I know many of you (okay, 1 or 2 perhaps) were looking forward to part 2 of last week’s post. Not to worry, it will be forthcoming. Today, however, I want to bring you up to date on what we are beginning to learn about the Stage 2 Meaningful Use Objectives. On January 12, the Health IT Policy Committee published for public comment a list of potential Stage 2 Meaningful Use Objectives. The list provides a starting point for a process that will conclude with the publication of a final rule for the Stage 2 Objectives sometime in 2012.
What does this early peek reveal? As has been mentioned elsewhere, the first thing that is apparent is that all ten Stage 1 menu set meaningful use objectives will become core measures in Stage 2. Also apparent within this proposed structure is the fact that many of the Stage 1 targets are unchanged in Stage 2 including those for:
1. Problem list (80%)
2. Medication list (80%)
3. Allergy list (80%)
4. Providing clinical summaries (50%)
5. Providing an electronic copy of health information upon request (50%)
6. Providing summary of care on outbound transitions of care (50%)
7. Incorporating lab results as structured data (40%)
8. Sending patient reminders (20%)
9. Patient specific education (10%)
10. Providing timely electronic access to health information (10%)
For other measures with a threshold, the target percentages rise in the Stage 2 proposal:
1. Demographics (50% -> 80%)
2. Vital signs (50% -> 80%)
3. Smoking status (50% -> 80%)
4. Medication reconciliation (50% -> 80%)
5. CPOE (30% -> 60%)
6. eRx (40% -> 50%)
This proposal also maintains the existing Stage 1 measures without a threshold and introduces several new objectives including:
30% of visits have at least one electronic note
Online secure messaging is in use
Patient preferences for communication medium recorded for at least 20% of patients
List of care team members (including PCP) available in EHR for at least 10% of patients
A longitudinal plan of care recorded for 20% of patients with high-priority health conditions
What can we learn from this early glimpse of Stage 2? As expected, many of the hurdles will be higher in Stage 2. The devil is always in the details and several of the objectives contain nuance that will warrant both public comment and additional attention. Lastly, of particular importance to the practicing nephrologists is the impact these changes will bring in relation to our work in the dialysis facility. It is important to recognize that this is a very preliminary view. Quoting from John Halamka’s recent blog post:
The comment period ends Feb. 25 and the Health IT Policy Committee will consider all of the comments in making its final recommendations this summer to the Office of the National Coordinator for Health Information Technology at HHS. Here’s the work plan as I understand it:
Jan, 12, 2011: release draft Meaningful Use criteria and request for comment
Feb-March, 2011: analyze comment submissions and revise Meaningful Use draft criteria
March, 2011: present revised draft Meaningful Use criteria to the HIT Policy Committee
2Q11: CMS report on initial Stage 1 Meaningful Use submissions
3Q11: Final HIT Policy Committee recommendations on Stage 2 Meaningful Use
4Q11: CMS Meaningful Use NPRM
Halamka, as many of you may know, is the Vice Chair for the HIT Standards Committee and, in my opinion, continues to provide very objective insights into the meaningful use glidepath.
We plan to submit a comment to ONC related to this proposed structure and I am sure others within the nephrology community will do so as well. I would encourage those of you with the interest and the time to participate in this process to forward your comments and concerns to ONC before the comment period closes on February 25. I look forward to hearing your thoughts regarding this brief glimpse into the future.
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