Where Meaningful Use Stage 2 Is Most Likely to Trip You Up

Kenneth J. Terry, MA


January 10, 2013

In This Article


Edward Rippel, MD, a solo internist in Hamden, Connecticut, has signed up nearly half of his patients to participate in a Web portal, linked to his eClinicalWorks electronic health record (EHR), that gives them access to their health records and allows them to message him securely.

That isn't a great percentage for a university community, he says, but it's enough to meet the patient record-sharing requirements of Meaningful Use stage 2, which begins for eligible professionals (EPs) on January 1, 2014.

Rippel believes that he'll be able to meet the stage 2 criteria for exchanging clinical summaries with other providers during transitions of care, such as referrals. His EHR can generate a summary in the mandatory format, and he can share that with other eClinicalWorks users, as well as physicians who use different EHRs.

But there's one stumbling block, he points out: Many of his colleagues don't yet have EHRs. In fact, he says, government figures indicate that only 22% of the doctors in his county had adopted the technology at the end of 2011.

Many other physicians also face significant challenges in meeting the Meaningful Use stage 2 requirements. "Stage 2 of Meaningful Use is going to be very difficult for small practices that aren't being helped by somebody bigger," notes David Kibbe, MD, a senior advisor to the American Academy of Family Physicians. "This is going to be a sea change."

Kibbe and Rosemarie Nelson, an MGMA consultant based in Syracuse, New York, believe that the health information exchange criterion will be the hardest for physicians to achieve. Other observers cite the requirement that doctors ensure that 5% of their patients view, download or transmit electronic copies of their records.

"The scary part of that is that there's no lever, there's no way to ensure that patients do it," says Chris Giancola, a principal consultant with CSC, a business and technology services company in Boston.

A Number of Challenges

There are also barriers to showing Meaningful Use in areas like lab orders, medication reconciliation, and preventive care reminders to patients. But on the whole, the stage 2 requirements should not be overly burdensome for EPs who attested in stage 1, maintains Graham Brown, vice president for clinical integration at The Camden Group, a healthcare consulting firm based in Los Angeles.

"Moving from stage 1 to stage 2 is just about demonstrating a higher level of use for more of your patient panel, or you're consistently using certain kinds of applications required by Meaningful Use, such as e-prescribing or communicating data to other providers or patients."

However, Brown adds, EPs will have to demonstrate Meaningful Use for the entire calendar year, not just for the 90-day period required in stage 1. "That's going to push doctors from a workflow perspective to the point of 'this is how we do it all the time. This is how we work.'"

Physicians are not paying enough attention to what they must do for Meaningful Use stage 2, Nelson notes. Cindy Dunn, another MGMA consultant, agrees. She says that practices should use the extra year they've been given before stage 2 begins to prepare, strategize, and consult with their EHR vendors. "Everyone will have to work together and cooperate," she points out.

Here are some details about what you need to know to get ready for Meaningful Use stage 2.