The industry is eagerly awaiting the release of the proposed rule for Stage 2 meaningful use requirements later this month. Unlike the three months of operational use of capabilities that had to be demonstrated for Stage 1, Stage 2 will require a full year of operation. A recent report from the Falls Church, Va.-based CSC delved into what Stage 1 menu items were deferred and why, as well as the challenges that organizations will face moving forward on Stage 2 requirements.
In Stage 1 meaningful use, organizations were most likely to defer requirements related to patient engagement and coordinating care, says Erica Drazen, Sc.D., managing director in the Waltham, Mass.-based Global Institute for Emerging Healthcare Practices at CSC. “It’s really disappointing for someone looking to the next era to see that all the areas that people are deferring are exactly the things that you’d like them to be moving forward on,” she adds. When asked why organizations planned to defer menu requirements, one-half of those surveyed cited internal operational readiness or process challenges; another 38 percent cited vendor product readiness.
According to the report, 93 percent of the hospitals that attested to Stage 1 for Medicare in 2011 deferred the requirement to electronically transmit summary records at transitions of care. Drazen says a part of the reason for this is because organizations must have access to an electronic transportation method and also have a partner to receive the informationn; and not all organizations have those two pieces in place.
Patient Engagement a Challenge
The report cited patient engagement as another much deferred requirement, with only 32 percent of hospitals that attested to Stage 1 in 2011 meeting the requirement to provide patients with an e-copy of their information, and 41 percent of hospitals providing patients with an e-copy of discharge instructions.
Drazen says it takes a lot of work not only to engage patients, but to create medical records that are designed to be read by patients. “You think that something like providing patients with educational materials would be an easy hit, but it was particularly skipped by hospitals,” she says. “I think that was because it’s really complicated to get the right information that’s at the right educational level for the patient and is also consistent with what you believe is best practice and that changes all the time.” Drazen mentions that even in a patient-centered medical home committee she’s on, her team is struggling to find prepared with educational materials for ambulatory patients that isn’t advertising a product and yet consistent with the doctor’s medical protocols.
Another menu item that organizations deferred was submitting reportable lab results for public health and submitting syndromic surveillance data for public health; only 16 percent of hospitals that attested to Stage 1 in 2011 submitted lab results, while 18 percent of hospitals submitted syndromic surveillance data. Seven percent of hospitals were actually exempt from this requirement because their public health departments were not able to accept electronic public health information. Drazen foresees this challenge to continue in Stage 2. “Yes, I think there will be improvements in Stage 2, but I bet there will still be situations where providers don’t have any place to send the information,” she says.
Medication reconciliation at admission and discharge was another item deferred by many hospitals (75 percent). The challenge, says Drazen, is that providers have to know the medications the patient is on when admitted in order to enter that information in the electronic health record (EHR), or have all of that information transfered electronically from the ambulatory side. “The other problem is ‘where do you get this information?’ Usually, you don’t have it electronically,” says Drazen. She adds that most EHRs didn’t have this med rec capability until recently, and therefore haven’t yet been optimized.
Areas of Focus
“I know there are huge challenges out there just meeting the letter of the law, but I think it’s a tragedy that people don’t have the time to think about how to do this smartly,” says Drazen. “They have to focus on ‘let’s get it done and let’s do what’s easy for us to do’, rather than what we really want to be doing as an organization.”
The report detailed three essential areas where organizations need to start preparing to meet Stage 2:
- Providing patients with access to their health information electronically through patient portals or directly from EHR systems
- Capturing electronic physician notes, including diagnosis and treatment, plus rationale for excluding patients from treatment recommendations
- Exchanging patient information at transitions in care
For more information on these three main areas of focus, listen to this podcast with Erica Drazen.