Meaningful Use Stage 2 Proposed Objectives Underscore Importance of Health Information Exchange & Interoperability

Proposed Guidelines Released at Annual HIMSS Conference

The widely anticipated preliminary guidelines for Stage 2 of Meaningful Use were released February 23 by the Centers for Medicare & Medicaid Services (CMS) at the Healthcare Information and Management Systems Society's (HIMSS) annual conference in Las Vegas. The proposal continues to push health care providers to improve quality and efficiency at the point of care through the use of health IT.

Proposed Guidelines for Stage 2

The Medicare and Medicaid Electronic Health Record ("EHR") Incentive Programs were created in 2009 under the federal stimulus bill to provide eligible health care providers with incentive payments for adopting, implementing and demonstrating Meaningful Use of Certified EHR Technology.

The criteria for Meaningful Use is being rolled out in three stages each of which requires increasing use of EHR technology and electronic information exchange.  While Stage 1 of Meaningful Use focused largely on capturing data and getting an EHR in place, Stage 2, which begins in 2014, focuses on improving clinical processes.

Stage 2 and HIE

Proposed Stage 2 objectives underscore the importance of health information exchange (HIE) for eligible professionals and hospitals. In particular, HIE functionality will help providers achieve a number of required and optional objectives in a manner that is more efficient and effective than individual or vendor-limited solutions may provide. Such HIE-related objectives that are required Core Objectives in the proposed rule include:

• Providing electronic summaries of care for a majority of transitions of care and referrals (65 percent), including 10 percent of transitions or referrals to a recipient with no organizational affiliation and using a different certified EHR vendor

• Incorporating clinical lab test results into a certified EHR (at least 55 percent of lab results)

• Performing successful, ongoing submission of immunization reports to public health agencies (for both professionals and hospitals, throughout the year-long reporting period)

• For eligible hospitals, performing successful, ongoing submission of electronic reportable lab results and data to detect disease outbreaks to public health agencies

• Providing a variety of services and functionality to help better engage patients in their care, such as giving patients the ability (and ensuring actual patient use of functionality) to view, download, and transmit health information online, providing hospital emergency department or inpatient discharge information online within 36 hours, providing clinical summaries within 24 hours of office visits, and receiving secure messages to a certified EHR from at least 10 percent of patients.

Similarly, HIE functionality will support eligible professionals and hospitals in achieving additional optional objectives, such as incorporating 40 percent of imaging results to be accessible through certified EHR technology and successful ongoing submission of cancer case and other specialized information to registries within public health agencies.

Extension of Stage 1

CMS is also proposing an extension of Stage 1, so that providers have an additional year for implementation of Stage 2 criteria regardless of when eligible providers begin Stage 1. CMS originally established that any provider who first attested to Stage 1 criteria in 2011 would have to begin using Stage 2 criteria in 2013. The proposed Stage 2 rule delays the onset of Stage 2 criteria until 2014, which CMS believes would allow the needed time for vendors to develop certified EHR technology that can meet the Stage 2 requirements.

What’s Ahead

Recognizing the importance of the proposed requirements for Stage 2 of Meaningful Use to participating providers, partner organizations, and community stakeholders, CORHIO is embarking upon a comprehensive stakeholder education and outreach process over the next few months. CORHIO will provide a detailed analysis and summary of the proposed rule, as well as an initial set of comments and recommendations, that will be distributed to interested stakeholders for review and input in early April.

The goal of this analysis and commentary is to provide consensus-based feedback to CMS and the Office of the National Coordinator for Health IT during the 60-day comment period (beginning March 7), to help inform the development of the final definitions for Stage 2 and advocate for the needs and desires of the Colorado health care community.  If you would like to be involved in this process or have comments and input regarding Stage 2, please contact Betsy Baker at bbaker@corhio.org or 720-285-3232.