Meaningful Use: Stage 2 Obstacles for Medical Practices

March 20, 2014

North Carolina-based Novant Medical Group is like a lot of medical practices: It has attested to Stage 1, but it is bracing for Stage 2 hurdles.

One provider practice that has benefitted from early adoption of its EHR is Novant Medical Group, headquartered in Charlotte, N.C. Novant is an integrated healthcare system with 14 medical centers and more than 1,000 physicians in 343 locations in the Southeast covering North Carolina, Virginia, Georgia, and South Carolina.                              

Novant's online patient portal has been particularly successful in engaging patients, which the practice hopes will help pave the way to meeting the EHR Incentive Program's Stage 2 patient engagement requirements. One particularly troublesome requirement is that more than 5 percent of unique patients must view, download, and transmit their health data in 2014. The key distinction is those attesting for meaningful use in Stage 1 only need to prove they provided patients online access to such information, and those in Stage 2 will need to attest for use.

Henry Capps Jr., senior vice president physician services for Novant, said vendor partner selection was a critical decision that affects transitioning to Stage 2 and beyond.

"Whether you are large or small [practice], the dynamic is the same, which is you have to have a vendor partner that keeps up, you have to have a mechanism inside your individual office, whether you're small or up to an enterprise like we are, that enables you to have some of the latest technology that's going to be necessary," Capps said. "The stages are really purposefully designed to either push you toward that or you fall off the chart because you have not been able to keep up."

Capps said that having a communication strategy was critical to achieving the Stage 1 requirements of meaningful use with so many physicians. In fact, Novant hired a marketing director to help get the word out about the incentive program among its physicians.

As of February 2014, 99.7 percent of Novant's physicians had successfully attested and the health system received $20 million in meaningful use dollars.

Keith Griffin, Novant's co-chief medical information officer, said meeting Stage 2 will present challenges since the threshold of patient engagement goes from 50 percent to 80 percent of patients. "I think a lot of the things that you do for Stage 1 and Stage 2 are the same, but the thresholds go up so it's harder to meet the same measure that you met the year before."

Griffin said the two requirements of Stage 2 that Novant will have to pay careful attention to are transitions of care and patient engagement with the portal.

"With transitions of care, you're not just giving after-visit summaries, but you're sending electronic conditions of care [documents] to people who are discharged from the hospital or are going to another provider so we're working on that work flow or process," he said. "The other one that is potentially onerous and a challenge for people to meet is … patient engagement where 5 percent of the patients have to send you a message to the portal."

Given the relative success of its member portal, Griffin said that of the current Novant physicians that will attest to Stage 2 in October, over half of them are already meeting the 5 percent threshold.

"If the doctors don't have enough patients on My Chart (the member portal), then there's no way they can meet it," Griffin said. "So we're really focusing on making sure doctors have a critical mass of My Chart patients."