EHR Incentive Programs - Meaningful Use Stages 1 and 2

EHRs are digital databases of patient health information transferable across clinical settings. This allows for improved care coordination and reduced overutilization. In addition, the structured format affords providers a more complete and systematic understanding of patient medical histories. Certified EHRs are systems specifically approved for the EHR Incentive Programs in accordance with guidelines by CMS and the Office of the National Coordinator for Health Information Technology (ONC).

There are three stages to continued participation in the EHR Incentive Programs. In general, each stage lasts for 2 years with the exception of the first stage. Subsequent stages have additional requirements approaching the envisioned end goals of EHR usage. CMS establishes objectives necessary to satisfy the meaningful use condition at each stage. Requirements and objectives for the first two stages will be discussed below. Information on Stage 3 and beyond is still in development.

Meaningful Use Stage 1

Meaningful use objectives are categorized as either core (required) or menu (elective). During Stage 1 eligible medical professionals must satisfy 15 core and 5 (out of 10) menu objectives. Additionally, providers must report on 6 clinical quality measures: 3 required and 3 (out of 38) selected measures. Requirements for participating hospitals and institutions vary slightly. Each objective is defined by a corresponding Meaningful Use Specification Sheet, which clarifies requirements for attestation and offers guidance for calculations. Stage 1 requirements must be met for a 90-day period in the first year of participation and a full calendar year in the second. Participants from the 2011 pilot study will abide by Stage 1 standards until 2014. No physician or hospital will advance to Stage 2 before then.

Meaningful Use Stage 2

Under Stage 2 criteria providers must continue to meet 20 objectives. However, 17 are core objectives and 3 are electives selected from a set of 6. There clearly is a gradual shift toward greater regulation. Based on evaluation efforts, CMS refined requirements to be most indicative of meaningful use. Some
Stage 1 objectives were reworded, combined or eliminated. Several new ones were also introduced.

Eligible professionals must satisfy one new core objective: "Use secure electronic messaging to communicate with patients on relevant health information." In addition, physicians must implement systems which allow patients to access and transmit their health information online. Patients, in turn, must exercise these abilities for the physician to achieve meaningful use. During the reporting period, 5% of patients must send a message via the communication system. Whether these requirements will be practical and welcomed by patients or prove too onerous is yet to be seen.

While the stages provide a simple timeline to follow, a couple exceptions should be noted: From 2014 onward physicians will report on 9 (out of 64) clinical quality measures regardless of their meaningful use stage. They must select these from at least 3 (out of 6) domains, such as patient safety and care coordination. Quality is deemed more important than precedence. As healthcare moves forward, all physicians will be accountable for the same standards. Secondly, providers will only need to demonstrate meaningful use for a 90-day period in 2014. CMS made this exception to allow physicians and hospitals enough time to upgrade to certified EHR technology, if necessary.


The Medicare and Medicaid EHR Incentive Programs hasten a new age in healthcare. Although there are exhaustive regulations and multiple timelines, the process is manageable. Let Transition Consultants be your guide in navigating healthcare reform. Rely on our expertise and we will assist you in realizing your vision. Call us today at 800-416-2055 for a complimentary consultation.

Christopher K. Lee is a valuation analyst and healthcare business strategist with Transition Consultants. He works on healthcare business appraisal and hospital integration projects, nationwide, and is a frequent contributor on editorial topics including healthcare reform.

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