standardized data exchange via the Web. That standardization took efforts from volunteers across the health care sector to consolidate hundreds—and even thousands—of ways to represent certain data sets, such as lab results and medication lists. “The big message here is the push on standards-based exchange and interoperability,” Mostashari said. On the provider side, CMS has paid


more than $6.6 billion in electronic health record (EHR) incentives to about 128,000 eligible professionals and 3,600 hospitals. Along the way to attesting to Stage 1 meaningful use, providers pointed out problems and inconveniences in the process that CMS addressed in Stage 2. Examples from the 672-page Stage 2 document include: Batch processing for physician


groups to submit attestation information all at once, instead of one by one as Stage 1 required—which some physician groups claimed was onerous.


An Ongoing Process Edits to Stage 1 requirements to harmonize them with exceptions/ alternative compliance methods written into Stage 2. For instance, there’s a new exclusion to the e-prescribing meaningful use objective for providers who neither operate a pharmacy within their organization nor have one within 10 miles accepting electronic prescriptions at the start of his/her reporting period. Since Stage 2 doesn’t introduce the rule—instead it expands Stage 1’s threshold from 40% to 50%—CMS needed to change the original Stage 1 rule as well. If they hadn’t, as the commenters put it, “it would create a strange scenario where an EP might have to electronically prescribe during their two years of Stage 1 and then meet an exclusion in Stage 2.”


Adjusting Thresholds Using computerized provider order


entry (CPOE) systems for lab and radiology orders is new to Stage 2, but the proposed rule requires these new items to be at the 60% threshold just like medication orders, which debuted in Stage 1 at 30%. Reflecting on stakeholder comments, CMS lowered lab and radiology CPOE requirements to 30% each.


Specialists Accommodated Specialty physicians sometimes


have a difficult time complying with meaningful use, which has been described as “primary care centric.” Rob Anthony, Office of E-Health Standards and Services health insurance specialist, said Stage 2 meaningful use accommodates specialists by adjusting objectives that would create hardships for compliance. For example, surgeons and


psychiatrists will be able to adjust for the controlled substances they prescribe electronically. Since controlled substances can’t count toward meaningful use e-prescribing thresholds, those prescriptions won’t count toward the physician’s total (the denominator) and therefore will no longer skew reporting during the attestation process to make it appear as if a smaller percentage of patients’ meds were prescribed electronically. Moreover, Anthony continued,


“We did introduce some hardship exclusions specifically for payment adjustments [penalties for providers who aren’t meaningful use compliant] in regard to certain specialties that we knew would have particular challenges—and that we heard from the public have had very difficult hurdles to get over for meaningful use—and [those] specifically [are] in [areas] of pathology, anesthesiology, and radiology.” Mostashari also said regulators


added optional “menu” meaningful use compliance objectives that cater to specialties based on feedback from specialist physicians in the period


between the release of Stages 1 and 2. These include reporting data to cancer registries or professional society registries, image viewing and collecting family health history. Along the same lines, the rules now


accommodate rural providers who have difficulties obtaining Internet access, a hardship that would make transmitting patient summary of care documents, e-prescribing data, public health reports and other mandates difficult. They may request one-year exceptions from penalties for up to five years, which CMS will review on a case- by-case basis. The agency also added an “extreme circumstances” exception for providers who experience compliance barriers through no fault of their own, such as hospital shutdowns, their EHR vendors going out of business, or natural disasters that knock out the EHR system during a reporting period. “This really represents the


culmination of a two-year-long process of laying out the next step in that escalator, that roadmap that is taking us from paper to a modernized health care system that really meets the promise of improving quality, safety, efficiency, and care coordination,” Mostashari said.


A Partner in Care How One Hospital Leveraged a Clinical Device


Assessment to Move Closer to Meaningful Use Listen to this podcast to learn what Mee Memorial, a 119-bed hospital in Southern Monterey County, CA, achieved with our Clinical Device Assessment Service. Mee Memorial wanted to take advantage of new technology and bring in medical carts and computing devices for their clinicians. In this podcast Nick Alatorre, Systems Administrator and Analyst, describes how they achieved their goals and moved closer to Meaningful Use using the Clinical Device Assessment Service from PC Connection.


Visit www.pcconnection.com/MeeMemorial to listen to the podcast today. IMAGES © SPECTRAL-DESIGN, ANDRES RODRIGUEZ, DAN KOSMAYER, LJUPCO SMOKOVSKI / FOTOLIA CONNECTION/HEALTHCARE IT 2012.Q4 3


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