Health Care IT Industry Digests Stage 2 Guidelines on 'Meaningful Use'

By Brian T. Horowitz  |  Posted 2012-02-29

Health Care IT Industry Digests Stage 2 Guidelines on 'Meaningful Use'

Although new federal guidelines on electronic health record (EHR) use bring few changes for IT vendors, doctors and hospitals will need to take note of some changes regarding encryption, data sharing and electronic entry of care directions.

The Centers for Medicare & Medicaid Services (CMS) released its Notice of Proposed Rule Making (NPRM) for Stage 2 requirements governing meaningful use of EHRs and published the document in the Federal Register.

Under the 2009 Health Information Technology for Economic and Clinical Health (HITECH) Act, eligible health care professionals can qualify for government incentives if they implement "meaningful use" of EHRs.

Health care providers now have an extra year to meet Stage 1 criteria. All EHR applications must be certified under Stage 2 by 2014 for providers to receive incentives from the federal government. Stage 2 rules are now in a comment period for six months.

CMS announced the Stage 2 rules on Feb. 23 at the Healthcare Information and Management Systems Society (HIMSS) conference in Las Vegas.

In Stage 2, CMS has added guidelines regarding secure messaging and encrypting data at rest.

Vendors' current EHR applications can handle these security requirements, said Erica Drazen, managing director for the Global Institute for Emerging Healthcare Practices at health care consulting firm CSC. "Encryption for data at rest was a new requirement under privacy, so that may be something that vendors need to be responding to, but in general it's not going to be such a huge change for the vendor community," Drazen told eWEEK.

Incentive guidelines will need to be structured to encourage providers and IT vendors to share data, according to Dr. Wendy Whittington, chief medical officer of health care IT services vendor Anthelio Healthcare Solutions.

"While the emphasis on health information exchange highlighted in the rules provides hope, an important question remains€”how is this financially sustainable?" Whittington said in a statement. "The document briefly acknowledges that this has been a problem in the past, but it doesn't explain how we're going to overcome the issue and align incentives in a way that makes health care providers and vendors more interested in sharing."

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."

Providers, however, will have to adjust to the new Stage 2 rules.

"Doctors' offices and hospitals have more work to do in Stage 2€”namely 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.


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