The final Stage 2 Meaningful Use rules were released last week by the Centers for Medicare and Medicaid Services (CMS), and the focus has not changed from the proposed rules, which is to move providers along the path from showing they have the ability to use electronic health record (EHR) technology in a meaningful way to actually doing it.
To that end, the measures have increased to require more care coordination, better clinical decision support, more information exchange, and more patient engagement. The chart below outlines the Stage 2 objectives, the measure for each, and the changes from Stage 1.
The good news for oncology providers is that our Patient Engagement Portal was designed with the knowledge that the patient engagement objectives would move from an optional menu item to a required objective, and the measures would increase to require a larger percentage of patients be engaged in their care. As a result, our product already solves many of the Stage 2 objectives.
Now that the Stage 2 rules have been finalized, it’s clear that EHRs alone will not be enough to provide patients and their healthcare team with an easy-to-use and efficient means of communication.
For example, our online patient registration replaces paper forms, and has patients entering their medical history from the comfort of home. This solves the demographics, smoking status and family history objectives with no data entry required by clinic staff.
Once patients register, they have a secure account where they can view their personal health information on the clinic’s patient portal, which is a branded extension of the clinic’s care model and is accessed through their website. When personal health information is updated, such as their diagnosis or lab results, patients are sent a secure message to login to access their information. Once the patient receives their diagnosis electronically, the portal is automatically personalized with educational resources based on their diagnosis, with no work required by clinic staff.
Now that the Stage 2 rules have been finalized, it’s clear that EHRs alone will not be enough to provide patients and their healthcare team with an easy-to-use and efficient means of communication. A patient portal is necessary to meet the patient engagement objectives, and must provide more than just transactional services.
In addition, patient engagement is also a central component of the oncology medical home and accountable care organization models, as well as new standards of care from professional organizations such as the Commission on Cancer. Ideally, the technology solutions oncology providers adopt should help them qualify for all these emerging patient centered programs.
Stage 2 Meaningful Use Objectives and Stage 1 Changes for Eligible Professionals
|
Stage 1 |
Stage 2 |
|
15 core objectives, 5 of 10 menu objectives 20 total |
17 core objectives, 3 of 6 menu objectives 20 total |
In Stage 2, eligible professionals (EPs) must meet all 17-core objectives, and 3 of 6 menu objectives.
|
Core Objective |
Measure |
Change from Stage 1 |
|
|
1 |
Use CPOE for medication, lab and radiology orders |
Use CPOE for more than 60% of medication, 30% of lab, 30% of radiology orders |
Increase to 60% from 30% for meds, new 30% level for lab and radiation. Measure based on orders, instead of unique patients. |
|
2 |
Utilize electronic prescriptions |
E-Rx for more than 50% |
Increase to 50% from 40%, now includes Stage 1 drug formulary checks objective |
|
3 |
Record key patient demographics |
Record demographics for more than 80% |
Increase to 80% from 50% |
|
4 |
Record and chart changes in vital signs |
Record vital signs for more than 80% |
Increase to 80% from 50%, required age for blood pressure increased from 2 to 3 |
|
5 |
Record smoking status |
Record smoking status for more than 80% |
Increase to 80% from 50% |
|
6 |
Clinical decision support |
Implement 5 clinical decision support interventions + drug/drug drug/allergy checks |
Increase to 5 from 1, includes Stage 1 drug/allergy interaction checks objective |
|
7 |
Incorporate lab test results into EHR |
Incorporate lab results for more than 55% |
Increase to 55% from 40%, moved to core set from menu set |
|
8 |
Generate lists of patients by specific conditions |
Generate patient list by specific condition |
Move to core set from menu set |
|
9 |
Send reminders to patients for follow up |
Use EHR to identify and provide reminders for preventative/follow-up care for more than 10% of patients with two or more office visits in the last 2 years |
Moved to core set from menu set, decrease to 10% from 20% |
|
10 |
Patient access to health information within 4 days |
Provide online access to health information for more than 50% with more than 5% actually accessing |
Moved to core set from menu set, increase time to 4 days from 3, 5% access is new |
|
11 |
Provide clinical summaries |
Provide office visit summaries for more than 50% of office visits |
Required within 1 business day instead of 3 |
|
12 |
Identify and provide education resources |
Use EHR to identify and provide education resources more than 10% |
Moved to core set from menu set |
|
13 |
Secure messages |
More than 5% of patients send secure messages to their EP |
New objective |
|
14 |
Rx Reconciliation |
Medication reconciliation at more than 50% of transitions of care |
Moved to core set from menu set |
|
15 |
Summary of care |
Provide summary of care document for more than 50% of transitions of care and referrals with 10% sent electronically and at least one sent to a recipient with a different EHR vendor or successfully testing with CMS test EHR |
Moved to core set from menu set, combines three Stage 1 objectives – maintain problem list, active medication and allergy list |
|
16 |
Immunization registries |
Successful ongoing transmission of immunization data |
Moved to core set from menu set, ongoing submission instead of just once |
|
17 |
Protect electronic health information |
Conduct or review security analysis and incorporate in risk management process |
No change |
|
. . |
|||
|
Menu Objective |
Measure |
Change |
|
|
1 |
Imaging Results |
More than 10% of imaging results are accessible through certified EHR technology |
New objective |
|
2 |
Family History |
Record family health history for more than 20% |
New objective |
|
3 |
Syndromic Surveillance |
Successful ongoing transmission of syndromic surveillance data |
Ongoing submission instead of just once |
|
4 |
Report cancer cases |
Successful ongoing transmission of cancer case information |
New objective |
|
5 |
Specialized Registry |
Successful ongoing transmission of data to a specialized registry |
New objective |
|
6 |
Record notes in patient records |
Enter an electronic progress note for more than 30% of unique patients |
New objective |