Electronic Medical Records Stimulus
EMR Software Stimulus - Meaningful Use Final Rules
Frequently Asked Questions on the Final Rules for Meaningful Use Released 7/13/2010
QUICK LINKS
15 Core Meaningful Use Objectives
5 Meaningful Use Menu Objectives
The earliest adopters who adopt EHR software today and demonstrate 'meaningful use' of the EHR software by 2011 will realize the highest possible electronic medical records software payments through the stimulus package. Eligible providers that elect not to utilize an EHR system by 2015 will see Medicare/Medicaid reimbursement penalties. The meaningful use final ruling outlines a graduated approach - meaningful use requirements will be increasingly stringent in the years following 2012 (Stage 2 and 3).
The following Q&A is MDS's interpretation of the final rules of the Centers for Medicare and Medicaid Programs (CMS); Electronic Health Record Incentive Program as outlined by the Department of Health and Human Services in this document.
What features of the EHR do I need to use in order to qualify for 'Meaningful Use' as outlined in the final rules?
The final rules for stage 1 meaningful use (qualifying year 2010 or 2011) contain 15 "core" objectives that eligible providers must meet.
| Core Objective |
Objective | Measure | Exceptions |
|---|---|---|---|
| 1 | 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 unique patients with at least one medication in their medication list seen by the EP or admitted to the eligible hospital or CAH have at least one medication entered using CPOE | |
| 2 | Implement drug-drug and drug-allergy interaction checks | The EP has enabled this functionality for the entire EHR reporting period | |
| 3 | Generate and transmit permissible prescriptions electronically (eRx or ePrescribing) | More than 40% of all permissible prescriptions written by the EP are transmitted electronically using certified EHR technology | If an EP does not write more than 100 prescriptions during the EHR reporting period, he/she can exclude themselves from this measure |
| 4 | Maintain up-to-date problem list of current and active diagnoses | More than 80% of all unique patients seen by the EP have at least one entry or an indication that no problems are known for the patient recorded as structured data | |
| 5 | Maintain an up-to-date problem list of current and active diagnoses. | More than 80% of all unique patients seen by the EP have at least one entry or an indication that no problems are known for the patient recorded as structured data | |
| 6 | Maintain an active medication list. | More than 80% of all unique patients seen by the EP have at least one entry (or an indication that the patient is not currently prescribed any medication) recorded as structured data. | |
| 7 | Maintain an up-to-date medication allergy list | More than 80% of all unique patients seen by the EP have at least one entry (or an indication that the patient has no known medication allergies) recorded as structured data. | |
| 8 | Record and chart the following vital signs:
|
More than 50% of all unique patients age 2 and over seen by the EP height, weight, and blood pressure recorded as structured data. | If an EP believes that these vital signs have no relevance to their scope of practice, he/she can exclude themselves from this measure |
| 9 | Record smoking status for patients 13 years old or older. | More than 50% of all unique patients 13 years old or older seen by the EP have smoking status recorded as structured data. | If an EP does not see any patients 13 years or older, he/she can exclude themselves from this measure |
| 10 | Record smoking status for patients 13 years old or older. | More than 50% of all unique patients 13 years old or older seen by the EP have smoking status recorded as structured data. | If an EP does not see any patients 13 years or older, he/she can exclude themselves from this measure. |
| 11 | Report ambulatory clinical quality measures to CMS (Centers for Medicare/Medicaid Services) or, in the case of Medicaid EPs, the States. For 2011, provide aggregate numerator, denominator, and Exclusions through attestation (Yes/No). | Yes/no attest | |
| 12 | Capability to exchange key clinical information (for example: problem list, medication list, allergies, and diagnostic test results), among providers of care and patient authorized entities electronically. | Yes/no attest. At least one test must be performed to attest for the capability to electronically exchange clinical information. | |
| 13 | Provide patients with an electronic copy of their health information (including diagnostics test results, problem list, medication lists, and medication allergies) upon request. | More than 50% of all patients of the EP who request an electronic copy of their health information are provided it within 3 business days. | If an EP has no requests from patients or their agents for an electronic copy of patient health information, he/she can exclude themselves from this measure. |
| 14 | Provide clinical summaries for patients for each office visit. | Provided to patients for More than 50% of all office visits within 3 business days. | If an EP has no office visits during the reporting period, he/she can exclude themselves from this measure. |
| 15 | Protect electronic health information created or maintained by certified EHR technology through the implementation of appropriate technical capabilities | Conduct or review a security risk analysis per 45 CFR 164.308(a)(1) and implement updates as necessary and correct identified security deficiencies as part of the EP’s risk management process |
For a complete look at the final rules for meaningful use, please review the document in its entirety: http://www.ofr.gov/OFRUpload/OFRData/2010-17207_PI.pdf
What are the additional "menu set" features of the EHR that are covered in Stage 1 Meaningful Use rules?
The final rules for stage 1 meaningful use (qualifying year 2010 or 2011) contain 10 "menu set" objectives - where eligible providers need to achieve 5 out of 10. Providers choose which menu set rules to select and defer. *Must choose one of these two.
- Drug formulary access
- Import/store 40% of lab results
- Patient lists by condition
- Provide patient-specific educational materials (>10%)
- Medication reconciliation between care settings (>50% in transitions of care)
- Care summaries to referred/transitioned patients (>50%)
- * Submit immunization data to registries (at least one test/follow-up)
- * Submit syndromic surveillance data to public health agencies (at least one test/follow-up)
- Patient reminders (>20% patients age 65+ or <5) # Eligible Providers Only
- Provide patients with health record (>10% within 4 days of updating)
When do I have to be up and running on EMR to get my first $18,000 Medicare Incentive in 2011?
You must be able to report starting no later than 90 days prior than December 31, 2010 (i.e. October 3rd 2010)
. The EHR reporting period may be any continuous 90-day period within the first payment year and the entire payment year for all subsequent payment years. Qualifying providers who adopt and are "meaningfully using" a certified EHR system by 2011 and 2012 will realize the highest incentive of $44,000. Providers who adopt in 2011 will receive the first payment of $18,000 beginning in 2011. CMS expects the first payments to begin in March of 2011.
