Meaningful Use EMR/EHR Update
Meaningful Use Final Rule on Electronic Health Records
On July 13th, 2010 The Centers for Medicare & Medicaid Services (CMS) and the Office of the National Coordinator for Health Information Technology (ONC) announced two complementary final rules to implement the electronic health records (EHR) incentive program under the Health Information Technology for Economic and Clinical Health (HITECH) Act.
As part of the American Recovery and Reinvestment Act (ARRA) of 2009, the HITECH Act supports the adoption of electronic health records by providing financial incentives under Medicare and Medicaid to hospitals and eligible professionals who implement and demonstrate “meaningful use” certified EHR technology. The CMS regulations announced today specify the objectives that providers must achieve in payment years 2011 and 2012 (Stage 1) to qualify for incentive payments; the ONC regulations specify the technical capabilities that EHR technology must have to be certified and to support providers in achieving the “meaningful use” objectives.
Overview of CMS Final Rule on Meaningful Use
- Greater flexibility with respect to eligible professionals and hospitals in meeting and reporting certain objectives for demonstrating meaningful use. The final rule divides the objectives into a “core” group of 15 required objectives and a “menu set” of procedures from which providers may choose any five to defer in 2011-2012. This gives providers latitude to pick their own path toward full EHR implementation and meaningful use.
- Outlines a phased approach to implement the requirements for demonstrating meaningful use. CMS will establish graduated criteria for demonstrating meaningful use through future rulemaking, consistent with anticipated developments in technology and providers’ capabilities.
15 Core Objectives - Stage 1 Meaningful Use
| 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 |
- CPOE for medication orders. Specifically, more than 30% of unique patients with at least one medication in their medication list seen by the eligible provider must have at least one medication order entered using CPOE.
- Implement drug to drug and drug allergy interaction checks.
- More than 40% of permissible prescriptions written are generated and transmitted electronically using certified EHR technology (for eligible providers only).
- Record demographic info, such as gender and race, for 50% of patients seen by eligible providers.
- Maintain up to date problem list of current and active diagnoses for 80% of patients.
- Maintain active medication list for 80% of patients.
- Maintain active drug allergy list for 80% of patients.
- Record and chart changes in vital signs, such as height, weight, BMI, blood pressure, for more than 50% of patients over age 2.
- Record smoking status for more than 50% of patients over age 13.
- Implement one clinical decision support rule for EP's specialty or hospital's high priority condition and track compliance with that rule.
- Report clinical quality measures to the Centers for Medicare and Medicaid Services.
- Provide more than 50% of patients with electronic copy of health information upon request within 3 business days.
- Provide 50% of patients with electronic copy of discharge instructions at time of discharge (for hospitals only.)
- Provide clinical summaries for each office visit to more than 50% of patients within 3 business days (eligible professionals only.)
- Perform at least one test of certified e-health record's capability to electronically exchange key clinical information, such as problem list or medication list, among providers of care or patient-authorized entities.
- Protect electronic health information created or maintained by certified EHR
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
