Stage 2 Certified EHR Systems: Your Guide to Meaningful Use

Lost in a sea of stage 2 criteria? Let us shine a light on core objectives and measures.

What does it take to achieve meaningful use stage 2? Successfully implementing certified EHR systems hinges on understanding requirements and proactively addressing challenges. 

This guide clarifies core stage 2 criteria for hospitals and practices spanning CPOE, clinical decision support, care coordination, patient access, and more. 

Learn how stringent certification and standards testing enable interoperability and health data exchange. Discover leading practices for EHR optimization, change management, and leveraging new functionality for improved outcomes

What Are Stage 2 Certified EHR Systems?

Stage 2 certified EHR systems are technology solutions officially tested and certified to meet expanded criteria enabling healthcare providers to achieve the second stage of “meaningful use” under Medicare and Medicaid EHR incentive programs

Unlike stage 1 which focused on basic EHR capabilities, stage 2 represents a major expansion in certified Health IT functionality around care coordination, patient engagement, and health information exchange between unaffiliated providers and organizations.

Core Objectives and Capabilities

Stage 2 sets new and expanded core objectives addressing advanced clinical processes like:

• Computerized provider order entry (CPOE) for medications, laboratory tests, and radiology orders
• Incorporating lab results as structured data in the EHR
• Providing patient access to view, download, and transmit their health records
• It also establishes more stringent thresholds for measures carried over from stage 1 meaningful use.

New Menu Set Objectives

In addition, stage 2 introduces new optional objectives such as:

• Submission of electronic syndromic surveillance data to public health agencies
• Recording electronic notes and incorporating lab test results
• Sharing care plan information across transitions of care

Rigorous Certification Requirements

Stage 2 also brings more rigorous testing and certification requirements for EHR systems related to:

• Standards-based interoperability between disparate systems
• Secure, reliable health information exchange capabilities

Obtaining Proper Stage 2 Certification

For EHR technology to qualify as “stage 2 certified,” it must be certified by an ONC-Authorized Certification Body to the 2014 Edition or 2015 Edition certification criteria, or a combination of both.

Eligible providers must validate an EHR system has the proper stage 2 certification before purchasing and implementing it for participation in the EHR Incentive Programs.

Calysta EMR optimizes stage 2 success. See how intuitive EHR improves care coordination.

What Is the Medicaid EHR Incentive Program Stage 2?

According to our experience, the Medicaid EHR Incentive Program provides financial incentives to eligible professionals and hospitals for adopting, implementing, upgrading, and meaningfully using certified electronic health records technology. This program has progressed through several key stages:

• Stage 1 (2011-2012) focused on foundational EHR adoption and data capture.
• Stage 2 (2014-2016) built upon Stage 1 by emphasizing advanced clinical processes such as health information exchange between unaffiliated providers, patient engagement via online portal access, and improved coordination of care supported by EHRs.

Key requirements for eligible professionals included meeting 17 core objectives, 3 out of 6 menu objectives, and reporting on clinical quality measures.

The 2017 Modified Stage 2 iteration relaxed certain Stage 2 requirements while still prioritizing interoperability and health data exchange.

• Stage 3 was proposed for 2018 and beyond to further enhance outcomes through superior patient access, experience, and population health management capabilities. However, the Medicaid EHR Incentive Program ended in 2021 and transitioned to the Merit-based Incentive Payment System Promoting Interoperability performance category.

What Is the EHR Stage 2 Payment Schedule?

The EHR stage 2 payment schedule involves Medicare EPs getting incentives 2011-2016 up to $44,000 over 5 years, Medicaid EPs through 2021 up to 6 years, payments declining annually, and Medicare payment adjustments starting 2015 for non-participation.

Medicare EPs

• Incentive payments started in 2011 and continue through 2016, for up to 5 years of continuous participation
• The last year to begin participation and qualify for incentives is 2014
• Payment amounts decline each year of participation
• For example, Medicare EPs starting Stage 2 in 2011 were eligible for up to $44,000 total through 2016

Medicaid EPs

• Incentive payments extend through 2021, for up to 6 years of participation
• Payment amounts decrease each year

Payment Adjustments

• Payment adjustments for non-participation began in 2015 for Medicare EPs and eligible hospitals
• These adjustments reduce Medicare reimbursements for providers not meeting Stage 2
• Adjustments do not apply to Medicaid providers or critical access hospitals
• Hardship exceptions are available in limited cases to avoid payment adjustments for providers facing difficulties implementing certified EHR systems

What Are the Criteria for Stage 2 EHR Meaningful Use?

The criteria for stage 2 meaningful use involves meeting core objectives for CPOE, clinical decision support, care coordination, patient messaging, and public health reporting, using certified EHR technology, reporting periods, quality measures, and increased thresholds versus stage 1.

Core Objectives

• Use computerized provider order entry (CPOE) for 60% or more of medication orders, 30% or more of laboratory orders, and 30% or more of radiology orders
• Implement 5 or more clinical decision-support interventions related to 4 or more clinical quality measures
• Create and transmit an electronic summary of care records for 10% or more of transitions of care and referrals
• Enable secure messaging between patients and providers
• Meet 1 public health objective (immunization reporting, syndromic surveillance, reportable lab results, etc.)

Additional Requirements

• Use EHR technology certified specifically for stage 2
• 90+ day reporting period for first-time participants, full year for subsequent years
• Report on clinical quality measures
• Increased thresholds versus stage 1 for objectives like e-prescribing and providing patients with electronic copies of their health information

How to Evaluate Stage 2 EHR Meaningful Use Compliance?

Evaluating stage 2 EHR meaningful use compliance involves understanding the requirements, ensuring certified EHR technology is implemented, reviewing objectives and measures, collecting documentation, and understanding the audit process for validation.

1. Understand the Requirements

Stage 2 focuses on using EHRs to improve quality of care, care coordination, patient engagement, and health information access/exchange

• Eligible professionals must meet 17 core objectives, 3 menu objectives out of 6, and report on clinical quality measures
• Eligible hospitals must meet 16 core objectives and 3 menu objectives out of 6

2. Ensure Certified EHR Technology is Implemented

EHR systems must have ONC certification for the 2014 edition to comply with stage 2 requirements

3. Review Objectives and Measures

• Core objectives have specific percentage-based thresholds that must be met
• Other objectives require yes/no attestation along with supporting documentation
• Clinical quality measures also have percentage-based thresholds

4. Collect and Retain Documentation

Documentation like screenshots, reports, and patient records should be kept for 6 years post-attestation to support attestation

5. Understand the Audit Process

• Audits ensure program integrity and validate attestation data
• Both pre-payment and post-payment audits may be conducted
• On-site audits can include reviewing EHR system functionality

What Does Stage II Certification Mean for EHR Systems?

Stage 2 certification for EHR systems refers to meeting criteria for capabilities like CPOE, clinical decision support, patient engagement, and interoperability to support achieving meaningful use stage 2 requirements under Medicare/Medicaid incentive programs.

EHR systems must demonstrate specific functionalities and capabilities related to computerized provider order entry, e-prescribing, clinical decision support, health information exchange, patient engagement portals, and other advanced areas. 

The Office of the National Coordinator for Health IT (ONC) establishes certification criteria.

• The certification aims to validate that EHR systems can technically support providers in meeting the various stage 2 meaningful use objectives and associated measures. So certification is tied directly to meaningful use requirements.
• EHR systems must be tested and certified by an ONC-Authorized Certification Body against the 2014 Edition certification criteria in order to qualify as stage 2 certified.
• Both complete EHR systems as well as individual modules can obtain certification, providing more flexibility.
• Stage 2 also emphasizes standards testing and interoperability to enable secure health data exchange between different certified EHR systems.

Stage 2 Certified EHR Systems for Specific Medical Specialties

Stage 2 certified EHR systems for specific medical specialties include cardiology systems optimized for workflows and data needs, oncology systems with coordination and e-rx features, behavioral health systems meeting meaningful use, and pediatric systems with growth charts and vaccine management.

1. Cardiology

Objective Medical Systems offers a cardiology-specific EHR and cardiovascular information system certified for stage 2. It is optimized for cardiology workflows and data needs like structured templates for history and physical exams, consult notes, specialty dashboards, and registries.

2. Oncology

CureMD has an oncology-focused EHR certified for stage 2 meaningful use. It includes features like care coordination, e-prescribing, appointments, and prescription fulfillment tailored to oncology care.

3. Behavioral Health

ICANotes meets stage 2-related behavioral health EHR certification criteria. It has functionality to support meeting meaningful use measures for eligible providers.

4. Pediatrics

Office Practicum's pediatric-focused EHR is certified for industry regulations including stage 2 meaningful use. Features cater to pediatric needs like growth charts, developmental milestones, vaccine management, and Bright Futures integration.

Major EHR vendors like eClinicalWorks, athenahealth, NextGen, and AdvancedMD also offer systems certified for stage 2 that can be customized for different specialties.

Later stage criteria like stage 3 further focus on optimizing interoperability, patient engagement, and improving outcomes.

Stage 2 Certified EHR Systems for Specific Care Settings

Stage 2 certified EHR systems for care settings include hospital systems for care coordination and public health reporting, physician practice systems to engage patients and improve outcomes, and behavioral health systems designed specifically for behavioral health needs rather than general physician systems.

1. Long-Term Care Facilities

Long-term care facilities would benefit from EHRs with functionality for care transitions, coordination, patient engagement, and public health reporting. This aligns with stage 2 hospital certification criteria.

2. Hospitals

Stage 2 hospital criteria include transmitting a summary of care records electronically for over 50% of transitions, providing patient access to view/download/transmit records, secure messaging with over 5% of patients, and submitting data to public health registries.

Over 60% of hospitals had systems meeting most stage 2 objectives even before required in 2014.

3. Physician Practices

Stage 2 focuses on care coordination, patient engagement, clinical decision support, and protecting health information for physician practices.

Specific objectives include electronically exchanging and incorporating a summary of care records, providing patient portal access, secure messaging, submitting public health data, and generating patient lists by condition.

Over 55% of lab results must be incorporated as structured data compared to 40% in stage 1.

4. Behavioral Health Settings

Behavioral health settings benefit from EHR systems designed specifically for their unique needs rather than general physician-focused systems.

Popular behavioral health EHRs include Carelogic, Valant, TherapyNotes, and ICANotes.

Systems should have at minimum stage 2 certification to qualify for EHR incentives. ICANotes meets stage 3 criteria.

Benefits of Stage 2 Certified EHR Systems for Specific Stakeholders

Benefits of stage 2 certified EHR systems for stakeholders include improved care coordination and exchange for organizations, expanded functionality and incentives for providers, and better coordination, access, and overall care for patients.

For Healthcare Organizations:

• Improves care coordination and health information exchange between providers through more rigorous data sharing capabilities. This enables more informed care.
• Streamlines process like e-prescribing and online lab reports, reducing administrative paperwork and costs.
• Allows analysis of clinical processes and outcomes data to identify areas for quality improvement.

For Healthcare Providers:

• Expands functionality like clinical decision support and patient health record access to further support patient care. This enables better care delivery.
• Reduces the burden of health information reporting requirements through consolidated objectives and measures. This simplifies compliance.
• Qualifies providers for financial EHR adoption incentives from Medicare/Medicaid programs. This helps offset costs.

For Patients:

• It improves coordination of care between different providers, leading to better health outcomes.
• Provides patient access to view, download, and transmit their health records and data. This enables greater engagement.
• Overall focus on advancing interoperability and health information exchange supports improved quality of care and better patient experiences.

Challenges of Implementing Stage 2 Certified EHR Systems

Challenges of implementing stage 2 certified EHR systems include limitations in interoperability, substantially increased meaningful use requirements, lack of certified system availability initially, high costs and administrative burdens, and difficult system/workflow changes for end users.

1. Interoperability and health information exchange: Stage 2 requires more advanced data-sharing capabilities, but many EHR systems do not properly support standardized formats like C-CDA for seamless exchange between systems.
2. Meeting complex new criteria and objectives: Stage 2 sets higher thresholds and introduces new objectives around care coordination and patient engagement, representing a significant increase in complexity for vendors and providers.
3. Obtaining 2014 certified technology: As of late 2013, relatively few vendors had completed testing and certification to the 2014 standards, making it difficult for providers to meet requirements.
4. Cost and administrative burden: Implementation assistance, staff training, and workflow redesign costs to meet stage 2 can be high, especially for small practices and rural hospitals with limited resources.
5. User adoption and change management: Transitioning staff to new stage 2 workflows and features is challenging, negatively impacting productivity and satisfaction during implementation rollouts.

Tips for Optimizing Stage 2 Certified EHR Systems for Improved Workflow

• Align leadership and clinicians on EHR optimization goals, reduce unnecessary EHR work, and leverage data to enhance workflows. Foster teamwork across roles.
• Optimize hardware with widescreen monitors, exam room printers, and speech recognition tools. Optimize software through templates, protocols, order sets, and clinical decision support.
• Improve order entry and documentation efficiency. Engage staff like MAs and nurses in EHR training for workflows like annual wellness visits.
• Rigorously test systems to ensure seamless health information exchange and interoperability capabilities required for stage 2 care coordination.
• Incorporate user-centered design principles in system development and certification to enhance physician satisfaction and usability.
• Leverage new stage 2 functionality like enhanced clinical decision support, care coordination, patient communication, and access to records to improve care delivery.
• Verify EHR systems have 2014 ONC certification to meet stage 1 and stage 2 criteria via the ONC Certified Health IT Product List website.
• Study workflows and workarounds to identify EHR and broader care delivery improvement opportunities through observations, surveys, log analysis, and more.

See how CalystaEMR achieves stage 2 interoperability. Request a demo now.