1. Goal: Protect electronic health information
Objective: Added language to security requirements to include administrative and physical safeguards.
Measure: Annual risk analysis or review.1
2. Goal: Electronic Prescribing
Objective: No changes from Stage 2.
Measures: Now more than 25% of hospital discharge medication orders for permissible prescriptions (for new and changed prescriptions) are queried for a drug formulary and transmitted electronically using the EHR.1
3. Goal: Clinical Decision Support
Objective: Implement clinical decision support interventions and improve performance for high priority health conditions.
Measures: As at Stage 2, and 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. If four such measures are not available, then clinical decision support interventions must be related to high priority health conditions. Also, the provider or hospital has enabled and implemented the functionality for drug/drug and drug/allergy interaction checks for the entire EHR reporting period.1
4. Goal: Computerized Provider Order Entry (CPOE)
Objective: Use CPOE for medication, lab, and diagnostic imaging orders, directly entered by any licensed healthcare professional, credentialed medical assistant, or a medical staff member credentialed to and performing the equivalent duties of a credentialed medical assistant, who is allowed by state, local, and professional guidelines to enter such orders into the medical record.
Measures: All three must be met: more than 80% of medication orders by eligible or authorized providers of the inpatient or emergency department are recorded using CPOE; more than 60% of lab orders created by such providers in those departments are recorded using CPOE; and more than 60% of diagnostic imaging orders must meet those same criteria.1
5. Goal: Patient Electronic Access to Health Information
Objective: For Stage 3, there are two policy goals: that patients have timely access to their full health records and important health information, and that the healthcare system engages in patient-centered communication to enhance care planning and coordination.
Measures: For more than 80% of all unique patients seen in inpatient or emergency departments, the patient or his or her representative has access to view online, download, and transmit their health information within 24 hours of its availability to the provider.
Alternatively, the patient or representative is provided access to a certified interface to retrieve that information within the same 24-hour period of its availability. Second, the provider or hospital must use clinically relevant information to identify patient-specific educational resources, and electronic access to those resources to more than 35% of unique patients.1
6. Goal: Coordination of Care through Patient Engagement
Objective: Use communications functions of certified EHR technology to engage with patients or their authorized representatives about the patient’s care — i.e. for secure dialogue between providers, care team members, and/or patients about health status or treatment or care planning. Also, use this as a way to capture and record patient-generated health data and information outside a clinical setting, such as weight or blood pressure taken at home.
Measures: Numerators must be attested for all three measures, but only two need be met for success.
First, more than 25% of unique patients seen as inpatients or in the ED actively engage with the EHR, either viewing it themselves, or downloading or transmitting to a third party. They can also meet this requirement if more than 25% do the same using a certified interface.
Second, more than 35% of unique patients — inpatients or emergency department — receive a secure message, using that function of the EHR.
Third, more than 15% of all patients (discharged by the ED or inpatient department) include self-generated health data, or data from a non-clinical setting in the EHR.
7. Goal: Health Information Exchange (HIE)
Objectives: Provider or hospital provides a summary of care record when transitioning or referring their patient to another setting of care, retrieves a summary of care record upon the first patient encounter with a new patient, and incorporates summary of care information from other providers into their EHR using the functions of certified EHR technology.
Measures: Providers must attest to the numerator and denominator for all three measures, but would only be required to successfully meet the threshold for two of the three proposed measures to meet the Health Information Exchange Objective.
Measure 1: For more than 50% of transitions of care and referrals to another setting of care or provider of care, the provider creates a summary of care record using and EHR and electronically exchanges the summary of care record.
Measure 2: For more than 40% of transitions or referrals received and patient encounters in which the provider has never before encountered the patient, the provider incorporates an electronic summary of care document into the EHR from a source other than the provider’s own EHR system.
Measure 3: For more than 80% of transitions or referrals received and patient encounters in which the provider has never before encountered the patient, there is a clinical information reconciliation for three clinical information sets:
- Medication Review, including the name, dosage, frequency, and route of each medication,
- Medication Allergy, and
- Current Problem List, including current and active diagnoses.1
8. Goal: Public Health and Clinical Data Registry Reporting
Objectives: To be in active engagement with a public health agency or clinical data registry to submit electronic public health data in a meaningful way using certified EHR technology, except where prohibited, and in accordance with applicable law and practice. The emphasis in Stage 3 is on “active engagement” rather than “ongoing submission”.
Measures: Hospitals have to choose from the following six measures, and would be required to attest to any combination of four of them. They are: immunization registry reporting; syndromic surveillance reporting; case reporting; public health registry reporting; clinical data registry reporting; and electronic reportable lab results.
- Department of Health and Human Services. Centers for Medicare & Medicaid Services Medicare and Medicaid Programs; Electronic Health Record Incentive Program -- Stage 3. http://1.usa.gov/1MRdO7l.