Meaningful Use Stage 2 | Hospital EMR and EHR

Hospitals, Health Systems Don’t Feel Prepared For Meaningful Use Stage 2

A new survey by KPMG confirms what most us would have guessed — that hospital and health system leaders aren’t that sure they’re ready to meet Meaningful Use Stage 2 requirements.

The study, which was conducted last month, found that 47 percent of hospital and health system business leaders surveyed were only somewhat confident in their readiness to meet Stage 2 requirements. Just over one-third (36 percent) said they were confident, and four percent weren’t confident at all, KPMG found. Another 11 percent said they didn’t know what their level of readiness was.

Respondents are also worried about meeting privacy and security standards included in both Stage 2 and HIPAA. Forty-seven percent of respondents were only somewhat comfortable with their organization’s ability to meet all parts of HIPAA, including the need for new annual risk assessments and protecting patient-identifiable information. Eight percent of respondents said they weren’t comfortable at all, 13 percent said they weren’t sure and 31 percent said they were comfortable, KPMG reported.

To help close the readiness gap, hospitals and health systems are bringing in outside help. Thirty percent of respondents said their organization had hired new or additional team members to help complete EMR deployment. And 22 percent said they’d hired outside contractors to get the job done.

So why are so many healthcare business leaders insecure about Stage 2? When asked to name the biggest challenge in complying with Stage 2 requirements, 29 percent cited training and change management issues.

Tied for second were lack of monitoring processes to ensure sustained demonstration of MU, and capturing relevant data as part of the clinical workflow, at 19 percent each. Twelve percent named lack of a dedicated Meaningful Use team, and 6 percent availability of appropriate certified vendor technology. Fourteen percent said “other.”

What HIMSS Told Congress

This week, a House subcommittee held a hearing entitled “Is ‘Meaningful Use’ Delivering Meaningful Results?: An Examination of Health Information Technology Standards and Interoperability.” The hearing follows a recent furor over Meaningful Use’s benefits, in which HHS head Kathleen Sebelius was written a stinging letter by a quartet of Congressman arguing that the program might not be pulling its weight.

Lots of interesting discussion took place at the hearing — see a report from the indefatigable HIT blogger and expert Brian Ahier for more background — but for the purposes of this item, I’m focusing on what HIMSS had to say.

HIMSS, which obviously has a massive stake in the topic discussed, is a big Meaningful Use fan. The trade group argues that “Meaningful Use and the Stage 2 regulations allow the healthcare community to continue the necessary steps to ensure health information technology will support the transformation of healthcare delivery in the United States.”

Not surprisingly, HIMSS showed up in full color at the hearing, ready to defend MU and the progress of health IT generally. HIMSS offered Congress seven recommendations as to how to keep the MU train moving, Ahier reports. Here’s my favorites:

Direct the administration to initiate an appropriate study of a nationwide patient data matching strategy with a report back to Congress.

Support harmonization of federal and state privacy laws and regulations to encourage the exchange of health information across health systems, payers, and vendor systems.

Continue to support and sponsor pilot programs addressing the collection, analysis and management of clinical data for quality reporting purposes to assist providers and provider organizations make informed decisions for public health, patient care and business purposes.

Preclude any additional delay in the nationwide implementation of ICD-10, International Classification of Diseases beyond the current October 1, 2014 deadline.

Other than the ICD-10 recommendation, which will probably be battled down to the last millisecond by some groups, I’m betting most readers would consider these to be reasonable steps. But I could be wrong. And I don’t see a lot here on the nitty-gritty of interoperability, which was the focus of the Congressmen’s ire in the first place. Folks, what would you add to/subtract from this list?

Meaningful Use Stage 3 Draft On The Way

Well, it looks like we’ve got a new set of MU regulations afoot. Though we don’t even have a final version of Meaningful Use Stage 2 regs in place yet, HHS apparently plans to issue Meaningful Use Stage 3 draft regulations sometime in August.

According to HealthcareInformatics, ONC plans to make sure Stage 2 and Stage 3 square by September or October of this year. (Why it would make sense to issue Stage 3 now, before Stage 2 has even been field tested, is a question clearly for wiser heads than my own. To me it just doesn’t make sense…)

The magazine reports that the core of Meaningful Use Stage 3 recommendations is likely to be as follows. It says providers and hospitals will be asked to have an EMR in place which:

Tracks individual care goals;
Records care team members, their roles, and their contact information across care settings;
Tracks tasks/steps and responsible party;
Feeds population health management;
Facilitates reconciliation of medications, problem lists, goals, and plan of care; and
Allows for input and viewing by all care team members, the patient and their caregivers.

And it says that potential measures would be:

A platform for collaborative care exists and is being used for at least 20 percent of patients.
Receiving care team members in a care transition access information for at least 10 percent of patients having an active collaborative care plan.

To me, the idea of having two other sets of MU standards swimming around out there when people are still struggling with Stage 1 is not a smart move. But hey, given all the delays in getting standards out there, maybe we should just be glad that they’re getting done!

AHA Slams MU Patient Portal Requirement, Pundits Slam AHA

As readers know, CMS is now reviewing comments on the proposed rules for Stage 2 Meaningful Use. Not surprisingly, one of the reviewers who’s sent in a critique is the American Hospital Association (AHA), which a few days ago sent a 68-page barrage complaining about the burden imposed on hospitals by on Stage 1 MU requirements.

Yesterday, the AHA made another MU move, this time slamming CMS’s Stage 2 proposal that hospitals be required to offer patients access their protected health information via a portal. As I noted in the previous post on AHA, I’m surprised at how late to the game AHA is — trade groups like these aren’t known for their delicacy — and this notion has been in the air since well before CMS made it an official proposal.

Anyway, in its current letter to CMS on portals, the AHA has given them a big thumbs-down. “CMS’s plan is not supported by current technology, raises significant security issues, and goes beyond current technical capacity,” the group argues in its issue brief.

The AHA argues that with systems integration levels still dicey, hospitals are being asked to offer data in a way that may end up violating HIPAA. (Unspoken additional thought: “And then you’re going to blame us, aren’t ya, huh, you meanies!”)

Since AHA issued the statement, talking heads have popped up to bash the AHA’s position, arguing that the hospital group is dragging its feet just as the most important part of the work has begun, i.e. empowering patients to share, use and benefit from their own health information.

Well, yes and no. While I’m known for ridiculing the trade group talking heads in this business, I’d wait just a minute before we declare the AHA to be the bad guys here.

On the one hand, I can see where people are frustrated with hospitals picking this moment to complain about the task at hand. It’s not as though they’re hearing about it for the first time.

On the other hand, creating a really bulletproof portal is no joke, either, and there’s definitely some truth in the notion that making it everything it should be is very tough. Hey, there’s no point in denying it; creating a patient portal may remain a part of MU Stage 2 requirements, but it’s not going to be a walk in the garden for hospitals. Let’s not come down on them too hard if they flinch.

Hospitals with EMRs, HIEs Serious About Cloud Possibilities

For a few years, the notion of cloud-based data sharing has been a least a bit controversial, with questions of security, control, throughput and the like slowing down adoption. But it seems like those days may be coming to an end. A new survey by Harris Interactive for the Optum Institute found that more than half of CIO respondents plan to do some cloud investing.

According to the researchers, almost 60 percent of CIOs with both an HIE and EMR in place plan to invest in “cloud-based open systems.” More specifically:

* 36 percent plan to use the cloud for both their EMR and HIE
* 12 percent plan to go cloud for their HIE only
* 11 percent plan to implement only cloud-based EMR technology

According to FierceHealthIT, top reasons for going cloud include access to additional apps, at 57 percent, and access to additional functionality, at 56 percent.

While it’s hard to tell whether the group selected by Harris is particularly savvy, it was interesting to hear that 71 percent of respondents participate in an HIE, and that almost two-thirds actually own the exchanges in question. (OK, I take that back; HIE ownership does seem to me to suggest extra sophistication.) On the other hand, according to the research firm, the HIEs in question are somewhat limited.

All told, these are interesting findings, though not incredibly surprising given that CIOs have to find a way to get interoperable under Meaningful Use Stage 2. My question is whether the cloud implementations (especially security) will differ so much that they defeat the purpose. Let’s hope we don’t end up with another layer of opacity.

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Hospitals, Health Systems Don’t Feel Prepared For Meaningful Use Stage 2

What HIMSS Told Congress

Meaningful Use Stage 3 Draft On The Way

AHA Slams MU Patient Portal Requirement, Pundits Slam AHA

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