Meaningful Use (Promoting Interoperability)
Meaningful Use is the Medicare and Medicaid EHR incentive program created by the HITECH Act in 2009, which rewarded hospitals and clinicians for using certified EHR technology for e-prescribing, health information exchange and quality reporting. It now runs as the Promoting Interoperability Program, and 42 CFR Part 495 still defines a meaningful EHR user.
Key takeaways
- Created by the HITECH Act, part of Public Law 111-5, as an EHR incentive program
- Three original tests: meaningful use with e-prescribing, health information exchange and quality reporting
- Now the Medicare Promoting Interoperability Program for hospitals and CAHs, under 42 CFR Part 495
- Use of certified EHR technology from the ONC Health IT Certification Program is required
- Stage 3 objectives cover e-prescribing, information exchange, patient access and public health
What Meaningful Use means
The HITECH Act set three tests for a meaningful EHR user: use certified EHR technology in a meaningful manner, including electronic prescribing; connect it so health information is exchanged to improve the quality of care, such as care coordination; and report clinical quality measures from it. Every later stage built on those three ideas.
The objectives were released in stages. The Stage 3 objectives in 42 CFR 495.24 apply from 2019 onward and sit inside the Medicare Promoting Interoperability Program for eligible hospitals and CAHs. The regulation still calls them meaningful use objectives.
For a product team, the lasting effect is certification. A meaningful EHR user has to use certified EHR technology, so the features behind each objective, from e-prescribing to patient API access, are features EHR vendors and add-on builders must support. Agnotic Technologies builds those features for EHR vendors and health systems.
Which measures were meant to change patient care?
The exchange objective touches care most directly. A hospital sends a summary of care record when it transfers or refers a patient, and receives one and incorporates it into its EHR when a patient arrives. That puts medication, allergy and problem lists in front of the next clinician.
Patient access is the second. Under the provider to patient exchange objective, patients get timely electronic access to view, download and transmit their information, including through an application of their choice. The public health objective asks the hospital to be in active engagement with a public health agency to submit data.
What do the objectives ask, and which software feature answers each?
| Objective area | What the hospital must do (42 CFR 495.24) | Software feature behind it |
|---|---|---|
| Protect patient health information | Protect electronic protected health information | Security risk analysis support, role-based access and audit logs |
| Electronic prescribing | Generate and transmit permissible discharge prescriptions electronically | E-prescribing to pharmacies using the NCPDP SCRIPT standard |
| Health information exchange | Send a summary of care record at transitions and referrals; receive one and incorporate it into the EHR | C-CDA create and receive, plus reconciliation of medications, allergies and problems |
| Provider to patient exchange | Give patients timely electronic access to their health information, including through an app of their choice | Patient portal and a standardized FHIR API certified to 45 CFR 170.315(g)(10) |
| Public health and clinical data exchange | Be in active engagement with a public health agency to submit data | Interfaces that submit data to public health agencies and clinical registries |
Facts and primary sources
Under the HITECH Act, a professional is a meaningful EHR user only if they use certified EHR technology in a meaningful manner, including electronic prescribing, connect it for the electronic exchange of health information, and report clinical quality measures.
Source: govinfo, Public Law 111-5, section 410142 CFR 495.4 defines a meaningful EHR user as an eligible professional, eligible hospital or CAH that demonstrates meaningful use of certified EHR technology by meeting the objectives and measures in 495.20, 495.22 and 495.24.
Source: eCFR, 42 CFR 495.442 CFR 495.24 sets the Stage 3 meaningful use objectives and measures for 2019 and later years, and its text refers to the Medicare and Medicaid Promoting Interoperability Programs.
Source: eCFR, 42 CFR 495.2445 CFR 170.315(g)(10) requires certified health IT to answer requests for a single patient's data through a standardized API that follows the US Core capability statement for the USCDI data classes.
Source: eCFR, 45 CFR 170.315
Explore this on Agnotic
Where Meaningful Use shows up in how we build.