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Meaningful Health Care Informatics Blog

May 22 2011   8:38PM GMT

Meaningful Use Stage 2 recommendations to the HIT standards committee

Posted by: RedaChouffani
MU, Stage 2

With incentives payments well underway for health organizations that have met all meaningful use criteria for stage 1, many are still wondering what the final requirements will look like for Stage 2 and 3 of MU.

Meaningful use stage 2 drafts have recently been released for public comments and feedback with a deadline that was back in Feb 25th, 2011. And at this stage many revisions have been made and recommendations to HITPC.

The HIT Policy Committee proposed several changes to the HIT standards committee. Some of them are listed below:

Improving Quality, Safety, Efficiency & Reducing Health Disparities

· CPOE for 60% of Rx and lab; radiology CPOE in use (≥ 1 order) (unless no radiology orders)

· Employ drug interaction (drug-drug, drug-allergy) checking; Providers have the ability to refine DDI [In stage 3, goal is to have nationally endorsed lists of DDI with higher positive predictive value and ability to record reason for overriding alert]

· 50% of outpatient medication orders and 20% of hospital discharge medication orders transmitted as eRx

· 80% of patients have demographics recorded and can use them to produce stratified quality reports using more granular demographic categories per IOM report—additions to value sets for existing fields for stage 2; new demographic fields for stage 3 (HITSC needs to work on standards)

· Report CQM electronically as per CMS

· Maintain problem list (80%)

· Maintain active med list (80%)

· 80% of patients have smoking status recorded [stage 3 add new field in certification for secondhand smoke]

· Maintain active med-allergy list (80%)

· 80% of patients have vital signs recorded during the reporting year; change age for peds BP from 2 yrs to 3 yrs

· Use CDS; HITSC: Suggest changing certification criteria definition as indicated on comment summary

· Implement drug formulary checks according to local needs (e.g., may use internal or external formularies, which may include generic substitution as a formulary check) (move to core)

· For hospitals, 50% of patients >65 who have recorded the result of an advance directive discussion and the directive itself if it exists; for EPs 10% of patients seen during reporting period (need more data on current use to decide on menu vs. core for EPs)

· Incorporate lab results as structured data (40%) (move to core); HITSC: Use LOINC where available

· EHs: Hospital labs send structured electronic lab results to outpatient providers for ≥ 40% of labs sent electronically HITSC: Use LOINC where available

Generate patient lists for multiple patient-specific parameters (move to core)

· EPs:10% of all active patients receive a clinical reminder (appointment reminder not count)

· 30% of EP visits have at least one electronic EP note and 30% of EH patient days have at least one electronic note by a physician, NP, or PA; non-searchable, scanned notes do not qualify [use broad definition of qualifying note types]

· EH medication orders automatically tracked via electronic medication administration record; (in-use in at least one hospital ward/unit)

· Consider adding recording of family health history in stage 3 (due to absence of standards for FH)

· EPs: Patient preferences for communication medium recorded for 20% of patients

· Hospitals: ≥ 25 patients receive electronic discharge instructions at time of discharge

· Hospitals: 10% of patients/families view and download relevant information about a hospital admission; information available for all patients within 36 hours of the encounter

· EPs: 10% of patients/families view & download their longitudinal health information; information available to all patients within 24 hours of an encounter

· EPs: patients are provided a clinical summary after 50% of all visits, within 24 hours (pending information, such as lab results, should be available to patients within 4 days of becoming available to EPs)

· Both EPs and hospitals: 10% of patients receive EHR-enabled patient-specific educational resources; make core; take out “if appropriate” instead of raising threshold

· EPs: patients are offered secure messaging online and > 25 patients have sent secure messages online

· Stage 3: Provide mechanism for patient-entered data (supply list); consider “information reconciliation” for stage 3 to correct errors

· Medication reconciliation conducted at 80% of transitions by receiving provider; keep threshold at 50% and move to core

· Summary of care record. EH: 10% of all discharges have summary of care record sent electronically to EP or LTC facility. EP: at least 25 transactions sent electronically (if exclusion for lack of electronic recipients, then must send on paper) [Need HIE preamble.]

· List of care team members available for 10-20% of patients via electronic exchange; 10% of patients have a list of care team members (including PCP, if available) (unstructured data for stage 2; for stage 3, code by NPI)

· For longitudinal care plan, merge with summary of care to create “summary and care plan” (old summary plus plan and patient engagement fields)

· Improve Population and Public Health

· EH and EP: Submit immunization data (attest to at least one) in accordance with applicable law and practice; move to core for both EH and EP [In Stage 3, view cumulative immunization record and recommendations]

· EH: Submit reportable lab results (attest to submitting to at least one organization) in accordance with applicable law and practice; move to core

· EH: Submit syndromic surveillance data (attest to at least one) in accordance with applicable law and practice; move to core

· EP: [CMS to consider]

· EP: [CMS to consider] Submit reportable cancer conditions (attest to at least one) in accordance with applicable law and practice (to HITSC: possible use of IHE cancer reporting implementation guide)

· For Stage 3: Patient-generated data submitted to public health agencies

Ensure adequate privacy and security protections for personal health information

· Perform, or update, security risk assessment and address deficiencies.

· Address encryption for data at rest and attest to policy (not required for all but need policy).


· Authentication of providers: certification of EHR needs two-factor authentication for controlled substances and providers to have digital certificates at entity level.

· Single factor authentication (user and password) for patient online account.

· Audit trails for access to patient online account.

· Provisions for data provenance.

· Portal should have secure download ability (e.g., to transfer to PHR).

· Instructions to standards committee about demographic fields, etc.

· Signal Stage 3 plans about NWHIN governance.

In addition to the recommendations on the MU stage 2 objectives, the group also recommended adjustments on the timelines. In the document submitted to the committee one of the options suggested seems to have the best overall impact on almost all the attributes: delay transition from stage 1 to stage 2 by one year. This would only affect the providers who have begun MU program during 2011.

It is clear that a lot of the feedback that was received was taken in consideration according to the changes and recommendations made. While we are still months if not at least a year before we receive the HHS MU Final rule, some of the objectives can be used as a guide for many who have already began their MU stage 1.

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