As healthcare providers pore over the Stage 2 meaningful use requirements, they will notice a number of changes, tighter requirements and higher percentages to hit.

Dan Prevost of Arcadia Solutions, a healthcare consulting firm that advises clients on technology developments, says providers need to be aware of key developments in Stage 2 in order to attain their full incentive payment upon implementation of an electronic health record.

"That payment requires a certain level of documentation, and you need a report to monitor that development and show what that documentation is," said Prevost, whose firm helps to create documentation for MU incentives.

Here, he outlines five challenging developments providers need to keep in focus as we move into Stage 2.

1. Structured lab results. A lab interface "makes the labor involved in managing lab results notably less," said Prevost. "Look out for a lab interface when trying to achieve Stage 2." Whereas normal lab results come back as a fax or PDF, implementing an interface means that the report feeds back in to the provider's EHR as structured data. Lab tests are a critical element of patient documentation, which itself is a major factor in attesting to Stage 2 as well as efficiently filing claims and receiving reimbursement. To attest to Stage 2, providers will need to increase their use of structured data in lab results to 55 percent.

2. Patient access to health information. "I've talked to patients, and it's become an expectation that they can go in and review their most recent lab results," said Prevost. "That is something that is really useful to them." In order to attest to Stage 2, providers must provide an electronic portal for health information to their patients. Five percent of their patients must have accessed the portal, raising concerns with doctors who say they have no control of patient behavior outside of the office, or who have elderly or low-income patients who may not have access to the internet. Additionally, Prevost notes that there are "certain information control issues" around patient access to their health information. "As a child or an adolescent grows up, at what point should their parent no longer have access to their portal?"

3. Ongoing submission to registries. While registries were addressed in Stage 1, fully implementing a health information exchange connection is addressed in Stage 2. Prevost notes that not all providers have the tools built in to their EHR software to submit documents to registries, and that many states do not even have the required registries in place. "There's a notable discrepancy between requirements and what's available in technology," Prevost says, pointing out that "there are a lot of requirements for Stage 2 that are a lot more demanding for vendors. As the market moves forwarded, we thing a lot of the smaller EHR vendors are not going to be keep up with all of the changes required with Stage 2."

4. Computerized provider order entry (CPOE). A critical part of a full-flight EHR, CPOE fell under some rules during Stage 1, and those requirements have grown more demanding. In Stage 2, healthcare providers are now required to have 60 percent of their prescriptions go through CPOE, in addition to 30 percent of their labs and diagnostic images. "It's important to have an interface for not only lab results but diagnostic images," says Prevost. CPOE, when implemented properly, can increase efficiency and reduce mistakes. Prevost notes that "this will reduce the labor intensive stuff."

5. Summary of care referrals. When a doctor refers a patient to a specialist or another doctor, they must send along their notes describing the patient's condition and what the specialist is needed to do. Although one or both providers may use an EHR, most systems are not linked well enough to facilitate easy transfer of data. As a result, care referrals often still take on printed form. If a summary of care "shows up on a piece of paper, then someone has to sit down and enter all these things manually, and it could be transmitted in a structured way electronically," said Prevost. Stage 2 begins to streamline the process for transmitting these documents electronically; the rules currently requires that 10 percent of a practice's summaries be transmitted in an electronic fashion.