CMS has released the proposed rule for Stage 2 requirements for the Medicare and Medicaid Electronic Health Record Incentive Programs. The Stage 2 rule includes criteria eligible professionals, eligible hospitals and critical access hospitals must meet in order to qualify for an incentive payment. The rule also introduces changes to the program timeline and details payment adjustments.
The proposed Stage 2 criteria for meaningful use are based on a series of specific objectives, each of which is tied to a proposed measure that all EPs and hospitals must meet in order to demonstrate that they are meaningful users of certified EHR technology. This approach is similar to the objective and measure approach used in Stage 1 (i.e., each objective has its own measure and percentage requirement for EPs, eligible hospitals and CAHs). Objectives are outlined below; to see the full list of the related measures, click here the view the complete Stage 2 rule document.
Stage 2 criteria
CMS proposes retaining nearly all of the Stage 1 core and menu structure for Stage 2. EPs must meet or qualify for exclusions to 17 core objectives and 3 of 5 menu objectives. Hospitals must meet or qualify for exclusions to 16 core objectives and 2 of 4 menu objectives.
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Core objectives for EPs, eligible hospitals and CAHs:
• Use computerized provider order entry for medication, laboratory and radiology orders directly entered by any licensed healthcare professional who can enter orders into the medical record per state, local and professional guidelines to create the first record of the order;
• Record the following demographics: preferred language, gender, race, ethnicity, date of birth. Eligible hospitals and CAHs would have to record date and preliminary cause of death as well;
• Record and chart changes in vital signs: height, weight, blood pressure and BMI;
• Record smoking status for patients 13 years old or older;
• Use clinical decision support to improve performance on high-priority health conditions;
• Incorporate clinical lab-test results into certified EHR technology as structured data;
• Generate lists of patients by specific conditions to use for quality improvement, reduction of disparities, research, or outreach;
• Use certified EHR technology to identify patient-specific education resources and provide those resources to the patient;
• The EP who receives a patient from another setting of care or provider of care or believes an encounter is relevant should perform medication reconciliation;
• The EP who transitions their patient to another setting of care or provider of care or refers their patient to another provider of care should provide summary care record for each transition of care or referral;
• Capability to submit electronic data to immunization registries or immunization information systems except where prohibited, and in accordance with applicable law and practice;
• Protect electronic health information created or maintained by the certified EHR technology through the implementation of appropriate technical capabilities.