Health News Digest
Three stages

August 5, 2013

More Meaningful Use: Stage 2 of the Electronic Health Records Incentives

By  Michael D. Shaw

Last week’s article was not particularly kind to Electronic Health Records (EHRs), and generated a fair amount of commentary. Your columnist-and others—have suggested that some of the issues with EHRs are a result of overly quick roll-out, to take advantage of cash incentives offered by the government. These incentives are given for the “meaningful use” of certified EHR technology to improve patient care.

Various objectives have been specified by the Centers for Medicare & Medicaid Services (CMS) for providers, in order to qualify for these payments. As CMS describes it, the incentive programs are “[S]taged in three steps with increasing requirements for participation.” As originally defined, Stage 1 comprises data capture and sharing; Stage 2 moves into advanced clinical processes; and Stage 3 to improved outcomes. The implementation dates for these stages have been changing, as have the fine details.

Stage 1 designates two classes of objectives: Core objectives and menu objectives. For hospitals, there are 14 required core objectives. For professionals, there are 15 required core objectives. For both groups, five menu items may be chosen from a list of ten.

 Hospital core objectives include…

  • Maintain up-to-date problem list of current and active diagnoses
  • Maintain active medication list
  • Maintain active medication allergy list
  • Record and chart changes in vital signs
  • Record demographics
  • Protect electronic health information


Professional core objectives include…

  • E-Prescribing (eRx)
  • Provide patients with an electronic copy of their health information, upon request
  • Provide clinical summaries for patients for each office visit
  • Drug-drug and drug-allergy interaction checks
  • Record demographics
  • Protect electronic health information

For both groups, the menu objectives include large scale reporting of patient information to external databases, rendering the last-listed core objective moot, in my judgment.  Stage 2 provides more rigorous thresholds for the Stage 1 criteria, and introduces new objectives–mostly menu items, with a small number of significant core objectives.


For hospitals…

  • Automatically track medications from order to administration using assistive technologies in conjunction with an electronic medication administration record (eMAR)
  • Provide patients the ability to view online, download and transmit their health information within 36 hours after discharge from the hospital


For professionals…

  • Use secure electronic messaging to communicate with patients on relevant health information
  • Provide patients the ability to view online, download and transmit their health information within four business days of the information being available to the provider


Note that three of these four core objectives fall into the realm of patient engagement, which really comes down to involving patients in their own care. It has been suggested that allowing ready access to medical information, thereby helping the patient to make important decisions on their care, can improve outcomes and reduce costs.

A leading company in this field is Get Real Health, based in Rockville, MD. I spoke with Jason Harmon, CTO & Founding Partner, about their flagship product, InstantPHR™ (Instant Personal Health Record), geared to the demands of Stage 2.

We’ve been 100% focused on IT-enabled patient engagement tools since 2007. It’s simply too expensive to ignore what is happening to patients outside of the four walls of a doctor’s office, clinic or hospital–especially now when there are so many readily available tools to track, monitor, and document important health metrics anywhere, anytime.

We’ve seen patients with diabetes lower their HbA1c levels when using glucometers connected to InstantPHR, which enables them to see their readings online in real-time, in a user-friendly format, accompanied by alerts and reminders of daily tasks to help them manage their condition. Patients and clinicians managing chronic mental health conditions benefit from InstantPHR care management tools like daily mood journals, available on a mobile device, which can be configured to prompt interaction and outreach from clinicians.

I’ll withhold comment on why patient engagement, beyond obtaining a copy of their records, had to wait for Stage 2.