Providers Must Pay Close Attention
While Stage 2 didn't have many changes for IT vendors to adopt, health care providers will need to pay close attention to the changes, according to health care industry experts. "For vendors, it's not as big a deal," said CSC's Drazen. "There are very few new requirements, and one of the things that CMS did was to eliminate some of the complexity about the things that have been proposed by the policy committee, so it's easier to implement and easier to register.""Doctors' offices and hospitals have more work to do in Stage 2namely more data to capture, more of their electronic health record software to utilize," Shahid Shah, CEO of IT consulting firm Netspective Communications and author of the Healthcare IT Guy blog, wrote in an email to eWEEK. One notable change is the requirement that doctors keep a stricter account of computerized provider order entry (CPOE) and whether or not they used an EHR platform to submit treatment orders, said Drazen. (CPOE is a doctor's electronically entered instructions for patient care.) "Instead of counting patients who have CPOE orders, now they have to be able to record all the orders and know how many of them were entered by a CPOE," she said. Previously, providers were required only to report on orders per patient rather than accounting for all orders. In addition, providers must report 60 percent of medication orders, up from 30 percent in Stage 1. Vendors will need to adapt their EHR applications when CMS issues its final rule on meaningful use this summer because that update will incorporate changes in quality-of-care measures, said Drazen. Providers must report quality-of-care measures electronically in Stage 2, she said. They will need to submit 12 quality measures, and hospitals will need to report 24. Measures include patient safety, care coordination, population and public health, efficient use of resources and clinical effectiveness. "Fewer measures were required in Stage 1, and they didn't have to be reported electronically to CMS," said Drazen. "You had to gather the information and have it reported out from a system and then transcribe that into a reporting system for CMS. Now all of those measures are going to be directly reported from the EHR." Meanwhile, the Stage 1 and Stage 2 meaningful-use guidelines address only incentives for manually entering data and not data from monitoring devices, Netspective's Shah noted. "Unfortunately, all the existing meaningful-use incentives promote the wrong kinds of collection: unreliable, slow, and error prone," he said. "That's because meaningful use Stage 1 and 2 force health professionals, patients and other human users to enter data manually, one value at a time, instead of getting the data from machines connected to our bodies." Shah suggested that the data reported will be "suspect" until Stage 3, when medical devices and lab systems will be factored into meaningful-use reporting. Still, hospitals are well on their way to meeting meaningful-use criteria, according to a recent report by HIMSS Analytics, which, as of September 2011, expected 41 percent of the 778 hospitals surveyed to meet Stage 1 of meaningful use--an increase from 25 percent in February 2011.
Providers, however, will have to adjust to the new Stage 2 rules.