Stage 2 of Meaningful Use began January 1, 2014, three years after the program launched. Some Stage 1 objectives no longer apply to Stage 2, while others are combined or consolidated. More importantly, Stage 2 introduces several new objectives. For Stage 1, eligible professionals (EPs) are required to meet 13 core objectives and five of nine menu objectives, 18 total. For Stage 2, EPs are required to meet 17 core objectives and three of six menu objectives, 20 total.
Differences between Stage 1 and Stage 2 are many. Those considered most significant are described in our eBook, 9 Ways Meaningful Use Stage 2 Differs from Stage 1.
Three key differences that impact EPs advancing from Stage 1 to Stage 2 are: (1) thresholds that apply to various measures, (2) level and mode of communication with patients, and (3) exchange of health information with other providers, as follows:
1. Threshold Percentages
Many Stage 2 objectives are essentially the same as Stage 1, but require higher threshold percentages. For example, in Stage 1, EPs must use computerized physician order entry (CPOE) to either:
- Place medication orders for more than 30% of patients who have at least one medication, or
- Place more than 30% of all medication orders
In Stage 2, (b) is the only option, and the threshold is 60%. A few other examples:
|Objective||Stage 1 Threshold||Stage 2 Threshold|
|Incorporate lab results as structured data||>40%||>55%|
|Record smoking status for age ≥13||>50%||>80%|
|Record vital signs||>50%||>80%|
|Use eRx for permissible prescriptions||>40%||>50%|
2. Patient Communication
Communication with patients is a driving force behind Stage 2 and all stages beyond, which is why a new objective for secure messaging was created.
To comply with Stage 2, EPs must use the secure messaging feature of certified EHR technology to communicate with more than 5% of patients. This fairly low threshold allows EPs to ease into a communication protocol that may not be familiar or immediately comfortable.
3. Health Information Exchange
For Stage 1, EPs must provide a summary of care record for more than 50% of referrals and transitions. This objective (same threshold) carries over to Stage 2, with additional caveats. For Stage 2, EPs must also provide a summary of care record electronically for more than 10% of referrals and transitions. They have the choice of two delivery methods:
- Certified EHR technology, or
- The eHealth Exchange (formerly NwHIM Exchange) or other manner consistent with the eHealth Exchange governance mechanism established by ONC
EPs must also satisfy one of the following criteria:
- Exchange at least one summary of care record with a recipient that uses a different certified EHR technology, or
- Conduct at least one successful test exchange with the CMS-designated test EHR during the Meaningful Use reporting period