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HHS announces Stage 2 EHR Meaningful Use rules

October 22, 2012

The U.S. Department of Health & Human Services (HHS) announced the Stage 2 Meaningful Use requirements health care practitioners will have to meet in order to qualify for bonus payments during the second stage of the Medicare and Medicaid electronic health records (EHR) incentive programs.

The HHS plans to begin Stage 2 of the incentive programs as early as 2014, emphasizing that practitioners will not be required to meet Stage 2 requirements prior to that time.

The agency also announced technical requirements for the Stage 2 EHR systems practitioners will need to meet the Stage 2 meaningful use criteria and qualify for incentive payments.

In addition, the HHS also announced changes to make its EHR certification process more efficient and Stage 2 EHR systems available as quickly as possible.

Practitioners can continue to use EHR systems that meet current (2011 edition) certification standards until 2014, the HHS emphasized.

The EHR incentive program will provide a flexible reporting period during 2014, giving practitioners more time to purchase, or update to, EHR technology that meets the Stage 2 standards, according to the HHS.

AOAExcel next year plans to introduce its XNetwork, an EHR health information exchange service designed specifically to meet the Stage II interconnectivity requirements.

Under Medicare’s five-year EHR incentive program, which began in 2011, health care practitioners can earn a total of up to $44,000 ($48,400 in federally designated Health Professional Shortage Areas) by implementing EHR systems certified for use in the program and then meeting the HHS criteria for “meaningful use” of those systems.

Medicaid offers practitioners who meet the EHR standards up to $63,750 in bonus payments over the six-year life of its incentive program.

The incentive programs are built around a three-stage EHR implementation process.

Stage 1 sets the basic functionalities EHRs must include, such as capturing data electronically and providing patients with electronic copies of health information.

Stage 2 increases health information exchange between providers and promotes patient engagement by giving patients secure online access to their health information.

Stage 3 will continue to expand meaningful use objectives to improve health care outcomes, according to the HHS.
The agency has not yet indicated when it might release rules for the third stage of the program.

The Stage 2 EHR incentive program rules were announced Aug. 23 through the HHS’ Centers for Medicare & Medicaid Services (CMS) and Office of the National Coordinator for Health Information Technology (ONC).

A fact sheet on CMS’s final rule is available at http://tinyurl.com/Stage2factsheet.

A detailed fact sheet on the ONC’s standards and certification criteria final rule is available at http://healthit.hhs.gov/standardsandcertification.

More information on the Stage 2 rule can be found at www.cms.gov/EHRIncentivePrograms.

Stage 2 EHR meaningful use standards for health care practitioners

Core elements

Objective: Use computerized provider order entry (CPOE) for medication, laboratory and radiology orders directly entered by any licensed health care professional who can enter orders into the medical record per state, local and professional guidelines.
Measure: More than 60 percent of medication, 30 percent of laboratory, and 30 percent of radiology orders created by the eligible provider (EP) during the EHR reporting period are recorded using CPOE.

Objective: Generate and transmit permissible prescriptions electronically (e-Rx)
Measure: More than 50 percent of all permissible prescriptions or all prescriptions written by the EP and queried for a drug formulary and transmitted electronically using certified electronic health records technology (CEHRT).

Objective: Record the following demographics: preferred language, sex, race, ethnicity, date of birth
Measure: More than 80 percent of all unique patients seen by the EP during the EHR reporting period have demographics recorded as structured data.

Objective: Record and chart changes in vital signs: height/length, weight, blood pressure (age 3 and over). Calculate and display BMI. Plot and display growth charts for patients 0-20 years, including BMI.
Measure: More than 80 percent of all unique patients seen by the EP during the EHR reporting period have blood pressure (for patients age 3 and over only) and height/length and weight (for all ages) recorded as structured data.

Objective: Record smoking status for patients 13 years old or older
Measure: More than 80 percent of all unique patients 13 years old or older seen by the EP or admitted during the EHR reporting period have smoking status recorded as structured data.

Objective: Use clinical decision support to improve performance on high-priority health conditions
Measure: 1. Implement five clinical decision support interventions related to four or more clinical quality measures at a relevant point in patient care for the entire EHR reporting period. Absent four clinical quality measures related to an EP’s scope of practice or patient population, the clinical decision support interventions must be related to high-priority health conditions. It is suggested that one of the five clinical decision support interventions be related to improving health care efficiency. 2. The EP has enabled and implemented the functionality for drug and drug allergy interaction checks for the entire EHR reporting period.

AOA members can access a complete list of the Stage 2 EHR meaningful use objectives and measures on the AOA website EHR page (www.aoa.org/EHR) or directly at http://tinyurl.com/8dxra47.

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