Meaningful Use

The HITECH Act defines Meaningful Use to have three main components:

1. The use of a certified EHR in a meaningful manner.
2.  The use of certified EHR technology for electronic exchange of health information to improve quality of health care.
3.  The use of certified EHR technology to submit clinical quality and other measures.

Meaningful use means providers “need to show they’re using certified EHR technology in ways that can be measured significantly in quality and in quantity”.

Medicare EP Meaningful Use Objectives Stage 1

A Medicare Eligible Professional must meet all of the Core Set of Objectives to meet meaningful use. Six core objectives have exclusions that can be taken as meeting the objective.

Core Objectives

1. Use computerized provider order entry for medication orders directly entered by any licensed healthcare provider who can enter orders into the medical record per state, local and provider guidelines

Measure: more than 30 percent of all unique patients with at least one (1) medication in their medication list seen by the EP have at least one (1) medication order entered using CPOE
Exclusions: Any EP who writes fewer than one hundred (100) prescriptions during the EHR reporting period

2. Implement drug-drug and drug-allergy interaction checks

Measure: the EP has enabled this functionality for the entire Electronic Health Record reporting period.
Exclusions: None

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

Measure: more than 80% of all unique patients seen by the EP have at least one (1) entry or an indication that no problems are known for the patient recorded as structured data
Exclusions: None

4. Generate and transmit permissible prescriptions electronically (eRx)

Measure: more than 40% of all permissible prescriptions written by the EP are transmitted electronically using certified Electronic Health Record Technology
Exclusions: Any EP who writes fewer than one hundred (100) prescriptions during the EHR reporting period

5. Maintain an active medication list

Measure: more than 80% of all unique patients seen by the EP have at least one (1) entry (or an indication that the patient is not currently prescribed any medication) recorded as structured data
Exclusions: None

 6. Maintain active medication allergy list

Measure: More than 80% of all unique patients seen by the EP have at least one (1) entry (or an indication that the patient has no known medication allergies) recorded as structured data
Exclusions: None

7. Record all of the following demographics: Preferred language, Gender, Race, Ethnicity, Date of Birth

Measure: More than 50% of all unique patients seen by the EP have demographics recorded as structured data
Exclusions: None

8. Record and chart changes in vital signs: height, weight, blood pressure; calculate and display the Body Mass Index; plot and display growth charts for children 2-20 years, including BMI

Measure: More than 50% of all unique patients age 2 and over seen by the EP have height, weight and blood pressure are recorded as structured data
Exclusions: Any EP who either sees no patients 2 years or older, or who believes that all three vital signs of height, weight, and blood pressure of their patients have no relevance to their scope of practice

9. Record smoking status for patients 13 years or older

Measure: more than 50% of all unique patients 13 years or older seen by the EP have smoking status recorded as structured data
Exclusions: Any EP who sees no patient 13 years or older

10. Report ambulatory clinical quality measures to CMS or, in the case of Medicaid EPs, the States

Measure: Successfully report to CMS ambulatory clinical quality measures selected by CMS in the manner specified (or in the case of Medicaid, the States)
Exclusions: None

11. Implement one (1) clinical decision support rule

Measure: Implement one (1) clinical decision support rule
Exclusions: None

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

Measure: more than 50% of all patients who request an electronic copy of their health information are provided it within 3 business days
Exclusions: Any EP than has no requests from patients or their agents for an electronic copy of patient health information during the EHR reporting period

13. Provide clinical summaries for patient for each office visit

Measure: clinical summaries provided to patients for more than 50% of all office visits within 3 business days
Exclusions: Any EP who has no office visits during the EHR reporting period

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

Measure: Performed at least one (1) test of certified Electronic Health Record technology’s capacity to electronically exchange key clinical information
Exclusions: None

15. Protect electronic health information created or maintained by the certified Electronic Health Record technology through the implementation of appropriate technical capabilities

Measure: 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
Exclusions: None

Menu Objectives

Eligible Professionals must meet all but 5 of Menu Set Objectives, deferring the selected 5 for later stages. Of the objectives being used, you must include one public health objective either #9 or #10. Eight of the ten objectives have exclusions that can be taken to meet the objective.

1. Implement drug-formulary checks

Measure: The EP enabled this functionality and has access to at least one (1) internal or external formulary for the entire Electronic Health Record reporting period
Exclusions: Any EP who writes fewer than 100 prescriptions during the EHR reporting period.

2. Incorporate clinical lab-test results into Electronic Health Record as structured data

Measure: more than 40% of all clinical lab tests results ordered by the EP during the Electronic Health Record reporting period whose results are either in a positive/negative or numerical format are incorporated in certified Electronic Health Record technology as structured data
Exclusions: An EP who orders no lab tests whose results are either in a positive/negative or numerical format during the EHR reporting period

3. Generate lists of patients by specific conditions to use for quality improvement, reduction of disparities, and outreach

Measure: generate at least one (1) report listing patients of the EP with a specific condition
Exclusions: None

4. Send reminders to patients per patient preference for preventive/follow up care

Measure: More than 20% of all patients 65 years or older or 5 years old or younger were sent an appropriate reminder during the Electronic Health Record reporting period
Exclusions: An EP who has no patients 65 years or older or 5 years old or younger with recorded maintained using certified EHR technology

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

Measure: at least 10% of all unique patients seen by the EP are provided timely (available to the patient within 4 business days of the information updated in the certified Electronic Health Record technology) electronic access to their health information, subject to the EP’s discretion to withhold certain information
Exclusions: Any EP that neither orders nor creates any of the information listed at 45 CFR 17-.304(g) during the EHR reporting period

6. Identify patient-specific education resources using certified Electronic Health Record technology and provide those resources to the patient if appropriate

Measure: more than 10% of all unique patients seen by the EP are provided patient-specific resources
Exclusions: None

7. Perform medication reconciliation

Measure: The EP performs medication reconciliation for more than 50% of all transitions of care in which the patient is transitioned into the care of the EP
Exclusions: An EP who was not the recipient of any transitions of care during the EHR reporting period

8. Provide a summary care record for each transition of care or referral

Measure: The EP 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
Exclusions: An EP who neither transfers a patient to another setting nor refers a patient to another provider during the EHR reporting period

9. Capability to submit electronic data to immunization registries or immunization information systems and actual submission according to applicable law and practice

Measure: Performed at least one (1) test of certified Electronic Health Record technology’s capacity to submit electronic data to immunization registries and follow up submission if test is successful (unless none of the immunization registries to which the EP submits such information has the capacity to receive the information electronically)
Exclusions: An EP who administers no immunizations during the EHR reporting period or where no immunization registry has the capacity to receive the information electronically

10. Capacity to submit electronic syndrome surveillance data to public health agencies and actual transmission according to applicable law and practice

Measure: Performed at least one (1) test of the certified Electronic Health Record technology’s capacity to provide electronic syndrome surveillance data to public health agencies and follow up submission if test is successful (unless none of the public health agencies to which an EP or eligible hospital submits such information have the capacity to receive the information electronically)
Exclusions: An EP does not collect any reportable syndrome information on their patients during the EHR reporting period or does not submit such information to any public health agency that has the capacity to receive the information electronically

Medicare Hospital Meaningful Use Objectives Stage 1

Core Objectives

A Medicare Eligible Hospital and Critical Access Hospitals (CAHs) must meet all of the Core Set of Objectives to meet meaningful use. Three core objectives have exclusions that can be taken as meeting the objective.

1. Use computerized provider order entry (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.

Measure: More than 30 percent of all unique patients with at least one medication in their medication list 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.
Exclusions: None

2.Implement drug-drug and drug-allergy interaction checks.

Measure: The eligible hospital or CAH has enabled this functionality for the entire EHR reporting period.
Exclusions: None

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

Measure: More than 80 percent of all unique patients 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.
Exclusions: None

4. Maintain active medication list.

Measure: More than 80 percent of all unique patients 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.
Exclusions: None

5. Maintain active medication allergy list.

Measure: More than 80 percent of all unique patients 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.
Exclusions: None

6. Record all of the following demographics: (A) Preferred language, (B) Gender, (C) Race, (D) Ethnicity, (E) Date of birth, (F) Date and preliminary cause of death in the event of mortality in the eligible hospital or CAH

Measure: More than 50 percent of all unique patients admitted to the eligible hospital’s or CAH’s inpatient or emergency department (POS 21 or 23) have demographics recorded as structured data.
Exclusions: None

7. Record and chart changes in the following vital signs: (A) Height, (B) Weight, (C) Blood pressure, (D) Calculate and display body mass index (BMI), (E) Plot and display growth charts for children 2-20 years, including BMI

Measure: For more than 50 percent of all unique patients age 2 and over admitted to the eligible hospital’s or CAH’s inpatient or emergency department (POS 21 or 23), height, weight, and blood pressure are recorded as structured data.
Exclusions: None

8. Record smoking status for patients 13 years old or older.

Measure: More than 50 percent of all unique patients 13 years old or older or admitted to the eligible hospital’s inpatient or emergency department (POS 21 or 23) have smoking status recorded as structured data.
Exclusions: Any eligible hospital or CAH that admits no patients 13 years or older to their inpatient or emergency department (POS 21 or 23).

9. Report hospital clinical quality measures to CMS.

Measure: Successfully report to CMS hospital clinical quality measures selected by CMS in the manner specified by CMS.
Exclusions: None

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

Measure: Implement one clinical decision support rule.
Exclusions: None

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

Measure: More than 50 percent of all patients of 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.
Exclusions: Any eligible hospital or CAH that has no requests from patients or their agents for an electronic copy of patient health information during the EHR reporting period.

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

Measure: More than 50 percent of all patients who are discharged from an eligible hospital or CAH’s inpatient or emergency department (POS 21 or 23) and who request an electronic copy of their discharge instructions are provided it.
Exclusions: Any eligible hospital or CAH that has no requests from patients or their agents for an electronic copy of the discharge instructions during the EHR reporting period.

13. 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.

Measure: Performed at least one test of certified EHR technology’s capacity to electronically exchange key clinical information.
Exclusions: None

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

Measure: Conduct or review a security risk analysis in accordance with the requirements under 45 CFR 164.308(a)(1) and implement security updates as necessary and correct identified security deficiencies as part of its risk management process.
Exclusions: None

Menu Objectives

Eligible Hospitals and CAHs must meet all but 5 of Menu Set Objectives, deferring the selected 5 for later stages. Of the objectives being used, you must include one pulic health objective #8, #9, or #10. Four of the ten objectives have exclusions that can be taken to meet the objective.

1. Implement drug formulary checks.

Measure: The eligible hospital or CAH has enabled this functionality and has access to at least one internal or external formulary for the entire EHR reporting period.
Exclusion: None

2. Record advance directives for patient 65 years old or older.

Measure: More than 50 percent of all unique patients 65 years old or older admitted to the eligible hospital’s or CAH’s inpatient (POS 21) have an indication of an advance directive status recorded as structured data .
Exclusion: An eligible hospital or CAH that admits no patients age 65 years old or older during the EHR reporting period.

3. Incorporate clinical lab test results into EHR as structured data.

Measure: More than 40 percent of all clinical lab test results ordered by an authorized provider of the eligible hospital or CAH for patients admitted to its inpatient or emergency department (POS 21 and 23) during the EHR reporting period whose results are either in a positive/negative or numerical format are incorporated in certified EHR technology as structured data.
Exclusions: None

4. Generate lists of patients by specific conditions to use for quality improvement, reduction of disparities, research, or outreach.

Measure: Generate at least one report listing patients of the eligible hospital or CAH with a specific condition.
Exclusions: None

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

Measure: More than 10 percent of all unique patients admitted to the eligible hospital’s or CAH’s inpatient or emergency department (POS 21 or 23) are provided patient-specific education resources.
Exclusions: None

6. The 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.

Measure: The eligible hospital or CAH performs medication reconciliation for more than 50 percent of transitions of care in which the patient is admitted to the eligible hospital’s or CAH’s inpatient or emergency department (POS 21 or 23).
Exclusions: None

7. The eligible hospital or CAH that transitions their patient to another setting of care or provider of care or refers their patient to another provider of care should provide summary care record for each transition of care or referral.

Measure: The eligible hospital or CAH that transitions or refers their patient to another setting of care or provider of care provides a summary of care record for more than 50 percent of transitions of care and referrals.
Exclusions: None

8. Capability to submit electronic data to immunization registries or immunization information systems and actual submission according to applicable law and practice.

Measure: Performed at least one test of 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 eligible hospital or CAH submits such information has the capacity to receive the information electronically).
Exclusions: An eligible hospital or CAH that administers no immunizations during the EHR reporting period or where no immunization registry has the capacity to receive the information electronically.

9. Capability to submit electronic data on reportable (as required by State or local law) lab results to public health agencies and actual submission according to applicable law and practice.

Measure: Performed at least one test of certified EHR technology’s capacity to provide electronic 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 an eligible hospital or CAH submits such information has the capacity to receive the information electronically).
Exclusions: No public health agency to which the eligible hospital or CAH submits such information has the capacity to receive the information electronically.

10. Capability to submit electronic syndromic surveillance data to public health agencies and actual submission according to applicable law and practice.

Measure: 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 an eligible hospital or CAH submits such information has the capacity to receive the information electronically).
Exclusions: No public health agency to which the eligible hospital or CAH submits such information has the capacity to receive the information electronically.