Meaningful Use Stage 2 NPRM Ramps Up HIE
With electronic health information exchange ("HIE") leaping out of the 132-page Meaningful Use Stage 2 Notice of Proposed Rulemaking ("Stage 2 NPRM), it is clear that while Stage 2 will continue to afford flexibility to eligible professionals ("EP"), hospitals and critical access hospitals ("CAH"), CMS is not shy about heightening its expectations for HIE. The Stage 2 NPRM proposes several changes to existing Stage 1 objectives as well as proposes additional objectives for Stage 2 which would officially begin in 2014.
For starters, only one of the Stage 1 hospital core objectives involves HIE with "capacity to exchange key clinical information" satisfied by a test or even a failed test of exchange of clinical information with an outside health care provider. And although four of the ten Stage 1 menu set objectives applicable to hospitals require HIE, at a minimum only one of these objectives would need to be satified out of the menu set objectives hospitals could choose from. Hospitals and EPs are required by Meaningful Use to meet all core objectives, whereas they have the option to choose from available menu set objectives (five of ten for hospitals in Stage 1, with two of four proposed in Stage 2), only one of which must be a population/public heath objective.
The Stage 2 NPRM would move these Stage 1 public health/population menu set objectives to the core objectives for hospitals and EPs, with syndromic surveillance remaining a menu set measure for EPs. Ongoing transmission of data to immunization registries as well as submission of data on reportable lab results and syndromic surveillance data to public agencies would also be required with testing no longer sufficient.
The Stage 1 core objective "capacity to submit key clinical information" would be removed effective in 2013 (with CMS welcoming comment on this and its replacement). For Stage 2, hospitals and EPs would move instead to the now-core objective of "provide summary of care document" with 10% required to be provided electronically through HIE to other health care providers. Likewise, new objectives and measures proposed for Stage 2 would also require HIE. For EPs, new menu set objectives would require ongoing submission of data to cancer and specialized registries. And for hospitals and EPs alike, although not proposed in the Stage 2 NPRM, CMS specifically requested comment on whether imaging results, which would have to be accessible through certified EHR technology as a new menu objective, should also be exchanged through HIE.
Another area clearly marked on CMS's agenda is stronger patient engagement through HIE, with patient utilization actually required in order to meet certain objective measures. In Stage 1, for example, EPs and hospitals were required to provide patients with an electronic copy of their health information upon request. The Stage 2 NPRM would propose to change this to requiring the ability of the patient to print, view, and download their health information online, but also to actually having a percentage of patients utilize this resource (10%). If 10% of all patients did not choose to access their health information this way, an EP or hospital would fail to meet meaningful use. EPs would also be required under the Stage 2 NPRM to use electronic messaging to communicate with at least 10% of their patients about their health information. Only messages sent by a patient would count for numerator calculation.
A public comment period will remain open for sixty days from the date of publication in the Federal Register (March 7 - May 7, 5pm) for both the Stage 2 NPRM and the Standards, Implementation Specifications and Certification Criteria NPRM. EPs and hospitals are strongly urged to submit comments, whether in general to proposed Stage 2 NPRM requirements as well as in response to specific questions posed by CMS.