FifieldLauren FifieldBY LAUREN FIFIELD

       Is your lab ready for Meaningful Use Stage 2? Beginning next year, Medicare-eligible providers will face a new set of requirements under the Meaningful Use program, the federal program incentivizing adoption and use of certified electronic health record (EHR) technology.
       While these requirements do not directly affect or apply to laboratories, they do affect how providers will assess and choose laboratories to work with. Learning about the impact of Meaningful Use Stage 2 will help your laboratory better respond to providers
that have concerns about meeting lab-related requirements.


       For background, participating professionals have been required to meet Meaningful Use Stage 1 requirements. Physicians in their third or fourth year of the program (as many as 60,000) will be required to meet stricter Stage 2 requirements beginning in 2014.
       Stage 2 includes more rigorous requirements for physicians to connect to laboratories and record orders. To meet Stage 1 requirements, physicians have to complete five ‘menu measures’ out of a set of 10, one of which is receiving 40% of lab results electronically. Stage 2 makes this measure required and raises the threshold to 55% of lab results. In effect, physicians will need to find a way to connect electronically to receive their laboratory results in structured data form, or lose out on thousands of dollars in incentives.
       In addition, physicians will also be required to use CPOE (computerized physician order entry) to record lab orders. While this doesn’t mandate physicians send orders electronically, it does make electronic ordering a more attractive feature for physicians, who would otherwise have to fill out and fax a lab order in addition to inputting the order into the EHR system. Laboratories that offer more advanced connectivity, including outbound lab ordering, may have an advantage in attracting providers to use their services.


       For providers, not having an electronic connection could mean the difference between earning thousands in incentives and losing between 1% to 5% in penalties over the coming years. Providers will be looking for laboratories that allow them to fulfill these requirements and gain additional benefits from using technology.

       While it is difficult to tell for sure how many providers will engage with their laboratories in new ways or look for new laboratory partners to meet Meaningful Use Stage 2 requirements, e-prescribing adoption trends may provide a good corollary with regard to motivation. From December 2008 to June 2012, the percentage of physicians e-prescribing on an EHR grew from 7% to 48%, accounting for 45% of prescriptions sent to pharmacies. Meaningful Use, which began requiring e-prescribing in 2011, drove this increase.
       Pharmacies had to adapt to meet this rising demand. The percentage of pharmacies accepting e-prescriptions grew from 76% to 94% over the same period. While laboratory ordering is not yet required in the way e-prescribing has been, electronic lab results and the expanded CPOE requirement will cause many physicians to think hard before choosing a solution that doesn’t offer lab results’ integration and, eventually, electronic lab ordering.


       According to the ONC’s statement on the clinical importance of lab results, “Incomplete or misplaced test results make efficient, safe, and effective clinical decision-making difficult. Having lab and test results in the patient’s record [within the EHR] allows for ease of access and reference when and where it is needed.”
       Beyond the need to fulfill incentive program requirements, electronic laboratory ordering and structured lab results cut down on errors for both the providers and laboratories alike, saving time and money while improving care. Electronic order submission, in particular, can help the provider choose the right test with the ability to select frequently ordered tests, previous tests for a patient, and tests they have marked as ‘favorites.’ Structured results sent back from the lab are linked directly to the patient’s chart to close the loop and avoid duplicate requests or administrative errors.
       Electronic orders also help laboratory vendors. A commonly cited statistic estimates that data entry from paper to computer systems typically results in about a 30% error rate, resulting in redundant work, delays, and higher overhead. With electronic ordering, information arrives directly and error-free in a laboratory information system (LIS), while also including information automatically prepopulated from a patient’s chart—such as insurance information, ABN-checks, and patient contact information. The result is better compliance for the physician and streamlined operations for the laboratory.


       Most laboratories will choose EHR partners based on where their customers are located. There are, however, certain differences to understand in how EHRs connect to laboratories and what they offer providers. These fall into four categories:

|1| EHRs that won’t be certified for Meaningful Use Stage 2
       An estimated 90% of EHRs are not yet certified for Stage 2, and many will still not be certified by the beginning of 2014. This will be most relevant for physicians who are pursuing incentive payments. However, certification will also likely be a barometer for EHR vendor viability as EHR users begin to switch solutions. Nearly one-quarter of providers are actively considering switching EHR systems, according to Black Book Rankings. Money invested in a connection to an EHR may end up wasted if the EHR is abandoned.

|2| Point-to-point desktop-based EHRs
       Many EHRs are desktop-based, installed directly on servers in the physician’s office. For these EHRs, point-to-point connections must be created for every provider or physical practice. These custom connections often take several months to install and configure, and costs apply for every new connection established, as well as ongoing maintenance. These connections may be worthwhile for high order volume and large practices, but if the practice decides to switch, the investment may be lost.

|3| Web-based EHR systems
       Web-based EHR systems often allow the laboratory to establish one connection to a central hub, which in turn can be used to connect to individual providers using the web-based system. This makes it more risk-free to the laboratory, which can recoup the investment of a customer who switches if they find new clients using the EHR that wish to connect.

|4| Web-based EHRs with API connectivity
       While web-based EHRs provide a more universal, risk-free connection, that connection can still take months to establish. The rise of API (application programming interface) technology offers a more seamless solution to connect with EHRs, provided they offer it. APIs are secure online connections that allow information to be shared instantly. Without knowing it, you use dozens of APIs each day just by searching the web, such as verifying credit card information when visiting a merchant website.

       These connections are instant and easy to establish, so it can take just a few weeks to establish a single connection with an EHR vendor that would serve all of your clients. The big advantage to this speed is that it allows laboratories to quickly meet the needs of their physician clients who lack the connectivity they need to meet new requirements.
       Meaningful Use Stage 2, while posing challenges for providers, is a big opportunity for laboratories to begin communicating with their providers digitally. In the beginning of 2014, a big push in that direction among providers will emerge. Laboratories that are aware of the EHR landscape will be able to use this momentum to streamline their operations, cut down on data entry errors, and bring more premium service to their clients.

Lauren Fifield serves as the senior health policy advisor, Practice Fusion, San Francisco. Fifield manages government relationships; stays attuned to the ever-changing landscape of legislation, regulation, and health industry developments; and  advocates for policies that promote improvements in health care delivery through innovation in health IT. She also serves on the executive committee of the Electronic Health Record Association. She wrote this piece on behalf of Practice Fusion.