The Centers for Medicare and Medicaid Services has issued an interim final rule making changes to the Stage 2 electronic health records meaningful use program, which already had been finalized.

The changes involve replacing some standards with more recent versions, and changing or exempting some meaningful use measures to provide more flexibility. CMS also gives notice via the rule that it intends to issue technical corrections to electronic specifications for clinical quality measures on or around Dec. 21, 2012. The rule, with a 30-day comment period, is available here with publication Dec. 7 in the Federal Register.

The changes or exemptions to meaningful use measures in the rule are:

1. CMS will add an alternative measure for hospitals for electronically reporting lab results to physicians. The existing measure is: “Hospital labs send structured electronic clinical lab results to the ordering provider for more than 20 percent of electronic lab orders received.”

But under this wording, the measure denominator is limited to lab orders received electronically by the hospital, and the wording assumes hospitals will actually receive more than 20 percent of lab orders electronically, CMS acknowledges. So, the alternative measure does not require a hospital to receive a certain threshold of orders electronically: “Hospital labs send structured electronic clinical lab results to the ordering provider for more than 20 percent of lab orders received.”

2. CMS also is correcting language in the two measures requiring hospitals to enable patients to view, download and transmit information. The measures refer to “all patients” instead of “all unique patients.” Consequently, the word “unique” is added to these measures:

“More than 50 percent of all unique patients who are discharged from the inpatient or emergency department (POS 21 or 23) of an eligible hospital or CAH have their information available online within 36 hours of discharge, and

“More than 5 percent of all unique patients who are discharged from the inpatient or emergency department (POS 21 or 23) of an eligible hospital or CAH (or their authorized representative) view, download or transmit to a third party their information during the EHR reporting period.”

3. Another change in the interim final rule is exempting hospitals from reporting in any meaningful use stage beginning in 2013 on clinical quality measures for which they have very few cases, thus not meeting a threshold number.

“Eligible hospitals and CAHs with 5 or fewer discharges during the relevant EHR reporting period (if attesting to a 90-day EHR reporting period), or 20 or fewer discharges during the year (if attesting to a full year EHR reporting period) as defined by the CQM’s denominator population would be exempted from reporting on that CQM,” according to the interim final rule.

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