A Gaping Hole in Achieving MU Beyond 2014

Joe Wivoda, Chief Information Officer

The new Stage 2 requirements for meaningful use have a significant focus on patient engagement and information exchange. There are also more requirements for physicians and others to use their electronic health records (EHRs) more completely (e.g. increased use of computerized provider order entry), but the requirements for information exchange and patient engagement represent a significant challenge, and exciting opportunity, for hospitals and clinics, both rural and urban. The requirement to have 5% of unique clinic patients (5% of hospital discharges) actively view their health information will take concerted communication and marketing efforts, but the electronic exchange of summaries of care at transitions will be the most difficult.

The reason this requirement will be the most difficult is because many of the players, such as long term care and home care, have no financial incentive to implement EHR technology that can accommodate electronic exchange. The rule states that 10% of transitions to a new care setting must have a care summary transmitted electronically. Consider a rural hospital as an example: Rural populations are often older than urban, and many care transitions are to home care or long term care (LTC). The numbers are difficult to find, but according to Examining Post Acute Care Relationships in an Integrated Hospital System (Feb. 2009, available from http://aspe.hhs.gov/health/reports/09/pacihs/report.shtml), 35.2% of Medicare patients were discharged to either long term care or home care. Considering that the majority of discharges are to the patient's home, long term care and home care represent the majority of discharges to other facilities.

Many long term care facilities have EHRs that are used for documenting care, but like hospitals and clinics, they vary in their capabilities and level of adoption. Most LTC EHRs are designed around payment requirements; documenting primarily what is required to get reimbursed by Medicare and Medicaid. Since meaningful use does not apply to LTC or home care, their EHRs are not focused on information exchange. Thus, we are faced with the requirement of exchanging information with facilities that have no financial incentive to implement expensive upgrades to their EHRs to accommodate the hospital's requirements so the hospital can get more money. That is a tough sell.

We know that this is the right thing to do for patient safety and efficiency. Hospitals should be looking at their referral patterns and talking with long term care facilities about the benefits of exchanging information electronically. Networks are perfectly positioned to facilitate these conversations. Know that it will take time to implement the technology required, both at the hospital and the LTC facility, so start planning now. Without partnering with LTC it will be nearly impossible to meet the information exchange requirement in Stage 2.