ONC Announces Meaningful Use Stage 2 Proposed Rule Release

National Coordinator Farzad Mostashari announced Wednesday morning at the HIMSS conference that new proposed Meaningful Use requirements have been sent to the Federal Register, with publication expected Thursday morning.

Mostashari says ONC followed the guidance provided by the Health IT Standards and Policy Committees, as the new proposed regulations “stayed the course” as ONC “listened and we learned.” He said ONC tried to get the new regulations out weeks ago, but could not complete the work in time to avoid release during the HIMSS conference.

The broad themes to be addressed in the Notice of Proposed Rule Making for Stage 2 are:

• Increased emphasis on health information exchange.
• Increased emphasis on patient engagement.
• New requirements for hospital patient safety, specifically with regard to electronic medication administration records.
• Requirements involving tying clinical decision support to quality measures.
• A philosophical goal of flexibility and reducing provider and vendor burdens.

Specific issues are:

• The Direct protocol will be required.
• SNOMED will become the standard for encoding problem lists.
• Infobutton (i.e. the blue button initiative) will e expanded, with requirements that patients be able to view, download, and exchange their own information. The proposed legislation calls for 10% of patients to actually do this.
• While Stage 1 required theoretical information exchange capability in test mode, Stage 2 will require providers to exchange information “across organizational and vendor boundaries,” which also includes submission to public health agencies.
• Encryption and usability requirements will increase.
• Viewing of images will be supported as an optional item.
• Physicians in group practice will be allowed to submit their quality measures electronically as a group.
• Stage 1 will be extended for another year, though 2013 for those who first attest in 2011. Providers can then stay on Stage 2 for another two years.
• The last date to attest without penalties will be October 1, 2014.
• An increased emphasis will be placed on making referrals electronic.
• Electronic submission to cancer registries will be added as a menu item.

ONC announced its intentions to create a new certification called Certified EHR Technology that would replace existing forms of certification. This would begin with the 2014 reporting period. If EPs can meet Meaningful Use via exclusion, they will not need a CEHRT product.

Under CEHRT certification, which ONC prefers to be called 2014 Edition, the baseline requirements would be for a Base EHR that would include:

• A history and problem list.
• Clinical decision support capability.
• Provider order entry.
• Quality capture and data query.
• Exchange and integration capability.
• Privacy and security capabilities.

MU Core and MU Menu will contain additional levels.

Providers can meet the definition of Core EHR in any of three ways:

• By using a Complete EHR compliant with 2014 criteria.
• By using a combination of modules.
• By using a single EHR module.

ONC says it will post the draft document in Word format to its Web site. It will also encourage using electronic submission for the comment process.