Meaningful use Stage 2 of the electronic health record incentive program is definitely tougher, with some particular elements – such as computerized physician order entry – that could catch some providers off guard, according to Laura Kreofsky, principal advisor at Impact Advisors, a consulting firm that helps providers comply with meaningful use.

It’s important to understand what has changed between Stage 1 and Stage 2 and making sure you're prepared for the changes, Kreofsky says.

"CPOE, one of the consternations of Stage 1, turned out to be a rather low-hanging fruit for most providers," she says. "But, that’s because if you look at the original denominator, just for medications – it was based on the number of unique patients with at least one medication order."

A physician who placed one of the 10 medications for a complex patient via CPOE met the requirement for Stage 1, Kreofsky says. 

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"Now you look to the new CPOE objectives; the denominator has changed to all orders entered, and it also includes radiology and lab," Kreofsy says. "The radiology and lab is not a particularly difficult objective for providers to wrap their arms around, because if they’re doing CPOE, they’re usually doing it across modalities. But, what gets tricky here is the ‘all orders entered’ requirement."

If a provider had the same patient with 10 medications under Stage 2 and ordered three of them via CPOE, he or she would not meet the new required threshold, which would require CPOE for all of the medications, she says.

"Providers who have been a little off on the CPOE margin or who have been inconsistently using CPOE could find themselves dipping below the threshold," Kreofsky adds.

"What’s different about CPOE, is we know it changes, numerator and scope and there is also a timing nuance here," she says. "There are something like four or five measures that change from Stage 1 to Stage 2, and they often take affect before Stage 2."

"There are some gotchas around timing of different requirements," Kreofsky says.

Kreofsky’s advises that physician practices run the numbers in 2013 to see what happens when the denominator is changed. Some percentage of doctors won’t pass. Organizations will then need to make a decision, on whether to implement the new denominator in 2013 or wait until Stage 2 and do a lot of intervention and coaching.

Do some target intervention to help doctors who aren’t doing so well with CPOE. They may know how to use it, but they may not understand the expanded requirements needed, she says.

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