Moving Upward The Escalator To Phase 2

The eagerly awaited Notice of Proposed Rule Making (NPRM) on Meaningful Use Stage 2 has been finally released inwards a sprawling 455 pages document. If you lot followed the discussions of the Federal Advisory Committees over the in conclusion twelvemonth or so, you lot would know that Meaningful Use Stage 2 is but to a greater extent than or less other modest stride towards an overarching goal of utilizing wellness IT to back upwardly electrical flow policies aimed at providing ameliorate tending for individuals, ameliorate wellness for populations as well as lower the costs of wellness care. We tin concur or disagree on the wisdom of those policies, but if you lot are using electronic wellness records or but contemplating a motility to computerized records, as well as accept an involvement inwards obtaining Meaningful Use incentives or avoiding penalties, you lot should accept a basic agreement of what the adjacent stride on the technology escalator consists of.

Meaningful Use Stage 2 distinguishes itself from Stage 1 mainly yesteryear proposing a major force to wellness information exchange. It also brings a novel bird of complexity to the assembly of diverse information sets that are intended to live on exchanged alongside other tending providers and/or patients. It would in all probability live on a fleck simpler to define 1 superset of information as well as exercise it for all information telephone substitution measures. The other notable characteristic of Stage 2 is that a twosome of measures are completely theme on patients’ willingness as well as mightiness to engage inwards Internet based communications.

Basically everything that was required for Stage 1 is also required for Stage 2, although to a greater extent than or less measures accept higher thresholds, as well as others accept been consolidated inwards 1 measure, or are but implied inwards other measures. For physicians, Meaningful Use Stage 1 had 25 measures, of which xx needed to live on met. Stage 2 has 22 measures, of which xx postulate to live on fulfilled inwards lodge to qualify for incentives starting inwards 2014 (yes, 2014). There is even as well as so a fleck of wiggle room, but non every bit much every bit inwards the past. Finally, but similar inwards Stage 1, at that topographic point are several exclusions available for measures that produce non utilize to your practice.
The next is an (almost) objective summary of the newly proposed measures.

The Departed
The next Stage 1 measures accept been removed from the Stage 2 listing for diverse reasons every bit described below,

• Maintain occupation lists – incorporated into summary of tending measure
• Maintain medication lists  – incorporated into summary of tending measure
• Maintain drug allergy lists – incorporated into summary of tending measure
• Perform drug formulary checks – incorporated into the electronic prescribing measure
• Drug-drug as well as drug-allergy interaction alerts – incorporated into the Clinical Decision Support measure

Golden Oldies
The next measures accept non changed from Stage 1 to Stage 2, but those that were optional are straight off mandatory.

• Generate 1 listing of patients alongside a specific condition
• Send reminders to 10% of patients (slight change: patients of all ages non seen inwards over ii years)
• Provide patient teaching materials to patients stays at 10%

Wee Bit Harder

• Recording patient demographics increased to 80%
• Recording vitals increased to 80%
• Recording smoking status increased to 80%
• Electronic prescribing threshold upwardly to 65% for ambulatory exercise as well as newly added for infirmary discharge medications at 10%
• Incorporate structured lab results into the EHR is upwardly to 55%
• Medications reconciliation upon transition of tending increased to 65%
• Recording being of Advanced Directives has increased to to a greater extent than than 50% for hospitals only.

Full Step upwardly the Escalator

• Computerized Physician Order Entry (CPOE) is straight off required for 60% of Medication orders, Laboratory orders as well as Radiology orders. Just to clarify, this is NOT a requirement to shipping orders out electronically. It is solely a requirement to document the orders inwards the EHR.
• Clinical Decision Support (CDS) is increased to the implementation of v distinct rules, related to v or to a greater extent than CQM. This should non live on a major occupation for most EHRs, unless the in conclusion CQM are real unlike than what was offered inwards Stage 1. Enabling drug-drug as well as drug-allergy alerts are inwards add-on to the above.
• Clinical summaries postulate to live on made available to to a greater extent than than 50% of patients inside 24 hours now, downwardly from iii days inwards Stage 1. Huge occupation for those who don’t destination their charts on the same day. Clinical summaries should include at to the lowest degree the next items:
• Patient Name.
• Provider's cite as well as component division contact information.
• Date as well as place of the visit.
• Reason for the component division visit.
• Current occupation listing as well as whatsoever updates to it.
• Current medication listing as well as whatsoever updates to it.
• Current medication allergy listing as well as whatsoever updates to it.
• Procedures performed during the visit.
• Immunizations or medications administered during the visit.
• Vital signs as well as whatsoever updates.
• Laboratory examination results.
• List of diagnostic tests pending.
• Clinical instructions.
• Future appointments.
• Referrals to other providers.
• Future scheduled tests.
• Demographics (gender, race, ethnicity, engagement of birth, preferred language). (New requirement for Stage 2.)
• Smoking status (New requirement for Stage 2.)
• Care conception field, including goals as well as instructions. (New requirement for Stage 2.)
• Recommended patient determination aids (if applicable to the visit). (New requirement for Stage 2.)
• Submission of information to immunizations registries is no longer but a test. Stage 2 requires ongoing submission to a registry. Hopefully yesteryear Stage 2 the electrical flow mess, where hundreds of fully certified EHRs are incapable of connecting to registries inwards reality, volition live on resolved.
• Hospitals also postulate to accept a working interface for lab results to populace wellness entities, instead of but performing a test.
• Menu Item (ambulatory): Syndromic Surveillance interfaces postulate to live on operational for Stage 2. For hospitals this is mandatory.
• Perform safety opportunity assessment as well as remediation of deficiencies has non changed, but at that topographic point is an explicit requirement to address “the encryption/security of information at rest”. So if you lot accept your EHR server inwards your office, you lot volition postulate your IT guy to pitch inwards a few hours here.
• Reporting clinical character measures to CMS increased from vi to 12 for ambulatory physicians as well as is upwardly to 24 for hospitals. There are extensive lists of measures as well as a twosome of choices on how to pick them. Note that at that topographic point are several novel measures as well as that CMS is expecting to live on able to have these reports electronically yesteryear 2014 as well as thence CQM reporting volition live on split from Meaningful Use attestation for Stage 2. Unlike Stage 1, physicians would live on able to elect grouping reporting for CQM.

New as well as Noteworthy

• Hospitals must attest that 10% of medications are automatically tracked via an electronic medication direction tape (eMAR).
• View/Download/Transmit – First, to a greater extent than than 50% of patients must accept timely online access to their wellness information four days after it is received yesteryear physicians (36 hours after discharge for hospitals). Second, over 10% of your patients must see or download or transmit their information to a 3rd party. This volition require a Patient Portal that tin log visits as well as an upgrade to most portals to allow transmission of records to somewhere. You volition postulate to accept over one-half of your patients registered for the Portal, which may live on a occupation if most of your patients don’t accept electronic mail accounts, since most EHR supplied Patient Portals require an electronic mail for registration. Note that you lot must somehow ensure that 1 inwards 10 patients genuinely logs into their Patient Portal delineate of piece of work concern human relationship as well as looks at the records. The Portal must brand available the next items at the real least:
• Patient name.
• Provider's cite as well as component division contact information.
• Problem list.
• Procedures.
• Laboratory examination results.
• Medication list.
• Medication allergy list.
• Vital signs (height, weight, blood pressure, BMI, growth charts).
• Smoking status.
• Demographic information (preferred language, gender, race, ethnicity, engagement of birth).
• Care conception field, including goals as well as instructions, as well as whatsoever additional known tending squad members beyond the referring or transitioning provider as well as the receiving provider.
• Secure messaging alongside over 10% of patients online is to a greater extent than or less other novel mensurate that tin live on satisfied yesteryear having a Patient Portal. The linguistic communication for this novel mensurate indicates that the secure messages must live on sent yesteryear the patients, as well as so every bit alongside the to a higher house measure, you lot volition accept to somehow ensure that your patients shipping you lot online messages.
• Summaries of tending postulate to live on transmitted for to a greater extent than than 65% of transitions or referrals. Of those over 10% must live on transmitted electronically to someone non organizationally affiliated alongside you, AND that someone must exercise an EHR that is unlike than the 1 you lot are using. Choose your referrals wisely as well as brand certain you lot enquire inwards advance virtually the EHR province of affairs at the receiving end. You volition in all probability accept to type it inwards your EHR for tape keeping purposes. If you lot go for a Kaiser-like organization, you lot may accept a serious occupation here.  Required information elements for these summaries are every bit follows (not certain why Meds as well as Allergies are excluded):
• Patient name.
• Referring or transitioning provider's cite as well as component division contact information (ambulatory only).
• Procedures.
• Relevant yesteryear diagnoses.
• Laboratory examination results.
• Vital signs (height, weight, blood pressure, BMI, growth charts).
• Smoking status.
• Demographic information (preferred language, gender, race, ethnicity, engagement of birth).
• Care conception field, including goals as well as instructions, as well as whatsoever additional known tending squad members beyond the referring or transitioning provider as well as the receiving provider.
• Discharge instructions for hospitals.
• Menu Item: Availability of images inwards the EHR is required for over 40% of orders for all scans as well as tests whose lawsuit is an image. Many EHRs volition postulate to a greater extent than or less retooling for this as well as you lot volition postulate to a greater extent than or less expensive interfaces to hitting the 40% threshold, especially if you lot lodge imaging tests at multiple facilities, assuming those facilities accept the mightiness (and willingness) to supply you lot access to their systems. The in conclusion affair you lot desire to produce hither is to accept those images go over the network. It volition kill your bandwidth as well as your server.
• Menu Item: Record Family History every bit structured information for over 20% of patients. This 1 is a walk inwards the green for practically all EHRs. Be certain to pick this one.
• Menu Item (ambulatory): Reporting to a Cancer Registry. This volition require an operational interface for the entire reporting period.
• Menu Item (ambulatory): Reporting to a Specialized Registry (other than cancer). Here besides a fully operational interface is needed. This is in all probability non much of a selection inwards most states.

If you lot managed to read to this dot without falling asleep or suffering an anxiety attack, delight bill that this is but an NPRM as well as populace comment is requested. Go ahead as well as brand your opinions heard. CMS as well as ONC accept listened to comments inwards the yesteryear as well as showed willingness to adjust. I would suspect that but similar Meaningful Use Stage 1, these regulations volition live on much relaxed yesteryear the fourth dimension the in conclusion dominion is issued after this year, as well as farther accommodations volition live on made every bit go inwards the champaign genuinely begins.

Note: Public comments tin live on posted here.