December 2011 
Meaningful Use Stage 2
While most hospital and care providers have made significant progress toward achieving Stage 1 of the Meaningful Use requirements for an electronic medical record, it is critical that planning for the subsequent stages begin now.
Stage 1 focuses on the capture and sharing of clinical information among the care team. Stage 2 and 3 focus on advanced care processes, decision support and improved outcomes.  
Completion and continued compliance with all Stage 1 requirements are prerequisites to meeting the Stage 2 and 3 goals. Hospitals and eligible providers need to implement and attest to all Stage 1 menu requirements that were not achieved during Stage 1. End users will also need to ensure that their software is upgraded to certification in order to meet subsequent Stage 2 and 3 functionality.
Requirements  
Stage 2 and 3 requirements include an expanded set that falls into these categories. 

        1. Thresholds are increased from Stage 1
        2. Functionality must be expanded from just having certain capabilities in 
            place to actually transmitting and measuring information
        3. New functionality is required
Key thresholds that are increased include:
  • Expanding order types and percentages of numerators for orders
  • Prescriptions
  • Demographics
  • Vital signs
  • Smoking status
  • Continuity of care record
  • Discharge instructions,
  • Providing summary of health information
  • Office visit summaries
  • Access to health information
  • Medication reconciliation
Menu set requirements that must be achieved include:
  • Advanced directives
  • Structured lab data
  • Medication reconciliation
  • Summary of care records
  • Patient reminders

Functionality that must be expanded to send actual data includes:

  • Drug interaction checks
  • Clinical decision support
  • Drug formulary checks
  • HIE
  • Submission of immunization data
  • Reportable lab results
  • Syndromic surveillance data
New functionality that is required includes:
  • Electronic notes for inpatient and outpatients
  • Electronic prescription checking
  • Web access to patient data
  • Secure Internet messaging with patients
  • Self-management tools
  • Electronic health records
  • Capturing and listing care team members
  • Longitudinal care plan
  • Public health alerts
“Completion and continued compliance with all Stage 1 requirements are prerequisites to meeting the Stage 2 and 3 goals.”
Jim Deren
Strategic IT Planning CareTech Solutions
Organizations must continue to capture a patient’s problems, active medications, and med allergy list, as well as continue to meet all security measures.
Timing
The Federal Government has extended the timeframe for requiring attainment of Stage 2 by an additional year. Measurement and attestation will require continuous compliance for the entire year, which is the federal fiscal year (October 1 – September 30) for hospitals and calendar year for ambulatory providers.  
Your target dates will vary depending upon when you attest to Stage 1. For hospitals first attesting in 2012, you must go live and begin measuring by October 1, 2014, in order to provide one year of data on September 30, 2015. If a hospital first achieves Stage 1 in 2013, they must go live and begin measuring Stage 2 by October 1, 2015, in order to attest to one year of measurement on September 30, 2016.
Reduced Medicare payments begin on October 1, 2014, if a hospital has not achieved Stage 1 or fails to continue to meet the minimum thresholds for the appropriate stage. For the ambulatory environment, reduced Medicare payments will begin January 1, 2015, for hospitals that have not achieved or sustained the appropriate stage for meaningful use. There are no penalties for Medicaid providers.
Based upon public feedback, the HIT Task Force is considering a number of changes to the law that may involve adding Behavioral Health, Rehabilitation Services, Ambulatory Surgery Centers, and Long-Term Care to the scope of services. The final rule for Stage 2 is expected to be completed in February of 2012.  

Timing