Meaningful Use and the HITECH Act

Electronic health records (EHRs) are great, but it’s the way that you use them that matters. In fact, over the past decade, healthcare organizations have had to meet a growing number of “meaningful use” metrics with their EHR software.

While it’s easy to take substantive EHR capabilities for granted - of course EHRs should see clinicians log in, store medication lists, and support data exports! - that wasn’t always the case.

It wasn’t until 2009 that the newly-passed HITECH Act turned EHRs from a nice-to-use into a must-use. This law was a pivotal moment in healthcare IT, establishing a number of new rules to promote and expand its use in real world settings.

Many healthcare organizations at the time saw Meaningful Use rules as an annoyance. They weren’t sure if it would generate results. Looking back, we can see that Meaningful Use and HITECH successfully laid the groundwork for interoperability today.

What Did the HITECH Act Do?

This cleverly-named law stands for the Health Information Technology for Economic and Clinical Health Act. It’s one part of the broader American Recovery and Reinvestment Act of 2009.

HITECH was created to promote and expand the adoption of health information technology — specifically the use of electronic health records (EHRs) by healthcare providers. Let’s dig into its big provisions:

First, HITECH defined details around federal health IT policy that had previously been missing. It established ONC as an actual federal agency in law (it had been started voluntarily by the White House) and set updated details around technical standards. The Act also created rules around how to report electronic healthcare security breaches.

In addition, the law took a lot of vaguely defined HIPAA rules and updated them to better address electronic health information. It modified HIPAA’s Third Party Directive, adding guidelines to help patients forward copies of their health information to any entity the patient designates. It extended HIPAA’s privacy and security provisions to apply not only to the covered entities who had protected health information, but also to the Business Associates whose technology is used to manage and access those records.

Most famously, HITECH outlined the first Meaningful Use program.

Meaningful Use and Five Pillars of Health Outcomes Policy

Meaningful Use was defined as using an EHR platform in a substantive way - for example, by transmitting a certain percentage of prescriptions electronically. It was both a formal program (capital letters Meaningful Use) and a good idea (plain ol' meaningful use).

Generally speaking, it meant that healthcare organizations were given incentive payments for adopting EHRs before 2014. After 2015, healthcare providers would receive reduced Medicare payments for not demonstrating that same meaningful EHR use.

The Meaningful Use program (sometimes called the EHR Incentive Programs) was managed with input from ONC and CMS, two agencies under the purview of the federal Department of Health & Human Services (HHS). CMS made the rules and payments, while ONC approved the technical standards and EHR software. Providers also had to submit information on population health and the quality of care to HHS.

Meaningful use itself remains a popular term, but it’s actually a bit outdated. It captured the idea of improving health tech so well that it took on a life of its own, occasionally discussed as a health tech goal unrelated to the actual federal program. More importantly, meaningful use has kind of been achieved. Nationwide EHR adoption is here, and the formal program eventually evolved into something else (the Promoting Interoperability Programs - more on that in a bit).

HHS emphasized that the idea of meaningful use supported its five pillars of health outcomes policy priorities, reproduced below:

Three Stages of Meaningful Use 

Meaningful Use was implemented in three stages from 2011 to 2017. Once Meaningful Use had reached Stage 3, it encompassed much of what EHRs can do today.

• Stage 1: Data capture and sharing (2011) was a soft landing for Meaningful Use, requiring providers to electronically record clinical data. Clinicians had to choose several goals to achieve out of a long list. Notably, this included rules around giving patients electronic copies of their health records.
• Stage 2: Advanced clinical processes (2014) built on the previously tested capture of clinical data by requiring additional fields like images and family history; making more data available to patients automatically; aligning that data with the National Quality Strategy program; and transmitting that data to regulatory agencies electronically.
• Stage 3: Improved outcomes (2017) continued to iterate on Meaningful Use, requiring physicians and care organizations to continuously meet every program objective (instead of choosing several). Security audits were also introduced during this stage. Finally, rudimentary API use and a minimal level HIE integration were introduced in the program.

Meaningful Use Issues

Meaningful Use seemed pretty great on paper, but it had a few problems, like...

• Lack of standardization: There was no commonly accepted way of identifying patients defined
• Inconsistency: Data quality within disparate systems was inconsistent at best
• Onerous enforcement: Implementing health IT interoperability standards across the ecosystem can be very complicated (to say the least)
• Convoluted process: Reporting requirements included overcomplicated and irrelevant measures
• Lack of consensus: Stakeholders across the industry have differing and sometimes opposing needs and viewpoints
• Incompatible design: System design and usability varied greatly depending on the system chosen

Promoting Interoperability Programs - The Next Chapter of Meaningful Use

In 2018, Meaningful Use was rebranded to Promoting Interoperability Programs. According to CMS, the new title better reflects the program’s growing focus on increased accessibility and improved facilitation of data exchange between providers and patients.

A few other things changed, like the streamlining of requirements that focus on reducing administrative burdens and... 🥁... 🥁... 🥁... the continuation of a discussion around the use of APIs by medical record systems to allow better data access. All in all, making it a pretty good time for some company to build a healthcare API.

One requirement that remained was bi-directional sharing of records with a health information exchange. Now that most clinicians have electronic data in the first place, data sharing takes on additional importance.

Meaningful Use only began a decade ago. Things that seem so basic now took a massive, public-private partnership to achieve back then. Imagine how interoperability will transform healthcare in the decade to come!