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Meaningful use stage 2 delay helps most stakeholders but hurts some

Providers and vendors see the meaningful use stage 2 delay as a godsend for developing, certifying and implementing EHR systems. But will the extra time hinder HIE sustainability?

Speculation throughout 2011 that federal policymakers would delay stage 2 of the Electronic Health Records Incentive Program ended in a pair of formal announcements by officials, who said providers would have an extra year to prepare for the next onslaught of meaningful use criteria. Providers and software developers welcomed the respite, but some wonder whether a delay would make the industry lose the IT momentum it's built up in the last two years.

The Centers for Medicare and Medicaid Services (CMS) emailed stakeholders in early December about the coming proposed extension to meaningful use stage 2 compliance deadlines for eligible providers and hospitals who signed up early for EHR incentives on the Medicare side. Providers who have already attested to stage 1 will now have until 2014 to begin the second stage, instead of trying to meet new criteria in 2013.

The agency shed light on an earlier announcement released by the U.S. Department of Health and Human Services and said the extension -- which it will likely include with draft meaningful use stage 2 criteria in a Notice of Proposed Rulemaking due in February -- not only would give providers some breathing room for getting certified EHR systems hardwired into their care workflows, but would also add some time to software vendors' development and certification schedules.

"By delaying stage 2 by one year, vendors will be able to rewrite software, customers will be able to implement it, and real use will occur by Oct. 1, 2013," wrote John Halamka, M.D., Beth Israel Deaconess Medical Center CIO and vice chair of the ONC's Health IT Standards Committee, in an email to SearchHealthIT.com. "It will still be tight, but doable."

On top of that vendor development, there's implementing, upgrading and training, all of which would be difficult for doctors to accomplish without the delay, said Steven Waldren, M.D., director of the American Academy of Family Physicians' Center for Health IT. "The timing has always been an issue with meaningful use."

Vendors stretched thin in road to meaningful use stage 2

EHR vendors could use some time for field staff to get their applications implemented at provider offices, said Eric Zerneke, vice president of sales and marketing for Arcadia Solutions LLC. His firm, a health IT consultancy whose customers include state health information exchanges (HIEs), sees firsthand how some vendors are struggling to keep up.

The extension "wasn't unexpected," Zerneke said, because providers and hospitals are having a difficult time meeting stage 1 criteria and keeping up with the deadlines for achieving EHR incentives. Installing the EHR software itself isn't the most difficult part for eligible providers and hospitals. Instead, it's getting frontline staff and those supporting them to interact with the software to achieve meaningful use compliance without draining productivity.

"Our customer base reflects what you see in the market. They don't have large IT staffs that are knowledgeable and experienced in not only just…core implementation of an EHR, but EHR optimization and the change management that comes with it," Zerneke said. "Really, it's, 'Are you embracing that technology? Do you have the right staff? Are you driving through the organizational change?' I think it's the organizational change that largely is taking a long period of time."

The toughest organizational change once all these systems are working together, he said, is getting hospital leaders and physicians to trust the data to help guide them in treatment decisions -- starting with chronic disease management -- and using analytics tools to crunch the financial impact of those treatment decisions and improve both patient outcomes and the bottom line.

"There are very few organizations taking that step," Zerneke said. Many who do are still mired in workflows that involve "opening PDFs and a lot of documents they just don't have time to look at."

HIEs look to meaningful use stage 2 for business help

On the state health information exchange front, the stage 2 extension could work like a double-edged sword, said Cindy Munn, executive director of the Louisiana Health Care Quality Forum, which runs the state HIE, regional extension center and is building an all-payer claims database.

By delaying stage 2 by one year, vendors will be able to rewrite software, customers will be able to implement it, and real use will occur by Oct. 1, 2013. It will still be tight, but doable.
John Halamka, M.D.CIO, Beth Israel Deaconess Medical Center

On one hand, it gives needed relief for building the networks and connecting regional HIEs to the statewide HIE. On the other, it delays meaningful use requirements for physicians to connect their EHRs to HIEs and therefore delays the HIE's ability to justify its business case as months pass by and grant money stretches out. Stages 2 and 3 of the EHR Incentive Programs are expected to include more interoperability and data exchange requirements.

The original meaningful use timeline was aggressive, Munn said, which caused anxiety among providers trying to hit compliance deadlines.

"The fact that there's a delay, for some of the providers, may be good, because it gives them more time," Munn said. "The flip side to that is, in trying to sign up participants for the exchange -- especially those who have invested significant dollars in their infrastructure -- they're evaluating the business proposition for the HIE and determining the business value that it brings to [physicians]," Munn said.

Physicians still focused on health information exchange

AAFP's Waldren said doctors are still focused on sharing information, even factoring in any delays to the meaningful use program. Other initiatives, such as the medical home, the accountable care organization and quality reporting, are still occurring. "The industry at large is still trying to push forward with interoperability and exchange."

If anything, the delay in rolling out stage 2 criteria will hopefully allow CMS and stakeholders to look more closely at how all the initiatives align, Waldren added. More harmony between meaningful use requirements and other mandates could alleviate the IT adoption load, especially for smaller practices with limited resources. "They only have so much capacity for change."

Let us know what you think about the story; email Don Fluckinger, Features Writer.

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