Stage 1 – Meaningful Use Objectives

The medical community was waiting until yesterday to determine WHEN they should purchase an EHR, because they didn’t want to purchase one without knowing if they can be eligible for the financial reimbursements.

Now, they know what “meaningful use” actually means. To begin with, a meaningful EHR user was defined in the final rule as: “an EP, eligible hospital or CAH who for an EHR reporting period for a payment year demonstrates meaningful use of a certified EHR technology in the form and manner consistant with the standards

The good news is that the ONC and CMS have updated the rules/standards to allow for some more flexibility. Originally, eligible professionals were required to meet 25 objectives while eligible hospitals were expected to meet 23 objectives to be considered a meaningful use user. Now eligible professionals are required to complete the 15 core objectives and only 5 or the 10 menu item objectives. Measures will be taken to determine whether or not an eligible professional has successfully completed any objective.

Stage 1 Meaningful Use Objectives (Core and Menu Set)*:

CORE SET

Health Outcomes Policy Priority

Stage 1 Objectives Stage 1 Measures
Eligible Professionals Eligible Hospitals and Critical Access Hospitals (CAHs)

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. 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 the unique patients with at least one 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 ordered entered using CPOE
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
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
Record demographics

  • Preferred lanuage
  • Gender
  • Race
  • Ethnicity
  • Date of BIrth
Record demographics

  • Preferred lanuage
  • Gender
  • Race
  • Ethnicity
  • Date of BIrth
  • Date and preliminary cause of the 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
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) habe at least 1 entry or an indication that no problems are known for the patient recorded as structured data.
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
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 is not currently prescribed any medication allergies) recorded as structured data
Record and chart changes in vital signs:

  • Height
  • Weight
  • Blood Pressure
  • Calculate and display BMI
  • Plot and display growth charts for children 2-20 years, inlcuding BMI
Record and chart changes in vital signs:

  • Height
  • Weight
  • Blood Pressure
  • Calculate and display BMI
  • Plot and display growth charts for children 2-20 years, inlcuding BMI
For more than 50% of all unique patients age 2 and over seen by the EP or admitted to eligible hospital’s or CAH’s inpatient or emergency department (POS 21 or 23), height, weight and blood pressure are recorded as structured data
Record smoking status for patients 13 years or older Record smoking status for patients 13 years or older More than 50% of all unique patients 13 years old or older seen by the EP or admitted to the eligible hospital’s or CAH’s inpatient or emergency department (POS 21 or 23) have smoking status recorded as structured data
Implement one clinical decision support rule relevant to specialty or high clinical priority along with the ability to track compliance of that rule Implement one clinical decision support rule relevant to specialty or high clinical priority along with the ability to track compliance of that rule Implement one clinical decision support rule
Report ambulatory clinical quality measures to CMS or the States Report ambulatory clinical quality measures to CMS or the State

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 disccused in section II (A) (3) of this final rule
Engage patients and families in their healthcare Provide patients with an electrontic copy of their health information (inlcuding diagnostic test results, problem list, medication lists, medication allergies), upon request Provide patients with an electrontic copy of their health information (inlcuding 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) and who request an electronic copy of their discharge instructions are provided it
N/A Provide patients with an electronic copy of thier 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 emgergency department (POS 21 or 23) and who request an electronic copy of thier discharge instructions are provided it
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
Improve care coordination Capability to exchange key clinical information (for example, problem list, medication list, medication allergies, diagnostic test results), among providers of care and patient authorized entities electronically Capability to exchange key clinical information (for example, 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 exhange key clinical information
MENU SET

Health Outcomes Policy Priority

Stage 1 Objectives Stage 1 Measures
Eligible Professionals Eligible Hospitals and Critical Access Hospitals (CAHs)

Improving quality, safety, efficiency and reducing health disparities

Implement drug-formulary checks Implement drug-formulary checks The EP/eligible hospital/CAH has enabled this functionality and has access to at least one internal or external durg formulary for the entire EHR reporting period
N/A Record advance directives for patients 65 years old or older More than 50% of all unique patients 65 years old or older admitted to the eligible hosptial’s or CAH’s inpatient department (POS21) have an indication of an advance directive status recorded
Incorportate clinical lab-test results into certified EHR technology as structured data Incorportate clinical lab-test results into certified EHR technology as structured data More than 40% of all clinical lab tests results ordered by the EP or by an authorized provider of the eligible hosptial or CAH for patients admitted to its inpatient or emgergency department (POS 21 or 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
Generate lists of patients by specific conditions to use for quality improvement, reduction of disparities, research or outreach Generate lists of patients by specific conditions to use for quality improvement, reduction of disparities, research or outreac Generate at least one report listing patients of the EP, eligible hosptial or CAH with a specific condition
Send reminders to patients per patient preferences for preventive/follow up care N/A More than 20% of all unique patients 65 years or older or 5 years old or younger were sent an appropriate reminder during the EHR reporting period.

Engage patients and families in their health care

Provide patients with timely electronic access to thier health information (inlcuding lab results, problem list, medication lists, medication allergies) within four business days of the information being available to the EP N/A More than 10% of all unique patients seen by the EP are provided timely (available to the patient within four business days of being updated by the certified EHR technology) electronic access to thier health information subject to the EP’s discretion to withhold certain information
Use certified EHR technology to identify patient-specific education resources and provide those resources to the patient if appropriate 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 admitted to the eligible hospital’s or CAH’s inpatient or emergency department (POS 21 or 23) are provided patient -specific education resources

Improve care coordination

The EP, eligible hospital or CAH who recieves 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 who recieves 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 medicaiton 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’s or CAH’s inpatient or emergency department (POS 21 or 23)
The EP, eligible hospital or CAH 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 refferral The EP, eligible hospital or CAH 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 refferral The EP, eligible hospital or CAH who transitions or refers thier 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

Improve population and public health

(Unless an EP, eligible hospital or CAH has an exception for all of these objectives and measures they must complete at least pne as part of thier demonstration of the menu set in order to be a meaningful EHR user.)

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 data to Immunization registries or Immunization information Systems and actual submission in accordance with applicable law and practice 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 EP, eligible hospital or CAH submits such information have the capacity to recieve the information electronically
N/A 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 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 eligible hospital or CAH submits such information have the capacity to recieve the information electronically
Capability to submit electronic syndromic surveillance data to public health agencies and actual submission in accordance with applicable law and practice 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’s 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 EP, eligible hospital or CAH submits such information have the capacity to receive the information electronically)

Now keep in mind that this is ONLY Stage 1 of meaningful use. Within the document it stated that the ONC and CMS will provide updates on the meaningful use criteria and as of now, there are 3 stages of meaningful use.

Stage 1 is the criteria discussed above and it begins immediately. Stage 2 is expected to be released at the end of 2011 and Stage 3 is expected to be released at the end of 2013

The next question that many people will ask is WHEN you will be able to actually begin recieving the incentive payment. This answer depends on when you determine to purchase and begin proving meaningful use. For example, if an eligible professional who wants to receive incentives as early as 2011 must satisfy the requirements of Stage 1 in your first and second payment years (2011 and 2012).

Below is a table to determine the criteria you will need to abide by in order to receive the payments:

First Payment Year Payment Year
2011 2012 2013 2014 2015
2011 Stage 1 Stage 1 Stage 2 Stage 2 TBD
2012 Stage 1 Stage 1 Stage 2 TBD
2013 Stage 1 Stage 2 TBD
2014 Stage 1 TBD

It is evident by looking at this table that nothing has been established for the year 2015. Within the final rules, it was stated that they are unsure as to what will be the difinitive ruling for the year 2015.