Meaningful use – Reach out to allies to improve interoperability, avoid stage 2 penalty.

If you’re not ready to share electronic health records (EHR) documentation with other practices, hospitals and ambulatory surgical centers (ASCs), you’re not alone — but you risk a 1% pay cut for failing to meet stage 2 meaningful use measures if you don’t call for help soon.

HHS recently reported that 39% of physicians say they electronically share data with other providers but only 14% electronically share data with ambulatory care providers or hospitals outside their organizations, according to the optimistically titled Aug. 7 HHS press release “More physicians and hospitals are using EHRs than before.”

If you’re one of the providers who can’t share data with other providers, you’ll fail to qualify when it comes time to attest to stage 2 meaningful use. One of the stage 2 core objectives is, “the EP [eligible professional] who transitions their patient to another setting of care or provider of care or refers their patient to another provider of care should provide a summary care record for each transition of care or referral.” The summary must be submitted electronically. If the 86% of providers whom CMS found incapable of sharing documents with their CEHRT technology don’t fix that, they won’t make stage 2.
Some providers are due to attest for three months of stage 2 compliance in 2014; they stand to lose $4,000 in incentives if they can’t exchange that summary record. A 1% penalty for non-compliance begins in 2015.
Challenges with interoperability
The problem is that EHR systems interoperability is not common, says James Deck, CEO of MTS Healthcare in Pasadena, Calif. Though vendors like to boast about compatibility, “establishing bidirectional connection is not
just plug and play,” he says.

“Getting EHRs to communicate is not difficult in theory, but in practice, it can be a real hassle,” says Sarah McMullin, customer development specialist for Camino Information Services in Spring, Texas. “Not all IT infrastructures are equal, and in the health care industry, there is a broad span of quality and funding for maintaining IT health.”
The big EHR companies aren’t helping, says Jeff Mongelli, CEO of Acentec Inc. in Irvine, Calif. “Creating a seamless flow between ECW [eClinicalWorks] and NextGen, for example, also means a NextGen user can more easily port their data to ECW and switch systems,” he says. “This ‘stickiness,’ or the difficulty of transitioning away to another system, is a factor for EHR companies to retain their client base. … As a result, you now have EHR companies attempting to dominate entire communities,” by pushing hospitals to require their providers to switch to their own EHR choice, for example.

6 tips to improve interoperability
If your system can’t talk to that of other providers, take these steps to improve your chances of meeting stage 2 meaningful use requirements:
Don’t modify the system yourself.
If you were thinking of getting a tech genius to go into the guts of your system code and modify its consolidated-clinical document architecture (C-CDA), the coding framework for electronic clinical documentation, to make it connect with your local hospital’s, don’t, says Mongelli. “First, it’s considered bad form to write to a vendor’s database without their support,” he says. “If it’s not done properly, it can corrupt a database or make it unstable.”
Also, if the vendor issues an update without your knowledge, the communication could break or the database can become unstable.
Finally, it probably would be a violation of your software contract, and the vendor “could go legal on you,” says Mongelli.
Contact your vendor to fix problems that prevent your system from communicating with another. It’s rare that a vendor can’t fix your problem, even if it’s a lack of interoperability with another vendor’s
system, says Mark Heaney, CEO of Get Real Health in Rockville, Md. So “hold vendors accountable,” he says. Make it clear that you expect a solution to the transfer problems and that you know they have the technology
and know-how to provide it. But be warned: “It takes time and energy” — and by energy, Heaney means money. Unless you have a very good scope-of-work contract with your vendor that requires them to do this for you, you’ll probably be paying big bucks for it.
Ask hospitals and ASCs to make changes on their ends that will aid your EHR connection. Even with the hospital’s help, setting it up will cost money, says Bob Robke, a vice president at Cerner, Kansas City,Mo. That’s why last December, OIG had to extend its safe harbor to include hospitals that were subsidizing practices’ EHR systems.
Look for state health information exchanges (HIEs). Not to be confused with health insurance exchanges, health information exchanges are state-level organizations funded by the federal government to promote the electronic sharing of health information among providers. They’re meant to be helpful and are often well-funded, Deck says. Recently, Anthem BCBS put up $80 million to start-up a new California HIE called Cal INDEX.Find a good health IT consultant. “Find one who has dealt with your EHR vendor,” says Heaney. Have him or her assess your system and help you deal with your vendor to establish connections.Find tips from EHR vendor user groups. Most EHR vendors have online communities in which users discuss their issues, says Heaney. You may find an issue similar to your own for which someone else has found a solution or even hook up with a consultant. — Roy Edroso (redroso@decisionhealth.com)
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