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Criteria for meaningful use of EHR

Updated: The federal government unveiled its criteria for the meaningful use of electronic health records (EHRs) on July 13. The criteria must be met in order for a hospital or eligible provider (EP) to qualify for reimbursement of the cost of EHR software under the American Recovery and Reinvestment Act of 2009 (ARRA).

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If a provider can demonstrate meaningful use of EHR, then it is eligible for incentive payments of up to $44,000 per physician, payable in installments beginning in the 2011 fiscal year. (The figure rises to $48,400 for those EPs who serve in a Health Professional Shortage Area as defined by the federal government.) Penalties, in the form of reduced Medicare reimbursements, will be assessed to those practitioners who do not demonstrate meaningful use of EHR by the beginning of the 2015 fiscal year.

Meanwhile, if a hospital can achieve meaningful use of EHR, then it is eligible for incentive payments. The payments include a base amount of $2 million, plus $200 per patient, starting with the hospital’s 1,150th discharged patient and ending with No. 23,000, beginning in the 2011 fiscal year. As with EPs, a hospital that cannot demonstrate meaningful use of EHR by the beginning of the 2015 fiscal year will be penalized.

The meaningful use criteria have been divided into two groups -- the core set, which is mandatory, and the menu set, from which hospitals and EPs may choose five of the 10 criteria. This differs from last December’s notice of proposed rulemaking (NPRM) for meaningful use, in which all criteria had to be met in order to achieve meaningful use.

The charts below spell out the core set and menu set of criteria for the meaningful use of EHR technology. Changes from the NPRM are marked in bold.

 

Stage 1 core requirements
How to meet the requirements
  
 Professionals Hospitals
REVISED: Implement drug-drug and drug-allergy checks.
Enable this functionality.
Enable this functionality.
REVISED: Implement one clinical decision support rule, including diagnostic test ordering, along with the ability to track compliance with that rule.
Implement rule relevant to specialty or high clinical priority.
Implement rule related to a high-priority hospital condition.
Use a computerized physician order-entry (CPOE) system.
Use CPOE for at least 30% of all orders.
Use CPOE for 30% of any type of order directly entered by authorizing provider.*
Maintain an up-to-date
problem list of current and active diagnoses.
Record at least one entry (or an indication of none) as structured data** for at least 80% of all unique patients.
Record at least one entry (or an indication of none) as structured data** for at least 80% of all unique patients.
Generate and transmit permissible prescriptions electronically (e-prescribing).
Using certified EHR technology, write and transmit electronically at least 40% of all permissible prescriptions.
NA.
Maintain active medication list.
Record at least one entry (or none) for at least 80% of all unique patients.
Record at least one entry (or none) for at least 80% of all unique patients.
Maintain active medication
allergy list.
Record at least one entry (or none) for at least 80% of all unique patients.
Record at least one entry (or none) for at least 80% of all unique patients.
Record demographic information.
Record demographics (preferred language, insurance type, gender, race, ethnicity and date of birth) for at least 50% of unique patients.
Record demographics (preferred language, insurance type, gender, race, ethnicity, date of birth and date and cause of death in the event of mortality) for at least 50% of unique patients.
Record and chart changes in
vital signs.
For at least 50% of all unique patients age 2 and over, record height, weight and blood pressure; calculate and display body mass index (BMI), and plot and display growth charts for patients 2-20 years, including BMI.
For at least 50% of all unique patients age 2 and over, record height, weight and blood pressure; calculate and display BMI, and plot and display growth charts for patients 2-20 years, including BMI.
Record smoking status for patients 13 years old or older.
Record for at least 50% of all unique patients.
Record for at least 50% of all unique patients.
Report quality measures to the Centers for Medicare & Medicaid
Services (CMS) or the states.
For 2011, submit summary information for ambulatory quality measures to CMS based on the attestation methodology of reporting clinical data; for 2012, electronically submit the measures.
For 2011, submit summary information for hospital quality measures to CMS based on an attestation methodology of reporting clinical data; for 2012, electronically submit the measures.
Provide patients with an electronic copy of their health information upon request.
Provide information (including diagnostic test results, problem list, medication lists, allergies) to at least 50% of all patients within three business days.
Provide information (including diagnostic test results, problem list, medication lists, allergies, discharge summary, procedures) to at least 50% of patients within three business days.
Provide patients with an
electronic copy of their discharge instructions and procedures at time of discharge, upon request.
NA
Provide information to at least 50% of all patients who are discharged and request an electronic copy of their discharge instructions and procedures.
Provide clinical summaries for patients for each office visit.
Provide clinical summaries for at least 50% of all office visits within three business days.
NA
Exchange key clinical information among providers of care and patient-authorized entities electronically.
Test the capacity of a certified EHR system to electronically exchange key clinical information (for example, problem list, medication list, allergies and diagnostic test results).
Test the EHR system's capacity to electronically exchange key clinical information (for example, discharge summary, procedures, problem list, medication list, allergies and diagnostic test results).
Protect electronic health information created or maintained by the certified EHR technology through the implementation of appropriate technical capabilities.
Conduct or review a security risk analysis and implement security updates as necessary.
Conduct or review a security risk analysis and implement security updates as necessary.

 

Stage 1 menu requirements
How to meet the requirements
  
 Professionals Hospitals
NEW: Use EHR technology to identify patient-specific education resources and provide those to the patient as appropriate.
Provide to more than 10% of patients.
Provide to more than 10% of patients.
NEW: Record advance directives for patients 65 years of age or older.
NA
Do so for at least 50% of patients 65 or older.
REVISED: Implement drug-formulary checks.
Enable this functionality and access at least one internal or external drug formulary.
Enable this functionality and access at least one internal or external drug formulary.
Incorporate clinical lab-test results into
EHRs as structured data.
Incorporate into certified EHR technology more than 40% of all clinical lab results that are given in a positive/negative or numerical format.
Incorporate into certified EHR technology more than 40% of all clinical lab results that are given in a positive/negative or numerical format.
Generate lists of patients by specific
conditions to use for quality improvement, reduction of disparities and outreach.
Generate at least one report listing patients with a specific condition.
Generate at least one report listing patients with a specific condition.
Send reminders
to patients per patient preference for preventive or follow-up care.
Send reminders to at least 20% of all unique patients seen by the EP who are under 5 years of age or over 65.
NA
Provide patients with timely electronic access to their health information.
Provide electronic access to the health information of at least 10% of all unique patients (including lab results, problem list, medication lists and allergies) within four business days of that information being made available to the EP.
NA
Perform medication reconciliation at relevant encounters and each transition of care.
Do so for at least 50% of encounters and transitions.
Do so for at least 50% of encounters and transitions.
Provide summary care record for each transition of care and referral.
Do so for at least 50% of transitions and referrals.
Do so for at least 50% of transitions and referrals.
Submit electronic data to immunization registries and actual submission where required and accepted.
Test the EHR system's capacity to submit electronic data to immunization registries.
Test the EHR system's capacity to submit electronic data to immunization registries.
Provide electronic submission of reportable lab results (as required by state or local law) to public health agencies and actual submission where it can be received.
NA
Test the EHR system's capacity to electronically submit reportable lab results to public health agencies (unless no agency to which a hospital submits such information can receive the information electronically).
Provide electronic syndromic surveillance data to public health agencies and actual transmission according to applicable law and practice.
Test the EHR system's capacity to provide electronic syndromic surveillance data to public health agencies unless none have the capacity to receive the information electronically.
Test the EHR system's capacity to provide electronic syndromic surveillance data to public health agencies unless none have the capacity to receive the information electronically.

* Authorizing providers include MD, DO, RN, PA and NP.
** Defined as "hav[ing] specified data type and response categories within an electronic record or file"

Let us know what you think about the story; email Brian Eastwood, Site Editor.

This was first published in July 2010

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