Proposed Stage 2 Meaningful Use Guidelines

The Health Information Technology Policy Committee (HITPC) published for comment its recommendations for stage 2 and stage 3 meaningful use guidelines in order for health care providers that are using a certified electronic health record to continue to receive incentive payments throughout the full five/six years of the incentive program.  A copy of these recommendations are here: MU Stage 2-3.

The Stage 1 final regulations were published last year.  Depending on the track and facility type, (whether through Medicare or Medicaid, and whether you are an eligible provider or eligible hospital), there are a number of “core” and “menu” requirements that must be met for an organization or individual provider to receive incentive payments for the first 2-3 years of the incentive program.  HITPC’s proposal would define the additional requirements that must be achieved by providers/hospitals in order to receive the balance of the incentive payments that are available.

In some cases, stage 2 and 3 goals are for the same thing (such as electronic prescribing), but the target is higher to achieve the goal (for example, in stage 1, an eligible provider is supposed to send prescriptions electronically at least 40% of the time, while stage 2 and stage 3 proposed goals are 50% and 80% respectively).  In other cases, HITPC has suggested that a “menu” requirement transition to a mandatory or “core” requirement for stage 2.  An example is the patient reminder that is on the stage 1 menu list for eligible providers at § 495.6(e)(4).  If patient reminders become a “core” or required objective, providers today should probably plan to try to comply with this menu item now if feasible, particularly if this is easier to implement as part of the core EHR package.

There are also some proposed new objectives for stage 2 and 3, such as the goal that 30% of patients have at least one electronic note in the EHR (which, if the practice has implemented the system in 2011, by definition, all patients seen would have one or more electronic notes in the system).

A simple google search on these proposals will turn up many comments and criticisms of these proposed stage 2 and stage 3 objectives.  Importantly, for those practices that wait until 2013 or later to implement an EHR, these practices will have to comply with the then-current meaningful use stage immediately to be considered a “meaningful EHR user” under section 495.6.  See § 495.314.  Based on the present HITPC recommendation, waiting to implement an EHR will make it harder to be a “meaningful EHR user” as compared to those practices that have implemented this year and have had a chance to work out the bugs with the system and their workflows.

Published by


Maryland technology attorney and college professor.

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