Are State Health Agencies Ready for Meaningful Use Stage 2?

Posted on September 23, 2013 I Written By

James Ritchie is a freelance writer with a focus on health care. His experience includes eight years as a staff writer with the Cincinnati Business Courier, part of the American City Business Journals network. Twitter @HCwriterJames.

As part of its public health objectives, Meaningful Use 2 requires doctors and hospitals to report sizable amounts of information.

The idea is that when significant patterns are forming — an outbreak of a certain disease, for example, or a peculiar cluster of symptoms — they’ll be apparent right away.

But someone has to be in position to receive the data.

The responsibility falls to local and public health departments. Agencies around the country should, theoretically, be preparing for the immunization records, laboratory results and other information they’ll soon be getting.

Just how many will be ready, though, remains to be seen. Many cash-strapped departments lack the IT infrastructure for what’s being asked of them — and the money allocated by the government hasn’t amounted to much, according to a 2012 American Journal of Public Health article by Drs. Leslie Lenert and David Sundwall.

In fact, the authors wrote, the federal effort “has created unfunded mandates that worsen financial strains” on health departments.

There’s a caveat, though: The mandates aren’t really mandates.

“Nothing compels them to do it” except the desire to do the right thing, said Frieda du Toit, owner of Lakeside, Calif.-based Advanced Business Software. “Some directors are interested, some are not. The lack of money is the main thing.”

In our recent interview, du Toit, whose company specializes in information management solutions for health departments, added: “One customer asked me: ‘Am I going to be punished in any way, form or fashion if I don’t support the efforts of my hospitals and care providers?”

Her firm’s Web-based Public Health Information Management System serves cities and counties throughout the United States, including in California, Texas and Connecticut.

The federal government’s goal is for public health agencies to be involved in four administrative tasks to support MU2, according to the Stage 2 Meaningful Use Public Health Reporting Task Force. The task force is a collaboration between the U.S. Centers for Disease Control and Prevention, nonprofit public health associations and public health practitioners.

The first step is to take place before the start of MU2 — that’s Oct. 1, 2013, for hospitals and Jan. 1, 2014, for individual providers.

The tasks:

  • Declaration of readiness. Public health agencies tell the Centers for Medicare & Medicaid Services what public health initiatives they can support.
  • Registration of intent. Hospitals and providers notify public health agencies in writing what objectives they seek to meet.
  • On-boarding. Medical providers work with health departments work to achieve ongoing Meaningful Use data submission.
  • Acknowledgement. Public health agencies inform providers that reportable data has been received.

For doctors and other eligible professionals, MU2 calls for ongoing submission of electronic data for immunizations. Hospitals are to submit not only immunizations but also reportable laboratory results and syndromic surveillance data.

Health care providers whose local public health departments lack the resources to support MU2 are exempt from the reporting requirements.

In Meaningful Use Stage 3, which health IT journalist Neil Versel wrote is likely to begin in 2017, “electronic health records systems with new capabilities, such as the ability to work with public health alerting systems and on-screen ‘buttons’ for submitting case reports to public health, are envisioned,” according to Lenert and Sundwall.

The authors noted: “Public health departments will be required not just to upgrade their systems once, but also to keep up with evolving changes in the clinical care system” prompted by the regulations.

They proposed cloud computing as a better way. Shared systems and remote hosting, Lenert and Sundwall suggested, could get the work done efficiently and affordably, albeit at a cost to individual jurisdictions’ autonomy.

As EMR adoption grows, it would be a shame not to take advantage of the opportunities for public health. The entire health IT effort being pushed by the federal government is, after all, geared toward improving the health of populations.

Without money for the job, though, public health agencies’ ability to support Meaningful Use will likely always be limited. It looks like a good time to think about committing significant funds, embracing cloud-based solutions or both.