ON THE HORIZON…
2011
NOVEMBER 30
Last day for eligible
hospitals and critical
access hospitals to register
and attest to receive an
incentive payment for
federal fiscal year 2011
LATE FALL
Proposed rule expected:
meaningful use stage 2
2012
JANUARY
Permanent certification
program scheduled to open
FEBRUARY 29
Last day for EPs to register
and attest to receive an
incentive payment for
calendar year 2011
SUMMER
Final rule expected: stage 2
Stage 2 EHR standards
and certification criteria
required
2013
JANUARY
Stage 2 program scheduled
to begin; delay possible
ing measure requirements in a way that
translated into process and system modifications, says Erica Drazen, managing
partner at consulting firm CSC’s Global
Institute for Emerging Healthcare Practices. The list of frequently asked questions on the CMS Web site had grown to
120 by this summer.
Rahman answers his share of frequently
asked questions, also. His clients commonly ask, “Exactly what do I need to tell
my physicians to do?” he says.
Vendors, too, have been working to understand the details and adapt their systems to the program’s requirements.
Even EHR products certified for use in
stage 1 may not have all the kinks worked
out, Rahman says. For example, one of his
clients struggled in meeting the requirement to electronically exchange health
information with other entities. In speaking with the system vendor, Rahman says,
“it turned out there was some health information exchange-related infrastructure issues, and [the EHR] wasn’t reading
the data properly.” The problem took the
vendor and provider weeks to solve.
Reporting has been another early problem. NorthShore has employed reporting
tools outside the EHR for its own data
gathering; however, in the meaningful
use program, attesters must report directly from their EHRs.
That is a challenge, Smith notes, because the systems “are not really reporting tools to begin with.” Quality reporting
requirements are difficult to meet because many certified EHR systems cannot adequately capture the quality data
needed.
The certification criteria only called
for EHRs to calculate and report quality
measures, not capture the information,
Drazen says. To fix this issue, CMS clarified that providers only have to calculate
and report on data that are in their EHR.
It is a short-term fix that decreases an
EHR’s usability for quality measures.
CPOE Issues
The stage 1 requirements related to CPOE
call for providers to use CPOE for medication orders with more than 30 percent
of patients. Meeting the measure has
been tough for providers who started
from scratch, Drazen says.
“Putting [CPOE] in is not the challenge,
but putting it in in a way that optimizes
the probability that people are going to
use it is challenging,” she says.
At Wellmont, CPOE was already in
place, but meeting the stage 1 measure
was still tricky. First, physicians had to be
reminded to use the functionality rather
than fax prescription orders.
“I had to teach the providers that faxing
was not e-prescribing—faxing is paper,”
Sunderman says. “From their point of
view it was the same thing. It was getting
them to click a different button.”
More CPOE challenges are ahead for
providers who are focused solely on
meeting the stage 1 criteria. Some provid-
ers are working on near-term solutions,
setting up systems that manage medica-
tion orders. However, as the meaningful
use stages advance, the program will add
more complex CPOE measures, requir-
ing these providers to again modify their
systems.
In addition to enabling medication or-
ders, providers should be enabling CPOE
to manage lab and imaging orders, Dra-
zen advises. “You don’t want three dif-
ferent processes for how the doc has to
order stuff. Indeed, stage 2 [draft criteria
do] require labs and radiology/imaging
orders.”
Providers should not focus on meet-
ing specific measures, Drazen says, but
instead implement systems that help
them achieve long-term goals. Rather
than ask, “How can I get 30 percent of my
CPOE orders to meet stage 1?” she says
they should say, “We are going to move to
computerized ordering because it is safer
and better.”
Though CMS did not require detailed
data reporting in the first year of stage 1—
summaries are accepted instead—it will
require more data in the future. Providers
should practice recording this detailed
data now so they can provide it in upcom-
ing phases of the program, Smith says.
Reproducing Records Proves
Difficult
Two of the hardest requirements for both
hospitals and physicians are centered on
providing patients with copies of their
medical information. One difficult measure to meet is providing electronic cop-
