The following is a guest blog post by Todd Stansfield from The Breakaway Group (A Xerox Company). Check out all of the blog posts in the Breakaway Thinking series.
Take a breather, implies the government’s latest rule for meeting meaningful use requirements of the EHR Incentive Program. Perhaps that’s not the best plan of action.
On the brink of Labor Day weekend, the Centers for Medicare and Medicaid Services (CMS) finalized the rule for Stage 2 and Stage 3 Meaningful Use, a move designed to make it possible for more healthcare providers to attest this year and beyond. The rule pushes Stage 3 to 2017 and allows providers to meet Stage 2 requirements this year using 2011 certified electronic health record technology, among other things.
While the rule alleviates the challenges of attesting to meaningful use in 2014, it doesn’t solve the more significant problems of the 2015 reporting year, which begins Oct. 1, 2014. That date marks the beginning of the 365-day period over which providers will have to attest to Stage 2 requirements using 2014 certified technology—four times as long as the 90-day span the CMS just relaxed for the 2014 reporting year. Among critics of the ruling is the College of Health Information Management Executives, as the added burden of a full reporting year means “‘industry struggles will continue well beyond 2014,’” according to a Forbes article.
Recent news has sparked hope amid the panic for many healthcare providers. Two weeks after CMS finalized its ruling, Congresswoman Renee Ellmers (R-NC) and Congressman Jim Matheson (D-UT) introduced the Flexibility in Health IT (Flex-IT) Reporting Act, which aims to shorten the Stage 2 reporting window for 2015 from 365 to just 90 days—the same timeframe CMS granted in 2014 after providers struggled to attest. While the move would certainly ease the burden on providers, the Flex-IT Act still awaits Congressional approval before being passed into law.
So far this year, only 5.8 percent of eligible providers attested to Stage 2, according to a Health Affairs article. It’s a markedly low percentage, suggesting that if Congress turned down the Flex-IT Act few providers would be ready and able to attest in 2015.
Providers who are working toward attestation this year and planning for 2015 could learn from those who have been through the process such as Cottage Hospital and Odessa Hospital. Engaged leadership was key to these two critical access hospitals’ (CAHs’) ability to cement proper focus and commitment across their organizations to attest to Stage 2, according to EHRIntelligence and Healthcare Informatics. Both CAHs prove that attesting, however difficult, is certainly possible, and their unique strategies offer a clear path for the approximately 3000 providers eligible to attest.
At Cottage, “full support from the top for Meaningful Use” and “an all-hands-on-deck-effort” reportedly consisted of weekly meetings held by project managers and key personnel focused on discussing progress and barriers to success.
In addition to leadership support, both hospitals also reportedly transferred ownership of the initiative from the IT department to staff involved in care delivery. At Cottage, the IT team set up the infrastructure to support the EHR and then handed it over to clinical informaticists who understood the workflow of clinical staff. Clinical informaticists identified areas where the application could not support established workflows. Any discoveries were then reported to the vendor, who adapted the application to how care was being delivered, reversing the usual and inefficient route of providers adapting their processes to EHR functionality. At Odessa, ownership transferred from a software vendor acting as Odessa’s IT department to their clinical team. While both Cottage and Odessa are fortunate to have vendors capable of meeting the 2014 certification criteria—a rarity among the 58.9 percent of eligible healthcare providers still yet to attest—both organizations are partly responsible for that success. They worked with their vendors to bring the EHR systems up to par with the requirements. This type of collaboration is crucial to establish certification-capable systems and will likely become a trend as more is asked of providers.
Both CAHs were also able to meet some of the most stringent requirements of Stage 2—which includes having 5 percent of patients view, download, and transmit their health information electronically. Cottage and Odessa found this particular requirement especially difficult, yet both were able to overcome it by educating patients, according to a Healthcare IT News article. Cottage reportedly “took down their [patients’] email addresses as they prepared for discharge and . . . [walked] them through the process of logging on and viewing their data.” This highlights that for a requirement solely within patients’ control, providers must take a more proactive approach to get their participation.
For providers to attest in 2015 no matter the reporting requirements, they will have to leverage strong leadership, clinical involvement, vendor collaboration, and strategies that focus on integrating patients in the overall care process. Cottage and Odessa prove these strategies are critical to meeting Stage 2 requirements. Their success has been validated by our research at The Breakaway Group, A Xerox Company, which shows that organizations with strong change leadership, effective education, ways to measure performance, and a means to sustain the effort are the best equipped to optimize their EHR use, and in the case of Stage 2, attest to the new requirements.
Stage 2 represents more than quantifiable criteria, but the start of using EHR systems in ways that can improve care and patient health. For our healthcare industry to ever realize buzz words like “interoperability” and “care continuum,” and for healthcare providers to breathe easier, this is a move we have to make.
Xerox is a sponsor of the Breakaway Thinking series of blog posts.