Meaningful Use Knowledge Center

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Electronic Health Records (EHRs) can contribute to a practice or organization when implemented, but how would one measure the success or benefits of adopting this change in the health care industry? The answer is Meaningful Use. Meaningful Use became one of the most frequently used terms in the healthcare industry in 2009. Meaningful Use is a set of standards, defined by CMS, that governs the use of EHRs & allows the opportunity for Eligible Providers (EPs) and Eligible Hospitals (EHs) to earn incentive dollars by complying to a set of specific criteria. 

Meaningful Use Stages:
Meaningful Use spans across five years with a total of three stages. In order for EPs and EHs to recieve incentive dollars, a certified EHR technology must be adopted and used to achieve objectives set forth by CMS. Below is a high-level view of each stage and its primary focus.

*This is table from the HealthIT.gov website.


The chart below is a representation of the progression of meaningful use stages from when a Medicare provider begins participation in the program.

**This chart is from the Stage 2 Overview Tipsheet from the CMS Website.


Understanding the Rules that Impact MU

(1) Centers for Medicare and Medicaid – EHR Incentive Program
This ruling sets the guidelines for the incentive programs made available through the American Recovery and Reinvestment Act of 2009 (ARRA). It defines who is eligible for incentive dollars through three programs:

  • Medicare Fee-for-Service (FFS) Program
  • Medicare Advantage Program
  • Medicaid Program


Within each of these programs there are guidelines set as to how providers are to use electronic health record technology in order to qualify to receive the incentive dollars supporting their adoption of an EHR. This phase of Meaningful Use adoption is referred to as Stage 1. Providers will be required to report to CMS data that demonstrates their usage of an EHR system.

View the Meaningful Use Stage 1 Objectives and Measures and preview eClinicalWorks functionality supporting the objective.

Review the CMS EHR Incentive Program website for a detailed understanding of the program.

Visit the eClinicalWorks Meaningful Use Resource Center for quick links to fact sheets produced by CMS.

(2) Office of the National Coordinator – Health Information Technology: Initial Set of Standards, Implementation Specifications, and Certification Criteria for Electronic Health Record Technology
To support the success of meaningful use, and the effective adoption of EHR technology, the ONC was tasked to establish requirements for Electronic Health Record vendors. This ruling was released in coordination with the CMS EHR Incentive Program to ensure that vendors comply with minimum product capabilities and standards to support Stage 1 objectives and measures. EHR vendors are expected to enhance their products, and make the required functionality available to providers.


(3) Office of the National Coordinator – Temporary Certification Program for Health Information Technology
With standards in place for Meaningful Use, it is also necessary to qualify the EHR technologies that meet the criteria established. This builds further confidence for providers and patients that the technology being used to support their records is compliant.

The ruling established is the first phase of the certification program designed to accelerate the formation of ONC – Authorized Testing and Certification Bodies (ONC-ATCBs). The ONC-ATCBs will be responsible for testing and certifying EHR vendors.

In order for healthcare providers to achieve Meaningful Use they must be using a product and version that is certified according to the meaningful use criteria.

Click here to see a list of ONC-ATCBs.
Click here to view the ONC Certified Health IT Product List.
Click here for details about the eClinicalWorks certification status.

MU - Stage 1

On July 13, 2010, the Centers for Medicare and Medicaid (CMS) announced the final ruling for the EHR Incentive Program based upon Stage 1 of Meaningful Use. This phase of adoption is focused on health care professionals using certified EHR technology to improve health outcomes in the following areas:

  • Electronically capturing health information in a standardized format
  • Using that information to track key clinical conditions
  • Communicating that information for care coordination processes
  • Initiating the reporting of clinical quality measures and public health information
  • Using information to engage patients and their families in their care


Stage 1 of Meaningful Use sets the foundation for health care providers using EHR technology and serves as a launch point for building a health care network across the United States. There will be future rulings to define the requirements for Stage 2 (est. 2014) and Stage 3 (est. 2016).

For Stage 1, eligible professionals are required to meet 15 core objectives and 5 out of 10 menu set objectives. With each objective, there is a threshold or measure that defines the minimum usage for each objective. With each stage of meaningful use, these thresholds will increase in addition to new objectives. Beginning with Stage 2 of meaningful use, the menu set objectives will all become core objectives, thus it is important to plan full adoption of these objectives as time progresses.

Eligible Professionals: 15 Core Objectives Measure
(1)
Use computerized provider order entry (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 all unique patients with at least one medication in their medication list seen by the EP have at least one medication order entered using CPOE.

Optional Alternate:
More than 30 percent of medication orders created by the EP during the EHR reporting period are recorded using CPOE.
(2)
Generate and transmit permissible prescriptions electronically (eRx).  More than 40 percent of all permissible prescriptions written by the EP are transmitted electronically using certified EHR technology.
(3)
Report ambulatory clinical quality measures to CMS. Successfully report to CMS ambulatory clinical quality measures selected by CMS in the manner specified by CMS.
(4)
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.
(5)
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 percent of all patients who request an electronic copy of their health information are provided it within 3 business days.
(6)
Provide clinical summaries for patient for each office visit Clinical summaries provided to patients for more than 50 percent of all office visits within 3 business days.
(7)
Implement drug-drug and drug-allergy interaction checks. The EP has enabled this functionality for the entire EHR reporting period.
(8)
Record all of the following demographics:
(A)Preferred language
(B)Gender
(C)Race
(D)Ethnicity
(E)Date of birth
More than 50 percent of all unique patients seen by the EP have demographics recorded as structured data.
(9)
Maintain an up-to-date problem list of current and active diagnoses. More than 80 percent 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.
(10)
Maintain active medication list. More than 80 percent 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.
(11)
Maintain active medication allergy list. More than 80 percent 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.
(12)
Record and chart changes in the following vital signs:
(A)Height
(B)Weight
(C)Blood pressure
(D)Calculate and display body mass index (BMI)
(E)Plot and display growth charts for children 2-20 years, including BMI
For more than 50 percent of all unique patients age 2 and overseen by the EP, height, weight, and blood pressure are recorded as structured data.

New Measure (Optional 2013; Required 2014 and beyond):
For more than 50 percent of all unique patients seen by the EP during the EHR reporting period have blood pressure (for patients age 3 and over only) and height and weight (for all ages) recorded as structured data.
(13)
Record smoking status for patients 13 years old or older.  More than 50 percent of all unique patients 13 years old or older seen by the EP have smoking status recorded as structured data.
(14) Capability to exchange key clinical information (ex: problem list, medication list, medication allergies, diagnostic test results), among providers of care and patient authorized entities electronically. Performed at least one test of the certified EHR technology’s capacity to electronically exchange key clinical information.
(15)
Protect electronic health information created or maintained by the certified EHR technology through the implementation of appropriate technical capabilities.  Conduct or review a security risk analysis in accordance with the requirements under 45 CFR 164.308(a)(1) and implement security updates as necessary and correct identified security deficiencies as part of its risk management process.



Eligible Professionals: 10 Menu Set Objectives (must meet 5 with at least 1 public health objective selected) Measure
(1)
Implement drug formulary checks. The EP has enabled this functionality and has access to at least one internal or external formulary for the entire EHR reporting period.
(2)
Incorporate clinical lab test results into EHR as structured data. More than 40 percent of all clinical lab test results ordered by the EP 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. – Lab interface optional
(3)
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 with a specific condition.
(4)
Send reminders to patients per patient preference for preventive/follow-up care. More than 20 percent of all patients 65 years or older or 5 years old or younger were sent an appropriate reminder during the EHR reporting period.
(5)
Provide patients with timely electronic access to their health information (including lab results, problem list, medication lists, and allergies) within 4 business days of the information being available to the EP. At least 10 percent of all unique patients seen by the EP are provided timely (available to the patient within four business days of being updated in the certified EHR technology) electronic access to their health information subject to the EP’s discretion to withhold certain information.
(6)
Use certified EHR technology to identify patient-specific education resources and provide those resources to the patient if appropriate. More than 10 percent of all unique patients seen by the EP are provided patient-specific education resources.
(7)
The EP 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 performs medication reconciliation for more than 50 percent of transitions of care in which the patient is transitioned into the care of the EP.
(8)
The EP 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 care record for each transition of care or referral. The EP 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 percent of transitions of care and referrals.
(9)
Capability to submit electronic data to immunization registries or immunization information systems and actual submission according to 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 submission if the test is successful, (unless none of the immunization registries to which the EP submits such information has the capacity to receive the information electronically), except where prohibited.
(10)
Capability to submit electronic syndromic surveillance data to public health agencies and actual submission according to applicable law and practice. Performed at least one test of certified EHR technology’s capacity to provide electronic syndromic surveillance data to public health agencies and follow-up submission if the test is successful, (unless none of the public health agencies to which an EP submits such information has the capacity to receive the information electronically) except where prohibited.

MU - Stage 2

On September 4th, 2012, CMS announced the final ruling that specifies the Stage 2 criteria that Eligible Professionals (EPs), Eligible Hospitals, and Critical Access Hospitals (CAHs) must meet in order to qualify for Medicare and/or Medicaid electronic health record (EHR) incentive payments. Stage 2 (2014) Meaningful Use criteria will focus on:

  • More rigorous health information exchange (HIE)
  • Increased requirements for e-prescribing and incorporating lab results
  • Electronic transmission of patient care summaries across multiple settings
  • More patient-controlled data

Providers need to meet two years of meaningful use under the Stage 1 criteria before advancing to the Stage 2 criteria in their third year. Some providers who were earlier adopters demonstrators of meaningful use in 2011 will meet three consecutive years of meaningful use under the Stage 1 criteria before moving forward to Stage 2 criteria in 2014.

In Stage 2, most of the thresholds percentages have increased compaired to Stage 1. Most of the menu set objectives from Stage 1 are now core objectives for Stage 2. Stage 2 requires that eligible providers must meet 17 core objectives, three of six menu objectives and nine out of 64 total CQMs. All providers must select CQMs from at least three of the six key health care policy domains recommended by HHS's National Quality Strategy.

Note: For 2014 only, according to CMS, all providers regardless of their stage of meaningful use are only required to demonstrate meaningful use for a three-month reporting period.


Eligible Professionals: 17 Core Objectives Measure
(1)
Use computerized provider order entry (CPOE) for medication, laboratory and radiology orders directly entered by any licensed healthcare professional who can enter orders into the medical record per state, local and professional guidelines. - 170.314(a)(1)
More than 60 percent of medication, 30 percent of laboratory, and 30 percent of radiology orders created by the EP during the EHR reporting period are recorded using CPOE.
(2)
Generate and transmit permissible prescriptions electronically (eRx). - 170.314(b)(3)
More than 50 percent of all permissible prescriptions, or all prescriptions, written by the EP are queried for a drug formulary and transmitted electronically using CEHRT.
(3)
Record the following demographics:preferred language, sex, race, ethnicity, date of birth. - 170.314(a)(3)
More than 80 percent of all unique patients seen by the EP have demographics recorded as structured data.
(4)
 

Record and chart changes in the following vital signs:

  • Height/Length (No age limit)
  • Weight (No age limit)
  • Blood pressure (Ages 3 & over)
  • Calculate and display: BMI
  • Plot and display growth charts for children 0–20 years, including BMI. - 170.314(a)(4)
More than 80 percent of all unique patients seen by the EP have blood pressure (for patients age 3 and over only) and/or height and weight (for all ages) recorded as structured data.
(5)
Record smoking status for patients 13 years old or older. - 170.314(a)(11)
More than 80 percent of all unique patients 13 years old or older seen by the EP have smoking status recorded as structured data.
(6)
Use clinical decision support to improve performance on high-priority health conditions. - 170.314(a)(8) & (a)(2)
Measure 1: Implement five clinical decision support interventions related to four or more clinical quality measures at a relevant point in patient care for the entire EHR reporting period. Absent four clinical quality measures related to an EP’s scope of practice or patient population, the clinical decision support interventions must be related to high-priority health conditions.

Measure 2: The EP has enabled and implemented the functionality for drug-drug and drug-allergy interaction checks for the entire EHR reporting period
(7)
 
Provide patients the ability to view online, download and transmit their health information within four business days of the inform ation being available to the EP. - 170.304(e)(1) Measure 1: More than 50 percent of all unique patients seen by the EP during the EHR reporting period are provided timely (available to the patient within 4 business days after the information is available to the EP) online access to their health information.

Measure 2: More than 5 percent of all unique patients seen by the EP during the EHR reporting period (or their authorized representatives) view, download, or transmit to a third party their health information.
(8)
 
Provide clinical summaries for patients for each office visit. - 170.314(e)(2)
Clinical summaries provided to patients or patient-authorized representatives within one business day for more than 50 percent of office visits.
(9)
 
Protect electronic health information created or maintained by the Certified EHR Technology through the implementation of appropriate technical capabilities. - 170.314(d)(1- 9)
Conduct or review a security risk analysis in accordance with the requirements under 45 CFR 164.308(a) (1), including addressing the encryption/security of data stored in CEHRT in accordance with requirements under 45 CFR 164.312 (a)(2)(iv) and 45 CFR 164.306(d)(3), and implement security updates as necessary and correct identified security deficiencies as part of the provider's risk management process for EPs.
(10)
Incorporate clinical lab-test results into Certified EHR Technology as structured data. - 170.314(b)(5)
More than 55 percent of all clinical lab tests results ordered by the EP 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.
(11)
Generate lists of patients by specific conditions to use for quality improvement, reduction of disparities, research, or outreach. - 170.314(a)(14)
Generate at least one report listing patients of the EP with a specific condition.
(12)
Use clinically relevant information to identify patients who should receive reminders for preventive/follow-up care and send these patients the reminders, per patient preference. - 170.314(a)(14)
More than 10 percent of all unique patients who have had 2 or more office visits with the EP within the 24 months before the beginning of the EHR reporting period were sent a reminder, per patient preference when available.
(13)
Use clinically relevant information from Certified EHR Technology to identify patient-specific education resources and provide those resources to the patient. - 170.314(a)(15)
Patient-specific education resources identified by Certified EHR Technology are provided to patients for more than 10 percent of all unique patients with office visits seen by the EP during the EHR reporting period.
(14)
 
The EP who receives a patient from another setting of care or provider of care or believes an encounter is relevant should perform medication reconciliation. - 170.314(b)(4)
The EP who performs medication reconciliation for more than 50 percent of transitions of care in which the patient is transitioned into the care of the EP.
(15)
 
The EP who transitions their patient to another setting of care or provider of care or refers their patient to another provider of care should provide a summary care record for each transition of care or referral. - 170.314(b)(1) & (b)(2)
EPs must satisfy both of the following measures in order to meet the objective:

Measure 1: The EP 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 percent of transitions of care and referrals.

Measure 2: The EP who transitions or refers their patient to another setting of care or provider of care provides a summary of care record for more than 10 percent of such transitions and referrals either (a) electronically transmitted using CEHRT to a recipient or (b) where the recipient receives the summary of care record via exchange facilitated by an organization that is a NwHIN Exchange participant or in a manner that is consistent with the governance mechanism ONC establishes for the NwHIN.

Measure 3: An EP must satisfy one of the following criteria:

(A) Conducts one or more successful electronic exchanges of a summary of care document, as part of which is counted in "measure 2" (for EPs the measure at §495.6(j)(14)(ii)(B) with a recipient who has EHR technology that was developed designed by a different EHR technology developer than the sender's EHR technology certified to 45 CFR 170.314(b)(2).

(B) Conducts one or more successful tests with the CMS designated test EHR during the EHR reporting period.
(16)
Capability to submit electronic data to immunization registries or immunization information systems except where prohibited, and in accordance with applicable law and practice. - 170.314(f)(1) & (f)(2) Successful ongoing submission of electronic immunization data from CEHRT to an immunization registry or immunization information system for the entire EHR reporting period.
(17)
Use secure electronic messaging to communicate with patients on relevant health information. - 170.314(e)(3) A secure message was sent using the electronic messaging function of CEHRT by more than 5 percent of unique patients (or their authorized representatives) seen by the EP during the EHR reporting period.
     
   
 
Eligible Professionals: 6 Menu Set Objectives (must meet 3 of the 6) Measure
(1)
Capability to submit electronic syndromic surveillance data to public health agencies except where prohibited, and in accordance with applicable law and practice. - 170.314(f)(3) Successful ongoing submission of electronic syndromic surveillance data from CEHRT to a public health agency for the entire EHR reporting period.
(2)
Record electronic notes in patient records. - 170.314(a)(9) Enter at least one electronic progress note created, edited and signed by an EP for more than 30 percent of unique patients with at least one office visit during the EHR reporting period. The text of the electronic note must be text searchable and may contain drawings and other content.
(3)
Imaging results consisting of the image itself and any explanation or other accompanying information are accessible through CEHRT. - 170.314(a)(12) More than 10 percent of all tests whose result is one or more images ordered by the EP during the EHR reporting period are accessible through CEHRT.
(4)
Record patient family health history as structured data. - 170.314(a)(13) More than 20 percent of all unique patients seen by the EP during the EHR reporting period have a structured data entry for one or more first-degree relatives.
(5)
Capability to identify and report cancer cases to a public health central cancer registry, except where prohibited, and in accordance with applicable law and practice. - 170.314(f)(5) & (f)(6) Successful ongoing submission of cancer case information from CEHRT to a public health central cancer registry for the entire EHR reporting period.
(6)
Capability to identify and report specific cases to a specialized registry (other than a cancer registry), except where prohibited, and in accordance with applicable law and practice. Successful ongoing submission of specific case information from CEHRT to a specialized registry for the entire EHR reporting period.

Incentive Program Selection and Enrollment

This section of the eClinicalWorks Meaningful Use website provides an overview for eligible professionals (EPs). For a detailed review of all eligibility criteria, including Medicare Advantage and eligible hospitals, refer to the CMS EHR Incentive Program website.

Eligible Professionals (EPs) by Incentive Program
Medicare Fee-For-Service
Incentives up to $44,000
Medicaid *
Incentives up to $63,750
Doctor of Medicine or Osteopathy Physicians
Doctor of Dental Surgery or Dental Medicine Nurse Practitioners (NPs)
Doctor of Podiatric Medicine Physician Assistants (PAs) working in a Federally Qualified Health Center or Rural Health Clinic that is led by a PA
Doctor of Optometry Certified Nurse-Midwives (CNMs)
Chiropractor Dentists
Eligible providers must not be hospital-based. A provider is considered hospital-based if 90% or more of their services are performed in inpatient or emergency room settings.
An EP may participate in either the Medicare FFS or Medicaid program. The EP may switch between programs once during the course of the incentive program (following the first payment).

* In addition to the above, to qualify for the Medicaid program, the EP must meet at least one of the following:

  • 30% or more Medicaid patient volume (excluding CHIP patients)
  • A pediatrician with 20% or more Medicaid patient volume (excluding CHIP patients)
  • An EP that practices predominately in a FQHC or RHC with a minimum of 30% of patients being needy individuals

Important Facts and Timelines
Medicare Fee-For-Service
Incentives up to $44,000 *
Medicaid
Incentives up to $63,750
Registration launches in January, 2011 States have the option to launch in January, 2011
Must demonstrate meaningful use in the first year.
Click here for more information.
Can qualify for payment for the first year if adopt, implement, upgrade or demonstrate meaningful use in the first year. Subsequent years require demonstration of meaningful use.
Must demonstrate meaningful use for 90 days in the first year; subsequent years require 365 days By the second year, must demonstrate meaningful us for 90 days; subsequent years require 365 days
Must begin participation by 2012 to be eligible to receive the maximum incentive dollars Must begin participation by 2016 to be eligible to receive the maximum incentive dollars
April 2011 – attestation begins The last year to begin participation is 2016
May 2011 – incentive payments begin 2021 is the last year that Medicaid will distribute an incentive payment
February 28, 2012 – last day an EP may register and attest to receive an incentive payment for CY 2011
2016 is the last year incentive payments can be received

* Health Provider Shortage Areas qualify for an additional $4,400.