he said, since the pattern is for optional metrics to become mandatory and mandatory thresholds to be raised.
"Stage 3 is going to be Stage 2, only bumped up," Johnson said. "I don't want to say it's going to be easy, but we're going to be in a better position to meet the measures" because of work invested in getting ahead now.
Among the most challenging aspects of Stage 2 are the metrics the organization can only influence, Johnson said. "Stage 1 is all technology, meaning IT can control it," he said. Stage 2 includes more requirements that the hospital partner with other institutions, with state government, and with patients.
An example is patient engagement, which requires showing that patients have accessed their own medical records or lab results through an online portal. In addition to implementing Cerner's patient portal, Penn Highlands created a full-time position for someone to coach patients on registering to use the portal.
"I think we needed 5% and got like 7 or 8%, so it wasn't an overwhelming response from people who were interested in doing that," Johnson said.
Stage 2 also includes several measures reflecting an organization's ability to exchange clinical information online. In the absence of a robust regional health information exchange (HIE) -- Johnson said the closest one is a two-hour drive away in Pittsburgh -- Penn Highlands had to implement its own HIE technology and seek organizations to exchange data with. "Everyone we contacted, they were saying we weren't ready," he said.
As a work-around, Penn Highlands met the requirement by inviting affiliated physician practices into a portal where each had its own secure inbox for viewing patient records and alerts. In other words, the hospital essentially had to implement the HIE infrastructure for its partners as well as itself.
The public health reporting requirements in Stage 2 were yet another challenge because they required the cooperation of state government -- a slow process of taking time to integrate with state systems for reporting immunizations or lab results requiring a report to the state, such as a positive test for Lyme disease. Johnson said he expects many organizations will dodge this requirement by clicking the "exempt" checkbox and claiming their state is not ready for this form of online reporting. "We did not click any 'exempt' boxes," he said.
While some healthcare executives debate the value of the meaningful use program, Johnson is convinced it "put health IT in the spotlight and really incentivized hospitals to do something they should have done but probably wouldn't have otherwise." In the process, it has "increased patient safety by some multiplier," he said. "The investment in health IT, patient safety, and quality measures -- clinical measures and outcomes -- that all accrues to our patients."
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