HITPC: Workflow, ecosystem maturity are biggest challenges for MU Stage 2 HIE requirements

Ecosystem maturity and workflow changes represent the two main challenges for vendors and providers as they implement two Meaningful Use (MU) Stage 2 requirements related to health information exchange: transition of care (ToC) and view, download and transmit (VDT) requirements.

These and other insights were shared by Micky Tripathi, PhD, president and CEO of the Massachusetts eHealth Collaborative and chair of the Information Exchange Workgroup, at the Health IT Policy Committee on April 8. He participated in two listening sessions to gather feedback on early experiences with ToC and VDT MU Stage 2 requirements.

“We’re in the early attestation period so we are looking for early insights to inform the policy committee and to identify red flag issues,” Tripathi said.

Ecosystem maturity and workflow were identified as early challenges, as the healthcare ecosystem is still in the beginning stages of building coordination and trust around the exchange of data. Workflow changes to accommodate information exchange require significant retraining, and in some instances, the development of entirely new workflows for providers, he said.

Technology did not come through as a major issue in meeting the ToC and VDT requirements, but Tripathi said participants in the listening sessions already were testing and had achieved EHR certification for 2014.

In other comments, he said providers reported struggles with finding sufficient trading partners to meet the 10 percent electronic requirement for exchange. Providers are working “above and beyond the call of duty” by reaching out aggressively to referral partners to educate them on how to exchange data, he said. Some providers are even purchasing Direct endpoints for their non-MU eligible trading partners to help meet the measure.

Rural providers also are experiencing difficulties because their only trading partners in the community are non-MU eligible providers.

Health Information Services Provider (HISP)-to-HISP interoperability often came up in the conversations. Many providers referenced participation in DirectTrust or establishing one-off contracts as their approach to enabling exchange across disparate HISPs. A lack of common widely deployed provider directory standards or common directory infrastructure made it difficult to find addressing information on providers participating in disparate HISPs, he said.

“If trust is not established between two HISPs, a patient is not able to transmit their information to the desired endpoint. This is a concern many providers and vendors have and they anticipate it will be a challenge for patients looking to transmit their data,” he said, adding that no real-world examples of solutions to this issue were shared during the listening sessions.

Also, the discussions brought to light confusion over what counts as a valid ToC for measurement. “This doesn’t speak to technology or infrastructure, but it’s a challenge that prevents us from moving forward with the Meaningful Use requirement,” Tripathi said. Common questions that arose included: How do I know if a provider received a message?; How do I know that the content of the message meets all the requirements?; and Does a referral within my health system count towards the denominator?

Providers are implementing entirely new workflows—sometimes over the course of six months—to ensure ToC aligns with other program requirements, such as patient-centered medical homes or accountable care. The main concerns revolved around training for providers on how to educate and engage patients and developing a workflow for receiving patient transmitted health data.

View and download “seemed to be relatively well understood and implemented by providers and vendors,” he said. The transmit requirement posed the biggest challenge for both vendors and providers. “It’s not a show stopper. There isn’t a whole lot of demand for that right now because providers can meet the requirement through view or download.”

The providers said that use of the c-CDA as a single content standard has helped drive standardization and eased implementation of VDT, Tripathi said.