Meaningful Use Stage 2 Is Problem for EHR Firms

Many smaller EHR companies are struggling to meet meaningful use rules; some won’t survive

CEO SUMMARY: EHR system vendors must now comply with the federal government’s Meaningful Use Stage 2 requirements. Well-established EHR vendors will survive. But smaller EHR companies may struggle to provide the enhancements to their first generation EHR products that are required to certify as MU Stage 2 compliant. These developments mean many physicians may need to find new EHR vendors. In turn, that will require clinical labs to build new interfaces to these physicians’ EHRs.

IN A TREND that has important consequences for many clinical labs and pathology groups, a significant number of EHR vendors are going out of business as they find it difficult to comply with the federal government’s Meaningful Use Stage 2 requirements.

“When EHR vendors go out of business, physicians using those EHR products and who want to continue using an EHR will need to go shopping again to select a vendor that complies with MU Stage 2,” stated Pat Wolfram, Director of EMR and Lab Integration for Liaison Healthcare Informatics in Alpharetta, Georgia. “Once that happens, clinical labs need to build new LIS-to-EHR interfaces in order to maintain the flow of lab test requisitions from those physicians.”

Because of this problem, for the second time in recent years, some labs find themselves building another interface to physicians forced to buy and install a second EHR. “Achieving MU Stage 1 compliance was relatively easy for EHR vendors,” explained Wolfram. “But meeting Stage 2 requirements is proving both complex and expensive for EHR vendors and that is causing some EHR companies to simply go out of business.

“The certification numbers tell part of the story,” he noted. “In 2011, the number of certified ambulatory ‘complete’ EHRs was 1,956. Last year, that number was down to only 547.

“Many small EHR companies have limited revenue and resources, making it impossible for them to get their Stage 1compliant EHR systems to meet the Stage 2 requirements, for three reasons,” Wolfram explained.

Struggle for Some EHR Firms

“First, when an EHR vendor wants to certify its EHR system as being Stage 2 compliant, it must put substantial development, quality assurance, and documentation resources into the process,” he said. “It’s a significant expense for some of the vendors. Second, the features required in MU Stage 2 are much more complex. This makes it harder for EHR vendors to develop, test, document, and train users compared to MU Stage 1 requirements.

“There is a third factor that every new software vendor has to address: the EHR system must complement physician workflow,” noted Wolfram. “To do that job well, the EHR vendors must master clinical workflows and enable the secure and convenient management of chart data. Clinical content must be easy to record in the EHR.

“Further, the EHR system must store clinical content securely, allow it to be accessed only by authorized users, and then make such data reportable in a manner that helps with disease management and illness trending,” he added.

Wolfram identified a related problem. “Some of the larger EHR vendors have accumulated multiple EHR products through mergers and will not continue to support them all,” he observed. “And even though they provide a migration path from the sunsetted EHR to one that the vendor is supporting, it still means a new EHR for some practices, something new to learn, and a new interface for a lab to build. There are cases where the practices are deciding to go EHR shopping again, instead of defaulting to another EHR from their original vendor.

“Because far fewer EHR vendors will comply with MU Stage 2, labs face both a new cost and a potential opportunity,” noted Wolfram. “The new cost is that physicians will be selecting a new EHR vendor and labs will need to interface to those systems. That will be both expensive and time-consuming for labs.

“On the other hand, this is also an opportunity for labs,” he continued. “Labs now have experience with multiple EHR products, so they can advise physicians on which EHR vendors have solid lab integration capabilities. Most physicians assume an EHR can integrate well, but that’s not always the case.

“When a client physician is considering that next EHR, the lab should step forward and share its experience gained from writing LIS-to-EHR interfaces with different EHR systems,” advised Wolfram. “In these situations, the lab has credibility because it is already working with different EHR systems. Physicians who want to get it right with a second EHR purchase will listen to their laboratory’s recommendation on these points.”

LIS-to-EHR Interface Checklist of Features

NY CLINICAL LABORATORY receiving lab test orders from physicians may want to advise physician clients on which EHR features are important to evaluate, said Pat Wolfram, Director of EMR and Lab Integration for Liaison Healthcare Informatics. To do so, physicians should ask questions to help determine if the EHR vendor will provide a product that can meet Meaningful Use Stage 2 and support the business for the long term.

Here are the questions:

  • MU Stage 2 requires physicians to record lab orders in the EHR chart record. Is it easy for the physician to record diagnostic tests?
  • MU Stage 2 requires that numeric lab results import as structured data to the patient chart. Can the vendor demonstrate this feature?
  • Does the EHR have its own result code database, such as LOINC? If so, the lab or clinic must be prepared to cross map the lab result codes to the codes of the EHR.
  • Can the EHR vendor show how it handles lab results that don’t match to the patient’s chart?
  • Must an EHR’s imported lab result be associated with an order from that EHR? If yes, then the EHR will have trouble supporting unsolicited lab results.
  • Can the EHR import a clear and understandable lab report? In particular, make sure the clinic evaluates the clarity of pathology and microbiology lab reports. If these are not satisfactory, then can the EHR import a lab report in PDF format?

Contact Pat Wolfram at 971-255-9282 or


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