HIPAA Regulatory Alert: Meaningful use Stage 2 final rule released

Patient portals, behavior changes top list of challenges

An extra year to prepare to meet meaningful use requirements was welcome news with the release of the 2012 final rule for the Centers for Medicare and Medicaid Services (CMS) Electronic Health Record Incentive Program (meaningful use). Eligible hospital participants will report and attest to Stage 2 meaningful use criteria in FY2014, and eligible providers will report in calendar year 2014.

The additional year will give vendors time to develop certified electronic health records (EHRs) and give providers time to implement new software to meet the challenges of Stage 2. However, it's important that providers look beyond just meeting a list of requirements, says Shane Pilcher, FHIMSS, vice president of Stoltenberg Consulting, a healthcare information technology consulting firm in Bethel Park, PA.

"The purpose of Stage 2 meaningful use requirements is to stretch our capabilities," Pilcher says.

To effectively meet meaningful use requirements in a sustainable manner, organizations need to go beyond "checking boxes on a to-do list," he adds. "You need to see that you are working toward coordinated care."

The extra year to prepare to report will give organizations that started early an advantage as they have more time to fine-tune their applications and train staff. CMS is requiring participants only to report and attest to 90 days of meaningful use in 2014, which should allow time to upgrade and implement 2014 Certified EHR Technology. However, organizations that have not yet begun to prepare can't look at the extra year as more time to put off implementation of plans, says Pilcher. "If you are waiting, you are already behind schedule," he says.

Some of the changes between Stage 1 and Stage 2 are simple increases in the percentages of records required for compliance. For example, Stage 1 required 50% of patients admitted have demographic information collected as structured data, and Stage 2 requires 80%. (See resource box at the end of the article for comparison charts and tip sheets from CMS.) There are, however, some changes that will present challenges, says Susan H. Patton, a healthcare attorney at Butzel Long in Ann Arbor, MI.

Patient portals and access to information

"Stage 2 requires hospitals to provide patients with a portal to view online, download, and transmit information about their hospitals admissions within 36 hours of discharge," Patton points out.

"This runs contrary to hospital systems and culture that are accustomed to locking down patient information." Changing the mindset created by the Health Insurance Portability and Accountability Act (HIPAA) and Health Information Technology for Economic and Clinical Health Act (HITECH) regulations will be a huge cultural challenge, she says.

In addition to the technical challenge to create a user-friendly, intuitive system that patients can use, hospitals also have to address the clinician component, says Pilcher. "This is more than an information technology issue," he says. "We have to make sure clinicians complete documentation in a timely manner so the information is there for patients to access."

There are also clinical ramifications to providing access to information in a short timeframe, he adds. Clinicians need to pay attention to diagnostic or lab results that should be discussed with the patient to ensure proper interpretation of the results' meaning.

Staff and physician training should include a reminder for clinicians to invite patients to use the portal and to access their information, points out Patton. Stage 2 requires that 5% of patients actually access, view, or transmit information through the portal. This number is a reduction in the 10% that appeared in the proposed rule, but it will be a challenge to change patient behavior, Patton says.

"Hospitals need to take portal development very seriously, make it easy to use, and build in incentives for patients to access information," she says.

Lack of broadband networks

"Some rural and critical access hospitals will not be able to meet Stage 2 requirements," says Patton. "The Federal Communications Commission is in the process of creating broadband access to all areas of the United States, including rural areas. This is happening slowly, and many hospitals, patients, and healthcare professionals cannot make Stage 2 happen for lack of infrastructure."

Even rural or small hospitals in areas with broadband access will have trouble complying with Stage 2, says Patton.

"Compliance will be expensive, time-consuming, and require highly specialized information technology expertise," she says.

Hospitals that lack these resources can "buddy up" with other hospitals that can provide the support, Patton suggests. "This can be done through mergers and acquisitions, or through structural or contractual joint ventures, or vendor service contracts," she says.

If you are using vendors to bring the hospital into compliance with meaningful use requirements, be sure you plan long-term to sustain the program, Pilcher suggests. "Overseeing implementation is a full-time job for a large hospital or health system, and it will last three to four years," he says. Smaller hospitals that are relying upon vendors or consultants for implementation can use a combination of outside sources and staff to be sure employees gain the expertise needed to continue the program throughout the years.

A key to successful implementation of a meaningful use program is the buy-in of all employees, Pilcher says. "Don't position meaningful use as an information technology project," he says. Include clinicians as you evaluate tools and develop policies. "This is an organization-wide project that will improve patient care," he says.

Another important thing to keep in mind is that compliance with meaningful use requirements is a long-term strategy, not just a matter of completing specific tasks, says Pilcher.

"Don't stop at the requirements, look at them as a starting point," he suggests. "Meaningful use is not a sprint — it is a marathon."


The Centers for Medicare and Medicaid Services provides comparison charts and tip sheets on the differences between Stage 1 and Stage 2 of meaningful use. To view and download the free documents, go to www.cms.gov. Select "Regulations and Guidance" from the top navigational bar, then under "Legislation," select "EHR Incentive Programs." On the left side of the page, choose "Stage 2." A list of documents as well as detailed timelines is displayed.

For more information about Stage 2 Meaningful Use, contact:

• Susan H. Patton, Attorney, Butzel Long, 301 E. Liberty St., Suite 500, Ann Arbor, MI 48104. Telephone: (734) 213-3432. Fax: (734) 995-1777. Email: patton@butzel.com.

• Shane Pilcher, FHIMSS, Vice President, Stoltenberg Consulting, 5815 Library Road, Bethel Park, PA 15102. Telephone: (412) 854-5688. Fax: (412) 854-5788. Email: spilcher@stoltenberg.com.