Meaningful Use stage two—and stage three: Labs take the lead

Nov. 20, 2015

Meaningful Use (MU) was first established in the Health Information Technology for Economic and Clinical Health (HITECH) Act of 2009 as a voluntary program for hospitals and physicians using certified electronic health record (EHR) technology. It was hoped that successful MU compliance would result in improved clinical outcomes, increased transparency, and individual patient empowerment, which would ultimately result in improved population health. MU has often been referred to as a “carrot and stick” program, with initial incentives in the first few years for compliance—and then penalties in subsequent years for noncompliance.

Hospitals and physician groups continue to struggle as MU enters its second stage, especially now that the penalties (euphemistically called payment adjustments by the Centers for Medicare and Medicaid Services) have kicked in, effective January 2015. These penalties are not small. Starting this year, the penalty is one percent to two percent, depending on whether the particular professional was subject to the pharmacy (e RX) component in 2014. For 2016, the penalty for those who are noncompliant is two percent. For 2017 the penalty is three percent, and by 2018 the penalty could be as high as five percent for those who are not MU compliant if greater than 75 percent of the eligible professionals are Meaningful Users. As Medicare already accounts for more than 50 percent of most hospitals’ revenues, and it tends to be one of the lower reimbursing payers to begin with, this additional reduction in payment can have a substantial negative effect on the ultimate financial performance of the institution. From this financial perspective alone, regardless of the clinical benefits and operational efficiencies, it is imperative that hospitals and physicians stay on top of MU.

The first part of MU, stage one (starting years 2011-2012), focused on basic data capturing and sharing. Stage two now includes more advanced clinical processes. Stage three (starting 2016) will focus on clinical outcomes. Stage one required eligible hospitals to meet 11 required core objectives and five elective objectives (from a total of 10 listed). In addition to the basic requirements of stage one, the second stage of MU now requires 16 core objectives and three electives (from a list of six), including the submission of electronic reportable laboratory results into EHR technology for both hospitals and providers. The ante has been raised for all. The lab is now a major player.

As the role of the clinical laboratory has expanded, the MU process has given the lab a new opportunity to provide truly meaningful medical information to the entire healthcare system. As patients become more involved with their own healthcare through increased health literacy, the opportunity only grows for the lab to provide information to individual patients as well as members of the healthcare team.

In many ways, the MU processes are no strangers to the labs. According to Dr. Kenneth Blick, Professor and Laboratory Director, OUHSC and Oklahoma University Medical Center, “The laboratory is really the poster child for Meaningful Use. We set the mark years ago.” To many labs, the initiatives now required by the second stage should be old hat. The laboratory system pioneered interfaces to EHRs years ago.

There will be continuing technical challenges for the laboratory. The EHR requires a coding system called LOINC (Logical Observation Identifiers Names and Codes). As standardization is implemented, there will be road blocks, such as the fact that not all systems currently use LOINC and the LOINC system itself can be difficult to implement because of its granularity. For example, there are over 60 different LOINC codes for glucose. These are difficult tasks for the lab.

But true MU is much more than connectors, software, and interfaces. From the perspective of the lab, MU should be truly meaningful in terms of the total care of the patient. Simply sending a lab result to a clinician or patient is not sufficient. Since approximately 80 percent of all lab studies ordered are for follow-up tests, the single value usually means little unless it is tied to previous studies. In order to be most useful, the provider or patient should be given the result in the context of the history, in other words, the serial values and significant trends.

Also, the information should be made available to the physician and the patient in real time. The trend in healthcare is to move faster. Delays in information processing can cost lives. Additionally, individual lab values need to be normalized to one scale if they were obtained on different machines.

More and more caregivers and patients are relying on mobile devices. In fact, I give an entire presentation to physicians entitled “Practicing medicine on the Smart Phone.” True MU means the ability to provide this information on the right device as well.

So I applaud the efforts of the physicians and the delivery system as we implement stage two. The lab has the capabilities already to produce truly meaningful information. Most of the world will be focused on the logistics—the connectors and the interfaces. Now labs have the opportunity to be able to provide more value than ever for patients and clinicians by providing real time trended data that will be able to proactively help achieve Meaningful Use’s third stage goals—better clinical outcomes. Let the lab lead the way. As Blick says, “We as laboratories can truly step to the plate and help to contribute valuable information to healthcare providers and patients.”

Steve Berkowitz, MD, has more than 25 years of experience in healthcare management and consulting. He serves as Chairman of the Board of the Texas Institute for Healthcare Quality and Efficiency, and for 13 years, he was the Chief Medical Officer of St. David’s Healthcare, a six-hospital system in Austin, Texas. He directs healthcare organizations on how they can improve quality care and organizational health.