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Stage 2 meaningful use of EHR: Some key points to note
e-Reports, June 10, 2013
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Here are tips from a Purdue Healthcare Advisors educational session on electronic health records (EHRs) meaningful use changes in Stage 1 and rules for Stage 2. Untitled document

Purdue Healthcare Advisors (PHA), a division of Purdue University, held educational sessions statewide for providers to instruct physicians, practice managers and others on what to focus on as they proceed with meaningful use (MU) compliance.

Session attendee and ISMA member Wylie McGlothlin, M.D., of New Castle Family & Internal Medicine said, “The session was an excellent first look at Stage 2 requirements. I learned we certainly have our work cut out for us. Stage 2 is a major leap from Stage 1.”

PHA said contacting your EHR vendor and getting on a list for a Stage 2 upgrade is imperative. Until then, PHA points hospitals and practices to an online toolkit at www.ismanet.org/go/MU51313. Remember that a security risk assessment must be completed every year of attestation.

“Documenting compliance with MU Stage 1 and Stage 2 is extremely important, and this documentation is what CMS is looking for when they audit providers who are attesting to and receiving incentive monies for their MU progress,” said PHA Field Operations Manager Allison Bryan, MS, CHES. “CMS audits are finding that many providers are falling short on providing appropriate and complete documentation of their security risk assessments.”

Timelines and timeframes
With release of Stage 2 rules, changes to Stage 1 include different attestation time frames for 2013:

  • If you started the process to achieve meaningful use in 2011, you can now do Stage 1 for three years.
  • The big year is 2014 when all users, whether in Stage 1 or 2, will attest for 90 days. After that time, attestation will occur quarterly for Medicare, and those seeking Medicaid incentives will be directed by the state.
  • In 2014, the attestation period will not be a rolling 90 days; you must choose a reporting period in one quarter of the year.
Need help with Stage 1?
Purdue Healthcare Advisors has notified the ISMA that grant-funded assistance is available to help primary care physicians meet the objectives of Stage 1 meaningful use. Services are limited and must be used in 2013.

Contact Caren Crum at
(765) 494-9204 or email her.

MU options for 2013
For Stage 1, you must complete the 15 core objectives, but you can choose five of 10 menu objectives, as well as six of 44 clinical quality measures (CQMs). In Stage 2, you must complete 17 core objectives and choose three of six menu objectives, as well as nine of 64 CQMs.

Dr. McGlothlin noted, “We are currently running Stage 2 reports within our EHR to see what quality measures we are already meeting and which ones may be in easy reach.”

PHA notes some top priorities
Security risk assessment – Last year’s security risk assessment will not count for this year. You must have a security risk assessment documented for each year of attestation – a separate assessment per year.

Patient engagement – Develop a patient engagement strategy; people will participate in a portal if given the option. Ask patients to email you to request lab results or to tell you how they’re doing after a procedure. Portals are now very user friendly.

An EHR user since 1999, Dr. McGlothlin employs a measured approach, “We intend to push ahead with a patient portal solution as soon as possible, realizing we will probably need to start with limited functionality and expand gradually.”

Summary of care – This requirement pertains to patient referrals or transitions. In Stage 2, the summary cannot be a letter. If you don’t do referrals, request an exclusion.

Clinical decision support – This function is no longer a choice; it must always be on. Additionally, you now must select five clinical decision support tools.

Clinical lab tests – Consider working with a lab that can interface with your EHR. Manually entering data is acceptable, but an excessive amount of work.

Dr. McGlothlin explained, “We are pushing ahead to get our local hospital to feed lab results into our EMR as structured data. We see the lab feed as fundamental to meeting Stage 2 requirements.”

Other meaningful use considerations
Demographics – To limit choices, provide a check box, not a write-in form. The use of “declined” is acceptable.

Vital signs – Height and weight can be self-reported. Blood pressure must be recorded one time during the reporting period for patients age three and older.

Smoking status – Eight choices are availableto describe smoking status for patients older than 13. Now cigars and pipes are included.

Medication reconciliation – This core item is required when a patient is new or transitioning from one health care setting or provider to another. You can take the patient’s word; information need not come from another provider.

ePrescribing – Core and menu items are combined in Stage 2; a formulary is required.

Patient lists – This is an easily accomplished core item in Stage 2, even though it is for all ages for 24 months, not just the reporting period.

Patient reminders – Determine the patient’s preference (mail, phone, secure message) and document within the EHR when reminders are sent by mail or phone.

Secure messaging – Regular email is not secure; all patient communication must be encrypted. However, you can provide information via a portal, jump drive or CD. This is required for Stage 2.

“We are all working in different environments with multiple EHRs, so it is hard to generalize about the challenges ahead as they may be different from practice to practice,” Dr. McGlothlin said. “Most of us are going to have to wait until we see the vendor's solutions to meaningful use requirements before we can get too far into the details.”

For a stage 2 toolkit, tipsheet and other resources, visit the Centers for Medicare & Medicaid Services website.

Some points to note
Two Regional Extension Centers (RECs) are available to help you with efforts to earn incentive dollars for using your electronic health records systems (EHRs) in a meaningful way. Purdue Healthcare Advisors serves the majority of Indiana, and the Tri-state Regional Extension Center here serves southeastern Indiana. The nonprofit Health Care Excel also offers EHR consulting services.

Also note that Medicare incentives are now subject to the 2 percent mandatory reductions in federal spending called sequestration, which is required by the Budget Control Act of 2011 – for a reporting period that ended on or after April 1, 2013.

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