SIIM: Is MU Stage 2 a win for radiology?

ORLANDO, Fla.—Since its launch more than two years ago, meaningful use (MU) has been plagued by myths. One of the more pervasive, detrimental and long-standing myths is that radiology practices cannot fulfill the criteria, said Arun Krishnaraj, MD, MPH, of Massachusetts General Hospital (MGH) in Boston, during a June 7 session at the annual meeting of the Society for Imaging Informatics in Medicine. However, practices can and have met MU. What’s more, Stage 2 could prove additionally meaningful for radiology, according to Keith J. Dreyer, DO, PhD, vice chair of informatics at MGH.

As of December 2011, 178 of the nearly 30,000 radiology professionals in the U.S. had attested for meaningful use Stage 1. A survey conducted by KLAS and RSNA during that time period revealed one potential reason for the lukewarm uptake—a large MU knowledge gap among radiologists.

Secrets to success
The MU tide may be turning as the radiology and informatics communities become more informed and early adopters share their experiences. At the Center for Diagnostic Imaging (CDI) in Minneapolis, 36 of 57 MU-monitored radiologists had attested by May.

The center was one of the country’s first radiology practices to jump on the MU bandwagon. “[When we started the process] there were few experts in meaningful use and even the Centers for Medicare & Medicaid Services couldn’t provide guidance,” said Sheryl Streich of CDI, adding that the information gap has “narrowed.”

Streich provides a few pointers to aid her colleagues. “Collect the data that best fit the practice.” At CDI, these included demographics, smoking status, medication allergy list, computerized physician order entry and clinical summaries. She also recommended that practices designate MU police to monitor compliance and build in ample time and staff to complete the certification process.

Dreyer shared a 10-step formula to steer practices through the MU maze.

1. Understand the MU eligible provider program.
2. Understand the organization’s plan for MU.
3. Gain institutional acceptance for participation by radiology.
4. Identify and understand the certified EHR eligible provider technology to be utilized for compliance.
5. Determine MU measures that are available and required in the practice.
6. Create MU policies.
7. Create a comprehensive set of MU compliance documents.
8. Review MU compliance documents with institutional stakeholders.
9. Review MU compliance documents with departmental stakeholders.
10. Implement strategy and monitor dashboards early for MU measure compliance.

Stage 2: On the horizon
With the proposed Stage 2 final rule expected in the fall, it appears that lobbying efforts on the behalf of radiology and other specialties may pay off. Although the final die has not yet been cast, there are a number of positives in the proposed rule.

The American College of Radiology vigorously lobbied for the removal of the requirement for a complete EHR. The proposed rule specifies base, rather than complete, EHR requirements. Another plus that gives a nod to the role of imaging across the enterprise is that the base EHR technology must include the ability to electronically download images. Stage 2 also may include a requirement for electronic ordering of lab and imaging studies.

Dreyer also noted that image data access may be included as a menu set objective in Stage 2. And a final important possibility for radiology practices is that CMS may allow a hardship exemption that would apply to physicians, such as radiologists, who don’t control technology.

Not quite a cakewalk
Despite the enthusiasm for MU (or MU dollars) among the panelists, they agreed that MU has instigated a fair share of challenges. For example, CDI is questioning the need to re-certify its technology for Stage 2. (The answer, at this point, is unknown.)

And operational changes are never easy. Streich said obtaining blood pressure measurements and convincing radiologists to use e-prescribing have been difficult. At MGH, Dreyer said physicians initially found it difficult to keep patient problem lists populated and provide electronic access to patients. Imaging informatics, however, played a starring role in developing solutions to both problems. On the former, the department mapped indications for exams to ICD-9 codes, which creates the problem list. The radiology department also registers patients for the MGH Patient Gateway, which helps eligible providers meet the MU measure for electronic access.