A_Deep_Dive_into_Meaningful_Use_Stage_2

A Deep Dive into
Meaningful Use
Stage 2
Understanding the Imaging
Accessibility Menu Requirement
A publication by DICOM Grid

Table of Contents
Introduction.............................................................................1
Key Terms and Acronyms..........................................................3
A Note From DICOM Grid.......................................................4
Understanding the Objectives...................................................6
How Does Imaging Come into Play?................................................7
Demystifying the MU Requirement Involving Imaging...................8
Commonly Asked Questions About the Imaging Requirement..................9
How to Attest - Image Enabling Your CEHRT..............................10
Usability Checklist.....................................................................11
Meeting the Attestion Requirements................................................12
Exclusions...............................................................................13
Aligning Your Imaging Solution with Meaningful Use.................14
A Closer Look at Stage 2 and How You Can Incorporate Imaging..........14
Imaging Solution Checklist...........................................................16
Closing Thoughts and Resources..............................................17
Works Cited............................................................................18
Appendix...............................................................................18
page 1

On September 4, 2012, CMS (Centers for Medicare & Medicaid Services) published a
final rule outlining Stage 2 criteria that eligible professionals (EPs), eligible hospitals, and
critical access hospitals (CAHs) must meet in order to continue to participate in the Medi-
care and Medicaid Electronic Health Record (EHR) Incentive Programs. To receive an EHR
incentive payment, and to avoid upcoming penalties, you must show that you are “mean-
ingfully using” your EHR by meeting thresholds for a number of objectives. Meaningful
Use (MU) Stage 2 ups the ante with additional core and menu objectives and higher clini-
cal quality reporting thresholds.
New criteria, specifically aimed towards making imaging results and accompanying
information accessible through a certified EHR, has been introduced into the mix.
Your medical practice likely has some questions about the imaging component. We’ve
put together this eBook to help you understand and navigate the new imaging require-
ment. We will specifically address what the imaging requirement means, how you’ll be
measured, and what your medical practice needs to consider in aligning with Meaningful
Use goals.
Introduction
page 2

MU (Meaningful Use)
Meaningful use is using certified electronic health record (EHR) technology to: improve
quality, safety, efficiency, and reduce health disparities; engage patients and family; and
improve care coordination, and population and public health.
EPs (Eligible Professionals)
Healthcare professionals and hospitals must meet the eligibility criteria defined by law in
order to receive incentive payments for implementing Electronic Health Records programs.
CAHs (Critical Access Hospitals)
A critical access hospital is an organization certified to receive cost-based reimbursement
from Medicare.
CEHRT (Certified Electronic Health Record Technology)
Certified EHR technology gives assurance to purchasers and other users that an EHR sys-
tem or module offers the necessary technological capability, functionality, and security to
help them meet the meaningful use criteria.
CMS (Centers for Medicare & Medicaid Services)
A federal agency within the U.S. Department of Health and Human Services that adminis-
ters the Medicare program and works in partnership with state governments to administer
Medicaid, the State Children’s Health Insurance Program, and health insurance portability
standards.
HHS (Department of Health and Human Services)
A department of the U.S. federal government with the goal of protecting the health of all
Americans and providing essential human services.
ONC (Office of the National Coordinator)
A staff division of the Office of the Secretary, within the U.S. Department of Health and
Human Services. ONC leads national health IT efforts, charged as the principal federal
entity to coordinate nationwide efforts to implement and use the most advanced health
information technology and the electronic exchange of health information.
HIE (Health Information Exchange)
Health information exchange (HIE) is the mobilization of healthcare information electroni-
cally across organizations within a region, community or hospital system. In this eBook,
the term HIE may also refer to the organization that facilitates the exchange.
page 3
Key Terms and Acronyms

A common question is, “When do I start MU Stage 2?” The onset of Stage 2 is 2014,
which means that this year is the earliest that anyone can participate. However, this does
not mean that everyone participating in the Meaningful Use program has reached Stage
2. For example, if you started the Meaningful Use program in 2013, then you won’t actu-
ally be eligible for Stage 2 until 2015.
Be aware of the fact that if you are just now getting started with Meaningful Use you will
not be eligible for full incentive amounts, but you will be able to avoid the looming penal-
ties!
If you are already underway with Meaningful Use Stage 1- congrats! You are well posi-
tioned to achieve Stage 2.
If you’re a little late to the game, don’t worry. It’s not too late to start the Meaningful Use
program, but time is running out. You can refer to this handy chart to determine when you
will start Stage 2 based on your Meaningful Use start year.
page 4
A Note From DICOM Grid

In addition, you can review the timeline below for important program and payment dates.
m
m

Like Stage 1, Stage 2 uses “core” and “menu” objectives to specify criteria that EPs,
eligible hospitals, and CAHs must meet in order to continue to participate in the Medicare
and Medicaid EHR Incentive Programs.
In order to achieve MU Stage 2, all providers must meet core objectives. In addition,
there are a set number of menu objectives that providers must select from in order to dem-
onstrate Meaningful Use.
Understanding the Objectives
For eligible hospitals and
CAHs, there are a total of 22
meaningful use objectives. To
qualify for an incentive pay-
ment, 19 of these 22 objec-
tives must be met:
list of 6 menu set objectives.
For eligible professionals,
there are a total of 23 mean-
ingful use objectives. To qual-
ify for an incentive payment,
20 of these 23 objectives must
be met:
list of 6 menu set objectives
For a complete list of Meaningful Use Stage 2 core and menu objectives please see the
charts for EPs and Eligible Hospitals in the appendix section of this eBook.
page 6

A new imaging requirement has been added to the list of menu objectives, and it ad-
dresses a need for increased access to medical imaging. Remember, there are a total of
six menu objectives, in order to qualify for incentive payments you’ll need to meet three
of the six. At this point in time, attesting to the imaging requirement is one of the six menu
objective options. Why choose the imaging requirement? If you work for an image in-
tensive practice or if your organization relies heavily on imaging, it would be especially
beneﬁcial to opt into the imaging requirement to meet your Stage 2 MU goals.
And without further ado, here is the menu objective involving imaging:
Imaging results consisting of the image itself and any explanation
or other accompanying information are accessible through CEHRT.
At a basic level, this menu objective calls for access to radiology images, and reports via
a certiﬁed EHR. In the following chapters, we will analyze what this requirement means
and what it does not mean, and we’ll also break down how you can tackle it.
How does imaging come into play?
page 7

There’s been a lot of confusion around the imaging requirement, so take a moment to
reread the requirement before we walk through the ins and outs.
Imaging results consisting of the image itself and any explanation
or other accompanying information are accessible through CEHRT.
First and foremost, you might be wondering what is meant by the word accessible as it is
used. The Department of Health and Human Services (HHS) sheds some light on the word
accessible by describing the following scenarios:
1. Incorporation of the image and accompanying information into CEHRT. In this sce-
nario, incorporation of the image means that the image and accompanying information is
stored by the CEHRT.
2. An indication in the CEHRT that the image and accompanying information are avail-
able for a given patient in another technology. In this scenario, a link to where the image
and accompanying information is stored must be available in the CEHRT.
What does this mean? Put simply, it’s not always possible to incorporate the actual image
into the CEHRT. Therefore, providing access to the image, whether it’s through a hyperlink
or connection to another system will sufﬁce.
Demystifying the MU requirement
involving imaging
page 8

In a 642 page-document, the HHS set the final rule for Stage 2 and fielded a number of
questions and concerns about the new imaging requirement. Below we have summarized
five key areas that respond to the questions and concerns that were raised by the public.
Make sure to read through these concerns because they answer some commonly asked
questions about the requirement.
1. How is imaging being defined?
The description of radiology services from the Stage 2 CPOE objective for MU is being
used as the minimum description of imaging. Essentially, radiologic services in the Stage
2 CPOE are described as any imaging service that uses electronic product radiation. To
further elaborate, electronic product radiation is defined as: “any ionizing or nonionizing
electromagnetic or particulate radiation, or any sonic, infrasonic, or ultrasonic wave that
is emitted from an electronic product as the result of the operation of an electronic circuit
in such product.” Keep in mind, if you’d like to include other types of imaging services
that do not rely on electronic product radiation you may do so as long as the policy is
consistent across all patients and for the entire EHR reporting period.
2. What is meant by the terms “imaging results” and “accompanying information”?
The term “imaging results” refers to the image(s) itself as the result. Any other supportive
narratives or explanation is refers to as the “accompanying information”. For example, a
study might be accompanied by a radiation dose.
3. Do you have to store images in the CEHRT?
No. Although storing images in the CEHRT is one way to make them accessible, you
can leverage other options, such as cloud storage. In another words, the CEHRT does not
need to store the images, it only needs to make them accessible.
4. What resolution is required for viewing images?
The images can be of any resolution. The technology required to view images of diagnos-
tic quality might be cost prohibitive for some providers. For that reason, there is no limita-
tion to the image resolution.
5. Can you leverage the image sharing capabilities of an HIE?
Participating in an HIE does not necessarily mean you can attest to the objective, but it
could be possible. If you are participating in an HIE that facilitates image exchange then
you might be able to leverage the image sharing capabilities to meet the imaging require-
ment. You’ll have to check with your HIE and imaging solution to see if the proper frame-
work and infrastructure can be made available to you through your CEHRT.
Commonly Asked Questions about the Imaging Requirement
page 9

The guidelines for imaging support in certified EHR technology are flexible, and vendors
have options to embed radiology viewers, link to 3rd party imaging platforms and store
image data in a number of different ways depending
on preferred workflows.
Ultimately, the configuration between your CEHRT
and imaging solution will need to do two things:
1. Electronically indicate to a user that a patient’s
images and any accompanying information (reports,
etc.) are available and 2. Enable electronic access to
the images and accompanying information.
Tip: Although the use of electronic exchange to incor-
porate imaging results into the CEHRT is encouraged,
in the absence of electronic exchange, it is accept-
able to manually add the image and accompanying
information to the CEHRT. To further clarify, you can
scan images and imaging results into the CEHRT.
DICOM Grid is a highly flexible imaging solution ca-
pable of fully supporting the Stage 2 imaging require-
ment, regardless of chosen CEHRT workflow configu-
ration. We can image enable your CEHRT through
HL7 feeds, APIs, or custom integration. In addition,
our viewer can be embedded in existing CEHRT, our
cloud platform can support both storage and data
transfer within HIEs, and our stand alone web app
gives patients quick, secure access to their imaging
data.
How to Attest – Image Enabling
your CEHRT
page 10

Usability Checklist
Certified EHR technology can meet this certification by
providing a context-sensitive link to an external application
which provides access to images and associated narrative.
You’ll need to make this process as seamless as possible.
Here are a few usability best practices to keep in mind:
Direct access: The link should enable access to the im-
ages themselves, not to the login screen of another pro-
gram.
Single sign-on: Nobody wants to have their workflow
interrupted by having to sign on to multiple systems. Users
should immediately be signed into a 3rd party imaging ap-
plication.
Security: Make sure your technology uses secure iden-
tity parameter passing.
Easy viewing: If you require a viewer to access the im-
ages, the viewer should require no downloads or plugins.
DICOM Grid can work with your organization and CEHRT
to help you attest.

You must meet certain thresholds in order to attest to the
imaging requirement.
Speciﬁcally, more than 10 percent of all tests whose
result is one or more images ordered by the EP or by an
authorized provider of the eligible hospital or CAH for
patients admitted to its inpatient or emergency depart-
ment (POS 21 or 23) during the EHR reporting period
are accessible through CEHRT.
Meeting the Attestation Requirements
page 12
In simple terms, if you order more than 100 imaging exams per year, you
need to be able to access more than 10% of the patient studies (and accom-
panying information) electronically through your certiﬁed EHR.
What is a POS 21 or 23?
POS 21: Inpatient Hospital
POS 23: Emergency Room

The following equation for calculating your threshold percentage and whether you fulﬁll
the requirement can be used.
Denominator: Number of tests whose result is one or more images ordered by the EP or
by an authorized provider on behalf of the eligible hospital or CAH for patients admit-
ted to its inpatient or emergency department (POS 21 and 23) during the EHR reporting
period. (Total number of imaging exams ordered).
Numerator: The number of results in the denominator that are accessible through CEHRT.
(Total number of image exams that were accessed through the CEHRT).
Threshold: The resulting percentage must be more than 10 percent in order to meet this
measure.
For example, an organization orders 42,000 image exams during their EHR reporting
period. Of the 42,000 image exams, 16,000 were able to be access by physicians via
links in the EHR.
You can qualify for an exclusion from the imaging requirement if you’re an eligible profes-
sional who orders less than 100 image exams during the EHR reporting period, and/
or you do not have access to electronic imaging results at the start of the EHR reporting
period.
It’s important to note, that an exclusion does not reduce the total number of objectives that
you need in order to qualify for an incentive payment. For example, an EP that has an
exclusion from the imaging objective, must meet three of ﬁve menu objectives instead of
three of six. Refer to the appendix for a list of all the six menu objectives.
Exclusions
This organization meets the threshold, because its percentage is greater than 10%
page 13

The overarching goal of the Meaningful Use
program is to utilize health IT to improve
health-related outcomes. Although the Mean-
ingful Use program has and will continue to
evolve in three stages between the years of
2011 and 2016, the overarching theme re-
mains constant.
On your quest to achieving Stage 2, it’s impor-
tant to keep the overall goal in perspective.
So how does imaging ﬁt into the equation?
By fully image enabling your EHR your prac-
tice and patients can reap numerous beneﬁts
and better align with the goals of the Meaning-
ful Use program.
Aligning Your Imaging Solution
with Meaningful Use
What are the goals of the Meaningful Use
program?
reduce health disparities
tion and public health
health information
Ultimately, it is hoped that the meaningful
use compliance will result in:
systems
page 14
A Closer Look at Stage 2 and How You Can Incorporate Imaging
There are two key focuses of Stage 2. One is the concept of patient engagement, and
getting patients and families involved in there own healthcare using health IT. The other is
the idea of electronically exchanging health information.

How can patient access to imaging data drive patient engagement?
Implementing a patient portal is not enough. In order to satisfy Meaningful Use Stage
2, patients actually have to utilize this technology. This is not going to happen without
your encouragement and online access to helpful information. By incorporating personal
health records for imaging into your patient portal, you can make it simple for patients to
access, view, and transfer medical images. In a recent survey conducted by DICOM Grid
and Radsite™, 220 patients between the ages of 18 and 75 were polled on the topic of
images and patient portals. 90% of respondents expressed some level of interest in ac-
cessing medical images through a patient portal. The bottom line: the easier you make
it for patients to access helpful information, such as imaging, the more likely they are to
engage with your patient portal.
How can you supplement electronic information exchange with imaging?
The other focus of Stage 2 is electronic exchange of information. If Stage 1 was about
recording information in a standardized way, Stage 2 is about taking it a step further by
sharing that standardized information with other providers and with public health agen-
cies.
Cloud imaging solutions can help your organization electronically exchange image data
to improve clinical care outcomes.
page 15
Improved interoperability
The idea is to improve image accessibility so that you can move beyond the walled gar-
dens of a particular organization or system, and close the loop between providers.
Reduced duplicate tests
On demand access to imaging data can reduce the cost and radiation exposure from
tests that are repeated solely because a prior test is not available. Image-enabling the
EHR simpliﬁes the process of exchanging data across the care continuum, which leads to
a reduction in costly duplicate testing.
Availability of image data at the point of care
Real-time access to images through an EHR enables sharing reduces delays during pa-
tients transfers and the referral process.

We’ve put together the following checklist to help you achieve your Meaningful Use Stage
2 goals and to plan for the future. When scoping out the vendor landscape, be sure to
ask about the following features to help with image accessibility and interoperability.
Image Sharing – The ability to easily distribute imaging between providers is hugely
valuable for collaboration, referrals, and patients transfers
Data Transfer – Automated data transfer allows your organization to efﬁciently move
images between systems and organizations
Universal Viewer – A zero footprint, HTML 5 viewer requires no downloads or plug-ins
and can be accessed from the web
Secure Remote Access – Remote, web-access to imaging data make it easy for care
providers and patients to view their images from any location.
Storage – Having affordable, vendor neutral storage is a must
API – An open API sets the framework for how software components can interact with
each other to improve interoperability
Imaging Solution Checklist
page 16

In this eBook we took a deep dive into the new menu objective involving imaging. Under-
standing the requirements and measurements is the ﬁrst step. Now you need take action.
Want to learn more about how optimizing your EHR with imaging can help you attest to
Stage 2? Make sure to request a consultation with one of DICOM Grid’s imaging special-
ists to learn more.
We’re excited to hear about your use case and help you reach your Meaningful Use
goals.
Closing Thoughts and Resources
page 17
Optimize your EHR with DICOM Grid’s Image
Exchange Solution.

Certification Bar for Your Cart. (n.d.). Certified Health IT Product List. Retrieved May 12,
2014, from http://oncchpl.force.com/ehrcert/ehrproductcriteriasearch
Clunie, D. (2012, March 3). Imaging and Meaningful Use 2 - First Impressions. : March
2012. Retrieved May 12, 2014, from http://dclunie.blogspot.
com/2012_03_01_archive.html
Federal Register. (2012, September 4). . Retrieved May 12, 2014, from http://www.
gpo.gov/fdsys/pkg/FR-2012-09-04/pdf/2012-21050.pdf
HealthIT.gov. (n.d.). Meaningful Use Definition and Meaningful Use Objectives of EHRs.
Retrieved May 12, 2014, from http://www.healthit.gov/providers-professionals/
meaningful-use-definition-objectives
Moving to Stage 2 of Meaningful Use. (2013, June 4). . Retrieved May 12, 2014, from
http://www.physicianspractice.com/meaningful-use/moving-stage-2-meaningful-
use
Stage 2. (n.d.). - Centers for Medicare & Medicaid Services. Retrieved May 12, 2014,
from http://www.cms.gov/Regulations-and-Guidance/Legislation/EHRIncentive
Programs/Stage_2.html
Test Procedure for §170.314(a)(12) Image results. (2012, December 14). . Retrieved
May 12, 2014, from http://www.healthit.gov/sites/default/files/170.314a12im
ageresults_2014_tp_approved_v1.2_1.pdf
Work Cited
Appendix

Stage 2
Eligible Professional (EP)
Meaningful Use Core and Menu Measures
Table of Contents
Date issued: October, 2012
Eligible Professional Core Objectives
(1)
Use computerized provider order entry (CPOE) for medication, laboratory and radiology orders
directly entered by any licensed healthcare professional who can enter orders into the medical
record per state, local and professional guidelines.
(2) Generate and transmit permissible prescriptions electronically (eRx).
(3) Record the following demographics: preferred language, sex, race, ethnicity, date of birth.
(4)
Record and chart changes in the following vital signs: height/length and weight (no age limit);
blood pressure (ages 3 and over); calculate and display body mass index (BMI); and plot and
display growth charts for patients 0-20 years, including BMI.
(5) Record smoking status for patients 13 years old or older.
(6) Use clinical decision support to improve performance on high-priority health conditions.
(7)
Provide patients the ability to view online, download and transmit their health information
within four business days of the information being available to the EP.
(8) Provide clinical summaries for patients for each office visit.
(9)
Protect electronic health information created or maintained by the Certified EHR Technology
through the implementation of appropriate technical capabilities.
(10) Incorporate clinical lab-test results into Certified EHR Technology as structured data.
(11)
Generate lists of patients by specific conditions to use for quality improvement, reduction of
disparities, research, or outreach.
(12)
Use clinically relevant information to identify patients who should receive reminders for
preventive/follow-up care and send these patients the reminders, per patient preference.
(13)
Use clinically relevant information from Certified EHR Technology to identify patient-specific
education resources and provide those resources to the patient.
(14)
The EP who receives a patient from another setting of care or provider of care or believes an
encounter is relevant should perform medication reconciliation.
(15)
The EP who transitions their patient to another setting of care or provider of care or refers their
patient to another provider of care should provide a summary care record for each transition of
care or referral.
(16)
Capability to submit electronic data to immunization registries or immunization information
systems except where prohibited, and in accordance with applicable law and practice.
(17) Use secure electronic messaging to communicate with patients on relevant health information.
1

Eligible Professional Menu Objectives
(1)
Capability to submit electronic syndromic surveillance data to public health agencies except
where prohibited, and in accordance with applicable law and practice.
(2) Record electronic notes in patient records.
(3)
Imaging results consisting of the image itself and any explanation or other accompanying
information are accessible through CEHRT.
(4) Record patient family health history as structured data.
(5)
Capability to identify and report cancer cases to a public health central cancer registry, except
(6)
Capability to identify and report specific cases to a specialized registry (other than a cancer
registry), except where prohibited, and in accordance with applicable law and practice.
View or download all of the EP Stage 2 Core and Menu Objectives for Stage 2.
2

1
Stage 2
Eligible Professional
Meaningful Use Menu Set Measures
Measure 3 of 6
Table of Contents
Definition of Terms
Attestation Requirements
Additional Information
Certification and Standards Criteria
Imaging Results
Objective
Imaging results consisting of the image itself and any explanation or other
accompanying information are accessible through CEHRT.
Measure
More than 10 percent of all tests whose result is one or more images ordered by the
EP during the EHR reporting period are accessible through CEHRT.
Exclusion
Any EP who orders less than 100 tests whose result is an image during the EHR
reporting period; or any EP who has no access to electronic imaging results at the
start of the EHR reporting period.
Definition of Terms
Imaging – The description of radiology services from the Stage 2 CPOE objective is the minimum
description of imaging. We describe radiologic services as any imaging service that uses electronic
product radiation. Electronic product radiation is defined at 21 CFR 1000.3 as: "any ionizing or
nonionizing electromagnetic or particulate radiation, or [a]ny sonic, infrasonic, or ultrasonic wave that is
emitted from an electronic product as the result of the operation of an electronic circuit in such
product." If the provider desires to include other types of imaging services that do not rely on electronic
product radiation they may do so as long as the policy is consistent across all patients and for the entire
EHR reporting period.
Accessible through – Either incorporation of the image and accompanying information into CEHRT or an
indication in CEHRT that the image and accompanying information are available for a giving patient in
another technology and a link to that image and accompanying information.
Incorporation of the Image – The image and accompanying information is stored by the CEHRT.
A Link to the Image and Accompanying Information – A link to where the image and accompanying
information is stored is available in CEHRT. This link must conform to the certification requirements
associated with this objective in the ONC final rule published elsewhere in this issue of the Federal
Register.
No Access – None of the imaging providers used by the EP provide electronic images and any
explanation or other accompanying information that are accessible through their CEHRT at the start of
the EHR reporting period.

2
DENOMINATOR / NUMERATOR / THRESHOLD / EXCLUSION
DENOMINATOR: Number of tests whose result is one or more images ordered by the EP during
the EHR reporting period.
NUMERATOR: The number of results in the denominator that are accessible through CEHRT.
THRESHOLD: The resulting percentage must be more than 10 percent in order to meet this
measure.
EXCLUSION: Any EP who orders less than 100 tests whose result is an image during the EHR
reporting period; or any EP who has no access to electronic imaging results at the start of the
There are no limitations on the resolution of the image.
Storing the images natively in CEHRT is one way to make them accessible through CEHRT, but
there are many other ways and native storage is not required by the objective and measure.
Images and imaging results that are scanned into the CEHRT may be counted in the numerator
of this measure.
In order to meet this objective and measure, an EP must use the capabilities and standards of
CEHRT at 45 CFR 170.314(a)(12).
Below is the corresponding certification and standards criteria for electronic health record technology
that supports achieving the meaningful use of this objective.
Certification Criteria*
§ 170.314(a)(12)
Image results
Electronically indicate to a user the availability of a patient’s images and narrative
interpretations (relating to the radiographic or other diagnostic test(s)) and enable
electronic access to such images and narrative interpretations.
*Depending on the type of certification issued to the EHR technology, it will also have been certified to
the certification criterion adopted at 45 CFR 170.314 (g)(1), (g)(2), or both, in order to assist in the
calculation of this meaningful use measure.
Standards Criteria
N/A

Stage 2
Eligible Hospital and Critical Access Hospital (CAH)
Meaningful Use Core and Menu Objectives
Table of Contents
Eligible Hospital Core Objectives
(1)
Use computerized provider order entry (CPOE) for medication, laboratory, and radiology orders
directly entered by any licensed healthcare professional who can enter orders into the medical
record per state, local, and professional guidelines.
(2)
Record all of the following demographics: preferred language, sex, race, ethnicity, date of birth,
date and preliminary cause of death in the event of mortality in the eligible hospital or CAH.
(3)
Record and chart changes in the following vital signs: height/length and weight (no age limit);
blood pressure (ages 3 and over); calculate and display body mass index (BMI); and plot and
display growth charts for patients 0-20 years, including BMI.
(4) Record smoking status for patients 13 years old or older.
(5) Use clinical decision support to improve performance on high-priority health conditions.
(6)
Provide patients the ability to view online, download, and transmit information about a hospital
admission.
(7)
Protect electronic health information created or maintained by the Certified EHR Technology
through the implementation of appropriate technical capabilities.
(8) Incorporate clinical lab test results into Certified EHR Technology as structured data.
(9)
Generate lists of patients by specific conditions to use for quality improvement, reduction of
disparities, research, or outreach.
(10)
Use clinically relevant information from Certified EHR Technology to identify patient-specific
education resources and provide those resources to the patient.
(11)
The eligible hospital or CAH who receives a patient from another setting of care or provider of
care or believes an encounter is relevant should perform medication reconciliation.
(12)
The eligible hospital or CAH who transitions their patient to another setting of care or provider
of care or refers their patient to another provider of care provides a summary care record for
each transition of care or referral.
(13)
Capability to submit electronic data to immunization registries or immunization information
systems except where prohibited, and in accordance with applicable law and practice.
(14)
Capability to submit electronic reportable laboratory results to public health agencies, where
except where prohibited, and in accordance with applicable law and practice.
(15)
Capability to submit electronic syndromic surveillance data to public health agencies, except
(16)
Automatically track medications from order to administration using assistive technologies in
conjunction with an electronic medication administration record (eMAR).
1

Eligible Hospital Menu Objectives
(1) Record whether a patient 65 years old or older has an advance directive.
(2) Record electronic notes in patient records.
(3)
Imaging results consisting of the image itself and any explanation or other accompanying
information are accessible through CEHRT.
(4) Record patient family health history as structured data.
(5) Generate and transmit permissible discharge prescriptions electronically (eRx).
(6) Provide structured electronic lab results to ambulatory providers.
View or download all of the eligible hospital and CAH Stage 2 Core and Menu Objectives for Stage 2.
2

Stage 2
Eligible Hospital and Critical Access Hospital
Meaningful Use Menu Set Measures
Measure 3 of 6
Imaging Results
Objective
Imaging results consisting of the image itself and any explanation or other
accompanying information are accessible through Certified EHR Technology.
Measure
More than 10 percent of all tests whose result is one or more images ordered by an
authorized provider of the eligible hospital or CAH for patients admitted to its
inpatient or emergency department (POS 21 or 23) during the EHR reporting period
are accessible through Certified EHR Technology .
Exclusion No exclusion.
Table of Contents
Definition of Terms
Definition of Terms
Imaging – The description of radiology services from the Stage 2 CPOE objective is the minimum
description of imaging. We describe radiologic services as any imaging service that uses electronic
product radiation. Electronic product radiation is defined at 21 CFR 1000.3 as: "any ionizing or
nonionizing electromagnetic or particulate radiation, or [a]ny sonic, infrasonic, or ultrasonic wave that is
emitted from an electronic product as the result of the operation of an electronic circuit in such
product." If the provider desires to include other types of imaging services that do not rely on electronic
product radiation they may do so as long as the policy is consistent across all patients and for the entire
Accessible through – Either incorporation of the image and accompanying information into Certified
EHR Technology or an indication in Certified EHR Technology that the image and accompanying
information are available for a giving patient in another technology and a link to that image and
accompanying information.
Incorporation of the Image – The image and accompanying information is stored by the Certified EHR
Technology.
A Link to the Image and Accompanying Information – A link to where the image and accompanying
information is stored is available in Certified EHR Technology. This link must conform to the certification
requirements associated with this objective in the ONC final rule published elsewhere in this issue of the
Federal Register.
1

DENOMINATOR/ NUMERATOR/THRESHOLD
DENOMINATOR: Number of tests whose result is one or more images ordered by an authorized
provider on behalf of the eligible hospital or CAH for patients admitted to its inpatient or
emergency department (POS 21 and 23) during the EHR reporting period.
NUMERATOR: The number of results in the denominator that are accessible through Certified
EHR Technology.
THRESHOLD: The resulting percentage must be more than 10 percent in order to meet this
measure.
There are no limitations on the resolution of the image.
Storing the images natively in Certified EHR Technology is one way to make them accessible
through Certified EHR Technology, but there are many other ways and native storage is not
required by the objective and measure.
Images and imaging results that are scanned into the Certified EHR Technology may be counted
in the numerator of this measure.
In order to meet this objective and measure, the eligible hospital or CAH must use the
capabilities and standards of CEHRT at 45 CFR 170.314(a)(12).
Below is the corresponding certification and standards criteria for electronic health record technology
that supports achieving the meaningful use of this objective.
Certification Criteria*
§ 170.314(a)(12)
Image results
Electronically indicate to a user the availability of a patient’s images and narrative
interpretations (relating to the radiographic or other diagnostic test(s)) and enable
electronic access to such images and narrative interpretations.
*Depending on the type of certification issued to the EHR technology, it will also have been certified to
the certification criterion adopted at 45 CFR 170.314 (g)(1), (g)(2), or both, in order to assist in the
calculation of this meaningful use measure.
Standards Criteria
N/A
2

A_Deep_Dive_into_Meaningful_Use_Stage_2

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