The vendor also is building a personal health record to offer another tool for facilitating patient access to their information. The PHR will support a Continuity of Care Document at a minimum, but also will be able to access data from multiple sources. Further, MRO is becoming a health information services provider, which builds secure gateways for health organizations, to support the core measure for physicians to use secure messaging technology to communicate with at least 5 percent of patients, and to provide clients with Web domains and e-mail addresses.
Release of information outsource vendor IOD Inc., Green Bay, Wis., also is building an infrastructure to support view/download/transmit and secure messaging. The company has adopted the Direct Protocol messaging specifications embedded in an Inbox for physicians to communicate with patients, and is creating a digital rights system to manage the process of authenticating the identity of physicians and patients, says Bill Sweeney, chief technology officer. Among other features, a database from identity management firm IDology Inc. in Atlanta, will store specific consumer information pulled form a multitude of market intelligence and public records databases across the nation to ask patients specific questions, such as, "What was the name of your landlord in Washington, D.C."
IOD also is working with personal health record vendors HealthVault and Dossia to enable patients to access their records via the PHR platforms.
The Delay In Stage 2 Delivers A Convoluted Timetable
Under the original timetable for the electronic health records meaningful use incentive program, providers who were early adopters and attested the first time for Stage 1 in 2011, then again in 2012 during the second year of Stage 1 (each stage is two years long and requires two attestations to receive payments), only had a few months to get ready for Stage 2, which was to begin in October 2012 for hospitals and January 2013 for eligible professionals.
Providers and software vendors lobbied federal officials for a delay in Stage 2 and got it in the final Stage 2 rule, with the second phase now starting in October 2013 for hospitals and January 2014 for eligible professionals. Further, those who attested in 2011 got a third year to attest to Stage 1 meaningful use.
With the delay, the feds in the final rule laid out timetables for meaningful use reporting periods in Stage 2 and subsequent stages, but the timetables are a bit confusing.
Under the new timetables, providers in their first year of participation in either stage have a 90-day reporting period of their choosing, while subsequent years of the stage require a one-year reporting period. That seems simple enough. But there is an exception for 2014 when providers have a 90-day reporting period for Medicare-fixed by quarters in the federal fiscal year for hospitals and quarters in the calendar fiscal year for eligible professionals. Hospitals and eligible professionals can choose their quarter, and hospitals also would attest for Medicaid meaningful use under the federal fiscal year.
But Medicaid reporting periods for eligible professionals will vary according to the rule: "Medicaid EPs will attest using an EHR reporting period of any continuous 90-day period between January 1, 2014, and December 1, 2014 as defined by the state Medicaid program, or if the state so chooses, any 3-month calendar quarter in 2014." Put another way, that means no one presently knows when eligible professionals can attest to meaningful use in 2014 and that won't been known until states start deciding.
Understanding the various timetables for 2014 isn't rocket science, but there is a chance of trading partners not interpreting the timetables exactly the same way. "I think there's definitely some confusion out there," says Scott Rohleder, information technology director at Hays Medical Center, in Kansas. He strongly suggests that providers talk to all of their information systems vendors whose products play a role in achieving meaningful use to make sure they are on the same page about when certain reporting functionalities must be ready for providers so they can attest within the various 2014 attestation timetables.
Jeanne Day, director of health information management at Greater Baltimore Medical Center, doesn't believe the timetable is confusing, nor is the first-year, fixed 90-day Medicare attestation periods a problem, with one caveat. A provider wanting to start a reporting period in January 2014 but consequently isn't ready until February must wait two more months, until the April-June quarter, to start the reporting period. That means rather than being done in March 2014 and having six months to focus on ICD-10, they'll be done with meaningful use in June and may not be as far along with ICD-10 as they hoped to be. So, the fixed reporting periods could impose some degree of time pressure for other major projects an organization is working on.
Overall, however, moving Stage 2 to 2014 remains very beneficial for all involved in meaningful use, says Lorna Green, R.N., senior business analyst for document management vendor Hyland Software in Westlake, Ohio. "It just gives us a little longer time to make sure we have the functionality in place and for hospitals to implement it, and that it's done well."