HIT/HIE - Achieving "Meaningful Use"

Standards


The Centers for Medicare and Medicaid Services (CMS) have adopted a phased approach to achieving "meaningful use" of Health Information Technology and Exchange consisting of the following stages:

Stage 1: Capture data in a coded format.

Stage 2: Expand upon the Stage 1 criteria in the areas of disease management, clinical decision support, medication management, support for patient access to their health information, transitions in care, quality measurement and research, and bi-directional communication with public health agencies.

Stage 3: Achieve improvements in quality, safety and efficiency, focusing on decision support for national high priority conditions, patient access to self management tools, access to comprehensive patient data, and improving population health outcomes.

Achieving Stage 1 Standards

The table below provides a summary of actions required to meet the Stage 1 standards for meaningful use of HIT/HIE. The table lists each of the Health Outcomes Policy Priorities and the objectives for each priority. There are separate objectives for eligible providers, and eligible hospitals and Critical Access Hospitals (CAHs). In addition, the table lists the measurement standards for each objective and explains the changes that have been made from the original proposed rule.

For both types of providers achieving Stage 1 requires demonstration of the meaningful use of an EHR each of the five "core" healthcare outcome priorities. In addition, eligible providers and hospitals must meet at least five of the 10 objectives in the "menu" set of Health Outcomes Policy Priorities. At least one of the five objectives chosen must be come from the priority area of "Improving Population and Public Health." The items not chosen from the menu set will be deferred to Stage 2 of the program.

Core Health Outcomes Policy Priorities for Stage 1 Meaningful Use

Health Outcomes Policy Priority

Stage 1 Objectives for Eligible Professionals

Stage 1 Objectives for Eligible Hospitals and CAHs

Stage 1 Measures

Changes from Proposed Rule

Improving quality, safety and 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 percent of unique patients with at least one medication in their 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 order entered using CPOE.
  • Clarified terms of order entry within objective
  • Reduced threshold for EPs from 80% of all orders
  • Increased threshold for hospitals from 10% of all orders

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.

  • Moved drug formulary check to menu set.

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.

  • Reduced threshold from 75%.
Recorded demographics:
  • Preferred language
  • Gender
  • Race
  • Ethnicity
  • Date of birth
Recorded demographics:
  • Preferred language
  • Gender
  • Race
  • Ethnicity
  • Date of birth
  • 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's or CAH's inpatient or emergency department (POS 21 or 23) have demographics recorded as structured data.

  • Deleted requirement to record insurance type
  • Reduced threshold from 80%
  • Clarified reporting of cause of death

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) have at least one entry or an indication that no problems are known for the patient recorded as structured data.

  • Removed reference to ICD-9-CM and SNOMED (described in the EHR standard rule)

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

  • Modified measure from "at least" 80%

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 has no known 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, including 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, including 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.

  • Reduced threshold from 80%
  • Added height and weight to measure
  • Removed BMI and growth chart from measure
  • Added structured data to measure

Record smoking status for patients 13 years of age or older

Record smoking status for patients 13 years of age or older

More than 50% of all unique patients 13 years of age or older seen by the EP or admitted to the eligible hospital's or CAH's inpatient emergency department (POS 21 or 23) have smoking status recorded as structured data

  • Reduced threshold from 80%
  • Added structured data to measure

Implement one clinical decision support rule relevant to specialty or high clinical priority along with the ability to track compliance with that rule

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

Implement one clinical decision support rule

Reduced threshold from 5

Report ambulatory clinical quality measures to CMS or the States

Report hospital clinical quality measures to CMS or the States

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 discussed in section II(A)(3) of this final rule.

No change

Engage patients and families in their health care

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

Provide patients with an electronic copy of their health information (including 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 eligibile hospital or CAH (POS 21 or 23) who request an electronic copy of their health information are provided it within 3 business days.

  • Amended objective to read "medication allergies"
  • Reduced threshold from 80%
  • Lengthened time requirement from 48 hours
  Provide patients with an electronic copy of their 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 emergency department (POS 21 or 23) and who request an electronic copy of their discharge instructions are provided it

  • Removed requirement to provide copy of procedures
  • Reduced theshold from 80%
  • Specified both inpatient and emergency department discharges

Provide clinical summaries for patients for each office visit

 

Clinical summaries provided to patients for more than 50% of all office visits within 3 business days

  • Reduced threshold from 80%
  • Added time requirement of 3 business days

Improve care coordination

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

Capability to exchange key clinical information (for example, discharge summary, procedures, 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 exchange key clinical information

  • Amended objective to read "medication allergies"

Ensure adequate privacy and security protections for personal health information

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

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

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

  • Added requirement to correct deficiencies

 

Menu Set Health Outcomes Policy Priorities for Stage 1 Meaningful Use

Health Outcomes Policy Priority

Stage 1 Objectives for Eligible Professionals

Stage 1 Objectives for Eligible Hospitals and CAHs

Stage 1 Measures

Changes from Proposed Rule

Improve quality, safety and efficiency, and reduce 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 drug formulary for the entire EHR reporting period

  • Separated from CPOE objective
  • Added access requirement
 

Record advance directives for patients age 65 years or older

More than 50% of all unique patients age 65 or older admitted to the eligible hospital's or CAH's inpatient department (POS 21) have an indication of an advance directive status recorded

New objective

Incorporate clinical lab-test results into certified EHR technology as structured data

Incorporate 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 hospital or CAH for patients admitted to its inpatient or emergency 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

  • Reduced threshold from 50%
  • Further specified lab tests

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 outreach

Generate at least one report listing patients of the EP, eligible hospital or CAH with a specific condition

 

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

 

More than 20% of all unique patients age 65 or older, or age 5 or younger, were sent an appropriate reminder during the EHR reporting period

  • Reduced threshold from 50%
  • Modified age requirements from age 50 or older

Engage patients and families in their health care

provide patients with timely electronic access to their health information (including lab results, problem list, medication lists, medication allergies) within four business days of the information being available from the EP

 

More than 10% of all unique patients seen by the EP are provided timely (available to the patient within four busines days of being updated in the certified EHR technology) electronic access to their health information subject to the EP's discretion to withold certain information

  • Amended objective to read "medication allergies"
  • Modified time requirements to specify business days

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 or admitted to the eligible hospital's or CAH's inpatient or emergency department (POS 21 or 23) are provided patient-specific education resources

New objective

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 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'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 referral

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 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

  • Specified triggers
  • Reduced threshold from 80%

Improve Population and public health

Exclusion Letter for Public Health Reporting

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 submissions if the test is successful (unless none of the immunization registries to which the EP, eligible hospital or CAH submits such information to have the capacity to receive the information electronically)

  • Added immunization information systems
  • Added follow up requirement

 

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 receive the information electronically)

  • Amended objective to specify 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

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 technology's capacity to provide elctronic syndromic surveillance data to public health agencies and follow-up submissions 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)

  • Amended objective to specify applicable law and practice