MU Stage 2: Mining for Clinical Gold in Government Red Tape

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Alberto Goldszal

In dissecting stage 2 of the meaningful-use program, Alberto Goldszal, MBA, PhD, drolly summarizes the meaningful-use challenge for radiologists: “In the meaningful-use rules, you are going to see some specific examples of things that are changing the radiology workflow that are perceived as a contraindication for radiology efficiency,” he says. “Overall, it does improve patient care—at least, that is the intended goal.”
 
Goldszal is CIO of University Radiology (East Brunswick, New Jersey), an 83-radiologist practice. On December 3, 2013, at the annual meeting of the RSNA in Chicago, Illinois, he was a copresenter of “Impact of Legislative Policy and Regulations in Imaging Informatics.”
 
With the meaningful-use program here to stay—notwithstanding a recently announced extension of the stage 2 time period through 2016—Goldszal’s approach has been to roll up his sleeves and get to work. University Radiology attested to stage 1 in 2011 and is deep in preparations to begin attestation to stage 2 (in either the second or the third quarter of 2014).
 
He makes it clear that complying with stage 2 objectives will add considerable complexity to the radiology practice’s IT infrastructure, but it also will protect the practice from penalties scheduled to commence in 2015. Ultimately, Goldszal suggests, the universal adoption of electronic health records (EHRs) for common purposes could lead to the simplification of information exchange.
 
With meaningful use scheduled to roll out in three (and perhaps more) stages, early adopters are on the cusp of the transition between stage 1 and stage 2. About 40% of the nearly 1 million physicians in the United States have implemented certified EHR technology (and have received incentive payments totaling $14.6 billion). Just 14% of radiologists can say the same.
 
Of those radiologists who have earned incentives, most are in stage 1, but some are transitioning to stage 2, Goldszal says. No matter when a radiologist begins attesting to stage 1, he or she must do so for two years.
 
“The initial stage is actually quite boring because it focuses on data collection, and you do not see the benefit of it—just the labor,” Goldszal says. “The hope is that future stages will provide improvements in clinical processes and will benefit clinical outcomes.”
 
Transition to Stage 2
 
The focus, in stage 2 of meaningful use, is on advanced clinical processes—through more rigorous exchange of information, transmission of patient-care summaries across multiple settings, and increased family and patient engagement. To comply with stage 1 meaningful use, eligible professionals had to implement a 2011 edition of certified EHR technology; for stage 2, there is a 2014 edition, and some (but not most) EHRs already are compliant.
 
To earn incentives, however, eligible professionals must attest to the meaningful use of that technology by complying with core, menu-set, and clinical-quality measures. These also have been modified, and Goldszal spent the bulk of his presentation time explaining the measures, how they have changed, and their implications for radiology. “I think it is important to put into perspective what these meaningful-use measures are so that providers can judge on their own their potential benefits vis-à-vis efforts (and costs) demanded to implement them,” he notes.
 
Core Measures
 
In stage 1, there were 15 core measures, six of which have been folded into other measures in stage 2; there are 17 core measures in stage 2. Some of the stage 1 menu-set measures have been moved to the core objectives, now mandatory for all participating eligible professionals. Eligible professionals may request exemptions from some (but not all) 17 core measures. In this list, the percentage following the name of the measure refers to the number of patients to whom the measure must apply.
 
CPOE (60%–30%–30%) and Electronic Prescribing (50%): Objectives 1 and 2. —Every certified EHR must be capable of both CPOE and electronic prescribing, but physicians can claim exemptions from both measures. In stage 1, physicians had to prescribe medication for 30% of patients using CPOE, and in stage 2, that jumps to 60%.
 
What changes for radiology is that 30% of radiology orders have to be entered electronically—in the referring physician’s electronic medical record system—in stage 2. Goldszal points out that this will result in a great number of referring physicians wanting to interface with the EHR of the practice that provides