Final Meaningful Use Stage 2 Rule Commentary--"Now Is the Time"

Joe Wivoda, Chief Information Officer

The final rule for Stage 2 of Meaningful Use came out August 23rd--earlier than expected and with few actual surprises. CMS took the public comments seriously and modified the proposed rule in many areas based on those comments. The final rule is released with commentary and is a full 672 pages long, and this overview is based on a quick review. More information will be available as we dig into the rule further.

Don't forget, this rule does not go into effect until 2014 at the earliest. If you attest to Meaningful Use Stage 1 you get two years to reach Stage 2, unless you attested in 2011, in which you get three years.

There is no reason to panic, you have time to understand the new rule, but there are some themes that are important to be aware of now.

Utilize Your EHR

The menu requirements for Stage 1 have, for the most part, been incorporated into core requirements in Stage 2. Many of the core requirements have higher thresholds under Stage 2. This means that you will need to utilize your EHR more. For example, in Stage 1 the CPOE requirement was that 30% of patients have at least one medication order. One could argue that if you met that requirement exactly, and no more, you would be operating in a less safe manner, since you now have multiple processes for the same tasks. The new rule for CPOE is that 60% of medication, 30% of lab, and 30% of radiology ORDERS need to be in CPOE.

Now is the time to understand the new core requirements and begin planning and redesigning workflows to meet them.

Information Exchange

Electronically transmitting information for transitions of care for 10% of care transitions is a new requirement for Stage 2. The work that is being done on HIEs today will create the infrastructure for these transmissions, but more work will need to be done. Since so many hospital discharges are to long term care (LTC) facilities, hospitals will need to work with them to participate in the HIE. LTC does not receive any incentives for Meaningful Use, and many LTC EHRs are not prepared to exchange information today (though some are).

Now is the time to consider your referral patterns and engage those providers to begin planning for information exchange.

Patient Engagement

Under Stage 1 providers only needed to provide electronic information to patients when they asked for it, and then providers were only required to provide it 50% of the time. Stage 2 will require hospitals and eligible professionals to not only provide the information, but it also requires that 5% of patients access their information through a portal. There is also a requirement that 5% of patients are communicated with using secure messaging. There are exclusions for areas that have limited Internet connectivity, but almost all providers will need to meet these requirements.

Now is the time to talk with your vendor about their portal offerings, or if they can interface with a Personal Health Record (PHR), and begin planning how you will engage patients to actively view their information online.

Clinical Quality Measures

The requirements for Clinical Quality Measure reporting in Stage 1 were fairly easy, although the measures did not necessarily apply well to rural facilities. The new rule provides many more options for reporting and electronic submission will be required. More information will be available about the quality measures that you can choose from.

Now is the time to speak with your vendor to make sure that the reports you think are most appropriate are incorporated into the Stage 2-certified version of your EHR.

Some Changes to Stage 1

There are some changes to Stage 1 requirements that go into effect in 2013 and 2014. Many are additional exclusions. For example, if you can demonstrate that collecting some vitals are not part of the scope of your practice (e.g. Chiropractor), then you do not need to meet the objective of collecting vitals. The requirement of exchanging clinical information will be removed in 2013, but since the Stage 2 exchange requirements are so important, you cannot put off work on the exchange requirements.

Now is the time, if you have questions about those exclusions, to understand the changes to Stage 1.

Conclusion

The new Stage 2 rules for Meaningful Use have only been out for a few hours, and for the most part do not go into effect until 2014 at the earliest. This provides time to fully understand the rules and begin discussions with your vendors, referral partners, patients, HIE, and other stakeholders to properly prepare to meet the rules. The purpose of these new rules is to encourage health care providers to utilize electronic systems to be more safe and efficient, and to improve quality. Information exchange between providers of care and providing relevant clinical information directly to patients electronically are important ways to achieve these goals.

More Information

CMS final rule * CMS final rule (42 CFR Parts 412, 413, and 495) * Fact sheet on CMS's final rule

ONC standards and certification criteria final rule * ONC final rule (45 CFR Part 170) * Fact sheet on ONC's standards and certification criteria final rule - forthcoming

More information on the Stage 2 rule * HHS news release * CMS EHR Incentive Programs website