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Proposed meaningful use stage 2 criteria

The meaningful use stage 2 proposed rule is here. These charts list the core and menu requirements, the philosophy behind them and how they have changed since stage 1.

The Centers for Medicare and Medicaid Services (CMS) has released the proposed rule for the meaningful use stage...

2 criteria for electronic health record (EHR) technology.

Farzad Mostashari, M.D., head of the Office of the National Coordinator for Health IT (ONC), outlined the proposed criteria at the Health Information and Management Systems Society's HIMSS 2012 conference. In discussing stage 2, Mostashari noted several differences when compared to the meaningful use stage 1 criteria, which were finalized in July 2010 and went into effect three months later.

  • There is an increased focus on patient-centered care, and not just in giving patients their personal health information (PHI). Patient engagement will also matter.
  • Likewise, patient safety has been incorporated into meaningful use stage 2 criteria.
  • Health information exchange (HIE) will move from simply testing connections to actually using them, with "a big push on standards-based exchange" by 2014, according to Mostashari. To that end, the Direct Project will be the standard for HIE.
  • Systematized Nomenclature of Medicine - Clinical Terms (SNOMED CT) terminology will be the single standard for problem lists.
  • Radiology image viewing, absent from stage 1, is now an optional criterion in stage 2.
  • Physicians working in a group setting can submit data pertaining to clinical quality measures as a group instead of individually.
  • The permanent EHR certification process will be in place by the summer of 2012, having been pushed back from its original start date of Jan. 1, 2012.

When does stage 2 of meaningful use begin?

Stage 2 begins on Oct. 1, 2013, which is the first day of the 2014 federal fiscal year, for hospitals and eligible providers (EPs) who meet stage 1 of meaningful use in 2011 or 2012. For organizations that meet stage 1 of meaningful use in 2013 or later, stage 2 begins two years after that organization meets stage 1.

That timeline has changed since the HITECH Act. When stage 1 went into effect, hospitals and EPs that completed meaningful use attestation during the 2011 federal fiscal year (which ended Sept. 30, 2011) were expected to begin stage 2 in the 2013 federal fiscal year. Some viewed this as a disadvantage to the organizations that were among the first to demonstrate the meaningful use of EHR.

In December 2011, however, CMS announced a meaningful use stage 2 delay. Organizations that had already completed meaningful use attestation for stage 1 were allowed to wait until 2014 to begin meeting stage 2 requirements. The delay puts hospitals and EPs who complete meaningful use attestation in 2011 on the same timeline as those who attest in 2012, meaning that both must begin meeting meaningful use stage 2 criteria in 2014.

The charts below outline the core (required) and menu (optional) meaningful use stage 2 criteria and indicate how, if at all, the requirements differ from stage 1 criteria.

Core meaningful use stage 2 criteria

Hospitals and eligible providers must meet, or qualify for an exclusion to, all of these requirements. There are 17 core requirements for EPs and 16 for hospitals.

Requirement

EPs

Hospitals

Change from Stage 1

Use a computerized physician order entry (CPOE) system.

Use for 60% of all medication, laboratory, and radiology orders.

Use for 60% of all medication, laboratory, and radiology orders.

Increases from 30% of all orders.

Generate and transmit permissible prescriptions electronically (e-prescribing).

Using certified EHR technology, write and transmit electronically at least 65% of all permissible prescriptions.

N/A.

Increases from 40% of all prescriptions.

Record demographic information.

Record preferred language, insurance type, gender, race, ethnicity and date of birth for 80% of all unique patients.

Record preferred language, insurance type, gender, race, ethnicity, date of birth and (if applicable) date of death for 80% of all unique patients.

Increases from 50% of all patients.

Record and chart changes in vital signs.

For at least 80% of all unique patients 2 years of age and older, record height, weight and blood pressure; calculate and display body mass index, and plot and display growth charts for patients 2 years old to 20 years old, including BMI.

For at least 80% of all unique patients 2 years of age and older, record height, weight and blood pressure; calculate and display body mass index, and plot and display growth charts for patients 2 years old to 20 years old, including BMI.

Increases from 50% of all patients.

Record smoking status for patients 13 years old or older.

Record for at least 80% of all unique patients.

Record for at least 80% of all unique patients.

Increases from 50% of all patients.

Use CDS to improve performance on high-priority health conditions.

Implement five clinical decision support interventions related to five or more clinical quality measures. In addition, enable and implement functionality for drug-drug and drug-allergy interaction checks.

Implement five clinical decision support interventions related to five or more clinical quality measures. In addition, enable and implement functionality for drug-drug and drug-allergy interaction checks.

Moves beyond simply implementing rule relevant to specialty or high clinical priority / hospital condition.

Incorporate clinical lab-test results into EHR systems as structured data.

Incorporate into certified EHR technology more than 40% of all clinical lab-test results that are given in a positive/negative or numerical format.

Incorporate into certified EHR technology more than 55% of all clinical lab-test results that are given in a positive/negative or numerical format.

Moves from menu to core requirements. Increases from 40% of all test results.

Generate lists of patients by specific conditions to use for quality improvement, reduction of disparities, and outreach.

Generate at least one report listing patients with a specific condition.

Generate at least one report listing patients with a specific condition.

Moves from menu to core requirements.

Send electronic reminders to patients per patient preference for preventive or follow-up care.

Send reminders to at least 10% of all unique patients seen by the EP in the 24 months prior to the reporting period.

N/A.

Moves from menu to core requirements.

Track medication orders using electronic medication administration recording.

N/A.

Track 10% of medication orders.

New.

Provide patients with timely electronic access to their health information.

Provide electronic access to the health information of at least 50% of all unique patients within four business days of that information being made available to the EP. See that at least 10% of all unique patients view, download , or transmit to a third party their protected health information (PHI).

N/A.

Moves from menu to core requirements. Increases from 10% of all patients.

Let view online, download, and transmit information about a hospital admission.

N/A.

Offer this feature to 50% of patients within 36 hours of discharge. See that at least 10% of all unique patients view, download , or transmit to a third party their PHI.

New.

Provide clinical summaries for patients for each office visit.

Provide summaries to at least 50% of patients within 24 hours of an office visit.

N/A.

New.

Use EHR technology to identify patient-specific education resources, and provide those to the patient as appropriate.

Provide to more than 10% of patients.

Provide to more than 10% of patients.

Moves from menu to core requirements.

Provide online, secure patient messaging.

Send a message to at least 10% of unique patients.

N/A.

New.

Perform medication reconciliation at relevant encounters and at each transition of care.

Do so for at least 65% of encounters and transitions.

Do so for at least 65% of encounters and transitions.

Moves from menu to core requirements. Increases from 50% of all encounters.

Provide summary care record for each transition of care and referral.

Do so for at least 65% of transitions and referrals. For at least 10% of transitions and referrals, transmission should go to a recipient with no organizational affiliation and using a different Certified EHR Technology vendor than the sender.

Do so for at least 65% of transitions and referrals. For at least 10% of transitions and referrals, transmission should go to a recipient with no organizational affiliation and using a different Certified EHR Technology vendor than the sender.

Moves from menu to core requirements. Increases from 50% of all encounters. Adds interoperability requirement.

Submit electronic data to immunization registries, and actual submission where required and accepted.

Successfully submit data.

Successfully submit data.

Moves from menu to core requirements. Moves beyond simply testing the EHR system.

Provide electronic submission of reportable lab-test results (as required by state or local law) to public health agencies, and actual submission where it can be received.

N/A.

Successfully submit data.

New.

Provide electronic syndromic surveillance data to public health agencies and actual transmission according to applicable law and practice.

N/A.

Successfully submit data.

Moves from menu to core requirements.

Protect electronic health information created or maintained by the certified EHR technology through the implementation of appropriate technical capabilities.

Conduct or review a security risk analysis and implement security updates as necessary.

Conduct or review a security risk analysis and implement security updates as necessary.

No change.

Menu meaningful use stage 2 criteria

Hospitals may choose two of four requirements, while EPs may choose three of five.

Requirement

EPs

Hospitals

Change from Stage 1

Record advance directives for patients 65 years of age or older.

N/A.

Do so for at least 50% of patients 65 years of age or older.

No change.

Make imaging results and information.

Make more than 40% of all scans and tests whose result is an image accessible through certified EHR technology.

Make more than 40% of all scans and tests whose result is an image accessible through certified EHR technology.

New.

Record patient family health history as structured data.

Enter data for one or more first- degree relatives for at least 20% of all unique patients.

Enter data for one or more first- degree relatives for at least 20% of all unique patients.

New.

Generate and transmit permissible prescriptions electronically (e-prescribing).

N/A.

Compare at least 10% of hospital discharge medication orders for permissible prescriptions to at least one drug formulary and transmit the order electronically.

New.

Provide electronic syndromic surveillance data to public health agencies and actual transmission according to applicable law and practice.

Successfully submit data.

N/A.

No change.

Identify and report cancer cases to a state cancer registry, except where prohibited, and in accordance with applicable law and practice.

Successfully submit data.

N/A.

New.

Identify and report specific cases to a specialized registry (other than a cancer registry), except where prohibited, and in accordance with applicable law and practice.

Successfully submit data.

N/A.

New.

Meaningful use stage 1 criteria eliminated in stage 2

The following requirements apply to stage 1 but are not listed among the meaningful use stage 2 criteria. All quotes come directly from the proposed rule.

  • The "exchange of key clinical information" core objective from stage 1 will be re-evaluated in favor of a more robust "transitions of care" core objective in stage 2.
  • The "Provide patients with an electronic copy of their health information" objective has been replaced by an "electronic/online access" core objective.
  • Multiple stage 1 objectives have been combined into more unified stage 2 objectives. For example, the Stage 1 objectives of maintaining an up-to-date problem list, active medication list, and active medication allergy list have been combined in stage 2 "with the objective of providing a summary of care record for each transition of care or referral by including them as required fields in the summary of care."

Meaningful use stage 2 criteria comment period

The meaningful use stage 2 public comment period ends 60 days after the proposed rule's publication in the Federal Register. The ONC encourages hospitals and eligible providers to submit comments on the criteria they like as well as the ones they don't like. Doing so will show ONC that it is on the right track and will ensure that the right meaningful use stage 2 criteria make it into the final rule, which is expected this summer.

The meaningful use of EHR technology was defined in 2009's HITECH Act. The Medicare and Medicaid EHR Incentive Programs are open to hospitals and eligible professionals that meet the necessary eligibility requirements.

Let us know what you think about the story; email Brian Eastwood, Site Editor or contact @SearchHealthIT on Twitter.

This was last published in February 2012

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