To Mu Or Non To Mu 2, That Is The Question

Meaningful Use Stage 2 is at nowadays on the clock. Three years after the computer program began inwards 2011, as well as a yr afterwards than originally planned, the escalator has hold upward moved upward i level. Surprisingly, the unremarkably boisterous as well as highly hyped wellness IT scientific discipline (HIT) media is largely soundless on the subject. It’s almost similar everybody gave up, or perchance the entire Meaningful Use exercise is at nowadays assumed, as well as the buzz has shifted to sophisticated analytic apps, preferably mobile, that volition utilize all the large information collected yesteryear EHRs to perform medical or financial miracles. Of course, the best engineered as well as the sleekest looking Ferrari cannot run without fuel, as well as since Meaningful Use participation is the fuel for all the cutting border project design floating about inwards the intelligent apps market, it may live useful to accept a quick aspect at the Meaningful Use acre of affairs for 2014.

Let’s larn some numbers set out first, then nosotros tin have got an informed discussion.

• According to CMS, dorsum inwards 2011, the showtime yr of Meaningful Use, roughly 60,000 physicians attested to Meaningful Use of a certified EHR as well as 50,000 to a greater extent than attested to buying or upgrading to one. That’s at to the lowest degree 110,000 doctors that purchased a certified EHR inwards 2011, as well as in all probability more.
• By Dec 2013, 213,000 unique physicians attested to Meaningful Use inwards the Medicare program, over 20,000 for the showtime fourth dimension inwards 2013, as well as most probable a bunch to a greater extent than newbies volition live added inwards Jan as well as Feb of 2014. For Medicaid, 100,000 doctors attested to something then far.
• If everybody continues to participate inwards the program, nosotros are looking at upwards of 350,000 physicians, non counting novel ones inwards 2014, that volition live needing an upgrade to a 2014 certified EHR, which is the alone allowed EHR edition inwards 2014, whether i is attesting to Meaningful Use Stage 1 or Stage 2.
• The let out of 2014 certified ambulatory EHRs is roughly the same at nowadays every bit the let out of certified EHRs was inwards Jan 2011. While the render is the same, the demand should live 3 times higher.

For anyone vaguely recalling the difficulties experienced yesteryear many inwards obtaining a “certified” EHR version inwards 2011, the iii flexure saltation inwards demand should straightaway die crusade of concern. This is most probable why CMS is allowing all Meaningful Users to attest for alone 3 months inwards 2014, regardless of the Stage they are at. Theoretically, i would have got until the showtime calendar week inwards Oct 2014 to get down this year’s attestation period. Unfortunately this is non precisely the illustration for everybody. If 2014 is your showtime yr of Meaningful Use, you lot must consummate your attestation yesteryear Oct 1st to avoid the penalty. You could scroll the die as well as start your reporting catamenia every bit slow every bit July 1st, hoping as well as praying that the reports volition live satisfactory, planning to piece of work slow on September 30th to larn all your materials ready, as well as keeping your fingers crossed that at that topographic point volition live no snags alongside the attestation site that evening. If the stars neglect to align, you lot volition live penalized. I am non certainly close this, but I wonder if the possibility exists that you lot volition live both penalized as well as incentivized inwards the same year.

If this is non your absolutely showtime yr of Meaningful Use, all attestation periods are tied to calendar quarters inwards 2014, then you lot tin either start on Jan 1st, Apr 1st, July 1st, or Oct 1st. You cannot but run reports until you lot abide by a “good” ninety days period. If i of those 4 periods is non practiced enough, that’s every bit good bad, you’re out for the year, as well as since this is a novel EHR version, chances are some unexpected “glitches” may occur. In the past, people devised several “workarounds” to improve on Meaningful Use reports prior to attestation. Those workarounds included, retrospective information updates for things similar work lists or demographics, as well as the perennial favorite of “print to file”, where clinical summaries are sent to a virtual PDF printer to increment the EHR count alongside minimal deforestation effects. Since attestation periods are fixed now, as well as since those attesting to Stage 2 are looking at significantly higher thresholds, as well as some novel ones to boot, i should await a much higher incidence of innovative fixes to workflows.

Another thing to maintain inwards heed is that clinical character measures (CQM) reported this year, partly for PQRS, may die public. While inwards the past, the numerator for these measures was irrelevant to attestation success, practiced functioning is real of import now, as well as carelessness alongside the numbers may real good come upward dorsum to haunt you lot inwards the non every bit good distant future. Fortunately, CMS has increased the puddle of CQM sanctioned for reporting, then everybody, including specialists, tin pick measures pertinent to their practice. Unfortunately, alongside the exception of a handful of EHRs, most vendors chose to non certify for all possible measures, then this year, but similar inwards 2011, most physicians volition have got no selection of CQMs. Keep inwards heed that the reporting requirements for CQMs inwards 2014 is the same for all participants (i.e. ix measures, electronically submitted), regardless of Meaningful Use Stage, except for showtime yr participants, who are exempt from the electronic requirement.

[Note: On 2/1/2014 HIMSS, the EHR vendors association, has posted a remark on the HIStalk blog stating that "CMS is permitting manual attestation on clinical character measures for meaningful usage inwards 2014, every bit has been done through 2013, non but for those inwards their showtime year". The official CMS website is stating otherwise, but I am non i to dispute the insider information of HIMSS, then await some changes.]

Speaking of choices, those planning to attest to Stage 2, are allowed to pick 3 measures out of half-dozen carte du jour choices, 2 of which are practically impossible to choose, since non many States have got the mightiness to have electronic information to cancer, or some other registry (other than immunizations), as well as also because almost all 2014 certified EHRs chose to non certify themselves for these measures. Realistically, at that topographic point are no carte du jour choices for Stage 2, as well as nosotros should have got in all probability never expected any, based on recalling that dorsum inwards 2011 many EHRs were certified for functionality they didn’t actually have got (e.g. immunizations interfaces inwards all l States).

Another baffling set of numbers comes from this year’s National Ambulatory Medical Care Survey (NAMCS). Influenza A virus subtype H5N1 joyfully reported 78.4% of physicians inwards the USA have got an EHR, as well as 48.1% have got a “basic” i (i.e. an EHR alongside functionalities that could satisfy basic Meaningful Use requirements), or better. The enquiry that e'er springs to my heed looking at this graph is what on globe do 30% of doctors have got inwards their practice? Microsoft Office? There is practically aught you lot tin purchase today that does non run into the Definition of “basic”, nonetheless the gap betwixt basic EHR as well as whatever EHR, shows no signs of narrowing down, which inwards my mind, makes these survey results questionable at best, but I digress.

The 48.1% of basic EHR users matches real good alongside the roughly 350,000 physicians that are participating inwards the Meaningful Use program. The NAMCS also finds that 13.1% of physicians are ready for Meaningful Use Stage 2, which agency that practically all physicians that started their Meaningful Use journeying inwards 2011 were using a 2014 certified EHR as well as were ready to motion upward the ONC escalator at the fourth dimension they were surveyed. Considering that the “2013 NAMCS EHR survey was conducted from Feb through June 2013”, I doubtfulness that real much, seeing that at that topographic point were no 2014 certified EHRs on the marketplace at that time. Perhaps those optimistic doctors meant that they are confident that they (and their EHR vendors) volition live ready when the fourth dimension comes.

Either way, nosotros are left alongside over a quarter i 1000 m doctors who don’t think they are ready for Meaningful Use Stage 2, as well as perchance unbeknownst to them, they are also non ready for Meaningful Use Stage 1, which requires this yr a build new, 2014 certified EHR, as well as some other 2 hundred 1000 physicians who think they have got an EHR, but actually don’t. If 2014 was designed to stress exam the $18 billion (so far) Meaningful Use program, odds are the crash volition live spectacular. If, on the other hand, the thinking was that every bit long every bit the camel is on the motion upward the escalator, nosotros tin happily add together bale of straw after bale of straw to its dorsum promotion infinitum, we’re inwards for a chip of a surprise this year.