Oncology Practices Be Prepared! Meaningful Use Stage 2 Is Here! Well Almost

Oncology-specific EMR with Patient Portal & Meaningful Use Training Provide Attestation Answers

The Office of the National Coordinator (ONC) for Health IT and The Centers for Medicare & Medicaid Services (CMS) released final requirements for Stage 2 Electronic Health Records (EHR) Incentive programs on August 23. After a Stage 2 delay that originally was to begin in 2012, the Meaningful Use (MU) final rule is now complete and the Standards and Certification Criteria are available for oncology practices to compare attestation preparation.

Stage 2 attestation with a certified-as-complete EHR for meeting MU measurements begins in 2014. American Recovery and Reinvestment Act (ARRA) incentives continue and Medicare eligible professionals (EPs) who first demonstrated MU Stage 1 in 2011 or 2012 will continue with Stage 1 criteria attestation in 2013. Then, beginning Stage 2 attestation in 2014, gives EPs more time to meet Stage 2 criteria. EPs must attest to MU Stage 1 prior to attesting to Stage 2; here’s how to get started!

Oncologists Stage 1 Attestation—There’s Still Time!

Stage 1 Attestation Required Prior to Stage 2

Oncologists still have time to attest to Stage 1, which then entitles the oncologist to the full $44,000 available throughout the attestation stages as determined by CMS. “Engaging and teaching the staff was crucial to achieving meaningful use[1]”, said Mithi Govil, MD.

If an oncologist has not attested to Stage 1, October 3, 2012 is the last day for the EP to begin their 90-day reporting period to demonstrate MU for the Medicare EHR Incentive. To get the maximum incentive payment of $44,000, EPs must begin participation by 2012 and Stage 1 attestation is required prior to moving onto Stage 2. See below CMS table of Medicare provider timeline for MU stages and participation.

EPs successfully demonstrating MU in 2011 have three years of MU with Stage 1 criteria before the Stage 2 criteria requirements become effective in 2014.

“Lake Norman Oncology was the first oncology practice to attest to Stage 1 in April 2011 with the support of our EHR vendor we were able to complete the attestation process shortly after CMS opened its portal for submission of data[2]”, stated David Eagle, MD.

Oncologists initially attesting in 2012 to Stage 1 have two years of MU Stage 1 criteria before advancing to the Stage 2 criteria. Stage 2 attestation does not begin until 2014 and only then in 2014 is a 3-month EHR reporting period required.

Stage 2 Attestation Begins in 2014

90 day EHR Reporting Period

With the initiation of Stage 2, oncology practices received another big reason for deploying an oncology-specific EMR certified as a complete EHR for meeting MU measurements. As expected, successful attestation includes an increase use of a patient portal, physician communication, and demonstrated use of core measures within a certified EMR.

For 2014 only, whether the EP is attesting to Stage 1 in 2014 or is eligible for Stage 2 attestation, the EP is only required to demonstrate MU for a 3-month EHR reporting period. If the EP is a Medicare provider, the 3-month reporting period is fixed to the quarter of either the fiscal year of the eligible hospital or critical access hospital (CAH) or the calendar year for the EP. Stage 2 has new core measurements and menu set aspects as well as incorporates a higher threshold of Stage 1 objectives. 

Stage 2 – What’s New? Core & Menu Set Items[3]

Includes Some Stage 1 Objectives

Many of Stage 1 objectives are now Stage 2 criteria core objectives with a higher threshold required to meet MU. There are some new objectives in Stage 2 with most of these being menu objectives. In Stage 2, the EP is to meet 17 core objectives and 3 menu objectives. The EP may select from a total of 20 core objectives.

The new Stage 2 objectives include:

  1. Use secure electronic messaging to communicate with patients on relevant health information.
  2. 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.
  3. Emphasis on health information exchange between providers to improve care coordination for patients. One of the core objectives requires providers who transition or refer a patient to another setting of care or provider of care to provide a summary of care record for more than 50% of those transitions of care and referrals. Additionally, there are new requirements for the electronic exchange of summary of care documents: for more than 10% of transitions and referrals of the patient to another setting of care or provider of care must provide a summary of care record electronically.

The new Stage 2 menu objectives include:

  1. Record electronic notes in patient records
  2. Imaging results accessible through certified EHR technology (CEHRT)
  3. Record patient family health history
  4. Identify and report cancer cases to a state cancer registry (for EPs only)
  5. Identify and report specific cases to a specialized registry (other than a cancer registry)

All of the above are new Stage 2 objectives; however there are 17 core objectives, and EPs can choose three menu objectives from a choice of six.


[1] Mithi Govil, Carla Wood, and Thomas R. Barr. “Achieving Meaningful Use and Operational Efficiency.” Presented at the Cancer Center Business Summit, Chicago, October 13-14, 2011.

[2] David Eagle, MD, Thomas R. Barr, MBA. Achieving Meaningful Use of Electronic Health Records for the Oncologist. ONCOLOGY. Vol. 25 No. 8 July 11, 2011.

[3] Stage 2, Centers for Medicare and Medicaid Services, http://www.cms.gov/Regulations-and-Guidance/Legislation/EHRIncentivePrograms/Stage_2.html

Oncology Practices Be Prepared! Meaningful Use Stage 2 Is Here! Well Almost

Oncology-specific EMR with Patient Portal & Meaningful Use Training Provide Attestation Answers

Stage 2 Core & Menu Objectives

17 Core Objectives Requirements & Choice of 3 Menu Objectives Reporting

  1. Use computerized provider order entry (CPOE) for medication, laboratory and radiology orders
  2. Generate and transmit permissible prescriptions electronically (eRx)
  3. Record demographic information
  4. Record and chart changes in vital signs
  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
  8. Provide clinical summaries for patients for each office visit
  9. Protect electronic health information created or maintained by the CEHRT
  10. Incorporate clinical lab-test results into CEHRT
  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
  13. Use CEHRT to identify patient-specific education resources
  14. Perform medication reconciliation
  15. Provide summary of care record for each transition of care or referral
  16. Submit electronic data to immunization registries
  17. Use secure electronic messaging to communicate with patients on relevant health information

Choose 3 of 6 Menu Objectives:

  1. Submit electronic syndromic surveillance data to public health agencies
  2. Record electronic notes in patient records
  3. Imaging results accessible through CEHRT
  4. Record patient family health history
  5. Identify and report cancer cases to a State cancer registry
  6. Identify and report specific cases to a specialized registry (other than a cancer registry)

Stage 2 & Patient Use Expectations & CQM

Higher Patient Use of Technology & Quality Measures Electronic Submission

Stage 2 measures also include Patient Access Objectives to use health information technology (HIT). EPs are expected to encourage patient use of HIT with the goal to further the patient’s own healthcare. Core objectives include providing patients the ability to view online, download and transmit their health information with more than 5% of patients seen by the EP and use secure electronic messaging to communicate with patients on relevant health information. The secure message must be sent using the electronic messaging function of the certified EHR by more than 5% of unique patients seen by the EP during the EHR reporting period, according to CMS.

All providers are required to report on clinical quality measures (CQMs) in order to demonstrate meaningful use. Beginning in 2014, all providers regardless of their stage of MU use will report on CQMs in the same way and the EP is required to report on 9 out of 64 total CQMs.

CQMs are to be selected from at least three of the six key health care policy domains recommended by the Department of HHS National Quality Strategy:

  1. Patient and Family Engagement
  2. Patient Safety
  3. Care Coordination
  4. Population and Public Health
  5. Efficient Use of Healthcare Resources
  6. Clinical Processes/Effectiveness

In 2014, all Medicare-eligible providers beyond their first year of demonstrating MU must electronically report their CQM data to CMS. What’s available to oncologists to aid their information, education, transition, and support of HIT use?

Is HIT A Long Road for Oncologists to Adopt EMR Technology?

EHR MU Education & Use Available Information

Using a certified-as-complete EHR for meeting MU in 2011 was immensely successful in aiding physicians to adopt and use EMR technology.  In September 2012, CMS[4] reports a total of $6.9 billion in incentives paid out to EPs and hospitals for successfully attesting to MU with their certified EHR. And available certified-as-complete EHRs are well-known and established in the oncology market. An oncology-specific EMR was first initiated in 1993[5] and in the past two decades, both web-based and client server oncology-specific EMR technology were developed. Physician adoption escalated with EMR web-based technology that incorporated ePrescribing, patient portal, and Meaningful Use training inclusion without additional costs and that avoided server costs and additional onsite or outsourced technology resources.

In 2009, the Health Information Technology for Economic and Clinical Health (HITECH) Act was enacted as part the ARRA of 2009. The final rule for ARRA/HITECH MU incentives for Stage 1 was released July 2010. EMR developers were required to achieve certification as a complete EHR for meeting MU measurements[6] in order for EPs to successfully attest to MU.  

There’s worthwhile news in the support to practices[7] to further assist oncology practices with understanding MU and attestation. CMS initiated a Listserv for program information that also includes attestation registration, updates, and the payment process specifics[8] and well as CMS provides several tipsheets[9] on an overview of Stage 2 and 2014 CQM as readily available.

ARRA incentive payments will be provided to EPs for achieving MU for several years to come. Ultimately, there will be reduced reimbursement to EPs for failing to use a certified EHR and attesting to MU use. Undoubtedly, this may not come as welcome news to an oncologist who is already feeling that expectations are expanding, and with heightened complexity and scrutiny.

The upside is that oncology-specific EMRs represent progressing prospective opportunities to arm the oncologist with quick access to knowledge of their patient population, treatments, and patient response as well as empower their patients or respective identified caregivers to be involved in accessing the health information.

There’s also power and revenue considerations to the oncologist in readily available clinical reporting knowledge and identification of patients for inclusion or exclusion of clinical trials, whether for the industry, government regulations, payer requirements, or claim denials. All of these initiatives are already on the radar screen or may be lurking on the horizon, however with these, CMS is providing oncologists with the roadmap[10]!

By: Barbara Robbins

Barbara Robbins, RN, BSN, MBA is a frequent author in oncology-specific EMR implementation, practice workflow changes, and ROI. She has presented oncology-specific EMR topics and ROI modeling analysis at both oncology and technology professional conferences. Ms. Robbins is the director of marketing with Altos Solutions, Inc., Los Altos, CA. USA.




Altos Solutions is the pioneer in web-based oncology software applications focusing on intuitive Electronic Medical Records, Practice Management, and Patient and Provider Portals that provide high-quality oncology-specific features with low-cost implementation. Oncology Metrics, a division of Altos Solutions, Inc., fosters a network of oncology practices to provide a platform of knowledge-based products and services. With an installed base of more than 1,000 oncology providers and thousands of daily users, OncoEMR™ is the answer for all oncology practices from the solo practitioner oncologist to multi-location cancer centers. Altos Solutions is headquartered in Los Altos, California, USA. To learn more about Altos Solutions, call (888) 662-6367 or 888-OncoEMR, or visit www.altossolutions.com


[4] Government Health IT. CMS EHR incentive payments flirt with $7 billion. September 2012

[5] Vital Software, Inc., in 1993. http://altossolutions.com/About_Us.htm

[7] Wood, C. C. (2011). “10 Steps to Achieve Meaningful Use.” Innovation and Change for Community Oncology. Oncology Practice Management, 1(4). December. http://www.valuebasedcancer.com/opm/article/10-steps-achieve-%E2%80%9Cmeaningful-use%E2%80%9D



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