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.”