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EHR and Health IT Consulting
Technical Doctor's insights and information collated from various sources on EHR selection, EHR implementation, EMR relevance for providers and decision makers
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Public Health Objectives: Reporting Requirements in Stage 1 and Stage 2

Public Health Objectives: Reporting Requirements in Stage 1 and Stage 2 | EHR and Health IT Consulting | Scoop.it

Public health registry reporting is required for providers participating in the EHR Incentive Programs. Objectives include submitting data to an immunization registry, submitting data to a syndromic surveillance database, and submitting reportable lab results to a public health agency (for hospitals only).

How This Objective Improves Care
The meaningful use public health objectives foster data collection in a format that can be shared across multiple health care organizations. The availability of more and better data will help public health organizations monitor, prevent, and manage diseases to improve population health.

Stage 1 vs Stage 2 Requirements
Stage 1Eligible professionals and eligible hospitals must complete (or qualify for an exclusion for) at least one public health objective in Stage 1 of meaningful use.

Stage 2 – In Stage 2 of meaningful use, some of the Stage 1 public health menu objectives become core objectives, and new public health reporting requirements are added to the menu objectives. Eligible professionals must demonstrate (or qualify for an exclusion for) the capability to submit electronic data for immunizations, while eligible hospitals must demonstrate (or qualify for an exclusion for) the capability to submit electronic data for immunizations, reportable laboratory results, and syndromic surveillance.

Also in Stage 2, new public health menu objectives for eligible professionals include the capability to identify and report cancer cases to a cancer registry and specific cases to a specialized registry (other than a cancer registry).

How to Report Public Health Measures
Following are the steps for reporting in Stage 1 and Stage 2. For additional information on how to report public health measures, please visit the EHR website.

Stage 1
Year 1

  1. Select at least one public health menu objective
  2. Perform test of certified EHR technology’s capacity to submit electronic data, and follow-up submission if that test is successful

Year 2 (and Year 3 if Applicable):

  1. Submit data on an ongoing basis OR
  2. Show evidence of action taken that demonstrates both that another test is not beneficial in moving towards follow-up submission and that follow-up submission is not possible in year 2 (and year 3 if applicable)

Stage 2

  1. Report core public health objectives
  2. Select menu public health objectives (optional)
  3. Meet one of four criteria under the umbrella of ongoing submission


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Stage 2 just too tough? | Healthcare IT News

Stage 2 just too tough? | Healthcare IT News | EHR and Health IT Consulting | Scoop.it

In November, a fresh batch of disheartening Stage 2 attestation numbers prompted several industry groups to once again implore the Centers for Medicare & Medicaid Services for relief.

CMS numbers released Nov. 4 show that fewer than 17 percent of U.S. hospitals have demonstrated Stage 2 capabilities. Even worse, fewer than 38 percent of eligible hospitals and critical access hospitals have met either stage of meaningful use in 2014.

As for eligible professionals, just 2 percent have managed to meet Stage 2 so far, and it seems unlikely that very many more will have reached that threshold by the Feb. 28, 2015, attestation deadline.

Officials from the AMA, CHIME, HIMSS and MGMA said in a joint press release that the numbers are "disappointing, yet predictable," and reiterated their calls for CMS to offer more leniency to help address providers' widespread difficulty in meeting federal electronic health record requirements.

"Providers have struggled mightily in 2014, in many instances for reasons beyond their control," said CHIME CEO Russell Branzell. "If nothing is done to help them get back on track in 2015, we will continue to see growing dissatisfaction with EHRs and disenchantment with meaningful use."

Given the disappointing numbers so far, and the "tremendous number of providers required, but likely unable to fulfill, Stage 2 for a full 365-days in 2015," the stakeholders have asked CMS numerous times for a shortened, 90-day reporting period in 2015.

If CMS continues to hold fast on a full-year of reporting data for 2015, she said, "we anticipate that large segments of providers will no longer be able to participate in the program," said Carla Smith, executive vice president of HIMSS.

It was a common refrain in the second half of 2014, as it became more and more clear just how hard a time hospitals and practices were having complying the stringent measures of Stage 2.


Beyond a shorter reporting period, many have called for more flexibility, especially around problematic measures around electronic transmission of care summaries and patient access,

"CMS must end its one-size-fits all approach to achieve the goals of the meaningful use program, which are to create a secure and interoperable infrastructure," said AMA President Elect Steven J. Stack, MD. "We believe the stringent pass fail requirements for meeting meaningful use, combined with a tsunami of other overlapping regulations, are keeping physicians from participating in the meaningful use program."

At the CHIME 2014 Fall CIO Forum in October, a big topic of concern is is the start of Medicare penalties in 2015 for hospitals failing to meet those meaningful use standards.

As Healthcare IT News contributor Neil Versel reported, CHIME Vice President for Public Policy Jeff Smith said the dearth of hospitals with Stage 2 success was a "troubling" trend – never mind the fact that "hospitals, by comparison, are leagues ahead" of their physician practice counterpart.

Even if thousands more docs were to attest to Stage 2 before the end of the year, he pointed out, the vast majority of more than half a million EPs are at risk of being penalized.

That, said Smith, means many will be calling their representatives in Congress – and about the only thing Congress knows how to do with something like meaningful use is to kill it, Versel wrote.

"I think meaningful use has been to a degree a victim of the federal rule-making process," Smith said. "We're still engaged with CMS to try and figure out a way to make these (attestation) numbers better," said Smith.

CMS has made conciliatory gestures – such as reopening the submission period for meaningful use hardship exception applications (some 44,000 providers applied for exceptions before the initial deadline). But for the most part it has held firm on MU's most contentious measures, so far.

Meanwhile, exasperation has only increased.

"I've never seen this level of frustration in our membership, as I have in the past six to eight months or so," says MGMA Senior Policy Advisor Robert Tennant. "It's not just meaningful use. But that is certainly one of the catalysts."

What that means for the future of a program that initially showed so much progress remains to be seen.

In September, an alphabet soup of industry groups – HIMSS, CHIME, MGMA  AMA, AHA and AAFP co-signed a letter to CMS in which they reiterated their concerns that "the pace and scope of change had outstripped our collective capacity to comply with meaningful use requirements," and warned that continued intransigence on the rules could result in otherwise well-meaning providers "having to drop out of the program."



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