The utilization of certified electronic health records (EHRs) to support coordinated care and secure patient health information (PHI) exchange is increasing. The Health Information for Economic and Clinical Health Act (HITECH) requires hospitals to adopt a multiyear ‘meaningful use’ program to receive incentive payments (Harrison & Lyerla, 2012).
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The initial 2010 ‘meaningful use’ rule required providers to use EHR to attain specified goals, quality metrics, and outcomes. The stage II rule sought to focus on the PHI exchange to support coordinated care delivery. This memorandum illuminates on expected changes in the hospital as the modified stage II rule, which merges stages 1 and II objectives, takes effect.
The communication is meant for the medical staff at the Kendall Regional Medical Center. It specifically targets physicians, physician assistants, nurses, and dentists.
The New Regulatory Requirement
The first stage requirements prescribed the use of EHRs to capture PHI, including family health history and demographic details. Stage II was initiated in 2014 with an objective of supporting the sharing of PHI between providers to improve care continuity and coordination. The ‘Modified Stage II’ requires hospitals to meet merged objectives over a three-year period (2015-2017) as opposed to achieving each stage’s objective singly.
The aim is to alleviate reporting difficulties and facilitate a more rapid achievement of the objectives of the two stages. In addition, the modified stage 2 is meant to support a successful transition to the final stage (stage III) by 2018 through enhanced EHR interoperability capabilities.
Providers will be evaluated based on a set of non-redundant objectives and performance metrics. The key objectives include protection of PHI, implementation of clinical decision support (CDS), utilization of CPOE, and use of eRx, among others (Kruse, DeShazo, Kim, & Fulton, 2014).
The provider has to report on key performance metrics, such as ePHI security risk analysis and drug-related allergy checks. The new rule will affect the hospitals reporting, as it requires providers to attest to ‘meaningful use’ for a whole year. Therefore, the healthcare staff will have to attest to the core objectives of the modified stage II as set out in the Eligible Professional (EP) guidelines.
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Internal Policy Changes
In compliance with the ‘meaningful use’ requirements, Kendall Regional Medical Center has implemented a range of policy changes and security measures. You are required to use CPOE when ordering, conduct medication reaction/allergy checks, capture all patient demographics, undertake a comprehensive physical assessment, and implement certified EHRs, including CDS, eRx, and ePHI. CPOE should be used to process up to 60% of pharmacy orders, lab orders, and diagnostic imaging orders.
The staff is further notified that the hospital has adopted physical and technical measures to enhance the security of EHRs. First, access controls inbuilt with the EHR systems would require a physician or nurse to use an issued PIN and password to log in and use the system (Harrison & Lyerla, 2012). The aim is to control access to patient health information. Second, authorized staff will receive a special code for decrypting patient data into an understandable format. Third, an audit trail will be used to capture the details of those accessing or entering PHI into the system. In case of an unauthorized access, you are required to notify the CNO of the breach so that necessary steps are taken to inform the patient on the same.
The Influence on Nursing Procedures
Nurse practitioners and certified nurse-midwives constitute the eligible professionals (EPs) under the EHR program. The meaningful use stage I objectives will influence multiple nursing procedures, particularly clinical supervision. Nurses are required to maintain an updated and standardized catalog of diagnoses and entries from 80% of patients without a reported diagnosis (Harrison & Lyerla, 2012).
Keeping a list of current patient medications and allergies is also a requirement. The rationale is to monitor patient allergies and drug reactions to provide patient-centered care. Nurse practitioners are also required to keep a structured record of patient demographics, including gender, race, and ethnicity. The rule also has an influence on the charting patient progress on vital signs, such as BMI and blood pressure.
Nursing CDS can enhance guideline adherence for high-priority areas. Harrison and Lyerla (2012) show that utilizing order sets inbuilt in CDS can enhance nursing adherence to hypoglycemia control in patients. Order sets also decrease medication error rates and improve medication safety and clinical outcomes (Harrison & Lyerla, 2012).
Data review features, such as virtual ICU inbuilt in the CDS, support remote monitoring of ICU patients. According to Menachemi and Collum (2011), nurses can “monitor patients in real time and check vital signs” using virtual ICU, enabling them to deliver lifesaving treatment appropriately (p. 49). Another area that has been affected by the ‘meaningful use’ rule is patient involvement in care delivery. The nurse is required to share e-PHI, including active diagnoses, problem and medication lists, and allergies, with the patient on request (Menachemi & Collum, 2011). The provision of appropriate education resources to the patient is also required.
The Influence on Patient Care
Certified EHRs provide a centralized platform for integrated and coordinated patient care in hospitals. Successful adoption of the EHRs as per the meaningful use guidelines can improve patient safety and quality outcomes. Shin, Menachemi, Diana, Kazley, and Ford (2012) found that EHRs, such as CPOE and eRX, support standardized care through functionalities like checklists and automatic signals. In addition, the use of eRX can reduce medication errors and the potential for adverse events, resulting in better patient outcomes.
EHRs have streamlined clinical communication processes among healthcare professionals as well as between hospitals. They have led to an improved PHI exchange, streamlined continuity of care, better federal reporting and payments, increased patient involvement, and robust tracking of performance metrics (Shin et al., 2012). Improved patient scheduling and better patient-clinician communication are the quality improvement outcomes of implementing EHR systems. In particular, the CPOE facilitates a more rapid physician ordering of drugs, lab results, and procedures, enhancing treatment accuracy and outcome (Zlabek & Mathiason, 2011). Consequently, hospitals report the lower length of stay and re-hospitalizations rates, which are indicators of quality patient care.
Implementing the Change across the Organization
A successful adoption of the modified stage II of the meaningful use rule across Kendall Regional Medical Center would require a transformative strategy that combines the technical aspects of EHR and change management. A change leadership methodology that entails planning, measuring, effective organization, resource allocation, and stakeholder engagement across the institution can accelerate the EHR implementation process (Kruse et al., 2014). Furthermore, the objectives of this regulation can be achieved through staff alignment, involvement, and accountability. In this view, the administrative team will oversee the credentialing of EPs, monitor EHR use across the practices, and submit attestations to the CMS.
The premise of the modified stage II of the ‘meaningful use’ is to facilitate a widespread utilization of EHR systems by eligible hospitals and professionals and lay the groundwork for a fully interoperable EHR envisioned in stage III. The utilization of EHRs can lead to quality improvement, enhance PHI protection, and better care coordination. In order to comply with this new rule, you are required to use EHRs as per the core objectives and measures prescribed in the EP guidelines.
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Harrison, R. & Lyerla, F. (2012). Using Nursing Clinical Decision Support Systems to Achieve Meaningful Use. Computer Informatics Nursing, 30(7), 380-385.
Kruse, C., DeShazo, J., Kim, F. & Fulton, L. (2014). Factors Associated with Adoption of Health Information Technology: A Conceptual Model Based on a Systematic Review. JMIR Medical Informatics, 2(1), 31-39.
Menachemi, N. & Collum, T. (2011). Benefits and Drawbacks of Electronic Health Record Systems. Journal of Risk Management and Healthcare Policy, 4, 47-55.
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Shin, D., Menachemi, N., Diana, M., Kazley, A. & Ford, W. (2012). Payer Mix and EHR Adoption in Hospitals. Journal of Healthcare Management, 57(6), 435-448.
Zlabek, J. & Mathiason, M. (2011). Early Cost and Safety Benefits of an Inpatient Electronic Health Record. Journal of the American Medical Informatics, 18(2), 169-172.