Stage 2 Meaningful Use Final Rule Released

The Centers for Medicare and Medicaid Services (CMS) and the Office of the National Coordinator for Health IT (ONC) have released final rules and requirements for the stage 2 meaningful use EHR Incentive Program. The program  provides incentive payments to eligible professionals, hospitals, and critical access hospitals that adopt and successfully demonstrate meaningful use of certified EHR technology.

The display copy for the CMS rule can be read here. This final rule is effective 60 days after the date of publication in the Federal Register.

The display copy for ONC’s standards and certification criteria is available here. The regulations will be effective 30 days after publication in the Federal Register.

“As HIM professionals, we are a critical component to the reporting of clinical and HIT quality measures in achieving meaningful use,” said Allison Viola, MBA, RHIA, senior director of federal relations at AHIMA. “We are pleased to see that CMS has heard our calls for increased alignment of quality reporting programs and acknowledgement of making an effort to reduce the reporting burden and duplication of reporting. 

“We also stand ready to support patients and their ability to have online access to their health information to ensure its privacy, integrity, and timeliness for their continued care.”

The program was first announced as part of the American Recovery and Reinvestment Act — Health Information Technology for Economic and Clinical Health (ARRA-HITECH) in 2009.  The rules include health information technology measures that will allow patients to view, download, and transmit their health records online, as well as a number of clinical quality measures that align with other CMS quality measurement programs.

Rule Ramps Up Electronic Record Access, Quality Measures

Some points included in the final rule include:

  • Consistent with the proposed regulation, health information technology (HIT) measures will allow patients the ability to view online, download, and transmit their health information from participating physicians within four business days of the information being available. 
  • Participating eligible hospitals must allow patients the ability to view online, download, and transmit their health information within 36 hours of discharge.
  • Physicians and hospital staff must track how many patients access their health records during the program reporting period. More than 5 percent of unique patients either seen by a physician or discharged by a hospital must access their records in order to meet the meaningful use measure. The stage 2 proposed rule called for 10 percent of patients to access records. The change  illustrates some give by CMS based on comments from healthcare stakeholders — including AHIMA — that 10 percent was too high since providers could not control patient use of the function.
  • Healthcare providers must offer and use secure electronic messaging to communicate with patients on relevant health information. While the proposed stage 2 rule stated at least 10 percent of patients must use the feature during the reporting period, the final rule lowered the measure to 5 percent.
  • CMS continues to acknowledge and align clinical quality measures with other reporting programs to reduce burden and duplication of efforts. 
  • All HIT Menu Set measures have been transitioned to the Core Set of measures with the exception of electronic syndromic surveillance data and advance directives.
Compliance Date Pushed Back

The EHR Incentive program is comprised of two supporting regulations – the standards and certification required for the use of EHRs in reporting measures to CMS, and the quality reporting requirements that must be met by participants and submitted to CMS.

The CMS stage 2 final regulations provides a compliance date of 2014, one year later than was identified in the proposed regulation. In stage 1 CMS established that any provider who first attested to stage 1 criteria in 2011 must begin using stage 2 criteria in 2013. The stage 2 final rule delays the onset of stage 2 criteria for all participants to 2014. 

This will enable providers, hospitals, vendors, and other industry stakeholders the opportunity to take advantage of extra time to prepare and implement the necessary components for reporting, Viola said.

HIM’s Role Expanded

Health Information Management (HIM) professionals serve at the core of this program through the support of quality measurement reporting, Viola said.  For example, the health IT measure that requires allowing patients the ability to view online, download, and transmit their health information will require the expertise of HIM professionals to implement and manage.  This requirement differs from that of Stage 1 when providers were only required to offer patients “electronic copies” of their health information. 

Although this measure does introduce various issues for HIM professionals working  to ensure the privacy and security, timeliness, and integrity of patient data, Viola noted CMS did make an effort to combine and align requirements for access to patient information in the final rule. 

CMS continued to push the industry toward the electronic exchange of patient information by requiring eligible providers to provide clinical summaries within one business day of a patient’s visit. This measure aims to ensure care coordination and continuation of care by advancing health record exchange, Viola said. 

In addition, CMS stayed the course with their commitment to improve population and public health, requiring in stage 2 the submission of electronic data to registries, labs, and public health agencies to track syndromic surveillance.

“We are encouraged to see CMS’ continued push toward actively exchanging health information to improve coordination of care thus improving patient safety,” said AHIMA CEO Lynne Thomas Gordon, MBA, RHIA, CAE, FACHE.  “We are also pleased to learn of CMS’ continued commitment toward engaging patients and families in their healthcare through the ability to view online, download and transmit their health information.  We believe patients must be partners and work side-by-side with their providers to achieve the best possible healthcare outcomes.”


  1. The rules would be more palatable if quality measures were geared toward specialty achievable measures specific to that specialty, rather than encouraging specialty providers to select quality measures at the fringes or outside of their mainstream practice in order to comply. The data collected would then be valuable. The rules are seen as pedantic rather than part of a process of improving provision of care.

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  2. The program seems to assume that all patients have access to computers and would want to access their records. We have a lot of poor and older patients that have no computers. They do not want to go to the library to use those free resources, either.

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