Stage 2 MU Remains Challenging, Yet Attainable

Clinical Quality Measures Still a Challenge
The specific requirements for clinical quality measures were not a part of the final rule for Stage 2; they have been disconnected from the meaningful use stages and will be published in October. “Clinical quality measures are no longer a core requirement, and that makes it a whole lot harder to sort out,” says Metzger. “And there are different rules and timelines for future Stage 1 attesters. So people who’ve already figured out Stage 1 and are still working toward it have to do a reality check. I think this makes it really hard for vendors.”

Velasco agrees that the requirements for the electronic recording of quality measures are not to be underestimated, and “hospitals and vendors need to look seriously at the pilot underway on electronic reporting.”

“The one thing that they didn’t do in Stage 1 that I hope they’ll address is capturing data on deferred items, such as laboratory data,” Velasco adds. “We could only report on minimum numbers; so CMS didn’t get any data on how far providers had actually gotten. Really, they should collect the data on all menu items; and they didn’t. It’s simple, really.”

Metzger contends there’s a whole lot of new complexity around denominators for some of the measures. “They’re options; there’s no longer just one way to comply with many of the measures,” she says. “And again, that’s confusing for the providers, but it’s very, very tough for the vendors, because regardless, they have to support those options.”

Raiford says that even though capturing all the clinical quality measures is still challenging, it was encouraging to see CMS ease up on the number of quality measures to report from 24 to 16. “The thing that has been really buried and not really talked about is there is a great relief in terms of quality measures,” says Raiford.

She says this requirement will signal vendors what they need to build and hospitals what they need to chart, which will make quality measures overall less burdensome. “In the hospital side particularly, there’s something called negation rationale of why didn’t you give a medicine or why didn’t you do an order, and they’re actually going to make a subset of which elements have to be made in the EHR, and which elements have to be charted against, which would be way less burden than there is right now.”

Further Recommendations for HIT Leadership     
Velasco says CIOs need to continue to move the ball forward in terms of achieving Stage 2, even though CMS added an extra year to achieve Stage 1. “They need to be very familiar with the legislation, and not just rely on the excellent analyses there because there are a lot of nuances involved; this is what we experienced in Stage 1,” he adds.

“A pro-active thing that you can do now without your 2014 edition certified software is start looking at those five measures that you deferred to Stage 2 and put those in your plan to do them in your next year,” says Raiford. “You’ll be ahead of game, so when you do have to do summary of care at 50 percent, you’re not struggling to get to that number.”

Raiford also recommends not pushing back software upgrades to anywhere close to July 1, 2014. She advocates getting upgrades earlier if available to get a buffer in case organizations need to redo their reporting periods in July.

“Though there was some relief in timing, there’s still an awful lot to do over a very short period of time,” concludes Metzger. “And with all these retroactive changes to Stage 1, it’s much more complex, not only for the providers, but especially for the vendors.”