The Centers for Medicare and Medicaid Services (CMS) have proposed health information technology (HIT) regulations to improve the usefulness of information written into electronic health records. This set of rules called Meaningful Use (MU) is now in its second stage. To ensure that nurses, the largest group of healthcare professionals, have a voice in these proposed regulations, the American Nurses Association (ANA) has sent official comments to CMS. Meaningful use stage 2 uses EHRs to improve care. Stage 2 focuses on using EHRs in new ways to improve care safety, quality and efficiency, and to reduce cost. For example, EHRs can collect data to capture quality measures (eMeasures). eMeasures can efficiently be used to evaluate the input of all clinical members of the team. The data collected will inform evidence-based practice and the best team mix of clinicians and safe staffing levels that yields the best outcomes (e.g., reduced healthcare acquired conditions and readmissions). The regulations specifically proposed new objectives, such as engaging and providing patients (and their identified caregivers) access to their EHR upon discharge from the hospital. The proposed regulations also require information (e.g., problem list, medication list) to improve care transitions. Nurses empower patients (and caregivers) in effective self-care and ensuring seamless care coordination upon hospital discharge, in transitional care between hospital and home or other settings, and in post-acute care/long term care (PAC/LTC) settings. This is what nurses do.
As the voice of nursing, the ANA prepares expert comments on many regulations, espcecially ones as high-powered as this. A team of ANA's experts in HIT and quality - myself, Darryl Roberts, PhD, RN, and Maureen Dailey, DNSc, RN, CWOCN - did a thorough analysis of the proposed rules prepared comments to submit to CMS. These comments support patient/caregiver access to their EHR and other proposed requirements. The ANA also provided comments on the proposed choice of clinical quality eMeasures. Specifically, the ANA identified the strengths and weaknesses of the proposed measures and gaps in care coordination and patient-engagement measures. The ANA called for funding of team-based eMeasure development and testing of usability (i.e., ease of use) of HIT. Prescribers (e.g., advanced practice registered nurses [APRNs], physicians, and other eligible primary care providers), other healthcare professionals, and hospitals can qualify for HIT incentives. ANA provided comments requesting extension of Meaningful Use incentives to other essential care settings (e.g., PAC/LTC), and pointed out the urgent need for APRNs to be eligible for Medicare incentives. Currently, APRNs only qualify for Medicaid incentives.
We'll see what happens when the final rules are released. Hopefully CMS will ensure that the work of nursing is captured in the electronic systems, to best utilize nursing's contribution on the interprofessional team where the patient is the center of all we do.