Positive reaction to MU Stage 2 aside, hard work and challenges ahead

Attendees at the Healthcare Information and Management Systems Society's annual conference in Las Vegas greeted the announcement today of the proposed rules for Stage 2 Meaningful Use and electronic health record certification with applause. But the actual implementation of these requirements--those that are retained in the final rule, at least--will certainly pose some major challenges to both providers and EHR vendors.

Stage 2 is "hard work, but we can get there, even with ICD-10 and other regulatory requirements," Neal Ganguly, vice president and CIO of CentraState Healthcare System in Freehold, N.J., told FierceHealthIT. CentraState has already attested to Stage 1 Meaningful Use and received its 2011 payment, he noted.

The Stage 2 Meaningful Use rules and EHR certification standards largely reflect the recommendations made last year by the Health IT Policy Committee and the Health IT Standards Committee, National Coordinator for Health IT Farzad Mostashari told the overflow crowd.

One challenge of Stage 2, Ganguly said, is getting more physicians to use computerized physician order entry (CPOE). About 60-70 percent of orders go through CPOE at CentraState today, he noted, but that's mainly because nearly all emergency department orders are placed online. In the hospital, the percentage is about 10 percent, and that's mainly early adopters, he said.

Erica Drazen, managing partner, emerging practices, for CSC Consulting, said that hospitals should pay close attention to the patient engagement aspects of Stage 2 Meaningful Use.

"The bottom line is you've got to start connecting with customers. Patient portals are not going to be optional, and you're going to be responsible not only for having portals but for patients using them." It will take a while to engage patients in portals, she added, so healthcare organizations should start doing so now. It will also be a boost to coordinated and accountable care. 

"In the hospital, the physician documentation is likely to be a challenge. Few organizations have implemented that. The products are available but they haven't been optimized over time."

Physician documentation will also required on the ambulatory side, she pointed out, but outpatient EHRs are more focused on documentation for billing reasons. "They're more developed and tested in ambulatory care."

Drazen also cited transitions-of-care criteria as a potential Stage 2 challenge. "Medication reconciliation and the transmission of information in transitions of care are clearly challenging because not many people did them when they were optional. And they're also pretty essential for accountable care. So that's the third area where people really need to get serious."

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