If you’ve been involved in the healthcare industry anytime in the last couple decades, it’s likely you’ve heard the terms “meaningful use” and “interoperability” before. These buzzwords are often uttered in connection with various pieces of federal legislation designed to encourage the healthcare industry to adopt Electronic Health Records (EHRs) and discontinue the use of traditional paper records.
While this is old news to hospital executives, meaningful use and interoperability - and their implications for the future - are relatively new to the behavioral health world. Now, with the increasing “medicalization” of addiction treatment and the growing influence of private equity groups on the industry, we are beginning to see concepts like “meaningful use” and “interoperability” play a larger role in the behavioral health conversation.
Today, let’s define “meaningful use” and “interoperability” and take a look at what these terms mean in a behavioral health context.
What is Meaningful Use? How Does it Work in An Addiction Treatment Setting?
Note: For reasons that will become clear in this section, the term “meaningful use” is somewhat outdated and has largely been replaced by “interoperability.”
“Meaningful use” has been used in different ways in different contexts, but historically speaking, meaningful use typically refers to the Health Information Technology for Economic and Clinical Health (HITECH) Act of 2009.
HITECH is one of several programs intended to define best practices for EHR use and encourage widespread EHR implementation among certain “eligible professionals” like doctors, dentists, podiatrists, optometrists and chiropractors.
HITECH defined what “meaningful use” of EHRs might look like in a clinical setting with five “tenets” or priorities. These tenets focus on improving the quality of care while controlling costs, resolving disparities in health outcomes tied to gender, race and other factors, keeping PHI secure, generally safeguarding public health, improving communication between patients, families and providers, as well as facilitating patient care between providers.
In order to get individual clinicians to adopt and “meaningfully use” EHRs, the Centers for Medicare and Medicaid Services (CMS) created what amounts to an awards program to incentivize EHR adoption.
What Were the Stages of Meaningful Use?
“Meaningful use” was achieved in a three-stage process:
Meaningful Use Phase 1: Focused on getting clinicians to initially invest in an EHR and begin capturing patient data electronically. This took place in 2011.
Meaningful Use Phase 2: Focused on learning how to share captured data with relevant parties in keeping with HIPAA requirements. Incrementally expanded EHR use to cover more patient charts than covered in Phase 1. This took place in 2014.
Meaningful Use Phase 3: Focused on improving outcomes through ever more expanded EHR use and care coordination. This took place in 2016.
What Was the Impact of Meaningful Use on the Behavioral Health Community?
In truth, meaningful use did make a huge impact on the behavioral health community. You will rarely encounter a clinician in an addiction treatment setting who grappled with the ins and outs of “meaningful use” because most providers associated with treating SUD were not considered “eligible professionals” under the meaningful use program. Medical doctors in non-hospital settings made up the bulk of clinicians impacted by meaningful use.
What is Interoperability or “Promoting Interoperability?”
Depending on the setting, interoperability can mean several different things.
First, the most obvious meaning. The word interoperability can simply describe an attribute of any software. Used in a general setting, interoperability points to a software’s ability to share and intelligently surface information in a strategic way and at a strategic time.
However, in a healthcare setting, “interoperability” usually refers to a set of EHR standards established by a newer CMS program called Promoting Interoperability. Promoting Interoperability is, itself, a part of a larger compliance program called MIPS or the Merit Based Incentive Program, also overseen by the Centers for Medicare and Medicaid Services.
Promoting Interoperability and its larger umbrella program, MIPS, were established in 2017 following the passing of the Medicare Access and CHIP Reauthorization Act of 2015 (MACRA).
MIPS and Promoting Interoperability continue the work started by meaningful use. A fairly complex point system is used over four categories to determine the financial reward (or penalty) a provider receives. One of those four categories essentially revolves around the question of whether or not a clinician is “meaningfully using” a qualifying EHR.
What Was the Impact of Promoting Interoperability on the Behavioral Health Community?
Unlike meaningful use, which applied to only a few select kinds of clinicians, MIPS has a broad range of eligible professionals who are obligated to participate. Doctors, clinical psychologists, dieticians, social workers and NPs are all considered eligible professionals under MIPS.
Because many more addiction treatment organizations now retain clinicians like these, we’re seeing a higher degree of awareness of Promoting Interoperability in the behavioral health community than we ever did with meaningful use.
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