Preliminary Stage 3 Meaningful Use Recommendations Released

Preliminary recommendations for stage 3 of the “meaningful use” EHR Incentive Program were released Tuesday by an Office of the National Coordinator for Health IT (ONC) workgroup.

The recommendations were presented by the Meaningful Use Workgroup during a meeting of the ONC Health IT Policy Committee, who reviewed and approved the recommendations, marking an important step toward the development of a final stage 3 rule.


163751742Updates to Stage 2 Measures Recommended

The majority of the stage 3 measure recommendations are updates to objectives included in stage 2 meaningful use, with some enhanced with more difficult provisions in order to increase the expected benefit to healthcare improvement that comes with meeting the measures.

For example, currently in stage 2 meaningful use eligible professionals must give at least 50 percent of their patients the ability to view online, download, and transmit their health information within four business days of the information becoming available to the provider. Hospitals are required to provide access to 50 percent of patients within 36 hours of discharge. Both providers need to ensure more than five percent of patients actually view their records.

In the stage 3 recommendations, both eligible professionals and hospitals would only have 24 hours to give at least a majority of their patients the ability to view online, download, and transmit their health information—if that information was generated during the course of their visit. Labs and other types of information not generated during the course of the visit would need to be available within four business days. The workgroup recommended that the requirement for patients to actually view their information be removed in stage 3.

Also, the current stage 2 measure to record patient demographics in the medical record for more than 80 percent of unique patients seen during the reporting period has been enhanced. In stage 2, eligible hospitals must have an EHR that can record the preferred language, sex, race, ethnicity, date of birth, and date and preliminary cause of death in the event of mortality.

The stage 3 recommendations call for hospital EHRs to record this data as well as record:

  • A patient’s preferred method of communication (i.e., e-mail, telephone, letter)
  • Occupation and industry codes
  • Sexual orientation or gender identity
  • Disability status


New Measures Recommended

Several new measures were added to the recommended slate as well. One new measure, if inserted into the stage 3 meaningful use final rule, would have vast implications for health information management (HIM) professionals and their oversight of the medical record.

A new recommended menu item states that eligible professionals and hospitals must receive provider-requested, electronically submitted patient-generated health information through either structured questionnaires—such as screening questionnaires, medication adherence surveys, and intake forms—or secure messaging. The method of entering the information into the EHR would be at the discretion of the provider. Patient-generated information provided through mobile devices would also count toward the measure.

Currently many HIM professionals have debated the best way to safely integrate patient-generated information into their health record, while physicians have debated over whether or not they can trust such data as reliable.

Another new measure that has HIM implications is a proposed menu measure that calls on hospitals to send electronic notifications of significant healthcare events to a patient’s care team—such as their primary care provider, referring provider, or care coordinator—within four hours of the event. Significant events that would trigger a notification include:

  • Arrival at an emergency department
  • Admission to a hospital
  • Discharge from an emergency department or hospital
  • Death


Stage 3 Next Steps

The recommendations from the workgroup are just a first step before stage 3 is finalized. With the Health IT Policy Committee approving the recommendations March 11, it is expected that ONC and the Department of Health and Human Services (HHS) will issue a stage 3 meaningful use proposed rule in the fall. After collecting public comments on the proposed rule, ONC/HHS is expected to issue a final rule in early 2015. Stage 3 is currently slated to begin in 2017.

Before the final rule is determined, ONC will likely receive many comments from the public and adjust the recommendations of the workgroup, which has occurred in the past with both stages 1 and 2 of the program.

The public comments have already begun. On February 21, 24 members of the US House of Representatives sent a letter to ONC head Karen DeSalvo and Centers for Medicare and Medicaid Services (CMS) Administrator Marilyn Tavenner asking her to use the stage 3 meaningful use criteria to address a number of healthcare issues, including a call to reduce health disparities and embrace mobile health platforms. While ONC develops the meaningful use measures, CMS operates the program and issues incentive payments.

View the full stage 3 recommendations of the Health IT Policy Committee’s Meaningful Use Workgroup here.


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