In Meaningful Use, Timing is Everything in Meeting Requirements

The Stage 2 rules of CMS' EHR Incentive Program will require providers to use the information they've gathered in Stage 1 to find gaps in care; improvements to care processes will likely come in later stages. In addition, there are substantial requirements around patient engagement in Stage 2.

According to the National Center for Health Statistics, about 13 percent of all office-based physicians reported in January that they both intended to participate in meaningful-use incentives and had EHR systems with the capabilities to support 14 of the 17 Stage 2 core objectives for meaningful use.

Fred Trotter, chief operating officer at Open Source Health Corporation, a digitally integrated healthcare company, said that one problem with meaningful use is that we are now starting to see laggards suffer.

"Practices that are on the ball are really focusing on [the Stage 2 rules] and looking forward to [the Stage 3 rules]," Trotter said, "but many smaller practices and hospitals have taken a 'wait and see' approach, and they've held that position for too long."

However, Trotter said, practices that are late adopters can afford to ask around to see who the real winners are. "They can actually see how vendors performed with their colleagues' practices so it's a huge advantage, but even that takes time to leverage," he said.

Practice size can be a determining factor for who will hold the primary responsibility for the meaningful use rollout said Trotter. "The line in the sand is whether you have enough money to hire a full-time IT person or if you are relying on your practice manager for that role," he said. "The best practice managers can handle this well, but many of them are computer phobic and handle this challenge poorly."

Longer commitment

Physicians who have delayed their commitment to meaningful use could face an uphill climb with difficult time constraints said Robin Raiford, senior director of The Advisory Board's IT Strategy Council. "Stage 2 will require demonstrating attestation for one year, which will be much harder since it is longer than practices have had to do before," Raiford said.

"Practices that are in it for the long term have to know that they are dedicating time, materials, and resources to this," said Mary Griskewicz, senior director of health information systems for the Healthcare Information and Management Systems Society (HIMSS).

Griskewicz said the bigger the practice, the longer implementation will take because physicians and staff need training.

Meanwhile, Raiford said meeting the Stage 2 requirements will be much harder because of patient engagement targets such as allowing patients to electronically view and download a copy of their health information and establishing secure health messaging systems.

"A lot of it is based on how much you [as a patient] trust your physician," she said."And if your physician says [you] really need to get on board and somebody helps you log on and gets you past that fear … [patients] will log on."

Vendor issues

Last fall, one significant obstacle for practices appeared to be the number of EHR vendors who would offer certified products for achieving meaningful use for Stage 2. According to the National Center for Health Statistics, by last summer only 11 EHR products designed for physician offices had completed 2014 certification requirements for Stage 2.

CMS recently added language to its hardship exemption language for meeting meaningful use, allowing eligible professionals and hospitals to apply for exemption in cases of "2014 vendor EHR issues." The move was meant to help those who participated in Stage 1, but may not be equally as able to meet the 2014 EHR certification criteria.

This comes despite recent Office of the National Coordinator for Health IT statistics indicating 70 percent of eligible professionals who attested to meaningful use Stage 1 had a primary vendor offering a 2014 Edition that met ONC’s base EHR definition.

Group practices that have been early EHR adopters such as Reliant Medical Group in Worcester, Mass., have benefitted from partnering with an established vendor, but according to Lawrence Garber, medical director for informatics for Reliant, he chose to ignore its vendor's suggestion to stagger the EHR rollout over a six-week period.

"There's no way I was going to make my colleagues do that, which is go from paper to paperless in five [weeks] or six weeks, because there's a whole bunch of issues besides learning the skills of how to use the system, and there's a change in how you have to think as you go from the paper to the electronic world," Garber said.