Meaningful Use Stage 2 Overview

The Second Phase in Electronic Health Technology

In This Article

“Meaningful use” is a term used in the health care industry to refer to a group of standards that providers and medical institutions in the United States should complete to bring their record-keeping and information sharing into the 21st Century.

These standards were rolled out by the government in phases to give the industry sufficient time to adopt and implement electronic health records (EHR) systems. Meaningful use stage 2 is the second phase of the regulations rollout and requires certain professionals and institutions to take steps to protect, share, and utilize EHR to improve their processes and quality of patient care.

History

In the early and mid-2000s—when the world started building Facebook profiles and getting internet on their phones—the health care industry was still largely doing its business on paper. Clinicians were slow to adopt new health information technologies like EHR systems that could make practices more accurate, efficient, and complete.

HITECH

To encourage clinicians to upgrade and improve their processes, Congress passed two pieces of legislation: the American Reinvestment and Recovery Act and the Health Information Technology for Economic and Clinical Health Act, or HITECH.

The HITECH Act authorized monetary incentives for clinicians, so long as they complied with specific criteria for information technology. These standards were collectively referred to as “meaningful use.”

While getting providers to switch from paper charts to EHRs was a significant part of the Centers for Medicaid and Medicare Services (CMS) incentive programs, it wasn’t the only goal.

CMS defines "meaningful use” by having doctors and hospitals implement automated safety measures, improving coordination of care, and communicating better with patients.

Standards were rolled out in three stages, with the later stages building on the previous stage(s).

The standards were rolled out with mixed results. More and more companies started selling medical software promising to help health care providers qualify for the incentives. Some of these offerings were hastily slapped together, resulting in some systems being glitchy or difficult to use.

While many providers embraced the new technologies and processes, others were left frustrated and unwilling to comply with the new standards.

Incentives and Penalties

Spotty EHR systems, combined with stringent guidelines, resulted in participation lagging behind expectations. In turn, the United States government took steps to encourage more health care providers and medical organizations to comply with the standards. In addition to thousands of dollars in incentives, CMS also introduced penalties for those who don’t comply with meaningful use standards.

Beginning in 2015, providers participating in CMS programs like Medicare who didn’t meet meaningful use criteria wouldn’t be fully reimbursed by CMS for their professional services. The standards were also revised based on feedback from the health care and health technology industries.

In this same year, the United States Congress also passed the Medicare Access and CHIP Reauthorization Act (MACRA), as well as meaningful use—in addition to the Physician Quality Reporting Program and the Value-Based Payment Modifier program—which were consolidated into MACRA’s new Merit-Based Incentive Payment System (MIPS).

Despite some bumps in the initial implementation of meaningful use, it is now the norm in the health care industry, particularly among larger medical institutions or practices. As of 2016, roughly 95 percent of all hospitals in the United States—and over 60 percent of office-based physicians—that are eligible to participate in the Medicare incentive program have complied with meaningful use standards.

Meaningful Use Stage 2

Meaningful use stage 2 is the second phase of the rollout for the standards and focuses largely on the application (rather than adoption) of EHR systems as well as how they can be leveraged to improve patient care. The standards were updated in 2015 based on feedback from the health care and technology industries.

In order to comply with the standards, eligible health care providers or medical institutions should already have an approved EHR system and be able to show that they complied with the standards during a 90-day reporting period within the past year. This often means showing that a certain percentage of health records, patients, or actions in the provider’s or organization’s EHR complied with the criteria.

Standards

The specific criteria that eligible professionals and medical institutions have to meet will differ slightly based on what CMS program they are participating in and who is applying for the incentives. For example, hospitals have a slightly different set of requirements than health professionals, and those accepting Medicaid might need to do things differently than those accepting Medicare.

At the bare minimum, however, health care professionals and facilities are expected to comply with the below standards.

Keeping Information Safe

Few things are as personal and sensitive as health information. That’s why health professionals and hospitals have to show they take tech security seriously.

In order to comply with this standard, they have to run a security analysis on their EHR at least once a year and/or when they install or upgrade to a new system to verify that nothing occurring within their system violates rules outlined in the Health Insurance Portability and Accountability Act of 1996 (or HIPAA) and the Privacy rule.

Electronic Prescribing

To meet this standard, health care professionals and hospitals have to show that a certain percentage of their prescriptions are sent electronically. Over 4 billion prescriptions were filled by retail pharmacies in the United States in 2017. Roughly 1.74 billion of those were sent electronically.

Electronic prescribing has a lot of benefits. It helps ensure prescriptions filled by pharmacies are accurate and safe for the people who will take them.

Electronic prescribing might also be called e-prescribing or eRx.

Pharmacists don’t have to squint to read illegible handwriting, more safety alerts can be set in place to prevent cross-reactions or allergies, and everything is captured in the patient’s EHR so that it can be referenced and reviewed during future doctor’s visits.

Exchanging Information With Other Providers

While your health information is protected by federal law, there are circumstances that would warrant your doctor passing along critical information. If your care plan involves you going to a different clinic or clinician (to a specialist, for example), then your provider should have a system in place to send on what’s called a “summary of care record” electronically.

These documents cover important elements of your health history, such as active diagnoses or a medication list, so that there’s a relatively smooth transition of care.

Educational Resources

In addition to making sure other care providers are up to speed on what they need to know about specific patients, patients should be informed about their own health status. To comply with this standard, health professionals and facilities should set up their EHR system to spot patients who could use more information about their medical conditions so that resources may be provided.

Reconciling Medications

Cross-reactions between medications can be hugely harmful in patients, which is why care providers need to be sure they’re working with the most up-to-date health information for their patients. Some medications can be accidentally left off or incorrectly typed into a “summary of care” record, or new ones could be added to the list by mistake.

Doctors rely on the list of medications to make treatment decisions, so it’s important for it to be accurate.

Meaningful Use Stage 2 standards require medical professionals and hospitals to verify that the list of medications in the EHR is correct and complete whenever a patient is transferred into their care. That might mean checking in with the patient’s primary care provider or pharmacy to see if the lists are the same, or by asking the patient directly.

Allowing Patients to See Electronic Records

In order to comply with meaningful use, providers and facilities must give patients a way to see their records online, download them, and transmit their own health information within a certain amount of time after visiting or being discharged.

This often entails setting up a website where patients have a unique username and password that will give them access to only their health information or that of their dependents under the age of 18.

Allowing patients to access their own data can help catch errors, facilitate changing providers, and provide a useful archive of information for the patient.

Reporting Statistics

A major benefit of bringing health records into the 21st century is putting information into a structured digital format in databases. This makes it a lot easier for public health professionals to research medical conditions and health trends in a given community or population.

Stage 2 requires those wanting to participate in the Medicaid or Medicare EHR incentive programs to actively engage with public health agencies in at least two ways: through immunization registries and syndromic surveillance. 

Immunization Registries

All 50 states have centralized databases (or immunization information systems) where providers can send and store patient immunization histories. Each state has a slightly different setup, but the general purpose of these databases is to ensure providers are still able to access patients’ immunization histories in the event records are lost (due to a natural disaster, for instance) or receive vaccines from multiple providers (at both their primary care provider and pharmacies).

These registries reduce the need for duplicate vaccination because records were lost, provide a means for health professionals to gather more complete health records on their patients (particularly in times of outbreaks or emergencies), and help doctors identify patients in their care who should be vaccinated.

Syndromic Surveillance Reporting Systems

Ever wonder how public health professionals spot outbreaks when they happen? One of the tools in their toolbox is syndromic surveillance, a process that relies on hospitals and other health facilities to send health-related information—like symptoms, behavioral patterns, or lab results—that, when compiled and combined with other information sources, can be used to spot unusual activity like an outbreak or bioterrorist attack.

For example, if a lot of health care providers are seeing patients with a cough and fever, schools are having unusually high absenteeism, and pharmacies are selling a lot of cold medicines, public health professionals could analyze all of that information to detect an influenza outbreak in a given community.

Depending on the CMS incentive program, health professionals or hospitals might also be asked to participate in other reporting systems, such as specialized registries or those specifically for laboratory results.

Additional Terms

For eligible professionals wanting to participate in the Medicaid incentive program, Stage 2 also requires a few extra standards.

Clinical Decision Support

Many EHRs have built-in functionality to filter, organize, or bring up information at specific times to help health care providers make smart decisions related to care. For example, many EHR systems can be programmed to flash an alert on the screen if a doctor prescribes something the patient is allergic to, or remind pediatricians about upcoming or overdue vaccine doses.

These triggers can help providers avoid costly or deadly mistakes.

Enter Electronic Medical Orders

Just like with handwritten prescriptions, handwritten orders are at risk of being misinterpreted if they’re scrawled quickly or written intelligibly.

Requiring the prescribing clinician to enter their orders directly into a computer system for things like medications, lab tests, and imaging helps reduce the chances that they are misunderstood by other care providers. This also allows orders to be run through algorithms that might catch errors before they can be carried out.

Communicate With Patients Electronically

A popular way this is implemented is through online patient portals. With these systems, people can register using a unique username and password. Once in, they can send and receive messages with members of their care team, including their doctor’s notes on lab results.

Unlike a phone message or snail mail, messages sent through these electronic messaging systems are less likely to be intercepted by people other than the intended recipient.

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