Autumn is truly one of my favorite seasons. The air is crisp, the skies are clear and the leaves are beginning their remarkable annual transformation. This fall of course there is something else in the air. Drive down the street of almost any neighborhood and you will see signs littering front yards; if you find yourself in a “swing state” your phone rings several times a day, bringing unsolicited political pitches from people you do not know; and heaven forbid you turn on the television. Yes, whether you lean toward donkeys or elephants, this is most certainly an election year.
I have mentioned before that politics and religion are two topics that I plan to avoid on this blog and today is no different. However, I had the opportunity to share the content of the Stage 2 final rule with a group of practice managers last week and one of them mentioned a letter four ranking members of Congress had written.
“Have you seen the letter?” one of the participants asked. “They are talking about stopping the program.”
When I first read the note to Secretary Sebelius I must admit I was shocked by the number of errors it contained. However, reading it more closely it was clear the facts cited are actually true, but very clearly designed to mislead. Early references in the note to the “proposed” Stage 1 rule as opposed to what was actually finalized cleverly create the perception that Stage 2 lowers the bar, that interoperability will not be achieved in a timely manner. This sets the stage for a call to halt the program until the standards are tougher.
These four Congressmen are almost certainly very bright and successful individuals, and members of Congress typically surround themselves with remarkably talented and energetic staffers who are very well informed. But this is an election year and I am sure their respective teams are very busy, too busy in fact perhaps to find the time to actually read the meaningful use final rules. Having read both, let me assure you the hurdles for Stage 2 are substantially higher than those in Stage 1 and the requirements for transport standards will bring us much closer to the interoperability promised land. To suggest, as the letter does, that retiring what I consider to be a window-dressing Stage 1 objective (exchange key clinical information) moves us away from achieving interoperability is either disingenuous or perhaps politicking at its finest.
The CMS EHR incentive program is far from perfect and it has a large number of challenges. But it is not a coincidence that EHR adoption in this country has increased substantially in parallel with the program’s introduction. And while there will always be unintended consequences associated with programs such as this one, I can assure you that every EHR vendor in the country has committed substantial resources towards ensuing your EHR will permit you to clear the Stage 2 hurdles, including the interoperability hurdles. Granted one could argue those resources might be better served by a different focus, but without the CMS incentive program, very important issues like harmonizing standards would stand little chance of seeing the light of day.
In a few short weeks the election will be behind us, the yard signs will come down, the phones will not ring as much and television commercials will revert back to apolitical, mind-numbing messages of deception. Members of Congress will come and go, and a couple of years from now we will repeat the cycle. Around that time we will be consuming the Stage 3 final rule. Perhaps another intriguing letter to the Secretary of HHS will make its way into the blog that fall. Political intrigue aside, whether you live in a red state or a blue one, I hope you have the chance to enjoy the foliage.
rg says
Terry,
I read through some of the CMS website on stage 2. May I ask a few questions:
1. Regarding order entry, say we quickly message a staff member to order a lab or call a patient to remind them of a low k diet—that “order” does not get credited, or kept track of. Am I right in thinking that our group has to phase out that work flow and use the new system that Acumen rolled out this week?
2. If the state of VA cannot accept the surveillance data, is there an exclusion? To my read of the program, if VA cannot accept the information, there is no recourse except to take the penalty.
3. Our NP does many face to face visits, therefore I am pretty sure we will not meet exclusion criteria, correct?
4. I agree about how this is substantially harder. Do you think it might be easier to take the penalty? We don’t want to invest a lot of time if the VA does not have their information system set up to accept our data.
Lastly, we all like the Acumen videos in the user manual. We used the medicine reconciliation one to get some background on what we need to do. Looking forward to your blog to take us through some of the objectives. Start with the hardest one first!
RG
Terry Ketchersid, Vice President and Medical Officer at HITSG says
Great questions RG.
1. The CPOE objective for Stage 2 counts 3 types of orders: Medications (eRx typically), lab orders and radiology orders. If you are simply messaging someone in the office and not creating an order per se, there is a differnt workflow opportunity to tackle this in our application. Touch base with our client services team for the details.
2. My read suggests the CDC may restrict whom they are willing receive data from and nephrology practices may not be on that list. Technically if your state cannot receive data for this objective you would be compelled to select a differnt objective from the menu in Stage 2.
3. This always comes down to the actual count for the “50% Rule”. If in fact more than half of YOUR face to face encounters occur in the office, you are not eligible for the hardship exception that applies to those for whom a majority of encounters occur where CEHRT is not deployed and the decision to deploy CEHRT is beyond their control.
4. Tough question. I recently read that almost 20% of the providers who attested in 2011 did not do so in 2012. I know many are contemplating opting out. I suspect some will also decide it is not worth the effort and they will accept the penalty. Of interest taking that approach removs the rsik of an MU audit. All of this falls squarely into the category of unintended consequences.
Stay tuned for the in depth review of Stage 2
RG says
I looked at core objective 16 for stage 2: Capability to submit electronic data to immunization registries or immunization information systems except where prohibited, and in accordance with applicable law and practice.
Fortunately, there is an exclusion which I found when I clicked on the link here it is: (2) the EP operates in a jurisdiction for which no immunization registry or immunization information system is capable of accepting the specific standards required for CEHRT at the start of their EHR reporting period;
Therefore, we are ok if the state is not up to speed! Looks like we are ok for this objective.