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Why Stage 1 Meaningful Use success may mean Stage 2 failure

By Kyle Murphy, PhD

Stage 2 Meaningful Use does not just represent a continuation of measures introduced by Stage 1. Also, it brings with it new challenges for eligible hospitals (EHs) and professionals (EPs) to overcome in order to ensure the next set of EHR incentive payments find their way to the healthcare organizations and providers participating in meaningful use.

According to Impact Advisors, a healthcare advisory services firm, success in Stage 1 Meaningful Use will not necessarily translate to continued success in future stages of the EHR Incentive Programs, beginning with Stage 2.

“While Stage 1 was challenging, it wasn’t particularly challenging for many, many organizations,” says the firm’s Principal Advisor Laura Kreofsky. “In some ways, it did a disservice to or put us at a disadvantage for Stage 2 because many organizations did not anticipate how challenging Stage 2 would be and as a result put it on the back burner with all of the other priorities and challenges.”

Case in point, take a look at the number of EHs and EPs taking advantage of the ability to defer certain measures in Stage 1 that are key to Stage 2 Meaningful Use.

“The biggest challenges in Stage 2 are transitions of care, patient engagement, and quality reporting,” explains  Jason Fortin, Senior Advisor at the firm. “If you look at the measures in Stage 1, there were some optional measures that folks could defer and almost all of them — there was something like 90 percent of hospitals and maybe 85 percent of EPs deferred the measure for transitions of care — didn’t do it. In Stage 2, it’s ten times harder.”

A successful demonstration of meaningful use in the first phase of the EHR Incentive Programs, therefore, means very little to predicting whether a hospital, practice, or provider will come out on the positive side of things in Stage 2 Meaningful Use.

Making the challenge of this next phase more difficult is the level of coordination and commitment needed from a number of different stakeholders, which now includes patients themselves.  “These are new. These are hard. One of the things that’s really different about Stage 2 and the transitions of care and patient engagement components in particular are the number of interdependencies,” adds Kreofsky.

In the case of transitions of care, these interdependencies take the form of bringing together resources and expertise from many departments in a healthcare organization, from the care and laboratory teams to legal and marketing departments.

Stage 2 Meaningful Use requirements for patient complexity add further complexity to the mix. No longer are EHs and EPs setting up health IT systems strictly for providers. For this portion of meaningful use, patients must also be properly educated about the technology and how to use it appropriately.

“For the patient engagement one, there’s a huge process component,” observes Fortin. “There are process changes and issues that need to be accounted for. It’s not just a matter of propping up a portal. That won’t be enough.”

Those eligible providers looking to satisfy this requirement for patient requirement should look to establishing outreach programs, Fortin recommends.

“You have to be able to identify patients who could benefit from it or might use it regularly,” he reveals. “Who’s responsible for that? When does that occur in a visit to make the patient aware that the portal’s there to provide them with the login information or maybe follow up if there’s no activity.”

As it stands, a successful attestation in Stage 2 Meaningful Use is going to come down to both care and organizational cooperation. “You’re not managing a contained set of challenges. You’re managing one set of challenges with many tentacles,” argues Kreofsky.

This next phase of the EHR Incentive Programs is a different kind of animal. As a result, healthcare organizations and providers need to plan accordingly.

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