Under the electronic health record (“EHR”) incentive programs offered by the Centers for Medicare and Medicaid Services (“CMS”), eligible professionals and hospitals may receive incentive payments for successfully adopting and demonstrating “meaningful use” of certified EHR technology.  On August 23, 2012, CMS and the Office of the National Coordinator for Health Information Technology (“ONC”) released final rules regarding the Stage 2 criteria that eligible professionals and hospitals must meet in order to qualify for Medicare and/or Medicaid electronic health record (“EHR”) incentive payments and the standard for certifying EHR technology.

Highlights of the Stage 2 final rule include the following:

• Extends the timeline for providers to progress to Stage 2 criteria, so that providers that first demonstrated meaningful use in 2011 (the earliest date possible) now have until 2014 (rather than 2013, as originally planned) to progress to Stage 2.  All other providers will need to meet two years of meaningful use under Stage 1 criteria before advancing to Stage 2 criteria in their third year.
• Increases the number of “core” objectives (i.e., objectives that all providers must meet) over Stage 1, and requires that eligible providers meet 17 core objectives and hospitals meet 16 core objectives.  E.g., for Stage 2, hospitals must be able to track medications “from order to administration” using assistive technologies in conjunction with an electronic medication administration record, and eligible professionals must be able to use secure electronic messaging to communicate with patients on relevant health information.
• Adds a number of “menu” objectives (i.e., objectives that providers may pick from), and requires that providers must report on 3 of 6 menu objectives. E.g., new menu objectives include the ability to record electronic notes in patient records and (for hospitals) the ability to generate and transmit permissible discharge prescriptions electronically.
• Combines several Stage 1 objectives into more unified Stage 2 objectives.  E.g., the Stage 1 objective to implement drug-drug and drug-allergy interaction checks has been incorporated into the Stage 2 objective requiring implementation of one clinical decision support rule relevant to the specialty or high clinical priority.
• Increases the threshold that providers must meet for many objectives. E.g., Stage 2 increases from 30% to 60% the percentage of patients receiving medication that must have at least one medication order entered using a computerized physician order entry system. 

In addition, Stage 2 replaces the previous Stage 1 objectives to provide electronic copies of health information or discharge instructions with objectives that allow patients to access their health information online.  The Stage 2 rules also encourage the health information exchange between providers to improve coordination of care for patients.  Thus, a core objective for all providers requires providers who transition or refer a patient to another setting of care or provider of care to provide a summary of care record for more than 50% of those transitions of care and referrals, and 10% of those must be provided electronically.  Finally, all providers must report on clinical quality measures (“CQMs”) in order to demonstrate meaningful use, with eligible professionals required to report on 9 out of 64 total CQMs and hospitals required to report on 16 out of 29 total CQMs.  Beginning in 2014, CQM data must be reported electronically to CMS for providers after their first year of demonstrating meaningful use.

Finally, Stage 2 finalizes the process by which providers failing to meet meaningful use will be penalized with downward adjustments to Medicare payments.  Providers that are meaningful EHR users by 2013 will avoid payment adjustment in 2015, and providers that first meet meaningful EHR use in 2014 can still avoid payment adjustment in 2015 if they can demonstrate meaningful use 3 months prior to the end of the year (calendar for eligible professionals, fiscal for hospitals) and meet certain registration and attestation requirements.  The Stage 2 rule also finalized 4 exceptions for payment adjustment, including lack of availability of internet access and lack of control over the availability of certified EHR technology at practice locations.  The target date for implementation of the Stage 3 meaningful use requirements for all providers remains 2016.

The 2014 Edition Standards & Certification Criteria final rule issued by the ONC adopts, among other requirements, a certification criterion that focuses on the encryption of health information if it is stored on end-user devices, a new certification criterion that enables secure messaging between a provider and a patient, and a new certification criterion that will enable providers to create a set of “patient summaries” (intended to help prevent the need to manually re-enter basic patient information into the new EHR in the event a provider switches EHR technology), and the final rule requires authorized certification bodies to ensure that an EHR technology developer notifies eligible providers about additional types of costs (i.e., one-time, ongoing, or both) that affect a certified Complete EHR or certified EHR Module’s total cost of ownership for the purposes of achieving meaningful use.

A copy of the Stage 2 meaningful use final rule may be found here, and a copy of the 2014 Edition Standards & Certification Criteria final rule may be found here.  If you have questions about these final rules, or any other questions about the meaningful use or EHR technology requirements, please contact a member of the Health and Life Sciences Practice Group.