2015-2017- Modified Stage 2- Objectives

Eligible Providers and Eligible Hospitals

There are a total of ten (10) Objectives in the Modified 2015-2017 Stage 2 Program. Below is a description of each objective with exclusions or alternative options following the CMS guidelines[1].

Objective 1- Protect Patient Health Information

Protect electronic health information created or maintained by the CEHRT through the implementation of appropriate technical capabilities.

• Measure: Conduct or review a security risk analysis in accordance with the requirements in 45 CFR 164.308(a)(1), including addressing the security (to include encryption) of ePHI created or maintained by 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 EP, eligible hospital, or CAH's risk management process.

Performed annually, no change from previous Stage 1/Stage 2 requirements.

Alternate Exclusions: None

Objective 2- Clinical Decision Support

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, eligible hospital’s or CAH's scope of practice or patient population, the clinical decision support interventions must be related to high-priority health conditions.

• Measure 2: The EP, eligible hospital, or CAH has enabled and implemented the functionality for drug-drug and drug allergy interaction checks for the entire EHR reporting period.

There is an exclusion as well as an alternate objective and measure for Stage 1 providers in 2015.

Alternate Exclusions: For an EHR reporting period in 2015 only, an EP who is scheduled to participate in Stage 1 in 2015 may satisfy the following in place of measure 1:

• Objective: Implement one clinical decision support rule relevant to specialty or high clinical priority along with the ability to track compliance with that rule.
• Measure: Implement one clinical decision support rule.

Objective 3-Computerized Provider Order Entry (CPOE)

Use 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.

• Measure 1: More than 60 percent of medication orders created by the EP or by authorized providers of the eligible hospital's or CAH's inpatient or emergency department (POS 21 or 23) during the EHR reporting period are recorded using computerized provider order entry.

• Measure 2:More than 30 percent of laboratory orders created by the EP or by authorized providers of the eligible hospital's or CAH's inpatient or emergency department (POS 21 or 23) during the EHR reporting period are recorded using computerized provider order entry.

• Measure 3:More than 30 percent of radiology orders created by the EP or by authorized providers of the eligible hospital's or CAH's inpatient or emergency department (POS 21 or 23) during the EHR reporting period are recorded using computerized provider order entry.

There are exclusions as well as two alternate exclusions for Stage 1 providers scheduled to demonstrate in 2015 and 2016, and an alternate measure for Stage 1 providers in 2015 only.

Alternate Exclusions:

• Alternate Measure 1: For Stage 1 providers in 2015, more than 30 percent of all unique patients with at least one medication in their medication list seen by the EP during the EHR reporting period have at least one medication order entered using CPOE; or more than 30 percent of medication orders created by the EP during the EHR reporting period are recorded using computerized provider order entry.
• Alternate Exclusion for Measure 2: Providers scheduled to be in Stage 1 in 2015 may claim an exclusion for measure 2 (laboratory orders) of the Stage 2 CPOE objective for an EHR reporting period in 2015.
• Alternate Exclusion for Measure 3: Providers scheduled to be in Stage 1 in 2015 may claim an exclusion for measure 3 (radiology orders) of the Stage 2 CPOE objective for an EHR reporting period in 2015.

Objective 4- Electronic Prescribing (eRx)

EP: Generate and transmit permissible prescriptions electronically (eRx) EH: Generate and transmit permissible discharge prescriptions electronically (eRx)

• EP Measure: More than 50 percent of permissible prescriptions written by the EP are queried for a drug formulary and transmitted electronically using CEHRT.

• Eligible Hospital/CAH Measure: More than 10 percent of hospital discharge medication orders for permissible prescriptions (for new and changed prescriptions) are queried for a drug formulary and transmitted electronically using CEHRT.

There are exclusions for EPs and eligible hospitals/CAHs as well as an alternate measure for EPs scheduled to demonstrate Stage 1 in 2015, and an alternate exclusion for eligible hospitals/CAHs scheduled to participate in Stage 1.

Alternate Exclusions:

• Alternate EP Measure: For Stage 1 providers in 2015, more than 40 percent of all permissible prescriptions written by the EP are transmitted electronically using CEHRT.

Objective 5- Health Information Exchange

The EP, eligible hospital, or CAH who transitions their patient to another setting of care or provider of care or refers their patient to another provider of care provides a summary care record for each transition of care or referral.

• Measure: The EP, eligible hospital or CAH that transitions or refers their patient to another setting of care or provider of care must--(1) use CEHRT to create a summary of care record; and (2) electronically transmit such summary to a receiving provider for more than 10 percent of transitions of care and referrals.

There is an exclusion as well as an alternate exclusion for Stage 1 providers in 2015

Alternate Exclusions:

• Alternate Exclusion: Provider may claim an exclusion for the Stage 2 measure that requires the electronic transmission of a summary of care document if for an EHR reporting period in 2015, they were scheduled to demonstrate Stage 1, which does not have an equivalent measure.

Objective 6- Patient Specific Education

Use clinically relevant information from CEHRT to identify patient-specific education resources and provide those resources to the patient.

• EP Measure: Patient-specific education resources identified by CEHRT 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.

• Eligible Hospital/CAH Measure: More than 10 percent of all unique patients admitted to the eligible hospital's or CAH's inpatient or emergency department (POS 21 or 23) are provided patient-specific education resources identified by CEHRT.

There is an exclusion as well as an alternate exclusions for Stage 1 providers.

Alternate Exclusions:

• Alternate Exclusion: Provider may claim an exclusion for the measure of the Stage 2 Patient Specific Education objective if for an EHR reporting period in 2015 they were scheduled to demonstrate Stage 1 but did not intend to select the Stage 1 Patient Specific Education menu objective.

Objective 7-Medication Reconciliation

The EP, eligible hospital, or CAH who receives a patient from another setting of care or provider of care or believes an encounter is relevant performs medication reconciliation.

• Measure: The EP, eligible hospital or CAH performs medication reconciliation for more than 50 percent of transitions of care in which the patient is transitioned into the care of the EP or admitted to the eligible hospital's or CAH's inpatient or emergency department (POS 21 or 23).

There is an exclusion as well as an alternate exclusion for Stage 1 providers in 2015.

Alternate Exclusions:

• Alternate Exclusion: Provider may claim an exclusion for the measure of the Stage 2 Medication Reconciliation objective if for an EHR reporting period in 2015 they were scheduled to demonstrate Stage 1 but did not intend to select the Stage 1 Medication Reconciliation menu objective.