Meaningful Use of Certified EHR Software
What is Meaningful Use of an EHR?
The Centers for Medicare and Medicaid Services (CMS) completed and released a Medicare and Medicaid EHR Incentive Program Final Rule that identifies the criteria for becoming a meaningful user of certified EHR technology. The CMS Final Rule on Meaningful Use became effective on September 27, 2010. Registration for EP and EH programs will begin on January 1, 2011.
For their first year of eligibility under Medicare, EPs will have to attest to having used certified EHR technology for 90 consecutive days in their applicable reporting year, with CMS readiness for first attestations to begin in April 2011. EPs will have to report on the specific meaningful use measures met as well as summary data on applicable quality measures. For those seeking Medicaid incentives, it will only be necessary to demonstrate adoption, implementation or upgrade of certified EHR technology in the first year of incentive payments. Future years will require meaningful use for 365 days and likely electronic reporting of quality measures from the EHR.
Phased implementation of Meaningful Use
Under this phased approach to meaningful use visualized by the Final Rule, the criteria of meaningful use will be updated through future rulemaking. While the initial meaningful use criteria are referred to as ‘‘Stage 1’’, two additional updates, referred to as Stage 2 and Stage 3, respectively, are also expected. The meaningful use criteria are expected to be updated on a biennial basis, with the Stage 2 criteria by the end of 2011 and the Stage 3 criteria by the end of 2013. The stages represent an initial graduated approach to arriving at the ultimate goal.
Meaningful Use – Stage 1
Stage 1 criteria include:
- 15 measures for EPs that require the collection of data to calculate a percentage, which will be the basis for determining if the Meaningful Use objective was met according to a minimum threshold for that objective. These are referred to as the Core Set.
- 10 additional criteria known as the Menu Set. From these set of 10 criteria, EPs have to meet at least five and defer up to five criteria to Stage 2. But Stage 1 must include one public health criterion (either 9 or 10 of the Menu Set)
Meanigful Use Stage 1: Core Set
- 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.
- Implement drug-drug and drug-allergy checks.
- Maintain an up-to-date problem of current and active diagnoses
- Maintain active medication list
- Maintain active medication allergy list
- Generate and transmit permissible prescriptions electronically (eRx).
- Record patient demographics: sex, preferred language, race, ethnicity, and date of birth.
- Record vital signs and chart changes in the following: height, weight, blood pressure, body mass index (BMI), growth charts for children.
- Record smoking status for patients 13 years old or older.
- On request, provide patients with an electronic copy of their health information (including diagnostics test results, problem list, medication lists, medication allergies).
- Provide clinical summaries for patients for each office visit.
- Implement capability to exchange key clinical information among providers and patient authorized entities electronically.
- Implement one clinical decision support rule along with the ability to track compliance with the rule.
- Implement systems to protect privacy and security of patient data in EHR
- Report clinical quality measures to CMS (or, for EPs seeking the Medicaid incentive payment, the States).
Meaningful Use Stage 1: Menu Set
- Generate lists of patients by specific conditions to use for quality improvement, reduction of disparities, research, and outreach.
- Send reminders to patients per patient preference for preventive/follow-up care. (Patient preference refers to the patient's choice of delivery method between internet based delivery or delivery not requiring internet access.)
- Incorporate clinical lab-test results into EHR as structured data.
- Implement drug-formulary checks
- Provide patients with timely electronic access to their health information (including lab results, problem list, medication lists, allergies) within 4 business days of the information being available to the EP either through the receipt of final lab results or a patient interaction that updates the EP's knowledge of the patient's health. (Electronic access may be provided by a number of secure electronic methods like PHR, patient portal, CD, USB drive).
- User certified EHR technology to identify patient-specific education resources and provide those resources to the patient if appropriate.
- The EP who receives a patient from another setting of care or provider of care or believes an encounter is relevant should perform medication reconciliation.
- The EP who transitions their patient to another setting of care or provider of care or refers their patient to another provider of care should provide summary of care record for each transition of care or referral.
- Capability to submit electronic data to immunization registries or Immunization Information Systems and actual submission in accordance with applicable law and practice
- Capability to submit electronic syndromic surveillance data to public health agencies and actual transmission according to applicable law and practice.