Healthcare organizations around the country have been working diligently to implement electronic health record (EHR) technology and attest for meaningful use (MU)—the federal government’s standards that allow eligible providers and hospitals to earn incentive payments if they meet specific criteria. The MU effort is divided into stages with each stage requiring organizations to meet more stringent criteria.
As Stage 1 MU draws to a close, there are some key points of difference to consider when preparing for Stage 2.
• Compliance percentages for Stage 1 are increasing significantly for Stage 2. It’s no longer enough to get your feet wet with EHR technology; you have to demonstrate more consistent use. For example, both Stage 1 and 2 MU criteria require organizations to record changes in vital signs. However, Stage 1 MU requires organizations to report blood pressure, height and weight as structured data for more than 50 percent of patients. Stage 2 requires such reporting for more than 80 percent of patients, demonstrating that the organization is continuing to improve on its ability to capture critical information.
• Health information exchange (HIE) requirements are also increasing. For Stage 1 MU, organizations only had to attest that they tried to achieve health information exchange. In Stage 2 MU, they must be able to successfully exchange information consistently while maintaining patient privacy.
• Efforts to empower and engage patients are also more prominent in Stage 2. In Stage 1 MU, providers had limited responsibility for sharing documents electronically with patients. However, in Stage 2 MU, physicians are not only required to share documents electronically but they must share them using specific delivery methods (email or a patient portal).
Of these changes, the second and third will present the most challenges for healthcare organizations and their information technology departments. The increase in HIE requirements will be complicated by the fact that there currently are not clear data standards in the marketplace to support smooth and comprehensive data exchange. Different technology systems still require different connection methods, and until that changes, interoperability will remain a potential stumbling block for compliance.
Meeting the new patient engagement requirements will necessitate a culture change for many organizations in addition to a technology upgrade. Organizations will need to shift their thought process focusing on just delivering care to patients to collaborating with patients to manage and deliver their care.
Once your organization has educated itself on the new requirements, it should take additional steps to lay the groundwork for attestation efforts. Some key activities include the following:
• Assess your organization’s capacity to change. Organizations should closely examine their infrastructure and decide whether they are prepared to support the new requirements. A first step is to assess IT resources and determine whether they have sufficient staff with the right skills to manage the initiative. Whether organizations meet Stage 2 MU requirements will depend heavily on the skills of internal IT departments, and organizations should verify their teams are prepared and ready for the process.
Organizations should also take a hard look at their culture and see if it supports comprehensive information exchange and patient involvement in care processes. In other words, physicians, nurses, and organization leadership must value transparency and open communication of information. They must place the patient at the center of all patient care activities and appreciate the need for direct patient involvement in care processes. This mindset represents a departure from the way healthcare organizations have historically operated. Before real work on MU attestation can begin, organizations must ensure they have the culture that will support this approach to information sharing and patient care.
• Gauge your vendor’s progress. Getting ready for Stage 2 MU will be challenging for vendors. Some of their clients will have attested for Stage 1 MU and be working toward Stage 2 MU. Others will just be starting the Stage 1 MU attestation process. Vendors will have the dual responsibility of addressing the needs of both sets of clients. Healthcare organizations should reach out to their IT vendors to get a sense of how they plan to manage the multiple priorities. Some questions to ask may include when the vendor expects to be certified for Stage 2 MU and when the vendor expects to release any software upgrades related to the new criteria. Organizations may also want to ask vendors about any additional plans to support attestation efforts such as educational webinars or customized training.
• Determine where providers are along the continuum. Different physicians your organization works with will be at different places in terms of EHR implementation. For example, an employed physician may have attested to Stage 1 and be in the process of preparing for Stage 2 while a community physician who refers patients to your organization may not have committed to pursuing any MU criteria at all. Depending on the stage in the MU attestation process, a provider is going to interact differently with technology. Organizations should figure out where physicians are in the attestation process and plan accordingly.
Readying your organization for Stage 2 MU is time well spent. Focused work in this area will help you face the Stage 2 attestation initiative in 2014 with confidence, knowing you will be as prepared as possible to address the enhanced criteria and support more comprehensive EHR use.