Clock Running on Comment Period for Meaningful Use Stage 3 Measures

by Davis Wright Tremaine LLP

[authors: Sarah S. Fallows, Adam H. Greene, Jane Eckels, Rebecca L. Williams]

On Nov. 16, 2012, the Office of the National Coordinator for Health Information Technology (ONC) released a request for comment regarding Stage 3 meaningful use measures, taking a step forward in the ongoing effort to define “meaningful use” of electronic health records (EHR) for purposes of Medicare and Medicaid incentive programs. The public is being asked to opine on the readiness and feasibility of new objectives and measures in three areas: (1) meaningful use; (2) quality; and (3) privacy and security.

The comment period ends at 11:59 p.m. Eastern time on Jan. 14, 2013, after which the ONC intends to hold additional public meetings in the first quarter of 2013. It is important to note that while meaningful use is described as an incentive program, providers who are not meaningful users by 2014 are currently scheduled to undergo “adjustments” decreasing Medicare Part B professional fees by 1 percent in 2015, 2 percent in 2016, and 3 percent in 2017, with further potential decreases beyond 2017. Accordingly, the requirements of Stage 3 likely will impact all Medicare health care providers at some later date.

Meaningful use objectives and measures
The measures subject to comment are provided in a grid format that compares the Stage 2 Final Rule with Stage 3 recommendations, and in some cases includes measures proposed for future stages. Notable new or revised meaningful use objectives and measures for Stage 3 include:

  • Using computerized provider order entry (CPOE) for referrals/transition of care orders directly entered by qualified licensed healthcare professionals (Stage 2 required CPOE only for medication, laboratory and radiology orders);
  • Implementing 15 clinical decision support interventions or guidance related to five or more clinical quality measures that are presented at a relevant point in patient care for the entire EHR reporting period (an increase from the five required in Stage 2); and
  • Providing patients the ability to submit patient-generated health information and request an amendment to their health record online (an online means for requesting amendments new for Stage 3).

In addition, some meaningful use objectives and measures are facing retirement, including:

  • Recording patient demographics;
  • Recording and charting changes in vital signs; and
  • Recording smoking status for patients 13 years old and older.

Quality measures
The comment period also affords stakeholders the opportunity to comment on the appropriateness of the fundamental mission and five key attributes for Stage 3 clinical quality measures (CQM):

Promoting the capabilities of EHRs to capture relevant data and calculate report measures efficiently to improve quality of care by:

  • Leveraging data routinely captured during the process of care;
  • Addressing measures for public reporting and quality improvement meaningful at the point of care;
  • Avoiding “hard coding” measures into the EHR;
  • Shifting quality measurement and reporting from human chart reviews to machine-automated;
  • Building flexibility into the system to account for new or revised measures.

The ONC requested feedback on how expansion of the features of the CQM set could be done in ways to minimize the health care costs and burdens on health care providers.

Privacy and security
Questions open for comment regarding privacy and security focus on multi-factor provider authentication for provider users remotely accessing protected health information, security risk issues (if any) that should be subject to meaningful use attestation in Stage 3, and standards for accounting of disclosures.

Providing comments
A copy of the request for comments is available here. Comments are due by the end of Jan. 14, 2013. If you are interested in assistance with filing comments, or would like more information, please contact one of the attorneys listed below.

For more information, please contact Sarah Fallows at (213) 633-6879 or sarahfallows@dwt.comJane Eckels at (206) 757-8037 or janeeckels@dwt.comAdam Greene at (202) 973-4213 or, or Becky Williams at (206) 757-8171 or


DISCLAIMER: Because of the generality of this update, the information provided herein may not be applicable in all situations and should not be acted upon without specific legal advice based on particular situations.

© Davis Wright Tremaine LLP | Attorney Advertising

Written by:

Davis Wright Tremaine LLP

Davis Wright Tremaine LLP on:

Readers' Choice 2017
Reporters on Deadline

"My best business intelligence, in one easy email…"

Your first step to building a free, personalized, morning email brief covering pertinent authors and topics on JD Supra:
Sign up using*

Already signed up? Log in here

*By using the service, you signify your acceptance of JD Supra's Privacy Policy.
Custom Email Digest
Privacy Policy (Updated: October 8, 2015):

JD Supra provides users with access to its legal industry publishing services (the "Service") through its website (the "Website") as well as through other sources. Our policies with regard to data collection and use of personal information of users of the Service, regardless of the manner in which users access the Service, and visitors to the Website are set forth in this statement ("Policy"). By using the Service, you signify your acceptance of this Policy.

Information Collection and Use by JD Supra

JD Supra collects users' names, companies, titles, e-mail address and industry. JD Supra also tracks the pages that users visit, logs IP addresses and aggregates non-personally identifiable user data and browser type. This data is gathered using cookies and other technologies.

The information and data collected is used to authenticate users and to send notifications relating to the Service, including email alerts to which users have subscribed; to manage the Service and Website, to improve the Service and to customize the user's experience. This information is also provided to the authors of the content to give them insight into their readership and help them to improve their content, so that it is most useful for our users.

JD Supra does not sell, rent or otherwise provide your details to third parties, other than to the authors of the content on JD Supra.

If you prefer not to enable cookies, you may change your browser settings to disable cookies; however, please note that rejecting cookies while visiting the Website may result in certain parts of the Website not operating correctly or as efficiently as if cookies were allowed.

Email Choice/Opt-out

Users who opt in to receive emails may choose to no longer receive e-mail updates and newsletters by selecting the "opt-out of future email" option in the email they receive from JD Supra or in their JD Supra account management screen.


JD Supra takes reasonable precautions to insure that user information is kept private. We restrict access to user information to those individuals who reasonably need access to perform their job functions, such as our third party email service, customer service personnel and technical staff. However, please note that no method of transmitting or storing data is completely secure and we cannot guarantee the security of user information. Unauthorized entry or use, hardware or software failure, and other factors may compromise the security of user information at any time.

If you have reason to believe that your interaction with us is no longer secure, you must immediately notify us of the problem by contacting us at In the unlikely event that we believe that the security of your user information in our possession or control may have been compromised, we may seek to notify you of that development and, if so, will endeavor to do so as promptly as practicable under the circumstances.

Sharing and Disclosure of Information JD Supra Collects

Except as otherwise described in this privacy statement, JD Supra will not disclose personal information to any third party unless we believe that disclosure is necessary to: (1) comply with applicable laws; (2) respond to governmental inquiries or requests; (3) comply with valid legal process; (4) protect the rights, privacy, safety or property of JD Supra, users of the Service, Website visitors or the public; (5) permit us to pursue available remedies or limit the damages that we may sustain; and (6) enforce our Terms & Conditions of Use.

In the event there is a change in the corporate structure of JD Supra such as, but not limited to, merger, consolidation, sale, liquidation or transfer of substantial assets, JD Supra may, in its sole discretion, transfer, sell or assign information collected on and through the Service to one or more affiliated or unaffiliated third parties.

Links to Other Websites

This Website and the Service may contain links to other websites. The operator of such other websites may collect information about you, including through cookies or other technologies. If you are using the Service through the Website and link to another site, you will leave the Website and this Policy will not apply to your use of and activity on those other sites. We encourage you to read the legal notices posted on those sites, including their privacy policies. We shall have no responsibility or liability for your visitation to, and the data collection and use practices of, such other sites. This Policy applies solely to the information collected in connection with your use of this Website and does not apply to any practices conducted offline or in connection with any other websites.

Changes in Our Privacy Policy

We reserve the right to change this Policy at any time. Please refer to the date at the top of this page to determine when this Policy was last revised. Any changes to our privacy policy will become effective upon posting of the revised policy on the Website. By continuing to use the Service or Website following such changes, you will be deemed to have agreed to such changes. If you do not agree with the terms of this Policy, as it may be amended from time to time, in whole or part, please do not continue using the Service or the Website.

Contacting JD Supra

If you have any questions about this privacy statement, the practices of this site, your dealings with this Web site, or if you would like to change any of the information you have provided to us, please contact us at:

- hide
*With LinkedIn, you don't need to create a separate login to manage your free JD Supra account, and we can make suggestions based on your needs and interests. We will not post anything on LinkedIn in your name. Or, sign up using your email address.