Special HIT report: Meaningful Use stage 2

February 22, 2013
by Nancy Ryerson, Staff Writer
In 2014, hospital CIOs and physicians will need to join in on the health IT revolution if they want to meet meaningful use stage 2 initiatives. While meaningful use stage 1 focused largely on setting up or upgrading electronic health records, stage 2 requires facilities to show that those implemented systems are actually being utilized properly. Originally slated for enforcement in 2013, the federal government released the final rules for stage 2 meaningful use on Sept. 4, 2012, announcing that the rules will not go into effect until 2014. Starting in 2015, providers will face the threat of Medicare payment penalties if they are not meeting the requirements.

The meaningful use program was begun to encourage information technology updates in a field often seen as being behind the times. The introduction of stage 1 was met with some success — in 2011, 39 percent of eligible hospitals were awarded a total of $1.7 billion in Medicaid EHR incentives for meaningful use, according to a Government Accountability Office report. Thirty-three percent of eligible medical professionals received incentives. While those numbers show utilization requirements being met from less than half of eligible groups, that’s still an improvement in health IT implementation in just a few years — in 2009, 78 percent of office-based physicians and 91 percent of hospitals had not adopted EHRs at all.

Stage 2 brings benefits, especially for patients, but initiatives like requiring patients to view their records online has many providers worried. So whether a facility sailed or struggled through stage 1, they’re still unlikely to have an easy time of dealing with stage 2, health IT experts say.

The second stage of meaningful use: apprehension
Many facilities feel some apprehension about stage 2 requirements, according to a recent poll from the auditing firm KPMG. Forty-seven percent of hospital and health system business leaders said they were somewhat confident in their level of readiness to meet stage 2 requirements. Thirty-six percent said they were confident, while 4 percent said they were not at all confident. Eleven percent of those surveyed said they didn’t know what their level of readiness was – not a promising response.

Based on the survey, it seems that most hospitals are more worried about staff training than technology. Only 6 percent cited vendor availability of appropriate certified technology as their top concern, while 29 percent selected training and change management. Twelve percent said they were concerned about their lack of a dedicated MU team.

In terms of training, most hospital CIOs admit that though it can be difficult to rope busy physicians into the conversation, it’s an important part of the process.

“Taking physicians away from patient care is a challenge,” says Troy May, CIO at the University of Louisiana Medical Center. “Having them sit on a weekly or monthly committee is a challenge. But it’s a mistake not to do that.”

Staff, or lack thereof, can also present problems for smaller facilities.

“While some of the meaningful use goals are really great, it’s also added a ton of burden, particularly on small groups who only have a few specialists in office,” says Lauren Fifield, senior health policy advisor for the EHR vendor Practice Fusion.

CIOs recommend engaging the entire staff, rather than just IT specialists. Even medical students can help a hospital transition into being more tech savvy.

“Stage 1 went really well for us because being a teaching hospital, we have a lot of residents and med students who come to you with an eagerness to use technology and computer systems,” says May. “They actually expected a lot more out of what stage 1 was doing.”

The patient engagement challenge
Several CIOs and consultants voiced concern over the requirement that more than 5 percent of all patients discharged from a facility view, download or transmit to a third party their health information. Stage 1 only required doctors to provide patients with an electronic copy of their health information.

“I think one of the biggest challenges will be around the patient portal,” says Dr. Lyle Berkowitz, medical director of IT & Innovation, Northwestern Memorial Physicians Group. “Fortunately, we have spent a lot of time and energy building this up in our group and have well over 50 percent of our patients online and using the portal regularly, but it takes years to do this, and most organizations will not have that much time.”

CIOs and health IT teams are working to build online patient portals that offer enough value to entice patients. That means creating something user-friendly and communicating to patients how to use the portal once they’re home at their computers.

“One method to getting patients involved is upon discharge, that providers actually take their patients and show them the patient portal, and show them how to log on, so they have someone in real time to assist them,” says Tammy Flick, lead health IT adviser at Telligen, a health IT consulting firm. “I think that could potentially be a good approach, because having someone there to help you log on if you’re not computer savvy can really help.”

While challenging, CIOs agree that the patient portal can help improve patient care and experience. For example, the patient-accessible EHRs are required to include medication lists.

“I know a problem with a lot of elderly people is that people don’t know the names of the medicine they’re on,” says May. “You have to make patients and families understand that they’re going to improve patient safety and care by being involved [with the electronic records].”

Prior planning is a plus
As with most projects, the best advice is to start early, health IT experts say. That means creating a plan of attack and keeping in close contact with vendors.

“A lot of facilities will have to implement a new module, such as one for medication reconciliation,” says Flick. “Plan ahead with the vendor and get [the plan] into a schedule so you’re not in a time crunch.”

If you don’t keep your vendors and IT staff notified of your needs, efforts might result in a difficult-to-use system rather than a user-friendly product, Berkowitz says.

“What is needed is ‘human-centered design,’ which is a more dynamic interaction where the IT team will observe users to understand how they do their job much more intimately, and then work with them very iteratively to design the best solution,” he says.

And once stage 2 initiatives have been met, CIOs at hospitals successful with IT say not to stop there. Besides continuing to enjoy the benefits of a robust health IT program, those who continue growing EHR use can get a head start on future initiatives.

“My only criticism of meaningful use is that I think it’s a fast pace in a year to meet so many initiatives, but I think it’s a needed pace,” says May. “I think four years from now, anybody that does not have a full blown EMR [system] can’t compete in health care. I really do believe that it’s a benefit for patient safety and patient care. It’s definitely needed.”