The struggle of patient care organizations to attest to Stage 2 of meaningful use has been well documented—the Centers for Medicare & Medicaid Services (CMS) has recently acknowledged that it has received approximately 44,000 hardship exemption applications from eligible providers, many of which are experiencing issues with their certified electronic health record technology (CEHRT).
Undoubtedly, the federal government has set the bar high for the medical community to achieve requirements for using electronic patient health communications in a meaningful way. On July 1, Mount Carmel Health System in Columbus, Ohio vaulted over that bar.
That’s the day that the health system—which consists of Mount Carmel East, Mount Carmel West, Mount Carmel New Albany, Mount Carmel St. Ann’s and Mount Carmel Grove City (part of CHE Trinity Health, one of the largest health systems in the U.S.)— successfully fulfilled the requirements for attestation to Stage 2 (the actual paperwork submission for attestation did not occur until September 2014). At that time, only 30 eligible hospitals in the country had attested to Stage 2; as of early September that number was up to just 143, compared to the 3,800 hospitals that have reached Stage 1 since the meaningful use program began in 2011.
To facilitate better care, Stage 2 requires hospitals to share timely information with doctors and other healthcare professionals when they are transitioning patients following a hospital stay or emergency room visit. When a patient is moved from one care setting to another, it’s essential for physicians and other healthcare professionals treating that patient to have as much health information as possible to provide the best care. This requires extensive coordination within the healthcare community.
“The collaboration between the hospitals and ambulatory sites was the secret of our success,” says Jay Wallin, M.D., chief clinical information officer of Mount Carmel. “This shows us that we are moving to an integrated care delivery model.”
One of the main challenges for the health system, says Wallin, was that the organization was going through not only attestation, but also software development and testing with its inpatient EHR vendor, Cerner, at the same time. “In April, the Cerner software couldn’t submit a single transition of care (TOC) document,” Wallin says. “We didn’t have the software developed on our inpatient EHR side, so we were developing and testing simultaneously. And we didn’t have a huge network to send these TOC summaries out too,” he says.
The Stage 2 requirement states that eligible providers and hospitals have to electronically send a summary of care document for 10 percent of transitions of care. To that end, CliniSync—the health information exchange (HIE) in Ohio—staff helped assist Mount Carmel with the ability to send and receive transitions of care documents with other treating providers. Historically, this kind of health information may not have been sent, and if it were, in many cases would have been faxed or placed in a paper file that would be transported to the doctor on the other end in a much less timely manner. But today, through a national Direct Trust framework, the information is exchanged information electronically through secure, encrypted emails, says Wallin.
“Faxing has been around for 30 or 40 years, but if there was ever an unsecure, unmanaged, free-for-all, it would be faxing,” Wallin says. “If we do this right, and I believe the federal government is doing it the right way, we might replace faxing with Direct. You don’t have to worry about faxing something to the wrong person because of a fat finger. With patient confidentiality becoming so important, this will be a great benefit,” he says.
Another Stage 2 requirement that many healthcare organizations seem to struggle with is patient engagement piece of meaningful use that requires at least 5 percent of a given provider's patients to be engaged in their own care either through an online portal or EHR. At Mount Carmel, however, having multiple entry points to engage the patient was the key to meeting that measure, says Wallin. The surgical hospital in New Albany would engage patients right at the moment of registering for surgery, he says. “We have nurses and other healthcare [administrative] staff talk to patients in the room as well. Our goal was to engage patients at multiple entries. By doing that, they can do things such as view their laboratory data right there in the hospital,” says Wallin.
Overall, Wallin notes, attesting to Stage 2 requires a true team effort, from the physician community to the corporate office to the nurses to the C-suite executives. Regarding the low number of eligible hospitals to attest thus far, Wallin says he isn’t overly concerned, and confident that the number will increase significantly as time goes on. “You have to remember, this isn’t a mom-and-pop type of activity, he says. “It takes a commitment, and you have to sit down with your administrative staff, your nursing staff and your physicians, and then put rigor into it,” he says. “If you’re following it very closely, you will be well apt to deal with problems that arise. That’s important because the attestation process goes by very quickly.”
In Part 1 of the series, St. Anthony’s Medical Center’s CIO explains how the organization was able to overcome two of the toughest Stage 2 requirements