Evaluation of Stage 3 Meaningful Use Objectives: Analysis in Maryland and Arkansas

This project was one of four task order contracts awarded under the Evaluation of Stage 3 Meaningful Use (MU) Objectives request for task order (RFTO). The purpose of the RFTO was to fund rapid-cycle evaluation studies of the implementation of Stage 3 MU proposed objectives of the Medicare and Medicaid Electronic Health Record (EHR) Incentive Programs.

This project evaluated the feasibility of two Stage 3 MU Care Coordination (CC) objectives at nine hospitals in Arkansas and Maryland, and provided feedback to policymakers and providers for their improvement.

The two objectives studied were:

• SGRP 305: For patients referred during an EHR reporting period, 50 percent of referral results generated from the EHR are returned to the requestor, and 10 percent are returned electronically. 
• SGRP 308: For 10 percent of patients with a significant health care event (arrival at an Emergency Department [ED], admission to a hospital, discharge from an ED or hospital, or death), electronic notification will be sent to at least one key member of the patient’s care team, such as the primary care provider, referring provider, or care coordinator, with the patient’s consent if required, within 2 hours of when the event occurs.

The specific objectives of this project were to answer three research questions for each proposed MU objective:

• How can the evaluated MU objective be improved at the policy level?
• What EHR innovations would support meeting the evaluated MU objective? 
• What will increase the value for hospitals and ambulatory practices implementing the proposed Stage 3 MU objective? 

The investigators conducted a mixed methods evaluation study including interviews, focus groups, and surveys. The results showed mixed outcomes for different elements of the measures. In general, hospitals expressed both positive and negative views on the language of the objectives, showed variable feasibility rates to implement each measure using their existing EHRs, and estimated moderate to large value added to their performance and outcome if the objectives were fully executed. The participating hospitals suggested simplifying and merging SGRP 305 into another existing measure and clarifying the details of SGRP 308.