The Office of the National Coordinator for Healthcare IT has published the final set of criteria that healthcare providers must meet in order to demonstrate that they have reached Stage 2 of "meaningful use" of electronic health records (EHR), and the final version had one significant change from previous versions: additional time for meeting the deadline.
Not unexpectedly, the final rules for reaching Stage 2 of the so-called meaningful use of EHRs will require that patients get involved in using the technology in order for providers to get reimbursement funds.
The U.S. government's Centers for Medicare & Medicaid Services (CMS) established an original timeline that would have required Medicare providers who first demonstrated that they had met the Stage 1 criteria for meaningful use in 2011 to meet the Stage 2 criteria in 2013.
The Stage 2 final rules, published yesterday, however, give providers more time to comply.
Under the change, a provider that fulfilled the Stage 1 criteria in 2011 will have until 2014 to reach Stage 2. In earlier versions of the rules, the deadline was 2013.
The CMS also created a special three-month reporting period -- rather than the standard 12 months -- to give providers attesting to Stage 1 or Stage 2 in 2014 time to deploy, or upgrade to, newly certified EHR technology. The shorter reporting period will give providers time to meet Stage 2 requirements without having to delay their participation in Stage 3, according to Dianne Bourque, a health law attorney in the Boston office of Mintz, Levin, Cohn, Ferris, Glovsky and Popeo.
"CMS is recognizing that vendors will need time to develop certified electronic health record technology," Bourque said in an email to Computerworld
"CMS has tried to reduce hurdles for certain [healthcare providers] and allow more to achieve meaningful use by expanding exceptions to payment adjustments. For example, there are now exceptions for providers who lack broadband Internet access, or who have been victims of natural disasters," Bourque added. "There are also exceptions for providers who lack face-to-face contact with patients, such as pathologists."
Members of the American Hospital Association (AHA) welcomed some of the timeline modifications but were disappointed with others, said Linda Fishman, senior vice president of public policy analysis & development at the AHA.
In a statement issued last night, Fishman said the AHA appreciates "that CMS has allowed for a shorter meaningful use reporting period for 2014," but added that "we are disappointed that this rule sets an unrealistic date by which hospitals must achieve the initial meaningful use requirements to avoid penalties." Moreover, the AHA feels that the CMS "complicated the reporting of clinical quality measures and added to the meaningful use objectives, creating significant new burdens," she said.
The final rules, which are the criteria for receiving reimbursement money and avoiding Medicare penalties, require hospitals, clinics and private physician practices to be able to share patient information electronically with unaffiliated facilities.
By 2016, there will be three sets of rules that the healthcare community must follow in rolling out EHRs in order to receive reimbursements and avoid penalties.
Stage 2 of the meaningful use rules program "will begin as early as 2014. No providers will be required to follow the Stage 2 requirements outlined in the final rules before 2014," said a separate CMS announcement released on Thursday.
For 2014 only, healthcare providers that are beyond the first year of demonstrating meaningful use will have a three-month reporting period, which will give them up to nine additional months to upgrade to certified EHR technology for Stage 2 in 2014.
Bourque said the CMS did respond to provider concerns about requirements for online access to health information by patients and secure messaging between providers and patients, "both of which create their own practical concerns."
"CMS has reduced the requirement from 10% to 5% of the patient population in recognition of these concerns. CMS believes that 5% is reasonable and that online access to health information and real time communication with providers will promote patient engagement," Bourque said.
Just as with Stage 1 rules, which were published in July of 2010, under Stage 2 criteria, clinicians must meet (or qualify for an exclusion from) more than a dozen core objectives and choose from another menu of objectives. Among the changes: Offering lab results in EHRs is no longer an option; it is now a core requirement.
The final Stage 2 rule adds "outpatient lab reporting" to the menu for hospitals and "recording clinical notes" as a menu objective for both physicians and hospitals. There will be 20 measures for "eligible providers" (17 core and three items from a menu of six choices) and 19 measures for eligible hospitals and critical access hospitals (16 core and three items from a menu of six).
Among other Stage 2 rules, healthcare providers must offer outpatients access to updated information on EHRs no longer than four business days after the data is available to the healthcare provider. Additionally, more than 50% of all patients who are discharged from the inpatient or emergency department care must have their information available online within 36 hours of discharge.
To spur provider commitment to electronic exchange of health records, the CMS had initially proposed two measures in Stage 2. The first required that a provider send a summary of care record for more than 65% of transitions of care and referrals. In the final rule, the CMS is reducing the first measure to a lower threshold of 50%.
Hospitals, clinics and private practices must also prove that at least 10% of their patients are actually accessing healthcare information on EHRs. That includes radiological imaging results, which can be accessed directly in an EHR or through a link in the records to the images.
Additionally, any EHR system must have the capacity to provide clinical decision support, include patient demographic and clinical health information such as medical history and a list of any health problems, and have the capacity to support physician order entry.
And all EHR systems must have the capacity to protect a patient's privacy and ensure the integrity and availability of the information stored and exchanged.
