Meaningful Use Stage 2 Final Rule—what changed?

On August 23, 2012 HHS released the final rule on Meaningful Use Stage 2.  Although a few of the thresholds were reduced from the preliminary ruling and some menu objectives were added the bar is still much higher than Stage 1 (see summary below).  Hospitals must meet 19 total objectives, 16 core and 3 out of 6 menu objectives. 

Key changes from the preliminary Stage 2 ruling for hospitals are below.  CMS has gotten much better at communicating the requirements around their programs so check out their page if you want more details than what I provide here.

Core Objectives

  • CPOE:  adds lab and radiology to the existing meds requirement but with a lower threshold than meds; 30% lab and radiology vs. 60% for meds.
  • Patient Access:  the requirement that patients access their information online went down to 5% of patients (from 10%) in the preliminary ruling.  This supports the theme of ‘patient engagement’ of Stage 2 but makes it achievable.
  • Summary of Care Record for Transitions of Care—added to the requirement to ‘transmit to organizations with no affiliation or that are using a different certified EHR’ to include successfully testing with CMS test EHR.
  • Medication Reconciliation—reduced to 50% of transitions of care (from 65%)

Menu Objectives

  • 2 new Menu objectives
    • Progress Notes:  Enter an electronic progress note for more than 30% of unique patients.  The Stage 2 proposed ruling indicated that electronic documentation is already widely implemented and does not need to be a meaningful use requirement.  Based on comments that not all EMRs have the capability to incorporate clinical documentation this was added as a menu option. 
    • Labs:  Provide structured electronic lab results to EPs for more than 20%
    • Imaging Results—reduced to 20% of imaging results are accessible through EHR (from 40%)

Below is a summary of the key changes and additions between Stage 1 and Stage 2 for hospitals with changes from the Stage 2 preliminary ruling shown in italic/underlined.

Objectives  from Stage 1 that changed
















CPOE (30% to 60% for med orders)

  • Denominator changed to total number of orders vs. unique patients with at least 1 order.
  • Lab and Radiology orders now included (beyond just meds)—at 30% each
  • CPOE order must now be the ‘first record of the order’ 

Record Demographics (50% to 80%)

Record Vital Signs (50% to 80%)

  • Height and weight must now be recorded for all patients (rather than 2 and over) and blood pressure for 3 and over.

Record Smoking Status (50% to 80%)

Clinical Decision Support (1 rule to 5 rules)

  • Rules must map to the clinical quality measures reported.
  • Drug-Drug/Drug Allergy Checks has been moved to this objective.

Lab Test Results as Structured Data (40% to 55%)

  • Moved from Menu to Core

Online Information to Patients (10% to 50%)

  • Replaces ‘Provide patients with an electronic copy of their discharge instructions and procedures at time of discharge, upon request.’
  • New additional measure that 5% of patients actually access the information.

Summary of Care Record for Transitions of Care (50% to 65%)

  • Replaces the Stage 1 ‘Exchange key clinical information’
  • Consolidates Stage 1 Requirements:  problem list, active medication list, active medication allergy list.
  • New Requirement to transmit to organizations with no affiliation or that are using a different certified EHR or successfully testing with CMS test EHR.

Protect Electronic Health Information

  • Specifically calls out encryption/ security of data at rest.

Objectives that moved from Menu to Core






Generate Patient Lists by Specific Condition

Educational Resources—use EHR to identify and provide educational resources for more than 10% of patients.

Medication Reconciliation—reduced from 65% to 50% of transitions of care

Immunization Data Submission

Reportable Lab Results Submission

Syndromic Surveillance Submission

New Core  Objectives

e-MAR:  more than 10% of medication orders

New Menu Objectives





Imaging Resultsreduced from 40% to 20% of imaging results are accessible through EHR

Record Family History for more than 20% of all unique patients

eRx at discharge (more than 10% of hospital discharge med orders)

Progress Notes (for more than 30% of unique patients)

Labs (structured electronic lab results to EPs for more than 20%)

No Change

Advanced Directives (Menu) (more than 50% of patients 65 years or older)