Sizing Up Meaningful Use Stage 2 Requirements

Ed Rabinowitz

The 2014 timeline for implementation of the stage 2 requirements may be a bit aggressive for physicians who haven't quite got stage 1 down just yet.

Like any well-structured, multi-part plan, the arrival of meaningful use stage 2 is aimed at building on the foundation that was achieved by its predecessor. As such, meaningful use 2 has, at its core, an emphasis on improving communication among providers and between providers and their patients, thus enhancing quality of care.

But for the many physicians who are still grappling with the requirements presented in the first of the three stages in the $27 billion incentive plan from CMS, it’s just one more set of challenges in an already demanding work schedule.

As a member of the policy committee that approved the stage 2 requirements during the review process, Marc Probst, chief information officer for Intermountain Healthcare, believes it may be too difficult for some physicians to reach the requirements.

“I’m in the camp that meaningful use stage 1 has piled a tremendous amount of requirements on particular people who hadn’t begun the process of electronic medical records prior to this whole meaningful use process,” Probst says. “The requirements were just very high in meaningful use stage 1, and I wasn’t real keen on increasing those requirements.”

Probst points out that his vote against forwarding the stage 2 requirements on to the Office of the National Coordinator didn’t mean that he thought poorly of the new requirements. On the contrary, he felt they were very thoughtful. He simply believed the requirements were a little too much, too soon.

“If I had my vote, I would have said meaningful use stage 2 would just be a continuation in time of meaningful use stage 1,” Probst explains. “So that, you know, all the parties could reasonably get there and do it in a productive and safe way.”

Probst says that meaningful use lays out some very specific goals medical facilities have to accomplish in order to capitalize on incentive payments — lots of goals, for that matter, ranging from network infrastructure to collecting certain types of data. And the timeline of 2014 for implementation of the stage 2 requirements may be a bit aggressive.

“I think [the 2014 timeline] is realistic for people who have achieved meaningful use stage 1,” Probst says. “But I think it’s going to be very hard for those who have not — who are still trying to get their arms around stage 1.”

One of the big differences between the two stages is the requirement that in stage 2 more than 10% of patients must be able to either view online, download or transmit their health information to a third party. No such requirement existed for stage 1. And while achieving that 10% level will be challenging for many physicians, Probst doesn’t see it as the second stage’s biggest challenge.

Probst’s biggest concern is the dependence on digital information systems. Although, he believes in the value of electronic medical records, he doesn’t know if all physicians will be able to do it right all of the time.

“I find it difficult to understand how clinicians — you know, a two- or one-physician practice that puts in an EMR — can put in all the infrastructure required to make sure that system is available all the time,” Probst says. “That it doesn’t crash; that they don’t go a week without a system because they don’t have a CIO or 1,000 people there working on information systems to assure the availability of those systems.”

Probst also points to the clinical notes aspects of meaningful use stage 2 as one of the biggest challenges physicians will face.

“It’s not all discreet data,” he says. “A lot of people use text or images and those kinds of things to keep their clinical notes. Seems to me that’s going to be a bit of a bar. Not unachievable, but I think one of the harder requirements to meet.”

For physicians and medical practices tackling the requirements surrounding meaningful use stage 2, Probst suggests sticking with the suggested best practices offered by their chosen information system vendor.

“Try not to modify those systems and those workflows,” he says. “It’s just the easiest way to make sure you don’t introduce problems into your system and the supportability of that system.”

He also stresses the importance of being closely aligned, at least technically aligned, with a large provider organization.

“If you’re looking to meet the interoperability requirements that meaningful use 2 is asking for, you need to at least by technically aligned with a provider organization that is going to help you achieve that goal,” Probst says. “A lot of the (information) exchange requirements are between hospitals and clinicians, so I think that’s a pretty important component.”

Read more:

Examining Meaningful Use Stage 2 Requirements: Part 1 (podcast)

Thoughtful, but too soon?Big challenges aheadMaking it work

Examining Meaningful Use Stage 2 Requirements: Part 2 (podcast)