The American Recovery and Reinvestment Act of 2009 (ARRA) calls for up to 4 years of Medicare incentive payments to hospitals who meet the requirements of "meaningful use" of "certified Electronic Health Record technology." To be eligible for the payments, hospitals must use the technology in a meaningful manner, to exchange electronic health information to improve the quality of care, and submit clinical quality measures as selected by the Secretary of Health and Human Services.
To inform this discussion, the Alliance for Nursing Informatics (ANI) provided written testimony in response to the National Committee for Vital and Health Statistics (NCVHS) hearings on Meaningful Use of Health Information Technology held on April 28 to 29, 2009. The written testimony included a statement of support from the American Nurses Association and identified the following summary recommendations:
* Include patient-centered documentation from all disciplines within the definition of meaningful use; initially focus on patient summary data at transitions of care.
* Collect standardized clinical performance measures as a byproduct of care delivery and clinician documentation.
* Submit quality measures to the Department of Health and Human Services and other reporting entities by using processes and infrastructure defined by the Healthcare Information and Technology Standards Panel (HITSP); initially focus on a subset of existing National Quality Forum-endorsed measures and include nursing-sensitive measures.
* Use existing initiatives such as HITSP and Integrating the Healthcare Enterprise to guide standards use within all systems that record, transmit, collect, and share information for care delivery.
* Expand the definition of "meaningful user" to encompass support of all healthcare professionals, including registered nurses and advanced practice registered nurses.
These recommendations outline the key elements that must be included in the dialogue on meaningful use. As identified by Judy Murphy, RN, FACMI, FHIMSS, vice president, Information Services Aurora Health Care, Milwaukee, WI, during her NCVHS testimony, the industry must answer the big question: "What path do we follow and how do we know when we've arrived?" During her testimony, this nursing leader discussed six key themes regarding the definition for meaningful use:
* accessibility,
* adoption,
* education,
* interoperability,
* measuring success, and
* personal health records.
Each theme incorporates one of my biases-a very strong patient point of view. Nurses, in general, have this partiality. There are 2.9 million practicing registered nurses, who comprise 55% of the US healthcare workforce. As the providers who spend the most time with patients, particularly in hospitals where we are the caregiver and patient advocate 24/7, we have always had a solid focus on seeing things from the patient's vantage point.
INFORMATICS-A CRITICAL ROLE
Nurses are poised to play a critical role in healthcare reform as organizations continue to expand their focus on leveraging the data contained in electronic health records. With the passage of the ARRA, registered nurses with experience in the informatics field will be able to apply their ability not only to understand all sides of the information technology (IT) process but also to act as a translator between those who understand the language of the technology and the language and those who understand the needs of clinicians and patients. The role of informatics nurses is not merely limited to IT? the HIMSS 2009 Impact of the Informatics Nurse Survey suggests that informatics nurses play an instrumental role with regard to patient safety, change management, and usability of systems as evidenced by their impact on quality outcomes, workflow, and user acceptance. These additional areas highlight the value of these knowledge-based workers-their expertise truly translates to the adoption of more effective, higher quality clinical applications in healthcare organizations.
To obtain a copy of the ANI written testimony, please visit http://www.allianceni.org/, and for a copy of the HIMSS 2009 Impact of the Informatics Nurse Survey Results, please visit http://www.himss.org/ni.