Stage 2 Criteria Overview

August 23, 2012, U.S. Department of Health and Human Services Secretary Kathleen Sebelius announced that the CMS published the final rule for Stage 2 of the Medicare and Medicaid EHR Incentive Programs. The rule provides new criteria that eligible professionals (EPs), eligible hospitals, and critical access hospitals (CAHs) must meet in order to successfully participate in the EHR Incentive Programs.

“The changes we’re announcing today will lead to more coordination of patient care, reduced medical errors, elimination of duplicate screenings and tests and greater patient engagement in their own care,” Secretary Sebelius said.

Rule Provisions
Through the Stage 2 requirements of the EHR Incentive Programs, CMS will expand meaningful use of certified EHR technology. The rule made consolidated several existing Stage 1 objectives and added new objectives for Stage 2. There will be 20 measures for EPs (17 core and 3 of 6 menu) and 19 measures for eligible hospitals (16 core and 3 of 6 menu) in Stage 2.

Stage 2 Timing
In the Stage 1 meaningful use regulations, CMS established an original timeline that would have required Medicare providers who first demonstrated meaningful use in 2011 to meet the Stage 2 criteria in 2013. The Stage 2 rule delays the onset of Stage 2 criteria. Any provider that attests to Stage 1 of meaningful use in 2011 or 2012 will attest to Stage 2 in 2014 instead of 2013. Therefore providers will not be required to demonstrate Stage 2 of meaningful use before 2014.

Stage 2 Core and Menu Objectives
Eligible Professionals Report on all 17 Core Objectives:
1. Use computerized provider order entry (CPOE) for medication, laboratory and radiology orders
2. Generate and transmit permissible prescriptions electronically (eRx)
3. Record demographic information
4. Record and chart changes in vital signs
5. Record smoking status for patients 13 years old or older
6. Use clinical decision support to improve performance on high-priority health conditions
7. Provide patients the ability to view online, download and transmit their health information
8. Provide clinical summaries for patients for each office visit
9. Protect electronic health information created or maintained by the Certified EHR Technology
10. Incorporate clinical lab-test results into Certified EHR Technology
11. Generate lists of patients by specific conditions to use for quality improvement, reduction of disparities, research, or outreach
12. Use clinically relevant information to identify patients who should receive reminders for preventive/follow-up care
13. Use certified EHR technology to identify patient-specific education resources
14. Perform medication reconciliation
15. Provide summary of care record for each transition of care or referral
16. Submit electronic data to immunization registries
17. Use secure electronic messaging to communicate with patients on relevant health information

Report on 3 of 6 Menu Objectives:
1. Submit electronic syndromic surveillance data to public health agencies
2. Record electronic notes in patient records
3. Imaging results accessible through CEHRT
4. Record patient family health history
5. Identify and report cancer cases to a State cancer registry
6. Identify and report specific cases to a specialized registry (other than a cancer registry)

Also, EPs must report on 9 out of 64 CQMs.

Eligible Hospitals and CAHs
Report on all 16 Core Objectives:
1. Use computerized provider order entry (CPOE) for medication, laboratory and radiology orders
2. Record demographic information
3. Record and chart changes in vital signs
4. Record smoking status for patients 13 years old or older
5. Use clinical decision support to improve performance on high-priority health conditions
6. Provide patients the ability to view online, download and transmit their health information within 36 hours after discharge.
7. Protect electronic health information created or maintained by the Certified EHR Technology
8. Incorporate clinical lab-test results into Certified EHR Technology
9. Generate lists of patients by specific conditions to use for quality improvement, reduction of disparities, research, or outreach
10. Use certified EHR technology to identify patient-specific education resources and provide those resources to the patient if appropriate
11. Perform medication reconciliation
12. Provide summary of care record for each transition of care or referral
13. Submit electronic data to immunization registries
14. Submit electronic data on reportable lab results to public health agencies
15. Submit electronic syndromic surveillance data to public health agencies
16. Automatically track medications with an electronic medication administration record (eMAR)

Report on 3 of 6 Menu Objectives:
1. Record whether a patient 65 years old or older has an advance directive
2. Record electronic notes in patient records
3. Imaging results accessible through CEHRT
4. Record patient family health history
5. Generate and transmit permissible discharge prescriptions electronically (eRx)
6. Provide structured electronic lab results to ambulatory providers

Also, eligible hospitals and CAHs must report on 16 out of 29 total CQMs.

Note: Complete list of CQMs have not been posted on the CMS website yet. In the future please check www.cms.gov/EHRIncentivePrograms