Taking it to the Next Level: Exploring Outreach Practices for Maximizing Meaningful Use

In the past several months, you have probably heard the term “Meaningful Use” in relation to health information technology.  But what does Meaningful Use really mean?  Why is it being talked about so much right now?  And how can you leverage Meaningful Use data and practices to better serve your community?   In this article we address these questions, focusing specifically on how outreach programs can contribute to the overall outcomes of Meaningful Use.

What is Meaningful Use?

The HITECH Act – Health Information Technology for Economic and Clinical Health – was enacted as part of the American Recovery and Reinvestment Act (i.e., stimulus law) of February 2009.[i]  It provides substantial Medicaid and Medicare incentive payments to providers who demonstrate the “meaningful use” of certified electronic health records (EHR) systems.  Examples of Meaningful Use practices include:

• Sending electronic reminders for preventive and follow-up care.
• Submitting prescriptions electronically. 
• Providing patients with electronic copies and access to their health care information.
• Submitting electronic data to immunization registries.
• Protecting information created or maintained by certified EHR technology. 

In order to qualify for Medicaid incentive payments, you must be an eligible provider, serve a certain patient mix, and adopt/use a certified Electronic Health Record (EHR) system; all other incentive payments come after reporting on Meaningful Use objectives.  Once implementation is underway, you should identify ways to maximize the strengths of your non-clinical team to move toward the ultimate desired outcomes of reduced costs, improved operations, and better patient outcomes.

 

How does Meaningful Use apply to current national priorities on primary care?

Because of escalating health care costs and national health care reform, community health centers are receiving well-deserved praise and attention for their cost-effective and high-caliber health services. Meaningful Use is part of a bigger picture focus on cost, quality, access and outcomes that also includes the concept of Patient Centered Medical Homes (PCMH).   The PCMH model is a health delivery system which incorporates highly coordinated medical care that responds to the needs of the “whole person.” Community health centers, with a long history of delivering accessible, comprehensive, continuous, and culturally competent care, are in many respects naturally positioned as PCMHs. 

While several PCMH models exist, the National Committee on Quality Assurance (NCQA) is arguably the most prominent organization providing PCMH recognition.  NCQA released new PCMH standards in January 2011, calling on medical practices to be more patient-centered, and reinforcing federal Meaningful Use incentives for primary care practices to adopt health information technology.  Meaningful Use and PCMH have the same general, patient-centered goals, and the adoption of a certified EHR greatly facilitates the implementation of a medical home over time, especially as EHRs become more oriented toward team-based care and data sharing among providers and patients.[ii]   Health Outreach Partners strongly advocates for including members of the outreach team on a PCMH care team; outreach staffs’ skills naturally complement and advance Meaningful Use implementation. 

 

How can outreach staff support Meaningful Use practices?

Meaningful Use objectives are organized according to five policy goals.  The policy goals focus on improving the quality, safety, efficiency, and coordination of care, engaging both individual populations and improving population health.  They include the following:

• Improving quality, safety, efficiency and reducing health disparities
• Engaging patients and their families in their health care
• Improving care coordination
• Improving population and public health
• Ensuring adequate privacy and security protections for personal health care information

Although these Meaningful Use goals are directed to providers, they are relevant to all health center staff and outreach teams are no exception.  Because of the nature of their work, health outreach professionals are uniquely situated to enhance the quality, safety, efficiency, and coordination of care of health centers’ most vulnerable populations.  Specifically, they work directly in communities where their target population(s) lives, works, and spends time.  They are often members of the community and understand the unique barriers to care that the most vulnerable populations face. Outreach staff are effective liaisons between the health center and the community, educating individuals and families about available services and how to access them, bringing health information and education to them, and, at times, facilitating their entry into primary health care.  Outreach staff also support care coordination internally, working closely with other outreach workers, clinicians, medical students, and other staff.  Outreach staff inform internal organizational staff about the health needs of special populations as well as showing innovative teaching methods, introducing them to community members, and helping staff access resources. 

For health centers that invest in mobile technology such as laptops for their staff, portable scanners, touch-screen tablets, or other technology, outreach staff can extend the value of EHR systems by recording detailed notes in patients’ electronic medical records, locate information about particular conditions and medications, process e-referrals, locate nearby pharmacies and assist patients in registering for health insurance and other benefits.  Given the transience of homeless and farmworker patients, having this on-the-spot ability to access and impart information, follow-up on medications, and make appointments and referrals is crucial.[iii] 

Cultural and linguistic competency is a vital component of quality health care.  Implementation of Meaningful Use objectives cannot ignore the unique needs of each individual.  For example, one criterion is the provision of electronic copies of health information as well as electronic access to these details.  However, many health center patients, such as individuals experiencing homelessness or migrant and seasonal farmworkers, may not have computer or internet access.  Outreach staff can advocate for practices that will enable populations without electronic access to still obtain this important health information.  Additionally, EHR systems are only available in English.  Outreach staff can also coordinate with clinical staff to ensure English-only health information (obtained from EHRs) is appropriately interpreted for non-English speaking or low-literacy patients. 

 

How can outreach staff leverage Meaningful Use data to improve outreach initiatives?

Meaningful Use requires data collection measures that align with the five policy goal areas and their corresponding objectives.  Measures are meant to track progress with these objectives and are related to such areas as: ePrescribing, the maintenance of electronic health records, patient reminders, the provision of electronic copies of health information to patients, adequate protection of information and providing electronic access to patients’ health care information.  Tracking this data allow care teams to examine the nature of health disparities in ‘real time’ and improve patient health outcomes in the design/re-design of clinical interventions or outreach activities.[iv]   Outreach staff can leverage this data in order to:

• Strengthen organizational sensitivity to special populations by collectively reviewing findings specific to these groups;
• Improve organizational communication and collaboration through scheduling standing meetings to review Meaningful Use data with a multidisciplinary team;
• Provide relevant contextual information or suggest a response to unique findings;
• Advocate for the health needs of special populations in organizational meetings and community forums;
• Inform the topics to be selected for health education activities and events;
• Direct activities implemented with community partners or coalitions; and,
• Shape outreach program planning priorities.

Because outreach staff have a direct understanding of the needs and constraints of underserved communities, they can provide unique perspectives on the interpretation of and response to EHR results.  Similarly, outreach staff can transform these findings into field practices that directly respond to health needs surfacing in the clinical setting. 

 

Conclusion

As we explore the role of outreach within Meaningful Use and the patient-centered medical home, we cannot forget the primary goals of these joint initiatives: lower costs, improved operations, and most importantly, better outcomes for patients.  It takes a team-based approach to truly impact these areas and outreach staff is integral to successfully bringing these initiatives to fruition.  In this article we explored specific outreach practices that either support Meaningful Use or demonstrate how to leverage its data.  These examples are just the beginning.  At Health Outreach Partners, we invite your feedback and look forward to learning how Meaningful Use practices or data support your outreach efforts and the communities you serve. 

 

Where can outreach staff learn more about Meaningful Use?

• Centers for Medicaid & Medicare  Website – Meaningful Use Overview https://www.cms.gov/EHRIncentivePrograms/30_Meaningful_Use.asp 

• The Centers for Disease Control & Prevention – Meaningful Use link http://www.cdc.gov/ehrmeaningfuluse/

• For questions about the Meaningful Use program contact: 

 Andie Martinez Patterson, MPP
Assistant Director of Policy
California Primary Care Association
1231 I Street, Suite 400
Sacramento, CA 95814
W: (916) 440-8170
F: (916) 440-8172
apatterson@cpca.org

• Healthcare Information and Management Systems Society – Meaningful Use link http://www.himss.org/ASP/topics_meaningfuluse.asp

• National Association of Community Health Centers – Meaningful Use link  http://www.nachc.com/meaningfuluseofhit.cfm

• The Office of the National Coordinator for Health Information Technology – Electronic Health Records and Meaningful Use Page http://healthit.hhs.gov/portal/server.pt?open=512&objID=2996&mode=2