Achieving Meaningful Use Standards

Overview

The Centers for Medicare and Medicaid Services (CMS) have adopted a phased approach to achieving meaningful use of Health Information Technology and Exchange consisting of the following stages:

  • Stage 1: Capture data in a coded format.
  • Stage 2: Expand upon the Stage 1 criteria in the areas of disease management, clinical decision support, medication management, support for patient access to their health information, transitions in care, quality measurement and research, and bi-directional communication with public health agencies.
  • Stage 3: Achieve improvements in quality, safety, and efficiency, focusing on decision support for national high priority conditions, patient access to self-management tools, access to comprehensive patient data, and improving population health outcomes.

Achieving Stage 1 Standards

The table below provides a summary of actions required to meet the Stage 1 standards for meaningful use of HIT/HIE. The table lists each of the Health Outcomes Policy Priorities and the objectives for each priority. There are separate objectives for eligible providers, and eligible hospitals, and Critical Access Hospitals (CAHs). In addition, the table lists the measurement standards for each objective and explains the changes that have been made from the original proposed rule.

For both types of providers achieving Stage 1 requires demonstration of the meaningful use of an EHR in each of the five "core" healthcare outcome priorities. In addition, eligible providers and hospitals must meet at least five of the 10 objectives in the "menu" set of Health Outcomes Policy Priorities. At least one of the five objectives chosen must become from the priority area of "Improving Population and Public Health". The items not chosen from the menu set will be deferred to Stage 2 of the program.

  1. Core Health Outcomes
  2. Menu Set Health Outcomes

Core Health Outcomes Policy Priorities for Stage 1 Meaningful Use

Health Outcomes Policy Priority

Stage 1 Objectives for Eligible ProfessionalsStage 1 Objectives for Eligible Hospitals and CAHStage 1 MeasuresChanges from Proposed Rule

Improving quality, safety, and efficiency, and reducing health disparities

Use CPOE for medication orders directly entered by any licensed healthcare professional who can enter orders into the medical record per state, local and professional guidelines.Use CPOE for medication orders directly entered by any licensed healthcare professional who can enter orders into the medical record per state, local and professional guidelines.More than 30% of unique patients with at least one medication in their medication list seen by the EP or admitted to the eligible hospital's or CAH's inpatient or emergency department (POS 21 or 23) have at least one medication order entered using CPOE.
  • Clarified terms of order entry within objective
  • Reduced threshold for EPs from 80% of all orders
  • Increased threshold for hospitals from 10% of all orders

Implement drug-drug and drug-allergy interaction checks.

Implement drug-drug and drug-allergy interaction checks.

The EP/eligible hospital/CAH has enabled this functionality for the entire EHR reporting period.

  • Moved drug formulary checks to menu set.

Generate and transmit permissible prescriptions electronically (eRx)

N/A

More than 40% of all permissible prescriptions written by the EP are transmitted electronically using certified EHR technology.

  • Reduced threshold from 75%.
Recorded demographics:
  • Preferred language
  • Gender
  • Race
  • Ethnicity
  • Date of birth
Recorded demographics:
  • Preferred language
  • Gender
  • Race
  • Ethnicity
  • Date of birth
  • Date and preliminary cause of death in the event of mortality in the eligible hospital or CAH

More than 50% of all unique patients seen by the EP or admitted to the eligible hospital's or CAH's inpatient or emergency department (POS 21 or 23) have demographics recorded as structured data.

  • Deleted requirement to record insurance type
  • Reduced threshold from 80%
  • Clarified reporting of cause of death

Maintain an up-to-date problem list of current and active diagnoses.

Maintain an up-to-date problem list of current and active diagnoses

More than 80% of all unique patients seen by the EP or admitted to the eligible hospital's or CAH's inpatient or emergency department (POS 21 or 23) have at least one entry or an indication that no problems are known for the patient recorded as structured data.

  • Removed reference to ICD-9-CM and SNOMED (described in the EHR standard rule)

Maintain active medication list

Maintain active medication list

More than 80% of all unique patients seen by the EP or admitted to the eligible hospital's or CAH's inpatient or emergency department (POS 21 or 23) have at least one entry (or an indication that the patient is not currently prescribed any medication) recorded as structured data

  • Modified measure from "at least" 80%

Maintain active medication allergy list

Maintain active medication allergy list

More than 80% of all unique patients seen by the EP or admitted to the eligible hospital's or CAH's inpatient or emergency department (POS 21 or 23) have at least one entry (or an indication that the patient has no known medication allergies) recorded as structured data

N/A
Record and chart changes in vital signs:
  • Height
  • Weight
  • Blood pressure
  • Calculate and display BMI
  • Plot and display growth charts for children 2 to 20 years, including BMI
Record and chart changes in vital signs:
  • Height
  • Weight
  • Blood pressure
  • Calculate and display BMI
  • Plot and display growth charts for children 2 to 20 years, including BMI

For more than 50% of all unique patients age 2 and overseen by the EP or admitted to eligible hospitals or CAH's inpatient or emergency department (POS 21 or 23), height, weight, and blood pressure are recorded as structured data.

  • Reduced threshold from 80%
  • Added height and weight to measure
  • Removed BMI and growth chart from measure
  • Added structured data to measure

Record smoking status for patients 13 years of age or older

Record smoking status for patients 13 years of age or older

More than 50% of all unique patients 13 years of age or older seen by the EP or admitted to the eligible hospital's or CAH's inpatient emergency department (POS 21 or 23) have smoking status recorded as structured data

  • Reduced threshold from 80%
  • Added structured data to measure

Implement one clinical decision support rule relevant to specialty or high clinical priority along with the ability to track compliance with that rule

Implement one clinical decision support rule related to a high priority hospital condition along with the ability to track compliance with that rule

Implement one clinical decision support rule

Reduced threshold from 5

Report ambulatory clinical quality measures to CMS or the States

Report hospital clinical quality measures to CMS or the States

For 2011, provide aggregate numerator, denominator and exclusions through attestation as discussed in section II(A)(3) of this final rule.
For 2012, electronically submit the clinical quality measures as discussed in section II(A)(3) of this final rule.

No change

Engage patients and families in their health care

Provide patients with an electronic copy of their health information (including diagnostic test results, problem list, medication lists, medication allergies) upon request

Provide patients with an electronic copy of their health information (including diagnostic test results, problem list, medication lists, medication allergies) upon request

More than 50% of all patients of the EP or the inpatient or emergency departments of the eligible hospital or CAH (POS 21 or 23) who request an electronic copy of their health information are provided it within 3 business days.

  • Amended objective to read "medication allergies"
  • Reduced threshold from 80%
  • Lengthened time requirement from 48 hours

Provide patients with an electronic copy of their discharge instructions at time of discharge, upon request

More than 50% of all patients who are discharged from an eligible hospital or CAH's inpatient department or emergency department (POS 21 or 23) and who request an electronic copy of their discharge instructions are provided it

  • Removed requirement to provide copy of procedures
  • Reduced threshold from 80%
  • Specified both inpatient and emergency department discharges

Provide clinical summaries for patients for each office visit

N/A

Clinical summaries provided to patients for more than 50% of all office visits within 3 business days

  • Reduced threshold from 80%
  • Added time requirement of 3 business days

Improve care coordination

Capability to exchange key clinical information (for example, problem lists, medication lists, medication allergies, diagnostic test results) among providers of care and patient authorized entities electronically

Capability to exchange key clinical information (for example, discharge summary, procedures, problem list, medication list, medication allergies, diagnostic test results) among providers of care and patient authorized entities electronically

Performed at least one test of certified EHR technology's capacity to electronically exchange key clinical information

  • Amended objective to read "medication allergies"

Ensure adequate privacy and security protections for personal health information

Protect electronic health information created or maintained by the certified EHR technology through the implementation of appropriate technical capabilities

Protect electronic health information created or maintained by the certified EHR technology through the implementation of appropriate technical capabilities

Conduct or review a security risk analysis per 45 CFR 164.308(a)(1) and implement security updates as necessary and correct identified security deficiencies as part of its risk management process

  • Added requirement to correct deficiencies