What is meaningful use Stage 2?

In the past few months, a great deal of information has circulated regarding the stage 2 meaningful objectives for the Centers for Medicaid and Medicare Services (CMS) Electronic Healthcare Records (EHRs) incentive program. There was an expectation that the CMS would delay stage 2, however, that is not the case. CMS will be lenient in reviewing and approving applications for hardship exemptions for eligible providers (EPs) and institutions.

Whereas stage 1 objectives are related to capturing information and setting a baseline for how that information will be shared, stage 2 objectives are about advanced clinical processes. Simply capturing information does not improve patient outcomes so stage 2 focuses on sharing information such a patient care summaries across multiple settings, as well as increasing patient and family engagement.

For EPs, there are 17 stage 2 core objectives which must be met, then there are 6 menu objectives, of which 3 must be met. The combined core and menu objectives total 20. Some of the core objectives for stage 2 were menu objectives for stage 1 and so will be familiar. Others are the same as in stage 1 but with higher thresholds.

Here are the 17 core objectives for stage 2:

1. Use computerized provider order entry (CPOE) for medication, laboratory and radiology orders.
2. Generate and transmit permissible prescriptions electronically (eRx).
3. Record demographic information.
4. Record and chart changes in vital signs.
5. Record smoking status for patients 13 years old or older.
6. Use clinical decision support to improve performance on high-priority health conditions.
7. Provide patients the ability to view online, download and transmit their health information.
8. Provide clinical summaries for patients for each office visit.
9. Protect electronic health information created or maintained by Certified EHR Technology.
10. Incorporate clinical lab-test results into Certified EHR Technology.
11. Generate lists of patients by specific conditions to use for quality improvement, reduction of disparities, research, or outreach.
12. Use clinically relevant information to identify patients who should receive reminders for preventive/follow-up care.
13. Use certified EHR technology to identify patient-specific education resources.
14. Perform medication reconciliation.
15. Provide summary of care record for each transition of care or referral.
16. Submit electronic data to immunization registries.
17. Use secure electronic messaging to communicate with patients on relevant health information.

The 6 menu objectives for stage 2 are:

1. Submit electronic syndromic surveillance data to public health agencies.
2. Record electronic notes in patient records.
3. Imaging results accessible through CEHRT.
4. Record patient family health history.
5. Report cancer cases to a public health central cancer registry.
6. Report specific cases to a specialized registry.

There are exclusions for many of the objectives. For example, EPs who write fewer than 100 prescriptions during the reporting period—as would be the case for the vast majority of chiropractors—are excluded from objectives involving prescriptions. The CMS provides detailed instruction sheets for each of the objectives, and offers many tools to help EPs correctly demonstrate that each one has been met.