In my reading, I heard someone bring up an interesting problem with meaningful use stages. As most of you are familiar, the stage 1 meaningful use criteria really focuses on EMR’s having the ability to share patient information, but doesn’t actually require them to share information. In stage 2 and stage 3, my understanding is that the requirements to start sharing this clinical information will be a major part of the criteria.
With that understanding, let’s imagine a clinical office spends more than they should on a certified EHR and show stage 1 meaningful use. No doubt they spent a fair amount of time dealing with the reporting requirements of stage 1 meaningful use. As with any EMR implementation they made a lot of changes in their office and for the most part their satisfied with getting the EMR stimulus money the first year.
Well, stage 2 meaningful use rolls in and now they’re required to start sending their patient data to some state designated HIE (or other similar entity). What’s going to happen if their state doesn’t have an HIE where they can send the data? Or what if you’re from a small state like Delaware or Montana (small in people) and your EMR vendor decides that they’re not going to build the features required for you to interact with your state EMR?
Scenarios like this make meaningful use and the EMR stimulus really messy. Of course, that’s why I keep repeating my mantra, “Don’t implement an EMR for the EMR stimulus money. Implement it because it’s the right thing to do for your clinic. Use the EMR stimulus as a nice bonus if all goes well.”
John,
It’s accurate that all of these activities are not necessarily linear in development. But I also believe that the CCD isn’t the only avenue of sharing that may define meaningful use (MU).
I also believe that MU may also include the requirement to share more granular data because the CCD isn’t a complete chronology of medical care but only a summary.
As a clinician, I often would like to see the granular data because an abstract or a summary may not be as faithful as the original content was.
[…] 6, 2010 From the EMR and HIPAA Blog, a concise example of how stimulus money for EHR’s can lead to inefficiencies in electronic investment: . . . […]
RE: “Or what if … your EMR vendor decides that they’re not going to build the features required for you to interact with your state EMR?”
But of course if the certifying agency was doing its job, common data formatting standards would be in place, and one EMR wouldn’t have to interact with another EMR — just pass the data along.
“Don’t implement an EMR for the EMR stimulus money. Implement it because it’s the right thing to do for your clinic. Use the EMR stimulus as a nice bonus if all goes well.”
I cannot have phrased it better. You are very right. Having said that, DE is probably one of the very few states who have their information network already in place – Delaware Health Information Network (DHIN) and are very well organized. In fact, they are inviting all the EMR vendors to participate in thier network. As the Richard commented earlier, all the actities are not necessarily linear and many of the requirments can be addressed in parallel.
I have to say I am a avid reader of your blog and its very informative.
Anthony Subbiah
David,
That’s the problem. The certifying agencies job isn’t to establish good standards. It’s a way for EMR vendors to market their product better.
Anthony,
Yes, I have heard that DE has done well in that regard. I wasn’t necessarily singling that state out, but illustrating the point of smaller states not getting the same support from an EMR vendor. That said, it’s certainly possible that only a few EMR vendors will want to support the DHIN which isn’t a very good thing for doctors in DE either.
Glad to have you as a reader and I hope you’ll contribute in the comments more often.
Absolutely; the topics you chose are very relevant.
Yes; probably DHIN may not get attention of many vendors to connect and be active considering the market participants on the provider side. Nevertheless, a good share of EHR vendors will participate.
On another note, I would like to know more about the HIEs and RHIEs and how they might play a significant role in shaping Health IT
HIEs will try to be the hub.
from my mobile device.
I think another player will Regional Extension Centers who might serve as an intermediary. EMR consultancy vendoers may need to negotiate with them rather directly with nedical providers.
From my mobile device
Anthony,
I’ve written quite a few times lately about HIE. Here’s all the posts I’ve done that talk about HIE: https://www.healthcareittoday.com/tag/hie/
The problem I’ve seen most with HIE is finding a business model that works. Otherwise, they’ll go the way of the RHIO’s.