HIMSS: MU Stage 2—Ready or not?
NEW ORLEANS—Meaningful use (MU) Stage 2 is in the headlights, cautioned Robin Raiford, RN, research director at The Advisory Board Company in Washington, D.C., March 3 at the Healthcare Information and Management Systems Society (HIMSS) annual conference. Raiford opened the session by chastising those griping about MU: "This is about patients. Practicing medicine without an EHR is like functioning without a brain."
Nevertheless, Raiford acknowledged the many challenges of MU. Although Stage 2 incorporates some flexibility absent in Stage 1, it maintains the tenets of Stage 1 with a much higher level of effort required to achieve them.
In 2013, for instance, providers can attest using the 2011 or 2014 edition of MU. Hardship exemptions are considered on a case-by-case basis, but are limited to providers in locations with an insufficient internet connection, providers opening a new hospital and providers affected by natural disaster. Everyday challenges, such as a software upgrade or changing an EHR vendor, do not qualify.
Mandatory Medicare payment adjustments will start in 2015.
Other key changes in 2014 include the switch from the mandatory electronic copy of the health information to a requirement to view, download and transmit the information and new computerized physician order entry entry (CPOE) requirements. Specifically, CPOE thresholds increase from 30 to 60 percent for medication and expand to 30 percent for laboratory and radiology.
Other elements, including medication reconciliation and summary of care records, have moved from menu to core objectives. Raiford also offered simple advice for participants unsure of which menu measures to select. “Go for the measures that will affect the most patients.”
Other uncertainties around Stage 2 center on vendors. Some components, said Raiford, will be standard. “All vendors are going to have to have data portability, provide summaries of care, support migration of data across EHRs and build foundation for true semantic interoperability.” The ideal approach to assessing vendor readiness, she said, is not asking the vendor if it is ready for Stage 2. Instead, ask specific questions, such as, “Have you complete message validation?”
Another readiness task prior to Stage 2, Raiford said, is to calculate the exact amount of incentive payments and payment adjustments.
Raiford also offered a few words of caution for providers in common tricky situations. Some providers have jumped the gun and started attesting prematurely. Those who start before 2014, and then skip one year are subject to penalties. “The clock is ticking. Skipping one year might put you right into payment adjustments.”
Others may realize they need to change EHR vendors. Raiford advised this group to map out the logistics of switching between Stage 1 and 2 and Stage 2 and 3, and consider the pros and cons of each scenario.
Although Raiford urged providers to focus on patients and emphasized the difficulty of meeting MU, she concluded with physician-centric advice. “Maintain workflow sustainability.” Now, she said, is the time to ask vendors to fix some of the odd workflows that were jammed into the initial software versions in the rush to certify.