The federal government may have delayed the start of Stage 2 of meaningful use by a year, to 2014, but that does not mean healthcare providers should relax in their pursuit of the intended goals of the EHR incentive program, namely better, safer healthcare at lower cost.

"There's still a bit of a timing issue even though we have some relief," Pam McNutt, senior vice president and CIO for Dallas-based Methodist Health System, said at the annual College of Healthcare Information Management Executives (CHIME) Fall CIO Forum.

Indeed, thousands of healthcare facilities will be installing or upgrading their systems next year after vendors update their products to meet the new 2014 EHR certification standards, and that could create a backlog with suppliers. "Get on your vendor's schedule now," McNutt advised. Providers that meet Stage 1 by 2012 can start on the second stage in fiscal year 2014. For Medicare Part A, that begins Oct. 1, 2013, so time really is getting short.

Another complicating factor is the need to adjust clinician workflows even more than in Stage 1 and truly start involving patients in their care.

One of the quirks of the final Stage 2 rules is that providers no longer have full control over whether they qualify for some measures. The new standards require hospitals and individual "eligible providers" to offer 50 percent of their patients access to their own health records through a portal, up from 10 percent in Stage 1. And, 5 percent of patients actually have to use the portal.

"We have to be very creative in doing this," McNutt said. She reported hearing that some hospitals were going to game the system by asking their employees to view their personal records online.

Charles E. Christian, CIO of Good Samaritan Hospital in Vincennes, Ind., asked how many people in attendance would have a patient portal in the next couple of years. A smattering of hands went up. "It should be everybody," said Christian, whom CHIME last week named to its inaugural class of lifetime members. (Christian also took home the 2010 John E. Gall CIO of the Year Award from CHIME and the Healthcare Information and Management Systems Society. McNutt won CIO of the Year in 2002.)

Christian said meaningful use Stage 2 makes the portal "a given," in part because it can help satisfy another requirement that hospitals, physicians and other eligible providers generate an electronic summary care record for at least 65 percent of transitions of care and referrals. This must include a minimum of 10 percent of transitions or referrals to unaffiliated providers using a different EHR system, too.

Hospitals must also be able to transmit patient data to a portal or to a referring physician within 36 hours of discharge in Stage 2. This, too, will require a potentially major change.

"How many of your physicians actually dictate discharge notes within 36 hours of discharge?" Christian asked, and got silence. "Exactly," he said. "Well, guess what? You're going to have to."