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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 2014. 

REQUIRED CHANGES for All Providers in 2015

Patient Electronic Access

Change: Addition of new core objective to provide patients with ability to view online,download, and transmit health information for all providers
Timing/Compliance: Added for 2014 and beyond
Affected Providers: Eligible professionals, eligible hospitals, and CAHs
What It Means: To better align Stage 1 objectives with the new 2014 capabilities of Certified EHR Technology, several Stage 1 objectives for providing electronic copies of and electronic access to health information have been replaced with objectives to provide patients the ability to view, download, or transmit their health information or hospital admission information online

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 eligible professional.

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

REQUIRED for All Providers in 2014
Record and Chart Changes in Vital Signs*
Change: Increase in age limit for recording blood pressure in patients to age 3; removal
of age limit requirement for height and weight
Timing/Compliance: Required in 2014 and beyond
Affected Providers: Eligible professionals, eligible hospitals, and CAHs
What It Means: In 2014, all providers must report using the new age limits below

New Measure:
More than 50 percent of all unique patients seen by the eligible professional 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.
*Exclusion for eligible professionals for Record and Chart Changes in Vital Signs also changed. 

REQUIRED for Eligible Professionals in 2015
Record and Chart Changes in Vital Signs
Change: Exclusion for eligible professionals: if they see no patients 3 years or older; if all three vital signs are not relevant to their scope of practice; if height and weight are not relevant to their scope of practice; or if blood pressure is not relevant to their scope of practice.
Timing/Compliance: Replaces prior exclusion criteria starting in 2014
Affected Providers: Eligible professionals
What It Means: Previously, eligible professionals could only exclude this objective if all three vital signs were not relevant to their scope of practice or if they saw no patients 3 years or older. Beginning in 2014, eligible professionals can be excluded from recording blood pressure if blood pressure is not relevant to their scope of practice, or from recording height and weight if both height and weight are not relevant to their scope of practice
Exclusion: Eligible professionals who: See no patients 3 years or older are excluded from recording blood pressure;
Believe that all three vital signs of height, weight, and blood pressure have no relevance to their scope of practice are excluded from recording them; Believe that height and weight are relevant to their scope of practice, but blood
pressure is not, are excluded from recording blood pressure; or Believe that blood pressure is relevant to their scope of practice, but height and weight are not, are excluded from recording height and weight.

REMOVED for All Providers in 2014
Electronic Copy of Health Information Change: Removal of electronic copy of health information core objective for Stage 1 for all providers
Timing/Compliance: Removed in 2014 and beyond
Affected Providers: Eligible professionals, eligible hospitals, and CAHs
What It Means: Providers will no longer have to meet or attest to this objective for the EHR
Incentive Programs, but will now meet the patient electronic access objective.

Objective Removed:
Beginning in 2014, the objective for providing electronic copies of health information will no longer be required for Stage 1 for eligible professionals, eligible hospitals, and CAHs. CMS is replacing this objective 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.


REMOVED for All Providers in 2015
Clinical Quality Measures
Change: Removal of clinical quality measure (CQM) as a separate core objective for Stage 1 for all providers
Timing/Compliance: Removed in 2014 and beyond Affected Providers: Eligible professionals, eligible hospitals, and CAHs
What It Means: Providers will no longer have to meet or attest to this objective for the EHR Incentive Programs, but are still required to report CQMS to achieve meaningful use.

Objective Removed:
Beginning in 2014, the separate objective to report clinical quality measures (CQMs) will no longer be required for Stage 1 for eligible professionals, eligible hospitals, and CAHs. Reporting CQMs will still be required in order to achieve meaningful use.

REMOVED for Eligible Professionals in 2014
Electronic Access to Health Information
Change: Removal of electronic access to health information menu objective for Stage 1 for eligible professionals
Timing/Compliance: Removed in 2014 and beyond
Affected Providers: Eligible professionals
What It Means: Eligible professionals will no longer have to meet or attest to this objective for the EHR Incentive Programs, but will now meet the new patient electronic access objective.

Objective Removed:
Beginning in 2014, the menu objective for timely electronic access to health information will no longer be required for Stage 1 for eligible professionals. CMS is replacing this objective and electronic copy of health information with objective to provide patients the ability to view, download, or transmit their health information online.

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 the ability to view, print and transmit an electronic copy of their health information, 
  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 the ability to view, print and transmit an electronic copy of their health information, 
  14. Provide patients with the ability to view, print and transmit 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

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)

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

(Required)

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

2013 Only

(Optional)

 

 

 

 

2014 – Onward (Required)

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)

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)

 

Stage 1 Objective

Changes to Objective

Effective Year (CY/FY)

Report ambulatory/hospital

clinical quality measures to

CMS or the States

Change: Objective is incorporated directly into the

definition of a meaningful EHR user and eliminated as an objective

2013 –

Onward

(Required)

EP and Hospital Objectives:

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.

 

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

 

 

 

 

 

 

Hospital Objective: Provide patients with an electronic copy of their discharge instructions

at time of discharge, upon

request.

Change: Replace these four objectives with the Stage 2

objective and one of the two Stage 2 measures.

 

 

 

 

 

 

 

 

 

 

 

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.

 

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.

 

 

 

 

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

 

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.

2014 –

Onward

(Required)

 

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.

 

 

 

 

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