data from EHRs and sharing information, including electronic copies and visit summaries, with patients. These requirements were included in Stage 1, which launched in 2011. In 2014, MU focused on additional health information exchange, such as online patient access to their health information and exchange of clinically relevant information between providers of care at transitions for care coordination. Stage 2 also focused on the capture of electronic data in a structured format. Expected to begin in 2017, MU in Stage 3 is projected to include measures that demonstrate further improvement in the quality of healthcare and outcomes. (Murphy & Johnson, 2015)

Relationship between Meaningful Use, Quality Measures, Evidence-Based Care, and Standards

One of the MU criteria for both hospitals and healthcare providers is to report clinical quality measures (CQMs) to either CMS (for Medicare) or to the States (for Medicaid). To comply with Stage 2, MU, healthcare providers will have to measure 12 of the 125 clinical quality measures from various areas, including patient/family engagement, population health, and others. Beginning in 2014, all providers, regardless of whether they are in Stage 1 or Stage 2 of MU, will be required to electronically report on the 2014 CQMs that are finalized in the Stage 2 rule.

As summarized by the Alliance for Nursing Informatics (ANI), “…’meaningful use’ of HIT, when combined with best practice and evidence-based care delivery, will improve healthcare for all Americans. This is an essential foundation for the future of nursing, and informatics nurses must be engaged as leaders in the effective use of information technology to impact the quality and efficiency of healthcare service.” (ANI, 2009, p.1)

Figure 1 depicts the relationship between standardized terminology, quality, and effectiveness in delivering care that utilizes clinical decision support based upon evidence to achieve optimal outcomes. At the center of the aggregation of data from consumers/patients is the use of standards/vocabularies and terminologies in nursing data and process. Combining nursing clinical judgment with nursing knowledge and clinical practice guidelines/evidence, leads to quality outcomes. Electronic health records and clinical decision support facilitate the processing of information. In each of the exemplars described in this paper, consumer data were aggregated to structured standardized data to determine if adherence to clinical guidelines/evidence could improve the quality of outcomes for the consumer. The repeatable steps within a data standardization framework also outline the process of converting the data from the consumer to quality consumer outcomes using clinical judgment, nursing knowledge and nursing knowledge management for the harmonization of concepts.