On Nov. 16, 2012, the Office of the National Coordinator for Health Information Technology (ONC) released a request for comment regarding Stage 3 meaningful use measures, taking a step forward in the ongoing effort to define “meaningful use” of electronic health records (EHR) for purposes of Medicare and Medicaid incentive programs. The public is being asked to opine on the readiness and feasibility of new objectives and measures in three areas: (1) meaningful use; (2) quality; and (3) privacy and security.

The comment period ends at 11:59 p.m. Eastern time on Jan. 14, 2013, after which the ONC intends to hold additional public meetings in the first quarter of 2013. It is important to note that while meaningful use is described as an incentive program, providers who are not meaningful users by 2014 are currently scheduled to undergo “adjustments” decreasing Medicare Part B professional fees by 1 percent in 2015, 2 percent in 2016, and 3 percent in 2017, with further potential decreases beyond 2017. Accordingly, the requirements of Stage 3 likely will impact all Medicare health care providers at some later date.

Meaningful use objectives and measures

The measures subject to comment are provided in a grid format that compares the Stage 2 Final Rule with Stage 3 recommendations, and in some cases includes measures proposed for future stages. Notable new or revised meaningful use objectives and measures for Stage 3 include:

  • Using computerized provider order entry (CPOE) for referrals/transition of care orders directly entered by qualified licensed healthcare professionals (Stage 2 required CPOE only for medication, laboratory and radiology orders);
  • Implementing 15 clinical decision support interventions or guidance related to five or more clinical quality measures that are presented at a relevant point in patient care for the entire EHR reporting period (an increase from the five required in Stage 2); and
  • Providing patients the ability to submit patient-generated health information and request an amendment to their health record online (an online means for requesting amendments new for Stage 3).

In addition, some meaningful use objectives and measures are facing retirement, including:

  • Recording patient demographics;
  • Recording and charting changes in vital signs; and
  • Recording smoking status for patients 13 years old and older.

Quality measures

The comment period also affords stakeholders the opportunity to comment on the appropriateness of the fundamental mission and five key attributes for Stage 3 clinical quality measures (CQM):

Promoting the capabilities of EHRs to capture relevant data and calculate report measures efficiently to improve quality of care by:

  • Leveraging data routinely captured during the process of care;
  • Addressing measures for public reporting and quality improvement meaningful at the point of care;
  • Avoiding “hard coding” measures into the EHR;
  • Shifting quality measurement and reporting from human chart reviews to machine-automated;
  • Building flexibility into the system to account for new or revised measures.

The ONC requested feedback on how expansion of the features of the CQM set could be done in ways to minimize the health care costs and burdens on health care providers.

Privacy and security

Questions open for comment regarding privacy and security focus on multi-factor provider authentication for provider users remotely accessing protected health information, security risk issues (if any) that should be subject to meaningful use attestation in Stage 3, and standards for accounting of disclosures.

Providing comments

A copy of the request for comments is available here. Comments are due by the end of Jan. 14, 2013.