January 2013 
Stage 1 Updated
On Sept. 4, 2012, the U.S. Department of Health and Human Services, Center for Medicare and Medicaid Services (CMS), officially adopted the Stage 2 requirements for Meaningful Use of Electronic Health Records(EHR).  
In addition to adopting specifications required for Stage 2, the Federal Register has been updated to describe new specifications that are required in order for hospitals and providers to comply with Stage 1 – regardless of their first year of attestation and EHR adoption. 
Stage 1 Updated  
The rule requires that all eligible hospitals and providers must acquire and install the “2014 Edition” of certified EHR software to attest with during the 2014 reporting period. This means that all hospitals who have attested, regardless of the stage of Meaningful Use they are at will need to upgrade from the “2011 Version” to the “2014 Version” of Certified Electronic Health Record Technology (CEHRT). (see chart below)  
Under the 2014 definition of CEHRT all hospitals and Eligible Providers (EPs), (regardless of what stage of Meaningful Use they are at) will only need to possess EHR capabilities certified to:
  1. Meet the requirements of a “BASE” EHR as defined by CMS
  2. Meet any other criteria associated with objectives and measures needed to qualify for the providers current stage of Meaningful Use
“Regardless of what stage of Meaningful Use you are at, all eligible hospitals and providers must acquire the “2014 Edition” of certified EHR software to attest with in 2014.”  
Jim Deren
Strategic IT Planning Specialist CareTech Solutions
As indicated in the chart, CMS has reduced the amount of time that an organization will need to measure and attest from an entire year to a three-month period that aligns with a reporting year quarter. The latest a hospital can perform their 90-day measurement is from July 1 through Sept 30, 2014, with submission of attestation no later than two months following the completion of the 90-day measurement period. The latest an EP can measure is Oct 1 through Dec 31, 2014, with submission of attestation no later than two months following the end of the measurement period.
In addition to timing, a number of Stage 1 requirements have been modified. Hospitals and EPs are required to fulfill the updated requirements in order to remain in compliance.  
Following is a summary of changes to the Stage 1 Meaningful Use requirements and Quality Core Measures (CQMs) that will take effect in 2013 or 2014.  
Core Requirements
  • Remove: Provide an electronic copy of health information for EPs and Hospitals (2014)
  • Remove: Provide patients with timely electronic access to their data for EPs (2014)
  • Remove: Electronic exchange of key clinical information by hospitals and EPs (2013)
  • Remove: Provide patients with an e-copy of discharge instructions for hospitals (2014)
Being replaced by:
  • Add: Ability for hospitals and providers to provide patients with the ability to view online, download, and transmit their health information (2014)
  • For EPs and Hospitals – CPOE: have an option to use unique Rx orders or unique patients as denominator (2013)
  • EPs can claim an exclusion for the e-prescribe requirement if they are not located within 10 miles of a pharmacy that accepts electronic prescriptions (2013)
  • Add: Record chart changes in vital signs; add blood pressure for patients who are 3 years old or older and height and weight for all ages. EPs may be able to claim exclusions for these new chart changes and vital signs (2014)
Menu Set Requirements  
  • Remove: EPs to provide patient with timely access to their medical data (2014)
Clinical Quality Measures: 2014 and Beyond  
  • Beginning In 2014: EPs must report on nine of the 64 approved CQMs. The selected CQMs must cover at least three of the National Quality Strategy domains. This is up from the six that were required initially.
  • Hospitals must report on 16 of the 29 approved CQMs from at least three of the six approved domains. This is up from the 15 CQMs that were defined initially, however all 15 are allowable as choices for 2014 – with one additional measure needed.
  • Beginning in 2014: Hospitals and EPs who have attested to Meaningful Use in a prior reporting year must electronically report the data to CMS.
To see more about Stage 2 and changes to Stage 1 visit the CMS Stage 2 web page at:
http://www.cms.gov/Regulations-and-Guidance/Legislation/EHRIncentivePrograms/Stage_2.html