Meaningful Use Quick Reference Guide

Yesterday, the Centers for Medicare and Medicaid Services (CMS) released draft criteria for the “Meaningful Use” of electronic health records (EHRs). Physicians that want to qualify for incentive payouts through CMS in 2011 must meet all of the so-called Stage 1 criteria listed below. CMS will probably add additional criteria beginning in 2013.

The following list has been excerpted from pages 47-65 of the CMS document. EHR vendors and providers should read the original document as part of any formal planning exercise and certainly in advance of any EHR purchasing decision.

Note that the CMS document is subject to a 60-day public comment period before it becomes law.

The Stage 1 Meaningful Use criteria are sorted into 5 groups, as follows.

Improving Quality, Safety and Efficiency, and Reducing Health Disparities:
• Provide access to comprehensive patient health data for the patient's healthcare team.
• Use evidence-based order sets and computerized provider order entry.
• Apply clinical decision support at the point of care.
• Generate lists of patients who need care and use them to reach out to those patients.
• Report information for quality improvement and public reporting.
• Use computerized physician order entry (CPOE). NOTE: For Stage 1 electronic transmission of the order to the pharmacy, laboratory, or diagnostic imaging center is not required.
• Implement drug-drug, drug-allergy, and drug-formulary checks.
• Maintain an up-to-date problem list of current and active diagnoses based on ICD-9-CM or SNOMED.
• Generate and transmit permissible prescriptions electronically (ePrescribing).
• Maintain active medication list.
• Maintain active medication allergy list.
• Record the following demographics: preferred language, insurance type, gender, race and ethnicity, and date of birth.
• Record and chart changes in the following vital signs: height, weight and blood pressure and calculate and display body mass index (BMI) for ages 2 and over; plot and display growth charts for children 2 - 20 years, including BMI.
• Record smoking status for patients 13 years old or older.
• Incorporate clinical lab-test results into EHR as structured data.
• Generate lists of patients by specific conditions to use for quality improvement, reduction of disparities, research, and outreach.
• Report ambulatory quality measures to CMS (or, for eligible providers seeking the Medicaid incentive payment, the States).
• Send reminders to patients per patient preference for preventive/follow-up care.
• Implement 5 clinical decision support rules relevant to specialty or high clinical priority, including for diagnostic test ordering, along with the ability to track compliance with those rules.
• Check insurance eligibility electronically from public and private payers.
• Submit claims electronically to public and private payers.

Engaging Patients and Families in their Health Care:
• Provide patients and families with timely access to data, knowledge, and tools to make informed decisions and to manage their health (consistent with all Federal and State laws).
• Provide patients with an electronic copy of their health information (including diagnostics test results, problem list, medication lists, allergies) upon request.
• Provide patients with timely electronic access to their health information within 96 hours of the information being available to the eligible provider (EP).
• Provide clinical summaries for patients for each office visit.

Improving Care Coordination:
• Exchange meaningful clinical information among professional health care team. For eligible providers (EPs) this means:
- 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.
- Perform medication reconciliation at relevant encounters and each transition of care.
- Provide summary care record for each transition of care or referral. Not explicitly included in the HIT Policy Committee's recommended objectives.

Improving Population and Public Health:
• The patient's health care team communicates with public health agencies. For EPs, this means:
- Capability to submit electronic data to immunization registries and actual submission where possible and accepted.
- Capability to provide electronic syndromic surveillance data to public health agencies and actual transmission according to applicable law and practice.

Ensuring Adequate Privacy and Security Protections for Personal Health Information:
• Ensure privacy and security protections for confidential information through operating policies, procedures, and technologies and compliance with applicable law.
• Provide transparency of data sharing to patient. For EPs, this means:
- Protect electronic health information created or maintained by the certified EHR technology through the implementation of appropriate technical capabilities. NOTE: Compliance with the HIPAA Privacy and Security Rules is required for all covered entities, regardless of whether they participate in the EHR incentive programs or not.

Glenn Laffel, MD, PhD
Senior VP, Clinical Affairs, Practice Fusion