Meaningful Use

Meaningful Use, or MU, is the general collective term used to sum up the intent of recent Federal health care change initiatives.  It is the end goal of a decade long project to change the health care culture in the USA toward interoperative portable care.  MU is currently composed of two key pieces of USA legislation, the ARRA and ACA Acts.  Due to the national cost equaling 17% of the USA’s gross domestic product, it was clear that the USA’s health care culture was focused on quantity of services over quality or need.  The industry and most citizens managed health care with a focus on sick care.  Services were redundant and information did not flow freely or completely between providers of services.  The end result is a health care system with ballooning costs.  To combat these factors, the USA focused on modifying the culture by leveraging its purchasing power to drive change.  In two Federal Acts, ARRA and ACA, the USA directed health care toward professional accountability for creating a culture focused on proactive well-patient care.  In addition, it directs individuals to focus on living healthy and being both pro-active and accountable for their health.   Each step in this project is guided toward creating a system where all the parts, personal and professional, have a meaningful purpose and positive outcome.

While not short, the pivotal keystone definition of “meaningful” as approved in 2009 is quite simple: “a meaningful EHR system is one that’s patient centered.  Care providers using this patient centric system catalog health related data and clinically relevant information to improve delivery of care while controlling costs.  Unique to the EHR is the patient’s ability to access their records through a secure portal and add or correct information.”  While the definition is lengthy, it is logical in its prescription for system design and utilization.

How is the clinical information shared?  

In ARRA Stage 1 of early adoption one of the criteria for enhanced reimbursement is the ability to share clinical information in real-time.  This is accomplished by the organization pushing its clinical information to a regional health information exchange, or HIE.  The HIE catalogs and secures the information in the same way a library manages books.  When a Provider or organization needs to review the information that is not unique to their facility or practice, their EMR requests a copy of all data.

There are a series of clinical terminologies and terminology servers focused on a specific type of clinical information that act a translators.  The piece of clinical information has a unique code crafted for it and attached to the string of electronic data.  It sets the data into a specific and predictable pattern, as well as defining what the information is.  Since laboratory study results are one of the Phase I requirement, let’s review an example.  A Troponin I study performed in the Country Emergency Department on the patient’s arrival concludes in an elevated result.  The result indicates the patient requires transfer to City Hospital where an angioplasty can be performed.  The patient is transferred, but paper records do not require copying.  Country Hospital’s EMR contains the medical terminology 10839-9 (Troponin I. cardiac [mass/volume in serum/plasma] ng/mL) and pushes the Troponin I result to the HIE where City Hospital’s EMR will retrieve it.  Provider or nursing intervention notes are SNOMED CT coded and shared in a similar fashion.

In 2009, the Federal government signed the American Recovery and Reinvestment Act, or ARRA.  The ARRA contains a section called the Health Information Technology for Economic and Clinical Health, or  HITECH, which is focused on driving health care to electronic health record (EHR) systems through incentives and penalties.  HITECH’s MU project is being directed and managed in stages.  This is a key component in portability.

In 2012, the Affordable Care Act, or ACA, was signed.  ACA focuses on placing health care in wellcare services with payment for patient centered quality care with measureable improvements in outcomes.  It is being managed in less formal stages than HITECH, but defines clear and specific goals and levels of accountability for health care providers being reimbursed for services by any Federal or State administered program.

ACA

The Affordable Care Act, or ACA, is a portion or the Patient Protection and Affordable Care Act of 2012 and commonly referred to as Obamacare for the US President who championed it into law.  The focus of ACA is to reduce the cost of health care while improving the safety and quality of the care given.  To accomplish this and the significant culture change required, the Federal government is leveraging its purchasing power to require specific targets be met and reported to receive payment for service.

For the hospital and physician’s part, they must demonstrate three core requirements; patient satisfaction with their care, excellence in treatment outcomes, and excellence in core measures.  Demonstration of these three measures is accomplished by contracting an outside service to manage the data collection or data mining the information.

  1. Patient satisfaction is commonly managed through an external service provider who conducts random surveys of patients and their families.   Questions focus on the environment, technical skill, and personal interaction the patient experienced during their health care service.  All hospitals and physicians are graded against each other and reported in a percentile in relation to others.  This score accounts for 30% of the overall determination for payment.
  2. Morbidity and Mortality Measurement examines the effectiveness of the care provided.  For example, following all patients with the diagnosis of Acute Myocardial Infarction (AMI) having an Angioplasty, data mining determines the rate and timing of death after the care was provided to determine if these patients have above, below, and average quality and length of life.  This score determine 25% of the overall reimbursement score.
  3. Quality measures focus on the level of reproducibility of technical excellence as defined industry best practices for patients with specific diagnosis.  An example of a quality measure is an emergency department patient presenting with a fever and a clinical presentation indicating pneumonia is the administration of antibiotics within 1 hour of arrival.  Using medical terminology coding, the provider can data mine statistics specific to their performance of this core measure.  The Quality Measures score accounts for 45% of the reimbursement percentage.

Once the three scores have been determined, payment for service is based on the percentile ranking.  Those with the top 25% tier scores receive enhanced payments; those with the bottom 25% may not receive any payment.

For the individual’s part, the law places expectations on the person to maintain a healthy lifestyle, visit the health care provider for wellcare, and limit the use of urgent and emergency care centers to the  acute care services they were designed for.  As with payment to the providers, the government is using its buying power to drive change.  Individuals not modifying their health care practices will share a greater percentage of payment responsibility.

How do BITAC’s services assist the customer in meeting their ACA requirements? 

Every piece of health care information that is vital to the overall diagnosis, treatment and management of a patient’s care has a specific coding system or clinical terminology. Data mining the required information can be managed discretely and cost effectively using information systems queuing off of specific clinical terminologies.

BITAC can provide services ranging from consultancy in managing terminologies to creation and maintenance of your organization or customer’s interoperability coding.

In the US, our terminological services promote the semantic interoperability and facilitate the ARRA HITECH meaningful use requirements in electronic health information exchange.