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Meaningful use stage 2 cannot succeed without learning from stage 1

When health care gets started with meaningful use stage 2, the lessons of stage 1 will still apply. That will mean proving ROI, aligning workflows and educating physicians again.

Even before the proposed meaningful use stage 2 criteria came out in February, it was understood that stage 2 would naturally be more difficult for providers and vendors than stage 1. While the first phase sets the stage for the meaningful use of electronic health record (EHR) technology, the second phase ups the ante for health information exchange (HIE), patient engagement and clinical decision support, among other initiatives.

Learn more about meaningful use stage 2

Read the proposed meaningful use stage 2 criteria

National Coordinator Farzad Mostashari's meaningful use stage 2 vision for patient data access

With some providers entering the second year of the meaningful use attestation process, it's worth examining the lessons learned from stage 1 before getting too caught up in stage 2, said Barry Chaiken, M.D., senior fellow and health IT chair, Institute for Health Technology Transformation (iHT2), and CMO of health IT consultancy DocsNetwork Ltd.

Chaiken moderated a panel discussion on meaningful use at the recent iHT2 Health IT Summit in San Francisco. Since so much of meaningful use stage 2 depends on the availability of usable data from EHR systems, panelists ranked data quality among the top health IT challenges facing stage 2 initiatives.

For example, Pravene Nath, M.D., CMIO for Stanford Hospital and Clinics, has two groups devoted to data abstraction tasks. In working in a sequestered environment to produce the data needed for external reporting, he said, "I suspect we're not alone."

Part of the issue, said Dorian Seamster, chief of health information services for the California Health Information Partnership and Services Organizations, or CalHIPSO, stems from EHR systems that make it hard for end users to see that they are entering useful data incorrectly -- a blood pressure of 300/60, say -- or, in the case of hard-to-find problem lists, not at all.

Fixing such issues could be done with a "dumb cleanup" at the spreadsheet level, but that takes time. Better to set parameters within the EHR system, Seamster said; better yet to make sure physicians and nurses know how unstructured, non-standardized data negatively impacts data analytics. Doing so will also help physicians realize that they cannot treat patients in the context of individual visits but, rather, as part of a continuum of care.

The effort that goes into each of those processes, not to mention the difficulty in measuring their outcomes, suggests that the ROI for meaningful use stage 2, as well as the as-yet-unannounced stage 3, will be difficult to determine, Nath said.

Just as CAD was not the ceiling of manufacturing innovation, meaningful use will not be the ceiling for health care.

Farid Agahi, senior business strategist with VMware Inc., compared health care's transition to EHR systems to the manufacturing's transition to computer-aided design, which grew from an evolution away from paper to a revolution that allows tolerances of thousandths of an inch.

Just as CAD was not the "ceiling" of manufacturing innovation, meaningful use will not be the ceiling for health care, Agahi said. "In 20 to 30 years, we will have perspective to see how transformative this vision was."

Vendors must prepare for meaningful use stage 2, too

Vendors, too, should view meaningful use requirements as a floor and not a ceiling, noted Mark Phillips, president and CEO of SLI Global Solutions Inc., one of six authorized testing and certification bodies (ATCBs) for the EHR certification program.

Put another way, there is a wide gap between simply addressing meaningful use and actually getting to the heart of what meaningful use aims to accomplish. For vendors, this means making sure that their EHR systems integrate with clinical workflows.

"If you do that right, you have a fighting chance" of reducing costs, Phillips said. Fail to do that -- or opt instead to integrate with a complex enterprise resource planning (ERP) system -- and you risk adding yourself to the growing list of failed EHR implementations, Phillips added.

Let us know what you think about the story; email Brian Eastwood, Site Editor or contact @SearchHealthIT on Twitter.

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