The “proposed rule” of meaningful use – stage 2 raised a lot of eyebrows. The daunting 455 page proposal perplexed healthcare professionals across the nation. This set the stage for an extensive feedback session as many reputable practitioners and large hospital networks joined forces to voice their concerns. Apart from the EMR interoperability requirements, providers felt that some objectives were not entirely within their control and had to be reconsidered. These included objectives such as ensuring that a significant portion of patients utilize web portals to interact with the practice and physicians felt that this did not take a lot of variable factors into consideration. American Hospital Association believes that requiring patients to electronically view, transmit and share health information is not feasible and may raise significant security concerns. AHA also suggests that discharge information should be made available within 30 days instead of 36 hours and the reporting period should be toned down to 90 days instead of 12 months.
A health IT expert commented that most requirements did resonate with the medical community. However, the approach itself may be incorrect, “We understand the importance of care quality, which is why we develop the tools for it. But it is not like we can flip a switch and be done with it. The process needs to be incremental and the objectives need to be realistic.” He added, “The government needs to consider the impact on physicians hoping to qualify this year and those who have already attested and completed the process.”
EMR adoption continues to improve over time and according to the numbers released by CMS almost 62000 providers have attested and received their incentives since May 2011. Industry experts and vendors believe that the meaningful use penalties will help improve EMR adoption rates. “We can already witness the change as more and more providers look to avoid eRx penalties. Nobody wants to lose money.”, says an EMR analyst.
The stage 2 is set to commence in 2014 for providers who have successfully demonstrated their meaningful use stage 1 objectives in 2011. The proposed rule increases the number of core objectives from 15 to 17. The proposed core objectives build on the basic functionality requirement, making it considerably more challenging in comparison to the previous objectives. The optional or menu objectives requirements are reduced from 5 out of 10 to 3 out of 5, while it may seem to provide respite, these menu objectives are not only different, but much more complex than their predecessors. In addition to the functionality requirements, stage 2 will also require physicians to report on 12 clinical measures. The physician will have the choice to choose between 3 reporting options, including PQRI measures as one of the three.
The stage 2 basically builds on the requirements set in stage 1. While the stage 1 required providers to simply demonstrate their ability to exchange health information, stage 2 will require them to do it. Similarly the computerized physician order entry requirements have been increased significantly ensuring that the majority of orders by the provider will be electronic. Physicians are also required to encourage their patients to utilize the functionality of electronic health records by using web portals. More importantly, the stage 2 emphasizes on reporting in an effort to improve and measure clinical quality.
While it is unclear as to what this rule be, CMS has made their intentions obvious of expanding upon on the stage 1 requirements while the medical community awaits nervously.