Federal Officials Unveil Final Stage 2 Rules for EHR Incentive Program

On Thursday, HHS announced the release of the final rules on Stage 2 of the meaningful use program, Modern Healthcare reports.

Under the 2009 federal economic stimulus package, health care providers who demonstrate meaningful use of certified electronic health record systems can qualify for Medicaid and Medicare incentive payments.

Release of the Final Rules

One of the final rules, issued by CMS, outlines the requirements for hospitals and health care providers seeking to attest to Stage 2 of meaningful use. A fact sheet about CMS' final rule is available on the agency's website.

The second final rule, issued by the Office of the National Coordinator for Health Information Technology, describes the standards and criteria for the certification of EHR systems under Stage 2 of the meaningful use program. A fact sheet about ONC's final rule is available on the agency's website (Daly, Modern Healthcare, 8/23).

Both of the final rules will be officially published in the Federal Register on Sept. 4 (Manos/Mosquera, Healthcare IT News, 8/23).

Details of CMS' Final Rule

CMS' final rule finalizes a delay to the Stage 2 timeline for eligible professionals. Although the Stage 1 rule called for any health care provider who first attested to meaningful use in 2011 to start complying with Stage 2 criteria in 2013, CMS' new final rule delays the Stage 2 compliance deadline until 2014 to give vendors more time to develop certified EHR products (Walsh, CMIO, 8/23).

According to an HHS release, CMS' final rule "provides a flexible reporting period for 2014 to give providers sufficient time to adopt or upgrade to the latest EHR technology certified for 2014" (HHS release, 8/23).

To meet the Stage 2 meaningful use criteria, eligible professionals will need to meet 17 core objectives and three out of six menu objectives. Hospitals will need to meet 16 core objectives and three out of six menu objectives (CMIO, 8/23).

CMS' final rule adds two new "core objectives" to the Stage 2 reporting requirements for doctors and hospitals. The new objectives call for:

• Physicians to use secure electronic messaging to share relevant health data with patients; and
• Hospitals to automatically track the ordering and administration of medications using "assistive technologies in conjunction with an electronic medication administration record" (Healthcare IT News, 8/23).

The rule also replaces the core objective to "provide patients with an electronic copy of their health information" with a core objective to allow patients to "view online, download, and transmit" their health information (Dick Tocknell/Mace, HealthLeaders Media, 8/24).

In addition, CMS' final rule adds:

• Outpatient lab reporting as an menu objective for hospitals; and
• Recording clinical notes as a menu objective for hospitals and physicians (Modern Healthcare, 8/23).

Some of the key provisions in CMS' final rule include:

• Allowing health care providers to use "2011 Edition Certified EHR Technology" until 2014;
• Allowing health care providers who are part of a group practice to submit "batch attestation" instead of attesting individually (Healthcare IT News, 8/23);
• Modifying the definition of a "hospital-based" physician to allow physicians to demonstrate that they self-fund their EHR systems and therefore are eligible to receive incentive payments directly (Modern Healthcare, 8/23);
• Allowing eligible hospitals to omit information from patients' online access if they believe that substantial harm could arise from the disclosure of the data;
• Requiring health care providers to send reminders to patients about preventive or follow-up care  (HealthLeaders Media, 8/24);
• Lowering from 65% to 50% the requirement that health care providers submit summary of care records for transitions of care and referrals (Modern Healthcare, 8/23);
• Lowering from 40% to 10% the percentage of images ordered by inpatient or emergency departments that must be accessible through a certified EHR system (HealthLeaders Media, 8/24);
• Finalizing a requirement that health care providers electronically submit summary of care records for more than 10% of transitions of care and referrals and that at least one instance of exchanging such data is with a health care provider using different EHR technology or with a CMS-designated test EHR system;
• Lowering from 10% to 5% the core objective requiring health care providers to give patients online access to health information; and
• Lowering from 10% to 5% the core objective requiring health care providers to enable secure messaging with patients (CMIO, 8/23).

Details of ONC's Final Rule

According to the HHS release, ONC's final rule modifies the EHR certification program to "cut red tape and make the certification process more efficient" (Modern Healthcare, 8/23).

The final rule revises the definition of certified EHR technology to let health care providers adopt only the EHR technology they need to meet the meaningful use stage that they are seeking to achieve (ONC Fact Sheet, 8/23).

The rule also requires that EHR software be designed to automatically encrypt electronic health information stored locally on end-user devices (Anderson, GovInfoSecurity, 8/23).

In addition, ONC's final rule:

• Adopts certification criteria for transitions of care to ensure that EHR systems support standards-based health information exchange;
• Requires that test reports for EHR certification be publicly available and that developers follow certain price transparency practices; and
• Allows "gap certification" for certain EHR criteria in an effort to make the process more efficient (Pulley, "Health IT Update," NextGov, 8/23).