Meaningful Use Criteria

In my last post, I discussed how meaningful use of the EHR was initiated. In this post, I will discuss the meaningful use criteria. Meaningful use refers to a set of fifteen criteria healthcare providers and hospitals must meet to prove they are using their EHR in a meaningful way.

There are also ten more requirements but only 5 out of the 10 are required. In total, providers need to demonstrate twenty of the twenty-five requirements. There are the 15 mandatory requirements healthcare providers and hospitals must meet in order to qualify:

1. Record patient demographics (50%) such as preferred language, gender, race, ethnicity, date of birth
2. Record and chart changes in vital signs (50%) Blood pressure, calculate and display BMI, height (may be self-reported) weight, plot and display growth charts for children 2-20 years
3. Maintain active medication allergy list (80%) one or more allergies or an indication of no allergy for each patient
4. Maintain an updated problem list of current and active diagnoses (ICD-9 or SNOMED) (80%) one or more problems, active diagnosis, or indication (i.e. “none” of no known problem for each patient)
5. Maintain active medication list (80%) one or more medication or an indication (i.e “none” that the patient is not currently prescribed any medication)
6. Use computerized physician order entry for medication orders (CPOE) (30% including meds)
7. Generate and transmit electronic prescriptions for non-controlled substances (40%)
8. Implement drug-drug or drug-allergy interaction checks (functionality enabled)
9. Record adult smoking status (50%)
10. Provide clinical summaries for patients for each office visit (50% in 3 days)
11. On request, provide patient and electronic copy of their hospital discharge instructions (50%)
12. Implement capability to electronically exchange clincial information among care providers and patient authorized entities
13. Implement clinical decision support (one rule)
14. Implement systems to protect privacy and security of patient data in the electronic health record (EHR)
15. Report clinical quality measures to CMS for Medicare or states for Medicaid (Blood pressure, BMI, and smoking)

The following are the set of criteria providers must choose 5 out of 10:

1. Implement drug-forumulary checks (one report)
2. Incorporate clinical lab test results in EHR (40%)
3. Generate patient lists by specific conditions to use for quality improvement, reduction of disparities, or research
4. Use EHR technology to identify patient-specific education resources and provide to patients (10%)
5. Perform medication reconcilation between care settings (50%)
6. Provide summary of care record for patients referred or transitioned to another provider or setting (50%)
7. Submit immunization data to immunization registries or immunization information system (perform at least one test)
8. Submit syndromatic surveillance data to public health agencies (perform at least one test)
9. Send reminders to patients for preventative and follow-up care (20% >65 years < 5 years
10. Provide patients with timely electronic access to their health information (lab results, problem list, medication lists, and medication allergies) (10% in 4 days)

These requirements are spread over a five year period and are in three stages. Each stage represents a level of adoption. The electronic health record must be certified with the United States Health and Human Services (HHS).

Stage 1 – major functionality of a certified electronic health record – document a set percentage of visits, diagnoses, prescriptions, and immunizations; use clinical support tools (warnings and reminders for the licensed care providers in the EMR); share patient information; and report quality measures and public health information

Stage 2: all of the functionality mentioned above for Stage 1 in addition to sending out lab orders and results

Stage 3: Criteria from stage 1 and 2; including clinical decision support for national high priority conditions

Physicians and hospitals not only need to capture all of the necessary data but also calculate and report results for all patients. Meeting the stage 1 functional requirements for data capture only covers 35% of the unique data elements needed for the 15 required quality measures. There are many exclusions for meaningful use.

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