What can we expect for Stage 2 of Meaningful Use?

Survey data released this month by the Office of the National Coordinator for Health Information Technology (ONC) showed promising figures in terms of adoption of electronic health records during the first stage to achieve meaningful use.

In survey data prepared by the American Hospital Association, 81 percent of hospitals said they plan to achieve meaningful use of EHRs and take advantage of incentive payments. About two-thirds of those hospitals (65 percent) responded that they will enroll during Stage 1 of the incentive programs during 2011-12.

On the physician side, the National Center for Health Statistics of the Centers for Disease Control and Prevention found that 41 percent of office-based physicians currently are planning to achieve meaningful use of certified EHR technology and take advantage of the incentive payments. About four-fifths of these physicians--or about a third of all office-based physicians (32.4 percent)--said they will enroll during Stage 1 of the programs. 

So far, so good, but what can be anticipated when moving on to Stages 2 and 3? Some of these concerns were expressed Jan. 10 at the ONC's Standards Committee Implementation Workgroup, run by Dan Nelson, practice administrator for Desert Ridge Family Physicians in Phoenix.

Nelson's practice has been using a certified EHR for six years now, and "so the jump to meaningful use is going to be rather low for us," Nelson said. But Nelson said he is concerned about the focus on Stage 1 of meaningful use by both EHR vendors and Regional Extension Centers--and not what occurs later during Stages 2 and 3.

He added that in his opinion, the technical bar of Stage 1 "is really quite low." His concern: Too many underqualified EHRs that are getting certified, "which adds a false legitimacy to their products," he told the panel.

For those practices that are evaluating EHRs, "a low price tag, a simplistic system, a certification star and perhaps a money back guarantee may be all the justification needed to make their choice," during stage 1, he said. But, in the long run, if a vendor is unable to meet Stages 2 or 3, "a money back guarantee will be useless to reclaim the lost time and effort for implementation."

If these underqualified systems are widely deployed--representing a significant market presence, the technical requirements of Stages 2 and 3 will need to be lowered if they are to remain attainable, Nelson said.

"In my view, watered down requirements will undermine the goals of the entire program," he said. But he added some potential solutions are now available such as through Regional Extension Centers. These centers could help by steering practices toward qualified EHRs.

"The RECs should represent the best interests of the communities they serve by ensuring that providers are using capable systems," Nelson said. When enough of these systems are in place, the medical community will benefit greatly--through better communications and streamlined access. 

This is something we will all need to consider now--and for the future. - Jan

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