Yesterday, the Meaningful Use Stage 2 Proposed Rule was made available on the Office of the Federal Register Electronic Public Inspection Desk. The Proposed Rule will be published March 7 and will be open for public comment for sixty days.
With a focus on data exchange, the Proposed Rule addresses the Stage 2 meaningful use criteria that eligible professionals and hospitals must meet as well as proposes certain changes to existing Stage 1 criteria. Nearly all Stage 1 core and menu objectives would remain in place for Stage 2, and eligible hospitals would be required to meet 16 core objectives and 2 out of 4 menu objectives. Eligible professionals would be required to meet 17 core objectives and 3 out of 5 menu objectives.
CMS has specifically requested public comment regarding processes for electronic clinical quality measure (CQM) reporting. Eligible hospitals would be required to report on 24 CQMs with eligible professionals reporting on 12. The Proposed Rule would also include clinical quality reporting within the definition of "meaningful EHR user" and remove it as a separate objective beginning in 2013.
Another significant area made more robust by the Proposed Rule is the ability of patients to have electronic access to their health information (e.g., view, download), rather than access to only electronic copies of their information and discharge instructions as originally required by Stage 1. Additionally, hospitals and eligible professionals are also required in connection with the HIPAA risk assessment that must be performed to specifically address encryption/security of EHR data at rest. While the Proposed Rule would not require actual implementation of encryption mechanisms, it would require each hospital and eligible professional to assess the reasonableness and appropriateness of encrypting electronic PHI, and, if not reasonable, adopting alternative equivalents.
Other proposed changes, although by far not an exhaustive list, include:
- A more "robust" "transitions of care" core objective instead of the core objective of Stage 1 "exchange of key clinical information", requiring exchange of summary of care records for each transition or referral of care;
- Requiring utilization of clinical decision support intervention for improving performance on high priority health conditions to relate to 5 or more CQMs which the EP or hospital would be required to report on (proof of actual improvement not required);
- Consolidation of certain Stage 1 objectives within Stage 2 objectives:
- "Use clinical decision support to improve performance on high-priority health conditions" would include Stage 1 drug-to-drug and drug-allergy checks
- "Summary of care record for each transition or referral of care" would include Stage 1 active medication, allergy and problem lists
- eRX objectives for eligible professionals and hospitals would include Stage 1 drug formulary checks
- Expansion of CPOE to medication, laboratory and radiology orders, clarification on how and when CPOE must occur, and increase of measure from 30% to 60% of orders created;
- Secure e-mail protocols
- Expansion of the definition of a Medicaid patient encounter;
- Process for Medicare payment adjustment beginning in 2015; and
- Official delay of Stage 2 until 2014.
The ONC Standards and Certification Proposed Rule with additional guidance and standards for certified EHR technology is also expected to be released today so stay tuned.