The 197-licensed-bed Beaufort Memorial has done meaningful use in phases, Ricks notes. Three-quarters of its physicians are independent, and of those, not all are yet using computerized physician order entry. As of late May, Beaufort was about to bring its OB-GYN and pediatricians live on CPOE. So certain rollouts vary by specialty.
"The biggest challenge may be the quality measures and collecting the discrete data from areas that historically were not pieces of discrete data, that we abstracted out," Ricks says. "Luckily we were migrating to a new version of Meditech software over the past couple of years, and so we tried to build in the collection of that data in the work flows up front for the clinicians so that we didn't have to do any kind of double work as we went on."
Two requirements in the meaningful use 2014 edition loom large and pose bigger challenges for all providers: information exchange and patient engagement.
Mostashari says the 2014 edition moves from tests of data exchange to actual exchange of information across organizational and vendor boundaries. "Patients are certainly quite aware that their care is not as coordinated as it could be," he says. "They certainly know there are tests repeated unnecessarily."
Outweighing even the cost of repeated tests is the patient safety danger from those tests—for example, excessive ionizing radiation, Mostashari adds.
The 2014 edition as proposed requires discharges to be accompanied by a care summary for 65% of transitions of care or referrals, and for that to be done electronically 10% of the time across organizational and vendor boundaries.
Not all physicians agree that the data exchange requirements in the 2014 edition are a win-win.
"This is a great example of where the system potentially is going to shift the work toward the doctor," says Lyle Berkowitz, MD, medical director of IT and innovation at Northwestern Memorial Physicians Group, a Chicago-based multisite practice of 100-plus primary care physicians who are on the medical staff at Northwestern Memorial Hospital and faculty members of Northwestern University's Feinberg School of Medicine. "Meaningful use isn't saying exactly how it's going to be done from a work flow perspective. We actually need to train doctors how to run a team. It's not a skill that's traditionally taught."
As for patient engagement, many providers remain unsure how their organizations will achieve this goal of the 2014 edition.
"I don't know how a healthcare provider can be responsible for making sure that a patient that receives information is going to look at it and use it in a meaningful way," says Jackie Lucas, FACHE, vice president and CIO of Baptist Healthcare System, a seven-hospital system with approximately 2,000 licensed beds headquartered in Louisville, Ky.
In discussing these meaningful use requirements, one of her staff suggested that a provider could offer a nonmonetary incentive to patients to access their information electronically. "We've got to be very careful," Lucas says. "I suggested anything a provider did would have to meet HIPAA regulations.