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American Medical News. But in stage 2, physicians and other EPs will have to meet these objectives to obtain government incentive payments.
Physicians had to attest that they could meet at least 5 of the 10 menu objectives in stage 1. In stage 2, which begins in 2014, all but one of the menu items will become mandatory, some with higher thresholds than in stage 1. So physicians will no longer be able defer items that they skipped in the first phase of the program.
According to the data from the Centers for Medicare and Medicaid Services (CMS) presented at a recent HIMSS meeting, and cited by American Medical News, the most commonly deferred optional items in stage 1 were providing clinical summaries at transitions of care (84%), sending preventive care reminders to patients (80%), transmitting disease surveillance data to public health agencies (68%), giving patients timely electronic access to medical records (66%) and doing electronic medication reconciliation (55%).
[ For more on Meaningful Use, see Meaningful Use Stage 2 Rules Finalized. ]
Chris Giancola, a principal consultant at CSC, told InformationWeek Healthcare that EPs will face two big barriers in stage 2: They'll have to exchange information online with other providers at transitions of care, and they'll have to ensure that 5% of patients view or download their medical records or transmit them to a third party.
"The patient engagement piece may be the toughest challenge," Giancola said. The technological barrier, he noted, is that in most cases, a patient portal will be required to enable patients to view/download/transmit their medical records. Many EPs don't have such portals, either because their EHR vendor doesn't have one or because it's too expensive.
"If the vendor doesn't make a patient portal available or makes it cost prohibitive, the hospital or EP is in trouble" in stage 2, he noted.
The requirement that 5% of patients view/download/transmit their records is also problematic, he noted, because providers can't control what patients do. In the end, more than 5% of patients will probably access their records, perhaps out of curiosity or because they want to learn more about their conditions. "But the fact that there's no lever [to move patients] makes hospitals and EPs nervous," he said.
Many providers deferred the sharing of clinical information at transitions of care in stage 1, Giancola said, because they lacked operational readiness, didn't know how to gather the right information at the right time and/or didn't have cooperative vendors that enabled them to exchange data with trading partners. Also, he said, some providers are more interested in sharing information within their own enterprises than in exchanging it with other providers.
The stage 2 criteria emphasize interoperability more than the stage 1 requirements do, but perhaps not enough to achieve a breakthrough, Giancola said. The original stage 2 proposal would have required providers to exchange data with other entities that had disparate EHRs. In the final rule, he pointed out, providers still have to exchange data electronically in 10% of care transitions, "but it can be within your own four walls."
While a test with a disparate EHR is also required, he added, it only has to be a single test, with an external trading partner or a yet-to-be announced reference implementation offered by CMS.
Giancola expressed hope that public health agencies might improve interoperability by adopting "a single transmission protocol or messaging specification" to allow providers with disparate EHRs to send them immunization records and disease surveillance data.
He doesn't see much of a problem in EPs getting lab orders and results incorporated into their EHRs to meet another stage 2 requirement. "The labs want to comply for market reasons. A doc who has to meet a requirement and who can't get the required information from their lab or choice is going to find a different lab to use."