As originally proposed within the joint CMS/ONC Meaningful Use EHR adoption initiative, standardized EHR functionality criteria required for certification, quality reporting and the receipt of incentive payments are scheduled to expand over time. Aspects of current Stage 1 criteria are to merge with new Stage 2 criteria and follow the same structure into future Stage 3 requirements. Recently, CMS/ONC has extended Stage 1 to continue through the end of 2013, and as a result Stage 2 will begin at the start of 2014.

Outlined below are several changes suggested in the CMS Notice of Proposed-Rulemaking (NPRM), released Feb. 23rd, 2012, of current Stage 1 measures for Stage 2.

• Changes to the denominator of computerized provider order entry (CPOE).
• Changes to the age limitations for vital signs.
• Elimination of the "exchange of key clinical information” core objective from Stage 1 in favor of a "transitions of care” core objective that requires electronic exchange of summary of care documents in Stage 2.
• Matching care coordination with HIT components of Accountable Care
• Replacing "provide patients with an electronic copy of their health information” objective with a "view online, download and transmit” core objective.

Notable changes are the proposed 17 core objectives and a further selection of three of five menu objectives required for EPs. EHs and CAHs are proposed to meet 16 core objectives and further select two of four menu objectives in Stage 2. Currently, Stage 2 is scheduled to commence on January 1st of 2014 for EPs and October of 2013 for hospitals.

A few of the key proposed changes include:

• The use of computerized provider order entry (CPOE) for medication orders increases from 30% to 60%, along with the addition of labs and radiology to this quality measure.
• Generate and transmit permissible scripts electronically (eRx) increases from 40% to 65%.
• Threshold levels to increase from 50% to 80% for the following:
  • Recording Demographics (preferred language, gender, race, ethnicity, etc.).
  • Record and chart changes in vital signs (height, weight, blood pressure, BMI, etc.).
  • Record smoking status for patients over 13 years of age

• The following are moving from the menu set to become core items:
  • Patients are provided online access to their health information (via a web portal) on 50% of the occasions, and further, 10% unique patients actually view, download or transmit that data to a third party.
  • Successful ongoing submission of electronic immunization data from certified EHR technology to an immunization registered is now required, previously only a test was acceptable
  • Provide a summary of care record for 65% of transitions of care during referrals or transfer of patient care settings, and electronically transmit 10% across EHR vendor types and organizations. This measure combines Stage 1 core items – problem list, active medication list and active medication allergy list - to emphasize increased data exchange.

• Stage 2 also proposes:
  • Secure electronic messaging is utilized to communicate with patients on relevant health information for 10% of unique patients.
  • Patient family health history is recorded for more than 20% of unique patients.
  • More than 40% of all imaging results and information are accessible through certified EHR technology

Proposed EMR Meaningful Use Criteria Stage 3 Summary:

• Stage 3 will maintain Stage 2 Criteria
  • Further increases patient volume and other thresholds in some areas, beginning 2015 or later
• Will enhance bi-directional data exchange with public health agencies utilizing existing criteria
  • Immunization data to registries
  • Lab data to registries
  • Syndromic surveillance to public health registries
• Demonstrate improvement in patient outcomes
  • Provide patients access to self-management tools
  • Allow patients to upload generated data
  • Example ~ Reduce major drug interactions & readmission rates