"CMS has reduced the requirement from 10% to 5% of the patient population in recognition of these concerns. CMS believes that 5% is reasonable and that online access to health information and real time communication with providers will promote patient engagement," Bourque said.
Just as with Stage 1 rules, which were published in July of 2010, under Stage 2 criteria, clinicians must meet (or qualify for an exclusion) to more than a dozen core objectives and choose from another menu of objectives. Among the changes: Offering lab results in EHRs is no longer an option; It is now a core requirement.
The final Stage 2 rule adds "outpatient lab reporting" to the menu for hospitals and "recording clinical notes" as a menu objective for both physicians and hospitals. There will be 20 measures for "eligible providers" (17 core and three of six menu items) and 19 measures for eligible hospitals and critical access hospitals (16 core and three of six menu).
Among other Stage 2 rules, healthcare providers must offer outpatients access to updated information on EHRs no longer than four business days after the data is available to the healthcare provider. Additionally, more than 50% of all patients who are discharged from the inpatient or emergency department must have their information available online within 36 hours of discharge.
To spur provider commitment to electronic exchange, CMS had initially proposed two measures in Stage 2. The first measure required that a provider send a summary of care record for more than 65% of transitions of care and referrals. In the final rule CMS is reducing the first measure to a lower threshold of 50%.
Hospitals, clinics and private practices must also prove at least 10% of their patients are actually accessing healthcare information on EHRs. That includes radiological imaging results, which can be accessed directly in an EHR or through a link in the records to the images.
Additionally, any EHR system must have the capacity to provide clinical decision support, include patient demographic and clinical health information such as medical history and problem lists, and have the capacity to support physician order entry.
And all EHR systems must have the capacity to protect the patient confidentiality, integrity, and availability of health information stored and exchanged.
Lucas Mearian covers storage, disaster recovery and business continuity, financial services infrastructure and healthcare IT for Computerworld. Follow Lucas on Twitter at @lucasmearian or subscribe to Lucas's RSS feed. His e-mail address is firstname.lastname@example.org.
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