What is Meaningful Use in Healthcare?
Meaningful use in healthcare is a term used to describe the requirements adopted and subsequently amended by HHS’ Centers for Medicare and Medicaid Services (CMS) in order for eligible healthcare providers to qualify for incentive payments under the HITECH Act’s “Promotion of Health Information Technology” provisions.
When Congress passed the American Recovery and Reinvestment Act of 2009 (ARRA), the Act contained two Titles relevant to explaining what is meaningful use in healthcare. The first Title – Division A Title XIII, or the Health Information Technology for Economic and Clinical Health Act (HITECH) – led to the development of standards for certified Electronic Health Records (EHRs).
The second Title – Division B Title IV, or Medicare and Medicaid Health Information Technology; Miscellaneous Provisions – incentivized the adoption and meaningful use of certified EHRs. It also authorized the Secretary of Health and Human Services (HHS) to penalize Medicare and Medicaid providers who did not comply with the meaningful use requirements within five years.
HITECH and Meaningful Use in Healthcare
Prior to the passage of ARRA, it was estimated that 10% of hospitals had adopted EHRs. However, not all EHRs had capabilities that aligned with the Federal Health IT Strategic Plan. Consequently, one of the objectives of HITECH was to introduce a nationwide health information network that could support:
- The electronic exchange and use of health information and the enterprise integration of such information.
- The utilization of an electronic health record for each person in the United States by 2014.
- The incorporation of privacy and security protections for the electronic exchange of an individual’s individually identifiable health information.
- Ensuring security methods to ensure appropriate authorization and electronic authentication of health information and specifying technologies or methodologies for rendering health information unusable, unreadable, or indecipherable.
- Specifying a framework for coordination and flow of recommendations and policies under this subtitle among the Secretary, the National Coordinator, the HIT Policy Committee, the HIT Standards Committee, and other health information exchanges and other relevant entities.
- Methods to foster the public understanding of health information technology.
- Strategies to enhance the use of health information technology in improving the quality of health care, reducing medical errors, reducing health disparities, improving public health, increasing prevention and coordination with community resources, and improving the continuity of care among health care settings.
- Specific plans for ensuring that populations with unique needs, such as children, are appropriately addressed in the technology design, as appropriate, which may include technology that automates enrollment and retention for eligible individuals.
To achieve this objective, Congress (via HITECH) instructed the Office of the National Coordinator for Health Information Technology (ONC) to develop standards for “certified EHRs”. The standards would become a “federal floor” of capabilities that would be the minimum required for a healthcare provider to be eligible for payments under the Miscellaneous Provisions Title of ARRA.
To further support the adoption of certified EHRs, HITECH provided several financial incentives. These included grants for investing in health IT infrastructure, to provide training to workforce members, and to develop best practices for meaningful use in healthcare. The Act also authorized low interest loans for eligible healthcare providers to purchase certified EHRs or upgrade existing EHRs to certified standard.
Meaningful Use Program Introduced in Phased Stages
Because of the tight deadlines imposed by Congress for the implementation of meaningful use in healthcare, HHS’ Centers for Medicare and Medicaid Services (CMS) and ONC worked closely to ensure that the definition of meaningful use of certified EHR technology and the standards for certified EHR technology were coordinated and published quickly.
The first set of standards for certified EHRs was published in January 2010, followed by proposals for testing and certifying all health IT technologies in March. This allowed CMS to publish the first stage of the meaningful use program in July – the Final Rule explaining that meaningful use in healthcare would be rolled out over three phased stages.
The three stages were initially scheduled to be released two years apart to enable a “graduated approach to arriving at the ultimate goal” (i.e., a nationwide health information network that supported the requirements of HITECH). However, CMS delayed the publication of the Meaningful Use Stage 2 requirements until 2014, and the Stage 3 requirements were introduced as the “Promoting Interoperability” program following the passage of the Medicare Access and CHIP Reauthorization Act of 2015 (MACRA).
Meaningful Use Requirements Subject to Annual Changes
Although the name has changed, many sources continue to refer to the Promoting Interoperability program as meaningful use in healthcare. Consequently, it is important to be aware that the meaningful use requirements are subject to annual changes. (You can review the current program requirements on the CMS website).
It is also important for Medicaid providers to be aware that CMS discontinued the Medicaid Promoting Interoperability Program in 2022. Eligible healthcare providers that previously participated in Medicaid EHR Incentive Programs are now required to participate in the Merit-based Incentive Payment System’s (MIPS) Promoting Interoperability Performance Category.
