Advisory Board on MU: Much ground covered, more to be gained

In 2014, most incentive-eligible hospitals and professionals (EHs and EPs) were pushed into ramping up for Meaningful Use stage 2 by financial factors—specifically, the promise of attractive bonuses and the peril of subtractive adjustments. There’s little naiveté around that EHR dynamic. Still, along the way, individuals in healthcare found themselves buying in to the program’s underlying principles to a degree they hadn’t when they started with Stage 1.

That’s one of the observations offered by a Meaningful Use expert who both studies the compliance numbers and works with the people behind them.

“As we’ve gotten into the implementation and use of health IT in direct patient care, we’ve seen that the founding aims of Meaningful Use—reducing error, coordinating care and making it safer, cutting wasteful spending—really resonate with people,” says Bethany Jones, a healthcare IT consultant with the Washington-based Advisory Board Company. The positive response makes sense, she points out, since so many chose a career in healthcare out of a desire to make a difference.

“When we look at the challenges in implementation details, people may find the program hard at times, but then they tend to think back to the basics,” Jones, a registered nurse, adds. There’s a lot to be thankful for given what Meaningful Use has brought about in such a short period of time, she says.

If Jones comes across as equal parts consultant and coach, that’s because her enthusiasm over the potential of Meaningful Use to transform U.S. healthcare is genuine—and because of the personal satisfaction she clearly derives from helping EH and EP teams not only meet but exceed their Meaningful Use goals.

The numbers speak

The most recent figures from CMS and ONC, presented by the federal Health IT Policy Committee in a January web conference, show that, as of New Year’s Day, just under 65% of 4,993 eligible hospitals scheduled to be in stage 2 in 2014 had attested to Stage 2 by the 2014 attestation deadline.

That impressive 65%, representing 1,814 hospitals, does not take into account hospitals that attested via the flexible reporting options allowed by CMS in 2014. (Flexible reporting allows providers who were plagued by certified EHR technology product-availability issues to revert to meeting or maintaining stage 1 goals.)

The stage 2 numbers aren’t so rosy for eligible professionals, as only 7% have attested for 2014. But that figure does not include the EPs who decided to go with flexible reporting, either. And it may rise substantially by the later deadline—Feb. 28—allowed for the EP cohort.

Jones, for one, likes what she sees in all of those numbers. “Even if the big picture isn’t quite clear yet, because not everything is in yet, it’s still very positive to see 65% of the hospitals [up to speed with stage 2],” she says. “And I expect a lot of the eligible professionals will be utilizing flexible reporting”—which would indicate good Meaningful Use adoption, albeit at a slower pace than some had hoped for.

Pick up, dust off …

When people stumble while trying to implement Meaningful Use stage 2, both EHs and EPs, the tripwires often emanate from two tough-to-reach goals, Jones says. One is the patient electronic access point, also known as VDT for View, Download and Transmit. The other is providing electronic summary of care records for transitions of care.

“Those are objectives that are generally more resource intense,” says Jones, adding to the list the eMAR objective, which calls for hospitals to roll out electronic medication administration records. “Some of our smaller locations may struggle more with such large undertakings, especially if they did not have that functionality in place or they have switched vendors.”

Eligible professionals sometimes find secure messaging not as easy as advertised, she says. And it can be hard for many to figure out which menu objectives to report, especially since changes were made around which of those can and can’t be included. “We get a lot of questions about that,” says Jones.

“Basically we see challenges around stage 2 objectives and measures that combine both technology and process [points], which all of these do,” she summarizes.  

Jones says her company often gets a call when providers get caught up in their day-to-day work in patient care and start to lose heart.

“It can be tough to get all of the pieces together in a short period of time,” she says. “But as we see in the numbers, and as we see by their progress, they consistently step up to the challenge and pull through.”

Count on clinicians  

Jones says the most effective strategies for rising above Meaningful Use challenges begin with a mindset—one that doesn’t accept failure as an option, but, instead, seeks to not only meet goals and objectives, but also surpass them.

“One good strategy is to engage clinicians to boost performance in patient engagement objectives,” she says, citing as an example secure direct messaging. “We’ve seen teams become very successful by involving clinicians in patient engagement and patient experience, helping clinicians to plan out [their approaches].”

“Make a plan, track your performance and work to surpass the Meaningful Use thresholds,” Jones says. “Meaningful Use is a program that builds upon itself. It’s a foundation. When you can, overachieve on the objectives. And look at the menu objectives and what possibilities you may have to meet additional objectives in order to help position yourself for future success.”

Frequently overlooked is the key area of internal communications around Meaningful Use. “How do you frame it at your practice, at your hospital?” Jones asks. “Are you creating internal incentives or friendly competitions between your clinicians? Are you making it a positive message? And are you getting people involved across the organization?”

And don’t forget the patients who interact with you via technology, as their feedback is a vital driver of continuous improvement. Never lose sight of the fact that Meaningful Use is all about the patient experience and about quality patient care, Jones reminds. “Patients notice. They’re aware of all of these changes going on. So that’s a big piece that we want to make sure people continue to remember. Meaningful Use is more than just a regulation.”

End game: empowered patients

To explicitly measure return on investment in certified EHR technologies (CEHRT), organizations must take a broad view and look ahead.

“It’s complex, determining that return, but looking at all the areas your certified EHR technology touches is important,” Jones notes. “Make sure you’re making good decisions on technology that will evolve with you in your stages of Meaningful Use, [enabling users to] move forward with all the additional capabilities that come with integrating mobile health technologies. The EMRs of the future are going to look significantly different than they look today.”

Indeed, says Jones, the best and brightest Meaningful Use adopters are those who see it as a bridge to where U.S. healthcare is headed with patient-centric care—from population health management to care coordination to patient experience to consumerism in healthcare.

And that’s just for starters. After all, EHRs produce big data. And when it comes to improving patient care, Jones suggests, big data can be not just valuable, but priceless. 

To get there, teamwork counts, concludes Jones. “However your Meaningful Use leadership team is structured—whether it’s led by the CIO or a program manager or a nurse or a Meaningful Use director—the key is that the team effectively engages the rest of the organization,” she advises. “That’s the piece that is sometimes most challenging but also the most beneficial. You have to have buy-in, and you have to always know what’s happening on the front lines.”