- The Centers for Medicare & Medicaid Services (CMS) has released the proposed rule and certification requirements for Stage 3 Meaningful Use regulations. The proposed rulings focus on increasing health information exchange (HIE) and better health outcomes for patients.
The Stage 3 proposed rule builds on the framework established in previous meaningful use stages and continues to promote EHR interoperability. The rule also focuses on providing more flexibility that simplifies the reporting requirements of the Medicare and Medicaid EHR Incentive Programs. There are eight major objectives proposed in the Stage 3 Meaningful Use rule.
Objective 1: Protect Patient Health Information
The first objective focuses on protecting patient medical information. New technical, physical, and administrative safeguards are recommended that provide more strict and narrow requirements for keeping patient data safe and secure.
CMS focuses on the Health Insurance Portability and Accountability Act (HIPAA) and its aim to prevent the identification of patient health data. Ensuring privacy and security of medical records – whether electronic or paper – is key to both HIPAA rules and the Stage 3 Meaningful Use proposed rulings.
Essentially, encryption of patient electronic health information is addressed and continues to be essential for the EHR Incentive Programs. The ruling states that relevant entities will need to conduct risk analysis and risk management processes as well as develop contingency plans and training programs. Ensuring physical safeguards like facility access controls and workstation security are in place is an important part of the proposed legislation.
Objective 2: Electronic Prescribing
With regard to electronic prescribing, CMS recommends increasing the threshold for a menu set objective among eligible hospitals and clinics. The proposed ruling requests that eligible providers send more than 80 percent of their drug/treatment prescriptions electronically through certified EHR systems. Additionally, more than 25 percent of hospital discharge medication orders may need to be electronically prescribed under the proposal.
Providers will continue to send drug prescriptions electronically to pharmacies in order to prevent fraudulent prescribing and keep patient data secure. CMS asks providers and other stakeholders to comment on whether there should be a requirement under Stage 3 Meaningful Use to electronically prescribe over-the-counter drugs.
E-prescribing is key in preventing medical errors and preventing illegal, fabricated prescriptions that are associated with drug abuse behaviors. Providers are allowed to prescribe controlled substances electronically but must do so across all patients, according to the proposed rule.
Objective 3: Clinical Decision Support
Clinical decision support is crucial for improving the quality of care among patients. The third objective under Stage 3 Meaningful Use focuses on improving performance on high-priority medical conditions by integrating clinical decision support tools and strategies.
This will lead to better patient safety and efficiency within the healthcare sector. Clinical decision interventions will need to be presented through certified EHR technology to a healthcare professional who will then decide on the action(s) necessary to benefit the patient.
CMS suggests eligible providers to implement five clinical decision support interventions that are adherent to at least four clinical quality measures at critical points in patient care for the whole EHR reporting period.
The second measure that CMS recommends is for eligible hospitals and providers to incorporate tools for drug-drug and drug-allergy interaction alerts for the entire EHR reporting period.
Objective 4: Computerized Provider Order Entry
Under Stage 2 Meaningful Use requirements, CMS mandated that computerized provider order entry (CPOE) needs to be used for recording medication, laboratory, and radiology requests.
Within the Stage 3 Meaningful Use proposed ruling, CMS continues to stress the importance of using CPOE for medication, laboratory, and diagnostic imaging orders by a licensed healthcare professional.
There are three specific measures that CMS set forth in the proposed ruling. First, eligible providers will need to use CPOE for more than 80 percent of medication orders during the EHR reporting period.
Within the same time period, more than 60 percent of laboratory orders created by the eligible provider will need to be recorded through the computerized order entry form. The final measure under the fourth objective asks for eligible providers to use CPOE for more than 60 percent of diagnostic imaging orders during the reporting period.
Objective 5: Patient Electronic Access to Health Information
Throughout the meaningful use stages, CMS has advocated increased patient access to healthcare information. This included integrating patient reminders, patient-specific education tools/resources, clinical summaries of medical appointments, and the ability to review and share health information with a third party.
Under the Stage 3 Meaningful Use proposed rule, the fifth objective focuses on improving timely access to health information and direct physician-patient communication channels for coordinating care.
The proposed objective for increasing electronic access to health data calls for eligible hospitals and providers to offer patients electronic access to view, download, and share their health information within 24 hours of its availability.
Objective 6: Coordination of Care through Patient Engagement
Patient engagement is really centered on increasing patient involvement in healthcare by changing prior behaviors among both providers and patients. Particularly, the initiatives focus on improving the communication channels between physicians and patients as well as improving health literacy among the patient population.
The proposed objective CMS puts forth in the Stage 3 Meaningful Use rule is for healthcare professionals to utilize secure and private communication capabilities of certified EHR technology to work with patients or authorized caregivers regarding the patient’s care. Additionally, the organization is recommending expanding the amount of options providers have to communicate with patients under the EHR Incentive Programs including the use of Application Program Interfaces.
Objective 7: Health Information Exchange
The electronic exchange of health information among providers across the healthcare spectrum will improve clinical care decisions and the coordination of care. Sharing this type of information quickly and efficiently will reduce many of the previous issues related to communication among providers. Most importantly, health information exchange is geared toward decreasing medical errors and improving patient safety.
The seventh proposed objective under Stage 3 Meaningful Use calls for physicians to provide summary of care records when transitioning patients among healthcare settings, accessing summary of care records during the first encounter with a new patient, and integrating summary of care records from other providers into their certified EHR technology.
Objective 8: Public Health and Clinical Data Registry Reporting
The eighth objective adds to the requirements set forth in Stage 2 Meaningful Use regulations and incorporates certain flexibilities, improvements, and innovations. Essentially, this objective puts more importance on the communication channels between providers and clinical data registries or public health agencies.
The proposal asks for providers to be actively engaged with public health agencies or clinical data registries and to submit electronic public health data meaningfully through certified EHR systems.
To read more about the Stage 3 Meaningful Use proposed rule, click here.