Mining for Clinical Gold in Government Red Tape

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 - Red Tape

In dissecting stage 2 of meaningful use, Alberto Goldszal, PhD, summarizes the meaningful-use challenge for radiologists: “In the meaningful-use rules, you are going to see some specific examples of things that are changing the radiology workflow that are perceived as a contraindication for radiology efficiency,” he says. “Overall, it does improve patient care—at least, that is the intended goal.”

Goldszal is CIO of University Radiology (East Brunswick, New Jersey), an 83-radiologist practice. On December 3, 2013, at the annual meeting of the RSNA in Chicago, Illinois, he was a copresenter of “Impact of Legislative Policy and Regulations in Imaging Informatics.”

With meaningful use here to stay, Goldszal’s approach has been to roll up his sleeves and get to work. University Radiology attested to stage 1 in 2011 and is deep in preparations to attest to stage 2 in 2014. 

Complying with stage 2 will add considerable complexity to the radiology practice’s IT infrastructure, but it also will protect the practice from penalties scheduled to commence in 2015. Ultimately, Goldszal suggests, the universal adoption of electronic health records (EHRs) could lead to the simplification of information exchange.

With meaningful use rolling out in three (or more) stages, early adopters are on the cusp of the transition to stage 2. About 40% of the nearly 1 million US physicians have implemented certified EHR technology and received incentive payments. Just 14% of radiologists can say the same. 

Of radiologists who have earned incentives, most are in stage 1, but some are transitioning to stage 2, Goldszal says. No matter when a radiologist begins attesting to stage 1, he or she must do so for two years.

“The initial stage is actually quite boring because it focuses on data collection, and you do not see the benefit of it—just the labor,” Goldszal says. “The hope is that future stages will provide improvements in clinical processes and will benefit clinical outcomes.”

The focus, in stage 2, is on advanced clinical processes, with rigorous information exchange, transmission of patient-care summaries across settings, and increased family/patient engagement. For stage 1, eligible professionals had to implement a 2011 edition of certified EHR technology; for stage 2, there is a 2014 edition, and some EHRs already comply. To earn incentives, eligible professionals must meet core, menu-set, and clinical-quality measures. These have been modified—with implications for radiology. 

Core Measures

In stage 1, there were 15 core measures (six of which have been folded into other measures in stage 2); there are 17 core measures in stage 2. Some stage 1 menu-set measures have been moved to the core objectives. Eligible professionals may request exemption from some (but not all) core measures. In this list, the percentage following the name of the measure refers to the number of patients to whom the measure must apply.

  • Computerized Provider Order Entry (CPOE), 60%/30%/30%, and Electronic Prescribing (50%): Objectives 1 and 2.—Every certified EHR must be capable of both CPOE and electronic prescribing, but physicians can claim exemptions from both. In stage 1, physicians had to prescribe medication for 30% of patients using CPOE, and in stage 2, that jumps to 60%, and 30% of radiology orders have to be entered electronically—in the referring physician’s electronic medical record system. 
  • Drug/Allergy Interaction.—Physicians will continue to be required to do drug–drug and drug-allergy checks before they dispense a medication, but the measure will be folded into the clinical decision-support measure. 
  • Problem List (80%).—Compiling patient problem lists is straightforward, but is no longer a separate measure because it has been merged into the transition-of-care record. 
  • Patient Demographics (50%): Objective 3.—“Every patient who comes into our hospital or clinic gets registered in our system, so this is not very challenging,” Goldszal notes. 
  • Medication List and Allergy List.—This has been merged into the transition-of-care measure and is therefore mandatory. Goldszal hopes that as certified EHR technology is universally adopted, the referring physician will electronically transmit this information to the radiologist. 
  • Vital Signs (50%): Objective 4.—“You can elect to be excluded if you believe that collecting vital signs is not an essential part of the radiology service,” Goldszal says. “We believed it was not meaningful for all exams. We do