By Debra Wood, RN, contributor
September 24, 2010 - In just a couple of short years, the term “meaningful use” has become an industry buzzword, as passage of the American Recovery and Reinvestment Act offered up to $27 million in incentives to providers to implement and meaningfully use health information technology.
“Nursing will be surprised at the level of impact,” said Erica Drazen, managing partner of emerging practices for the CSC Healthcare Group in Waltham, Mass. She added that a first glance of meaningful use requirements fails to indicate the effect they may have on nursing. They require electronic recording of vital signs, which is a nursing responsibility, and many of the quality reporting requirements, starting in 2012, will rely on nursing documentation.
“Anything that puts a burden on physicians to do documentation flows over to nurses,” she noted. And the requirements are steep for physicians, who are being asked to order at least 30 percent of medications using a fully enabled computer provider order entry (CPOE) system that can check for drug and allergy interactions; and maintain problem, medication and allergy lists; among other things.
Hospitals may receive millions of dollars over a period of years. CSC estimates a typical 275-bed hospital that meets the requirements will be eligible for $6 million. Eligible professionals, such as physicians and nurse practitioners, can receive $63,750 under Medicaid. Physicians also can earn as much as $44,000 under Medicare.
Michael Burger, director of clinical product management at Sage software’s healthcare division in Tampa, said he expects many physicians in the clinic or office setting will rely on nurses to enter the data during the exam.
“The use of EHRs [(electronic health records)] affects the workflow of the nursing staff,” Burger said. “Doctors are turning to nurses to do some of the entry. And there is a growing use of scribes.”
The Centers for Medicare and Medicaid Services (CMS) will pay the providers when they demonstrate meaningful use for 90 consecutive days, starting in January 2011. In addition to the incentives, hospitals must demonstrate meaningful use by 2015 or they will face lower reimbursement rates.
“Change is coming, and it’s really complicated,” Drazen said.
About 67 percent of hospitals have started implementing EHRs and 51 percent plan to qualify for meaningful use in 2011, according to a CSC survey of hospital executives. Nurses in facilities just starting the implementation process will face many changes as employers switch from paper to electronic documentation and order entry.
Getting a jump start
Many hospitals did not wait for the federal government to issue incentives to implement EHRs. Nurses in those facilities will note few changes to practice.
Emma Brandon, RN, BSN, MHA, said nurses at Cooper University Hospital will not find meaningful use taxing, because they have documented electronically for years.
“It’s not taxing [for our nurses], because they have been on an electronic system for 12 years,” said Emma Brandon, RN, BSN, MHA, clinical director of information technology at Cooper University Hospital in Camden, N.J.
Nearly a quarter of Cooper’s outpatient offices also have converted to EHRs, so information will flow between settings. The rest of the offices are converting to computerized records.
“Our goal is by the end of 2010 to have reached meaningful use,” Brandon added. That includes going live with a health information exchange in October and a patient portal in December.
MCGHealth in Augusta, Ga., began implementing its EHR system in 2003 and is now focusing on medication reconciliation and bringing electronic recordkeeping to ambulatory settings, which is still needed to achieve meaningful use. Inpatient nurses now will update medication history, but overall they will not need to make many adjustments.
“Because we planned early, it will be much easier [for nurses],” said Marlene Sides, RN, MHSA, director of information services at MCGHealth.
Marlene Sides, RN, MHSA, reported that early planning has made achieving meaningful use easier on the nurses at MCGHealth.
Beaumont Hospitals in Troy and Royal Oak, Mich., also started on the EHR journey before the government began talking about meaningful use. In 2008, it transitioned medical records to an electronic system. It recently went live with computer order entry and is working on electronic care plans and patient teaching documentation.
“In building the EHR, we’re trying to incorporate meaningful use, without additional work for nurses,” said Rose-Marie Prasatek, RN, MIS, director of informatics for Beaumont Hospitals. However, “meaningful use will increase documentation in some fields. The challenge for the hospital is to get a fully integrated EHR. If it’s integrated, meaningful use will come.”
Meaningful use will require more functionality in the years ahead, but specifics about what the government will mandate remain unknown. Drazen and Burger encourage providers to install systems to improve quality, efficiency and the patient experience, not just to receive the federal incentive money.
“Nurses will need to speak up about care being safe and efficient,” said Drazen, who recommends nurses volunteer to serve on implementation teams, so their voices are heard. “Nurses are the ones who will have to make sure this works for patients and for them.”
Staff nurses from every unit serve on an informatics council at Cooper and determine changes to the system.
“It’s important to push the end users to own their products,” Brandon said. “It’s a great journey, and you have to embrace it.”
In April, Cooper changed vendors. Now devices such as ventilators automatically transfer data to the system, for the nurse to verify. Brandon reports these changes have the possibility of saving one hour per 12-hour shift, giving nurses more time with patients.
Sides also encourages nurses to get involved from the start, help pick the EHR system and implement it.
“Nurses have been our champions,” Sides said. “Staff nurses in the clinics have been helping us with the workflow to make sure we get the data collected.”
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