Health service providers in the US have been struggling with rising costs of care while trying to improve service quality and accessibility. In 2009, the US federal government implemented the Health Information Technology for Economic and Clinical Health (HITECH) Act to revive the health economy. Under this Act, legislators allotted $20 billion of the total $787 billion to the American Recovery and Reinvestment Act (ARRA) to improve health IT infrastructure and ensure Meaningful Use. The government believed this initiative would control escalating costs of healthcare, minimize waste, enhance quality of care, and improve the overall health outcomes
‘Meaningful Use’ refers to the deployment of EHRs as per the guidelines established by the federal government within a healthcare organization. The successful certification of Meaningful Use decides whether an organization is eligible for financial incentives either from the Medicare or the Medicaid EHR Incentive Program. The efficient utilization of EHRs is monitored through standards for Meaningful Use set by the Centers for Medicare and Medicaid Services (CMS). CMS has laid out a three-stage plan for providers to comply with Meaningful Use criteria by 2017.
Some of the common goals, which the providers must ensure for a compliant EHR are:
- Structure the data to efficiently capture a patient’s clinical data
- Ensure clinical data can be shared electronically
- Ensure predictive analytics for accurate decision making
Steps to Achieve Meaningful Use: A Testing Perspective
Physicians need to take greater responsibility and ensure that the EHRs are upgraded, so that information management can drastically improve the quality of care. The following are some of the steps that can be taken to achieve Meaningful Use:
- Early Involvement of QA Team
- Creation of a robust Test Plan
- Beta Testing
- Enterprise Roll out
- Certify for Meaningful Use
Testing and Meaningful Use: A Smart Way to Ensure Compliance
It is critical to test the modified EHR to ensure Meaningful Use compliance. Verifying and validating the changes and demonstrating the appropriate usage depends primarily on testing (and more testing).
Some of the testing best practices which can assure Meaningful Use of an EHR system are as follows:
- Experienced testing resources: Appropriately skilled testing resources who possess domain knowledge and a thorough understanding of the workflow within the tailored EHR should be deployed.
- Identification of right-sized testing for EHR Meaningful Use: There can be many new modules in the customized EHR that need to be tested in an organized manner and sequenced for effectiveness. A qualified tester ensures that sufficient testing is carried out across the system. Given below are the testing types which are expected to be performed for an EHR Upgrade testing.
- Internal Readiness Testing verifies whether an individual system module (for example, patient admission, patient information updates, provider referral and medical writing) is working efficiently.
- Confirmation Testing verifies the completeness of business process flows between the EHR system and external systems to ensure if they are working as expected. Usability Tests can also be conducted to ensure there is no visual clutter and complex screen flows.
- Right testing approach: To plan, execute, and certify the various types of testing required for ensuring Meaningful Use compliance, a defined Entry-Task-Validation-Exit (ETVX) model with stringent quality gates can be enforced. This ETVX model envisages co-ordination and control between various stakeholders across all the phases in a testing process, namely, Business, Development Teams and the Testing Team.
- Knowledge management: A knowledge base of all that has been done during this upgrade exercise, including the application documentation, test case repository, impacted workflow definitions to training kits should be created.
- Continuous improvements through adaptive assurance: Feedback can be taken from the go-live to ensure any errors which creep up in real time be avoided in the immediate release.
Successful implementation of an EHR through Meaningful Use is possible only when physicians along with the right set of test professionals are completely committed to the task. Although several issues might creep up during the transition to the modified EHR system, a successful transition is possible if it encompasses the right set of people, processes, governance, and technology. With the successful implementation of EHR, through effective QA practices, the healthcare providers can contribute to revolutionizing healthcare services through affordable care, lower rates of error, administrative inefficiencies, and improved accessibility.