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Meaningful Use – Stage 2 Objectives and Quality Measures

Posted in Meaningful Use, Uncategorized

As we reported last month, the Centers for Medicare and Medicaid Services (“CMS”) released its final rule for Stage 2 of its EHR Incentive Programs.  This post is our second in a multi-part series addressing various aspects of the final rule.

“Meaningful use” is achieved in three stages.  All providers must meet the meaningful use objectives under the Stage 1 criteria before moving on to Stage 2.  Major changes from Stage 1 to Stage 2 are in the meaningul use objectives and clinical quality measures which providers must satisfy in order to receive incentive payments.

Stage 2 Core and Menu Objectives

To qualify for incentive payments under Stage 2, providers must satisfy a combination of core objectives and menu objectives. Providers must meet all core objectives, whereas providers may choose certain menu objectives from a list of available options.

To demonstrate Stage 2 meaningful use,

  • Eligible professionals (“EPs”) must meet 17 core objectives and 3 menu objectives that they select from a total list of 6, or a total of 20 core objectives.
  • Eligible hospitals (“EHs”) and critical access hospitals (“CAHs”) must meet 16 core objectives and 3 menu objectives that they select from a total list of 6, or a total of 19 core objectives.

A number of new core objectives were also introduced for Stage 2, which CMS believes will have a positive impact on patient care and safety:

  • Use secure electronic messaging to communicate with patients on relevant health information (for EPs only).
  • Automatically track medication from order to administration using assistive technologies in conjunction with an electronic medication administration record (for EHs and CAHs).

Stage 2 also replaces the Stage 1 objective to provide electronic copies of health information or discharge instructions with the following objectives which would allow patients to access their health information online:

  • Provide patients the ability to view online, download and transmit their health information within 4 business days of the information being available to the EP.
  • Provide patients the ability to view online, download and transmit their health information within 36 hours after discharge from the hospital.

The majority of the new Stage 2 objectives are menu objectives.  These are as follows:

  • Record electronic notes in patient records.
  • Make accessible imaging results through CEHRT.
  • Record patient family health history.
  • Identify and report cancer cases to a State cancer registry (EPs only).
  • Identify and report specific cases to a specialized registry (EPs only).
  • Generate and transmit permissible discharge prescriptions electronically (EHs and CAHs only).
  • Provide structured electronic lab results to ambulatory providers (EHs and CAHs only).

Stage 2 Quality Measures

All providers must report on clinical quality measures in order to qualify for incentive payments:

  • EPs must report on 9 out of 64 CQMs.
  • EHs and CAHs must report on 16 out of 29 CQMs.

In addition, all providers must select CQMs from at least 3 of the 6 following key health care policy domains recommended by HHS’s National Quality Strategy:

1.  Patient and Family Engagement

2.  Patient Safety

3.  Care Coordination

4.  Population and Public Health

5.  Efficient Use of Healthcare Resources

6.  Clinical Processes/Effectiveness

A complete list of 2014 CQMs and their associated National Quality Strategy domains will be posted on the CQM page of CMS’s EHR Incentive Programs website in the future.