SOAPware, Inc. has engaged an ONC-ATCB Certified Organization, and has begun its 2014 Meaningful Use, Stage 2 Certification process. This process is an in-depth and comprehensive process involving product design work and development, as well as extensive support systems development. We expect to achieve our certification in early 2014.

Rather than being focused on just meeting the requirements in fashions that tend to lead to meaningless use, we are taking our time to attempt to achieve meaningful usefulness instead. This often means redesign of workflows so that extra work is not added. This is in contrast to the approach where new MU functions are simply cobbled-on. While that approach allows an EHR to achieve MU certification earlier, it forever adds extra work every day for doctors. Many of the new functions for Stage 2, 2014 edition of meaningful use have already been added to the current releases, and the remainder will be gradually added to the updates that our clients regularly install via our cloud-based updating system. The transition to Stage 2 is thus a gradual transition rather than a sudden, disruptive event.

The table displayed above shows the progression of Meaningful Use stages that an eligible Medicare provider would complete based upon their first year of MU attestation.  Notice that all providers will complete, at minimum, two years of Stage 1 criteria before completing Stage 2 criteria regardless of the year that they first begin attestation.

In a providers first year of participation, they must complete meaningful use requirements for a 90-day EHR reporting period.  In all subsequent years, eligible providers will complete meaningful use requirements for a full calendar year, except in 2014.

In 2014, all eligible providers, regardless of their stage of Meaningful Use, will only be required to demonstrate Meaningful Use for a 3 month reporting period.  Medicare providers will demonstrate Meaningful Use over a 3 month reporting period that is fixed to the calendar year quarter in order to align with existing CMS quality measurement programs.  The 3 month reporting period will not be fixed to the calendar year for Medicaid eligible providers that are only eligible to receive Medicaid EHR incentives.

To meet Stage 2 Meaningful Use criteria, eligible providers must meet 17 core objectives and 3 menu objectives that they select from a total list of 6, or a total of 20 core objectives.

These core and menu set objectives are listed below.  For more information on these measures, please see the CMS Stage 2 Eligible Professional Meaningful Use Core and Menu Measures Table of Contents.

1. CPOE: Use computerized provider order entry (CPOE) for medication, laboratory and radiology orders directly entered by any licensed healthcare professional who can enter orders into the medical record per state, local and professional guidelines. More than 60 percent of medication, 30 percent of laboratory, and 30 percent of radiology orders created by the EP during the EHR reporting period are recorded using CPOE.
2. ePrescribing: Generate and transmit permissible prescriptions electronically (eRx).  More than 50 percent of all permissible prescriptions, or all prescriptions, written by the EP are queried for a drug formulary and transmitted electronically using CEHRT.
3. Record Demographics: Record the following demographics: preferred language, sex, race, ethnicity, date of birth.  More than 80 percent of all unique patients seen by the EP have demographics recorded as structured data.
4. Record Vital Signs: 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.  More than 80 percent of all unique patients seen by the EP have blood pressure (for patients age 3 and over only) and/or height and weight (for all ages) recorded as structured data.
5. Record Smoking Status: Record smoking status for patients 13 years old or older.  More than 80 percent of all unique patients 13 years old or older seen by the EP have smoking status recorded as structured data.
6. Clinical Decision Support Rule: Use clinical decision support to improve performance on high-priority health conditions.  Measure 1: Implement five clinical decision support interventions related to four or more clinical quality measures at a relevant point in patient care for the entire EHR reporting period. Absent four clinical quality measures related to an EP’s scope of practice or patient population, the clinical decision support interventions must be related to high-priority health conditions. Measure 2: The EP has enabled and implemented the functionality for drug-drug and drug-allergy interaction checks for the entire EHR reporting period.
7. Patient Electronic Access: 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.  Measure 1: More than 50 percent of all unique patients seen by the EP during the EHR reporting period are provided timely (available to the patient within 4 business days after the information is available to the EP) online access to their health information.  Measure 2: More than 5 percent of all unique patients seen by the EP during the EHR reporting period (or their authorized representatives) view, download, or transmit to a third party their health information.
8. Clinical Summaries: Provide clinical summaries for patients for each office visit.  Clinical summaries provided to patients or patient-authorized representatives within one business day for more than 50 percent of office visits.
9. Protect Electronic Health Information: Protect electronic health information created or maintained by the Certified EHR Technology through the implementation of appropriate technical capabilities.  Conduct or review a security risk analysis in accordance with the requirements under 45 CFR 164.308(a) (1), including addressing the encryption/security of data stored in CEHRT in accordance with requirements under 45 CFR 164.312 (a)(2)(iv) and 45 CFR 164.306(d)(3), and implement security updates as necessary and correct identified security deficiencies as part of the provider's risk management process for EPs.
10. Clinical Lab-Test Results: Incorporate clinical lab-test results into Certified EHR Technology as structured data.  More than 55 percent of all clinical lab tests results ordered by the EP during the EHR reporting period whose results are either in a positive/negative or numerical format are incorporated in Certified EHR Technology as structured data.
11. Patient Lists: Generate lists of patients by specific conditions to use for quality improvement, reduction of disparities, research, or outreach.  Generate at least one report listing patients of the EP with a specific condition.
12. Preventive Care: 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.  More than 10 percent of all unique patients who have had 2 or more office visits with the EP within the 24 months before the beginning of the EHR reporting period were sent a reminder, per patient preference when available.
13. Patient-Specific Education Resources: Use clinically relevant information from Certified EHR Technology to identify patient-specific education resources and provide those resources to the patient.  Patient-specific education resources identified by Certified EHR Technology are provided to patients for more than 10 percent of all unique patients with office visits seen by the EP during the EHR reporting period.
14. Medication Reconciliation: 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.  The EP who performs medication reconciliation for more than 50 percent of transitions of care in which the patient is transitioned into the care of the EP.
15. Summary of Care: 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.  Measure 1: The EP who transitions or refers their patient to another setting of care or provider of care provides a summary of care record for more than 50 percent of transitions of care and referrals.  Measure 2: The EP who transitions or refers their patient to another setting of care or provider of care provides a summary of care record for more than 10 percent of such transitions and referrals either (a) electronically transmitted using CEHRT to a recipient or (b) where the recipient receives the summary of care record via exchange facilitated by an organization that is a NwHIN Exchange participant or in a manner that is consistent with the governance mechanism ONC establishes for the NwHIN.  Measure 3: An EP must satisfy one of the following criteria: (1) Conducts one or more successful electronic exchanges of a summary of care document, as part of which is counted in "measure 2" (for EPs the measure at §495.6(j)(14)(ii)(B) with a recipient who has EHR technology that was developed designed by a different EHR technology developer than the sender's EHR technology certified to 45 CFR 170.314(b)(2). (2) Conducts one or more successful tests with the CMS designated test EHR during the EHR reporting period.
16. Immunization Registries Data Submission: Capability to submit electronic data to immunization registries or immunization information systems except where prohibited, and in accordance with applicable law and practice.  Any EP that meets one or more of the following criteria may be excluded from this objective: (1) the EP does not administer any of the immunizations to any of the populations for which data is collected by their jurisdiction's immunization registry or immunization information system during the EHR reporting period; (2) the EP operates in a jurisdiction for which no immunization registry or immunization information system is capable of accepting the specific standards required for CEHRT at the start of their EHR reporting period; (3) the EP operates in a jurisdiction where no immunization registry or immunization information system provides information timely on capability to receive immunization data; or (4) the EP operates in a jurisdiction for which no immunization registry or immunization information system that is capable of accepting the specific standards required by CEHRT at the start of their EHR reporting period can enroll additional EPs.
17. Use Secure Electronic Messaging: Use secure electronic messaging to communicate with patients on relevant health information.  A secure message was sent using the electronic messaging function of CEHRT by more than 5 percent of unique patients (or their authorized representatives) seen by the EP during the EHR reporting period.

1. Syndromic Surveillance Data Submission: Capability to submit electronic syndromic surveillance data to public health agencies except where prohibited, and in accordance with applicable law and practice. Successful ongoing submission of electronic syndromic surveillance data from CEHRT to a public health agency for the entire EHR reporting period.
2. Electronic Notes: Record electronic notes in patient records. Enter at least one electronic progress note created, edited and signed by an EP for more than 30 percent of unique patients with at least one office visit during the EHR Measure reporting period. The text of the electronic note must be text searchable and may contain drawings and other content
3. Imaging Results: Imaging results consisting of the image itself and any explanation or other accompanying information are accessible through CEHRT. More than 10 percent of all tests whose result is one or more images ordered by the EP during the EHR reporting period are accessible through CEHRT
4. Family Health History: Record patient family health history as structured data. More than 20 percent of all unique patients seen by the EP during the EHR reporting period have a structured data entry for one or more first-degree relatives.
5. Report Cancer Cases: Capability to identify and report cancer cases to a public health central cancer registry, except where prohibited, and in accordance with applicable law and practice.  Successful ongoing submission of cancer case information from CEHRT to a public health central cancer registry for the entire EHR reporting period.
6. Report Specific Cases: Capability to identify and report specific cases to a specialized registry (other than a cancer registry), except where prohibited, and in accordance with applicable law and practice. Successful ongoing submission of specific case information from CEHRT to a specialized registry for the entire EHR reporting period.

For providers who are currently completing Meaningful Use Stage 1 requirements, no additional preparation is needed at this time for Stage 2.   Workflow for these measures and the calculations within SOAPware are currently in the development phase.  Please watch the SOAPware website for future information on release dates, certification and training documentation.  We advise continuing with Stage 1 2011/2012/2013 requirements at this time.

For more information on Meaningful Use Stage 2, please visit CMS.gov.