Two words: Stage 2 (Part 1 of 3)

At an ONC-sponsored "summit" in late May in Washington, Director Farzad Mostashari, M.D. told the audience that many of the things we'd been looking forward to, needing, in order to move healthcare to where it must go, could be wrapped up in two words: "Stage 2". In my opinion, he has delivered as promised.

In Meaningful Use Stage 2: A Giant Leap in Data Exchange, Dr. Mostashari reflects on a number of the key concepts that both he and we have been discussing for some time now. But before we go there for a high-level review, let me re-state that our distinct purpose here on EMRlogic Live is to sift the greater reform discussion down to its eye care essentials. Here at least we are, and without apology, looking at the transformation of health care in terms of what it all means for eye care providers, whether optometrist or ophthalmologist. 

Let me also be clear in acknowledging that Meaningful Use per se, Stage 1 or Stage 2, has nothing to do with any specialty. MU distinguishes between the Eligible Professional (EP) and the Critical Access Hospital (CAH) but not between the primary care provider and the specialty care provider, at least not yet. Nevertheless, there are implications for primary care and specialty care. Those are of particular interest to us. We see those implications unfolding largely through pilot projects and new initiatives, all of which are part of the package we call "the transformation of healthcare".

Let's look at some key concepts that have been around for many years but which come now to the forefront, in the limelight of Meaningful Use Stage 2:

Exchange and interoperability.  
The discussion is no longer simply about "meaningful use" but now about "meaningful use and health information exchange". Meaningful use of EHRs, insofar as they involve the electronic documentation of health information, is now more or less assumed. Remember when software for your practice meant scheduling and billing software? Today, that's not what you go looking to buy. You're looking for EHRs and just assume they also do scheduling and billing, and a bunch more stuff as well. Same deal here. Of course EHRs gather the information you need! The new question is, "Can they communicate?" As of today, for most the answer is no. Stage 2 is about changing that answer to yes.

Summary of Care Records.
In Stage 1, we saw CCDs and CCRs. With some fine tuning, they're now essentially consolidated into SCRs, Summary of Care Records. "The Meaningful Use Stage 2 final rules define a common dataset for all summary of care records, including an impressive array of structured and coded data to be formatted uniformly and sent securely during transitions of care." In Stage 1, CCDs and CCRs were used for, respectively, patient-oriented and physician-oriented continuity of care. The focus on transitions of care has not changed; it's now just more doable, the higher standard now more achievable and, therefore, expected. So again, we're moving from documenting to communicating. It's time to internalize the idea that your EHRs are not about merely gathering but also exchanging health information. And to be clear, that's not about printing, faxing or emailing a traditional referral letter. The SCR is about the use of a common data set, a standardized interoperable document sent as a secure electronic transmission.

To be continued ...

Alistair Jackson, M.Ed.