Even before the rules for Stage 1 of meaningful use were finalized, health IT policymakers were already turning their attention to Stage 2 to determine which criteria would best enhance patient engagement, care coordination, and public health initiatives. As with the first stage, the question is how specific they will be in terms of requirements and timelines.
When the Centers for Medicare and Medicaid Services (CMS) unveiled the meaningful use Stage 1 final rule on July 13, health system CIOs breathed a collective sigh of relief that the agency had scaled back some requirements and deferred others. And many expressed an eagerness to pore over the 864-page document explaining the final rule, then roll up their sleeves and get to work.
CMS is giving providers the benefit of the doubt,” says Daniel Barchi, CIO of eight-hospital Carilion Clinic health system in Roanoke, Va. “If they have invested in infrastructure, this will give them time to continue working on clinical pathways and processes so that what might have seemed unachievable is now achievable.”
While CMS did not offer many specifics on Stage 2 in its Stage 1 final document, the agency did make clear that it will expect more robust use of health information exchange (HIE) and that all the optional objectives will become mandatory.
But if there is one thing CIOs, analysts, and policymakers seem to agree on, it is that people shouldn't focus too narrowly on Stage 1. Instead, they should keep their eye on where they need to be in 2015.
The meaningful use incentives were created to help offset costs and to be a guidepost, so it would be a mistake to look too narrowly at Stage 1 incentives without a broader sense of the overall vision, says Paul Tang, M.D., vice president and chief medical information officer with the Palo Alto Medical Foundation in California. “It is better if you are not chasing rules or incentives,” he adds. “Those may help you along the path, but a more long-term, strategic approach with a vision of improving outcomes for patients is best.”
Indeed, some analysts say too narrow a focus could be detrimental. “Health reform is going to intervene with its own set of requirements, so it will pay dividends to take a bigger picture view of where you need to be in 2015,” says Erica Drazen, managing director of CSC's Waltham, Mass.-based Emerging Practices Group. She also believes it is a mistake to wait for Stage 2 to do electronic medicine administration with bar coding. “It will definitely be there in Stage 2,” she says, “so you might as well plan now and implement it if you can.”
While it is difficult to speculate about what will be in Stages 2 and 3 specifically, Mitch Morris, M.D., a principal in Deloitte Consulting's Life Sciences and Health Care practice in New York, says you don't have to look much further than what CMS is doing with accountable care organizations, alternative payment mechanisms, and pay for performance to see that it has implications for CIOs, because EHRs are central to those efforts.
Morris, former CIO at the University of Texas MD Anderson Cancer Center in Houston, suggests that CIOs have a visual picture of health reform and meaningful use in overlapping circles. “Have a plan that addresses both generally and fine-tune it as you move forward,” he says. “Ask yourself what type of technology you need to meet the broad elements.”
Stage 2 will also see a ramp-up in the expectations regarding clinical quality measures derived from electronic health records (EHRs) rather than claims data.
Janet Corrigan, president and CEO of the National Quality Forum (NQF), Washington, D.C., says her nonprofit performance improvement organization is working on recommendations to present in September to the federal advisory committees of quality measures that can feasibly be accomplished for 2013.
YOU MIGHT THINK THAT JUST GETTING PHYSICIANS ON ANY EHR SYSTEM IS OK, BUT IF YOU HAVE SIX DIFFERENT SYSTEMS BEING USED BY PHYSICIANS IN YOUR ORGANIZATION, YOU'LL PROBABLY HAVE TO ADOPT A SEVENTH JUST TO DO CARE COORDINATION.-ERICA DRAZEN