I have frequently said that meaningful use is a primary-care program, and I still maintain that it was designed with primary-care physicians and their patients in mind. But I believe that specialists will be the greatest beneficiaries of Stage 2’s shift in focus to interoperability. If EHR vendors expand upon the groundwork laid by meaningful use, they will provide physicians with not only a reliable way to get information about their patients’ clinical history, but also an efficient way to reconcile that information and incorporate it into their charts.
As increasing amounts of discrete clinical data is shared between physicians—Stage 2 adds new elements to the Stage 1 required data set—many physicians will find themselves subject to significant workflow disruptions as they struggle to incorporate all of this data into their patient charts. The workflow impact is clearly greatest when the physician sees a new patient, so specialists—for whom new patients typically constitute 25–35% of their office visits—will feel the impact more intensely than primary-care physicians, who may see only a few new patients a week.
How does the physician get this data into the patients’ chart, and where should the data come from? While patients are a good source of demographic data, the primary-care physician is the best source of an authoritative and vetted record of the patient’s health history. Stage 2 of meaningful use creates standards that facilitate the transport of this clinical data from the primary-care physician to the specialist via the “Direct” messaging protocol—a secure e-mail-like exchange process. The data is sent in a standard format called the CCDA (Consolidated Clinical Document Architecture). But this is where meaningful use ends, leaving it up to the recipient of the data to incorporate it into the patient’s digital chart, and this can be time-consuming and disruptive to workflow if the process is not automated.
For physicians, having the tools to accomplish these tasks in an efficient, productivity-focused manner will be a veritable game changer. It will not be sufficient for an EHR to merely display the data from the primary-care physician. Rather, it will be critical for vendors to provide physicians with an efficient means of reconciling this data and automating the process of entering the approved discrete clinical data elements into the patients’ charts. The key for EHR vendors will be to go above and beyond the requirements specified by meaningful use.