The federal government released the final rules for Stage 2 of meaningful use on Aug. 23, with federal officials’ assurance that the public’s voice was heard. The rule is set to become effective for participants in the program no earlier than 2014.

Farzad Mostashari, MD, national coordinator for health IT said the Stage 2 rules will step up interoperability, but regulators did their best to employ “maximum flexibility” to reduce the regulatory burden, he told reporters on a press call.

“You will see many, many options for providers,” both on how to proceed and on the timing, he added. 

“It does take time, we’ve listened and we’ve heard very clearly,” Mostashari said of the process.

[A detailed fact sheet detailing the Stage 2 final rule is available here.]

The rules, part of a federal incentive program for Medicare and Medicaid physicians to adopt electronic health records, were co-written and issued  in the Federal Register by the Centers for Medicare & Medicaid Services (CMS) and the Office of the National Coordinator for Health Information Technology (ONC). The final rules will be officially published in the Federal Register on Sept. 4.

Since the program began in January 2011, more than 120,000 eligible healthcare professionals and more than 3,300 hospitals have qualified to participate – some 23,000 more than the federal government had hoped to enlist by now, according to the Department of Health and Human Services.

To date, $6.6 billion has been paid out in incentives, according to Elizabeth Holland, director of health IT initiatives at CMS.

Mostashari said the rule represents a combination of a two-year long process. “This is best understood as a continuation,” he said, adding, “We are staying on course with the roadmap we established in Stage 1."

Stage 1 was about beginning of the journey, collecting the data, and beginning toward using decision support, Mostashari said. Stage 2 will take time, he said, “to make the most meaningful use of meaningful use.”

The big push in the Stage 2 rules is to move beyond data collection to improving care, he emphasized. 

Holland said one of the changes added to Stage 2 that federal officials hope will help providers is the allowance for “batch attestation.” Group providers will no longer have to attest to participation in the program, one-by-one.

Rob Anthony, from the CMS Office of e-Health Standards and Services, said the Stage 2 final rule represents “a lot of tweaking” from comments to the proposed rule, issued earlier this year.

20 measures

The final rule contains 20 measures for physicians, of which 17 are core and 3 of 6 are menu, and 19 measures for hospitals, of which 16 are core and 3 of 6 are menu.

The timing for the start of Stage 2 continues to be 2014 as in the proposed rule. Also retained is the focus on health information exchange and access to health data. The Stage 1 measure for a test of exchange of key clinical information is eliminated for a more robust core objective for transitions of care in Stage 2. And instead of providing patients with an “electronic copy of their health information,” Stage 2 requires “electronic or online access” to their health data.

The final rule adds “outpatient lab reporting” as a menu option for hospitals and “recording clinical notes” as a menu objective for both physicians and hospitals.

The final rule also reduces some thresholds for some measures and modifies some criteria for exclusions based on difficulty. For example, CMS had proposed that providers send a summary of care record for more than 65 percent of transitions of care and referrals. The final rule decreases that threshold to 50 percent. 

CMS also finalized two new core objectives from the proposal for physicians to use secure electronic messaging to communicate relevant health information with patients, and for hospitals to automatically track medications from order to administration using assistive technologies with an electronic medication administration record.

The requirements announced today:

• Make clear that Stage 2 of the program will begin as early as 2014. No providers will be required to follow the Stage 2 requirements outlined in the Aug. 23 release before 2014. 
• Outline the certification criteria for the certification of EHR technology, so eligible professionals and hospitals may be assured that the systems they use will work, help them meaningfully use health information technology, and qualify for incentive payments.
• Modify the certification program to cut red tape and make the certification process more efficient.
• Allow current “2011 Edition Certified EHR Technology” to be used until 2014.