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Meaningful Use Stage 2 Overview

Meaningful Use 2015–17 Overview

The EHR Incentive Program requires eligible providers to integrate meaningful use of certified EHR technologies into their practices in stages. Each stage requires providers to meet specific measures and attest to their completion. Typically, you must complete two years of Stage 1 before you can begin Stage 2.

However, CMS has modified the EHR Incentive Programs for the 2015, 2016, and 2017 reporting years. To simplify the program, CMS is requiring all participants to report on a modified version of Stage 2. To help providers adapt to this change, CMS also implemented 90-day reporting periods for all providers in 2015, 2016, and 2017.

To help you get started, this page contains the following topics:

 

Reporting Periods

For 2016, all providers will attest to 90 days of continuous meaningful use.

The table below outlines the attestation periods for the Medicare EHR Incentive Program.

Attestation Year 2011 Adoption 2012 Adoption 2013 Adoption 2014 Adoption 2015 Adoption 2016 Adoption
2015
Modified Stage 2
90 days
Modified Stage 2
90 days
Modified Stage 2
90 days
Modified Stage 21
90 days
Modified Stage 21
90 days
2016
Modified Stage 2
90 days
Modified Stage 2
90 days
Modified Stage 2
90 days
Modified Stage 2
90 days
Modified Stage 2
90 days
Modified Stage 2
90 days
2017
Modified Stage 2 or Stage 3
90 days (as part of MIPS)
Modified Stage 2 or Stage 3
90 days (as part of MIPS)
Modified Stage 2 or Stage 3
90 days (as part of MIPS)
Modified Stage 2 or Stage 3
90 days (as part of MIPS)
Modified Stage 2 or Stage 3
90 days (as part of MIPS)
Modified Stage 2 or Stage 3
90 days (as part of MIPS)
2018
Stage 3
Full Year (as part of MIPS)
Stage 3
Full Year (as part of MIPS)
Stage 3
Full Year (as part of MIPS)
Stage 3
Full Year (as part of MIPS)
Stage 3
Full Year (as part of MIPS)
Stage 3
Full Year (as part of MIPS)

1 If you were scheduled to attest to Stage 1 in 2015, you may attest to alternate exclusions and specifications for certain objectives and measures in 2015 only. After 2015, all providers must attest to the Modified Stage 2 objectives.

 

Objectives

Like the previous stages, the Modified Stage 2 is broken down into objectives. These objectives are categorized as core, public health, and clinical quality measures. You'll notice that there are fewer objectives than previous stages. There are fewer objectives because CMS removed several redundant objectives and objective that have been widely adopted by the industry as best practice.

You must complete 9 core objectives, 1 public health objective, and 9 clinical quality measures.

Stage 1 Stage 2 Modified Stage 2
15 core measures
17 core measures 9 core objectives
5 menu measures
3 menu measures 1 public health objective
6–9 clinical quality measures
9 clinical quality measures 9 clinical quality measures

 

Security Risk Analysis

The security risk analysis was one of the biggest hurdles providers faced in Stage 1. The security risk analysis requires much more than turning on a feature within your certified EHR; it requires a thoughtful and thorough evaluation of how well your practice protects patient data. You'll need to consider several risk areas in your practice:

  • Physical safeguards
  • Technical safeguards
  • Policies and procedures
  • Administrative safeguards
  • Organizational safeguards

The security risk analysis is again required in Stage 2. There are no exclusions from this measure, but there aren't any additional requirements either. Whether you're a security expert or the thought of conducting another security risk analysis makes you cringe, review CMS' Security Risk Analysis Tipsheet for information on fulfilling this measure.

 

Modified Stage 2 Objectives

All of the Modified Stage 2 objectives will seem familiar. That's because all of the objectives derive from Stage 1 and Stage 2 objectives. Many have been consolidated while some others have lower thresholds than before..

Review the tables below to learn more about the Modified Stage 2 objectives.

Core Objectives

You must complete all 9 core objectives.

 

Objective

Measure

Exclusions

1

Protect Electronic Health Information

Conduct or review a security risk analysis in accordance with the requirements in 45 CFR 164.308(a)(1), including addressing the security (to include encryption) of ePHI data stored in CEHRT in accordance with requirements in 45 CFR 164.312(a)(2)(iv) and 45 CFR 164.306(d)(3), and implement security updates as necessary and correct identified security deficiencies as part of the EP's risk management process.

———

2

Clinical Decision Support

Measure 1: Implement five clinical decision support interventions related to four or more clinical quality measures (CQMs) at a relevant point in patient care for the entire EHR reporting period. Absent four CQMs related to an EP’s scope of practice or patient population, the clinical decision support messages must be related to high-priority health conditions. It’s suggested that one of the five clinical support interventions be related to improving healthcare efficiency.

Measure 2: The EP has enabled and implemented the functionality for drug-drug and drug-allergy interaction checks for the entire EHR reporting period. Exclusion: For the second measure, any EP who writes fewer than 100 medication orders during the EHR reporting period.

Exclusion for Measure 2: Any EP who writes fewer than 100 medication orders during the EHR reporting period.

3

Computerized Provider Order Entry (CPOE)

Measure 1: More than 60% of medication orders created by the EP during the EHR reporting period are recorded using computerized provider order entry.

Measure 2: More than 30% of laboratory orders created by the EP during the EHR reporting period are recorded using computerized provider order entry.

Measure 3: More than 30% of radiology orders created by the EP during the EHR reporting period are recorded using computerized provider order entry.

Exclusion for Measure 1: Any EP who writes fewer than 100 medication orders during the EHR reporting period.

Exclusion for Measure 2: Any EP who writes fewer than 100 laboratory orders during the EHR reporting period.

Exclusion for Measure 3: Any EP who writes fewer than 100 radiology orders during the EHR reporting period.

4

Electronic Prescribing

More than 50% of all permissible prescriptions, or all prescriptions written by the EP are queried for a drug formulary and transmitted electronically using a certified EHR.

Any EP who

(a) writes fewer than 100 permissible prescriptions during the EHR reporting period; or

(b) does not have a pharmacy within their organization and there are no pharmacies that accept electronic prescriptions within 10 miles of the EP's practice location at the start of their EHR reporting period.

5

Health Information Exchange (formerly Summary of Care)

The EP who transitions or refers their patient to another setting of care or provider of care (1) uses a certified EHR to create a summary of care record and (2) electronically transmits such summary to a receiving provider for more than 10% of transitions of care and referrals.

Any EP who transfers a patient to another setting or refers a patient to another provider fewer than 100 times during the EHR reporting period.

6

Patient-Specific Information

Patient-specific education resources identified by a certified EHR are provided to patients for more than 10% of all unique patients with office visits seen by the EP during the EHR reporting period.

Any EP who has no office visits during the EHR reporting period.

7

Medication Reconciliation

The EP performs medication reconciliation for more than 50% of transitions of care in which the patient is transitioned into the care of the EP.

Any EP who was not the recipient of any transitions of care during the EHR reporting period.

8

Patient Electronic Access

Measure 1: More than 50% of all unique patients seen by the EP during the EHR reporting period are provided timely (within four business days after the information is available to the EP) online access to their health information subject to the EP’s discretion to withhold certain information.

Measure 2: At least one patient seen by EP during EHR reporting period (or their authorized representative) views, downloads, or transmits his or her health information to a third party.

Any EP who

(a) neither orders nor creates any of the information listed for inclusion as part of the measures; or

(b) conducts 50% or more of his or her patient encounters in a county that has 50% or less of its housing units with 4 Mbps broadband availability according to the latest information available from the FCC on the first day of the EHR reporting period.

9

Secure Messaging

During the EHR reporting period, the capability for patients to send and receive a secure electronic message with the provider was fully enabled.

Any EP who has no office visits during the EHR reporting period, or any EP who conducts 50% or more of his or her patient encounters in a county that has 50% or less of its housing units with 4 Mbps broadband availability according to the latest information available from the FCC on the first day of the EHR reporting period.

Public Health Objective

You must complete two measures from the public health objective.

 

Objective

Measure

Exclusions

1

Public Health

You must report on two of the following:

Measure 1—Immunization Registry Reporting: The EP is in active engagement with a public health agency to submit immunization data and receive immunization forecasts and histories from the public health immunization registry/immunization information system.

Measure 2—Syndromic Surveillance Reporting: The EP is in active engagement with a public health agency to submit syndromic surveillance data from a non-urgent care ambulatory setting for EPs.

Measure 3—Specialized Registry Reporting: The EP is in active engagement to submit data to a specialized registry.

Exclusions for Option 1: Any EP meeting one or more of the following criteria may be excluded from the immunization registry reporting measure if the EP

(a) doesn't administer any immunizations to any of the populations for which data is collected by its jurisdiction's immunization registry or immunization information system during the EHR reporting period;

(b) operates in a jurisdiction for which no immunization registry or immunization information system is capable of accepting the specific standards required to meet the certified EHR definition at the start of the EHR reporting period; or

(c) operates in a jurisdiction where no immunization registry or immunization information system has declared readiness to receive immunization data from the EP at the start of the EHR reporting period.

Exclusion for Option 2: Any EP meeting one or more of the following criteria may be excluded from the syndromic surveillance reporting measure if the EP

(a) isn't in a category of providers from which ambulatory syndromic surveillance data is collected by their jurisdiction's syndromic surveillance system;

(b) operates in a jurisdiction for which no public health agency is capable of receiving electronic syndromic surveillance data from EPs in the specific standards required to meet the certified EHR definition at the start of the EHR reporting period; or

(c) operates in a jurisdiction where no public health agency has declared readiness to receive syndromic surveillance data from EPs at the start of the EHR reporting period.

Exclusion for Option 3: Any EP meeting at least one of the following criteria may be excluded from the specialized registry reporting measure if the EP

(a) doesn't diagnose or treat any disease or condition associated with, or collect relevant data that is collected by, a specialized registry in their jurisdiction during the EHR reporting period;

(b) operates in a jurisdiction for which no specialized registry is capable of accepting electronic registry transactions in the specific standards required to meet the certified EHR definition at the start of the EHR reporting period; or

(c) Operates in a jurisdiction where no specialized registry for which the EP is eligible has declared readiness to receive electronic registry transactions at the beginning of the EHR reporting period.

 

Additional Resources

We've collected a few resources to help you learn more about Modified Stage 2.