Among the reasons why federal officials recently proposed new flexibility in the electronic health records meaningful use program was the inability of vendors to get their products ready in time for Stage 2.

Stakeholder pleas that the final timetable for Stage 2 was unrealistic--particularly with ICD-10 compliance looming at the same time--had landed on deaf ears. The government was not attuned to the vendor community, recalls Stephen Dart, product manager for mobile and EHR products at ambulatory software firm ADP AdvancedMD. That was borne out on May 6 when the Centers for Medicare and Medicaid Services announced that only four hospitals and 50 physicians had attested for Stage 2.

AdvancedMD, which sells a cloud-hosted, single-database practice management and electronic health records system along with billing services to small practices, was among those struggling to be ready.

Stage 2 has multiple challenges for vendors, such as the need for codified vocabularies to support the Clinical Document Architecture standard for a summary of care and interoperability, Dart notes. Another challenge is the requirement to support secure messaging using the Direct Project protocols. It’s one thing to say to do it, he explains, and another to make it useful and easy to use in the workflow.

And, with hundreds of vendors establishing relationships at the same time with health information service providers who offer secure messaging, selecting a partner and getting the contract done takes time. “Smaller organizations serving smaller physicians find it tough to get on the radar of other vendors,” he adds. Doing ICD-10 at the same time exacerbated efforts of vendors to finish both projects with limited resources. Dart calls the scenario “death by a thousand cuts across the industry.”

AdvancedMD expects by mid-year to have its EHR certified under the 2014 Edition criteria and its 13,000 physicians and 60,000 total users will have quick access to the cloud-based system because on-site implementation is not necessary. The company now is working on educating physicians on new data reporting requirements under Stage 2. Among other services, it is rolling out short YouTube videos on how collecting data impacts meaningful use measures.

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