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Meaningful Use Stage 2 Requirements

Stage 2 Timeline

In the Stage 1 meaningful use regulations, CMS had established a timeline that required providers to progress to Stage 2 criteria after two program years under the Stage 1 criteria. This original timeline would have required Medicare providers who first demonstrated meaningful use in 2011 to meet the Stage 2 criteria in 2013. 

However, CMS has delayed the onset of Stage 2 criteria. The earliest that the Stage 2 criteria will be effective is in fiscal year 2014 for eligible hospitals and CAHs or calendar year 2014, for EPs. The table below illustrates the progression of meaningful use stages from when a Medicare provider begins participation in the Incentive program. 

Note that providers who were early demonstrators of meaningful use in 2011 will meet three consecutive years of meaningful use under the Stage 1 criteria before advancing to the Stage 2 criteria in 1st Year Stage of Meaningful Use. 

Meaningful Use Stage 2 Timeline
2011 2012 2013 2014 2015 2016 2017 2018 2019 2020 2021
2011   1 1 1 2 2 3 3 TBD TBD TBD
2012 1 1      2 2 3 3 TBD TBD      TBD TBD
2013 1 1 2 2 3 3 TBD TBD TBD  
2014 1 1 2 2 3 3 TBD      
2015 1 1 2 2 3 3 TBD      
2016 1 1 2 2 3 3        
2017 1 1 2 2 3 3        

Reporting period in 2014
Stage 1 and 2 MU Reporting period: Three-month period fixed to a calendar quarter for Medicare EPs and any 90 days for Medicaid² EPs.
 
¹ attested for 90 days
² Verify with your State Medicaid

e-Health Programs Interactive Timeline

Stage 2 Overview 

CMS recently published a final rule that specifies the Stage 2 criteria that eligible professionals (EPs), eligible hospitals, and critical access hospitals (CAHs) must meet in order to continue to participate in the Medicare and Medicaid Electronic Health Record (EHR) Incentive Programs. 

 

If you have not participated in the Medicare or Medicaid EHR Incentive Programs previously, or if you have never achieved meaningful use under the Stage 1 criteria, please visit the CMS EHR Incentive Programs website (www.cms.gov/EHRIncentivePrograms) for more information about how to take part in the program. 

In 2014: All providers regardless of their stage of meaningful use are only required to demonstrate meaningful use for a three-month EHR reporting period. 

For Medicare providers, this 3-month reporting period is fixed to the quarter of either the fiscal (for eligible). All other providers would meet two years of meaningful use under the Stage 1 criteria before advancing to the Stage 2 criteria in their third year. 

In the first year of participation, providers must demonstrate meaningful use for a 90-day EHR reporting period; in subsequent years, providers will demonstrate meaningful use for a full year EHR reporting period (an entire fiscal year for hospitals or an entire calendar year for EPs) except in 2014, which is 
described below. Providers who participate in the Medicaid EHR Incentive Programs are not required to demonstrate meaningful use in consecutive years as described by the table above, but their progression through the stages of meaningful use would follow the same overall structure of two years meeting the criteria of each stage, with the first year of meaningful use participation consisting of a 90-day EHR reporting period. 

For 2014 only (eligible hospitals and CAHs) or calendar (for EPs) year in order to align with existing CMS quality measurement programs, such as the Physician Quality Healthcare measures.

Core Menu and Measures

Meaningful Use PPT Slide 2014

New Objectives & New Measures 
Though most of the new objectives introduced for Stage 2 are menu objectives, EPs and eligible 
hospitals each have a new core objective that they must achieve. CMS believes that both of these 
objectives will have a positive impact on patient care and safety and are therefore requiring all providers 
to meet the objectives in Stage 2. 

New Stage 2 Core Objectives: 

  • Use secure electronic messaging to communicate with patients on relevant health information (for EPs only).
  • Automatically track medications from order to administration using assistive technologies in 

           conjunction with an electronic medication administration record (eMAR) (for Eligible Hospitals/CAHs only).

  • Stage 2 also replaces the previous Stage 1 objectives to provide electronic copies of health information 

          or discharge instructions and provide timely access to health information with objectives that allow 

          patients to access their health information online.

Stage 2 Patient Access Objectives: 

  • Provide patients the ability to view online, download and transmit their health information within four business days of the information being available to the EP (for EPs only). 
  • Provide patients the ability to view online, download and transmit their health information within 36 hours after discharge from the hospital (for Eligible Hospitals/CAHs only).

New Stage 2 menu objectives for EPs, eligible hospitals, and CAHs: 

  • Record electronic notes in patient records 
  • Imaging results accessible through CEHRT 
  • Record patient family health history 
  • Identify and report cancer cases to a State cancer registry (for EPs only) 
  • Identify and report specific cases to a specialized registry (other than a cancer registry) (for  EPs only)
  • Generate and transmit permissible discharge prescriptions electronically (eRx) (new for  eligible hospitals and CAHs only)
  • Provide structured electronic lab results to ambulatory providers (for eligible hospitals and CAHs only) 

Finally, there are new Stage 2 measures for several objectives that require patients to use health information technology in order for providers to achieve meaningful use. CMS believes that EPs, eligible hospitals, and CAHs are in the best position to encourage the use of health IT by patients to further their own health care. 

Under the Stage 2 core objectives to provide patients the ability to view online, download and transmit 
their health information, more than 5 percent of patients seen by the EP or admitted to an inpatient 
(Place of Service 21) or emergency department (Place of Service 23) of an eligible hospital or CAH view, 
download, or transmit to a third party their health information. 

Under the Stage 2 core objective to use secure electronic messaging to communicate with patients on 
relevant health information, a secure message must be sent using the electronic messaging function of 
Certified EHR Technology by more than 5 percent of unique patients seen by an EP during the EHR 
reporting period. 

Under the Stage 2 core objectives to provide patients the ability to view online, download and transmit 
their health information, more than 5 percent of patients seen by the EP or admitted to an inpatient 
(Place of Service 21) or emergency department (Place of Service 23) of an eligible hospital or CAH view, 

Clinical Quality Measures for 2014 and Beyond 

Although clinical quality measure (CQM) reporting has been removed as a core objective for both EPs and eligible hospitals and CAHs, all providers are required to report on CQMs in order to demonstrate meaningful use. Beginning in 2014, all providers regardless of their stage of meaningful use will report on CQMs in the same way. 

The certified EHR 2014 upgrade provides the technology for Clinical Reporting on the 6 national eCQMs, 3 of which are required for MU Stage 2, as shown below.

The 6 National Quality Strategy domains are:
1. Patient and Family Engagement
2. Patient Safety
3. Care Coordination
4. Population/Public Health
5. Efficient Use of Healthcare Resources
6. Clinical Process/Effectiveness

CMS has recommended 9 CQMs for adult clinical quality measures and 9 CQMs for pediatric clinical quality measures.

Recommended list of 9 CQMs for adults

Recommended list of 9 CQMs for pediatrics

EPs must report on 9 out of 64 total CQMs. 

  • Eligible hospitals and CAHs must report on 16 out of 29 total CQMs. 
  • In addition, all providers must select CQMs from at least 3 of the 6 key health care policy domains recommended by the Department of Health and Human Services’
  • Although clinical quality measure (CQM) reporting has been removed as a core objective for both EPs 
    and eligible hospitals and CAHs, all providers are required to report on CQMs in order to demonstrate 
    meaningful use. Beginning in 2014, all providers regardless of their stage of meaningful use will report 
    on CQMs in the same way. 


A complete list of 2014 CQMs and their associated National Quality Strategy domains will be posted on the CMS EHR Incentive Programs website (www.cms.gov/EHRIncentivePrograms) in the future. CMS will also post a recommended core set of CQMs for EPs. 

Beginning in 2014, all Medicare-eligible providers beyond their first year of demonstrating meaningful 
use must electronically report their CQM data to CMS. (Medicaid EPs and hospitals that are eligible only 
for the Medicaid EHR Incentive Program will electronically report their CQM data to their state.) There 
will be a variety of options for providers to electronically report their CQMs. 
EPs can electronically report CQMs either individually or as a group using the following methods: 
 
Physician Quality Reporting System (PQRS)—Electronic submission of samples of patient-level 
data in the Quality Reporting Data Architecture (QRDA) Category I format. EPs can also report as 
group using the PQRS GPRO tool. EPs who electronically report using this PQRS option will meet 
both their EHR Incentive Program and PQRS reporting requirements. 
CMS-designated transmission method—Electronic submission of health data.

 
Stage 1 vs. Stage 2 Comparison Table for Eligible Professionals
Stage 1 vs. Stage 2 Comparison Table for Eligible Hospitals and CAHs

CMS Stage 2 Tip Sheet

Stage 2 Overview

Stage 2 Patient Access Objectives:

  • Provide patients the ability to view online, download and transmit their health information within four business days of the information being available to the EP (for EPs only).
  • Provide patients the ability to view online, download and transmit their health information within 36 hours after discharge from the hospital (for Eligible Hospitals/CAHs only).
  • In addition, the Stage 2 criteria place an emphasis on health information exchange between providers to improve care coordination for patients. One of the core objectives for both EPs and eligible hospitals and CAHs requires providers who transition or refer a patient to another setting of care or provider of care to provide a summary of care record for more than 50% of those transitions of care and referrals.

Additionally, there are new requirements for the electronic exchange of summary of care documents:

  • For more than 10% of transitions and referrals, EPs, eligible hospitals, and CAHs that transition or refer their patient to another setting of care or provider of care must provide a summary of care record electronically.
  • The EP, eligible hospital, or CAH that transitions or refers their patient to another setting of care or provider of care must either a) conduct one or more successful electronic exchanges of a summary of care record with a recipient using technology that was designed by a different EHR developer than the sender's, or b) conduct one or more successful tests with the CMS-designated test EHR during the EHR reporting period.

Requirements for Meaningful Use Stage 2

Stage 2 Core and Menu Objectives

Eligible Professionals

Report on all 17 Core Objectives:

1. Use computerized provider order entry (CPOE) for medication, laboratory and radiology orders

2. Generate and transmit permissible prescriptions electronically (eRx)

3. Record demographic information

4. Record and chart changes in vital signs

5. Record smoking status for patients 13 years old or older

6. Use clinical decision support to improve performance on high-priority health conditions

7. Provide patients the ability to view online, download and transmit their health information

8. Provide clinical summaries for patients for each office visit

9. Protect electronic health information created or maintained by the Certified EHR Technology

10. Incorporate clinical lab-test results into Certified EHR Technology

11. Generate lists of patients by specific conditions to use for quality improvement, reduction of disparities, research, or outreach

12. Use clinically relevant information to identify patients who should receive reminders for preventive/follow-up care

13. Use certified EHR technology to identify patient-specific education resources

14. Perform medication reconciliation

15. Provide summary of care record for each transition of care or referral

16. Submit electronic data to immunization registries

17. Use secure electronic messaging to communicate with patients on relevant health information

Report on 3 of 6 Menu Objectives:

1. Submit electronic syndromic surveillance data to public health agencies

2. Record electronic notes in patient records

3. Imaging results accessible through CEHRT

4. Record patient family health history

5. Identify and report cancer cases to a State cancer registry

6. Identify and report specific cases to a specialized registry (other than a cancer registry)

There are also new Stage 2 menu objectives for EPs, eligible hospitals, and CAHs:

  • Record electronic notes in patient records
  • Imaging results accessible through CEHRT
  • Record patient family health history
  • Identify and report cancer cases to a State cancer registry (for EPs only)
  • Identify and report specific cases to a specialized registry (other than a cancer registry) (for EPs only)
  • Generate and transmit permissible discharge prescriptions electronically (eRx) (new for eligible hospitals and CAHs only)
  • Provide structured electronic lab results to ambulatory providers (for eligible hospitals and CAHs only)
  • Finally, there are new Stage 2 measures for several objectives that require patients to use health information technology in order for providers to achieve meaningful use. CMS believes that EPs, eligible hospitals, and CAHs are in the best position to encourage the use of health IT by patients to further their own health care.
  • Under the Stage 2 core objectives to provide patients the ability to view online, download and transmit their health information, more than 5 percent of patients seen by the EP or admitted to an inpatient (Place of Service 21) or emergency department (Place of Service 23) of an eligible hospital or CAH view, download, or transmit to a third party their health information.
  • Under the Stage 2 core objective to use secure electronic messaging to communicate with patients on relevant health information, a secure message must be sent using the electronic messaging function of Certified EHR Technology by more than 5 percent of unique patients seen by an EP during the EHR reporting period.

 

Criteria for Reporting Clinical Quality Measures

      Medicare EHR Incentive Program

Beginning in 2014, the reporting of clinical quality measures (CQMs) will change for all providers. EHR technology that has been certified to the 2014 standards and capabilities will contain new CQM criteria, and eligible professionals (EPs), eligible hospitals, and critical access hospitals (CAHs) will report using the new 2014 criteria regardless of whether they are participating in Stage 1 or Stage 2 of the Medicare and Medicaid Electronic Health Record (EHR) Incentive Programs.

Although clinical quality measure (CQM) reporting has been removed as a core objective for both EPs and eligible hospitals and CAHs, all providers are required to report on CQMs in order to demonstrate meaningful use.

2013

Report same as Stage 1 CQM requirements.

2014 and Beyond

EPs must report on 9 of the 64 approved CQMs

Medicaid EHR Incentive Program

2013 and Beyond

  • EPs, eligible hospitals, and CAHs participating only in a Medicaid EHR Incentive Program will submit their CQM data directly to their State.
  • Each State is responsible for sharing the details on the process for electronic reporting with its provider community.
  • Subject to CMS’s prior approval, the process and the timeline are within the States’ purview.

Clinical Quality Measures for 2014 and Beyond

Although clinical quality measure (CQM) reporting has been removed as a core objective for both EPs and eligible hospitals and CAHs, all providers are required to report on CQMs in order to demonstrate meaningful use. Beginning in 2014, all providers regardless of their stage of meaningful use will report on CQMs in the same way.

EPs must report on 9 out of 64 total CQMs.

Eligible hospitals and CAHs must report on 16 out of 29 total CQMs.

In addition, all providers must select CQMs from at least 3 of the 6 key health care policy domains recommended by the Department of Health and Human Services’ 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

Beginning in 2014, all Medicare-eligible providers beyond their first year of demonstrating meaningful use must electronically report their CQM data to CMS. (Medicaid EPs and hospitals that are eligible only for the Medicaid EHR Incentive Program will electronically report their CQM data to their state.) There will be a variety of options for providers to electronically report their CQMs.

EPs can electronically report CQMs either individually or as a group using the following methods:

  • Physician Quality Reporting System (PQRS)—Electronic submission of samples of patient-level data in the Quality Reporting Data Architecture (QRDA) Category I format. EPs can also report as group using the PQRS GPRO tool. EPs who electronically report using this PQRS option will meet both their EHR Incentive Program and PQRS reporting requirements.
  • CMS-designated transmission method—Electronic submission of aggregate-level data in QRDA Category III format.

Medicare / Medicaid Incentive Program Timeline

For any other details on the Medicare / Medicaid Incentive program, go to http://www.cms.gov/EHRIncentivePrograms/

 

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