Looking for Meaningful Use in COVID Reporting

The progress of Meaningful Use

In 2009, President Barack Obama, signed the American Recovery and Reinvestment Act (ARRA) into law. Included in the ARRA were provisions to support Health Information Technology (HIT) which allocated billions of dollars to incentivize and support the adoption and implementation of interoperable Electronic Health Records (EHR) in all health systems in the United States.

This established the Meaningful Use program, driving the meaningful use of EHRs and electronic data in an effort to improve the quality of healthcare and to improve public health activities.

We pretty much all know this part, but the program actually had another goal of facilitating “the early identification and rapid response to public health threats and emergencies, including bioterror events and infectious disease outbreaks.”

Eleven years later, after dedicating significant effort, time and resources to meet the Meaningful Use program requirements, here are the stats:

• 95%+ of hospitals have a certified Electronic Health Record technology in place.
• 80%+ of hospitals have adopted and implemented that technology.
• 95% of all eligible and Critical Access Hospitals (CAHs) have demonstrated meaningful use of certified health technology through participation in the now renamed Promoting Interoperability (PI) program.
• Hospitals actively submit Electronic Clinical Quality measures (eCQMs) to meet PI, Inpatient Quality Reporting and Joint Commission ORYX® program requirements.
• If a hospital or provider fails to meet any of these program requirements, they face hefty penalties against reimbursement rates and accreditation status.

Today, the majority of hospitals are meeting the initial intent of the Meaningful Use program by using health information technology to improve the quality of healthcare. 

But what about using HIT to facilitate “early identification and rapid response to…infectious disease outbreaks?”

The other goal of the Meaningful Use program

For 11 years, at the behest of our government, hospitals and providers implemented EHRs and met associated requirements in order to improve healthcare and avoid penalty. Today we stand in the middle of the COVID-19 national health crisis and wonder why, with EHR data and electronic reporting processes in place, are we struggling with early identification and rapid response.

Maybe you’ve read one of the many articles describing the reporting problems associated with COVID-19 data. Initially, there was no reporting process, then a manual process (in many cases using spreadsheets submitted via email or fax), then a new reporting process was introduced as data was redirected via HHS which is wrought with problems as well.

It shouldn’t be a surprise to anyone that there is very little public trust in the numbers. The disorganization and confusion creates inconsistencies and inaccuracies and a lack of public confidence in the results.

None of this is easy, but after 11 years, hospitals have already done the hard part. Manual documentation, faxing and spreadsheets need to be in a museum somewhere that our grandchildren visit not as a solution to reporting outcomes during a pandemic.

How we could have used EHR data for Meaningful COVID-19 reporting

COVID-19 patient information is readily available and ready to be extracted, calculated and reported electronically, now, today, months ago.

Simply put, here’s how it works:

• Patient A gets admitted to Memorial Hospital → Documented in the EHR
• Patient A gets a COVID-19 test and a positive result → Documented in the EHR
• Patient A is put on a ventilator in the ICU → Documented in the EHR
• Patient A dies → Documented in the EHR

A few things to note here:

• These data points make up most of the data being submitted daily and manually by hospitals to HHS.
• This data is currently stored in a structured format in a database that sits “behind” the hospital’s EHR.
• The data can be extracted, evaluated and submitted electronically, with little to no human intervention, in the same way as Promoting Interoperability and eCQM data.

This can all happen TODAY. Which allows front line workers to do what they are supposed to do … care for patients, not manually enter numbers in a spreadsheet and fax the results.

I’d love to sit on that government committee and tell them that this isn’t as hard as they are making it.

So what can healthcare workers do to demonstrate that electronic reporting works and that the data can be used meaningfully?

We continue to:

• Improve electronic documentation, reporting and capabilities
• Use the data for quality improvement
• Improve clinical processes

What should we do going forward?

• Commit to the PI program, eCQMs and the soon-to-be-required Hybrid measures
• Get involved, give feedback and participate in pilot programs
• Report early and often
• Most importantly, improve the care of our patients

But it should not be all on our healthcare workers. The government and vendors can and should do more. The government should have called upon vendors across the country to pull and submit this data on behalf of their clients.

We don’t need to ask our healthcare workers to do more. We need to ask our government and our vendors to do more.

Sources:
https://www.congress.gov/bill/111th-congress/house-bill/1/text page 123 STAT. 231
https://dashboard.healthit.gov/quickstats/quickstats.php