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What Stage 2 'meaningful use' e-health rules mean

The deadlines for Stage 2 and Stage 3 have been extended by a year each

February 28, 2012 05:31 PM ET

Computerworld - The U.S. government's Centers for Medicare & Medicaid Services (CMS) last week published to the Federal Register the second of three sets of guidelines that the healthcare community must follow in rolling out electronic medical records (EMR).

The proposed guidelines came with few surprises, but CMS did give healthcare providers an additional year to implement the changes.

Those providers that 'attest' to meaningful use first in 2011 now have until 2014 to meet Stage 2 criteria and until 2016 to meet the Stage rules.

The proposed Stage 2 rules are now subject to a six-month comment period before they'll be finalized.

Hospitals and private physician practices must adhere to Meaningful Use rules to qualify for Medicare and/or Medicaid EMR reimbursements, which admittedly only cover a fraction of the costs to implement the technology. The total federal cost of the Medicare and Medicaid EHR Incentive Programs is estimated to total $14.6 billion between 2014 and 2019, according to CMS.

What providers need to know

Just as with Stage 1 of Meaningful Use, Stage 2 requires healthcare providers to meet core objectives and chose from a menu of other objectives. For example, one menu option includes making up to 40% of all radiological scans available for viewing on an EMR.

Under Stage 2 criteria, clinicians must meet (or qualify for an exclusion to) 17 core objectives and 3 of 5 menu objectives. Eligible hospitals and critical access hospitals (CAH) must meet 16 core objectives and 2 of 4 menu objectives. By comparison, under Stage 1 criteria clinicians were required to meet 15 core objective and choose from five of 10 menu items.

Clinicians must also report on 12 clinical quality measures, compared to Stage 1's six quality measures. Eligible hospitals and CAHs must report 24 clinical quality measures, whereas Stage 1 required only 15.

As expected, the proposed Stage 2 criteria focuses on how healthcare facilities can exchange key clinical information about patients and provide patients with online access to their health data.

CMS also proposed modifications to existing the Stage 1 criteria, including changes to the age limitations for vital signs, and the electronic exchange of summary-of-care documents.

Another proposed change to Stage 1 objectives includes the use of computerized physician order entry (CPOE) systems for medications. Stage 1 currently requires providers to track the number of patients receiving at least one medication. The CPOE measurement was changed so it's a percentage of all orders, which will raise the bar considerably, according to IT healthcare consultancy CSC.

Stage 2 raises the percentage by which CPOE must be used for medications from 30% to 60%.

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