Meaningful Use, stage 2: Ready or not, here it comes

This information is part of a Medical Economics exclusive ranking of the top 100 EHR companies. (medicaleconomics.com/top-100-EHRs)

As stage two of the meaningful use (MU) incentive program for electronic health records (EHRs) draws near, opinions are divided as to how prepared doctors and EHR vendors are to meet the program’s requirements. 

Some observers think that solutions to the major technical challenges to attesting to meaningful use’s second phase (MU2)-mainly the inability of different EHR systems to communicate with one another-are emerging. They also say that EHR vendors will be ready with products that meet MU2’s more demanding requirements.

On the other hand, the American Academy of Family Physicians (AAFP), and the American College of Physicians have written to government officials urging a delay in MU2’s implementation. In September, they were joined by a group of 17 U.S. senators, who wrote to Kathleen Sebelius, secretary of the U.S. Department of Health and Human Services, requesting a 1-year extension of deadlines for providers who need more time to meet MU2’s requirements.

Doctors and other eligible providers (EPs) who successfully attested to the first phase of meaningful use (MU1) in 2011 or 2012 are eligible to begin attesting to MU2 starting on January 1, 2014. In addition, 2014 is the last year in which EPs can start attesting to meaningful use so as to avoid financial penalties-or “payment adjustments,” as the Center for Medicare and Medicaid Services (CMS) calls them-beginning in 2015. About 44% of EPs, or 230,000 providers, had attested to the program’s first stage through May of this year, according to CMS.

“I’d say right now we’re cautiously optimistic about the situation,” says Robert Anthony, deputy director of health information technology initiatives and lead for policy and outreach in CMS’ office of e-health standards and services.

Anthony says that about 60% of EPs who have qualified for MU1 did so using EHR vendors who now have products that the government has certified as meeting the requirements for MU2. According to statistics compiled by Medical Economics, 22 vendors have complete EHR systems that are MU2-certified.

“We’re feeling good about the number of products available,” says Anthony. “The question now is to see how quickly providers are able to implement them into their workflow so they can get to stage 2 of Meaningful Use.”

Time pressures draw concern

Jason Mitchell, MD, director of the AAFP’s Center for Health Information Technology, isn’t so sure. Although AAFP agrees with the overall goals of the MU program, “the concern we have is with the timeframe, and the pressures on practices to implement the significant changes from the first to the second stage of meaningful use,” he says. “It’s not just turning those functions on, it’s figuring out how to have them be compatible with the practice’s workflow.”

Moreover, Mitchell points out, even EPs who have already attested to the first stage of Meaningful Use or are planning to do so in 2014 will be required to use what the government is calling “2014-certified” software in their EHR systems by the end of 2014.

“That means everyone who’s doing meaningful use has to interact with their vendor to upgrade their system, to add new features and functionalities,” says Mitchell. “That’s a big burden on the practices and on the vendors to be able to meet that need. We’re hearing from vendors that they don’t think they’ll be able to pull it off.”

CMS’ Anthony says that as of early October he’d seen no indication of a delay in implementing MU2.

MU2’s attestation requirements

Successfully attesting to MU2 requires physicians to meet all of a set of 17 “core” objectives and three from a list of six “menu” objectives. Among the core objectives are three involving the electronic exchange of information:

• providing a summary of care record for more than 50% of the patients referred to another provider or transitioned to another care setting;

• supplying the summary of care record electronically for more than 10% of those referrals or transitions; and

• conducting at least one successful electronic exchange of a summary of care with a recipient who uses a different EHR system.

The electronic information exchange requirements caused a great deal of concern among physicians when they were first announced, because virtually all EHR systems lacked interoperability-the ability to communicate with systems made by other vendors. That concern is dissipating somewhat due to the work of groups such as the Direct Project and Health Level 7 International (HL7).

The Direct Project has defined standards used for point-to-point communication between providers, while HL7-the global authority on standards for interoperability of health information technology-has been developing standards for a common “continuity of care document” (CCD) that all U.S. providers could use when transitioning patients to another provider or care setting. HL7 has been working with the Office of the National Coordinator for Health Information Technology (ONC) to incorporate its standards into vendor requirements for stage 2 MU certification, says Diana Warner, MS, RHIA, director of health information management practice excellence for the American Health Information Management Association.

“If all vendors use the standard, then that information should be easily shared and understood by the provider or organization receiving it,” Warner says.

Robert Rowley, MD, a family practitioner, healthcare information technology consultant and blogger, and chief medical officer for GroupMD, thinks that most EHR vendors will have no choice but to adopt the standards developed by HL7 and the Direct Project. “Otherwise they’ll be done in the marketplace,” he says.

Another option for meeting the summary of care transmission requirement is by joining a health information exchange (HIE)-a centralized electronic repository that members can use for sending and receiving patient CCDs. But while HIEs have been growing in number and reach, not all healthcare providers have access to one.

Encouraging patient engagement

A second source of concern over meeting MU2 requirements stems from the objectives dealing with patient access to information, or “patient engagement.” Doctors must provide patients with the ability to view, download, and transmit their information online within 4 days of the information being available to the doctor, and ensure that at least 5% of the practice’s patients access their information online. For many doctors, especially those with a large number of elderly patients, it will require both persuading patients of the benefits of going online for their information and walking them through the process of doing so.

Rowley says he often uses lab tests as a hook to get patients started. “I’ll remind them that if they’re signed up online they can look at the results themselves (through his practice’s patient portal) without having to wait for me to provide them,” he says. “That’s been pretty successful.”

Warner recommends assigning one person in the practice the responsibility of asking patients if they know how to access the patient portal, and if the answer is no, demonstrating how to do so. “Being able to see the medications they’ve been prescribed and that they’re taking them appropriately, and seeing the plan of care written down, may be a way to get seniors engaged,” Warner says.

CMS’ Anthony recommends that practices begin planning for the changes their upgraded, 2014-certified EHR systems will bring. “You don’t necessarily have to be on a certified EHR to start thinking about the changes you’ll have to make to your practice’s workflow,” he says. He adds that because several of the core objectives in stage 2 were menu objectives in stage 1, “providers should already have an idea of what those requirements are. Thinking about them now will make the transition easier.”