Ian's Insights: Differences in Stage 1 and Stage 2 of Meaningful Use
The staged approach to certified EHR adoption is really a change management process on a massive national scale. All of healthcare is being nudged along the roadmap to a new level of coordinated patient care in a series of stages so we won't have the huge task of implementing everything that needs to be done all at once.
And, because we are all human and tend to resist change, the government has provided us with a series of positive and negative reinforcements. The positive incentive is the money you'll receive if you implement and demonstrate Meaningful Use by attestation, showing that you and your staff have met the basic threshold of entering data and use the information in a limited fashion for Stage 1.
And when it comes to your EHR software, you have a two year window to research the EHR that suits your practice, acquire it, install it, get trained, and use it at your convenience. You can start reporting for Meaningful Use the 1st day of any quarter, and for at least 90 consecutive days in the first year. In the second year you will be reporting in the full calendar year.
The same is true for EHR companies, no matter which healthcare discipline. The industry has to design and develop software that follows a rigorous set of specifications issued by the HHS Office of the National Coordinator for Health Information Technology (now known by the acronym HIT). This set of standards must be built into every certified EHR to assure that irrespective of whether a doctor is a Generalist or a Specialist, Eye Care Practitioner, or any other health care provider, certain common functionalities exist in order to transfer patient health care information securely, effectively, and efficiently. Each certified EHR has to go through a detailed testing process to demonstrate that their system meets the standards that you require in order to attest for the stage of Meaningful Use that you are planning on accomplishing. Please also be aware that every EHR must recertify every couple of years in order to prove that the EHR is keeping up with the times. So systems that have 2011 certification will expire and must be recertified for 2014, or you won't be eligible to attest to either Stage 1 or 2 in 2014.
Stage 1 focuses on EHR implementation, data capture, and small steps in information sharing. Meaning, you have to install an EHR and demonstrate some basic use of your EHR system like entering data for certain basic items, most of which you probably document already whether you are still using paper or a non-certified EHR in order to receive payment for Stage 1. And you have to demonstrate that you and your staff are using the EHR meaningfully.
All doctors, including Optometrists and Ophthalmologists must meet the requirements of 15 core objectives, 5/10 menu objectives, and 6 clinical quality measures (3 core and 3 additional). The reporting period for attestation is a consecutive 90-day period for the first year and a full year subsequently. Some doctors started this journey as early as 2011 and 2012 and are therefore ready to move to Stage 2. If you haven't started on Stage 1 it's not too late. You can still start Stage 1 next year in 2014, but don't procrastinate any longer as this is the last year that the government incentive will be available for Stage 1.
2014 certification is a quantum leap up in requirements for EHR companies, so it is essential to have the discussion with whichever EHR vendor you are using, or plan on using, to find out if and when they plan on certifying for 2014 certification (more on this later in the blog series).
What's Different About Stage 2?
To begin with, you can't start Stage 2 until you have successfully completed Stage 1, nor can you do them simultaneously. It's the same as it is in Optometry or Medical school; you don't get to participate in clinic until you demonstrate a minimum level of proficiency. Stage 2 is built upon the foundation of your learning in Stage 1.
Stage 2 begins on January 1, 2014, and concentrates on advanced clinical processes. What does that mean to an eyecare practitioner? Well, it means increased use of E-Prescribing, incorporating lab results, and electronic transmission of patient care summaries across different healthcare settings such as eyecare and other health disciplines like primary care. What's different is that with a 2014 Certified EHR you can send reports and referrals electronically which can be imported directly in to the receiving doctor's EHR, even if the EHR is built for another specialty. Each 2014 Certified EHR uses the same codes (ICD-9, and next year, ICD-10).
The EHRs are all operating on the same standards for codes which literally translate into the words we use when we write a report or referral letter. These coded reports are created in the EHR and attached to a secure web-based email (like Gmail) and emailed directly to the doctor with whom you wish to communicate. This email is received in the inbox for the doctor to read, and this information contained in the report can directly be imported into their EHR. These reports contain the information which we have in common and considered necessary for any healthcare provider in order to have an as close as possible and up to date patient history.
As you might imagine the contents of these reports are the usual suspects: Problem List, Active Medication, Active Allergies, Procedures, Lab Work, and special procedures such as OCT, Fundus Photography, and Visual Fields, etc.
The next blog in this series will demystify terminology like core objectives, menu objectives, and clinical quality measures.
Want to learn more about getting started with Stage 1 of Meaningful Use? Check out our eBook for more info!