Meaningful Use Stage 2 to Challenge Labs in 2014

Delay in MU stage 2 provides some relief, but deadline for ICD-10 stays at October 1, 2014

CEO SUMMARY: On December 6, the Centers for Medicare & Medicaid Services proposed to delay implementation of Meaningful Use (MU) Stage 2 until 2016. One reason is that only about 80 vendors have certified their products to MU Stage 2. That is a small proportion of the almost 900 vendors who hold MU Stage 1 certification for their electronic health record (EHR) products. If physicians must acquire a new EHR to comply with MU Stage 2, their laboratory providers will then need to build new LIS-to-EHR interfaces.

NATIONWIDE, A PERFECT STORM is brewing for information technology (IT) departments in hospitals, laboratories, and medical clinics.

This perfect storm will be caused by the need to meet meaningful use (MU) requirements at nearly the same time that physicians, hospitals, and clinical laboratories must switch from ICD-9 codes to the more-complex ICD-10 coding system that starts on October 1, 2014.

The good news for clinical labs and pathology groups is that on December 6, the federal Centers for Medicare & Medicaid Services (CMS) proposed extending the period providers need to demonstrate compliance with MU2 by one year. This would push the new deadline for MU2 compliance into 2016. Officially, federal officials said, MU Stage 2 compliance will be extended through 2016 and Stage 3 will begin in 2017 for providers who have completed at least two years in Stage 2.

“With these extensions, IT departments will have to juggle their priorities,” stated Ken Willett, Vice President, Health IT Strategy for Liaison Healthcare Informatics. “Also, because of the uncertainty about what providers will need to do to meet the requirements of MU Stage 2, this proposed delay will take some pressure off of IT departments.”

Liaison, based in Atlanta, helps hospital labs and clinical labs connect their laboratory information systems (LIS) to the electronic health record (EHR) systems of physicians and hospitals.

Few EHRs Meet Stage 2

Willett explained another problem that was causing grief for CMS. “To comply with MU Stage 1, providers could choose from more than 900 vendors with products certified to meet MU Stage 1,” he noted. “Currently, only about 80 developers have products certified to meet MU Stage 2.” This is a double-edged dilemma. CMS officials recognized that many hospitals and physicians now use EHR products that were certified to MU Stage 1. These providers would be reluctant to buy another EHR product that is MU Stage 2 compliant. However, only about 10% of the 900 certified MU Stage 1 systems are certified as compliant with MU Stage 2.

“The fall-off in the number of certified Stage 2 products was predicted because it is more expensive and time-consuming for vendors to get their EHR products to meet Stage 2 than for Stage 1,” explained Willett. “Now reality hits. Expectations are that many of the smaller EHR vendors—with a limited number of customers—will not be able to meet MU2 requirements and are thus likely to go out of business.

“If these smaller EHR vendors cannot continue to operate, physicians will have trouble accessing their longitudinal patient data,” he added. “This fear helps to explain why about 17% of physicians today are considering switching to another EHR system.”

This may be mixed news for clinical labs and pathology groups that have spent considerable money and time to interface their LISs to the EHRs of their client physicians. It means they would have to do a second interface if physicians bought a new EHR in order to meet MU Stage 2 requirements.

Established EHR Vendors

“For those physician groups considering a switch, the vendors getting the most con- sideration are the long-established EHR companies,” said Willett. “Included are companies such as AllScripts, Cerner, eClinicalworks, athenahealth, Practice Fusion, and GE.”

“Lab managers should know that many of the companies Ken named above are well established and had robust functionality established years before meaningful use was even a term used to describe an EHR system’s functionality,” declared Pat Wolfram, Liaison’s Director of EMR and Lab Integration. “What we see now in the EHR market is that a number of smaller companies that shipped new EHRs over the past six years have only achieved MU Stage 1 compliance. Now, in order to meet MU2, they have a great deal of work to still do.

“Expectations are that some of these smaller companies will struggle and, when they do, their client physicians will replace those EHR systems,” he continued. “In such instances, labs will need to develop new interfaces for physician clients who are moving on to their second EHR system.

“For hospital labs, the challenge is two-fold,” he added. “First, hospital labs will need to support the efforts of physicians to bring their ambulatory EMRs to MU ‘Eligible Providers’ compliance. Second, they will need to update their LIS and informatics systems in ways that allow their parent hospitals to demonstrate compliance with ‘Eligible Hospital’ MU requirements. This second effort will allow the hospitals to collect the financial incentives CMS is paying for meeting the MU2 requirements.”

“Independent labs may have it easier,” added Willett. “They do not have to meet MU2 requirements internally. Rather, they need to work closely with their client physicians to ensure that their physicians have the lab data needed for such compliance.”

CORHIO Supports Full Menu of Functions and Services

IN THE MEANINGFUL USE (MU) STAGE 2 REQUIREMENTS, physicians using electronic health record (EHR) systems will need to incorporate certain functions that include lab test orders and access to lab test data.

  • Computerized physician order entry (CPOE): must include lab test orders.
  • Incorporate lab results, which will become a core measure.
  • Electronic laboratory reporting (ELR) can be done either by sending directly from the LIS or by using the EHR.
  • For hospitals, Stage 2 necessitates transmitting electronic lab test results to outpatient providers.


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