Meaningful Use Stage 2 - What to expect as healthcare consumers

The Center of Medicare and Medicaid Services (CMS) announced the final rules for the second stage of Meaningful Use Requirements for Electronic Health Records (EHR) on August 23, 2012, six months after it published the preliminary rules.  Hospital administrators, health IT vendors and physicians have been closely watching the emergence of Stage 2 requirements, so this announcement was much awaited by them.  For healthcare consumers, it passed without much notice.  Nonetheless, I would like to highlight a few changes that will start happening in your doctor's office due to these new requirements.

Before we get into the details, these are not requirements that doctors will have to meet to continue practicing medicine.   The CMS has offered up financial incentives for physicians to implement EHRs to digitize their medical practice.  If they meet the specified requirements in 3 stages, they would qualify for Medicare reimbursement incentives, up to $44,000 per doctor.  After the incentives have been doled out through 2016, the Medicare reimbursement rate will be cut for the physicians who do not meet the requirements.  This is a carrot and stick approach, with significant financial penalty down the road, but nobody goes to jail for not following these EHR Meaningful Use rules.

The main goals of Meaningful Use Stage 1 were

• For physicians to adopt a certified EHR and start recording patients' health information in structured data so they can be queried effectively by computer programs.
• Make data sharing easier among doctors who care for a patient.  

Doctors used to write their encounter notes in whatever form that they deemed sufficient for later reference.  These "unstructured" notes made it difficult for computerized Clinical Decision Support tools to help the doctor with quality and patient safety issues, such as detecting drug-drug interaction problems when prescribing a new drug.
With Stage 2 of Meaningful Use (MU), the bar for recording structured data has been raised.  At the same time, additional requirements were added to move the physician workflow in a direction that hopefully will improve patient outcomes.  I expect some of these MU Stage 2 requirements will change our physician visit experience noticeably.  Let's review the notable ones:

1. Doctors are required to record patient demographics for 80% of the unique patients in structured data format.  The data elements include
1. Preferred language
2. Gender
3. Race
4. Ethnicity
5. Date of birth
2. Doctors are required to record and chart - that means plot a graph - the following vital signs for up to 80% of their patients
1. Height
2. Weight
3. Blood Pressure
4. Calculate and display BMI
5. Plot and display growth charts for patients 0-20 yrs old
3. Record the smoking status of 80% of patients
4. In Stage 1 of MU, doctors were required to have the tool to allow patients to view their health information online within 4 business days of their encounter.  In Stage 2, the doctors are required to have 5% of their patients actually use the tool (typically a web portal).
5. A new requirement of doctors providing clinical summaries to 50% of the patients within 24 hours.
6. Another new requirement states that 5% of the doctor's patients have to be recorded as using the secured electronic messaging function of the doctor's certified EHR.    

What do I think about these rules and their impact to patient experience?  The doctors are going to insist even more (if they have not already) that you provide demographics, vital signs and smoking status during your visit.  If you are one of the internet-savvy patients, you will be encouraged to use the doctor's web portal or even mobile app to discuss issues with your doctor, access your health record and visit summary.

As Dr Ashish Jha (MD) said in his blog post,  Meaningful Use is not going to fix the cost and quality problems in our healthcare system.  However, it moves the US Health IT infrastructure and physician workflow forward.  With an interoperable infrastructure and deeper patient engagement, we would be closer to fixing our problems than otherwise. 

As a healthcare consumer, I am cautiously optimistic that doctors and hospitals will stay engaged as we go through this significant transformation of healthcare technology.  I would love to have my health data available to me digitally.  Our current process of disseminating only cryptic health insurance Explanation of Benefit (EOB) forms but not the clinical summaries indicate where we have been misdirecting our patients' attention and infrastructure investment.  That needs to change.