meaningful-use-successThere is a new wrinkle impacting Stage 2 Meaningful Use success that was not anticipated by EPs or even CMS. This hurdle is almost impossible to overcome if an EP wants to be a successful Meaningful Use Stage 2 participant in the first quarter of 2014 and probably much longer. Remember, we reported in previous blog posts that controlling your success with regard to Stage 2 Meaningful Use is not only dependent on what you do, but also what others do. As an example, patient engagement measures are dependent on patient behavior, not the EPs – but we consider those patient engagement measures manageable with appropriate patient education and the adoption of a robust patient portal.

The issue revolves around the Core (mandated – not optional) measure called; Provide Summary Care Record for Each Transition of Care or Referral (Summary of Care)

Even the most diligent EP cannot manage this new obstacle, because “it takes a village”.

Per CMS, to meet the Summary of Care measure the provider must:

  1. For over half of the patients you refer to another provider or transfer to another setting of care (e.g., nursing home), you have to send the next provider of care either an electronic or paper summary of care document that is generated by your certified EHR.
  2. Of those summary of care documents you send, more than 10% must be sent electronically—either directly (via the Direct Secure Email protocol) to a recipient or using the eHealth Exchange standards. At least one of the summary of care documents that are sent electronically must be sent to someone who is using a completely different EHR vendor or to the CMS designated test EHR.

For most community based EPs, this means they must use the new Direct Project Secure Email system to exchange data with their referral network 10% of the time. For a large amount of EPs this is still not possible, because most providers in their referral network do not have a Direct Project Secure Email address. This is a consequence of the lack of 2014 certified vendors that have deployed this new communication method to their client base. Even if you use a progressive, successful EHR like MediTouch and you have signed up for your free secure email address, you are not guaranteed that your community-based referral network can successfully receive your message. For the clients of the few 2014 certified EHRs that have successfully deployed Direct Secure Email, the circumstances are reminiscent of the early adopters of standard email back in the early 1990s – they had an address but they had no one to email because their friends and family had not yet embraced standard email technology.

When defining the latest version of the Meaningful Use rule, CMS viewed 2014 certification through rose-colored glasses. They assumed that by January 1, 2014, most EPs would have new 2014 certified technology fully deployed. They created a standard that is dependant on the majority of providers having a technology, when in fact the adoption rate is much slower than anticipated. As of today, CMS has failed to rule on how to handle this technology gap. The best answer I have received from a CMS official is:

… this issue has some nuances so it is taking a while to consider.  At present there isn’t a hardship exception specific to this problem, but I know that there is a new hardship category which would deal with issues of access to 2014 CEHRT, so I think the policy team needs to consider the nuances of your question before providing a formal response.

As far as a contingency plan for beginning in January, there is no reason a provider should not try to begin Stage 2 in January if they are ready to do so.  If they are unable to meet the threshold for the measure during the first possible reporting period, there are still 3 full reporting periods available in the 2014 reporting year.  That is a part of why we made the reporting period flexible in 2014; so that we could accommodate providers who were ready with 2014 CEHRT to begin stage 2 at the beginning of the year, and to allow those who were not as ready to participate by removing the full year requirement.

This answer is at best incomplete. It does not support the provider that wants to attest early this year. Many providers want to get Meaningful Use finished and focus their attention on ICD-10, but the complexities of the latest Meaningful Use rule combined with slow adoption of 2014 technology is making that impossible.

We’ve asked the CMS policy folks to provide an exemption for this part of the Summary of Care measure until such time that the nation’s secure email system is fully operational. Until then, Meaningful Use Stage 2 remains a pipe dream for most community-based providers.