Although there has been concern expressed over which healthcare standards were going to be required in the Meaningful Use regulations, the Interim Final Rule (IFR) does not make any drastic changes, at least for Stage 1. The key healthcare standards outlined for Stage 1 include (taken from the Standards & Certification IFR):
| Purpose | Adopted Standard(s) to Support Meaningful Use Stage 1 | Category |
| Patient Summary Record | HL7 CCD R2 CCD Level 2 or ASTM CCR | Content Exchange |
| Problem List | Applicable HIPAA code set required by law (i.e., ICD-9-CM) or SNOMED CT® | Vocabulary |
| Medication List | Any code set by an RxNorm drug data source provider that is identified by the US National Library of Medicine as being a complete data set integrated within RXNorm | Vocabulary |
| Procedures | Applicable HIPAA code set required by law (i.e., ICD-9-CM or cpt-4®) | Vocabulary |
| Lab Orders and Results | LOINC® when LOINC codes have been received from a laboratory | Vocabulary |
| Drug Formulary Check | Applicable Part D standard required by law (i.e., NCPDP Formulary & Benefits Standard 1.0) | Content Exchange |
| Electronic Prescribing | Applicable Part D standard required by law (i.e., NCPDP SCRIPT 8.1) or NCPDP SCRIPT 8.1 and NCPDP SCRIPT 10.6 | Content Exchange |
| Any code set by an RxNorm drug data source provider that is identified by the US National Library of Medicine as being a complete data set integrated within RXNorm | Vocabulary | |
| Administrative Transactions | Applicable HIPAA transaction standards required by law | Content Exchange |
| Quality Reporting | CMS PQRI 2008 registry XML Specification | Content Exchange |
| Submission of Lab Results to Public Health Agencies | HL7 2.5.1 | Content Exchange |
| LOINC® when LOINC codes have been received from a laboratory | Vocabulary | |
| Submission to Public Health Agencies for Surveillance or Reporting | HL7 2.3.1 or HL7 2.5.1 | Content Exchange |
| According to Applicable Public Health Agency Requirements | Vocabulary | |
| Submission to Immunization Registries | HL7 2.3.1 or HL7 2.5.1 | Content Exchange |
| HL7 2.3.1 or HL7 2.5.1 with CVX vocabulary | Vocabulary |
What is Stage 1? There are three stages for Meaningful Use criteria, as defined by the Centers for Medicare & Medicaid Services (CMS). Outlined below are the three stages and their criteria (bold emphasis added to highlight key points).
| Stage | Timing | Criteria |
| 1 | Beginning in 2011 | “focuses on electronically capturing health information in a coded format; using that information to track key clinical conditions and communicating that information for care coordination purposes (whether that information is structured or unstructured, but in structured format whenever feasible); consistent with other provisions of Medicare and Medicaid law, implementing clinical decision support tools to facilitate disease and medication management; and reporting clinical quality measures and public health information.” |
| 2 | Beginning in 2013 | “consistent with other provisions of Medicare and Medicaid law, expand upon the Stage 1 criteria to encourage the use of health IT for continuous quality improvement at the point of care and the exchange of information in the most structured format possible, such as the electronic transmission of orders entered using computerized provider order entry (CPOE) and the electronic transmission of diagnostic test results (such as blood tests, microbiology, urinalysis, pathology tests, radiology, cardiac imaging, nuclear medicine tests, pulmonary function tests and other such data needed to diagnose and treat disease). Additionally we may consider applying the criteria more broadly to both the inpatient and outpatient hospital settings.” |
| 3 | Beginning in 2015 | “consistent with other provisions of Medicare and Medicaid law, to focus on promoting improvements in quality, safety and efficiency, focusing on decision support for national high priority conditions, patient access to self management tools, access to comprehensive patient data and improving population health.” |
Stage 1 is more clearly defined, with Stages 2 and 3 open for public comment and guidance. Within the IFR, public comment is encouraged throughout the document especially as it relates to the later stages. The focus in Stages 2 and 3 is to narrow the healthcare standards required so, in other words, fewer standards choices as Meaningful Use criteria unfolds in 2013 and beyond.
Although this article is a little tedious, the point is to highlight the healthcare standards being pulled forward for Stage 1 and draw attention to the direction in the subsequent years. More articles will be offered to add to the understanding and insight on the real impacts to healthcare IT’s role in supporting these new goals and regulations.
