When CMS and ONC revealed the latest statistics on Tuesday morning, showing that 1 percent of eligible providers and 3 percent of eligible hospitals have attested to Stage 2 to date, Elisabeth Myers of CMS' Office of e-Health Standards and Services was careful to point out that the data is early -- so much so, in fact, that “it’s dangerous to apply interpretations” to those numbers.
The 1 percent figure includes EPs who have installed a 2014-certified EHR by Jan. 1 of this year, completed the reporting period ending April 1, and attested as of July 1. That's an aggressive timeline for healthcare entities so naturally the first wave was small, though few expected it to be as low as 1 and 3 percent.
CMS will start seeing second quarter attestations coming in July 1, Myers added. Whereas previous years' reporting periods could be conducted in any 90-day stretch, 2014 is the first time CMS required it to be done according to calendar quarters.
"We've never actually had a reporting period structured in this way," Myers said. "Is this the normal rate? We just don't know."
[See also: How one hospital fast-tracked MU.]
Some people watching meaningful use progress like hawks will no doubt find the Stage 2 attestation rate alarmingly small.
"It's a valid concern," said Paul Tang, MD, vice chair of the HIT Policy Committee and chief medical and innovation officer at the Palo Alto Medical Foundation, adding that the committee should be careful "not to over-interpret on a small number."
And Myers explained that in terms of practice size, CMS is seeing a good proportion of smaller medical groups in the Stage 1 cohort that would be able to make Stage 2.
One example of a hospital that made it
DuBois Regional Medical Center, a 214-bed hospital in Dubois, Pa., is one illustration of an organization that worked hard to prepare, by integrating the Stage 2 project into everything it did.
"We really strived to do 100 percent of every measure, including the menu items," said Tom Johnson, DuBois CIO. Participation was not optional for physicians. "So positioning ourselves for Stage 2 began in Stage 1."
Johnson encountered two major hurdles in the second stage of meaningful use: patient engagement and health information exchange.
After realizing that DuBois would have to train all its nurses, many of whom may not have been apt to learn about the patient portal and view-download-transmit issues, Johnson addressed the patient engagement piece by hiring a full-time LPN to work directly with patients.
Tackling health information exchange, however, was not as simple as a new hire.
[See also: Hospitals lag on data exchange.]
"We already had a relatively well-connected community so it was pretty difficult for us to do HIE," Johnson said.
At DuBois and some other health entities, existing relationships and information sharing practices, though conceptually very similar to exchange under meaningful use, do not necessarily meet federal requirements. For such organizations, that essentially means having to re-wire what they're already doing with new interfaces and processes simply to achieve federal regulations. Rather than adding actual value, that reality only makes it more difficult to earn any sort of return on their investment.
ROI is also a challenge at Mountain States Health Alliance, where CIO Paul Merrywell said it’s becoming harder to justify acquiring and rolling out products like electronic health records.
"I call it a 'rat race' we’re in to manage the varying parts," Merrywell said.
Is Stage 2 working?
The steepest problem underlying so many aspects of forward progress in digitizing America's healthcare system, from small rural practices to IT-savvy large health networks, is of course interoperability.
Merrywell said that Mountain States' vendor, Siemens, delivered meaningful use Stage 2 software like most vendors did: just in time.
Both DuBois and Mountain States are among the early attesters for Stage 1 and will soon attest for Stage 2, the CIOs said, adding that they have strong partnerships with their EHR vendors; DuBois uses Cerner.
Yet against the backdrop of EHR vendors struggling to keep pace with meaningful use, and the most recent progress report from the Centers for Medicare and Medicaid Services and the Office of the National Coordinator for Health IT, it's terribly difficult to discern whether Stage 2 is shaping up to be a hard-driving push toward interoperable EHRs or the sort of party to which numerous invitations are sent, the table is set, and so many seats remain empty.
Balancing dangers of 'backsliding' with reality
DuBois CIO Johnson spoke clearly when he addressed the HIT Policy Committee Tuesday morning: Do not lower the standards bar.
"I'm concerned about backsliding even within our own organization," Johnson continued. "It's too easy to get distracted with ACOs and all the other initiatives. I do appreciate the ICD-10 delay, but it's still out there and a distraction moving forward."
DuBois may be among the elite healthcare providers far enough along with meaningful use and other federal mandates to actually want to push forward, but among the overwhelming percentage trailing -- some of whom, like Mountain States, are veritable first-movers -- there are increasingly loud cries that Stage 2 is overly burdensome, costly, and requires measures beyond providers control.
"We struggled a great deal with the pace of change that meaningful use poses," Mountain States CIO Merrywell said. "We finished collecting data for Stage 2 on June 30."
Having already concluded that reporting period puts Mountain States among the Stage 2 attestation front-runners, but Merrywell said he remains concerned about interoperability.
"We're never going to get to interoperability without standards that can be universally applied," Merrywell said. He was encouraged by ONC's recent interoperability plan -- except for the caveat that it stretches far too long into the future. "Interoperability will take 10 years, which -- interestingly enough -- is how long it took us to put somebody on the moon."