This document discusses the requirements for Meaningful Use Stage 2. It outlines the core and menu objectives including clinical quality measures, electronic prescribing, health information exchange, patient electronic access, and secure messaging. It provides guidance on exclusions and gives workflows within Practice Fusion for how to meet each objective. Key requirements include reporting 9 clinical quality measures covering 3 domains, using computerized physician order entry for 60% of medications and incorporating structured lab results.

1. Meaningful Use Stage 2
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Continue success with the EHR Incentive
Program

2. Stages of Meaningful Use
2
Stages of Meaningful Use
1
STAGE
Data capture
and
sharing
2
STAGE
3
STAGE
Advanced
clinical
processes
Improve
outcomes

3. Stages of Meaningful Use
(based on year of adoption)
3

4. Reporting Period
4
Stage 2 Requirements
9 Clinical Quality Measures (CQMs)
+ You must report at least 9 CQMs covering 3 NQS domains directly from
Practice Fusion’s CQM report
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CORE
3
MENU
20MEASURES

5. + Requirement: Report at least 9 CQMs that relate
to at least 3 National Quality Strategy (NQS)
domains:
+ CMS selected 9 recommended CQMs for adult
and pediatric populations
 The recommended CQM sets focus on areas that
represent national public health priorities or
disproportionately drive health care costs
CQM Requirements in 2015
Patient and Family Engagement Patient Safety
Care Coordination Population and Public Health
Efficient Use of Healthcare Resources Clinical Processes/Effectiveness

6. CQM Reporting Methods
+ Medicare EPs will submit CQMs to CMS electronically or via
attestation
+ Medicaid EPs must submit CQM data to their State Medicaid Agency
+ Reporting period: Entire calendar year
+ Electronic submission for 2014: January 1, 2015 – February 28,
2015
+ Electronic submission for 2015: January 1, 2016 – February 28,
2016
 Medicare EPs have the option to submit a full year of data electronically to receive
credit for the EHR Incentive Program and the Physician Quality Reporting System
(PQRS) if using the PQRS EHR reporting mechanism.

7. + Medicare
 Full year reporting period
 January 1, 2015 – December 31, 2015
+ Medicaid
 State Medicaid programs may allow different reporting periods
 Check with your state agency for more details
Reporting Period
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8. + Similar to Stage 1, you may qualify for exclusions
for certain measures if they are outside the scope
of your practice
+ Exclusions do not count towards meeting the
requirements of the menu measures, so you must
first select menu measures that are relevant to
your scope of practice
+ If there aren’t enough menu measures for you to
achieve 3 of the 6, you must attest to an exclusion
for the remaining menu measures
Exclusions Reminder

9. + You must record all patients you see, regardless
of their insurance, in the outpatient setting for
Meaningful Use.
+ If you see patients in the hospital, you do not
need to include them in Practice Fusion for
Meaningful Use.
+ At minimum, you must maintain more than 80% of
your patients in the certified EHR for Meaningful
Use.
Is Meaningful Use based on all patients?
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10. Review of Stage 2 Measures

11. Changes in Stage 2
Measures
with
Minor
Changes
Measures
with
Additions
Brand
New
Measures

12. PF Workflows are
suggestions and may not be
the only way to meet a
measure

13. Measures with Minor Changes from Stage 1
Measure Change
Clinical Summaries Timeframe decreases to 1 business day
Clinical Lab Test Results Now a core measure; Threshold increases
to 55%
Demographics Threshold increases to 80%
Smoking Status Threshold increases to 80%
Generate Patient List Now a core measure
Medication reconciliation Now a core measure
Patient-specific education Now a core measure
Protect Health Information Security risk analysis includes additional
criteria

14. + Measure: Provide clinical summaries to patients within 1
business day of the office visit for more than 50% of all
office visits.
 Because this measure is time sensitive and is based on the total
number of office visits, and not based on the number of unique
patients, it is important that you and your practice develop a
sustainable workflow for meeting this measure’s requirements.
+ Exclusion: Any provider who has no office visits during
the reporting period is excluded from this measure.
+ Business Day: The 24 hour weekday period after
midnight on the DOS is "1 business day."
 For example: If your patient is seen on Friday, the clinical summary
needs to be provided by 11:59 PM on the following Monday.
Clinical Summaries (Core)

15. + PF Suggested Workflow: Give patients access to the Patient Portal
 You can achieve this measure by giving a patient or an authorized
representative access to the Patient Portal under Actions from their
chart.
 Once a patient has been given access to the Patient Portal, you will
automatically achieve credit for this measure at the conclusion of
each office visit since the Patient Portal is updated with any new
information that results from each encounter.
Clinical Summaries (Core)

16. + If patient declines the clinical
summary:
 You will receive credit for this
measure as long as you offer all
of your patients clinical
summaries at the conclusion of
their office visit.
 If the patient declines to receive
the clinical summary, you must
notate this in the chart note from
that date of service prior to
signing it.
 In the Quality of Care section,
mark “Patient declined to receive
clinical summary.”
Clinical Summaries (Core)

17. + Measure: Incorporate more than 55% of all
clinical lab test results ordered during the
reporting period into the EHR as structured data.
+ Exclusion: Any provider who orders no lab tests
with results that are either in positive/negative or
numeric format during the reporting period is
excluded.
Clinical Lab Test Results as Structured Data
(Core)

18. + PF Suggested Workflow: Connect your labs to
your EHR account
Clinical Lab Test Results as Structured Data
(Core)

19. + Navigate to the Labs/Imaging section and
select an individual lab result.
Clinical Lab Test Results as Structured Data
(Core)

20. + Attribute the result to the correct patient and
ensure that the provider seeking credit for the
measure signs the result.
Clinical Lab Test Results as Structured Data
(Core)

21. Measures with additions and multiple sub-measu
Measure Change
eRx • Threshold increase to 50%
• Incorporation of drug formulary
Vital Signs • Threshold increases to 80%
• New age requirements for height, weight, and blood
pressure
Clinical Decision Support A minimum of 5 CDS rules now required to be enabled
during the entire reporting period
Syndromic Surveillance
Data Submission
Successful ongoing submission now required
CPOE • Addition of lab and radiology orders
• Medication orders threshold increases to 60%
Preventative Care
Reminders
• No age limitation
• Based on patients seen at least twice in last 24
months
Summary of Care • Now includes 3 sub-measure requirements which
includes sending electronic summary of care
records
Immunization Registry
Data Submission
• Successful ongoing submission now required
• Now a core measure

22. + Measure: Use computerized physician order
entry (CPOE) to record the following items during
your reporting period:
 Measure 1: More than 60% of medication orders
 Measure 2: More than 30% of lab orders
 Measure 3: More than 30% of radiology orders
+ Exclusion: Any provider who writes fewer than
100 medication, radiology, or laboratory orders
during the reporting period is excluded from the
corresponding measure.
CPOE for Medication, Lab, & Radiology Orders
(Core)

23. + PF Workflow:
 From the Medications
section of a SOAP note or
the patient’s Medication
List, select Record or +.
 Search for and order the
medication.
 Enter the details for the
prescription including
quantity, SIG, and refills,
then select “Order.”
CPOE for Medication Orders (Core)

24. + PF Suggested Workflow: Under the Actions
menu of a patient’s chart, select Add lab/imaging
order to gain access to the ordering workflow.
CPOE for Lab & Imaging Orders (Core)

25. + Add a Diagnosis
to the order
+ Add the test you
would like to
order
+ Click next to
move to the next
screen
CPOE for Lab and Imaging Orders (Core)

26. + Ensure that the
provider seeking
credit for this
measure is selected
as the ordering
provider
+ Click “Send” to
record the order
CPOE for Lab and Imaging Orders (Core)

27. + Measure: Send a reminder for more than 10% of
all unique patients who had two or more office
visits within the 24 months before the beginning of
the reporting period, per patient preference when
available.
+ Exclusion: Any provider who has had no office
visits in the 24 months before the reporting period.
Preventative Care Reminders (Core)

28. + PF Suggested Workflow: To find out which of
your patients qualify for this measure, use the
Gap Report function of the Meaningful Use
Dashboard that applies to this measure under the
Status column.
Preventive Care Reminders (Core)

29. + This report will list the patients that have had two
or more office visits in the past 24 months so that
you can send them an appropriate reminder.
Preventive Care Reminders (Core)

30. + Once you send the appropriate reminder to those patients, click
Record patient reminder in the Actions drop-down of the patient's chart
and select your name to receive credit for this measure.
 Anyone in your practice can select the Patient reminder sent from
button as long as you are selected as the provider from which the
reminder was sent.
Preventive Care Reminders (Core)

31. + Measure: Provide a summary of care record when you transition or
refer a patient to another setting or provider:
 1) Provide a summary of care record for more than 50% of
transitions
 2) Provide an electronic summary of care record for more than 10%
of transitions
 3) Conduct one or more successful electronic summary of care
exchanges of a clinical document with a recipient using a different
certified EHR OR with a CMS designated test EHR (completed
through DIRECT messaging protocol)
+ Exclusion: Any provider who transfers a patient to another setting or
refers a patient to another provider less than 100 times during the
reporting period is excluded from all three measures.
Summary of Care (Core)

32. + PF Suggested Workflow:
Electronic summary of care
records can be sent by using the
digital referral in Practice
Fusion.
 From Actions drop-down, select
“Add referral.”
Summary of Care (Measure 1 & 2)

33. + Ensure the referral contains
either a Chart note, clinical
summary, or a clinical
document.
+ In order to get credit for
measure 2, the recipient
must open the referral
 Recipient must be a
provider you’ve exchanged
messages with previously
or a verified Practice
Fusion provider
Summary of Care (Measure 1 & 2)

34. + You must first sign up for
Direct messaging by
visiting the Practice
Dashboard
+ In order to send a Direct
message, ensure your
colleague’s Direct address
must also be entered under
My connections
Summary of Care (Measure 3) – Direct Method
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35. + Before sending a direct
message, create a
Referral Summary for
the patient
+ Under the Actions
drop-down menu,
select “Create clinical
document”
+ Select “Referral
Summary”
+ Include all data
elements and click
“Create”
Summary of Care (Measure 3) – Direct Method
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36. + Navigate to your
patient’s chart and
initiate a referral
+ Include the Continuity
of Care document,
and send to your
colleague with a
Direct address
Summary of Care (Measure 3) – Direct Method
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37. + Measure: Successful ongoing submission of electronic immunization
data to an immunization registry for the entire reporting period, except
where prohibited, and in accordance with applicable law and practice.
+ Exclusion: Any of the following can apply. Any provider who:
 Does not administer any immunizations during the reporting period
 Operates in a jurisdiction where no immunization registry can
receive the data electronically according to the specific certification
standards
 Operates in a jurisdiction where no immunization registry provides
timely information on capability to receive immunization data
 Operates in a jurisdiction where no immunization registry that is
capable of accepting the specific certification standards at the start
of the reporting period can enroll additional providers.
Immunization Registry Data Submission (Core)

38. + Any of the four criteria below are included under the umbrella of
ongoing submission:
 Ongoing submission was already achieved for a reporting period in
a prior year and continues throughout the current reporting period.
 Registration with the PHA or other body to whom the information is
being submitted of intent to initiate ongoing submission was made
by the deadline (within 60 days of the start of the reporting period)
and ongoing submission was achieved.
 Registration of intent to initiate ongoing submission was made by
the deadline and the provider is still engaged in testing and
validation of ongoing electronic submission.
 Registration of intent to initiate ongoing submission was made by
the deadline and the provider is awaiting invitation to begin testing
and validation.
How is ongoing submission defined?

39. + PF Suggested Workflow: You can register for electronic
submission of Immunization files to your state registry by
accessing the Immunization Settings page.
+ Go to Settings > Immunization Registry and complete
the information in the bottom section labeled “Electronic
Transmission.”
+ Visit our Knowledge Base article for instructions on how
to complete this process.
Immunization Registry Data Submission

40. + Patient Electronic Access &
View/Download/Transmit (Core)
+ Secure Electronic Messaging (Core)
+ Imaging Results (Menu)
+ Electronic Notes (Menu)
+ Family History (Menu)
+ Cancer Case Registry (Menu)*
+ Specific Case Registry (Menu)*
 *Practice Fusion does not support this measure at this time.
this measure is not required to meet Meaningful Use.
Brand New Measures

41. + Measure 1: Provide more than 50% of all unique patients
seen during the reporting period online access to their
health information within four business days.
+ Measure 2: More than 5% of all unique patients seen
during the reporting period must view, download their
health information or transmit to a 3rd party.
+ Exclusion: Any provider who:
 Doesn’t order or create any of the information listed for inclusion as part of both
measures, except for "Patient name" and "Provider's name and office, contact
information,” may exclude both measures.
 Conducts 50% or more of their patient encounters in a county that doesn’t have 50%
or more of its housing units with 3Mbps broadband availability according to the latest
information available from the FCC on the first day of the reporting period may
exclude only the second measure.
Patient Electronic Access (Core)

42. + PF Suggested Workflow:
 Give patients or their authorized representatives
access to the Patient Portal from the Actions drop-
down menu.
Patient Electronic Access (Measure 1)

43. + PF Suggested
Workflow: After
you enroll patients
in the Patent
Portal, they will
receive an email
with instructions
for creating an
account.
Patients View Online / Download / Transmit
(Measure 2)

44. + Encourage your patients to
complete the Patient Portal
enrollment either at the office using
the PIN code or phone number on
their account
+ Your patients must log into the
Patient Portal at least once during
the reporting period in order for you
to get credit for this measure.
Patients View Online / Download / Transmit (Mea

45. + Patients aged 18-85 are
automatically given access to
their Patient Portal after you
sign their chart note
 With an email address, a
phone number and a chart
note signed, patients will
automatically receive an
email with instructions on
how to register for their
patient portal
 You can enable/disable this
under Settings  Patient
Engagement Settings
Auto-invite to the Patient Portal

46. + Measure: More than 5% of unique patients seen
during the reporting period must send the provider
a secure message using the electronic messaging
function of the Patient Portal.
+ Exclusion: Any provider who has no office visits
during the reporting period or any provider who
conducts 50% or more of their patient encounters
in a county that doesn’t have 50% or more of its
housing units with 3Mbps broadband availability
according to the latest information available from
the FCC on the first day of the reporting period is
excluded from this measure.
Secure Electronic Messaging (Core)

47. + PF Suggested Workflow: You must first enable
secure messaging for your patients by visiting the
Patient Communications settings.
 Once messaging is enabled, every provider in your
practice can use the new feature.
Secure Electronic Messaging (Core)

48. + After your patient has successfully logged into
the Patient Portal, they must send you a
message.
+ You do not need to respond to the messages in
order to achieve credit for this measure.
Secure Electronic Messaging (Core)

49. + Measure: More than 10% of imaging tests
ordered during the reporting period whose result
is an image should be accessible through the
EHR.
+ Exclusion: Any provider who orders less than
100 tests whose result is an image during the
reporting period or has no access to electronic
imaging results at the start of the reporting period.
Imaging Results (Menu)

50. + PF Suggested Workflow: Connect with your imaging
center to set up your EHR for results. Attribute the results
to the applicable patient and provider and sign the results
when they are received.
+ Images and imaging results that are scanned into Practice
Fusion and stored in the documents folder may be
counted towards this measure.
 Imaging results that are scanned into the EHR will not be
counted in the Meaningful Use Dashboard. You will need
to keep track of these results on your own and maintain
the appropriate documentation that supports the value
you use during attestation for at least 6 years.
Imaging Results (Menu)

51. + Measure: Record patient family health history as
structured data for one or more first-degree
relatives for more than 20% of all unique patients
seen during the reporting period.
+ Exclusion: Any provider who has no office visits
during the reporting period.
Family Health History (Menu)

52. + PF Suggested Workflow:
 Click Record New Relative from the Family History
section of the patient chart.
 Select a first degree relative (mother, father, sister,
brother, daughter, son), enter a diagnosis, and click
Save.
Family Health History (Menu)

53. + In order to receive credit for Meaningful Use measures
based on unique patients seen during the reporting period,
you must sign a note with an encounter type of “Office
visit,” “Home visit,” “Nursing Home visit,” or “Telemedicine
visit.”
+ Only the provider who signs the note receives
denominator credit.
Choosing an encounter type for Meaningful Use
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54. Resources
www.practicefusion.com/meaningfuluse
Meaningful
Use
Center
Meaningful
Use
Dashboard
Practice
Fusion
Knowledge
Base

55. Next Steps for Success
55
Familiarize
yourself with the
new measures
Use the MU
Dashboard to
track progress
Click on
measures from
the Dashboard for
calculation details