Setting the Stage for Stage 2. Where We Are Now & What You Need to Know.

(Part 1 of 4)

Stage 2 of the Meaningful Use (MU) incentive program is being billed by some as “a giant leap in data exchange1.” The overriding goal of the program is to advance the secure exchange of information within our health system between all of a patient’s providers as well as the patients themselves —and that is a giant leap from where the system is currently, indeed. Of course, with every giant leap comes the chance for big missteps. That’s why the time is now to prepare for Stage 2 objectives and requirements.

The Biggest Challenges Revealed in Stage 1
According to a recent study published in the Journal of the American Informatics Association, the biggest challenge for hospitals participating in the MU program is Computerized Provider Order Entry (CPOE). Out of 2,475 hospitals in the study that intended to participate in MU, only 313 received incentive payments in 2011 during Stage 1. Half of those hospitals that didn’t meet Stage 1 requirements cited CPOE criteria as a top challenge. As we move to Stage 2, issues related to CPOE will remain as many hospitals are only beginning to adopt EHRs and build infrastructure to meet MU criteria.

For hospitals that were awarded incentive payments, giving patients access to their data in electronic form and generating numerator and denominator data for quality reporting directly from the Electronic Health Record (EHR) were reported to be the most significant challenges. The difficulty of providing electronic data to patients is very important to note and prepare for, as Stage 2 focuses on electronic patient communications and assigns heightened requirements to achieve program incentives.

According to Stage 2 Meaningful Use requirements final rule by Centers for Medicare & Medicaid Services (CMS), providers must achieve meaningful use under Stage 1 criteria before advancing to Stage 2. CMS has announced certain changes to Stage 1 CPOE; details may be found by clicking here.

What is different in Stage 2 as compared to Stage 1
In Stage 2, there are more core objectives for Eligible Professionals, Eligible Hospitals and Critical Access Hospitals (CAHs). Many Stage 1 core objectives have been merged or folded into other requirements. Eligible Professionals have 20 total objectives, including 17 core objectives and 3 (of 6) menu objectives. For Eligible Hospitals and Critical Access Hospitals (CAHs), there are 19 total objectives comprised of 16 core objectives and 3 (of 6) menu objectives.

Here’s a quick look at core objectives that Eligible Professionals must report on, as well as the six menu objectives they may choose from.

Core Objectives
1. Computerized Provider Order Entry (CPOE)
a. Use CPOE for more than 60 percent of medication, 30 percent of laboratory, and 30 percent of radiology.

2. ePrescribing (eRx)
a. Use eRx for more than 50 percent.

3. Demographics
a. Record demographics for more than 80 percent.

4. Vital Signs
a. Record vital signs for more than 80 percent.

5. Smoking Status
a. Record smoking status for more than 80 percent.

6. Interventions
a. Implement 5 clinical decision support interventions + drug/drug and drug/allergy.

7. Labs
a. Incorporate lab results for more than 55 percent.

8. Patient List
a. Generate patient list by specific condition.

9. Preventive Reminders

10. Use Electronic Health Record (EHR) to identify and provide reminders for preventive/follow-up care for more than 10 percent of patients with two or more office visits in the last 2 years.

11. Patient Access
a. Provide online access to health information for more than 50 percent with more than five percent actually accessing.

12. Visit Summaries
a. Provide office visit summaries for more than 50 percent of office visits.

13. Education Resources
a. Use EHR to identify and provide education resources more than 10 percent.

14. Secure Messages
a. More than five percent of patients send secure messages to their Eligible Professionals (EP).

15. Prescription Reconciliation
a. Medication reconciliation at more than 50 percent of transitions of care.

16. Summary of Care
a. Provide summary of care document for more than 50 percent of transitions of care and referrals with 10 percent sent electronically and at least one sent to a recipient with a different EHR vendor or successfully testing with CMS test EHR.

17. Immunizations
a. Successful ongoing transmission of immunization data.

18. Security Analysis
a. Conduct or review security analysis and incorporate in risk management process.

Menu Objectives (select 3 of 6)
1. Imaging Results
a. More than 10 percent of imaging results are accessible through Certified EHR Technology.

2. Family History
a. Record family health history for more than 20 percent.

3. Syndromic Surveillance
a. Maintain successful ongoing transmission of syndromic surveillance data.

4. Cancer
a. Maintain successful ongoing transmission of cancer case information.

5. Specialized Registry
a. Maintain successful ongoing transmission of data to a specialized registry.

6. Progress Notes
a. Enter an electronic progress note for more than 30 percent of unique patients.

For even more details, view the CMS’ Stage 2 Tipsheet by clicking here.

The Five Percent+ Factor: Focusing on Patient Engagement in Stage 2
Patient engagement—reciprocal communication between patients and providers—is a significant focus that everyone must be prepared for in Stage 2. To be eligible for incentives, providers must achieve the following patient action.

- More than five percent of patients must send secure messages to their eligible providers.

- More than five percent of patients must access their health information online.

For many Eligible Professionals, it may be quite daunting to evoke such engagement from over five percent of patients, as so many factors affect the transition to electronic information sharing. Technological, cultural and organizational barriers exist across communities nationwide. For example, CMS is introducing exclusions based on broadband availability by county, as some areas simply don’t have the Internet access necessary for five percent to take action even if they are willing to do so.

Timing for Stage 2
The final rule has been out since August 2012 and though there is an urgency for Stage 2, there is not the mad rush that surrounded Stage 1. Stage 2 test scripts have not yet been released in full from certification bodies and at this writing only three are out. Test scripts from vendors will be released in phases, with the launch of testing anticipated for December 2012 or January 2013.

For a complete look at Stage 2, visit CMS’ website by clicking here. There you’ll find tables, tipsheets and updates directly from CMS. In addition, continue to follow Emdeon for targeted announcements and interpretation of latest updates as it relates to your business. Emdeon will continuously guide you through Stage 2 so that you are prepared to offer expertise to your customers every step of the way.

Stay tuned for our next article in series, Planning for Certification and Strategies in Testing.


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