Analysis of the impact of meaningful use on clinical performance in non-profit hospitals and health systems

Meaningful Use of Electronic Health Records are the processes and standards by which hospitals, health systems and providers must abide by or meet in order to obtain incentive payments from the Centers for Medicare and Medicaid Services. Developed as part of the 2009 Health Information Technology for Economic and Clinical Health legislation, Meaningful Use was developed to help promote the use of Electronic Health Records to improve patient care and reduce costs by establishing a minimum level of Electronic Health Record functionalities that providers and hospitals use to record, transmit and communicate the care of their patients. To this end, this study was created to investigate whether Meaningful Use was creating the benefits it was intended to. Based on the hospitals that have attested for Meaningful Use in 2011 and 2012, clinical and financial data were obtained on Ischemic Stroke and Venous Thromboembolism to determine whether Meaningful Use attestation had created a difference in length of stay, mortality and costs. The first objective was to determine whether early compared to later attestation made a significant difference in the metrics for these diseases. Secondly, did continued attestation overtime create a substantial difference in these indicators. Finally, would there be a difference in the indicators between hospitals that have attested for Meaningful Use and those that have not. Based in the context of the RE-AIM model, this study set out to understand whether Meaningful Use was an effective public health intervention.18 Ultimately, there was no difference in early versus late attestation for any of the studied variables. Alternatively, there was a significant increase in mean ischemic stroke costs overtime from 2010 to 2011 ($10,545.88 to $10,809.27, p\u3c0.02, t=-3.02) and from 2010 to 2012 ($10,545.88 to $11,371.83 p\u3c0.004, t=-3.48). Median ischemic stroke costs were also found to have significantly increased overtime for 2010 to 2011 ($4,588.05 to $4,780.66, p=0.05, t=-2.14) and from 2010 to 2012 ($4,588.05 to $4,827.98, \u3c0.02, t=-2.97). There was also a substantially lower length of stay (4.8 vs 5.1 days, p\u3c.04, t=-2.113) and costs ($12,399.80 vs. $13,832.20, p\u3c.04, t=-2.095) for stroke correlated with hospitals that had attested for Meaningful Use. Lower venous thromboembolism mortality was associated (2.9 vs. 3.0 deaths, p\u3c.04, t=2.475) with hospitals that have attested for Meaningful Use compared to those that have not. Although it is not clear whether Meaningful Use is helping to reduce costs for hospitals that have attested there does appear to be limited success in improving patient care in hospitals that have attested. At this stage in its implementation Meaningful Use has limited effectiveness and could benefit from continuous review of the effectiveness of the legislation and long term adjustments to the laws