Meeting Meaninful Use

[ma2rn2008]

I am new to nursing informatics having recently accepted a position as a Clinical Applications Specialist RN. The main focus at our hospital,of course, is meeting meaningful use criteria in order to receive the government incentive payments. There are so many gray areas in the CMS Core Measures. For Measure 13, which the objective is to have the capability to exchange key clinical information among providers of care electronically, it does not state specifically how the electronic exchange must take place. It says if the data is available in a structured format it should be transferred in a structured format. Does this mean the data has to transfer directly into the the medical record of the receiving entity or can this be an electronic PDF document? Also can someone define discrete data? Is this the same as structured data?

[rninformatics, DNP, RN]

Welcome to the specialty and to this Forum!

The Meaningful Use/ARRA Quality Measures' (not "Core Measures") specific meanings have seemed very amiguous (to say the least) since the the first draft was released in 2009 and even up to when the final, final rule was released this year. As you are playing catch up, you may want to familiarize yourself more with the fundamentals of the measures.

To learn how you can become a "meaningful user" see:

http://community.advanceweb.com/blogs/nurses_18/archive/2011/01/03/can-you-say-a-r-r-a-what-is-it-and-how-can-you-become-a-meaningful-user.aspx

One must understand the underlying principles of what Meaningful Use is “about”. Meaningful Use is “about” the patient and is aimed at improving the quality of care delivered within the US healthcare system (healthcare reform), through the effective use of technology. The goals of Meaningful Use are aimed at assisting providers and health care delivery organizations in:

•Improving health care quality, patient safety and efficiency of care

•Improving communication between the health care provider and the patients

•Improving care coordination

•Ensuring adequate privacy and security protection for PHI

•Improving population and public health

Sure hospitals and physicians should pay attention to the potential loss of Medicare reimbursement but this can't/shouldn't be the primary focus. Did you know there aren't any incentives after 2015 and 2016 and that the financial penalties for not meeting meaningful use are far greater than the incentive payments?

Discrete data is data that is seperate, distinict and individual. A set of data having a finite number of values or data points For example: the number of students in a class (you can't have half a student).

See this link for additonal explanation:

http://www.usablestats.com/lessons/datatypes2

The MU quality measures speak of "structured data". Neither handwriting nor free text entry is considered structured data. Structured data can be stored, is consistent and standarized in its format; is organized in a computer so that it can be used efficiently - structured data can can be retrieved, queried and exchanged. i cant do that to a PDF document.

The objective reads: "Performed at least one test of certified EHR technology's capacity to electronically exchange key clinical information"

among providers and patient authorized entities.

Examples of "key clinial information" would include :discharge summary, procedures, problem list, medication list, medication allergies, diagnostic test results

Organizations are looking at using either the Continuity of Care Record (CCR) standard or HL7 Continuity of Care Document (CCD) to achieve this objective.

I hope the above helps you get started learning more about MU/ARRA.

I am new to nursing informatics having recently accepted a position as a Clinical Applications Specialist RN. The main focus at our hospital,of course, is meeting meaningful use criteria in order to receive the government incentive payments. There are so many gray areas in the CMS Core Measures. For Measure 13, which the objective is to have the capability to exchange key clinical information among providers of care electronically, it does not state specifically how the electronic exchange must take place. It says if the data is available in a structured format it should be transferred in a structured format. Does this mean the data has to transfer directly into the the medical record of the receiving entity or can this be an electronic PDF document? Also can someone define discrete data? Is this the same as structured data?

[ma2rn2008]

Thank you RNINFORMATICS for your reply.

I understand and totally agree that the primary focus of meeting meaningful use is improving quality of care and keeping our patients at the center of our focus. After reading your reply I reread my post and realized how it may have sounded. I in no way intended to imply that the incentives are more important than improving patient care. We must, however, consider the incentive payments and potential penalties in our planning process.

You also mentioned the ARRA Quality Measures which I think are different than the Core Measures I referred to. The Eligible Hospital and CAH Attestation Worksheet for Medicare EHR Incentive Program states that eligible hospitals must meet all 14 Core Measures; 5 out of 10 Menu Measures (including at least one public health measure) and all 15 of the Clinical Quality Measures. Is this correct?

Again, thanks for sharing your expertise on the subject and for pointing me in the right direction. I look forward to the journey into this exciting new world of nursing!