Stage 2 Meaningful Use is intended to build on the objectives and measures set in the inaugural phase of the EHR Incentive Programs. Whereas Stage 1 Meaningful Use aimed to promote the adoption and sharing of electronic health information, Stage 2 looks to “advance clinical processes” as described by the Office of the National Coordinator for Health Information Technology (ONC).
Geneally speaking, this advance takes the form of higher thresholds rather than the introduction a greater number of new categories of data to be capture — the most notable exception being patient engagement and health information exchange. The inability of eligible professionals (EPs) or hospitals (EHs) to achieve Stage 2 Meaningful Use, therefore, may not come down to meeting all the requirements but instead keeping track of all the moving parts and the number of pieces that need to be in place.
“Each one is a small hurdle by itself, but when you put them all together it’s really a tremendous change,” says Dr. Anita Karcz, Chief Medical Officer at IHM Services, which works with providers to improve the reporting of quality measures required by meaningful use and other government programs. “There are a number of things you need to put in place before walking into Stage 2.”
An important difference between Stage 1 and Stage 2 Meaningful Use is the emphasis being placed on codified data. “Stage 2 has really upped the ante in terms of codified data,” explains Dr. Karcz. “Basically, Stage 1 was about making sure data is structured and there was some codification. One of the big things in Stage 2 is that there’s a lot more codification, and this is where things change.”
For instance, there is the matter of coding data using the appropriate terminology. While Stage 1 Meaningful Use gave participants the option to use SNOMED or ICD-9, Stage 2 definitively calls for SNOMED which may cause problems for healthcare organizations unfamiliar with it.
A new feature of meaningful use, patient engagement, is also causing concern for eligible providers. Implementing a patient portal on the provider side doesn’t guarantee that a sufficient percentage of patients will make use of it. And considering that the “digital experience” of patient populations varies geographically and based on other factors, this requirement could prove troublesome for some EPs or EHs, says Dr. Karcz.
To keep track of these subtle and not-so-subtle components of Stage 2 Meaningful Use, Dr. Karcz advises providers to take a careful look at their performance frequently in order to avoid a rude awakening come meaningful use attestation time:
With meaningful use, you have to report over a time period, but we also provide daily reports that show people how they’re doing on a day-to-day basis. It’s really key. The worst nightmare of the IT department is to wake up at the end their 90 days and find out that they weren’t meeting some measure. That’s not on anyone’s fun list for sure.
Another piece of advice to bear in mind is selecting the timing and appropriate reporting period for moving on to Stage 2 Meaningful Use. In Stage 1 Meaningful Use, EHs and EPs could choose their own 90-day reporting periods. In the next phase, they must select from one of four quarters to report on. How providers proceed could pose risks to their success in the second stage of the EHR Incentive Programs.
“The way the regulations were originally penned, the process was that on Sept. 30 you would end Stage 1 and then Oct. 1 you would start Stage 2,” notes Dr. Karcz. “Just making that change in the information system isn’t easy. So are you going to have two parallel things running and training people while they’re still using something else?”
In the end, Stage 2 Meaningful Use is about timing. The amount of time put into carefully monitoring health information systems and clinician use of certified EHR systems will determine whether providers achieve success in Stage 2. Time is money, and in this case, no money can be had without first putting in the necessary time.
