On the way to Stage 2

By Bernie Monegain
11:07 AM

The proposed Stage 2 meaningful use rule – a 455-page document – raises the bar on many Stage 1 requirements and introduces several new ones.

Delivered Feb. 24 at HIMSS12 in Las Vegas, where 37,000 health IT professionals were gathered, the rule, as one CIO put it is “where the rubber meets the road.”

Eligible providers must meet 17 core objectives and 3 of 5 menu objectives. Eligible hospitals must meet 16 core objectives and 2 of 4 menu objectives.

The standing-room-only crowd at HIMSS12 applauded select provisions as ONC chief Farzad Mostashari, MD, discussed them in a “sneak peak” session. Extending Stage 1 to 2014, received resounding applause. That would provide two years for Stage 1 and two years for Stage 2.

Mostashari told the audience there would be a lot of interoperability in Stage 2, and that spurred applause, too. “Here we come interoperability and exchange,” he said. In another talk at HIMSS12, Mostashari said he thought of HIE as a verb, not a noun. Also central to Stage 2 is patient engagement, an emphasis on sharing more information with the patients.

Healthcare IT News asked CIOs for their early impressions of the proposed rules. Any surprises?

Some. But there were good surprises, said Pam McNutt, senior vice president and CIO at Methodist Health System in Dallas. One of them was “rethinking modular certification,” she said. If a hospital decided not to pursue a menu item, in the past it would be required to have that piece of certified technology even if there were no plans to use it. That is no longer the case.

“I really think there was an effort made to listen to the comments they received earlier,” she said.
Three of Methodist’s four hospitals have met Stage 1 requirements and received incentive payments. The fourth, which was an acquisition, will attest soon. McNutt said.

“MU-2 definitely ramps up some key parameters but, most importantly, begins the key engagement of the patients with the healthcare information stream, said William Bria, MD, CMIO at Shriners Hospitals for Children. “This is a transformative moment as a father of a child with a chronic medical issue, I can tell you that this dimension of the second phase will be the most important to America.”

The Shriners network operates 22 hospitals across the country, Canada and Mexico. Bria said the system planned to meet Stage 1 requirements this year.

Bill Spooner, senior vice president and CIO of Sharp Healthcare in San Diego, says Sharp would be attesting for Stage 1 shortly. He agrees with McNutt that the ONC and CMS appear to have been listening.

He cites a number of positives for Stage 2:

• The rules do not require major product upgrades for new functionality
• Specific standards are specified to ease the interoperability among all vendors and providers
• Reasonable increases are proposed for compliance thresholds and the number of quality indicators
• Patient engagement is emphasized through targeted utilization of portals and faster turnaround of information requests

While the proposed Stage 2 rule, to be commented upon and finalized by next summer, has been embraced by many as consistent with what was anticipated, it is not without its challenges.

Doing the transitions of care items well will be a challenge, said Scott MacLean, CIO at Newton-Wellesley Hospital in Newton, Mass. “This has been a focus of ours for several years, and we have some electronic tools to assist,” he said. “Making all transitions safe and efficient will require more process and IT support to comply with both MU and state regulations. This will continue to be challenging, but also will be very good for out patients and our efficiency when complete.”

Newton-Wellesley Hospital is part of Partners HealthCare in Boston, whose electronic health record systems are developed in-house. MacLean said most eligible hospital attestations for Stage 1 are slated for later this year or early 2013. Eligible provider attestations would “ramp up quickly now,” he said.

“We have already begun work on Stage 2 as we were anticipating some of the requirements,” MacLean said.

For McNutt, it’s the reporting of quality metrics that still concern her. She worries about their accuracy. The measures are generated from the electronic health record system. “You have to map all those codes. There’s a big gap. We have quite a lot of work to do.”

McNutt recognizes that on the plus side, the proposed rule calls for aligning clinical quality measures under the meaningful use program with other programs that involve quality reporting, such as the Medicare Physician Quality Reporting System (PQRS) and the shared savings program for accountable care organizations. The ONC is also is proposing that all EHRs use single terminologies for various data elements, including SNOMED for problem lists, RxNorm for medication lists and LOINC for lab data.

“I’m still a little worried,” McNutt said.