Challenges, Strategies and Benefits of Meeting the Stage 2 Requirements

Challenges, Strategies and Benefits of Meeting the Stage 2 Requirements

For those who do attest to the Meaningful Use Stage 2 (MU Stage 2) objectives, clinical care summaries offer many benefits to the healthcare setting, from reduced paperwork to point-of-care access that allows for greater patient care. Since the Centers for Medicare and Medicaid Services (CMS) initiated MU Stage 2 objectives, institutions have struggled to alter their workflow and IT infrastructure to satisfy the requirements. What issues have they experienced, and what are some ways that institutions can close the gap and meet the MU Stage 2 measures?

Stage 2 Requirements for Meaningful Use

The requirements for Stage 2 of Meaningful Use involve three measures regarding transitions of care. Measure one states that eligible providers must submit a summary of care document to at least 50 percent of patients undergoing a transition of care to another setting or provider. Measure two states that 10 percent of these summaries must be sent electronically. And measure three requires that providers show proof of a successful electronic transition (or test exchange) to another provider with another vendor system and billing identity than their own.

Using EHR technology as well as available healthcare information exchanges (HIEs), providers must have the following standards in place to exchange transition of care summaries:

  • Ability to receive transition of care or referral summaries according to standards specified
  • Electronically display the summary data in a readable format for the recipient
  • Must properly match data to patient
  • Incorporates key data about the patient, such as medications, problems, allergies, etc.
  • Should display individual section views of a patient’s record for easy display
  • Enable user to create an electronic transition of care or referral summary with the following data expressed:
    • Encounter diagnoses
    • Immunizations
    • Cognitive status
    • Functional status
    • Reason for referral (ambulatory only)
    • Discharge instructions (impatient setting only)
  • Transmit the summary in accordance with CMS standards
  • Enable users to record, change or access a patient’s problem list or active medication list and allergy history within the ambulatory and inpatient settings.

Gaps in Provider Readiness for Stage 2 Transition of Care

Institutions have been working feverishly with electronic health record (EHR) vendors and technology integrators to meet the objectives of stage 2, but have run into many challenges along the way. In some cases, the institutions couldn’t get the EHR technology up and running in time, due to workflow or other issues. Others had EHR vendors, but they lacked the certification needed. And some could not find a provider to accept their summary of care records electronically. Because of these obstacles, CMS has relaxed the requirements slightly, allowing exceptions for some providers to roll back to stage 1 requirements. In addition, eligible providers who transfer patient records fewer than 100 times during the EHR reporting period, or who could not find trading partners for transitions, were excluded from these measures. Consequently, due to the 2014 exclusion allowance, only 14 percent of eligible providers actually met the transition of care requirement, with many providers reporting well below the 50 percent requirement.

Closing the Gap in Provider Readiness

How can providers plan for meeting the requirements in a timely and efficient manner? Here are some best practices:

  • Create a timeline: Institutions should plan ahead for meeting MU Stage 2 objectives. Depending on a provider’s current systems, they should follow a timeline ranging from 30 days to six months to integrate the new components involved with MU Stage 2 into their workflow.
  • Look at existing workflow: To begin the process, your IT department and/or technology integrators should properly map your current workflow in order to better fit the new components, such as sending, receiving, routing and data updates, into the system.
  • Enlist the help of an EHR vendor and/or integrator: Ensure your IT staff has the resources to meet the objectives by working with an outside consultant or integrator like CoreTech Revolution, as well as your EHR provider, to make for a more efficient process.
  • Test routing method: Be sure to examine existing referral processes to ensure proper routing and receipt, while avoiding redundancies and errors. Eligible providers that use a health information exchange (HIE) may be able to integrate with their EHR for easier interoperability and attestation.
  • Think strategically: Rather than looking at your MU attestation as a checklist, think about how you can fulfill other, long-term institutional objectives, as well as ways that you can improve your workflow to support all of your processes and improve efficiencies as well as enhance patient care and outcomes.

As CMS works toward releasing Stage 3 of meaningful use, providers should focus on getting the basic systems in place to allow for the proper exchange of information during a transition of care. Completing this task alone will help lay the foundation for making the information exchanged more actionable, relevant and useful to the provider – which in the end is the ultimate goal.

Sources: Healthcare Informatics, The Advisory Board Company,