Share this article on:

Meaningful Use Expectations Worklist

Hess, Cathy Thomas BSN, RN, CWOCN

Advances in Skin & Wound Care: December 2012 - Volume 25 - Issue 12 - p 576
doi: 10.1097/01.ASW.0000423444.85660.53
Departments: Practice Points

Cathy Thomas Hess, BSN, RN, CWOCN, is Vice President and Chief Clinical Officer, Net Health Systems, Inc.

Please address correspondence to: Cathy Thomas Hess, BSN, RN, CWOCN, via e-mail:

As we wrap up 2012, one important item on our “to-do” list is electronically attaining, and maintaining, “meaningful use.”

The Government has detailed Stages 1, 2, 3 within the Federal Register.1 Take a moment to review all expectations as we move into 2013.

“Under this phased approach to meaningful use, we update the criteria of meaningful use through staggered rulemaking. We published the Stage 1 final rule July 28, 2010, and this rule outlines our proposed Stage 2 approach. We currently anticipate at least one additional update, and anticipate updating the Stage 3 criteria with another proposed rule by early 2014. The stages represent an initial graduated approach to arriving at the ultimate goal.

Stage 1: The Stage 1 meaningful use criteria, consistent with other provisions of Medicare and Medicaid law, focused on: electronically capturing health information in a structured format; using that information to track key clinical conditions and communicating that information for care coordination purposes (whether that information is structured or unstructured, but in structured format whenever feasible); implementing clinical decision support tools to facilitate disease and medication management; and using electronic health records (EHRs) to engage patients and families and reporting clinical quality measures and public health information.

Stage 1 focused heavily on establishing the functionalities in Certified EHR Technology that will allow for continuous quality improvement and ease of information exchange. By having these functionalities in certified EHR technology at the onset of the program and requiring that the eligible professionals (EP), eligible hospital, or critical access hospitals (CAH) become familiar with them through the varying levels of engagement required by Stage 1, we believe we created a strong foundation to build on in later years. Though some functionalities were optional in Stage 1, all of the functionalities are considered crucial to maximize the value to the health care system provided by Certified EHR Technology. We encouraged all EPs, eligible hospitals, and CAHs to be proactive in implementing all of the functionalities of Stage 1 in order to prepare for later stages of meaningful use, particularly functionalities that improve patient care, the efficiency of the healthcare system, and public and population health. The specific criteria for Stage 1 of meaningful use are discussed in the Stage 1 final rule.2 We are proposing certain changes to the Stage 1 criteria in section II.B.3.b. of this proposed rule.

Stage 2: Our Stage 2 goals, consistent with other provisions of Medicare and Medicaid law, expand upon the Stage 1 criteria with a focus on ensuring that the meaningful use of EHRs supports the aims and priorities of the National Quality Strategy. Specifically Stage 2 meaningful use criteria encourage the use of health information technology (HIT) for continuous quality improvement at the point of care and the exchange of information in the most structured format possible. Stage 2 meaningful use requirements include rigorous expectations for health information exchange including: more demanding requirements for e-prescribing; incorporating structured laboratory results; and the expectation that providers will electronically transmit patient care summaries to support transitions in care across unaffiliated providers, settings, and EHR systems.

Increasingly robust expectations for health information exchange in Stage 2 and Stage 3 will support the goal that information follows the patient. In addition, as we forecasted in the Stage 1 final rule, we now consider nearly every objective that was optional for Stage 1 to be required in Stage 2, and we reevaluated the thresholds and exclusions of all the measures.

Stage 3: We anticipate that Stage 3 meaningful use criteria will focus on: promoting improvements in quality, safety, and efficiency leading to improved health outcomes; focusing on decision support for national high-priority conditions; patient access to self-management tools; access to comprehensive patient data through robust, patient-centered health information exchange; and improving population health.

For Stage 3, we currently intend to propose higher standards for meeting meaningful use. For example, we intend to propose that every objective in the menu set for Stage 2 (as described later in this section) be included in Stage 3 as part of the core set. Although the use of a menu set allows providers flexibility in setting priorities for EHR implementation and takes into account their unique circumstances, we maintain that all of the objectives are crucial to building a strong foundation for HIT and to meeting the objectives of the Act. In addition, as the capabilities of HIT infrastructure increase, we may raise the thresholds for these objectives in both Stage 2 and Stage 3.”1

Wishing you a happy, healthy, and productive 2013!

Back to Top | Article Outline


1. Centers for Medicare & Medicaid Services. Medicare and Medicaid Programs; Electronic Health Record Incentive Program-Stage 2. Federal Register. Last accessed October 25, 2012.
2. Centers for Medicare & Medicaid Services. Medicare and Medicaid Programs; Electronic Health Record Incentive Program. Last accessed October 25, 2012.
© 2012 Lippincott Williams & Wilkins, Inc.