The Meaningful Use (MU) program was a major United States federal incentive initiative established under the Health Information Technology for Economic and Clinical Health (HITECH) Act of 2009. Designed to encourage healthcare providers to adopt and effectively utilize Certified Electronic Health Record (EHR) Technology (CEHRT), the program offered financial incentives through Medicare and Medicaid. The Centers for Medicare & Medicaid Services (CMS) sought to improve the quality, safety, and efficiency of patient care. The program was rolled out in phases, with each stage building upon the last to drive increasing sophistication in the use of health information technology.
Defining Stage 2 Requirements
Meaningful Use Stage 2, effective for most providers in 2014, represented a significant shift from Stage 1. While Stage 1 focused on the basic electronic capture and sharing of patient data, Stage 2 targeted advanced clinical processes and active data exchange. Progression was cumulative; providers had to continue meeting all prior objectives while adopting the new, more complex requirements. CMS designed this stage to push providers past simple adoption into the active, beneficial use of their certified EHR systems.
The new requirements introduced considerably higher compliance thresholds. Objectives optional in Stage 1, such as computerized provider order entry (CPOE), became mandatory core objectives in Stage 2. The required reporting period was extended from 90 days to a full calendar or fiscal year in subsequent years for most participants. Eligible Professionals (EPs) were required to meet 17 core objectives, alongside a selection of menu objectives, demonstrating a deeper integration of the EHR into their daily clinical workflows.
Emphasis on Patient Electronic Access
One of the two primary pillars of Meaningful Use Stage 2 was a powerful mandate for patient engagement through electronic means. The Stage 1 objective, which required providing an electronic copy of health information upon request, was replaced and expanded. Providers now had to ensure patients could actively view, download, and transmit (VDT) their health information online using a patient portal. This shift empowered patients by giving them direct, timely access to their medical records.
The requirements specified a narrow timeframe for this access. Eligible Professionals had to provide patients with data access within four business days of the information becoming available. For hospitals, this timeframe was 36 hours of discharge. Stage 2 also introduced a participation threshold that measured actual patient use of the system, moving beyond simply offering the technology.
Providers had to demonstrate that more than 5% of unique patients seen during the reporting period actively viewed, downloaded, or securely transmitted their health data. This metric forced providers to educate and encourage patients to use the new electronic tools. Furthermore, a new core objective required EPs to use secure electronic messaging to communicate relevant health information, fostering a more collaborative relationship.
Mandates for Health Information Exchange
The second major functional pillar of Meaningful Use Stage 2 was the significant increase in requirements for health information exchange (HIE) and interoperability. The Stage 1 objective for basic exchange was replaced by the more rigorous “transitions of care” core objective. This requirement focused on the structured electronic transmission of a summary care record when a patient was referred, transferred, or discharged to another provider.
To ensure true interoperability, providers were mandated to use CEHRT to exchange a summary of care document electronically for more than 10% of transitions and referrals. Critically, this exchange had to be conducted with a recipient using technology from a different EHR developer. This measure was designed to break down information silos and ensure patient data could flow seamlessly across diverse, unconnected systems, supporting continuity of care.
To facilitate this structured data flow, the rules defined a common, standardized dataset for all summary care records. This required the use of standardized clinical vocabularies for specific information, such as SNOMED CT for vital signs and RxNorm for medications. By requiring these coded data standards, Stage 2 pushed the industry toward a common language for health data, making it machine-readable and exchangeable. This ensured the receiving provider could easily and accurately incorporate the standardized patient information into their electronic record.
The Transition to MIPS
While Meaningful Use Stage 2 marked a significant achievement, the regulatory environment continued to evolve. Following Stage 2, the program’s structure was reformed under new federal legislation. The Medicare Access and CHIP Reauthorization Act (MACRA) of 2015 created the Quality Payment Program (QPP), which fundamentally restructured how providers were reimbursed.
The Meaningful Use program was integrated into the Merit-based Incentive Payment System (MIPS), a track within the QPP. The objectives of Meaningful Use continued under the Advancing Care Information category. This transition moved the focus from simply demonstrating the use of certified technology to demonstrating improved patient outcomes and value-based care. The foundational requirements established during the Meaningful Use phases, especially interoperability and patient access, became permanent components of the modern healthcare payment system.