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A New Meaning of Meaningful Use

A version of this article was published in The Daily Record on November 22, 2012.

In August, the Centers for Medicare and Medicaid Services (CMS) finalized new "Stage 2" rules for the meaningful use of electronic health records (EHR). CMS' Medicare and Medicaid EHR Incentive Programs, a component of the 2009 stimulus package, are designed to reward Medicare and Medicaid providers (such as physicians and hospitals) that adopt EHR systems and incorporate "meaningful use" of those systems into their practices.

A. Background

Although participation in the Programs is not mandatory, the reimbursement gap between participating providers and non-participating providers is significant, and is planned to grow in the coming decade.

CMS expects providers to adopt "meaningful use" of EHR gradually, in three stages. Stage 1 rules apply to providers in their first two years in the Programs, Stage 2 rules to providers in their third and fourth years, and Stage 3 rules to providers by their fifth year of participation.

In each stage, the rules mandate that providers enlarge their "core" use of EHR while adopting a subset of peripheral uses of EHR from a "menu" of acceptable peripheral uses. In general, CMS has moved many "peripheral" uses in Stage 1 into the "core" use category in Stage 2.

B. Core Uses

Stage 2 rules now include the following core uses:
1. E-Prescribing - over 50% of prescriptions must be transmitted electronically (vs. 40% in Stage 1);

2. Patient Information - over 80% of unique patients must have structured data within the EHR system concerning their demographics, blood pressure, height, weight, and smoking status (vs. 50% in Stage 1);

3. PatientAccess - a provider must introduce online portals for patient access to health records and must communicate with patients electronically (vs. access to discrete electronic records, and by request only, in Stage 1);

4. ClinicalInterventions - the EHR system must support at least 5 clinical decisions, including drug and drug-allergy interaction checks (vs. 1 decision support function in Stage 1);

5. Confidentiality - a provider must address the encryption and data security requirements of the Health Insurance Portability and Accountability Act (HIPAA) rules (vs. general HIPAA compliance commitments in Stage 1);

6. PatientEducation - a provider must introduce certified education resources for patients (vs. permitted uncertified resources in Stage 1);

7. ClinicalSummaries - over 50% of office visits must result in the delivery of clinical summaries to patients within one business day of a visit (vs. 3 business days in Stage 1);

8. Referrals - in addition to an electronic summary of care record for over 50% of referrals (as in Stage 1), providers must begin to use electronic health exchanges; and

9. ElectronicOrdering - over 55% of lab tests ordered are recorded in either a positive/negative or numerical format as structured data (vs. 40% in Stage 1).

C. Menu Uses

Optional "menu" selections now include reporting diseases to specialized registries (for example, cancer registries) and public health authorities, recording electronic notes and family history in patient electronic health records and the use of EHR systems for imaging results.

Hospitals and physicians should study the new rules closely to ensure their eligibility for EHR incentives. Those providers concerned that they may fall out of compliance should consider contacting their EHR vendor or servicer for assistance.


September 23, 2012




Rosen, Barry F.


Health Care