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regional centers that guide providers as they adopt EHRs and offer technical support.Meeting the criteria for meaningful use (MU) of an EHR is one of the methods of Medicare and Medicaidreimbursement associated with the HITECH Act. The Centers for Medicare & Medicaid Services (CMS) serves as the primary regulator, with each individual state dictating the Medicaid operations within its jurisdiction (Health Information Technology for Economic and Clinical Health Act, 2009). This statute identifies the eligible providers, including APNs, for the Medicare and Medicaid reimbursement structure. Such prescriptive language does not recognize, embrace, or support the interprofessional team and the critical and collaborative work completed by such an entity to improve access, improve health care, andreduce costs.The third and final stage of MU is currently underway and entails a single set of criteria focused on the advanced use of EHR systems. CMS decided to move away from the staged approach and will require all providers (including first-time participants) to satisfy the objectives and measures of Stage 3 by 2018. Beginning in 2019, the MU program will transition into a new merit-based incentive payment system (MIPS) program established by the Medicare Access and CHIP (Children's Health Insurance Program) Reauthorization Act. The Stage 3 requirements and objectives will be maintained (Resnick, Meara, Peltzman, & Gilley, 2016).Throughout the MU phases, providers and hospitals that implement EHRs meeting federal standards outlined under the meaningful use regulatory requirements are financially incentivized with payments from CMS. The incentive program started in 2011 and extends over several years with the time table determined by whether a provider elects to access the Medicaid or Medicare incentive program. Hospitals can access both Medicaid and Medicareincentives, and in many cases these incentives equate to millions of dollars.23.TIGER-based Nursing Informatics Competencies Model:The TIGER(2007) initiative identified steps toward a 10-yearvision and stated a key purpose:“to create a vision for the future of nursing that bridges the quality chasm with information technology,
enabling nurses to use informatics in practice and education to providesafer, higher-quality patient care” (p. 4). The pillars of the TIGER vision include the following:Management and Leadership: Revolutionary leadership that drives, empowers, and executes the transformation of health care.Education:Collaborative learning communities that maximize the possibilities of technology toward knowledge development and dissemination, driving rapid deployment and implementation of bestpractices.Communication and Collaboration: Standardized, person-centered, technology-enabled processes to facilitate teamwork and relationships across the continuum of care.Informatics Design:Evidence-based, interoperable intelligencesystems that support education and practice to foster quality care and safety.