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Meaningful Use of Electronic Health Records


Like other areas of life, the healthcare system has been actively implementing new technologies, such as electronic health records (EHRs). An EHR is a computer technology and software designed for better control and prevention of fraud with the potential to decrease medical errors and raise productivity (Penner, 2017). EHRs are meant to trace patient medical information and replace paper-based health records (Penner, 2017). In the last few years, the application of EHRs has doubled and was partially facilitated by the Electronic Health Records Incentive Program (Cohen et al., 2018). The EHR Incentive Program established standards for the meaningful use of EHRs, including their enactment and demonstration of their usage in improving care (Cohen et al., 2018). Meaningful use (MU) of EHRs is represented by three stages, with each one well-organized but facing specific challenges and barriers.

Meaningful Use

Electronic health records were a significant point in advancing health care services. In the beginning, EHRs were expected to generate meaningful data, enable accurate measurement, and improve care and its outcomes (Cohen et al., 2018). With time, the EHR Incentive Program has defined several electronic clinical quality measures, which were meant to decrease the necessity for clinicians’ involvement in reporting by using data already collected via EHRs (Cohen et al., 2018). The purpose of MU was for EHRs to measure and document measurements, but EHRs were obliged to be certified by the Office of the National Coordinator for Health Information Technology (ONC) (Cohen et al., 2018). The functionality of ONC-certified EHRs was aligned with the incentives and quality criteria of the Centers for Medicare and Medicaid Services (CMS) (Cohen et al., 2018). The implementation of MU proceeded in three stages, intending to create an interoperable EHR system across all US hospitals (Saba & McCormick, 2021). National committees proposed regulations reviewed by the public for each stage and submitted to CNS and healthcare facilities (Saba & McCormick, 2021). EHRs were designed to enhance the healthcare system and followed several rules.


The first of the three stages of meaningful use focused on healthcare providers. In 2009, CMS and ONC presented Stage 1 and initiated a public comment period (Saba & McCormick, 2021). Next year, the authorities reviewed 2000 commentaries, and the stage was issued with five initiatives (Saba & McCormick, 2021). The initiatives included improving quality and safety, patient engagement, care coordination, advanced public health, and privacy of personal health information (Saba & McCormick, 2021). Stage 1 began in 2011 and was meant to encourage and assist providers in adopting EHRs (Gillen et al., 2018; Saba & McCormick, 2021). At this stage, MU involves transferring data to EHRs and sharing information, such as electronic copies and patient visit summaries (Saba & McCormick, 2021). Upon completing the stage’s objectives and submitting appropriate measurements, hospitals and providers receive an incentive payment (Saba & McCormick, 2021). Stage 1 was the beginning of EHRs’ meaningful use, with benefits for patients and health care providers.

The second stage of meaningful use started soon after the first one. Stage 2 concentrated on professionals in health care who were using EHRs and receiving incentive payments from Stage 1 and was followed by commentaries from the public (Saba & McCormick, 2021). Medical providers were said to face penalties starting from 2015 if they failed to meet the program’s participation requirements or demonstrate using a certified EHR (Saba & McCormick, 2021). While Stage 1 aimed at collecting and sharing information, the goal of Stage 2 was the advancement of clinical processes (Gillen et al., 2018). Stage 2 expanded MU of EHRs and prioritized the electronic capture of structured health data and its exchange between health care providers at care transitions (Saba & McCormick, 2021). The stage also emphasized the importance of specialty providers and leadership roles in identifying and reporting cancer and specific cases (Saba & McCormick, 2021). Stage two continued the previous one, setting additional objectives and inspecting providers of care.

The third stage of meaningful use was meant to complete the implementation of EHRs. The main purpose of Stage 3 was oriented toward improved outcomes in 2017 and the following years through the use of certified electronic health record technology (CEHRT) (Saba & McCormick, 2021). The stage was intended to ease reporting requirements, promote innovation, and encourage good behavior (Saba & McCormick, 2021). Moreover, Stage 3 facilitated the usage of application programming interfaces (APIs) to increase data access and further the interoperability of MU (Saba & McCormick, 2021). However, Stage 3 was eventually substituted by the Medicare Access and CHIP Reauthorization Act (MACRA), which created a new Medicare Quality Payment Program (QPP) (Saba & McCormick, 2021). QPP emphasized value-based care over volume-based care and revised reimbursement by requiring clinicians to use CEHRT and addressing quality outcome measures (Gillen et al., 2018; Saba & McCormick, 2021). Stage 3 was supposed to finalize the MU of EHRs but was replaced by a modified program to ensure adequate results.


A variety of measures characterizes each stage of meaningful use. Measurements of Stage 1 were employed to assess specific objectives and calculate annual incentive payments (Saba & McCormick, 2021). Stage 2 removed and changed some of the previous goals, and its measures were aimed at enhancing the quality and efficiency of care, increasing care coordination, and engaging patients (Saba & McCormick, 2021). Stage 3 included better healthcare quality measures, but the modified version revised them to exchange health data between medical providers and patients (Saba & McCormick, 2021). Every stage had distinct measurements and objectives, some of which were changed.

Although stages of MU had separate measures, they all centered on quality of care. Since the purpose of incentives that involved new technologies was to reform the healthcare system, quality measurement was considered one of the most crucial components of MU (Saba & McCormick, 2021). Stage 1 included 44 quality measures for providers and 15 for hospitals, but while the former needed to report on 6 of the measures, the clinics were obliged to account for all (Saba & McCormick, 2021). Stage 2 altered initial objectives and its measurements focused on assessing that more than 5% of patients could view and share their health information online and that CEHRT messaging was secure (Saba & McCormick, 2021). Although Stage 3 had its objectives, it was quite flexible in selecting measures most suitable for each patient and practice (Saba & McCormick, 2021). Overall, the measurements of every stage of MU were supposed to estimate the use of EHRs and their impact.

Challenges and Barriers

The challenges and barriers of the MU have been identified since its beginning. In 2011, the US Department of Health and Human Services (HHS) acknowledged that many healthcare providers had difficulties gathering information about best practices, and some vendors could not keep up with changing requirements for new technologies (Saba & McCormick, 2021). At the time, HHS itself was not ready to accept electronic quality measure reporting (Saba & McCormick, 2021). By the beginning of Stage 2, Congress noticed that EHRs’ interoperability was progressing slowly, resulting in the healthcare system being “trapped in information silos” (as cited in Saba & McCormick, 2021, p. 303). The Information Exchange Workgroup (IEW) suggested that the required documentation for MU needed to be simplified and coordinated better (Saba & McCormick, 2021). Following that, the replacement of Stage 3 requires consideration of more challenges. Cohen et al. (2018) suggest certain complications in generating tailored reports of electronic clinical quality measures. Some EHRs produced meaningful use metrics only for a minority of patients with Medicare or Medicaid coverage (Cohen et al., 2018). Despite the benefits of MU of EHRs, people’s unfamiliarity with it caused obstacles.


To summarize, meaningful use of EHRs aims to simplify health care providers’ work and offer better quality care. The adoption of MU has been a prolonged process with three stages concerning the public’s opinions. Stage 1 promoted the adoption of EHRs to collect and share data and had quality measures for hospitals and providers. Stage 2 extended MU and measured the accessibility and safety of EHRs to advance clinical processes. Stage 3 strived to ensure improved outcomes for each practice and patient but was replaced by an advanced program. Healthcare providers received payments and penalties to control EHRs’ usage but encountered several problems, including a lack of information and the first EHRs’ inability to trace all patients. Meaningful use of electronic health records presented benefits for the healthcare system, but its implementation had some challenges.


Cohen, D. J., Dorr, D. A., Knierim, K., DuBard, C. A., Hemler, J. R., Hall, J. D., & Balasubramanian, B. A. (2018). Primary care practices’ abilities and challenges in using electronic health record data for quality improvement. Health Affairs, 37(4), 635-643. Web.

Gillen, E., Berzin, O., Vincent, A., & Johnston, D. (2018). Certified electronic health record technology under the quality payment program. RTI Press, 1-4. Web.

Penner, S. J. (2017). Economics and financial management for nurses and nurse leaders (3rd ed.). Springer Publishing.

Saba, V. K., & McCormick, K. A. (2021). Essentials of nursing informatics (7th ed.). McGraw Hill Education.

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ApeGrade. 2022. "Meaningful Use of Electronic Health Records." December 1, 2022. https://apegrade.com/meaningful-use-of-electronic-health-records/.


ApeGrade. (2022) 'Meaningful Use of Electronic Health Records'. 1 December.

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