Over the past several weeks we have been unpacking the Stage 2 core objectives. Today, let’s finish up the Stage 2 core by exploring the three remaining objectives: Patient Electronic Access, Secure Messaging, and that crowd favorite, CPOE.
Patient Electronic Access
The Patient Electronic Access Stage 2 core objective combines an underutilized Stage 1 core objective with an unpopular Stage 1 menu objective. One of the original Stage 1 core objectives examined whether patients who requested an electronic copy of their health information received an e-copy at least 50% of the time. Two weeks ago I mentioned the CMS white paper describing the 2011 experience. This Stage 1 core objective was the leader of the pack in terms of exclusions. Almost 70% of providers attesting in 2011 reported an exclusion for this objective because none of their patients asked for an electronic copy of their health information.
The other component of this Stage 2 core objective traces its heritage to the Stage 1 menu. That objective—to provide patients with timely electronic access to their health information—was rarely selected from the Stage 1 menu, in spite of the fact the target was only 10%. Combining elements of both of these Stage 1 objectives, ONC created the Stage 2 core objective under discussion.
There are effectively two parts to the Patient Electronic Access objective. The first examines the provider’s unique patient encounters during the reporting period and asks if at least 50% of those patients had timely online access to their health information. Timely in this case means within 4 business days after the information is available to the provider. Notice, unlike the objectives in Stage 1, the denominator is not patients who requested the information, it’s every patient you see during the reporting period.
Part 2 of this objective examines the same group of patients in part 1 (unique patients seen during the reporting period). But part 2 requires the patients to take action. Success with part 2 requires at least 5% of those patients to either view, download, or transmit their health information to a third party. Stated another way, your success in Stage 2 is dependent upon patient engagement—a theme that continues below.
Secure Messaging
Secure messaging is the only new objective in the Stage 2 core. Its presence is further testament to ONC’s interest in facilitating patient engagement. This objective examines the provider’s unique patient encounters during the reporting period and asks if at least 5% of those patients (or their authorized representative) sent the provider a secure message during the reporting period. Notice, like the view, download, or transmit objective mentioned above, this objective requires action on the part of the patient in order for the provider to be successful. Granted 5% is a very low hurdle to clear, but you cannot just “turn something on” and expect to meet these two patient-engagement objectives.
My advice would be to determine how your certified EHR intends to meet these patient-engagement objectives. Potential solutions might include a patient portal, a personal health record, or a secure email solution. Bottom line, you need to begin engaging your patients early, making sure they understand the value proposition provided by these tools, in order to ensure a reasonable number interact with the system.
CPOE
Let’s finish up the Stage 2 core with a review of everyone’s favorite, Computerized Provider Order Entry. Much has changed for CPOE as it graduates to the Stage 2 core. As you may recall, the Stage 1 core objective examined unique patient encounters with patients who had at least one medication on their med list (essentially every nephrology patient). Of this group of patients the Stage 1 core CPOE objective was checking to ensure at least 30% of these patients had at least one medication entered in the certified EHR’s CPOE system. What made this relatively easy in Stage 1 is the fact that CPOE was only examining medication orders and EHRs were permitted to use their e-prescribing solution as a proxy for CPOE.
Fast forward to Stage 2. First, the denominator has changed from unique patients to all orders created by the provider during the reporting period. The next big change for Stage 2 is the CPOE objective now consists of three fractions: med orders, lab orders, and radiology orders. Further, each type of order has a unique target and a specific exclusion displayed in the table below.
What’s likely to draw the nephrologist’s attention is the last column. Those of you facing the Stage 2 objectives in 2014 will do so for a single calendar quarter. Depending on practice patterns, I suspect a large number of nephrologists will be excluded from reporting the radiology arm of CPOE. That still leaves the lab and med components, but perhaps it will ease the reporting burden for some.
Implications for Your Practice
In summary, the Stage 2 core consists of 17 objectives. Four of these objectives are asking us to attest to the fact that we did something and for the remaining 13 we are pursuing a threshold target. With the exception of the secure messaging objective reviewed above, we saw most of these objectives in Stage 1. Many are largely unchanged, but as described in our recent posts, there are some nuances within Stage 2 that will require your attention and minor modifications within your workflow. Of particular interest are the two objectives mentioned today which require patient engagement for success. Take a close look at those as you make your preparations. Waiting until the last minute will likely create unnecessary heartache for some of you. Next up on our journey are the six Stage 2 menu objectives. Until then, keep us posted on the challenges and opportunities you see ahead. Drop us a comment and join the conversation.
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