--Additionally CMS may consider applying the criteria more broadly to all outpatient hospital settings, not just the emergency department.
CMS expects the Stage 2 meaningful use requirements will include more demanding requirements for e-prescribing and incorporating structured laboratory results, as well as providers electronically transmitting patient care summaries to support transitions in care--so the record "follows" the patient.

Stage 3: The criteria expected to go in effect in 2015 will focus on:
--Promoting improvements in quality, safety and efficiency, leading to improved health outcomes;

--Decision support for national high-priority conditions;

--Patient access to self-management tools; and

--Access to comprehensive patient data through a robust, patient-centered health information exchange and improving population health.

CMS is not finalizing Stage 2 or Stage 3 at this time, but plans to build upon Stage 1 by increasing the expectations of the functionalities in Stage 1 and adding new objectives for Stage 2. In the next rule-making, every objective in the menu set for Stage 1 will likely be included in Stage 2 as part of the core set.

The Core Objectives

The final rule has a set of core objectives for meaningful use in Stage 1, 15 for eligible professionals and 14 for hospitals. The core objectives are:

--Use of CPOE;

--Implementing drug to drug and drug allergy interaction checks;

--E-Prescribing (EPs only);

--Recording patient demographics;

--Maintaining an up-to-date problem list;

--Maintaining an active medication list;

--Maintaining an active medication allergy list;

--Recording and charting changes in vital signs;

--Recording smoking status;

--Implementing one clinical decision support rule;

--Reporting clinical quality measures;

--Electronically exchanging key clinical information;

--Providing patients with an electronic copy of their health information;

--Providing patients with an electronic copy of their discharge instructions (eligible hospital or critical access hospital only);

--Providing clinical summaries for patients for each office visit (EP Only); and

--Protecting privacy and security of electronic health information.

EPs and hospitals will also have a separate "menu" of 10 additional activities from which five can be chosen to implement in Stage 1; the rest would be deferred to Stage 2.

The additional "menu" activities are:

--Implementing drug formulary checks;

--Recording advance directives for patients 65 years or older (hospitals only);

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