The federal Centers for Medicare & Medicaid Services (CMS) has announced modest changes to some of the technical requirements under Stage 2 of the meaningful use process under the Health Information Technology for Economic and Clinical Health (HITECH) Act. In an interim rule set to be published Dec. 7, CMS announced that it was replacing a small number of standards with new versions, and changing or exempting some meaningful use measures to allow providers to fulfill them in a more flexible way.

Among the changes:

>  The objective “Provide structured electronic lab results to ambulatory providers” has been modified, in order to allow for the alternative measure, “Hospital labs send structured electronic clinical lab results to the ordering provider for more than 20 percent of lab orders received.” As CMS officials noted, “In cases where hospitals send a large number of lab results electronically in response to orders they receive through non-electronic means (for example, by phone or on paper), the measure might not capture a hospital’s performance of the objectives.”

> The objective “Provide patients the ability to view online, download, and transmit information about a hospital admission” has been modified in its requirements. As CMS officials noted, “Because we intended for the regulation text to be consistent with the measure specifications as described in the preamble, we are correcting the regulation text …. To clarify that these measures are based on the number of unique patients discharged from a hospital’s inpatient or emergency department during the EHR reporting period.”

> Case threshold exemption: In the Stage 2 final rule, CMS adopted a policy beginning in FY 2014 that would allow eligible hospitals critical access hospitals with five or fewer inpatient discharges per quarter or 20 or fewer inpatient discharges per year to be exempted from reporting on any particular clinical quality measure. CMS is now expanding that exemption to FY 2013 as well.

 Technical errors: CMS officials say they have identified a small number of technical errors in the 2014 CQM e-specifications; they promise to issue those corrections by Dec. 31.

 In addition, has updated the “Data Element Catalog” (DEC) that helps to define what is required to calculate the clinical quality measures (CQMs) under meaningful use. Performing a gap analysis, CMS officials noted that, “If we do not act now to immediately update the verison of the DEC currently incorporated by reference, EHR technology would be required to be tested and certified to DEC version 1.0 and thus capture, in some cases, less data than necessary to support the accurate calculation and reporting of the 2014 CQMs.” CMS has also modified a few technical aspects of the Quality Reporting Document Architecture (“QRDA III”).

The full details of all these changes can be found at: https://s3.amazonaws.com/public-inspection.federalregister.gov/2012-29607.pdf