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Meaningful Use Stage 1 Requirements

This page provides an overview of the Meaningful Use Stage 1 requirements and changes to those requirements as of 2013.

EHR Incentive Program Timeline

Requirements of Meaningful Use Stage 1

Stage 1 Objectives and Measures Reporting

Eligible Professionals must complete:

  • 13 core objectives (formerly 15)
  • 5 objectives out of 10 from menu set
  • 6 total Clinical Quality Measures (3 core or alternate core, and 3 out of 38 from additional set)

Hospitals must complete:

  • 14 core objectives
  • 5 objectives out of 10 from menu set
  • 15 Clinical Quality Measures

Meaningful Use Core Measures

Eligible Professionals –13 Core Objectives

  1. Computerized provider order entry (CPOE)
  2. E-Prescribing (eRx)
  3. Report ambulatory clinical quality measures to CMS/States (required in 2012)
  4. Implement one clinical decision support rule
  5. Provide patients with an electronic copy of their health information, upon request
  6. Provide clinical summaries for patients for each office visit
  7. Drug-drug and drug-allergy interaction checks
  8. Record demographics
  9. Maintain an up-to-date problem list of current and active diagnoses
  10. Maintain active medication list
  11. Maintain active medication allergy list
  12. Record and chart changes in vital signs
  13. Record smoking status for patients 13 years or older
  14. Capability to exchange key clinical information among providers of care and patient-authorized entities electronically (required in 2012)
  15. Protect electronic health information

Hospitals –14 Core Objectives

  1. Computerized provider order entry (CPOE)
  2. Providers of care and patient-authorized entities electronically
  3. Protect electronic health information.
  4. Drug-drug and drug-allergy interaction checks
  5. Record demographics
  6. Implement one clinical decision support rule
  7. Maintain up-to-date problem list of current and active diagnoses
  8. Maintain active medication list
  9. Maintain active medication allergy list
  10. Record and chart changes in vital signs
  11. Record smoking status for patients 13 years or older
  12. Report hospital clinical quality measures to CMS or States
  13. Provide patients with an electronic copy of their health information, upon request
  14. Provide patients with an electronic copy of their discharge instructions at time of discharge, upon request

 

Meaningful Use Stage 1 Core Measures                     Objectives and Measurements

Health Outcomes Policy Priority

Stage 1 Objective

Stage 1 Measure

Improving quality, safety, 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

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 or CAH have at least one medication entered using CPOE

 

Implement drug-drug and drug-allergy interaction checks

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

 

EP Only: Generate and transmit permissible prescriptions electronically (eRx)

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

 

Record demographics: preferred language, gender, race, ethnicity, date of birth, and 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 or CAHhave demographics as recorded structured data

 

Maintain 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 or CAH have at least one entry or an indication that no problems are known for the patient recorded as structured data

Engage patients and families in their healthcare

 

EPs Only: Provide patients with timely electronic access to their health information (including lab results, problem list, medication lists, medication allergies) within 4 business days of the information being available to the EP

 

 

 

 

Use certified EHR technology to identify patient-specific education resources and provide those resources to the patient, if appropriate

More than 10% of all unique patients seen by the EP are provided timely (available to the patient within 4 business days of being updated in the certified EHR technology) electronic access to their health information subject to the EP’s discretion to withhold certain information.

 

More than 10% of all unique patients seen by the EP or admitted to the eligible hospital or CAH are provided patient-specific education resources

 

Improve care coordination

 

The EP, eligible hospital or CAH 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, eligible hospital or CAH performs medication reconciliation for more than 50% of transitions of care in which the patient is transitioned into the care of the EP or admitted to the eligible hospital or CAH

 

The EP, eligible hospital or CAH who receives a patient from another setting of care or provider of care or refers their patient to another provider of care should provide a summary of care record for each transition of care or referral

The EP, eligible hospital or CAH who transitions or refers their patient to another setting of care or provider of care provides a summary of care record for more than 50% of transitions of care and referrals

 

Meaningful Use: Menu Set Objectives

Menu objectives –may defer 5 of 10

Beginning in 2014, EPs, eligible hospitals, and CAHs will no longer be permitted to count an exclusion toward the minimum of 5 menu objectives on which they must report if there are other menu objectives which they can select. In other words, a provider cannot select a menu objective and claim an exclusion for it if there are other menu objectives they can meet.

EPs, eligible hospitals, and CAHs will not be penalized for selecting a menu objective and claiming the exclusion if they would also qualify for the exclusions for all the remaining menu objectives. For example, EPs who must select to test the capability to submit data to either an immunization registry or a syndromic surveillance database as one of their menu objectives can select the menu objective for submitting data to an immunization registry and claim the exclusion if they would also be able to claim the exclusion for submitting data to a syndromic surveillance database. They would not be penalized for claiming this exclusion.

Eligible Professionals –10 Menu Objectives

  1. Drug-formulary checks
  2. Incorporate clinical lab test results as structured data
  3. Generate lists of patients by specific conditions
  4. Send reminders to patients per patient preference for preventive/follow up care
  5. Provide patients with timely electronic access to their health information
  6. Use certified EHR technology to identify patient-specific education resources and provide to patient, if appropriate
  7. Medication reconciliation
  8. Summary of care record for each transition of care/referrals
  9. Capability to submit electronic data to immunization registries/systems*
  10. Capability to provide electronic syndromic surveillance data to public health agencies*
  11. At least 1 public health objective must be selected.

Public Health Reporting Objectives

Beginning in 2013, all of the Stage 1 public health objectives (submitting data to an immunization registry, submitting data to a syndromic surveillance database, or submitting reportable lab results to a public health agency) will require that providers perform at least one test of their Certified EHR Technology’s capability to send data to public health agencies, except where prohibited. The intent of this modification is to encourage all EPs, eligible hospitals, and CAHs to submit public health data, even when not required by State/local law.

Therefore, if providers are authorized to submit the data, they should do so even if it is not required by either law or practice. If the test of submission is successful, provider should institute regular reporting with the entity with whom the successful test was conducted.

 

Stage 1 Objective

Changes to Objective

Effective Year (CY/FY)

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

Change: Addition of an alternative measure

More than 30 percent of medication orders created by the EP or authorized providers of the eligible hospital's or CAH's inpatient or emergency department (POS 21 or 23) during the EHR reporting period are recorded using CPOE

2013 - Onward (Optional)

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

Change: Addition of an alternative measure

More than 30 percent of medication orders created by the EP or authorized providers of the eligible hospital's or CAH's inpatient or emergency department (POS 21 or 23) during the EHR reporting period are recorded using CPOE.

2013 - Onward (Optional)

Generate and transmit permissible prescriptions electronically (eRx)

Change: Addition of an additional exclusion

Any EP who: does not have a pharmacy within their organization and there are no pharmacies that accept electronic prescriptions within 10 miles of the EP's practice location at the start of his/her EHR reporting period.

2013 - Onward (Optional)

Stage 1 Objective Changes to Objective Effective Year (CY/FY) Record and chart changes in vital signs

Change: Age Limitations on Growth Charts and Blood Pressure

More than 50 percent 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) during the EHR reporting period have blood pressure (for patients age 3 and over only) and height and weight (for all ages) recorded as structured data

 

Public Health Objectives:

Change: Addition of "except where prohibited" to the objective regulation text for the public health objectives under § 495.6

2013 – Onward (Required)

Record and chart changes in vital signs

Change: Changing the age and splitting the EP exclusion

Any EP who

(1) Sees no patients 3 years or older is excluded from recording blood pressure;

(2) Believes that all three vital signs of height, weight, and blood pressure have no relevance to their scope of practice is excluded from recording them;

(3) Believes that height and weight are relevant to their scope of practice, but blood pressure is not, is excluded from recording blood pressure; or

(4) Believes that blood pressure is relevant to their scope of practice, but height and weight are not, is excluded from recording height and weight.

 

2013 Only (Optional)

2014 – Onward (Required)

 

Change: Changing the age and splitting the EP exclusion

Any EP who

(1) Sees no patients 3 years or older is excluded from recording blood pressure;

(2) Believes that all three vital signs of height, weight, and blood pressure have no relevance to their scope of practice is excluded from recording them;

(3) Believes that height and weight are relevant to their scope of practice, but blood pressure is not, is excluded from recording blood pressure; or

(4) Believes that blood pressure is relevant to their scope of practice, but height and weight are not, is excluded from recording height and weight.

 

 

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

Change: Objective is no longer required

2013 – Onward (Required)

 

REQUIRED for All Providers in 2013

Public Health Reporting Objectives

Stage 1 Menu Set Objectives and Measurements

Health Outcomes Policy Priority

Stage 1 Objective

Stage 1 Measure

 

Improve population and public health1

Capability to submit electronic data to immunization registries or Immunization Information Systems and actual submission in accordance with applicable law and practice.

Performed at least one test of the certified EHR technology’s capacity to submit electronic data to immunization registries and follow-up submission if the test is successful (unless none of the immunization registries to which the EP, eligible hospital or CAH submits such information have the capacity to receive such information electronically).

 

Hospitals Only: Capability to submit electronic data on reportable (as required by state or local law) lab results to public health agencies and actual submission in accordance with applicable law and practice

Performed at least one test of certified EHR technology’s capacity to provide submission of reportable lab results to public health agencies and follow-up submission if the test is successful (unless none of the public health agencies to which the EP, eligible hospital or CAH submits such information have the capacity to receive such information electronically)

 

Capability to submit electronic syndromic surveillance data to public health agencies and actual submission in accordance with applicable law and practice

Performed at least one test of certified EHR technology’s capacity to provide electronic syndromic surveillance data to public health agencies and follow-up submission if the test is successful (unless none of the public health agencies to which the EP, eligible hospital or CAH submits such information have the capacity to receive such information electronically)

 

 

REMOVED for All Providers in 2013

Electronic Exchange of Key Clinical Information

Objective Removed: Beginning in 2013, the objective for electronic exchange of key clinical information will no longer be required for Stage 1 for EPs, eligible hospitals, and CAHs. Stage 2 will include a more robust requirement for electronic health information exchange as a part of the objective for providing a summary of care record following a transition of care or referral.

Clinical Quality Measures

Eligible Professionals –Alternate Core Set CQMs

NQF Measure Number & PQRI Implementation Number

Clinical Quality Measure Title

NQF 0024

Weight Assessment and Counseling for Children and Adolescents

NQF0041

PQRI 110

Preventive Care and Screening: Influenza
immunization for Patients 50 Years Old or Older

NQF 0038

Childhood Immunization Status

 

Additional Set CQM–EPs must complete 3 of 38

  1. Diabetes: Hemoglobin A1c Poor Control
  2. Diabetes: Low Density Lipoprotein (LDL) Management and Control
  3. Diabetes: Blood Pressure Management
  4. Heart Failure (HF): Angiotensin-Converting Enzyme (ACE) Inhibitor or AngiotensinReceptor Blocker (ARB) Therapy for Left Ventricular Systolic Dysfunction (LVSD)
  5. Coronary Artery Disease (CAD): Beta-Blocker Therapy for CAD Patients with Prior Myocardial Infarction (MI)
  6. Pneumonia Vaccination Status for Older Adults
  7. Breast Cancer Screening
  8. Colorectal Cancer Screening
  9. Coronary Artery Disease (CAD): Oral AntiplateletTherapy Prescribed for Patients with CAD
  10. Heart Failure (HF): Beta-Blocker Therapy for Left Ventricular Systolic Dysfunction (LVSD)
  11. Anti-depressant medication management: (a) Effective Acute Phase Treatment, (b)Effective Continuation Phase Treatment
  12. Primary Open Angle Glaucoma (POAG): Optic Nerve Evaluation
  13. Diabetic Retinopathy: Documentation of Presence or Absence of Macular Edema and Level of Severity of Retinopathy
  14. Diabetic Retinopathy: Communication with the Physician Managing Ongoing Diabetes Care
  15. Asthma Pharmacologic Therapy
  16. Asthma Assessment
  17. Appropriate Testing for Children with Pharyngitis
  18. Oncology Breast Cancer: Hormonal Therapy for Stage IC-IIIC Estrogen Receptor/Progesterone Receptor (ER/PR) Positive Breast Cancer
  19. Oncology Colon Cancer: Chemotherapy for Stage III Colon Cancer Patients
  20. Prostate Cancer: Avoidance of Overuse of Bone Scan for Staging Low Risk Prostate Cancer Patients
  21. Smoking and Tobacco Use Cessation, Medical Assistance: a) Advising Smokers and Tobacco Users to Quit, b) Discussing Smoking and Tobacco Use Cessation Medications, c) Discussing Smoking and Tobacco Use Cessation Strategies
  22. Diabetes: Eye Exam
  23. Diabetes: Urine Screening
  24. Diabetes: Foot Exam
  25. Coronary Artery Disease (CAD): Drug Therapy for Lowering LDL-Cholesterol
  26. Heart Failure (HF): WarfarinTherapy Patients with AtrialFibrillation
  27. Ischemic Vascular Disease (IVD): Blood Pressure Management
  28. Ischemic Vascular Disease (IVD): Use of Aspirin or Another Antithrombotic
  29. Initiation and Engagement of Alcohol and Other Drug Dependence Treatment: a) Initiation, b) Engagement
  30. Prenatal Care: Screening for Human Immunodeficiency Virus (HIV)
  31. Prenatal Care: Anti-D Immune Globulin
  32. Controlling High Blood Pressure
  33. Cervical Cancer Screening
  34. Chlamydia Screening for Women
  35. Use of Appropriate Medications for Asthma
  36. Low Back Pain: Use of Imaging Studies
  37. Ischemic Vascular Disease (IVD): Complete Lipid Panel and LDL Control
  38. Diabetes: Hemoglobin A1c Control (<8.0%)

 

Eligible Hospitals and CAHs must complete all 15:

  1. Emergency Department Throughput –admitted patients Median time from ED arrival to ED departure for admitted patients
  2. Emergency Department Throughput –admitted patients –Admission decision time to ED departure time for admitted patients
  3. Ischemic stroke –Discharge on anti-thrombotic
  4. Ischemic stroke –Anticoagulation for A-fib/flutter
  5. Ischemic stroke –Thrombolytic therapy for patients arriving within 2 hours of symptom onset
  6. Ischemic or hemorrhagic stroke –Antithrombotic therapy by day 2
  7. Ischemic stroke –Discharge on statins
  8. Ischemic or hemorrhagic stroke –Stroke education
  9. Ischemic or hemorrhagic stroke –Rehabilitation assessment
  10. VTE prophylaxis within 24 hours of arrival
  11. Intensive Care Unit VTE prophylaxis
  12. Anticoagulation overlap therapy
  13. Platelet monitoring on unfractionatedheparin
  14. VTE discharge instructions
  15. Incidence of potentially preventable VTE

Additional Measures & Exclusions 2013 - 2014

Computerized Provider Order Entry (CPOE)

Beginning in 2013, CMS is adding an optional alternate measure to the objective for computerized provider order entry (CPOE). The current measure for CPOE is based on the number of unique patients with a medication in their medication list that was entered using CPOE. The new, alternate measure is based on the total number of medication orders created during the EHR reporting period. An EP, eligible hospital, or CAH may select either measure for this objective in Stage 1 in order to achieve meaningful use. (Note that this alternative measure will be required for all providers in Stage 2.)

Alternate Measure:

More than 30 percent of medication orders created by the EP or authorized providers of the eligible hospital's or CAH's inpatient or emergency department (POS 21 or 23) during the EHR reporting period are recorded using CPOE.

Electronic Prescribing

Beginning in 2013, CMS is adding an additional exclusion to the objective for electronic prescribing for providers who are not within a 10 mile radius of a pharmacy that accepts electronic prescriptions. 1

New Additional Exclusion:

Any EP who: does not have a pharmacy within their organization and there are no pharmacies that accept electronic prescriptions within 10 miles of the EP's practice location at the start of his/her EHR reporting period.

Record and Chart Changes in Vital Signs

CMS is changing the measure of the objective for recording and charting changes in vital signs for EPs, eligible hospitals, and CAHs. The current measure specifies that vital signs must be recorded for more than 50 percent of all unique patients ages 2 and over. The new measure amends that age limit to recording blood pressure for patients ages 3 and over and height and weight for patients of all ages.

The exclusions for this objective for EPs are also changing. The current exclusions only allow an EP to claim the exclusion if all three vital signs (height, weight, blood pressure) are not relevant to their scope of practice or if the EP sees no patients 2 years or older. However, under the new Stage 1 changes, an EP can claim an exclusion if the EP sees no patients 3 years or older (the EP would not have to record blood pressure), if all three vital signs are not relevant to their scope of practice (the EP would not record any vital signs), if height and weight are not relevant to their scope of practice (the EP would still record blood pressure), or if blood pressure is not relevant to their scope of practice (the EP would still record height and weight).

This new measure and these new exclusions are optional in 2013 but will be required in 2014 and beyond.

New Measure:

More than 50 percent 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) during the EHR reporting period have blood pressure (for patients age 3 and over only) and height and weight (for all ages) recorded as structured data.

New Exclusion:

Any EP who

1. Sees no patients 3 years or older is excluded from recording blood pressure;

2. Believes that all three vital signs of height, weight, and blood pressure have no relevance to their scope of practice is excluded from recording them;

3. Believes that height and weight are relevant to their scope of practice, but blood pressure is not, is excluded from recording blood pressure; or

4. Believes that blood pressure is relevant to their scope of practice, but height and weight are not, is excluded from recording height and weight.

Electronic Exchange of Key Clinical Information

Beginning in 2013, the objective for electronic exchange of key clinical information will no longer be required for Stage 1 for EPs, eligible hospitals, and CAHs. Providers faced numerous challenges in understanding the requirements for this objective, so we are moving instead to a more robust requirement for electronic health information exchange as a part of the Stage 2 objective for providing a summary of care record following a transition of care or referral.

 

Report Clinical Quality Measures

Beginning in 2014, there will no longer be a separate objective for reporting ambulatory or hospital clinical quality measures as a part of meaningful use. It is important to note, however, that EPs, eligible hospitals, and CAHs will still be required to report on clinical quality measures in order to achieve meaningful use. CMS is simply removing the standalone objective that requires providers to attest that they plan to report on clinical quality measures because it is redundant.

 

Electronic Copy of and Electronic Access to Health Information

In order to better align Stage 1 objectives with the new 2014 capabilities of Certified EHR Technology, CMS is replacing several Stage 1 objectives for providing electronic copies of and electronic access to health information with objectives to provide patients the ability to view, download, or transmit their health information or hospital admission information online. The capability to provide patients online access to this information will be a part of Certified EHR Technology beginning in 2014, therefore the new Stage 1 objectives will be required beginning in 2014.

The following current Stage 1 objectives will be replaced beginning in 2014:

EPs/Hospital Stage 1 Core Objective: Provide patients with an electronic copy of their health information (including diagnostics test results, problem list, medication lists, medication allergies, discharge summary, procedures) upon request.

Hospital Stage 1 Core Objective: Provide patients with an electronic copy of their discharge instructions at time of discharge, upon request.

EP Stage 1 Menu Objective: Provide patients with timely electronic access to their health information (including lab results, problem list, medication lists, and allergies) within 4 business days of the information being available to the EP.

New Objectives and Measures

New EP Objective:

Provide patients the ability to view online, download and transmit their health information within 4 business days of the information being available to the EP.

New EP Measure:

More than 50 percent of all unique patients seen by the EP during the EHR reporting period are provided timely (within 4 business days after the information is available to the EP) online access to their health information subject to the EP's discretion to withhold certain information.

New Hospital Objective:

Provide patients the ability to view online, download and transmit information about a hospital admission.

New Hospital Measure:

More than 50 percent of all patients who are discharged from the inpatient or emergency department (POS 21 or 23) of an eligible hospital or CAH have their information available online within 36 hours of discharge.

Medicare / Medi-cal Incentive Program Timeline

For any other details on the Medicare / Medi-cal Incentive program, go to http://www.cms.gov/EHRIncentivePrograms/

 

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