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How EHR standards align with meaningful use

Under the federal government's meaningful use criteria, hospitals and other eligible health care providers must use an electronic health record system that meets certain EHR standards

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and implementation requirements.

The Office of the National Coordinator for Health Information Technology (ONC) outlined these EHR standards in a final rule released July 13 in conjunction with the meaningful use final rule, which the Centers for Medicare & Medicaid Services (CMS) unveiled the same day. (Both documents subsequently were published in the Federal Register on July 28.)

The chart below summarizes the EHR standards that correspond to each meaningful use criterion. For an EHR system to be "meaningful use certified," it first must meet each of these requirements, then undergo the EHR testing and certification process that has been outlined in a third federal rule, also written by the ONC. (As of now, only the temporary certification program final rule applies. A permanent certification program is forthcoming.)

It should be noted that there is one EHR standard that is not tied to any specific meaningful use objectives: For each meaningful use objective with a percentage-based measure, the EHR system must be able to record the numerator and denominator electronically and generate a report including the numerator, denominator and resulting percentage associated with each applicable meaningful use measure.

Meaningful use core objective
EHR standards
Implement drug-drug and drug-allergy checks.
Generate notifications at the point of care for drug-drug and drug-allergy indications based on medication list, medication allergy list and CPOE1. Let certain users adjust notifications for drug-drug and drug-allergy interaction checks.
Implement one clinical decision support rule including diagnostic test ordering, along with the ability to track compliance with that rule.
Implement automated, electronic rules (in addition to drug-drug and drug-allergy checks) based on the data elements included in problem lists, medication lists, demographics and lab results. Automatically generate real-time notifications and care suggestions based on clinical decision support rules.
Use CPOE system.
Record, store, retrieve and modify, at a minimum, medications, laboratory, and radiology or imaging order types.
Maintain an up-to-date problem list of current and active diagnoses.
Record, modify and retrieve a patient's problem list for longitudinal care in accordance with standards such as SNOMED-CT2 and ICD-9-CM3.
Generate and transmit permissible prescriptions electronically (e-prescribing).
Generate and transmit prescriptions and prescription-related information in accordance with NCPDPSCRIPT4 10.6 or 8.1 and any source vocabulary identified by NLM5 RxNorm Documentation.
Maintain active medication list.
Record, modify and retrieve a patient's active medication list and medication history.
Maintain active medication allergy list.
Record, modify and retrieve a patient's active medication allergy list and medication allergy history.
Record demographic information.
Record, modify and retrieve patient demographic data including preferred language, gender, race, ethnicity and date of birth. Record race and ethnicity in accordance with NTTAA6.
Record and chart changes in vital signs.
Record, modify and retrieve a patient's vital signs including, at a minimum, height, weight and blood pressure. Automatically calculate and display BMI7 based on a patient's height and weight. Plot and display, upon request, growth charts for patients 2 years old to 20 years old.
Record smoking status for patients 13 years old or older.
Record, modify and retrieve smoking status, which must include current everyday smoker; current some-day smoker; former smoker; never smoker; smoker, current status unknown; and unknown if ever smoked.
Report quality measures to CMS8 or the states.
Calculate all core measures specified by CMS as well as, at a minimum, three clinical quality measures for eligible professionals. Let user submit calculated quality measures in accordance with PQRI9 standards.
Provide patients with an electronic copy of their health information upon request.
Create a copy including, at a minimum, diagnostic test results, problem list, medication list and medication allergy list; copy should be in human-readable format and on electronic media or available as a CCD10 or CCR11.
Provide patients with an electronic copy of their discharge instructions and procedures at time of discharge, upon request.
Create a copy of a patient's clinical summary including, at a minimum, diagnostic test results, problem lists, medication lists, medication allergy lists and procedures; copy should be in human-readable format and on electronic media or accessible through some other electronic means.
Provide clinical summaries for patients for each office visit.
Provide summaries to patients for each office visit that include, at a minimum, diagnostic test results, problem lists, medication lists and medication allergy lists. If the clinical summary is provided electronically, it must be in human readable format, and on electronic media or available as a CCD or CCR.
Exchange key clinical information among providers of care and patient-authorized entities electronically.
Transmit to and receive from other providers a patient's summary record in the CCD or CCR format; record should include, at a minimum, diagnostic test results, problem lists, medication list and medication allergy lists. Upon receipt, display record in human readable format.
Protect EHI12 created or maintained by the certified EHR technology through the implementation of appropriate technical capabilities.
*

* The final rule sets numerous standards for how EHR systems must protect EHI.

  • Assign unique name/number for identifying and tracking user identity.
  • Establish controls that permit only authorized users to access EHI.
  • Verify that user seeking access to EHI is in fact that user, and is authorized to access such information.
  • Permit authorized users to access EHI during an emergency.
  • Terminate an electronic session after a predetermined time of inactivity.
  • Record actions related to EHI in accordance with the HIPAA13 Security Rule.
  • Let user generate and sort entries in an audit log for a specific time period.
  • Detect the alteration of audit log.
  • Create message digest.
  • Verify upon receipt that EHI has not been altered.
  • Encrypt, decrypt EHI in accordance with NIST14 standards, unless HHS determines that the use of such algorithms would pose a significant security risk for certified EHR technology.
  • Encrypt, decrypt EHI when exchanged.
  • Optional criterion: Record disclosures made for treatment, payment and operations.
Meaningful use menu objective
EHR standard
Use EHR technology to identify patient-specific educational resources, and provide those to the patient as appropriate.
Identify and provide resources according to, at a minimum, the data elements included in the patient's problem list, medication list and lab results.
Record advance directives for patients 65 years of age or older.
Record whether a patient has an advance directive.
Implement drug-formulary checks.
Check if drugs are in a formulary or preferred drug list.
Incorporate clinical lab-test results into EHRs as structured data.
Receive results in a structured format and display such results in human readable format. Attribute, associate or link results to a laboratory order or patient record.
Generate lists of patients by specific conditions to use for quality improvement, reduction of disparities and outreach.
Let user select, sort, retrieve and generate patient lists according to, at a minimum, data from problem lists, medication lists, demographics and lab results.
Send reminders to patients per patient preference for preventive or follow-up care.
Generate a patient reminder list according to patient preferences based on, at a minimum, the data elements included in problem lists, medication lists, medication allergy lists, demographics and lab results.
Provide patients with timely electronic access to their health information.
Let user give patients online access to their clinical information including, at a minimum, lab test results, problem lists, medication lists and medication allergy lists.
Perform medication reconciliation at relevant encounters and each transition of care.
Compare two or more medication lists.
Provide summary care record for each transition of care and referral.
Transmit, receive and display a patient's summary record including, at a minimum, diagnostic test results, problem lists, medication list and medication allergy lists, in accordance with the CCD or CCR formats. Upon receipt, display record in human readable format.
Submit electronic data to immunization registries and actual submission where required and accepted.
Record, modify, retrieve and submit immunization information in accordance with HL715 and IIS16 standards
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.
Record, modify, retrieve and submit reportable clinical lab results in accordance with HL7 v2.5.1.
Provide electronic syndromic surveillance data to public health agencies, and actual transmission according to applicable law and practice.
Record, modify, retrieve and submit syndrome-based public health surveillance information in accordance with HL7 standards.

1 CPOE: computerized physician order entry
2 SNOMED-CT: Systematized Nomenclature of Medicine -- Clinical Terms
3 ICD-9-CM: International Classification of Diseases, Ninth Revision, Clinical Modification
4 NCPDP: National Council for the Prescription Drug Programs
5 NLM: National Library of Medicine
6 NTTAA: National Technology Transfer and Advancement Act of 1995
7 BMI: body mass index
8 CMS: Centers for Medicare & Medicaid Services
9 PQRI: Physician Quality Reporting Initiative
10 CCD: Continuity of Care Document
11 CCR: Continuity of Care Record
12 EHI: electronic health information
13 HIPPA: Health Insurance Portability and Accountability Act of 1996
14 NIST: National Institute of Standards and Technology
15 HL7: Health Level 7 International
16 IIS: Immunization Information Systems

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This was first published in September 2010

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