Federal Government Finalizes Stage 2 Meaningful Use Requirements

Robert Belfort, Proje­ct HealthDesign Regulatory and Assurance Advisory Group, Manatt, Phelps & Phillips, LLP

The Centers for Medicare and Medicaid Services (CMS) and the Office of the National Coordinator for Health IT (ONC) recently released a final regulation setting forth the requirements for Stage 2 of Meaningful Use under the Medicare and Medicaid Electronic Health Record Incentive Program (the “Final Rule”).  In the Final Rule, CMS adopted a number of provisions that require eligible professionals and hospitals to increase their efforts to share data electronically with patients.  As a result, the Final Rule is likely to encourage greater patient engagement in health care, something the Robert Wood Johnson Foundation advocated in comments it submitted on the proposed rule.  Here is a relevant excerpt from RWJF’s comments::

We are encouraged by efforts in the proposed rule regarding patient and consumer engagement, especially regarding secure messaging; direct, downloadable access to patient data; patient reminders; inclusion of family health history; and provision of patient education. Nevertheless, we would like to see the required percentages higher than proposed in some cases. In addition, as our Project HealthDesign makes clear, patients now expect to engage with their personal health data in apps and on mobile devices of their choosing. We expect this trend to increase significantly. Further, patients will almost certainly expect that the flow of information be in two directions. In other words, patients will reasonably expect they will have both access to personal health data but also the ability to provide personal data to their health professionals.

RWJF’s full comments are available here.

The chart below lists the “patient engagement” requirements in the Final Rule:

Stage 2 Objectives		Stage 2 Measures
Eligible Professionals (EPs)	Eligible Hospitals (EHs) and Critical Access Hospitals (CAHs)
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.		1.  More than 50% of all unique patients seen by the EP during the EHR reporting period are provided timely (within 4 business days after the information is available to the EP) online access to their health information, subject to the EP’s discretion to withhold certain information.   2. More than 5% of all unique patients seen by the EP during the EHR reporting period (or their authorized representatives) view, download, or transmit to a third party their health information
	Provide patients the ability to view online, download and transmit information about a hospital admission.	1. More than 50% of all patients who are discharged from the inpatient or emergency department (POS 21 or 23) of an EH or CAH have their information available online within 36 hours of discharge   2.  More than 5% of all patients (or their authorized representatives) who are discharged from the inpatient or emergency department (POS 21 or 23) of an EH or CAH view, download or transmit to a third party their information during the reporting period.
Provide clinical summaries for patients for each office visit		Clinical summaries provided to patients or patient-authorized representatives within 1 business day for more than 50% of office visits
Use certified EHR technology to identify patient-specific education resources and provide those resources to the patient	Use certified EHR technology to identify patient-specific education resources and provide those resources to the patient	Patient-specific education resources identified by the certified EHR technology are provided to patients for more than 10% of all unique patients with office visits seen by the EP during the EHR reporting period.   More than 10% of all unique patients admitted to the EH’s or CAH’s inpatient or emergency department (POS 21 or 23) are provided patient-specific education resources identified by the certified EHR technology.
Use secure electronic messaging to communicate with patients on relevant health information		A secure message was sent using the electronic messaging function of certified EHR technology by more than 5% of unique patients (or their authorized representatives) seen by the EP during the EHR reporting period.

Also of note to Project HealthDesign:  the Final Rule includes a new “menu set” requirement that eligible professionals and hospitals record a patient’s family history.

Stage 2 begins in 2014.  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 Final Rule gives providers more time to meet the Stage 2 requirements. A provider that attested to Stage 1 of meaningful use in 2011 would attest to Stage 2 in 2014, instead of in 2013.  Therefore, providers are not required to meet Stage 2 meaningful use before 2014.

Since the Medicare and Medicaid EHR Incentive Programs began in January 2011, more than 120,000 eligible healthcare professionals and more than 3,300 hospitals have qualified to participate –23,000 more than the federal government had hoped to enroll by now, according to the U.S. Department of Health and Human Services, which oversees the programs.

The Final Rule – along with a fact sheet describing it -  are available at  http://www.hhs.gov/news/press/2012pres/08/20120823b.html

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