Providers pursuing meaningful use Stage 2 incentives offered by the Centers for Medicare & Medicaid Services for adoption of certified EHR technology need to be aware of key developments in order to qualify for full payment under the program. And as they study Stage 2, they will notice a number of tighter requirements and higher threshold percentages.[See also: EHR adoption rises at solo and two-physician practices]
Dan Prevost of Arcadia Solutions, a healthcare consulting firm that advises clients on technology developments, noted that payment "requires a certain level of documentation, and you need a report to monitor that development and show what that documentation is."
Prevost outlined five challenging developments providers need to keep in focus as they move into Stage 2.
1. Structured lab results. A lab interface "makes the labor involved in managing lab results notably less," said Prevost. "Look out for a lab interface when trying to achieve Stage 2." Whereas normal lab results come back as a fax or PDF, implementing an interface means that the report feeds back in to the provider's EHR as structured data. Lab tests are a critical element of patient documentation, which itself is a major factor in attesting to Stage 2 as well as efficiently filing claims and receiving reimbursement. To attest to Stage 2, providers will need to increase their use of structured data in lab results to 55 percent.[See also: EHR-using physicians affirm the power of exchanging health information]
2. Patient access to health information. "I've talked to patients, and it's become an expectation that they can go in and review their most recent lab results," said Prevost. "That is something that is really useful to them." In order to attest to Stage 2, providers must provide an electronic portal for health information to their patients. Five percent of their patients must have accessed the portal, raising concerns with doctors who say they have no control of patient behavior outside of the office, or who have elderly or low-income patients who may not have access to the Internet. Additionally, Prevost noted that there are "information control issues" around patient access to their health information. "As a child or an adolescent grows up, at what point should their parent no longer have access to their portal?"
3. Ongoing submission to registries. While registries were addressed in Stage 1, fully implementing a health information exchange connection is addressed in Stage 2. Prevost said that not all providers have the tools built in to their EHR software to submit documents to registries, and that many states do not even have the required registries in place. "There's a notable discrepancy between requirements and what's available in technology," Prevost continued, pointing out that "there are a lot of requirements for Stage 2 that are a lot more demanding for vendors. As the market moves forward, we think a lot of the smaller EHR vendors are not going to be keep up with all of the changes required with Stage 2."
4. Computerized provider order entry (CPOE). A critical part of a full-flight EHR, CPOE fell under some rules during Stage 1, and those requirements have grown more demanding. In Stage 2, healthcare providers are now required to have 60 percent of their prescriptions go through CPOE, in addition to 30 percent of their labs and diagnostic images. "It's important to have an interface for not only lab results but diagnostic images," explained Prevost. CPOE, when implemented properly, can increase efficiency and reduce mistakes. Prevost noted that "this will reduce the labor-intensive stuff."5. Summary of care referrals. When a doctor refers a patient to a specialist or another doctor, he or she must send along notes describing the patient's condition and what the specialist is needed to do. Although one or both providers may use an EHR, most systems are not linked well enough to facilitate easy transfer of data. As a result, care referrals often still take on printed form. If a summary of care "shows up on a piece of paper, then someone has to sit down and enter all these things manually, and it could be transmitted in a structured way electronically," said Prevost. Stage 2 begins to streamline the process for transmitting these documents electronically; the rules currently require that 10 percent of a practice's summaries be transmitted in an electronic fashion.
[See also: Stage 3 MU policy draft wraps around decision support]