Are your spidey senses tingling yet? Meaningful Use Stage 2 attestations are right around the corner, and while Stage 2 isn’t the Green Goblin or Doctor Octopus (I promise!), Meaningful Use (MU) can seem like the villian when it comes to remembering what to document, when to document it, and how to document it to get it to count.
So, if Stage 2 is the villian, guess who gets to be the superhero?
Let’s start by taking Uncle Ben’s advice, “With great power comes great responsibility.” And the first responsibility you’ll have as “MU Man” or “MU Woman” is learning everything you can about the requirements for attestation.
We will soon be posting a training presentation (eligible for CME credit) which will detail what and how to document the Stage 2 requirements, but as a quick summary, below are the 17 core measures and 3 menu measures that are required for Stage 2.

Stage 2 Core and Menu Measures

Core Objectives (17 total)
(1) Use computerized provider order entry (CPOE) for medication (>60%), laboratory (>30%) and radiology orders (>30%) directly entered by any licensed healthcare professional who can enter orders into the medical record per state, local, and professional guidelines.

(2) Generate and transmit permissible prescriptions electronically (>50%).

(3) Record the following demographics: preferred language, sex, race, ethnicity, and date of birth (>80%).

(4) Record and chart changes in the following vital signs: height/length and weight (no age limit); blood pressure (ages 3 and over); calculate and display body mass index (BMI); and plot and display growth charts for patients 0-20 years, including BMI (>80%).

(5) Record smoking status for patients 13 years old or older (>80%).

(6) Use 5 clinical decision support interventions to improve performance on high-priority health conditions (these must be related to Clinical Quality Measures) AND enable and implement drug-drug and drug-allergy checks.

(7) Provide patients the ability to view online, download, and transmit their health information within four business days of the information being available to the EP (>50%).

(8) Provide clinical summaries for patients for each office visit (>50%).

(9) Protect electronic health information created or maintained by the Certified EHR Technology through the implementation of appropriate technical capabilities.

(10) Incorporate clinical lab-test results into Certified EHR Technology as structured data (>55%).

(11) Generate lists of patients by specific conditions to use for quality improvement, reduction of disparities, research, or outreach.

(12) Use clinically relevant information to identify pa­tients who should receive reminders for preventive/follow-up care and send these patients the reminders, per patient preference (>10%).

(13) Use clinically relevant information from Certified EHR Technology to identify patient-specific education resources and provide those resources to the patient (>10%).

(14) The EP who receives a patient from another setting of care or provider of care or believes an encounter is relevant should perform medication reconciliation.

(15) The EP who transitions their patient to another setting of care or provider of care or refers their patient to another provider of care should provide a summary care record for each transition of care or referral (>50%).(16) Capability to submit electronic data to immunization registries or immunization information systems except where prohibited, and in accordance with applicable law and practice (Yes/No).

(17) Use secure electronic messaging to communicate with patients on relevant health information (>5%).

Eligible Professional Menu Objectives (3 of 6)
(1) Record electronic notes in patient records (>30%).

(2) Imaging results consisting of the image itself and any explanation or other accompanying information are acces­sible through CEHRT (>10%).

(3) Record patient family health history (1st degree rela­tive) as structured data (>20%) .

If you’re still learning the ropes on how to use your su­perpowers (a.k.a. EHR documentation skills), this Stage 2 summary may have you rethinking your superhero status, but no one ever promised saving the world was easy.
And I haven’t even mentioned CQMs!

CMS Extends Timeline for EHR Incentive Program
A few weeks ago, the Centers for Medicare & Medicaid Services (CMS) proposed a new timeline for the implementation of meaningful use. The new timeline extends Stage 2 through 2016, and Stage 3 will begin in 2017 for providers who have completed at least two years in Stage 2. The extension was made for two reasons: one, to allow CMS “to focus efforts on the successful implementation of the enhanced patient engagement, interoperability and health information exchange requirements in Stage 2”; and, two, to have access to the data from Stage 2 to inform policy decisions for Stage 3.
The three stages are set up to transition participants, from creating information in Stage 1, to exchanging information in Stage 2, to improving outcomes in Stage 3. 

According to CMS, the new timeline would have several benefits:

• More analysis of feedback from Stage 2 
• More available data on Stage 2 adoption and measure calculations – especially on new patient engagement measures and health information exchange objective
• More consideration of potential Stage 3 requirements
• Additional time for preparation for enhanced Stage 3 requirements
• Ample time for developers to create and distribute certified EHR technology before Stage 3 begins, and incorporate lessons learned about usability and customization.

CMS plans to release a notice of proposed rulemaking for Stage 3 in the fall of 2014. The final rule with all requirements for Stage 3 would follow in the first half of 2015.  All comments from those individuals with a direct interest will be “reviewed and carefully considered” before the final rules are released.

What this means for Quillen Providers
Although this announcement doesn’t immediately affect us, it does give us a little more breathing room, as many of our providers were early participants in the program. For any provider who started the program in 2011, the new timeline will look similar to the following:

2011  Adopt, Implement, Upgrade
2012  Demonstrate 90 days of Stage 1
2013  Demonstrate a  Full Year of Stage 1
2014  Demonstrate 90 days of Stage 2
2015  Demonstrate a Full Year of Stage 2
2017 Begin Stage 3

Not all of our providers started in 2011, so your particular timeline may look a little different. CMS offers a timeline tool  that participants can use to see a personalized timeline.
As we enter a new year and start working on a new timeline, perhaps the song below won’t be as applicable, but just in case you are still in a panic about Meaningful Use, here’s a song for you!

I was panicking when I wrote this
Forgive me if it goes astray
But when I got to work this mornin'
Could of sworn it was Attestation Day.

The computer screen was all black
There were patients waitin’ everywhere
Tryin' to get relief from sickness
But CMS didn’t seem to care.

'Cause they say two thousand one three
Stage One is over, oops out of time
So today I’ve got to click like it's 2014
(Sorry, couldn’t make it rhyme)

I was panicking when I wrote this
So sue me if I go too fast
Stage 2 is not a party
And clicking is not a blast.

The EHR is all around us
My eyes say too much screen time
But if I gotta click
I'm gonna make it by the deadline.

Yeah, they say two thousand one three
Stage One is over, oops out of time
So today I’ve got to click like it's 2014.
(Sorry, couldn’t make it rhyme)

Lemme tell ya somethin'
If you didn't come to document
Don't bother seeing patients
We got CMS wanting data
And, doc, we’re runnin’ outta time!

You may have already heard more than you care to about the topic, but like it or not, secure exchange of protected health information is required for HIPAA compliance. Not surprisingly, some of the required measures for achieving Stage 1 and Stage 2 Meaningful Use involve the secure electronic exchange of  patient health information.  Stage 2 Core Measure 17 “Use Secure Electronic Messaging” is a prime example:

The Objective is to use secure electronic messaging to communicate with patients on relevant health information.  A secure message must be sent using the electronic messaging function of the provider’s CEHRT by more than 5 percent of unique patients seen by the eligible provider (EP) during the reporting period. 

A Secure Message is defined as  “Any electronic communication between a provider and patient that ensures only those parties can access the communication. This electronic message could be 1) email, 2) the electronic messaging function of a PHR, 3) an online patient portal, or 4) any other electronic means. An EP or staff member can follow-up with a telephone call or office visit if deemed more appropriate to address the concerns raised in the patient’s e-message. And don’t get too panicking just yet if you’re thinking what a lot of other providers are thinking, “Yikes! Email from patients?!”. . .There isn’t a requirement that the EP must personally respond to electronic messages to the patient. Designated office staff can manage the email under the supervision of the physician.
As Quillen ETSU Physicians prepares to meet the requirements of this measure and to comply with the HIPPA Security Rule, we have started the process of registering our users in the Direct Project.  If you’ve been asked to send us your driver’s license and ETSU ID, then you’re on your way to being registered. The Direct Project offers providers a secure way to send protected health information, including clinical summaries, continuity of care documents (CCDs), and laboratory results, to other providers who also have a Direct address. Presently, we are participating in the most basic implementation of the Direct Project, a secure email system via an email client, which works just like regular email, but with an added level of security required to transport sensitive health information.
Over the next few weeks, some of our users will be receiving an email much like the one you see below. Once you receive it, you’ll be asked in another email by the EHR administrator to forward it to her. She’ll be providing you with additional information for using it later.
Admittedly, there are many changes going on in healthcare right now, which may have you feeling overwhelmed. But, what I keep reminding myself—as I try to muddle through and stay current in serving our users—is that these changes are being implemented for improved quality of patient care and, eventually, to make providing that care to our patients more convenient for everyone.
It wasn’t too long ago that we all heard the chime, “You’ve got mail!” as we logged into our AOL accounts through our dial-up modems (can you remember how slow that connection was?). Now we are blazing across the internet on our smart phones and tablets, with instant access to almost any information we need, including patient health records.
Healthcare technology’s day will soon arrive and all of the changes that are being implemented now will seem routine and outdated as we continue to move forward. Rather than having to leave voicemails, send faxes, call the pharmacy again and again, or wait on a patient’s return call, wait on a fax, or wait on the pharmacy to call you back, the exchange of secure information will be at your fingertips and as fast as you can say, “You’ve Got Secure Mail.”