HHS Issues Final Rule on Stage 2 of 'Meaningful-Use' Guidelines

The Obama administration's final rule on stage 2 of "meaningful use" calls for batch reporting, data encryption and interoperability of data standards.

The U.S. Department of Health and Human Services has issued a final rule on Stage 2 of the meaningful-use incentive program for electronic health records.

Announced Aug. 23, the final rule calls for a delay of the deadline for implementation of Stage 2 to 2014. The 2009 American Recovery and Reinvestment Act (ARRA) set 2013 as the original deadline for attesting to Stage 2 guidelines.

"The changes we're announcing today will lead to more coordination of patient care, reduced medical errors, elimination of duplicate screenings and tests, and greater patient engagement in their own care," Health and Human Services Secretary Kathleen Sebelius said in a statement.

"Certified EHR technology used in a meaningful way is one piece of a broader health information technology infrastructure needed to reform the health care system and improve health care quality, efficiency and patient safety," the Centers for Medicare & Medicaid Services (CMS) stated in a fact sheet on Stage 2.

More than 120,000 health care professionals and at least 3,300 hospitals have qualified to receive meaningful-use incentives since the start of the program in January 2011, according to HHS. More than one in five of eligible health care professionals have qualified since that time.

In Stage 2, HHS encourages vendors to write features into EHR applications that enable secure, standardized data exchange. Data from lab results and medication lists need to be in a standard format for the records to be shared in health information exchanges.

"The big message here is the push on standards-based exchange and interoperability," Dr. Farzad Mostashari, the national coordinator for health information technology, told reporters on Aug. 23, according to SearchHealthIT.com.

"Stage 2 is being presented as a shift toward more patient access to their data and more robust and interoperable exchange of information," Patricia Wise, vice president of health care information systems, at the Health Information Management and Systems Society (HIMSS), told eWEEK in an email. HIMSS is a nonprofit organization focused on encouraging use of technology and management systems in health care.

In Stage 1, HHS set the basic functions of an EHR, including saving data electronically and awarding electronic copies to patients.

Stage 2 calls for increased health information exchange between providers as well as a 90-day reporting period to ease a tight timeframe for software companies and providers to implement the new code.

"Due to the tight time frame and implementation challenges for vendors and providers for Stage 2, HIMSS, along with several other organizations, advocated for a 90-day reporting period for Stage 2 in 2014," said Wise.

The final Stage 2 rule streamlined the process of certifying EHR products, according to HIMSS. In Stage 3, HHS will expand the meaningful-use objectives to improve patient outcomes.

The Stage 2 rule will be published by the Federal Register on Sept. 4. CMS initially announced the Stage 2 rules at the HIMSS conference on Feb. 23 in Las Vegas. A six-month comment period followed.

In a change from February's proposed Stage 2 rules, doctors need only provide access to online messages and secure messaging for 5 percent of patients rather than 10 percent. Doctors are required to enter medication orders electronically for 60 percent of patients.

The rule also outlines guidelines on encryption of data from EHRs. When doctors finish accessing an EHR, they must encrypt all temp files, cookies or other types of data caches.

As noted in the February proposal, providers must encrypt HIPAA data at rest to properly secure health care information under Stage 2.

Stage 2 also outlines rules on batch reporting, in which doctors submit data for individual doctors in one file instead of individual files.