Meaningful use Stage 2 is an ambitious step forward in care coordination. Most "payloads" of Direct secure messages are structured as consolidated clinical document architecture (CCDA) documents, allowing transitions of care around problem lists, medications, allergies, and lab results and more to be shared upon discharge or referral between caregivers.
"It's the ability to package key data into a report that has codes inside to help computers decipher what each thing means, and then send it off to where your next care will be, or to your personal health record," says Joseph Schneider, MD, vice president, chief medical information officer, and medical director of clinical information of Baylor Scott & White Health, a 46-hospital system based in Dallas, with more than 500 patient care sites, 36,000 employees, as well as 6,000 affiliated physicians. "I really do see that this might eventually be the way that things will be done, rather than the health information exchange databanks at, say, a state or a regional level."
Meeting meaningful use Stage 2 this year means submitting a 90-day attestation of compliance with the Centers for Medicare & Medicaid Services. That 90-day period will vary depending upon health system and practice, and applies only to those eligible providers who attested for meaningful use Stage 1 in 2011 or 2012, leaving those who attested last year or this year to attest in future years.
At Baylor Scott & White, some physician practices will attest in July, August, and September. Hospitals will attest starting in October. At least one Direct message must travel between one vendor make of EHR and another. For those lacking such diversity, CMS has set up a test server that will randomly receive a provider's test Direct message.
At Baylor Scott & White, diverse EHR technology is a given. The organization's central Texas division runs Epic software, and its north Texas division runs Allscripts and GE EHR software, Schneider says.
"We're trying to set things so that they happen, I'll call it, automagically," Schneider says. "At the end of the visit, what we want to have is to whom should this information be sent, and build that right into the EMR, so that when the visit is closed or the discharge takes place, that it automatically goes out to those people."