number in spotlightLast week CMS released a notice of proposed rulemaking (NPRM) for Stage 3 Meaningful Use.

According to CMS, the proposed requirements aims to: establish a single reporting period for all providers based on the calendar year; align quality data for reporting via a single submission method for multiple CMS programs; simplify MU reporting requirements to eight objectives that focus on advanced use of EHR technology and quality improvement.

These 8 objectives include:

1. Protect patient health information
Stage 3 adds language to the security requirements for the implementation of technical, administrative and physical safeguards for patient information.

2. Electronic prescribing
For EPs, 80% of all permissible prescriptions must be queried for a drug formulary and transmitted electronically. For EHs, 25% of hospital discharge medication orders for permissible prescriptions must be queried for a drug formulary and transmitted electronically.

3. Clinical decision support
Must implement 5 CDS interventions related to 4 or more clinical quality measurements and must implement technology for drug interaction and drug-allergy interaction for the entire reporting period.

4. Computerized physician order entries
80% of medication orders must be recorded in a CPOE and more than 60% of lab orders and diagnostic imaging orders must be created using a CPOE.

5. Patient access
More than 80% of all unique patients should be provided access to view, download or transmit health information within 24 hours of availability or access to an online ONC-certified API. EPs and EHs must use clinically relevant information from the EHR to identify patient-specific educational resources and provide access to those materials to more than 35% of patients. For Stage 3, the provider is only required to provide access; the patient is not required to take action for the provider to meet the objective’s goals.

6. Coordination of care through patient engagement
More than 25% of all unique patients must actively engage with the EHR by viewing, downloading, or transmitting their info through a portal or an ONC-certified API. A secure message must be sent to 35% of patients. Patient-generated data or data from a non-clinical setting must be incorporated into the EHR for more than 15% of all unique patients.

7. Exchange of health information
More than 50% of transitions of care and referrals must create a summary of care record using an EHR and exchange the record.  Summary of care documents for more than 40% of transitions or referrals received and new patient encounters must be incorporated into the EHR. For more than 80% of new patient encounters, the EP or EH must implement clinical information reconciliation for medication, medication allergy and a current problem list.

8. Public health and clinical data registry reporting
Stage 3 removes the “ongoing submission” requirement from stage 2 and replace it with “active engagement.” Active engagement can be met in one of three ways: by completing registration to submit data within 60 days after the start of the reporting period, by being in the process of testing and validating the electronic submission of data, or by submitting data to the public health agency or clinical data registry.

EPs or EHs must contribute to 3 of the following 6 measures: immunization registry reporting, syndromic surveillance reporting, case reporting, public health registry reporting, clinical data registry reporting and electronic reportable lab result reporting.

Stage 3 proposed rule is available here.
Additional EHR Incentive Program information is available here.