Meaningful Use for Nurses
The end of the 20th – the beginning of the 21st centuries saw the growing importance of technology-based solutions in nursing care. Under the influence of new legislation, nurses had to question earlier beliefs about medical care and assume new technology-related responsibilities. Today, the use of electronic health records has become a routine matter for nurse practitioners. Yet, having easy access to technologies is not a sufficient condition to ensure the quality and consistency of patient-centered care. Only when used meaningfully and professionally can such technologies create a foundation for delivering outstanding care to patients and populations. In this sense, the term "meaningful use" signifies a new stage in the evolution of nursing care technologies. The meaningful use core criteria incentivize hospitals to pursue greater technological efficiency and promise financial rewards. The purpose of the present work is to highlight the most essential aspects of meaningful use and offer recommendations for further improvement. The paper includes an overview of the meaningful use philosophy. Its implications for nurses, the nursing field, patient outcomes, population health, and policymaking are analyzed. The paper offers recommendations for the inclusion of additional meaningful use criteria and measures.
Meaningful Use Overview
Meaningful Use: What It Means
The term "meaningful use" has already become a buzzword in nursing research and practice. Nevertheless, many nurses are not aware of its true meaning. Meaningful use implies that healthcare providers use information technologies in ways that meet the standards of quality, efficiency, and safety set by law. Bolla describes meaningful use as "an extensive list of criteria and terms to direct the collection and reporting of clinical data elements within an EHR during a set period of time". Simply stated, it is a novel philosophy of information management that governs the nursing care field. Nurses are encouraged to meet the quality benchmarks set by law. In return, they will receive incentive payments for their successes.
When it comes to nurses, incentive-based payments are administered either via Medicare or through Medicaid. All nurse practitioners are eligible for these payments under Medicaid. However, it is wrong to believe that meaningful use is an entirely voluntary ambition of individual nurses. Gone are the times when nurses enjoyed the freedom of using available information resources in any possible way. Today, considerable limitations are imposed on the nurse and healthcare providers who fail to meet the core criteria of meaningful use. Financial penalties also follow. Beginning in 2015, all nurse practitioners who are eligible for meaningful use incentives under Medicare will face reductions in their reimbursement, if they fail to comply with the provisions of meaningful use. Such losses should become a strong force of motivation for the nurses, who are still at the beginning of their way to meeting the meaningful use criteria.
Meaningful Use Stages
The meaningful use process is divided into three stages. Stage 1 covers the period between 2011 and 2013. Its focus is on coding the existing health information to monitor the patterns of individual and public health and share this information with other healthcare providers. Stage 2 covers the period between 2013 and 2015. Its purpose is to ensure that all health providers adopt health information technologies and use them wisely to promote continuous improvements in nursing care. Finally, Stage 3 begins in 2015. It "focuses on promoting improvements in quality, safety and efficiency, decision support, patient self-management tools, and improving population health". The entire process is intended to promote a stronger technology orientation in all aspects of health care, while offering solid guarantees that such technologies will not disrupt the foundational pillars of quality in the nursing profession.
Meaningful Use Implications
Implications for Nurses
The meaningful use criteria have profound implications for every nurse working in the present-day healthcare system. The fact is that nurses are ideally positioned to speed up the process of meeting the meaningful use requirements. Among others, the meaningful use core criteria require that healthcare providers use health information technologies to manage patient care, supply patients with meaningful, comprehensive information about health, as well as report on the basic clinical quality measures to overarching health organizations. Nurses who work as a liaison between patients and the healthcare system assume primary responsibility for facilitating the required change. For instance, they can submit electronic data on immunization and reportable disease surveillance.
Simultaneously, meaningful use empowers nurses to have a stronger voice in organizational and policy decisions. Bolla writes that nurse practitioners can use the advantages of meaningful use to express their concerns and increase the visibility of the most painful nursing issues. For example, they can use the data obtained via the meaningful use process as an evidence base for encouraging a collective professional action against the most pertinent problems, including chronic health conditions, hospital-acquired infections, and so on. Certainly, when it comes to using technologies in health care, nurses must display high levels of readiness and possess outstanding technology skills. Thus, the meaningful use philosophy necessitates the provision of quality training opportunities for nurses, who want to meet the requirements of the technology age.
Implications for Nursing
Meaningful use also heavily affects the nursing field. According to Jacobsen and Juste, because nurses should promote easy access to patient data among all members of a multidisciplinary team, the nursing profession will have to develop more diligence and perseverance in capturing and processing patient data. Simultaneously, the focus will have to shift from the nursing care providers to patients and their families. The latter will have to be actively engaged in data exchange processes and opportunities (Jacobsen & Juste, 2010). Consequently, the nursing field will become deeply involved in sharing health information with relevant stakeholders and educating patients and families on how technologies can benefit their health. Simultaneously, care coordination will have to become one of the top priorities for the entire nursing field. Meeting the meaningful use criteria is impossible without ensuring the consistency and safety of patients' data at points of transition. Interoperability also matters, since the data obtained at one point of care and transitioned to another should be readable, understandable, and user-friendly. All these changes in the nursing field will have implications for policy, patient outcomes, and population health.
Meaningful Use and Policy, Patient Outcomes, and Population Health
Meaningful use is by itself a unique kind of policy, which has far-reaching implications for patient outcomes and population health. However, it should be noted that the healthcare providers who seek to become more thorough in meeting the meaningful use criteria may adopt new policies advocate policy changes at higher system levels to create more favorable conditions for quality performance. Here, the role of meaningful use requirements in improving patient outcomes also deserves attention. Tagalicod confirms that the effects of meaningful use on patients are complex. Most meaningful use criteria influence patients, facilitating their access to primary health data. Patient reminders, electronic prescribing, and other changes in nursing care are intended to improve patient outcomes. The only question is whether patients themselves are ready to adopt a new technological perspective and utilize the advantages promised by meaningful use to their fullest. Ahern, Woods, Lightowler, Finley, and Houston suggest that technologies will play a pivotal role in improving the quality of patient care but, like nurses, patients will also need to develop robust technology skills to make sure they have regular access to the advantages delivered by meaningful use.
Of particular importance are the implications of meaningful use for population health. At its core, meaningful use requires that nurses and physicians share the clinical data needed to conduct population assessments. Furthermore, under the meaningful use policy, all nurses and healthcare providers will need to submit immunization and disease surveillance information to public health registries. Meaningful use is expected to "inform health care policy decisions, drive best practices, and improve our nation's public health". This, however, is possible only when the existing meaningful use criteria are reviewed to incorporate the elements of ethics and physician expectations related to the use of technology in their everyday practices.
Recommendations to Include Additional Core Criteria
The meaningful use criteria were developed to cover the most important aspects of nurses' clinical performance. Unfortunately, in their current state, they ignore two essential facets of effectiveness and efficiency in nursing care. First, it is the ethical dimension of the meaningful use strategies implemented by healthcare providers. When the meaningful use criteria are developed to obligate hospitals to share their health data with higher bodies of authority, the ethics of such procedures should also be reviewed. Also, the meaningful use criteria do not seem to address the issue of justice. If it promises to improve the quality, consistency, and efficiency of nursing care, such improvements should be readily available to everyone using the healthcare system. With additional ethics-oriented criteria, healthcare providers will have better opportunities to accomplish their quality mission and meet the requirements of meaningful use.
Another issue to consider is how physicians and nurses perceive the implementation of the meaningful use requirements in practice. The meaningful use core criteria display outstanding objectivity, ignoring the perspectives and perceptions of its stakeholders. Jacobsen and Juste confirm that the implementation of the meaningful use policies has not been easy for nurses and physicians. They have encountered substantial barriers to making quality, consistency, and efficiency parts of their clinical decisions. Differences in background knowledge, skills, and education, as well as willingness to adopt the advantages of electronic health systems impose new burdens of issues on nurses. They and the physicians they work with have the right to express their views openly. By incorporating physicians' and nurses' perspectives into meaningful use, policymakers will meet two goals. First, they will ensure that the voices of nurses are heard. Second, they will obligate healthcare providers to hear the voices of physicians and nurses, while managing their technology systems.
To conclude, meaningful use promises to improve the quality and consistency of nursing care in the U.S. It has profound implications for how healthcare providers and nurses manage limited care resources. Nurses face new possibilities to enhance patient outcomes. However, they are also entitled to develop advanced technology and information management skills. Likewise, meaningful use empowers patients to access and use their health data to achieve the desired individual and public health results. To achieve these objectives, patients and other stakeholders should be ready to update their knowledge and data management capabilities. Meaningful use promises to improve population health and the quality of policy decisions. What is needed is developing additional measures to address nurses' ethics and technology concerns. The meaningful use framework should include additional core criteria to create a better picture of information management achievements in the healthcare system.