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Stage 2 Meaningful Use Challenges

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Advisory Board’s Robin Raiford shares what the biggest MU stumbling blocks are

I was talking to Robin Raiford, R.N., research director and part of the meaningful use navigator team at The Advisory Board, the other day about some of the biggest challenges of Stage 2 meaningful use. What she mentioned, and what’s not surprising when you look at what eligible providers and hospitals deferred in Stage 1, was that patient engagement, care coordination, and quality measures were some of the main obstacles.  

In a HIMSS12 presentation to its members, The Advisory Board said that organizations needed to look outside their four walls and work on engaging patients and families through secure health messaging, e-prescribing at discharge, and allowing patients to view and download a copy of their health information. The Advisory Board also said organizations and providers need to improve care coordination through a exchanging a summary of care record, reporting population health measures to public health, and report new clinical quality measure data elements that with more continuity of care (CCD) elements than Stage 1.

“We see with the members we deal with, that quality measures are a challenge,” said Raiford. “The whole journey of going to real-time data capture and not abstracting [is difficult], specifically around the quality measures.” Raiford noted that the list the HIT Policy Committee put out before Stage 2 was extensive, with 262 quality measures for eligible professionals. Only 162 were unique, as there were many that crossed over different categories.

“Documenting exclusions and exceptions is a challenge, and you need to capture it in real-time, otherwise your numerator is skewed, and you don’t have all the data,” Raiford said. “And getting [clinicians] in that culture change to capture it, knowing that the eventual goal is to affect outcomes [is challenging]. I think it was Rob Anthony that said, ‘If you don’t have accurate data you can’t affect outcomes.’ If all the sudden you have a skewed numerator and exclusion because you haven’t captured the data, you can’t move forward with that going into outcomes.”

Another challenge organizations face, Raiford said, is aligning multiple EHRs. “If they don’t have a master patient index or a single feed to a medical record number; that will get you. What if you had someone come to the ED, and then go home. And the same person later came to a hospital with another EHR—you count that person once. You have to figure out how you’re going to get that straight.”




Hi Jennifer Prestigiacom:
My name is Jacqueline Townsend, I am a student at Governor State University. I am write a paper on how the new reform act is going to affect nursing homes, and are they able to be a part of meaningful use. Please advice me with any information you can give me.

Hi Jacqueline,
Thanks for your interest in Healthcare Informatics and meaningful use. As for how MU will affect nursing homes, I would like to direct you to our sister publication Long-Term Living Magazine, where you can get more information on how policy affects long-term care facilities.
Thanks for reading,


Skilled nursing facilities are not eligible for incentives under meaningful use. However, skilled nursing facilities are still encouraged to participate to aid in closing the transition of care. Skilled nursing facilities can also offer valuable information toward setting standards and quality measurement criteria.

Kevin Kolus
Long-Term Living

Hi Jennifer:

where can I find information on Analysis of upcoming challenges with meeting Stage II MU and ACO clinical performance measures?

Hi There,
Thanks for your question. There are many resources to find what you're looking for. If you want real, on the ground thoughts on the challenges going on right now, check our CIO networking group on LinkedIn and pose the question there yourself and see what others are saying:

I would also try checking out CSC's thoughts on MU2 and the challenges ahead:

For commentary on Accountable Care, check out what Advisory Board has to say:

And please check our our ACO coverage here:

Hope that Helps,