Several themes were hot-buttons at the 2012 International MUSE Conference, and became recurring topics of conversation at the education sessions. Some of the recurring topics were directly related to the Meaningful Use (MU) Stage 2 proposed requirements, while others were related to the growing complexities of exchanging patient health information beyond the four walls of the hospital.
1. Patient portal demands for MU Stage 2 are unrealistic
Likely causing the most anxiety among MUSE IT professionals is the new criteria included in the proposed rules for MU Stage 2 regarding patient portal use:
More than 10 percent of all unique patients seen during the Electronic Health Record (EHR), as defined in Defining Key Health Information Technology Terms (The National Alliance for Health Information Technology, April 28, 2008): An electronic record of health-related information on an individual that conform... reporting period (or their authorized representatives) view, download, or transmit to a third party their health information.
Hospitals are naturally worried about criteria for which they have no direct control. For its part, an IT department could provide a robust and easily accessible patient portal, only to have patients decline to use it for a variety of reasons.
In its session titled “Stage 2 Meaningful Use Winnie the Pooh Halloween Movie Preview,” Citizens Memorial Hospital indicated that they have provided patient portal access to their patients for 3 years. During this time they also employed marketing efforts to spread the word regarding patient portal availability. However, the highest percentage of use they have been able to achieve is 5 percent. This left all in attendance a little uneasy about the requirement.
2. Electronic transmittal of summary of care record might not be applicable
Also creating much conversation was the requirement for the electronic transmittal of summary of care records for MU Stage 2, which is as follows:
The eligible hospital that transitions or refers their patient to another setting of care electronically transmits a summary of care record using certified EHR technology to a recipient with no organizational affiliation and using a different Certified EHR Technology vendor than the sender for more than 10 percent of transitions of care and referrals.
Many Meditech hospitals are smaller in size and often in rural settings, which creates unique circumstances to meeting this requirement. With an elderly and rural population, many hospitals have the majority of their patient transitions made to long-term care facilities. These facilities are often not yet capable of meeting the requirement for receiving an electronic summary of care record. This means the denominator of the formula grows and puts a large requirement on all other non-long-term care transfers to employ electronic summary of care transmittals.
Another concern is related to hospitals which are the only hospital facility within a reasonable driving distance. In this case, most other settings of care either have an organizational affiliation or are a long-term care facility, making it highly unlikely to achieve even 10 percent, which at first glance might seem like a reasonable number. For MU Stage 1, this requirement was simple to have the capability and to test it once.
3. Physician governance and support is key to CPOE
Whether it’s the implementation of CPOE or the beginnings of an An Accountable Care Organization (ACO), according to the Centers for Medicare & Medicaid Services (CMS) “is an organization of health care providers that agrees to be accountable for the quality, cost, and overall care of Medicare beneficiaries who..., physician governance and support will be instrumental to the success. To gain acceptance of workflow changes, buy-in from the physician community from the beginning makes for a smoother implementation down the road. Several hospital facilities were eager to share their experiences on how they effectively engaged physicians during project implementations.
Leigh Shipper of Beaufort Memorial Hospital framed the problem as, "It’s not technical, it’s cultural." He emphasized that the new way of doing things must focus on the physicians perspective:
- Allow them to access the data the same way as with other applications
- Enable them to treat the patient, not chase data
- Make work-life balance easier
- Compensate them for their time
A panel on “Physician Engagement and Governance” agreed. A member of the panel indicated that all physicians were given the opportunity to participate in the project up-front, with the knowledge that they would be reimbursed for their time at average physician earnings rates. Participation was very high and engaged, leading to a successful implementation that paid back the physician compensation many times over.
4. Health Information Exchange (HIE) focuses on the mobilization of healthcare information electronically across organizations within a region or community. HIE provides the capability to electronically move clinical information between disparate health... connectivity growing, although push-based
Based on the number of educational sessions discussing HIE connectivity, the number of hospitals engaged in connecting to an HIE is growing among Meditech hospitals. However, the sessions I attended did not utilize the Meditech Continuity of Care Document (CCD) The HL7 CCD is the result of a collaborative effort between the Health Level Seven and American Society for Testing Materials (ASTM) to “harmonize” the data format between ASTM’s Continuity of Care Record (CCR)... module, but rather used traditional HL7 is a Standards Developing Organization accredited by the American National Standards Institute (ANSI) to author consensus-based standards representing a board view from healthcare system stakeholders. HL7 has compiled a collection of message form... v2 messages over a secure transport such as VPN.
Several hospitals are already gearing up for the proposed MU Stage 2 requirement of using secure e-mail, based on The Direct Project was launched by the ONC within Health and Human Services (HHS) on March 1, 2010. It was initially called NHIN Direct. The object of the Direct Project is to replace the use of faxes, phones, and paper transactions with a simple and... standards, to enable the electronic transfer of clinical documents. However, I did not hear mention of any hospitals currently planning to implement the NwHIN exchange standards, which use the more advanced query-based profiles to transfer clinical documents across communities.
In general, the educational sessions were packed with facilities willing to share experiences regarding Meaningful Use and external connectivity. One of the chair persons for MUSE indicated that not all facilities willing to deliver presentations were given the opportunity due to an abundance of submittals. This shows the eagerness of the Meditech community to get involved. The educational sessions were rich with content, and attendees were eager to share stories of success and pit-falls based on the evolving standards and requirements in healthcare IT.
For more information, read:Health IT Matters, Meaningful Use HiTech