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MU Stage 2: Ten New Requirements?

May 11, 2011
by David Raths
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Work group’s draft proposal raises some thresholds, adds objectives on patient engagement

At the May 11 meeting of the federal Health IT Policy Committee, the Meaningful Use Work Group presented its Stage 2 draft proposals that call for 10 new objectives, increased thresholds on others such as CPOE and e-prescribing, and an array of timing options for the committee to choose from. After gathering more feedback from the public and the committee, the MU Work Group will present final Stage 2 recommendations for Policy Committee approval on June 8.

Farzad Mostashari, M.D.

Farzad Mostashari, M.D., national coordinator for health information technology, began the meeting by noting that the committee’s challenge is to “keep its eyes on the prize and feet on the ground.” By that he meant it has to work within the dynamic tension between maintaining momentum toward its health IT goals and meeting providers where they are. “The onramp has to be feasible for new groups just now implementing systems,” he added. “It has to be something they feel they can do. But we also must keep in mind where we need to be by the time 2016 rolls around.”

He said ONC also has been made keenly aware that it has an obligation to support larger health care transformation goals involving payment reform and patient-centered quality improvements. “We have to frame this so that no hospital CIO has to make a choice between accountable care and meaningful use,” Mostashari said. “We should make meaningful use the roadmap they follow.”

In its proposals, the MU Work Group wants Stage 2 to maintain momentum in the breadth of uses of electronic health records. Among the new measures proposed to the larger HIT Policy Committee for consideration are:
• For hospitals, 10 percent of patients/families can view and download relevant information about a hospital admission; information available for all patients within 36 hours of the encounter.
• 30 percent of provider visits have at least one electronic provider note and 30 percent of eligible hospital patient days have at least one electronic note.
• Hospital medication orders are automatically tracked via electronic medication administration record (in-use in at least one hospital ward/unit).
• For providers, patients are offered secure messaging online and more than 25 patients have sent secure messages online.
• Ten percent of patients have a list of care team members (unstructured data for Stage 2).

On the question of the timing of Stage 2, the work group is suggesting that the Policy Committee consider recommending one of three options to CMS:
1. Maintain current timeline and one-year EHR reporting period; or
2. Maintain current timeline and permit 90-day EHR reporting
period; or
3. Delay the transition from Stage 1 to Stage 2 by one year (affects only providers who begin meaningful use program in 2011).

Paul Tang, M.D.

But in making their presentation, MU Work Group Chairman Paul Tang, M.D., vice president and chief medical information officer at the Palo Alto Medical Foundation in California, suggested option 3 would optimize the overall meaningful use momentum, and several committee members seemed to agree with him.

Because of its perceived complexity, the work group dropped an idea for a phased-in approach that separates existing functionalities from new functionalities. In this model 2013 would have been Stage2a, using existing certified EHR functions with all-core objectives, increased performance thresholds and new quality measures; 2014 would have brought Stage 2b objectives requiring new EHR functionalities.

The MU Work Group also plans to hold a public hearing on Friday, May 13, on how the meaningful use program can better meet the needs of specialists.

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