Stage 2 changes may be rude awakening

The 'overreliance on the vendors is stunning.'
By Mike Miliard
11:20 AM
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During a frank discussion of the meaningful use program in Denver last week, one hospital IT chief said he wasn't sure some organizations "really, truly grasp the magnitude of some of the changes" demanded by Stage 2.

The panel, convened at The Institute for Health Technology Transformation's Denver Health IT Summit, was meant to offer assessments and advice for tackling the program at the point where the rubber hits the road. If Stage 1 meaningful use means providers had to demonstrate the capability to perform core measures, after all, Stage 2 is where they'll actually have to perform them.

Those tasks include data exchange, more robust security, imaging availability and patient engagement. And they could be a tall order for some hospitals, said those who've been in the trenches.

Hank Fanberg, director of technology advocacy at Irving, Texas-based CHRISTUS Health, said he agrees "in principle with the goals" of meaningful use, but said, "it's been a long, difficult, trying road to get there."

The "readiness of our EMR vendor" has been one of the biggest challenges so far, he said, leaving his facility "at the mercy" of its ability to release the necessary upgrades.

Derek Kosiorek, principal at MGMA Healthcare Consulting, has seen similar issues with his clients, for whom the "overreliance on the vendors is stunning." Too many of them, he explained, are "waiting for the vendors to release the product" they need.

Stage 2 demands more than that, said Fanberg, noting that CHRISTUS has been taking a proactive approach to getting a huge group of stakeholders working in concert to tackle the many facets of meaningful use.

"We have a meaningful use workgroup that meets every Wednesday," he said – 54 different people representing an array of different departments from nursing to pharmacy to health information management.

"We've been meeting for two years now," said Fanberg. "We need to deconstruct every single one of the meaningful use criteria and figure out the workflow."

Some panelists had some success stories to share, in areas such as patient engagement. Judy McCarthy, chief technology officer at Denver-based National Jewish Health, cited the easy uptake so far of the hospital's patient portal. 
"We wrote it ourselves, and 3,000 patients signed up," she said. "We didn't do any marketing."

Of course, it's not quite as simple as that, McCarthy added: "It's one thing to put a portal out there, and it's another thing to truly engage the patient."

Indeed, said Kosiorek, "Secure messaging is a complete change for providers and the way they do things."

And it's just one of many, said Fanberg, adding that "magnitude of some of the changes" in Stage 2 "will be very surprising" for some providers. PACS, labs, EDIS, "all need to talk with the EMR," he said. "How are they going to accomplish this unless they start thinking now?"

All this is happening, of course, with the ICD-10 deadline looming – and competing for already-scarce resources. With the Oct. 1, 2014 switchover date apparently "nonnegotiable" at this point, one panelist suggested hospitals "try to do as much in concert as possible," coordinating between Stage 2 and ICD-10, because "they are related."

Despite the many challenges, there have been hidden benefits along the way. Fanberg mentioned, for instance, that his hospital has "leveraged meaningful use as a hammer to make physicians to do (computerized) order entry."

"I think in the long-run we'll see more benefits," added McCarthy. "I think Stage 1 may not be a huge difference for us in the way we're providing care, but we'll see a big change for our providers in Stage 2."

Added Kosiorek: "I'm one of those crazy, starry-eyed people who thinks meaningful use has been a good thing."

[See also: Stage 2 MU released at last]