Meaningful Use of Electronic Health Records
An eligible professional (EP) and an eligible hospital shall be considered a meaningful EHR user for an EHR reporting period for a payment year if they meet the following three requirements:
- Use certified EHR in a meaningful manner
- Utilize certified EHR technology that is connected in a manner that provides for the electronic exchange of health information to improve the quality of healthcare such as promoting care coordination
- Submit information on clinical quality measures and other measures in a form and manner specified by the Secretary
Meaningful Use Stages and Incentives
Meaningful Use follows a phased-in implementation. This is in recognition of the fact that physicians across the country are at various points of readiness, with some medical facilities already using EHRs to the fullest extent, and others not yet having made the investment.
The Stage 1 Meaningful Use criteria focus on electronically capturing health information in a coded format; using that information to track key clinical conditions, and communicating that information for care coordination purposes (whether that information is structured or unstructured, but in structured format whenever feasible); consistency with other provisions of Medicare and Medicaid law, implementation of clinical decision support tools to facilitate disease and medication management; and the reporting of clinical quality measures and public health information.
The table below shows how Meaningful Use Stages 1 and 2 will be phased in depending on the starting year. Medicare incentives and penalties for Eligible Professionals are also included for reference.
Meaningful Use divides objectives into a “core” set and a “menu” set. In order to qualify as a meaningful user in Stage 1, participants must meet the measure for each objective in the core set, which features 15 objectives for eligible professionals and 14 for eligible hospitals and critical access hospitals:
Core Set
- Use CPOE
- Implement drug to drug and drug allergy interaction checks
- E-prescribing (EPs only)
- Record demographics
- Maintain an up-to-date problem list
- Maintain active medication list
- Maintain active medication allergy list
- Record and chart changes in vital signs
- Record smoking status
- Implement one clinical decision support rule
- Report CQM as specified by the secretary
- Electronically exchange key clinical information
- Provide patients with an electronic copy of their health information
- Provide patients with an electronic copy of their discharge instructions (eligible hospitals only)
- Provide clinical summaries for patients for each office visit (EPs only)
- Protect electronic health information created or maintained by certified EHR
The Menu Set includes 10 additional objectives, of which eligible professionals and hospitals will choose five. The items not chosen will be deferred to Stage 2 of the program. Participants may select any five objectives from the menu set, with one limitation. They must choose at least one population and public health measure. The menu set objectives includes 12 total items, 10 of which apply to EPs and 10 of which apply to hospitals:
Menu Set
- Implement drug-formulary checks
- Record advance directives for patients 65 years old or older (eligible hospitals only)
- Incorporate clinical lab-test results into certified EHR technology as structured data
- Generate lists of patients by specific conditions to use for quality improvement, reduction of disparities, research or outreach
- Send reminders to patients per patient preference for preventive/follow up care (EPs only)
- 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 to the EP (EPs only)
- Use certified EHR technology to identify patient-specific education resources and provide those resources to the patient if appropriate
- 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 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
- 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 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 (eligible hospitals only)
- Capability to submit electronic syndromic surveillance data to public health agencies and actual submission in accordance with applicable law and practice
