Even though the federal government has delayed the implementation of Stage 2 meaningful use criteria until 2014, AAOS members should not relax efforts to incorporate electronic medical records (EMR) into their practices. It is important to continue pursuing the goals of the government’s electronic health records incentive program—namely, better, safer health care at lower costs.

“Don’t stop now,” says Richard M. Dell, MD, a member of the AAOS Electronic Health Records Project Team. “AAOS members should be calling their EMR vendors and asking when their practices can get on the schedule for updating software to meet Stage 2 requirements. With thousands of medical practices and hospitals—each one expecting prompt vendor services to update their systems—competing for time and attention, it’s important that individual and group practices make sure they’re not forgotten.”

Any provider who meets Stage 1 requirements by the end of 2012 can start with Stage 2 requirements in calendar year 2014. For Medicare Part A, Oct. 1, 2013, is the start date, just nine months off.

What may be required
Stage 2 meaningful use requirements ask orthopaedic surgeons to adjust their workflows even more than Stage 1 did. A significant change is to involve patients in their care.

“As physicians, we don’t have full control anymore for some measures,” said Dr. Dell. “We need to rely on our patients to help us meet Stage 2 requirements.”

The final Stage 2 rules require orthopaedic surgeons to provide more than half of their patients with timely (within 4 business days), online access to their own health records through a secure patient portal. Under Stage 1 rules, online access for only 10 percent of patients was required. Even more significant, more than 5 percent of patients actually have to use the portal to view, download, or transmit their health information to a third party.

Creating a secure patient portal requires time, testing, tracking, and a patient communication plan. In particular, orthopaedic surgeons should ask themselves the following questions:

• How will you motivate patients to access their records?
• Does your vendor’s software provide the necessary security authentication systems to ensure that you are meeting HIPAA privacy and security requirements?
• What training will your office staff members need?

Documentation
Further, to meet Stage 2 requirements, hospitals will be placing new requirements on all physicians for patient discharge documentation on both inpatient and emergency department encounters. Stage 2 rules require hospitals to provide more than 50 percent of patients with online access to their health information within 36 hours of discharge. Similar to the requirement for physicians, more than 5 percent of discharged patients have to view, download, or transmit their health information to a third party.

Hospitals must provide a summary of care record for more than 50 percent of transitions of care and referrals. They must also provide an electronic summary of care record for at least 10 percent of patient transitions to unaffiliated referring physicians who use different EMR systems.

“When was the last time any of us completed patient documentation for in-hospital care within 36 hours?” asked Dr. Dell. “Orthopaedic surgeons can expect significant pressures from hospital administration to help achieve this requirement.”

Howard Mevis is the AAOS director of the electronic media, evaluation programs, course operations, and practice management group. He can be reached at mevis@aaos.org

Additional information
How to attain meaningful use criteria
Final rule—Electronic Health Record Incentive Program
AAOS Electronic Medical Records Information and Resources (member login required)
Stage 1 meaningful use toolkit (member login required)