Meaningful Use of EHRs Stage 2: What to Expect in the Proposed Rules

There will be many blogs and news reports, on Health Affairs Blog and elsewhere, about the very-soon-to-be-released Stage 2 proposed rules on the Meaningful Use of electronic health records (EHRs). This report is more impressionistic. The message of the proposed rules, delivered to a packed house yesterday at the HIMSS conference in a pre-release presentation by the Office of the National Coordinator for Health Information Technology and the Centers for Medicare and Medicaid Services, is Interoperability. Safety. Patient engagement. Incremental advancement that will still be a stretch. A request for robust comments, the good and the bad.

The presentation by ONC and CMS was mostly directional, although there were some specifics. More to come when the Rules are released. There were congratulations to healthcare providers and health IT vendors for their success to date with Stage 1. The Stage 2 Rules build on Stage 1. To quote the health IT national coordinator Farzad Mostashari: “Continuing what’s in Stage 1 and getting better at it.”

There will be a heightened emphasis on interoperability, actual exchange, and clarity of standards (standard = 1 choice, for example, problem lists coded in SNOMED, medications in RxNorm, care summaries in Consolidated CDA). While Stage 1 focused on use within a setting, Stage 2 looks to connect settings. Public health reporting will also expand and professional society disease registries will be included. Direct will join CONNECT as a required communication protocol. In this case, two options...