Stage 2
Meaningful
Use:
What You Need to
Know
Tri-State Regional
Extension Center
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the Office of the National Coordinator for HIT, US Dept. of Health and
Coordinator for HIT, US Dept. of Health and Human
Human Services
Services
Definition of Meaningful Use
• Use of ONC-HIT Certified Electronic Health
Records (EHR)
• Electronic Exchange of Health Information
• Quality Reporting
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2
HITECH: Policy Framework
Better care for individuals, better health for populations, and lower per-capita costs.
IHI-Triple Aim Initiative
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4
Why S2MU Matters
• Stage 2 Meaningful Use serves as a foundation for
other health care innovation initiatives
• S2MU is a glide path to:
• Accountable care organizations
• Medical home
• Payment reform initiatives
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5
Meaningful Use – Who is eligible for incentives?
Eligible Providers in
Medicare
Eligible Providers in
Medicaid
Eligible Professionals (EPs)
Doctor of Medicine or
Osteopathy
Doctor of Dental Surgery or
Dental Medicine
Doctor of Podiatric Medicine
Doctor of Optometry
Chiropractor
Eligible Professionals (EPs)
Physicians (Pediatricians have
special eligibility & payment rules)
Nurse Practitioners (NPs)
Eligible Hospitals
Acute Care Hospitals
Critical Access Hospitals (CAHs)
Eligible Hospitals
Acute Care Hospitals
Children’s Hospitals
Certified Nurse-Midwives (CNMs)
Dentists
Physician Assistants (PAs) who
practice in a Federally Qualified
Health Center (FQHC) or rural
health clinic (RHC) that is led by a
PA
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No Changes
from Stage 1
Meaningful
Use
Medicare Payment Adjustments
Medicare EPs who are not
meaningful users will be subject
to a payment adjustment
beginning on January 1, 2015.
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7
Medicare Payment Adjustments
% Adjustment Assuming Less than 75% of EPs are
Meaningful Users
EP is not
subject to the
payment
adjustment
for the e-Rx
in 2012
EP is subject
to the
payment
adjustment
for the e-Rx
in 2014
2015
2016
2017
2018
2019
2020+
99%
98%
97%
96%
95%
95%
98%
98%
97%
96%
95%
95%
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8
Medicare Payment Adjustments
% Adjustment Assuming More than 75% of EPs are
Meaningful Users
EP is not
subject to the
payment
adjustment
for the e-Rx
in 2012
EP is subject
to the
payment
adjustment
for the e-Rx
in 2014
2015
2016
2017
2018
2019
2020+
99%
98%
97%
97%
97%
97%
98%
98%
97%
97%
97%
97%
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9
Medicare Payment Adjustments
EPs who first demonstrated meaningful use in
2011 or 2012 must demonstrate meaningful use
for a full year in 2013 to avoid payment
adjustments in 2015. They must continue to
demonstrate meaningful use every year to avoid
payment adjustments in subsequent years.
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10
Hardship Exceptions for Medicare
EPs
EPs can apply for hardship exceptions in the following
categories:
• Infrastructure
• New EPs
• Unforeseen circumstances
• By specialist/provider type
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11
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12
For Medicare Hospitals:
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13
Contrasting S1MU
to S2MU
An Overview
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Stage 2 Meaningful Use Overview
Stage 2 Meaningful Use (S2MU) Final Rule
was published on August 23, 2012.
Beginning in 2014, providers participating in
the EHR Incentive Programs who have met
Stage 1 for 2 or 3 years will need to meet
S2MU criteria.
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What is in the Rule
•
•
•
•
•
Changes to Stage 1 of Meaningful Use
Stage 2 of Meaningful Use
New clinical quality measures (CQMs)
New CQM reporting mechanisms
Medicaid program changes
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S2MU Change in Total Objectives
Required
Stage 1 MU – Eligible Professionals
Stage 2 MU – Eligible Providers
15 core objectives
17 core objectives
5 of 10 menu objectives
3 of 6 menu objectives
20 total objectives
20 total objectives
Stage 1 MU – Eligible Hospitals &
CAHs
Stage 2 MU – Eligible Hospitals &
CAHs
14 core objectives
16 core objectives
5 of 10 menu objectives
3 of 6 menu objectives
19 total objectives
19 total objectives
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17
How to Get to S2MU
17 Core
Objectives
3 of 6 Menu
Objectives
9 Clinical
Quality
Measures
Meaningful Use
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18
Key Changes to Stage 1 Meaningful
Use
Menu Objective Exclusion– While you can
continue to claim exclusions if applicable for menu
objectives, starting in 2014 these exclusions will no
longer count towards the number of menu objectives
needed.
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Medicaid Eligibility Changes
The definition of what constitutes a Medicaid patient
encounter has changed.
A Medicaid encounter now includes anyone enrolled in a
Medicaid program, including:
• Medicaid expansion encounters (excluding stand alone Title
21)
• Zero-pay claims
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20
Medicaid Eligibility Changes
States have the option to allow providers to calculate
Medicaid patient volume across 90-day period in last
12 months preceding a provider’s attestation.
This also applies to needy patient volume and patient
panel methodology with at least one Medicaid
encounter taking place in the 24 months prior to the
90-day period.
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21
2014 Changes
EHRs Meeting ONC 2014 Standards – starting
in 2014, all EHR Incentive Programs participants
will have to adopt certified EHR technology that
meets ONC’s Standards & Certification Criteria
2014 Final Rule
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2014 Changes
Reporting Period Reduced to Three Months – to allow
providers time to adopt 2014 certified EHR technology
and prepare for Stage 2, all participants will have a threemonth reporting period in 2014.
All providers regardless of their stage of meaningful
use are only required to demonstrate meaningful use
for a three-month EHR reporting period.
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23
2014 Changes
For Medicare providers, this 3-month reporting period
is fixed to the quarter of either the fiscal (for eligible
hospitals and CAHs) or calendar (for EPs) year in
order to align with existing CMS quality measurement
programs, such as the Physician Quality Reporting
System (PQRS) and Hospital Inpatient Quality
Reporting (IQR).
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24
2014 Changes
For Medicaid providers only eligible to receive
Medicaid EHR incentives, the 3-month reporting
period is not fixed, where providers do not have the
same alignment needs. CMS is permitting this onetime three-month reporting period in 2014 only so that
all providers who must upgrade to 2014 Certified EHR
Technology will have adequate time to implement their
new Certified EHR systems.
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25
Stage 2: Batch Reporting
Stage 2 MU rules allows for batch reporting:
Starting in 2014, groups will be allowed to submit
attestation information for all of their individual EPs
in one file for upload to the Attestation System, rather
than having each EP individually enter data.
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How do CQMs relate to the CMS
Incentive Programs?
Although reporting CQMs is no longer a core objective
of the EHR Incentive Programs, all providers are
required to report on CQMs in order to demonstrate
Meaningful Use.
In 2014 and beyond, reporting programs (i.e., PQRS,
eRx reporting) will be streamlined in order to reduce
provider burden.
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Alignment Among Programs
2014 represents
CMS’s commitment to
aligning quality
measurement and
reporting among
programs, including
Hospital Inpatient
Quality Reporting
Program, PQRS,
CHIPRA, and ACO
Programs.
Hospital
Inpatient
Quality
Reporting
Program
ACO
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PQRS
CHIPRA
Reporting CQMs in 2014 and Beyond
Beginning in 2014, all Medicare-eligible providers in their
second year and beyond of demonstrating meaningful
use must electronically report their CQM data to CMS.
Medicaid providers will electronically report their CQM
data to their state.
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Clinical Quality Measures
Provider
Prior to 2014
Complete 6 out of 44:
EPs
3 core or 3 alt. core
+
3 menu
Eligible Hospitals
Complete 15 out of 15
and CAHs
2014 and Beyond*
Complete 9 out of 64
Choose at least 1 measure in 3 NQS
domains
Recommended core CQMs include:
9 CQMs for the adult population
9 CQMs for the pediatric population
Prioritize NQS domains
Complete 16 out of 29
Choose at least 1 measure in 3 NQS
domains
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Stage 2 MU EP Core Objectives
Core
Objective
Measure
1. CPOE
Use CPOE for more than 60% of medication, 30% of laboratory, and 30%
of radiology
2. E-Rx
E-Rx for more than 50%
3. Demographics
Record demographics for more than 80%
4. Vital Signs
Record vital signs for more than 80%
5. Smoking Status Record smoking status for more than 80%
6. Interventions
Implement 5 clinical decision support interventions + drug/drug and
drug/allergy
7. Labs
Incorporate lab results for more than 55%
8. Patient List
Generate patient list by specific condition
9. Preventive
Reminders
Use EHR to identify and provide reminders for preventive/follow-up care
for more than 10% of patients with two or more office visits in the last 2
years
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Stage 2 MU EP Core Objectives
Core Objective
Measure
10. Patient Access
Provide online access to health information for more than 50% with
more than 5% actually accessing
11. Visit Summaries
Provide office visit summaries for more than 50% of office visits
12. Education
Resources
Use EHR to identify and provide education resources more than 10%
13. Secure Messages
More than 5% of patients send secure messages to their EP
14. Rx Reconciliation
Medication reconciliation at more than 50% of transitions of care
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
16. Immunizations
Successful ongoing transmission of immunization data
17. Security Analysis
Conduct or review security analysis and incorporate in risk management
process
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Stage 2 MU EP Menu Objectives
Menu Objective
Measure
1. Imaging Results
More than 20% of imaging results are accessible through
Certified EHR Technology
2. Family History
Record family health history for more than 20% of unique
patients
3. Syndromic
Surveillance
Successful ongoing transmission of syndromic surveillance data
4. Cancer
Successful ongoing transmission of cancer case information
5. Specialized
Registry
Successful ongoing transmission of data to a specialized
registry
6. Progress Notes
Enter an electronic progress note for more than 30% of unique
patients
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Stage 2 MU Hospital Core Objectives
Core
Objective
1. CPOE
Measure
Use CPOE for more than 60% of medication, 30% of laboratory, and
30% of radiology
2. Demographics Record demographics for more than 80%
3. Vital Signs
Record vital signs for more than 80%
4. Smoking Status Record smoking status for more than 80%
5. Interventions
Implement 5 clinical decision support interventions +drug/drug and
drug/allergy
6. Labs
Incorporate lab results for more than 55%
7. Patient List
Generate patient list by specific condition
8. eMAR
eMAR is implemented and used for more than 10% of medication orders
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Stage 2 MU Hospital Core Objectives
Core Objective
Measure
Provide online access to health information for more than 50%
with more than 5% actually accessing
Use EHR to identify and provide education resources more than
10. Education Resources
10%
9. Patient Access
11. Rx Reconciliation
Medication reconciliation at more than 50% of transitions of care
12. 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
13. Immunizations
Successful ongoing transmission of immunization data
14. Labs
Successful ongoing submission of reportable laboratory results
15. Syndromic
Surveillance
Successful ongoing submission of electronic syndromic
surveillance data
Conduct or review security analysis and incorporate in risk
management process
16. Security Analysis
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Stage 2 MU Hospital Menu Objectives
Menu Objective
Measure
1. Progress Notes
Enter an electronic progress note for more than 30% of
unique patients
2. E-Rx
More than 10% electronic prescribing (eRx) of discharge
medication orders
3. Imaging Results
More than 20% of imaging results are accessible through
Certified EHR Technology
4. Family History
Record family health history for more than 20% of unique
patients
5. Advanced Directives
Record advanced directives for more than 50% of patients 65
years or older
6. Labs
Provide structured electronic lab results to EPs for more than 20%
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Q&A Session
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• Type your question in the box and hit the send button to
submit your question
We will make every effort to answer all of the questions
that we receive.
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37
Next Steps
Contact us via phone, email or online if you have
additional questions.
Tri-State REC Information
Phone: 513-469-7222, option 3
Email: rec@healthbridge.org
Online: www.tristaterec.org/s2mu
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Additional MU Information
Tri-State Regional Extension Center
www.tristaterec.org/S2MU
CMS EHR Incentive Program Home Page
http://www.cms.gov/EHRIncentivePrograms/
Office of National Coordinator for Health IT
http://healthit.gov/
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39
EP Core Requirements
Objective
Use of
computerized
provider order
entry
Stage 1 MU
Stage 2 MU
More than 30% of
unique patients
with at least one
medication in their
medication list seen
by the EP have at
least one
medication order
entered using
CPOE.
More than 60% of
medication, 30% of
laboratory and 30% of
radiology orders
created by the EP
during the reporting
period are recorded
using CPOE.
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Summary of
Change
Revised
Threshold
Revised
Requirement
40
EP Core Requirements
Objective
Generate
and transmit
permissible
prescriptions
electronically
(eRx)
Stage 1 MU
Stage 2 MU
More than 40% of
all prescriptions
written are
transmitted
electronically
using certified
EHR technology
(CEHRT).
More than 50%
of all
permissible
prescriptions or
all prescriptions
written by the
EP and queried
for a drug
formulary and
transmitted
electronically
using CEHRT.
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Summary of
Change
Increased
Threshold
Revised
Requirement
41
EP Core Requirements
Objective
Record the
following
demographic
s:
•
•
•
•
•
Preferred
language
Gender
Race
Enthnicity
Date of
birth
Stage 1 MU
Stage 2 MU
More than 50% of
all unique patients
seen by the EP
have
demographics
recorded as
structured data.
More than 80%
of all unique
patients seen by
the EP during
the EHR
reporting period
have
demographics
recorded as
structured data.
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Summary of
Change
Increased
Threshold
42
EP Core Requirements
Objective
Stage 1 MU
Stage 2 MU
More than 50% of
all unique patients’
age 2 and over
seen by the EP
height, weight and
blood pressure are
recorded as
structured data.
More than 80% of
all unique patients
seen by the EP
during the EHR
reporting period
have blood
pressure (for
patients age 3 and
over only) and
height/length and
weight (for all ages)
recorded as
structured data.
Record and chart
changes in the
following vital
signs:
•
•
•
•
Height/length
and weight
Blood pressure
Calculate and
display BMI
Plot and
display growth
charts for
patients 0-20
years (incl.
BMI)
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Summary of
Change
Increased
Threshold
Revised
Requirement
43
EP Core Requirements
Objective
Stage 1 MU
Stage 2 MU
Record smoking
status for patients
13 years old or
older
More than 50% of
all unique patients
13 years old or
older seen by the
EP have smoking
status recorded as
structured data.
More than 80% of
all unique patients
13 years old or
older seen by the
EP have smoking
status recorded as
structured data.
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Services
Summary of
Change
Increased
Threshold
44
EP Core Requirements
Objective
Use clinical
decision
support to
improve
performance
on high
priority health
conditions
Stage 1 MU
Implement one
clinical decision
support rule
relevant to
specialty or high
clinical priority
along with the
ability to track
compliance with
that rule.
Stage 2 MU
Implement five clinical
decision support
interventions related to
four or more clinical
quality measures at a
relevant point in patient
care for the entire EHR
reporting period.
The EP has enabled and
implemented the
functionality for drug-drug
and drug-allergy
interaction checks for the
entire EHR reporting
period.
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Summary of
Change
Revised
Requirement
Increased
Threshold
45
EP Core Requirements
Objective
Incorporate
clinical labtest results
into CEHRT
as structured
data
Stage 1 MU
More than 40% of
all clinical lab tests
results ordered by
the EP during the
EHR reporting
period whose
results are either in
a positive/negative
or numerical format
are incorporated in
certified EHR
technology as
structured data.
Stage 2 MU
More than 55% of all
clinical lab tests ordered
by the EP during the EHR
reporting period whose
results are either in a
positive/negative or
numerical format are
incorporated in a CEHRT
as structured data.
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Summary of
Change
Menu to Core
Increased
Threshold
46
EP Core Requirements
Objective
Generate lists
of patients by
specific
conditions to
use for quality
improvement,
reduction of
disparities,
research or
outreach
Stage 1 MU
Stage 2 MU
Generate at least
one report listing
patients of the EP
with a specific
condition.
Generate at least one
report listing patients of
the EP with a specific
condition.
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Summary of
Change
Menu to Core
47
EP Core Requirements
Objective
Use clinically
relevant
information to
identify patients
who should
receive reminders
for
preventive/followup care and send
these patients the
reminder, per
patient preference
Stage 1 MU
Stage 2 MU
More than 20%
of all unique
More than 10% of all
patients 65
unique patients who have
years or older
had two or more office
or 5 years old
visits with the EP within
or younger
the 24 months before the
were sent an
beginning of the EHR
appropriate
reporting period were
reminder
sent a reminder, per
during the EHR
patient preference when
reporting
available.
period.
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Summary of
Change
Menu to Core
Decreased
Threshold
48
EP Core Requirements
Objective
Provide patients
the ability to view
online, download
and transmit their
health information
within 4 business
days of the
information being
available to the
EP
Stage 1 MU
More than 10% of
all unique
patients seen by
the EP are
provided timely
electronic access
to their health
information.
Stage 2 MU
More than 50% of all unique
patients seen by the EP are
provided timely electronic
access to their health
information.
More than 5% of all unique
patients seen by the EP
during the EHR reporting
period (or their authorized
representatives) view,
download or transmit to a
third party their health
information.
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Summary of
Change
Menu to Core
Revised
Requirement
49
EP Core Requirements
Objective
Provide clinical
summaries for
patients for each
office visit
Stage 1 MU
Clinical
summaries
provided to
patients for
more than 50%
of all office
visits within 3
business days.
Stage 2 MU
Summary of
Change
Clinical summaries
provided to patients within
1 business day for more
than 50% of office visits.
Revised
Requirement
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50
EP Core Requirements
Objective
Use CEHRT to
identify patientspecific education
resources and
provide those
resources to the
patient
Stage 1 MU
More than 10% of
all unique patients
seen by the EP
during the EHR
reporting period
are provided
patient-specific
education
resources.
Stage 2 MU
Summary of
Change
Patient-specific
education resources
identified by CEHRT are
provided to patients for
more than 10% of all
office visits by the EP.
Menu to Core
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Revised
Requirement
51
EP Core Requirements
Objective
Use secure
electronic
messaging to
communicate with
patients on relevant
health information
Stage 1 MU
N/A
Stage 2 MU
A secure message was
sent using the electronic
messaging function of
CEHRT by more than 5%
of unique patients seen by
the EP during the EHR
reporting period.
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Services
Summary of
Change
New
Requirement
52
EP Core Requirements
Objective
Stage 1 MU
Stage 2 MU
The EP who
receives a patient
from another
setting of care or
provider of care or
believes an
encounter is
relevant should
perform medication
reconciliation
The EP performs
medication
reconciliation for
more than 50% of
transitions of care
in which the
patient is
transitioned into
the care of the
EP.
The EP performs
medication reconciliation
for more than 65% of
transitions of care in
which the patient is
transitioned into the care
of the EP.
REC support is. provided under cooperative agreement
90RC0025/01 from the Office of the National
Coordinator for HIT, US Dept. of Health and Human
Services
Summary of
Change
Increased
Threshold
Menu to Core
53
EP Core Requirements
Objective
The EP who
transitions their
patient to another
setting of care or
provider of care or
refers their patient
to another provider
of care provides a
summary care
record for each
transition of care
or referral
Stage 1 MU
The EP who
transitions their
patient to another
setting of care or
provider of care
provides a
summary of care
record for more
than 50% of
transitions of care
and referrals.
Stage 2 MU
The EP who transitions their
patient to another setting of care
or provider of care provides a
summary of care record for
more than 50% of transitions of
care and referrals.
10% of such transitions or
referrals are electronically
transmitted.
Summary of
Change
Menu to Core
Revised
Requirement
One or more successful
exchanges of a summary of
care document with a recipient
on a different EHR technology.
REC support is. provided under cooperative agreement
90RC0025/01 from the Office of the National
Coordinator for HIT, US Dept. of Health and Human
Services
54
EP Core Requirements
Objective
Capability to
submit electronic
data to
immunization
registries or
immunization
information
systems except
where prohibited,
and in
accordance with
applicable law
and practice
Stage 1 MU
Performed at least one
test of certified EHR
technology’s capacity to
submit electronic data
to immunization
registries and follow up
submission if the test is
successful (unless the
immunization registries
do not have the
capacity to receive the
information
electronically).
Stage 2 MU
Successful ongoing
submission of
electronic
immunization data
from CEHRT to an
immunization registry
or immunization
information system for
the entire EHR
reporting period.
REC support is. provided under cooperative agreement
90RC0025/01 from the Office of the National
Coordinator for HIT, US Dept. of Health and Human
Services
Summary of
Change
Revised
Requirement
Menu to Core
55
EP Core Requirements
Objective
Stage 1 MU
Stage 2 MU
Protect
electronic
health
information
created or
maintained
by the
CEHRT
through the
implementati
on of
appropriate
technical
capabilities
Conduct or review
a security risk
analysis per 45
CFR 164.308
(a)(1) and
implement security
updates as
necessary and
correct identified
security
deficiencies as
part of its risk
management.
Conduct or review a security risk
analysis in accordance with the
requirements under 45 CFR
164.308(a)(1), including
addressing the encryption/security
of data stored in CEHRT in
accordance with requirements
under 45 CFR 164.312 (a)(2)(iv)
and 45 CFR 164.306(d)(3), and
implement security updates as
necessary and correct identified
security deficiencies as part of the
provider’s risk management
process.
REC support is. provided under cooperative agreement
90RC0025/01 from the Office of the National
Coordinator for HIT, US Dept. of Health and Human
Services
Summary of
Change
Revised
Requirement
56
EP Menu Set Requirements
Objective
Imaging results
consisting of the
image itself and
any explanation or
other
accompanying
information are
accessible through
CEHRT
Stage 1 MU
N/A
Stage 2 MU
More than 10% of all tests
whose result is one or
more images ordered by
an EP during the EHR
reporting period are
accessible through
CEHRT.
REC support is. provided under cooperative agreement
90RC0025/01 from the Office of the National
Coordinator for HIT, US Dept. of Health and Human
Services
Summary of
Change
New
Requirement
57
EP Menu Set Requirements
Objective
Record patient
family health history
as structured data
Stage 1 MU
N/A
Stage 2 MU
More than 20% of all
unique patients seen by
the EP during the EHR
reporting period have a
structured data entry for
one or more first-degree
relatives.
REC support is. provided under cooperative agreement
90RC0025/01 from the Office of the National
Coordinator for HIT, US Dept. of Health and Human
Services
Summary of
Change
New
Requirement
58
EP Menu Set Requirements
Objective
Record electronic
notes in patient
records
Stage 1 MU
N/A
Stage 2 MU
Enter at least one
electronic progress note
created, edited and signed
by an EP for more than
30% of unique patients
with at least one visit
during the EHR reporting
period. Electronic progress
notes must be textsearchable.
REC support is. provided under cooperative agreement
90RC0025/01 from the Office of the National
Coordinator for HIT, US Dept. of Health and Human
Services
Summary of
Change
New
Requirement
59
EP Menu Set Requirements
Objective
Capability to submit
electronic
syndromic
surveillance data to
public health
agencies, except
where prohibited,
and in accordance
with applicable law
and practice
Stage 1 MU
N/A
Stage 2 MU
Successful ongoing
submission of electronic
syndromic surveillance
data from CEHRT to a
public health agency for
the entire EHR reporting
period.
REC support is. provided under cooperative agreement
90RC0025/01 from the Office of the National
Coordinator for HIT, US Dept. of Health and Human
Services
Summary of
Change
New
Requirement
60
EP Menu Set Requirements
Objective
Capability to
identify and report
cancer cases to a
State cancer
registry, except
where prohibited,
and in accordance
with applicable law
and practice
Stage 1 MU
N/A
Stage 2 MU
Successful ongoing
submission of cancer case
information from CEHRT
to a public health central
cancer registry for the
entire EHR reporting
period.
REC support is. provided under cooperative agreement
90RC0025/01 from the Office of the National
Coordinator for HIT, US Dept. of Health and Human
Services
Summary of
Change
New
Requirement
61
EP Menu Set Requirements
Objective
Capability to
identify and report
specific cases to a
specialized registry
(other than a
cancer registry),
except where
prohibited, and in
accordance with
applicable law and
practice
Stage 1 MU
N/A
Stage 2 MU
Successful ongoing
submission of specific
case information from
CEHRT to a specialized
registry for the entire EHR
reporting period.
REC support is. provided under cooperative agreement
90RC0025/01 from the Office of the National
Coordinator for HIT, US Dept. of Health and Human
Services
Summary of
Change
New
Requirement
62
EH Core Requirements
Objective
Use of
computerize
d provider
order entry
Stage 1 MU
Stage 2 MU
More than 30% of
unique patients with at
least one medication in
their medication list
seen by the EP have at
least one medication
order entered using
CPOE.
More than 60% of
medication, 30% of
laboratory and 30% of
radiology orders created by
authorized providers of the
eligible hospital’s or CAH’s
inpatient or emergency
department (POS 21 or 23)
during the EHR reporting
period are recorded using
CPOE.
REC support is. provided under cooperative agreement
90RC0025/01 from the Office of the National
Coordinator for HIT, US Dept. of Health and Human
Services
Summary of
Change
Increased
Threshold
Revised
Requirement
63
EH Core Requirements
Objective
Stage 1 MU
Stage 2 MU
More than 50% of all
unique patients seen
by the EP have
demographics
recorded as
structured data.
More than 80% of all
unique patients seen by
the EP or admitted to
the eligible hospital’s or
CAH’s inpatient or
emergency department
(POS 21 or 23) have
demographics recorded
as structured data.
Record the following
demographics:
•
•
•
•
•
•
Preferred
language
Gender
Race
Enthnicity
Date of birth
Date and
preliminary
cause of death
REC support is. provided under cooperative agreement
90RC0025/01 from the Office of the National
Coordinator for HIT, US Dept. of Health and Human
Services
Summary of
Change
Increased
Threshold
64
EH Core Requirements
Objective
Record and chart
changes in the
following vital
signs:
•
•
•
•
Stage 1 MU
Record height, weight
and blood pressure as
structured data for
Height/length
more than 50% of all
and weight
unique patients age 2
Blood pressure
and over admitted to
Calculate and
the eligible hospital’s
display BMI
or CAH’s inpatient or
Plot and display
emergency
growth charts
department.
for patients 020 years (incl.
BMI)
Stage 2 MU
More than 80% of all unique
patients seen by the EP or
admitted to the eligible
hospital’s or CAH’s inpatient
or emergency department
(POS 21 or 23) have blood
pressure (for patients age 3
and over only) and
height/length and weight (for
all ages) recorded as
structured data.
REC support is. provided under cooperative agreement
90RC0025/01 from the Office of the National
Coordinator for HIT, US Dept. of Health and Human
Services
Summary of
Change
Increased
Threshold
Revised
Requirement
65
EH Core Requirements
Objective
Record
smoking
status for
patients 13
years old or
older
Stage 1 MU
Stage 2 MU
More than 80% of all unique
Have “smoking status”
patients 13 years old or
recorded as structured
older seen by the EP or
data for more than 50% of
admitted to the eligible
all unique patients 13
hospital’s or CAH’s inpatient
years old or older admitted or emergency department
to the eligible hospital’s or
(POS 21 or 23) during the
CAH’s inpatient or
EHR reporting period have
emergency department.
smoking status recorded as
structured data.
REC support is. provided under cooperative agreement
90RC0025/01 from the Office of the National
Coordinator for HIT, US Dept. of Health and Human
Services
Summary of
Change
Increased
Threshold
66
EH Core Requirements
Objective
Use clinical
decision
support to
improve
performance
on high priority
health
conditions
Stage 1 MU
Implement
one clinical
decision
support rule.
Stage 2 MU
Implement five clinical decision
support interventions related to
four or more clinical quality
measures at a relevant point in
patient care for the entire EHR
reporting period.
The EP has enabled and
implemented the functionality for
drug-drug and drug-allergy
interaction checks for the entire
EHR reporting period.
REC support is. provided under cooperative agreement
90RC0025/01 from the Office of the National
Coordinator for HIT, US Dept. of Health and Human
Services
Summary of
Change
Revised
Requirement
Increased
Threshold
67
EH Menu Set Requirements
Objective
Incorporate
clinical lab-test
results into
certified EHR
technology as
structured
data
Stage 1 MU
More than 40% of all
clinical lab test results
ordered by an
authorized provider of
the eligible hospital or
CAH during the EHR
reporting period whose
results are either in a
positive/negative or
numerical format are
incorporated in certified
EHR technology as
structured data.
Stage 2 MU
More than 55% of all
clinical lab test results
ordered by the EP or an
authorized provider of the
eligible hospital or CAH for
patients admitted to its
inpatient or emergency
department (POS 21 or 23)
during the EHR reporting
period whose results are
either in a positive/negative
or numerical format are
incorporated in certified
EHR technology as
structured data.
REC support is. provided under cooperative agreement
90RC0025/01 from the Office of the National
Coordinator for HIT, US Dept. of Health and Human
Services
Summary of
Change
Menu to
Core
Increased
Threshold
68
EH Core Requirements
Objective
Generate lists
of patients by
specific
conditions to
use for quality
improvement,
reduction of
disparities,
research or
outreach
Stage 1 MU
Stage 2 MU
Generate at least
one report listing
patients of the
eligible hospital or
CAH with a specific
condition.
Generate at least one
report listing patients of
the EP, eligible hospital or
CAH with a specific
condition.
REC support is. provided under cooperative agreement
90RC0025/01 from the Office of the National
Coordinator for HIT, US Dept. of Health and Human
Services
Summary of
Change
Menu to Core
69
EH Menu Set Requirements
Objective
Automatically track
medications from
order to
administration
using assistive
technologies in
conjunction with an
electronic
medication
administration
record (eMAR)
Stage 1 MU
Stage 2 MU
N/A
More than 10% of medication
orders created by authorized
providers of the eligible
hospital’s or CAH’s inpatient or
emergency department (POS
21 or 23) during the EHR
reporting period are tracked
using eMAR.
REC support is. provided under cooperative agreement
90RC0025/01 from the Office of the National
Coordinator for HIT, US Dept. of Health and Human
Services
Summary of
Change
New
Requirement
70
EH Core Requirements
Objective
Provide patients the
ability to view
online, download
and transmit
information about a
hospital admission
Stage 1 MU
N/A
Stage 2 MU
More than 50% of all patients
who are discharged from the
inpatient or emergency
department (POS 21 or 23) of
an eligible hospital or CAH
have their information available
online within 36 hours of
discharge.
Summary of
Change
New
Requirement
Menu to Core
More than 5% of all patients
discharged view, download or
transmit to a third party their
information during the reporting
period.
REC support is. provided under cooperative agreement
90RC0025/01 from the Office of the National
Coordinator for HIT, US Dept. of Health and Human
Services
71
EH Core Requirements
Objective
Use CEHRT to
identify patientspecific education
resources and
provide those
resources to the
patient
Stage 1 MU
Stage 2 MU
More than 10 percent
of all unique patients
More than 10% of all
admitted to the
unique patients
eligible hospital’s or
admitted to the eligible
CAH’s inpatient or
hospital’s or CAH’s
emergency
inpatient or emergency
department during
department (POS 21 or
the EHR reporting
23) are provided
period are provided
patient-specific
patient-specific
education resources
education resources.
identified by CEHRT.
REC support is. provided under cooperative agreement
90RC0025/01 from the Office of the National
Coordinator for HIT, US Dept. of Health and Human
Services
Summary of
Change
Menu to Core
Revised
Requirement
72
EH Core Requirements
Objective
The EH or CAH
who receives a
patient from
another setting of
care or provider of
care or believes an
encounter is
relevant should
perform medication
reconciliation
Stage 1 MU
Stage 2 MU
Perform
The eligible hospital or
medication
CAH performs medication
reconciliation for
reconciliation for more
more than 50% of
than 50% of transitions of
transitions of care
care in which the patient is
in which the
transitioned into the care
patient is admitted
of the EP or admitted to
to the eligible
the eligible hospital’s or
hospital’s or CAH’s
CAH’s inpatient or
inpatient or
emergency department
emergency
(POS 21 or 23).
department.
REC support is. provided under cooperative agreement
90RC0025/01 from the Office of the National
Coordinator for HIT, US Dept. of Health and Human
Services
Summary of
Change
Menu to Core
73
EH Core Requirements
Objective
The EH or CAH who
transitions their
patient to another
setting of care or
provider of care or
refers their patient to
another provider of
care provides a
summary care
record for each
transition of care or
referral
Stage 1 MU
The eligible
hospital or CAH
provides a
summary of
care record for
more than 50%
of transitions of
care and
referrals.
Stage 2 MU
The EH or CAH who transitions
or refers their patient to another
setting of care or provider of
care provides a summary of
care record for more than 50%
of transitions of care and
referrals.
10% of such transitions or
referrals are electronically
transmitted.
Summary of
Change
Menu to Core
Revised
Requirements
One or more successful
exchanges of a summary of
care document with a recipient
on a different EHR technology.
REC support is. provided under cooperative agreement
90RC0025/01 from the Office of the National
Coordinator for HIT, US Dept. of Health and Human
Services
74
EH Core Requirements
Objective
Capability to
submit electronic
data to
immunization
registries or
immunization
information
systems except
where prohibited,
and in
accordance with
applicable law
and practice
Stage 1 MU
Performed at least one
test of certified EHR
technology’s capacity to
submit electronic data
to immunization
registries and follow up
submission if the test is
successful.
Stage 2 MU
Successful ongoing
submission of
electronic
immunization data
from CEHRT to an
immunization registry
or immunization
information system for
the entire EHR
reporting period.
REC support is. provided under cooperative agreement
90RC0025/01 from the Office of the National
Coordinator for HIT, US Dept. of Health and Human
Services
Summary of
Change
Revised
Requirement
Menu to Core
75
EH Core Requirements
Objective
Stage 1 MU
Performed at least one
Capability to
test of certified EHR
submit electronic
technology capacity to
reportable
provide electronic
laboratory results
submission of
to public health
reportable lab results
agencies, except
to public health
where prohibited,
agencies and follow-up
and in accordance
submission if the test is
with applicable law
successful.
and practice
Stage 2 MU
Successful ongoing
submission of
electronic reportable
laboratory results from
CEHRT to public
health agencies for the
entire EHR reporting
period.
REC support is. provided under cooperative agreement
90RC0025/01 from the Office of the National
Coordinator for HIT, US Dept. of Health and Human
Services
Summary of
Change
Revised
Requirement
Menu to Core
76
EH Core Requirements
Objective
Stage 1 MU
Capability to submit
electronic syndromic
surveillance data to
public health
agencies, except
where prohibited,
and in accordance
with applicable law
and practice
Performed at least
one test of certified
EHR technology
capacity to provide
electronic syndromic
surveillance data to
public health
agencies and followup submission if the
test is successful.
Stage 2 MU
Successful ongoing
submission of
electronic syndromic
surveillance data from
CEHRT to public
health agencies for the
entire EHR reporting
period.
REC support is. provided under cooperative agreement
90RC0025/01 from the Office of the National
Coordinator for HIT, US Dept. of Health and Human
Services
Summary of
Change
Revised
Requirement
Menu to Core
77
EH Core Requirements
Objective
Protect
electronic health
information
created or
maintained by
the CEHRT
through the
implementation
of appropriate
technical
capabilities
Stage 1 MU
Conduct or review
a security risk
analysis per 45
CFR 164.308
(a)(1) and
implement
security updates
as necessary and
correct identified
security
deficiencies as
part of its risk
management
process.
Stage 2 MU
Conduct or review a security
risk analysis in accordance
with the requirements under
45 CFR 164.308(a)(1),
including addressing the
encryption/security of data
stored in CEHRT in
accordance with requirements
under 45 CFR 164.312
(a)(2)(iv) and 45 CFR
164.306(d)(3), and implement
security updates as necessary
and correct identified security
deficiencies as part of the
provider’s risk management
process.
REC support is. provided under cooperative agreement
90RC0025/01 from the Office of the National
Coordinator for HIT, US Dept. of Health and Human
Services
Summary of
Change
Revised
Requirement
78
EH Menu Set Requirements
Objective
Stage 1 MU
Stage 2 MU
Record advance
directives for
patients age 65
and older
More than 50% of
all unique patients
65 years old or
older admitted to
the eligible
hospital’s or
CAH’s inpatient
department have
an indication of an
advance directive
status recorded.
More than 50% of all
unique patients 65 years
old or older admitted to the
eligible hospital’s or CAH’s
inpatient department (POS
21) during the EHR
reporting period have an
indication of an advance
directive status recorded
as structured data.
REC support is. provided under cooperative agreement
90RC0025/01 from the Office of the National
Coordinator for HIT, US Dept. of Health and Human
Services
Summary of
Change
Revised
Requirement
79
EH Menu Set Requirements
Objective
Imaging results
consisting of the
image itself and
any explanation or
other
accompanying
information are
accessible through
CEHRT
Stage 1 MU
N/A
Stage 2 MU
More than 10% of all tests
whose result is one or more
images ordered by
authorized provider of an
eligible hospital or CAH for
patients admitted to its
inpatient or emergency
department during the EHR
reporting period are
accessible through CEHRT.
REC support is. provided under cooperative agreement
90RC0025/01 from the Office of the National
Coordinator for HIT, US Dept. of Health and Human
Services
Summary of
Change
New
Requirement
80
EH Menu Set Requirements
Objective
Record patient
family health history
as structured data
Stage 1 MU
N/A
Stage 2 MU
More than 20% of all
unique patients admitted
to the eligible hospital or
CAH’s inpatient or
emergency department
(POS 21 or 23) during the
EHR reporting period have
a structured data entry for
one or more first-degree
relatives.
REC support is. provided under cooperative agreement
90RC0025/01 from the Office of the National
Coordinator for HIT, US Dept. of Health and Human
Services
Summary of
Change
New
Requirement
81
EH Menu Set Requirements
Objective
Generate and
transmit
permissible
discharge
prescriptions
electronically (eRx)
Stage 1 MU
N/A
Stage 2 MU
More than 10% of hospital
discharge medication
orders for permissible
prescriptions (for new,
changed and refilled
prescriptions) are queried
for a drug formulary and
transmitted electronically
using CEHRT.
REC support is. provided under cooperative agreement
90RC0025/01 from the Office of the National
Coordinator for HIT, US Dept. of Health and Human
Services
Summary of
Change
New
Requirement
82
EH Menu Set Requirements
Objective
Record
electronic
notes in patient
records
Stage 1 MU
N/A
Stage 2 MU
Enter at least one electronic
progress note created, edited and
signed by an authorized provider
of the EH’s or CAH’s inpatient or
emergency department (POS 21
or 23) for more than 30% of
unique patients admitted to the
EH’s or CAH’s inpatient or
emergency department during the
EHR reporting period. Electronic
progress notes must be textsearchable.
REC support is. provided under cooperative agreement
90RC0025/01 from the Office of the National
Coordinator for HIT, US Dept. of Health and Human
Services
Summary of
Change
New
Requirement
83
EH Menu Set Requirements
Objective
Provide structured
electronic lab
results to
ambulatory
providers
Stage 1 MU
N/A
Stage 2 MU
Hospital labs send
structured electronic
clinical lab results to the
ordering provider for more
than 20% of electronic lab
orders received.
REC support is. provided under cooperative agreement
90RC0025/01 from the Office of the National
Coordinator for HIT, US Dept. of Health and Human
Services
Summary of
Change
New
Requirement
84