Tech firms refocus to address Stage 3 meaningful-use rules

A new group of innovators are entering the final phase of the federal electronic health-record program as its focus shifts away from implementation and toward quality outcomes and patient-centered data exchange.

Stage 3 meaningful-use rules—which outline what providers need to do to get incentive payments for EHR adoption and how developers can ensure their systems are certified for the program—further emphasize tools to help with clinical decisionmaking, increase electronic communication between physicians and patients, and incorporate patient-generated data into the EHR.

They also aim to promote greater interoperability among EHR platforms, whether data are being shared among providers, between providers and their patients, or with public health agencies.

That call is being answered not only by traditional EHR companies, but also by a number of digital-health hopefuls. Allscripts was on hand at the recent Health 2.0 conference promoting a program that invites outside programmers to create apps that can integrate with its EHR.

While some of those applications deal with practice management issues such as scheduling and billing, others focus on patient engagement, or how to transfer data from testing devices directly into a patient's record.

The thrust of the meaningful-use rules has been documentation, or how doctors record information about their patients, said Stanley Crane, Allscripts chief innovation officer. But the company wants to be a “platform for innovation,” he said.

“The brilliance of Apple is not that they created the (iPhone) technology,” he said. Rather, the iPhone created the platform for developers to design mobile apps that create a customized experience for each iPhone user.

The focus on patient-generated data in Stage 3 is good for companies such as Validic, which aims to provide a platform from which its clients can access information from dozens of digital health apps, from wearable pedometers such as Fitbit to a blood pressure monitors like Omron's.

Validic has partnered with EHR vendors Cerner Corp. and Meditech, which integrate the data directly into EHR platforms. The company's health system clients such as Sutter Health and UPMC similarly flow data into their Epic EHR systems, said Validic's co-founder and chief technology officer, Drew Schiller.

But the future is not only in data aggregation, tech innovators say, but in platforms that can read that data and alert a clinician when a patient may need an early intervention.

“What we're talking about is this new era of cognitive computing,” said Dr. Kyu Rhee, chief health officer at IBM.

IBM Watson Health is working to create a platform that can take the unstructured data that physicians enter into an EHR and use it, for example, to offer a differential diagnosis. Its latest software application, the Watson Care Manager, can collect data from wearable and remote monitoring devices, and identify warning signs before a patient becomes acutely ill.

That level of automated feedback may be the missing link to explaining why EHR use by itself has not been linked to improved quality outcomes, Rhee noted.

“This fits completely (into) this whole concept of interoperability,” he said. “It's about 'how do you translate big data into big insights?' ”

Still, the CMS wants to make it easier for providers to adhere to Stage 3 of meaningful use. Only a single patient per payment year has to electronically view, download or transfer their health information to meet requirements.