The Meaningful Use program was established to promote the adoption of electronic health records (EHR) to improve the quality of care. It was launched by the Centers for Medicare and Medicaid Services (CMS) in 2011, encouraging providers not only to introduce EHR software but also to demonstrate its Meaningful Use (Rosario, 2017). Hospitals and individuals that meet the objectives and measures of the program receive financial incentives. Nevertheless, many organizations are still reluctant to join the program due to some legal, financial, and ethical issues related to EHR implementation. According to Green (2020), more than 50% of EHR systems fail or are not adequately utilized, leading to negative consequences such as project delay or lower performance. It also may contribute to high clinician burnout and low job satisfaction among unprepared health care professionals. Despite the high costs and possible risks, EHR should be adopted by every health care organization since it standardizes health care and improves its quality.
Summary of the Legal, Financial, and Ethical Issues
Billions of dollars have been already invested in meeting the Health Information Technology for Economic and Clinical Health (HITECH) Act requirements. The Meaningful Use program financially encourages health care providers to adopt EHR in order to improve patient care and the practice of good medicine (Rathert et al., 2019). Although EHR can potentially improve decision-making within health care settings, its omnibus adoption is still questionable as it bears some legal, ethical, and financial challenges. Balestra (2017) claims that EHR adoption introduces several additional liabilities to providers compared to a traditional paper-based system. The related increase in legible and accurate patient data puts pressure on clinicians who lack time to analyze all the accessible records. They may miss important detail and make mistakes in treatment decisions due to information overload. In this case, they or their institution would be liable for negligence since critical clinical data were present in the system.
The EHR liability log contributes to increased practitioners’ accountability and responsibility by identifying all individuals who review or fail to review the electronic record data. It also brings documentation-related problems regarding clinicians’ copy and paste approach to import clinical findings (Balestra, 2017). Papadakos (2018) reports that faulty copying and pasting is the primary user error raising the number of malpractice claims. For that reason, practitioners tend to spend more time in sophisticated systems to ensure that added information is accurate instead of connecting the data to the actual patient. In other words, Meaningful Use dehumanizes medicine by limiting the doctor-patient interaction in practice that often results in additional litigation.
The ethical dilemmas stem from privacy and confidentiality of the health data, possible security breaches, and data inaccuracies. The system provides access to protected health information (PHI) only to authorized users. However, the unauthorized disclosure of the PHI is still possible due to disloyal coworkers, poor password management, or theft of electronic devices (Layman, 2020). Some clinicians may use their position to access and sell the patient files contributing to a security breach issue. What is more, EHR vendors can sell deidentified patient data for secondary for-profit use. The main problem here is that such data can be reidentified with the help of publicly available data sources (Balestra, 2017). The opt-out provisions that allow patients to have separate paper-based records cause additional ethical issues. Regarding financial dilemmas, the main question remains who should finance the EHR implementation since the health care payers receive the most monetary benefits.
Barriers to Successful Implementation Within an Organization
The already mentioned issues of EHR are the main barriers to its successful implementation within the healthcare settings. For instance, health professionals overloaded with patient data may overlook important health facts making false treatment decisions. Considering that EHR provides access to reliable documentation, such a mistake would result in clinicians’ liability for negligence (Balestra, 2017). For instance, one mistakenly checked box from the drop-down menu can cause harm to a patient with underdose, overdose, or change of disease. For instance, it is possible to select unintentionally 200 mg of morphine instead of 15 mg that, together with a dose of alprazolam, causes slurred speech (Papadakos, 2018). EHR and HITECH Act incentives increase the concentration of clinicians on the system itself instead of establishing a connection with patients.
It is also challenging to assure that authorized professionals that review personal health information stored in the system would not contribute to breaches raising legal and ethical issues. What is more, some EHR vendors have already sold duplicates of their patients’ PHIs to different gadget creators and medical organizations. Although such collaboration may benefit both organizations, it raises ethical questions and drives people to opt-out of the system. The EHR implementation requires significant investment by providers, while the main benefits accrue to payers and society. This record system is more challenging to use than a paper-based one, especially for untrained and unfamiliar staff.
The Ways to Enhance Return on EHR Investments
Although there are some issues, EHR should be implemented in every US healthcare organization to boost the overall health care quality. It should invest in the EHR technology certified by the HHS and establish a productive relationship with vendors to train the staff. As seen, significant issues come from the faulty design of the system or clinicians’ inability to insert or manage the data it collects. According to Jason (2021), the implementation should be accompanied by high-quality EHR training to enhance the IT knowledge of the clinicians and user satisfaction. The new providers who receive a brief training instead of extensive one self-report less confidence and lower proficiency. They also express uncertainty regarding EHR’s ability to boost the quality of care. It is not enough to invest in modern software to meet the requirements of Meaningful Use. The hospital should also ensure that these standardized patient records are used in a meaningful manner by health care professionals.
Another option that should be considered by the hospitals that want to qualify is a time-driven, activity-based costing (TDABC). This cost-accounting method concentrates on such parameters as the capacity cost rate and the time to perform different activities (Londral, 2019). In general, it helps healthcare organizations to manage their resources through the care delivery value chain and increase returns on the EHR investments. The accurate patient care costs will show the importance of meticulous patient care documenting and motivate providers to follow the best practices. Hospitals also should encourage physicians to create connections between the data and actual patients, promoting empathy and a humanistic approach. These ways may help the clinical settings make the most of their EHR investments in health quality and financial terms.
Implementation Process of EHR-related Meaningful Use Legislation
My organization was successful in implementing the Meaningful Use program that consists of three major stages building on and complementing each other. “Stage 1” is about meeting base requirements to capture and share data using EHR technology. For instance, it comprises 15 core objectives such as recording demographic information and providing clinical summaries for patients (American Nurses Association, 2008). Clinical quality measures are also used in reporting to measure outcomes, patient perceptions, and healthcare processes. “Stage 2” encourages professionals to extend the system’s application covering more representatives of their patient population (Rosario, 2017). Finally, “Stage 3” is designed to improve interoperability within the healthcare setting in order to enhance patient outcomes. In my organization, clinicians had comprehensive training that made them less mistake-prone, more confident, and satisfied with the new health record system. For that reason, the investment in EHR technology did not cause and face resistance and already mentioned issues. The hospital successfully qualified for the program’s incentives by meeting core objectives and passing final attestation.
To conclude, EHR incentive programs have been launched to improve patient health data collection and distribution between healthcare organizations, leading to a higher quality of care. Although EHR software brings many benefits, its implementation is associated with legal, ethical, and financial challenges. The increased number of treatment mistakes due to data overload and the system’s complicated design reveals such legal issues as the increased liability of authorized health care professionals. The EHR implementation is also associated with the higher number of malpractice claims, dehumanized treatment approach, high investment costs, and PHI breaches. In order to address these issues, the health care organization can turn to the TDABC cost-accounting method and provide comprehensive training to their staff. EHR should be present in every clinical setting since it helps monitor and improve the quality of health inside and outside the hospital.
American Nurses Association. (2008). Nursing informatics: Scope and standards of practice. Silver Spring, MD.
Balestra, M. L. (2017). Electronic health records: Patient care and ethical and legal implications for nurse practitioners. The Journal for Nurse Practitioners, 13(2), 105-111. Web.
Green, J. (2020). Ten EHR failure statistics: Why you need to get it right first time. EHR in Practice. Web.
Jason, C. (2021). How to design, implement EHR use training courses. EHR Intelligence. Web.
Layman, E. J. (2020). Ethical issues and the electronic health record. The Health Care Manager, 39(4), 150-161. Web.
Londral, A. R. (2019). Cost analysis in healthcare pathways: A short description of TDABC method. VOH CoLAB. Web.
Papadakos, P. J. (2018). Usability and legal pitfalls of electronic health records. Clinical Oncology News. Web.
Rathert, C., Porter, T. H., Mittler, J. N., & Fleig-Palmer, M. (2019). Seven years after meaningful use: Physicians’ and nurses’ experiences with electronic health records. Health Care Management Review, 44(1), 30-40. Web.
Rosario, C. (2017). What is meaningful use? Advanced Data Systems Corporation. Web.