Providers Guide to Meaningful Use
Updated: 5/16/2011
Providers Guide to Meaningful Use
2 © 2011 Meditab Software, Inc. 333 Hegenberger Road, Suite 800, Oakland, CA 94621 (866) 99-GO-EMR
Table of Contents
1. Purpose of this Guide................................................................................................................................................ 3
2. Meaningful Use: A Summary Overview ................................................................................................................ 4
3. Eligibility Requirements for Professionals ............................................................................................................. 7
4. Registering for the Incentives .................................................................................................................................. 9
5. Guidance on the Meaningful Use Attestation Process ......................................................................................... 12
6. IMS Meaningful Use Report .................................................................................................................................. 16
7. Meaningful Use Core Requirements ..................................................................................................................... 22
CR01: CPOE for Medication Orders ........................................................................................................................... 22
CR02 - Drug Interaction Checks .................................................................................................................................. 24
CR03 – Transmit Permissible Prescriptions Electronically .......................................................................................... 25
CR04 - Record Demographics ...................................................................................................................................... 27
CR05 - Maintain Problem List ...................................................................................................................................... 29
CR06 - Active Medication List ..................................................................................................................................... 31
CR07 - Medication Allergy List ................................................................................................................................... 32
CR08 - Record Vital Signs ........................................................................................................................................... 34
CR09 – Record Smoking Status ................................................................................................................................... 36
CR10 - Clinical Decision Support Rule ........................................................................................................................ 39
CR11 - Clinical Quality Measures (CQMs) ................................................................................................................. 40
CR12 - Electronic Copy of Health Information ............................................................................................................ 41
CR13 - Clinical Summaries .......................................................................................................................................... 45
CR14 - Electronic Exchange of Clinical Information .................................................................................................. 47
CR15 - Protect Electronic Health Information ............................................................................................................. 49
8. Meaningful Use Menu Requirements.................................................................................................................... 52
MN01 - Drug Formulary Checks .................................................................................................................................. 52
MN02 - Clinical Lab Test Results ................................................................................................................................ 54
MN03 - Patient Lists ..................................................................................................................................................... 55
MN04 -Patient Reminders ............................................................................................................................................ 58
MN05 - Patient Electronic Access ................................................................................................................................ 61
MN06 - Patient-specific Education Resources ............................................................................................................. 64
MN07 - Medication Reconciliation .............................................................................................................................. 65
MN08 - Transition of Care Summary ........................................................................................................................... 67
MN09 - Immunization Registries Data Submission ..................................................................................................... 69
MN10 - Syndromic Surveillance Data Submission ...................................................................................................... 70
9. Summary IMS Core and Menu Set Requirements Checklist ............................................................................. 71
10. Referenced and Additional Resources .................................................................................................................. 78
Providers Guide to Meaningful Use
3 © 2011 Meditab Software, Inc. 333 Hegenberger Road, Suite 800, Oakland, CA 94621 (866) 99-GO-EMR
1. Purpose of this Guide
The Centers for Medicare and Medicaid Services (CMS) make a vast library of ―Meaningful Use‖ resources available
to eligible providers on their website. ―A Providers Guide to Meaningful Use‖ pulls from these resources with a
specific focus on the eligible professional and includes:
A Summary Overview of Meaningful Use
Eligibility Requirements for Professionals
Registering for the Incentives
Guidance on the Meaningful Use Attestation Process
Instruction for the IMS Meaningful Use Report
Detailed Core and Menu Requirements with IMS Related Function
Summary IMS Core and Menu Requirement Checklist
Since the primary focus of this guide is intended for the eligible professional, information pertaining to hospital
requirements has been largely excluded. For further clarification or additional guidance on any of the material
covered herein, the CMS website should be referenced. ( Source: www.cms.gov/EHRIncentivePrograms )
Important Dates for Eligible Professionals
January 1, 2011 – Reporting year begins for eligible professionals.
January 3, 2011 – Registration for the Medicare EHR Incentive Program begins.
January 3, 2011 – For Medicaid providers, states may launch their programs if they so choose.
April 2011 – Attestation for the Medicare EHR Incentive Program begins.
May 2011 – EHR Incentive Payments expected to begin.
October 1, 2011 – Last day for eligible professionals to begin their 90-day reporting period for calendar
year 2011 for the Medicare EHR Incentive Program.
December 31, 2011 – Reporting year ends for eligible professionals.
February 29, 2012 – Last day for eligible professionals to register and attest to receive an Incentive
Payment for calendar year (CY) 2011.
2014 – Last year to initiate participation in the Medicare EHR Incentive Program
2015 – Medicare payment adjustments begin for eligible professionals that are not Meaningful Users of
EHR technology
2016 – Last year to receive a Medicare EHR Incentive Payment
2016 – Last year to initiate participation in the Medicaid EHR Incentive Program
2021 – Last year to receive a Medicaid EHR Incentive Payment
Providers Guide to Meaningful Use
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2. Meaningful Use: A Summary Overview
What is Meaningful Use?
Meaningful Use was introduced as part of the American Recovery and Reinvestment Act of 2009 (ARRA2009) with
a focus on improving health care through the use of health information technology. ARRA2009 specifies three main
components of Meaningful Use:
The use of a certified EHR in a meaningful manner, such as e-prescribing
The use of certified EHR technology for electronic exchange of health information to improve quality of
health care
The use of certified EHR technology to submit clinic quality and other measures
Why EHR and Why Now?
For the purposes of the Medicare and Medicaid Incentive Programs, eligible professionals, eligible hospitals and
critical access hospitals (CAHs) must use certified EHR technology. Certified EHR technology gives assurance to
purchasers and other users that an EHR system or module offers the necessary technological capability, functionality,
and security to help them meet the meaningful use criteria. Certification also helps providers and patients be confident
that the electronic health IT products and systems they use are secure, can maintain data confidentially, and can work
with other systems to share information. IMS is designed to provide this confidence.
The Medicare EHR Incentive Program
The Medicare EHR Incentive Program will provide incentive payments to eligible professionals, eligible hospitals,
and CAHs that demonstrate meaningful use of certified EHR technology.
Participation can begin as early as 2011.
Eligible professionals can receive up to $44,000 over five years under the Medicare EHR Incentive
Program. There's an additional incentive for eligible professionals who provide services in a Health
Professional Shortage Area (HSPA).
To get the maximum incentive payment, Medicare eligible professionals must begin participation
by 2012. Important! For 2015 and later, Medicare eligible professionals, eligible hospitals, and CAHs that
do not successfully demonstrate meaningful use will have a payment adjustment in their Medicare
reimbursement.
The Medicaid EHR Incentive Program
The Medicaid EHR Incentive Program will provide incentive payments to eligible professionals, eligible hospitals,
and CAHs as they adopt, implement, upgrade, or demonstrate meaningful use of certified EHR technology in their
first year of participation and demonstrate meaningful use for up to five remaining participation years.
The Medicaid EHR Incentive Program is voluntarily offered by individual states and territories and may
begin as early as 2011, depending on the state.
Eligible professionals can receive up to $63,750 over the six years that they choose to participate in the
program.
There are no payment adjustments under the Medicaid EHR Incentive Program.
Providers Guide to Meaningful Use
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What are the Criteria for Meaningful Use?
Meaningful Use will be implemented over the course of the next five years.
Stage 1 (2011 and 2012) sets the baseline for electronic data capture and information sharing.
Stage 2 (expected to be implemented in 2013) and Stage 3 (expected to be implemented in 2015) will
continue to expand on this baseline and be developed through future rule making.
How To Meet Meaningful Use Requirements?
To qualify for incentive payments, meaningful use requirements must be met in the following ways:
Medicare EHR Incentive Program: Eligible professionals, eligible hospitals, and critical access
hospitals (CAHs) must successfully demonstrate meaningful use of certified electronic health record
technology every year they participate in the program.
Medicaid EHR Incentive Program: Eligible professionals and eligible hospitals may qualify for
incentive payments if they adopt, implement, upgrade or demonstrate meaningful use in their first year
of participation. They must successfully demonstrate meaningful use for subsequent participation years.
Adopted: Acquired and installed certified EHR technology. (For example, can show evidence of
installation.)
Implemented: Began using certified EHR technology. (For example, provide staff training or data entry
of patient demographic information into EHR.)
Upgraded: Expanded existing technology to meet certification requirements. (For example, upgrade to
certified EHR technology or add new functionality to meet the definition of certified EHR technology.)
What are the requirements for Stage 1 of Meaningful Use (2011 and 2012)?
For eligible professionals, there are a total of 25 meaningful use objectives. To qualify for an incentive payment, 20
of these 25 objectives must be met.
There are 15 required core objectives.
The remaining 5 objectives may be chosen from the list of 10 menu set objectives.
Details of each Core and Menu requirement are provided later in this guide.
What are "Clinical Quality Measures"? (Source: http://www.cms.gov/QualityMeasures/ )
Quality measures are tools that help CMS measure or quantify healthcare processes, outcomes, patient perceptions,
and organizational structure and/or systems that are associated with the ability to provide high-quality health care
and/or that relate to one or more quality goals for health care. These goals include: effective, safe, efficient, patient-
centered, equitable, and timely care.
To demonstrate meaningful use in this area successfully, eligible professionals are required also to report discipline
specific clinical quality measures. Eligible professionals must report on 6 total clinical quality measures: 3 required
core measures (substituting alternate core measures where necessary) and 3 additional measures (selected from a set
of 38 clinical quality measures). CMS accepts PRQI quality measures data extracted from a qualified EHR product
for a limited subset of PQRI quality measures. IMS provides a PQRI reporting utility for this purpose and a separate
instructional guide is available. In addition to PQRI, other quality measures pertaining to the eligible professional
include the use of an EHR, End Stage Renal Disease, and eRx usage. For additional information about Clinical
Quality Measure requirements, please see:
Providers Guide to Meaningful Use
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Guide for Reading the EHR Incentive Program EP Measures
(http://www.cms.gov/QualityMeasures/Downloads/QMGuideForReadingEHR.pdf)
Overview of Electronic Specifications for Clinical Quality Measures
(http://www.cms.gov/QualityMeasures/03_ElectronicSpecifications.asp)
Zip File with Core CQM Specifications
(http://www.cms.gov/apps/ama/license.asp?file=/QualityMeasures/Downloads/EP_MeasureSpecificatio
ns.zip)
Zip File with Supplemental CQM Specifications
(http://www.cms.gov/apps/ama/license.asp?file=/QualityMeasures/Downloads/QMEPSupplemental.zip)
Physician Quality Reporting System Information (Formerly PQRI)
(http://www.cms.gov/PQRI/20_AlternativeReportingMechanisms.asp)
Providers Guide to Meaningful Use
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3. Eligibility Requirements for Professionals (Source: http://www.cms.gov/EHRIncentivePrograms/15_Eligibility.asp#TopOfPage )
Eligibility Requirements for Professionals
Incentive payments for eligible professionals are based on individual practitioners.
If you are part of a practice, each eligible professional may qualify for an incentive payment if each
eligible professional successfully demonstrates meaningful use of certified EHR technology.
Each eligible professional is only eligible for one incentive payment per year, regardless of how many
practices or locations at which he or she provide services.
Hospital-based eligible professionals are not eligible for incentive payments. An eligible
professional is considered hospital-based if 90% or more of his or her services are performed in a
hospital inpatient (Place Of Service code 21) or emergency room (Place Of Service code 23) setting.
Who is an Eligible Professional under the Medicare EHR Incentive Program?
In addition to the requirements above, Medicare eligible professionals must have Medicare Part B allowed charges
and must be enrolled in an ―approved status‖ for Provider Enrollment, Chain and Ownership System (PECOS).
Eligible professionals under the Medicare EHR Incentive Program include:
Doctor of medicine or osteopathy
Doctor of dental surgery or dental medicine
Doctor of podiatry
Doctor of optometry
Chiropractor
Who is an Eligible Professional under the Medicaid EHR Incentive Program?
Eligible professionals under the Medicaid EHR Incentive Program include:
Physicians (primarily doctors of medicine and doctors of osteopathy)
Nurse practitioner
Certified nurse-midwife
Dentist
Physician assistant who furnishes services in a Federally Qualified Health Center or Rural Health Clinic
that is led by a physician assistant.
To qualify for an incentive payment under the Medicaid EHR Incentive Program, an eligible professional must meet
one of the following criteria:
Have a minimum 30% Medicaid patient volume*
Have a minimum 20% Medicaid patient volume, and is a pediatrician*
Practice predominantly in a Federally Qualified Health Center or Rural Health Center and have a
minimum 30% patient volume attributable to needy individuals
* Children's Health Insurance Program (CHIP) patients do not count toward the Medicaid patient volume criteria.
Eligible for Both Programs?
Professionals eligible for both the Medicare and Medicaid EHR Incentive Programs must choose which incentive
program they wish to participate in when they register. Before 2015, an eligible professional may switch programs
Providers Guide to Meaningful Use
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only once after the first incentive payment is initiated. Most eligible professionals will maximize their incentive
payments by participating in the Medicaid EHR Incentive Program.
Providers Guide to Meaningful Use
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4. Registering for the Incentives (Source: http://www.cms.gov/EHRIncentivePrograms/20_RegistrationandAttestation.asp#TopOfPage)
Medicare EHR Incentive Program Registration opened on January 3, 2011, so all eligible professionals may now
register at any time. Medicaid Registration is also open in the following states:
As of January 3, 2011
Alaska North Carolina
Iowa Oklahoma
Kentucky South Carolina
Louisiana Tennessee
Michigan Texas
Mississippi
As of April 1, 2011
Alabama
As of April 4, 2011
California
Missouri
Other states likely will launch their Medicaid EHR Incentive Programs during the spring and summer of 2011.
Steps to Registration
(NOTE: At this time, eligible providers must complete the registration process personally. In May 2011, CMS plans
to implement functionality that will allow an eligible professional to designate a third party to register and attest on
his or her behalf.
1. Gather the following required information ahead of time and have available at time of registration
a. National Provider Identifier (NPI).
(To locate your NPI number, visit: https://nppes.cms.hhs.gov/NPPES/NPIRegistryHome.do
b. National Plan and Provider Enumeration System (NPPES) User ID and Password.
a) If NPPES is unknown, contact the PECOS Help Desk at (866) 494-8049 or online at
https://pecos.cms.hhs.gov
b) If NPPES is required, gather the information below and request via
https://nppes.cms.hhs.gov/NPPES/IACreateLogin.do.
1. Type 2 NPI
2. Taxpayer ID Number
3. Address from IRS Form CP-575. (A copy will also need to be mailed in)
c. Payee Tax Identification Number (if you are reassigning your benefits).
d. Payee National Provider Identifier (NPI) (if you are reassigning your benefits).
2. Eligible professional should determine EHR incentive programs to register for. Once decided, eligible
professional should read the appropriate ―CMS Registration User Guide for Eligible Professionals‖ for
Medicare, Medicaid, or both.
a. Medicare Guide –
http://www.cms.gov/EHRIncentivePrograms/Downloads/EHRMedicareEP_RegistrationUserGuide.pdf
b. Medicaid Guide –
http://www.cms.gov/EHRIncentivePrograms/Downloads/EHRMedicaidEP_RegistrationUserGuide.pdf
3. Once a clear understanding of what is required has been attained, eligible professionals should now follow the
instructions within the appropriate guide(s) to complete the registration process.
Providers Guide to Meaningful Use
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4. Medicare Registration: Specific notes regarding Steps within EHRMedicareEP_RegistrationUserGuide.pdf
(NOTE: While on the website, click ―Help‖ at the top of the screen if there are any questions.)
a. Step 1 – Enter https://ehrincentives.cms.gov into browser and follow guide
b. Step 2 – Login via NPPES number
c. Step 3 – Click the ―Registration‖ tab
d. Step 4 – Click on ―Register‖ in the action column at the bottom to proceed. Other options for Resubmit,
Modify, Cancel, and Reactivate will be available at next login.
e. Step 5 – Click ―Start Registration‖
f. Step 6
a) Select ―Medicare‖ and click ―Apply‖
b) Select appropriate ―Eligible Professional Type‖
c) Select ―Yes‖ for ―Do you have a certified EHR?‖
a. If you do not already have the EHR Certification Number, do the following:
1) Go to http://healthit.hhs.gov/CHPL
2) Select Practice Type as ―Ambulatory Practice Type‖
3) In the center search option, set ―Select search type‖ to be ―Vendor
Name‖ and enter ―Meditab‖ in the ―Search for‖ field. Click Search
4) In the next window, click on the ―Add to Cart‖ link at the end of the
CCHIT row in the table
5) Click the ―Get CMS EHR Certification ID‖ button
6) The CMS EHR Certification ID is what is to be entered when
prompted
b. Complete the required information for the certified EHR
c. Click ―Save And Continue‖
g. Step 7 – Follow guide in relation to assigning payments.
h. Step 8
a) Review information for accuracy. This should match what is in NPPES. If a change is
made here, be sure to make the same change in NPPES. A change here DOES NOT update
NPPES.
b) Enter your valid email address and then repeat once more for confirmation.
c) Click ―Save and Continue‖
i. Step 9 – Verify all Topics are checked as ―Completed‖. If not, click ―Modify Registration‖ and provide
required information. Once all are checked ―Completed‖, click ―Begin Submission‖.
j. Step 10 – Verify Registration Information is correct. If not correct, click ―Previous Page‖ to make
changes. Once the information is correct, click ―Submit‖.
k. Step 11 – Read the Disclaimer and click ―Agree‖ to proceed or ―Disagree‖ to be redirected back to the
Registration Instructions Page. From here, ―Modify‖ may be clicked as Action to restart.
l. Step 12– At this point, a Submission Receipt is received and should be printed as a confirmation record.
If successful, the receipt will read ―Successful Submission‖. If it was not successful, it will read
―Failed Submission‖ and the eligible professional should read the instructions on the screen and make
appropriate corrections.
m. Step 13 – Click the ―Status‖ tab to view the registration summary. For detailed information, click
―Select‖ in the Action column. Click ADDITIONAL INFORMATION for, the registration status
reason, Fiscal Intermediary (FI)/ Carrier/Medicare Administrative Contractor (MAC) and validations
performed on registration.
5. Medicaid Registration: Specific notes regarding Steps within EHRMedicaidEP_RegistrationUserGuide.pdf
(NOTE: While on the website, click ―Help‖ at the top of the screen if there are any questions.)
a. Step 1 – Enter https://ehrincentives.cms.gov into browser and follow guide
b. Step 2 – Login via NPPES number
c. Step 3 – Click the ―Registration‖ tab
Providers Guide to Meaningful Use
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d. Step 4 – Click on ―Register‖ in the action column at the bottom to proceed. Other options for Resubmit,
Modify, Cancel, and Reactivate will be available at next login.
e. Step 5 – Click ―Start Registration‖
f. Step 6
a) Select ―Medicaid‖ and click ―Apply‖
b) Select the appropriate ―Medicaid State/Territory‖
c) Select appropriate ―Eligible Professional Type‖
d) Select ―Yes‖ for ―Do you have a certified EHR?‖
a. If you do not already have the EHR Certification Number, do the following:
1) Go to http://healthit.hhs.gov/CHPL
2) Select Practice Type as ―Ambulatory Practice Type‖
3) In the center search option, set ―Select search type‖ to be ―Vendor
Name‖ and enter ―Meditab‖ in the ―Search for‖ field. Click Search
4) In the next window, click on the ―Add to Cart‖ link at the end of the
CCHIT row in the table
5) Click the ―Get CMS EHR Certification ID‖ button
6) The CMS EHR Certification ID is what is to be entered when
prompted
b. Complete the required information for the certified EHR
c. Click ―Save And Continue‖
g. Step 7 – Follow guide in relation to assigning payments.
h. Step 8
a) Review information for accuracy. This should match what is in NPPES. If a change is
made here, be sure to make the same change in NPPES. A change here DOES NOT update
NPPES.
b) Enter your valid email address and then repeat once more for confirmation.
c) Click ―Save and Continue‖
i. Step 9 – Verify all Topics are checked as ―Completed‖. If not, click ―Modify Registration‖ and provide
required information. Once all are checked ―Completed‖, click ―Begin Submission‖.
j. Step 10 – Verify Registration Information is correct. If not correct, click ―Previous Page‖ to make
changes. Once the information is correct, click ―Submit‖.
k. Step 11 – Read the Disclaimer and click ―Agree‖ to proceed or ―Disagree‖ to be redirected back to the
Registration Instructions Page. From here, ―Modify‖ may be clicked as Action to restart.
l. Step 12– At this point, a Submission Receipt is received and should be printed as a confirmation record.
a) If successful, the receipt will read ―Successful Submission‖. As stated, wait 24 hours and
then return and click the link associated with ―You can find your state here‖ to complete the
Medicaid registration.
(NOTE: Visit http://www.cms.gov/apps/files/statecontacts.pdf for state specific launch and
website information)
b) If it was not successful, it will read ―Failed Submission‖ and the eligible professional
should read the instructions on the screen and make appropriate corrections.
m. Step 13 – Click the ―Status‖ tab to view the registration summary. For detailed information, click
―Select‖ in the Action column. Click ADDITIONAL INFORMATION for, the registration status
reason, Fiscal Intermediary (FI)/ Carrier/Medicare Administrative Contractor (MAC) and validations
performed on registration.
For either of the EHR Incentive Program Registrations, if there are questions, the eligible provider should consult the
CMS Frequently Asked Questions resource at http://questions.cms.hhs.gov/app/answers/list/p/21,26,1058. If the
answer cannot be found, there is an ―Ask a Question‖ tab from which a question may be submitted online for answer.
There is also a ―Contact Us‖ link that provides phone number and web link information for assistance with both
Medicare and Medicaid.
Providers Guide to Meaningful Use
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5. Guidance on the Meaningful Use Attestation Process (Source: http://www.cms.gov/EHRIncentivePrograms/32_Attestation.asp#TopOfPage)
Attestation for the Medicare Electronic Health Record (EHR) Incentive Program opened April 18th
.
What do I need to do to receive my Medicare EHR incentive payment?
Successfully register (http://www.cms.gov/EHRIncentivePrograms/20_RegistrationandAttestation.asp)
for the Medicare EHR Incentive Program;
Meet meaningful use (http://www.cms.gov/EHRIncentivePrograms/30_Meaningful_Use.asp) criteria
using certified EHR technology; and
Successfully attest, using CMS' Web-based system, that you have met meaningful use criteria using
certified EHR technology.
How will I attest for the Medicare and Medicaid Incentive Programs?
Medicare eligible professionals, eligible hospitals and critical access hospitals will have to demonstrate meaningful
use through CMS' web-based Registration and Attestation System (https://ehrincentives.cms.gov/). In the Medicare &
Medicaid EHR Incentive Program Registration and Attestation System, providers will fill in numerators and
denominators for the meaningful use objectives and clinical quality measures, indicate if they qualify for exclusions
to specific objectives, and legally attest that they have successfully demonstrated meaningful use. A complete EHR
system will provide a report of the numerators, denominators and other information. Then you will need to enter that
data into our online Attestation System. Providers will qualify for a Medicare EHR incentive payment upon
completing a successful online submission through the Attestation System—immediately after you submit your
results you will see a summary of your attestation, and whether or not it was successful. The Attestation System for
the Medicare EHR Incentive Program will open on April 18, 2011.
For the Medicaid EHR Incentive Program, providers will follow a similar process using their state's Attestation
System. Check here to see states' scheduled launch dates for their Medicaid EHR Incentive Programs:
http://www.cms.gov/apps/files/statecontacts.pdf
When can I attest?
To attest for the Medicare EHR Incentive Program in your first year of participation, you will need to have met
meaningful use for a consecutive 90-day reporting period. If your initial attestation fails, you can select a different 90-
day reporting period that may partially overlap with a previously reported 90-day period and attest again. To attest for
the Medicare EHR Incentive Program in subsequent years, you will need to have met meaningful use for a full year.
Please note the reporting period for eligible professionals must fall within the calendar year.
April 18, 2011, is the earliest an eligible professional, eligible hospital or critical access hospital can attest that they
have demonstrated meaningful use of certified EHR technology under the Medicare EHR Incentive Program.
Under the Medicaid EHR Incentive Program, providers can attest that they have adopted, implemented or upgraded
certified EHR technology in their first year of participation to receive an incentive payment. Medicaid EHR Incentive
Program participants should check with their state to find out when they can begin participation.
What can I do now to prepare for attestation?
Visit the CMS Registration page and get registered for the EHR Incentive Programs right now. If you haven't
previously registered, you can complete the registration and attestation process at the same time.
Register here: https://ehrincentives.cms.gov/hitech/login.action
Providers Guide to Meaningful Use
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Review the CMS Attestation User Guide, which provides step-by-step instructions for login and completing
attestation.
Attestation User Guide: http://www.cms.gov/EHRIncentivePrograms/Downloads/EP_Attestation_User_Guide.pdf
Finally, you can enter your information in the CMS Meaningful Use Attestation Calculator prior to submitting your
attestation to see if you would be able to meet all of the necessary measures to successfully demonstrate meaningful
use and qualify for an EHR incentive payment.
MU Attestation Calculator: http://www.cms.gov/apps/ehr/
What will I need to login to the Attestation System?
If you are an eligible professional, you'll need:
Your Type 1 National Provider Identifier (NPI)
The same user ID and password you used to register
What is the CMS EHR Certification Number?
During attestation, CMS requires each eligible professional, eligible hospital and critical access hospital to provide a
CMS EHR Certification ID or Number that identifies the certified EHR technology being used to demonstrate
meaningful use. This unique CMS EHR Certification ID or Number can be obtained by entering the certified EHR
technology product information at the Certified Health IT Product List (CHPL) on the ONC website:
http://healthit.hhs.gov/chpl
NOTE: The ONC CHPL Product Number issued to your vendor for each certified technology is different than the
CMS EHR Certification ID. Only a CMS EHR Certification ID obtained through the CHPL will be accepted at
attestation.
Eligible professionals, eligible hospitals and critical access hospitals can obtain a CMS EHR Certification ID or
Number by following these steps:
1) Go to the ONC CHPL website: http://healthit.hhs.gov/chpl
2) Select your practice type by selecting the Ambulatory or Inpatient buttons.
3) Search for EHR Products by browsing all products, searching by product name or searching by criteria met.
4) Add product(s) to your cart to determine if your product(s) meet 100% of the CMS required criteria.
5) Request a CMS EHR Certification ID for CMS attestation.
NOTE: The "Get CMS EHR Certification ID" button will not be activated until the products in your cart
meet 100% of the CMS required criteria. If the EHR product(s) do not meet 100% of the CMS required
criteria to demonstrate Meaningful Use, a CMS EHR Certification ID will not be issued.
6) The CMS EHR Certification ID contains 15 alphanumeric characters.
I'm an Eligible Professional (EP). Can I designate a third party to register and/or attest on my behalf?
In April 2011, CMS implemented functionality that allows an EP to designate a third party to register and attest on his
or her behalf. To do so, users working on behalf of an EP must have an Identity and Access Management System
(I&A) web user account (User ID/Password), and be associated to the EP's NPI. If you are working on behalf of an
EP(s), and do not have an I&A web user account, please visit I&A Security Check
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(https://nppes.cms.hhs.gov/NPPES/IASecurityCheck.do) to create one. States will not necessarily offer the same
functionality for attestation in the Medicaid EHR Incentive Program. Check with your State to see what functionality
will be offered.
When will I get paid?
Incentive payments for the Medicare EHR Incentive Program will be made approximately four to six weeks after an
eligible professional, eligible hospital or critical access hospital meets the program requirements and successfully
attests they have demonstrated meaningful use of certified EHR technology. CMS expects that Medicare incentive
payments will begin in May 2011. Payments will be held for eligible professionals until the eligible professional
meets the $24,000 threshold in allowed charges.
Medicaid incentives will be paid by the states and are expected also to begin in 2011. States are required to issue
incentive payments within 45 days of providers successfully attesting to having adopted, implemented or upgraded
certified EHR technology during their first year of participation in the Medicaid EHR Incentive Program. Launch date
for the Medicaid EHR Incentive Program varies by state, so the earliest date attestation can begin also varies by state.
Several states have disbursed incentive payments as early as April 2011.
How will I get paid?
Payments to Medicare providers will be made to the taxpayer identification number (TIN) you selected at the time
you registered for the Medicare EHR Incentive Program.
CMS will deposit payment in the first bank account on file. It will appear on your bank statement as "EHR Incentive
Payment". If you receive payments for Medicare services via electronic funds transfer, you will receive your
Medicare EHR Incentive Program payment the same way. If you currently receive Medicare payments by paper
check, you will also receive your first Medicare EHR Incentive Program payment by paper check.
IMPORTANT: Medicare Administrative Contractors (MACs), carriers and fiscal intermediaries will not be making
these payments. CMS has contracted with a Payment File Development Contractor to make these payments.
Have questions about your EHR incentive payment or other related needs?
DON'T: Call your MAC/carrier/fiscal intermediary with questions
DO: Call the EHR Information Center
1-888-734-6433. TTY users should call 1-888-734-6563
Hours of Operation: 7:30 a.m. – 6:30 p.m. (Central Time) Monday through Friday, except federal holidays
Why the payment amount may be less than you thought:
The Medicare & Medicaid EHR Incentive Program Registration and Attestation System contains a Status tab at the
top which will contain the amount of the incentive payment, the amount of tax or nontax offsets applied, and the
remittance advice reason code containing the reason for any reduction. For those receiving paper checks, there will
be a tear-off pay stub which identifies offsets made to the incentive payment.
Where you can find more information about the offsets:
For more information about tax offsets, call the Internal Revenue Service (IRS) at 1-800-829-3903.
For more information about non tax offsets, call the Department of the Treasury, Financial Management Service
(FMS) at 1-800-304-3107.
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Will CMS conduct audits?
Any provider attesting to receive an EHR incentive payment for either the Medicare EHR Incentive Program or the
Medicaid EHR Incentive Program potentially may be subject to an audit. Here's what you need to know to make sure
you're prepared:
Overview of the CMS EHR Incentive Programs Audits
All providers attesting to receive an EHR incentive payment for either Medicare or Medicaid EHR
Incentive Programs should retain ALL relevant supporting documentation (in either paper or electronic
format used in the completion of the Attestation Module responses). Documentation to support the
attestation should be retained for six years post-attestation. Documentation to support payment
calculations (such as cost report data) should continue to follow the current documentation retention
processes.
CMS, and its contractors, will perform audits on Medicare and dually-eligible (Medicare and Medicaid)
providers.
States, and their contractors, will perform audits on Medicaid providers.
CMS and states will also manage appeals processes.
Preparing for an Audit
To ensure you are prepared for a potential audit, save the supporting electronic or paper documentation
that support your attestation. Also save the documentation to support your Clinical Quality Measures
(CQMs). Hospitals should also maintain documentation to support their payment calculations.
Upon audit, the documentation will be used to validate that the provided accurately attested and
submitted CQMs, as well as to verify that the incentive payment was accurate.
Details of the Audits
There are numerous pre-payment edit checks built into the EHR Incentive Programs' systems to detect
inaccuracies in eligibility, reporting and payment.
Post-payment audits will also be completed during the course of the EHR Incentive Programs.
If, based on an audit, a provider is found to not be eligible for an EHR incentive payment, the payment
will be recouped.
CMS will be implementing an appeals process for eligible professionals, eligible hospitals and critical
access hospitals that participate in the Medicare EHR Incentive Program. More information about this
process will be posted to the CMS Web site soon.
States will implement appeals processes for the Medicaid EHR Incentive Program. For more
information about these appeals, please contact your State Medicaid Agency.
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6. IMS Meaningful Use Report
IMS has a Meaningful Use Report (MU) incorporated into the program design that allows the user to access real-time
meaningful use data for the Core and Menu Set criteria. The results obtained through the use of this report will be
used during the Attestation portion of the Meaningful Use reporting. Throughout the reporting period, this report will
help eligible professionals assess performance in relation to all Core and selected Menu Requirements. For those
Requirements that have not yet qualified as ―Objective Achieved‖, information pertaining to the CMS requirements
and related IMS function for each Core and Menu requirement can be found in the sections that follow. Access to the
Meaningful Use Report is provided via the Reports menu.
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Meaningful Use Report Layout
The top panel (A) of the Meaningful Use Report contains filters and settings to control the data that is returned:
Report Date Range – Set the From and To fields to designate the date range in which to search for the
data. For 2011, a 90-day reporting period is required. For 2012 and beyond, the reporting period will be
a calendar year.
Filters – The Office filter allows the user to filter the report based on one or more offices. Similarly, the
Provider filter allows to filter the report based on one or more Providers. To set the Office filter, click
the ―Set Office‖ icon to the right of the Office field. Within the ―Select Office‖ window (B), choose the
appropriate office(s) from the left panel and click the center arrow to select. Click ―Ok‖. To set the
Provider filter, click the ―Set Provider‖ icon and select appropriate Provider(s) in a similar fashion (C).
A
B C
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Group By – Select the Office check box if the data returned should be divided into separate groups of
data for each office. Select the Provider check box if the data returned is to separate into group of data
for each Provider. NOTE: If both boxes are checked, a separate group of data will be returned for each
office and provider combination.
Show – Selecting ―Core Set‖ will return Meaningful Use results for the 15 Core Requirements.
Selecting ―Menu Set‖ will return results for the 10 Menu Requirements. If both are selected, results
from all Core and Menu Requirements will be returned.
Retrieve – Once the Report Date Range, Filters, Group By and Show have been set, clicking ―Retrieve‖
will produce the Meaningful Use Report in the bottom panel (D).
The bottom panel of the Meaningful Use Report displays the results of the filtered data retrieved. The green bar is
used to group the Core and Menu Requirements and also provides label information as to what information follows.
ID – This indicates which Core or Menu Requirement is being reported.
Objective – For Meaningful Use, the Objective is what CMS requires of the eligible provider to qualify
for the incentive. This is a general definition of the requirement.
Measures – The Measures define the specific criteria that must be met in order to achieve the Objective.
TR (Total Records) – For percentage based Requirements, TR displays the total number of records
added within the date range specified, that apply to that Objective.
OA (Objective Achieved) – OA displays the specific number of records within the Total Records
population that met all criteria set by the Measures.
% - Displays the percentage of records that achieved the objective (OA). For each percentage based
Objective, this is calculated by dividing the Numerator by the Denominator as defined by each Core or
Menu requirement. A green background means the Measure has been satisfied to qualify. Red indicates
the required qualification percentage has not yet been met.
D
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IMS Option – Click the icon to open a ―Help‖ window that displays the Objective, Measure, and
Help text for the Objective. Additional text in this column pertains to relevant function within IMS
specific to this Objective and may be further explanation and/or instruction to the provider.
Note – This field may be used to record additional information related to the Objective.
The bottom panel is an active window, and additional functionality exists within the panel itself. By right-clicking on
any Objective line, an action menu appears as highlighted below.
View ‗Objective Achieved‘ Records – This list presents all of the patients from the Total Records
population that met the requirements of the Objective.
View ‗Objective NOT Achieved Records – This list presents all of the patients from the Total Records
population that DO NOT meet the requirements of the Objective.
View Chart - Displays a graphical representation of the criterion data. An image with explanation is on
the following page.
Below is an example of output for View ‗Objective Achieved‘ Records.
In the output window, use the checkbox next to each patient name to select for actions such as label creation, sending
an email, printing, faxing or exporting. Action buttons are found along the bottom of the window:
Set Reminder – Used to set reminders for a selected patient. (NOTE: Cannot select multiple patients)
Label – Used to select and print specific label types for all selected patients.
Email – Used to send a Letter Template to selected patients via email (if database configured for use).
Print – Used to print a Letter Template and Address Label for selected patients.
Fax – Allows to fax Letter Templates to selected patients (NOTE: fax number must be in patient
master)
Export – Exports the entire list of patients to one of several file formats for print or distribution.
Export to HL7 – Exports the entire list of patients to an HL7 file for distribution.
Print List – Prints the entire list of patients.
Close – Exits the output window
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As mentioned previously, there is a ―View Chart‖ option available within the right-click menu in the bottom panel.
Selecting this option will produce a graphical chart similar to the one shown below.
The chart provides a visual representation of the data shown in the panel. The top left hand corner of the chart will
display the % of Total Records that have qualified as Objective Achieved. Also at the top of the graph is a label that
corresponds to the Objective data being displayed in the chart. If desired, the user may click on ―Chart‖ in the top
right hand corner to select from a number of different display options such as bar, line, pie, or grid style graphs. The
chart may also be printed. To print, right-click on the chart and select ―Print Chart‖. As new Objectives with
percentage based measures are selected, the chart will update with the corresponding data. If the chart is no longer
required or desired for viewing, right-click on any Objective and choose ―Hide Chart‖.
Along the bottom of the Meaningful Report window, a Key is present to explain the column headings for TR, OA,
and %. There are also several other icons as seen below.
View Guideline – This button is not yet functional, but will be used for a future feature.
Set Parameter – When clicked, presents the following to set Objective required parameters such as
Letter and Reminder Categories and selection of specific Visit Note questions to be measured against.
An option to select appropriate smoking habit status is also defined here.
o Reminder, Letter and Smoking Parameters are covered in detail within the corresponding Core or
Menu Requirement in the next section of this guide.
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o Exclude Visit Type allows flexibility in the office so that specific Visit Types (phone calls, refill
requests, etc) that are not considered ―provider‖ visits can be excluded from the reporting
process. Multiple Visit Types may be selected, but the selections will apply to all EP‘s within
the database. To select, click the ―select‖ icon (A) within the Parameter window. Select one or
more Visit Types (B) from the ―Select Visit Type‖ window and click ―Ok‖ (C). The selected
Visit Types (D) will now be excluded as a qualified ―unique visit‖ for the Core and Menu
Requirements that specify this need. Click ―Ok‖ (E) to save changes.
Print – Prints a copy of the entire report based on filtering options set at time of retrieval.
Close – Exits the Meaningful Use Report.
A
B
C D
E
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7. Meaningful Use Core Requirements
CR01: CPOE for Medication Orders
Objective: 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.
Measure: 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.
Exclusion: Any EP who writes fewer than 100 prescriptions during the EHR reporting period.
Definition of Terms
Computerized Provider Order Entry (CPOE) – CPOE entails the provider‘s use of computer assistance
to directly enter medication orders from a computer or mobile device. The order is also documented or
captured in a digital, structured, and computable format for use in improving safety and organization.
Unique Patient – If a patient is seen by an EP more than once during the EHR reporting period, then for
purposes of measurement that patient is only counted once in the denominator for the measure. All the
measures relying on the term ‗‗unique patient‘‘ relate to what is contained in the patient‘s medical
record. Not all of this information will need to be updated or even be needed by the provider at every
patient encounter. This is especially true for patients whose encounter frequency is such that they would
see the same provider multiple times in the same EHR reporting period.
Attestation Requirements
DENOMINATOR: Number of unique patients with at least one medication in their medication list seen
by the EP during the EHR reporting period.
NUMERATOR: The number of patients in the denominator that have at least one medication order
entered using CPOE.
EXCLUSION: EPs who write fewer than 100 prescriptions during the EHR reporting period would be
excluded from this requirement. EPs must enter the number of prescriptions written during the EHR
reporting period in the Exclusion box to attest to exclusion from this requirement.
The resulting percentage (Numerator ÷ Denominator) must be more than 30 percent in order for an EP to meet this
measure.
Additional Information
The provider is permitted, but not required, to limit the measure of this objective to those patients whose
records are maintained using certified EHR technology.
Any licensed healthcare professionals can enter orders into the medical record for purposes of including
the order in the numerator for the objective of CPOE if they can enter the order per state, local and
professional guidelines.
The order must be entered by someone who could exercise clinical judgment in the case that the entry
generates any alerts about possible interactions or other clinical decision support aides. This necessitates
that the CPOE occurs when the order first becomes part of the patient‘s medical record and before any
action can be taken on the order.
Electronic transmittal of the medication order to the pharmacy, laboratory, or diagnostic imaging center
is not a requirement for meeting the measure of this objective. However, a separate objective (EPCMU
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04) addresses the electronic transmittal of prescriptions and is a requirement for EPs to meet Meaningful
Use.
Related IMS Function
1) Current Medications within the Visit Note must include at least one medication.
2) Patient must have been prescribed a medication from within IMS during the reporting period. Chart history
should show that a prescription was given to the patient on the specific date. (NOTE: Prescription does not
have to be sent electronically to meet this requirement)
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CR02 - Drug Interaction Checks
Objective: Implement drug-drug and drug-allergy interaction checks.
Measure: The EP has enabled this functionality for the entire EHR reporting period.
Exclusion: No exclusion.
Attestation Requirements
YES / NO Eligible professionals (EPs) must attest YES to having enabled drug-drug and drug-allergy interaction
checks for the length of the reporting period to meet this measure.
Related IMS Function
User Parameters for Prescription set to ―Yes‖ for:
Patient Allergy Check Required
o Cross Sensitive Allergy Check
o Inactive ingredient based Allergy Check
Drug Drug Interaction Check Required
o Medium Severity Interaction Check
o Low Severity Interaction Check
Drug Validation (NOTE: If this is not set to yes, interactions will not be checked)
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CR03 – Transmit Permissible Prescriptions Electronically
Objective: Generate and transmit permissible prescriptions electronically.
Measure: More than 40 percent of all permissible prescriptions written by the EP are transmitted
electronically using certified EHR technology
Exclusion: Any EP who writes fewer than 100 prescriptions during the EHR reporting period.
Definition of Terms
Permissible Prescriptions- The concept of only permissible prescriptions refers to the current restrictions
placed by the Department of Justice on electronic prescribing for Schedule II-V controlled substances.
(Schedule II-V substance list: www.deadiversion.usdoj.gov/schedules/orangebook/e_cs_sched.pdf ).
Any prescription not subject to these restrictions would be permissible.
Prescription – The authorization by an EP to a pharmacist to dispense a drug that the pharmacist would
not dispense to the patient without such authorization.
Attestation Requirements
DENOMINATOR: Number of prescriptions written for drugs requiring a prescription in order to be
dispensed other than controlled substances during the EHR reporting period.
NUMERATOR: Number of prescriptions in the denominator generated and transmitted electronically.
EXCLUSION: EPs who write fewer than 100 prescriptions during the EHR reporting period would be
excluded from this requirement. EPs must enter the number of prescriptions written during the EHR
reporting period in the Exclusion box to attest to exclusion from this requirement.
The resulting percentage (Numerator ÷ Denominator) must be more than 40 percent in order for an EP to meet this
measure.
Additional Information
The provider is permitted, but not required, to limit the measure of this objective to those patients whose
records are maintained using certified EHR technology.
Authorizations for items such as durable medical equipment, or other items and services that may
require EP authorization before the patient could receive them, are not included in the definition of
prescriptions. These are excluded from the numerator and the denominator of the measure.
Instances where patients specifically request a paper prescription may not be excluded from the
denominator of this measure. The denominator includes all prescriptions written by the EP during the
EHR reporting period.
Although the Department of Justice recently published an Interim Final Rule that allows the electronic
prescribing of controlled substances, these recent guidelines could not be incorporated into the Medicare
and Medicaid EHR Incentive Programs. The determination of whether a prescription is a ''permissible
prescription'' for purposes of this measure should be made based on the guidelines for prescribing
Schedule II-V controlled substances in effect on or before January 13, 2010.
EPs cannot receive incentive payments for e-prescribing under both the Medicare Improvements for
Patients and Providers Act of 2008 (MIPPA) and the Medicare EHR Incentive Program for the same
year. However, EPs can receive payments from both the MIPPA E-Prescribing Incentive Program and
the Medicaid EHR Incentive Program for the same year.
Providers can use intermediary networks that convert information from the certified EHR into a
computer-based fax in order to meet this measure as long as the EP generates an electronic prescription
and transmits it electronically using the standards of certified EHR technology to the intermediary
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network, and this results in the prescription being filled without the need for the provider to
communicate the prescription in an alternative manner.
Prescriptions transmitted electronically within an organization (the same legal entity) do not need to use
the NCPDP standards. However, an EP's EHR must meet all applicable certification criteria and be
certified as having the capability of meeting the external transmission requirements of §170.304(b). In
addition, the EHR that is used to transmit prescriptions within the organization would need to be
Certified EHR Technology. For more information, refer to ONC‘s FAQ at http://healthit.hhs.gov/portal/server.pt/community/onc_regulations_faqs/3163/faq_22/21286.
EPs should include in the numerator and denominator both types of electronic transmissions (those
within and outside the organization) for the measure of this objective.
For purposes of counting prescriptions "generated and transmitted electronically," we consider the
generation and transmission of prescriptions to occur constructively if the prescriber and dispenser are
the same person and/or are accessing the same record in an integrated EHR to creating an order in a
system that is electronically transmitted to an internal pharmacy.
Related IMS Function
Prescriptions should be sent by the EP to pharmacy electronically when prescribed. Currently, this means a client
must be registered for and submitting prescriptions through either New Crop or Surescripts.
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CR04 - Record Demographics
Objective: Record all of the following demographics: (A) Preferred language; (B) Gender; (C) Race;
(D) Ethnicity; (E) Date of birth
Measure: More than 50 percent of all unique patients seen by the EP have demographics recorded as
structured data.
Exclusion: No exclusion.
Definition of Terms
Preferred Language – The language by which the patient prefers to communicate.
Unique Patient – If a patient is seen by an EP more than once during the EHR reporting period, then for
purposes of measurement that patient is only counted once in the denominator for the measure. All the
measures relying on the term ‗‗unique patient‘‘ relate to what is contained in the patient‘s medical
record. Not all of this information will need to be updated or even be needed by the provider at every
patient encounter. This is especially true for patients whose encounter frequency is such that they would
see the same provider multiple times in the same EHR reporting period.
Attestation Requirements
DENOMINATOR: Number of unique patients seen by the EP during the EHR reporting period.
NUMERATOR: Number of patients in the denominator who have all the elements of demographics (or
a specific exclusion if the patient declined to provide one or more elements or if recording an element is
contrary to state law) recorded as structured data.
The resulting percentage (Numerator ÷ Denominator) must be more than 50 percent in order for an EP to meet this
measure.
Additional Information
Race and ethnicity codes should follow current federal standards published by the Office of
Management and Budget (http://www.whitehouse.gov/omb/inforeg_statpolicy/#dr).
If a patient declines to provide all or part of the demographic information, or if capturing a patient‘s
ethnicity or race is prohibited by state law, such a notation entered as structured data would count as an
entry for purposes of meeting the measure. In regards to patients who do not know their ethnicity, EPs
should treat these patients the same way as patients who decline to provide race or ethnicity— identify
in the patient record that the patient declined to provide this information.
EPs are not required to communicate with the patient in his or her preferred language in order to meet
the measure of this objective.
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Related IMS Function
Patient demographics are created for every patient in IMS. Date of Birth (DOB) and Gender are required fields. EP
should verify that Race, Ethnicity, and Language have been captured or documented as ―Patient declined‖.
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CR05 - Maintain Problem List
Objective: Maintain an up-to-date problem list of current and active diagnoses.
Measure: 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.
Exclusion: No exclusion.
Definition of Terms
Problem List – A list of current and active diagnoses as well as past diagnoses relevant to the current
care of the patient.
Unique Patient – If a patient is seen by an EP more than once during the EHR reporting period, then for
purposes of measurement that patient is only counted once in the denominator for the measure. All the
measures relying on the term ‗‗unique patient‘‘ relate to what is contained in the patient‘s medical
record. Not all of this information will need to be updated or even be needed by the provider at every
patient encounter. This is especially true for patients whose encounter frequency is such that they would
see the same provider multiple times in the same EHR reporting period.
Up-to-date – The term ‗‗up-to-date‘‘ means the list is populated with the most recent diagnosis known
by the EP. This knowledge could be ascertained from previous records, transfer of information from
other providers, diagnosis by the EP, or querying the patient.
Attestation Requirements
DENOMINATOR: Number of unique patients seen by the EP during the EHR reporting period.
NUMERATOR: Number of patients in the denominator who have at least one entry or an indication that
no problems are known for the patient recorded as structured data in their problem list.
The resulting percentage (Numerator ÷ Denominator) must be more than 80 percent in order for an EP to meet this
measure.
Additional Information
The Medicare and Medicaid EHR Incentive Programs do not specify the use of ICD-9 or SNOMED-
CT® in meeting the measure for this objective. However, the Office of the National Coordinator for
Health Information Technology (ONC) has adopted ICD-9 or SNOMED-CT® for the entry of structured
data for this measure and made this a requirement for EHR technology to be certified. Therefore, EPs
will need to maintain an up-to-date problem list of current and active diagnoses using ICD-9 or
SNOMED-CT® as a basis for the entry of structured data into certified EHR technology in order to meet
the measure for this objective.
For patients with no current or active diagnoses, an entry must still be made to the problem list
indicating that no problems are known.
An EP is not required to update the problem list at every contact with the patient. The measure ensures
the EP has a problem list for patients seen during the EHR reporting period, and that at least one piece of
information is presented to the EP. The EP can then use their judgment in deciding what further probing
or updating may be required given the clinical circumstances.
The initial diagnosis can be recorded in lay terms and later converted to standard structured data or can
be initially entered using standard structured data.
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Related IMS Function
Patient Diagnosis must either:
a) Be entered within the Visit Note (A) for the specific encounter and be visible within the ―Active Diagnosis‖ tab
in the Diagnosis Visit Note Template and also within Chart View on the Dx tab (C).
Or
b) Be entered within the Visit Note for the specific encounter and recorded with the ―Mark as No Known
Problem‖ button (B) if the patient does not have any current problems.
A
B
C
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CR06 - Active Medication List
Objective: Maintain active medication list.
Measure: 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.
Exclusion: No exclusion.
Definition of Terms
Active Medication List – A list of medications that a given patient is currently taking.
Unique Patient – If a patient is seen by an EP more than once during the EHR reporting period, then for
purposes of measurement that patient is only counted once in the denominator for the measure. All the
measures relying on the term ‗‗unique patient‘‘ relate to what is contained in the patient‘s medical
record. Not all of this information will need to be updated or even be needed by the provider at every
patient encounter. This is especially true for patients whose encounter frequency is such that they would
see the same provider multiple times in the same EHR reporting period.
Attestation Requirements
DENOMINATOR: Number of unique patients seen by the EP during the EHR reporting period.
NUMERATOR: Number of patients in the denominator who have a medication (or an indication that the
patient is not currently prescribed any medication) recorded as structured data.
The resulting percentage (Numerator ÷ Denominator) must be more than 80 percent in order for an EP to meet this
measure.
Additional Information
For patients with no active medications, an entry must still be made to the active medication list indicating that there
are no active medications. An EP is not required to update this list at every contact with the patient. The EP can then
use his or her clinical judgment to decide when additional updating is required.
Related IMS Function
Current Medications within the Visit Note should include the following:
a) A list of all active medications that the patient is currently taking
Or
b) It must be documented that the ―Patient is not taking any medication.‖
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CR07 - Medication Allergy List
Objective: Maintain active medication allergy list.
Measure: 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.
Exclusion: No exclusion.
Definition of Terms
Active Medication Allergy List – A list of medications to which a given patient has known allergies.
Allergy – An exaggerated immune response or reaction to substances that are generally not harmful.
Unique Patient – If a patient is seen by an EP more than once during the EHR reporting period, then for
purposes of measurement that patient is only counted once in the denominator for the measure. All the
measures relying on the term ‗‗unique patient‘‘ relate to what is contained in the patient‘s medical
record. Not all of this information will need to be updated or even be needed by the provider at every
patient encounter. This is especially true for patients whose encounter frequency is such that they would
see the same provider multiple times in the same EHR reporting period.
Attestation Requirements
DENOMINATOR: Number of unique patients seen by the EP during the EHR reporting period.
NUMERATOR: Number of unique patients in the denominator who have at least one entry (or an
indication that the patient has no known medication allergies) recorded as structured data in their
medication allergy list.
The resulting percentage (Numerator ÷ Denominator) must be more than 80 percent to meet this measure.
Additional Information
For patients with no active medication allergies, an entry must still be made to the active medication
allergy list indicating that there are no active medication allergies.
An EP is not required to update this list at every contact with the patient. The measure ensures that the
EP has not ignored having a medication allergy list for patients seen during the EHR reporting period
and that at least one piece of information on medication allergies is presented to the EP. The EP can then
use their judgment in deciding what further probing or updating may be required given the clinical
circumstances at hand.
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Related IMS Function
Drug Allergy within the Visit Note should include the following:
a) A list of all known drugs that patient is allergic to (A)
Or
b) It must be specifically documented that patient has ―No Known Drug Allergies‖ (B)
A
B
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CR08 - Record Vital Signs
Objective: 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
Measure: For more than 50 percent of all unique patients age 2 and over seen by the EP, height, weight,
and blood pressure are recorded as structured data.
Exclusion: Any EP who either see no patients 2 years or older, or who believes that all three vital signs
of height, weight, and blood pressure of their patients have no relevance to their scope of practice.
Definition of Terms
Unique Patient – If a patient is seen by an EP more than once during the EHR reporting period, then for
purposes of measurement that patient is only counted once in the denominator for the measure. All the
measures relying on the term ‗‗unique patient‘‘ relate to what is contained in the patient‘s medical
record. Not all of this information will need to be updated or even be needed by the provider at every
patient encounter. This is especially true for patients whose encounter frequency is such that they would
see the same provider multiple times in the same EHR reporting period.
Attestation Requirements
DENOMINATOR: Number of unique patients age 2 or over seen by the EP during the EHR reporting
period.
NUMERATOR: Number of patients in the denominator who have at least one entry of their height,
weight and blood pressure are recorded as structured data.
EXCLUSION: An EP who sees no patients 2 years or older would be excluded from this requirement.
Additionally, an EP who believes that all three vital signs of height, weight, and blood pressure have no
relevance to their scope of practice would be excluded from this requirement. EPs must select NO next
to the appropriate exclusion, then click the APPLY button in order to attest to the exclusion.
The resulting percentage (Numerator ÷ Denominator) must be more than 50 percent in order for an EP to meet this
measure.
Additional Information
The provider is permitted, but not required, to limit the measure of this objective to those patients whose
records are maintained using certified EHR technology.
The only information required to be input by the provider is the height, weight, and blood pressure of the
patient. The certified EHR technology will calculate BMI and growth chart if applicable, based on age.
Height, weight, and blood pressure do not have to be updated by the EP at every patient encounter. The
EP can make the determination based on the patient‘s individual circumstances as to whether height,
weight, and blood pressure need to be updated.
Height, weight, and blood pressure can get into the patient‘s medical record as structured data in a
number of ways. Some examples include entry by the EP, entry by someone on the EP‘s staff, transfer
of information from another provider or entered directly by the patient through a portal or other means.
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Related IMS Function
Vital Signs must be completed for a minimum of Height, Weight and Blood Pressure. If any one or more of the
elements are missing, the requirement will not be met.
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CR09 – Record Smoking Status
Objective: Record smoking status for patients 13 years old or older.
Measure: More than 50 percent of all unique patients 13 years old or older seen by the EP have smoking
status recorded as structured data.
Exclusion: Any EP who sees no patients 13 years or older.
Definition of Terms
Unique Patient – If a patient is seen by an EP more than once during the EHR reporting period, then for
purposes of measurement that patient is only counted once in the denominator for the measure. All the
measures relying on the term ‗‗unique patient‘‘ relate to what is contained in the patient‘s medical
record. Not all of this information will need to be updated or even be needed by the provider at every
patient encounter. This is especially true for patients whose encounter frequency is such that they would
see the same provider multiple times in the same EHR reporting period.
Attestation Requirements
DENOMINATOR: Number of unique patients age 13 or older seen by EP during EHR reporting period.
NUMERATOR: Number of patients in the denominator with smoking status recorded as structured data.
EXCLUSION: An EP who sees no patients 13 years or older would be excluded from this requirement.
EPs must enter ‗0‘ in the Exclusion box to attest to exclusion from this requirement.
The resulting percentage (Numerator ÷ Denominator) must be more than 50 percent in order for an EP to meet this measure.
Additional Information
The provider is permitted, but not required, to limit the measure of this objective to those patients whose
records are maintained using certified EHR technology.
This is a check of the medical record for patients 13 years old or older. If this information is already in
the medical record available through certified EHR technology, an inquiry does not need to be made
every time a provider sees a patient 13 years old or older. The frequency of updating this information is
left to the provider and guidance is provided already from several sources in the medical community.
Related IMS Function
1. Within the Meaningful Use Report window, ensure that the EP has defined the appropriate Social History value
to be recorded as capturing this data.
a) Open the Meaningful Use Report window
b) Click on the ―Set Parameter‖ button in bottom left
c) Within the Parameter window, click on ―Click here to set smoking option‖
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d) Within the ―Select from Social History‖ window, check the box next to the Question (A) that relates to
patient smoking history. (NOTE: If a question does not exist or does not adequately meet these
requirements, it may be necessary to customize the Social History visit note template prior to associating
in this window.)
e) Once the proper Question has been checked, click the ―Select‖ button to save the setting
f) Click ―OK‖ to exit the Parameter window
A
B
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2. For all patients over 13 years of age, Social History within the Visit Note should include the following:
a) Smoking Status recorded as positive within the Question selected in Parameter
Or
b) Smoking Status recorded as negative within the Question selected in Parameter
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CR10 - Clinical Decision Support Rule
Objective: Implement one clinical decision support rule relevant to specialty or high clinical priority
along with the ability to track compliance with that rule.
Measure: Implement one clinical decision support rule.
Exclusion: No exclusion.
Definition of Terms
Clinical Decision Support (CDS)– HIT functionality that builds upon the foundation of an EHR to
provide persons involved in care processes with general and person-specific information, intelligently
filtered and organized, at appropriate times, to enhance health and health care.
Attestation Requirements
YES / NO Eligible professionals (EPs) must attest YES to having implemented one clinical decision support rule for
the length of the reporting period to meet the measure.
Additional Information
CMS will not issue additional guidance on the selection of appropriate clinical decision support rules for
Stage 1 Meaningful Use. This determination is best left to the EP taking into account their workflow,
patient population, and quality improvement efforts.
Drug-drug and drug-allergy interaction alerts cannot be used to meet the meaningful use objective for
implementing one clinical decision support rule. EPs must implement one clinical decision support rule
in addition to drug-drug and drug-allergy interaction checks.
Related IMS Function
Within IMS, there are a number of features available that qualify as clinical decision support rules. Essentially, this
means that based on findings during a patient visit, IMS will offer diagnostic or treatment options to the provider.
The ―link with‖ functionality within IMS can be configured to assist EP‘s by providing reference information and
other tools to support decisions within clinical workflow. Proper use of alerts and reminders qualify as CDS rules.
Incorporating clinical guidelines or protocols into IMS workflow would also qualify. Defining appropriate Health
Maintenance rules for specific patient populations is another option. EP‘s may use order sets to improve CPOE. The
use of reports and dashboards to aid in clinical decision support would also qualify. Within IMS, the Visit Note
dashboard is customizable to allow the EP to be presented with patient specific data pertinent to decision making and
care. As mentioned above, it is up to the EP to determine which CDS rules to incorporate into their clinical setting.
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CR11 - Clinical Quality Measures (CQMs)
Objective: Report ambulatory clinical quality measures to CMS.
Measure: Successfully report to CMS ambulatory clinical quality measures selected by CMS in the
manner specified by CMS.
Exclusion: No exclusion.
Attestation Requirements YES / NO Eligible professionals (EPs) must attest YES to reporting to CMS ambulatory clinical quality measures selected by
CMS in the manner specified by CMS to meet the measure.
Additional Information
The provider is permitted, but not required, to limit the measure of this objective to those patients whose
records are maintained using certified EHR technology.
Attesting to the measure of this objective indicates that the EP will submit complete ambulatory clinical
quality measure information as required during the attestation process. During attestation, EPs will also
attest to the numerators, denominators, and exclusions for individual ambulatory clinical quality
measures. For requirements and electronic specifications related to individual ambulatory clinical
quality measures, EPs should refer to:
http://www.cms.gov/QualityMeasures/03_ElectronicSpecifications.asp
In the ―Downloads‖ section accessible from the link above, detailed information regarding specific clinical measures
that meet this requirement are outlined. EPs should download and refer to the materials provided in order to
determine which measures are relevant to their specialty.
Related IMS Function
IMS provides a PQRI/NQF reporting tool for tracking of quality measures. This tool allows each EP to define clinical quality
measures relevant to their specialty for reporting. Please view the recently conducted PQRI webinars for additional information
on how to configure PQRI reporting within IMS. Additionally, a PQRI Help guide is available. The PQRI reporting tool is
accessible from the Reports menu as shown below:
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CR12 - Electronic Copy of Health Information
Objective: Provide patients with an electronic copy of their health information (including diagnostic test
results, problem list, medication lists, medication allergies) upon request.
Measure: More than 50 percent of all patients who request an electronic copy of their health
information are provided it within 3 business days.
Exclusion: Any EP that has no requests from patients or their agents for an electronic copy of patient
health information during the EHR reporting period.
Definition of Terms
Business Days – Business days are defined as Monday through Friday excluding federal or state
holidays on which the EP or their respective administrative staffs are unavailable.
Diagnostic Test Results – All data needed to diagnose and treat disease. Examples include, but are not
limited to, blood tests, microbiology, urinalysis, pathology tests, radiology, cardiac imaging, nuclear
medicine tests, and pulmonary function tests.
Attestation Requirements
DENOMINATOR: Number of patients of the EP who request an electronic copy of their electronic
health information four business days prior to the end of the EHR reporting period.
NUMERATOR: Number of patients in the denominator who receive an electronic copy of their
electronic health information within three business days.
EXCLUSION: An EP who has no requests from patients or their agents for an electronic copy of patient
health information during the EHR reporting period would be excluded from this requirement. EPs must
enter ‗0‘ in the Exclusion box to attest to exclusion from this requirement.
The resulting percentage (Numerator ÷ Denominator) must be more than 50 percent in order to meet this measure.
Additional Information
The provider is permitted, but not required, to limit the measure of this objective to those patients whose
records are maintained using certified EHR technology.
When responding to patient requests for information, the EP should accommodate patient requests in
accordance with the HIPAA Privacy Rule, as specified at 45 CFR 164.524, Access of individuals to
protected health information. HIPAA contains requirements for providing patients copies of their health
information.
Information that must be provided electronically is limited to that information that exists electronically
in or is accessible from the certified EHR technology and is maintained by or on behalf of the EP. At a
minimum, this would include the elements listed in the ONC final rule at 45 CFR 170.304(f) for EPs and
45 CFR 170.306(d) for eligible hospitals and CAHs as required for EHR technology to become certified.
An EP may withhold information from the electronic copy of a patient‘s health information in
accordance with the HIPAA Privacy Rule, as specified at 45 CFR 164.524.
An EP should provide a patient with all of the health information they have available electronically,
subject to withholding as described in the HIPAA Privacy Rule, as specified at in 45 CFR 164.524.
Form and format should be human readable and comply with the HIPAA Privacy Rule, as specified at
45 CFR 164.524(c). The media could be any electronic form such as patient portal, PHR, CD, USB fob,
etc. EPs are expected to make reasonable accommodations for patient preference as outlined in 45 CFR
164.522(b).
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The charging of fees for this information is governed by the HIPAA Privacy Rule at 45 CFR
164.524(c)(4) (which only permits HIPAA covered entities to charge an individual a reasonable, cost-
based fee for a copy of the individual‘s health information).
If provision of the copy involves the mailing of physical electronic media, then it would need to be
mailed by at least the third business day following the request of the patient or their agents.
Third-Party Requests: Only specific third-party requests for information are included in the
denominator. Providing the copy to a family member or patient‘s authorized representative consistent
with federal and state law may substitute for a disclosure of the information to the patient and count in
the numerator. A request from the same would count in the denominator. All other third-party requests
are not included in the numerator or the denominator.
Related IMS Function
Reminder Category Creation
EP shall create a Reminder Category specific to this purpose. Reminder Category shall contain all Reminder Tasks
that inform staff that patient requires a copy of their health information in electronic format (CD, USB drive, portal,
etc). (NOTE: For Meaningful Use, only one category will be reported on, so it is important that ONLY health
information request related reminders are stored within this category.)
1) Click the ―Reminder‖ icon or access via ―Activities > Reminder‖
2) Click the ―Setup‖ (A) option in the center of the left panel
3) Click the ―Add‖ (B) button to define a Reminder Category for this purpose
a. Enter a Description such as ―MU Patient Info Request‖ (C)
b. Set a priority for this category if desired
c. Leave Type set as ―General‖
d. Leave Assign To set to ―None‖. Assignment will be at Task level
e. Leave Remind set to ―None‖
4) Click ―Save‖ (D)
A
B
C
D
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Reminder Task Creation
1) Select the ―Task‖ tab (A) at the top of the Reminder Setup window
2) Click ―Add‖ (B) to define a health information request related reminder (ex: copy of chart, med list request,
problem list, etc)
a. Enter a Description such as ―Med List Request‖ or ―Chart Request‖ (C)
b. Set Category to the Reminder Category created just created
c. Set Priority in relation to the other health information requests
d. If desired, select user(s) or group(s) to assign the task to upon creation in the Assign To field.
i. Click the icon to the right of the Assign To field
ii. Leave ―Create‖ set to ―One task for selected group‖. This means that if one user completes the
task, it will mark as complete for all.
iii. Select individual users or groups from the list. (NOTE: If groups are not present, they have not
yet been created on the Group tab).
iv. Once all necessary personnel are selected, click ―Ok‖
e. Do not click the Reminder Repeat Setup icon as these will be patient initiated requests
f. Click the Reminder Alert/Action Setup
g. In the Alert section, select the areas within IMS that you want an alert to appear reminding the user to
complete the task
h. If a Reminder Letter has been created for use with this specific health information request, select from
the list as a Default Letter.
i. Click ―Ok‖
j. Set a Seq No if desired
k. If the Provider will want to be able to quickly assign this Reminder Task while in the course of creating
a Visit Note, check the box in ―Q‖ column to add to the Quick Reminders list
l. Do not click the ―M‖ column
m. Do not Link as this is a request for information and not a request for clinical action
3) Click ―Save‖ (D)
4) If additional Reminder Tasks are needed, repeat Step 2 Otherwise, click ―Close‖ (E)
A
B
C
D E
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Setting Parameter in Meaningful Use Report
1) Within the Meaningful Use Report window, ensure that the EP has defined the appropriate Reminder Category
for health information requests.
a. Open the Meaningful Use Report window
b. Click on the ―Set Parameter‖ button in bottom left
c. Within the Parameter window, click on the pull-down menu button for ―Reminder Category for CR12‖
d. From the list, select the appropriate Reminder Category that pertains to health information requests
e. Once the proper category has been selected, click ―OK‖ to exit the Parameter window
Health Information Reminder Sample Flow
1) Create a health information Reminder request for patient by pressing CTRL-F2
2) Select a Reminder Task created in ―Reminder Task Creation‖ and the defaults for Category, Assign To and
Alerts should already be set
3) Due Date should be set to the date the patient requested the information. This will trigger the 3 day period in
which the information must be provided to the patient within.
4) If a specific note is needed to advise the User or Group what the patient requires, add to the Note box
5) Select the appropriate ―Patient‖
6) Click ―Save‖
7) ―Close‖ out of the Reminder Task window
8) As one of the Users assigned or a member of a Group assigned to the Reminder Task, they will now see the
Reminder in their ―My Tasks > Reminder‖ list. (TIP: Filter by Category and/or Task below left panel to
shorten a lengthy list.)
9) The User will take action on the Reminder as requested by right-clicking on the Task name.
10) Once completed, the User may right-click and choose ―Set Done‖ or click the box next to the Reminder and
click ―Set Done‖ below the list
11) In the Meaningful Use Report window, the OA column (objective achieved) will increase by one and the TR
column (total records) will also increase by one. The increase is due to the fact that the Reminder in the
Sample Flow was created and completed on the same day. As long as a Reminder Task is completed within 3
business days of creation, this objective will be achieved. If a Reminder Task takes longer than 3 business
days to complete, the objective will not be achieved. Again, the 3 days are triggered based on Due Date, so be
sure to set this as the date of patient request.
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CR13 - Clinical Summaries
Objective: Provide clinical summaries for patients for each office visit.
Measure: Clinical summaries provided to patients for more than 50 percent of all office visits within 3
business days.
Exclusion: Any EP who has no office visits during the EHR reporting period.
Definition of Terms
Clinical Summary – An after-visit summary that provides a patient with relevant and actionable
information and instructions containing the patient name, provider‘s office contact information, date and
location of visit, an updated medication list, updated vitals, reason(s) for visit, procedures and other
instructions based on clinical discussions that took place during the office visit, any updates to a
problem list, immunizations or medications administered during visit, summary of topics
covered/considered during visit, time and location of next appointment/testing if scheduled, or a
recommended appointment time if not scheduled, list of other appointments and tests that the patient
needs to schedule with contact information, recommended patient decision aids, laboratory and other
diagnostic test orders, test/laboratory results (if received before 24 hours after visit), and symptoms.
Office Visit – Office visits include separate, billable encounters that result from evaluation and
management services provided to the patient and include: (1) Concurrent care or transfer of care visits,
(2) Consultant visits, or (3) Prolonged Physician Service without Direct (Face-To-Face) Patient Contact
(tele-health). A consultant visit occurs when a provider is asked to render an expert opinion/service for a
specific condition or problem by a referring provider.
Attestation Requirements
DENOMINATOR: Number of unique patients seen by the EP for an office visit during the EHR
reporting period.
NUMERATOR: Number of patients in the denominator who are provided a clinical summary of their
visit within three business days.
EXCLUSION: EPs who have no office visits during the EHR reporting period would be excluded from
this requirement. EPs must enter ‗0‘ in the Exclusion box to attest to exclusion from this requirement.
The resulting percentage (Numerator ÷ Denominator) must be more than 50 percent in order for an EP to meet this
measure.
Additional Information
The provider is permitted, but not required, to limit the measure of this objective to those patients whose records are
maintained using certified EHR technology. The provision of the clinical summary is limited to the information
contained within certified EHR technology. The clinical summary can be provided through a PHR, patient portal on
the web site, secure e-mail, electronic media such as CD or USB fob, or printed copy. If the EP chooses an electronic
media, they would be required to provide the patient a paper copy upon request. If an EP believes that substantial
harm may arise from the disclosure of particular information, an EP may choose to withhold that particular
information from the clinical summary. Providers should not charge patients a fee to provide this information. When a
patient visit lasts several days and the patient is seen by multiple EPs, a single clinical summary at the end of the visit
can be used to meet the meaningful use objective for ―provide clinical summaries for patients after each office visit.
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Related IMS Function
1. EP shall create a Document Sub-Category that will contain all clinical summary letter options. Document Sub-
Category can be named ―CR13 Clinical Summaries‖ within IMS for ease of identification. (NOTE: For
Meaningful Use, only one sub-category will be reported on, so it is important that ONLY clinical summary
letters are stored within this sub-category. It is equally important that ALL are stored within this sub-
category. Letters not assigned to this sub-category will not be factored into the objective requirements.)
2. Within the Meaningful Use Report window, ensure that the EP has defined Letter Category for CR13.
a) Open the Meaningful Use Report window
b) Click on the ―Set Parameter‖ button in bottom left
c) Within the Parameter window, click on the pull-down menu button for ―Letter Category for CR13 ‖
d) From the list, select the pre-defined Document Category that pertains to clinical summary letters.
(NOTE: Only one category may be selected as indicated in step 1 above.)
e) Once the proper category has been selected, click ―OK‖ to exit the Parameter window
The above should be set for all clients as the functionality is available within IMS by default. For other methods such
as patient portal or secure email, the clinical summary letter will still be generated first and the method of
transmission to the patient will be the only variance.
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CR14 - Electronic Exchange of Clinical Information
Objective: Capability to exchange key clinical information (for example, problem list, medication list,
medication allergies, and diagnostic test results), among providers of care and patient authorized entities
electronically.
Measure: Performed at least one test of certified EHR technology‘s capacity to electronically exchange
key clinical information.
Exclusion: No exclusion.
Definition of Terms
Diagnostic Test Results – All data needed to diagnose and treat disease. Examples include, but are not
limited to, blood tests, microbiology, urinalysis, pathology tests, radiology, cardiac imaging, nuclear
medicine tests, and pulmonary function tests.
Different Legal Entities – A separate legal entity is an entity that has its own separate legal existence.
Indications that two entities are legally separate would include (1) they are each separately incorporated;
(2) they have separate Boards of Directors; and (3) neither entity is owned or controlled by the other.
Distinct Certified EHR Technology – Each instance of certified EHR technology must be able to be
certified and operate independently from all the others in order to be distinct. Separate instances of
certified EHR technology that must link to a common database in order to gain certification would not
be considered distinct. However, instances of certified EHR technology that link to a common,
uncertified system or component would be considered distinct. Instances of certified EHR technology
can be from the same vendor and still be considered distinct.
Exchange – Clinical information must be sent between different legal entities with distinct certified EHR
technology and not between organizations that share a certified EHR technology. Distinct certified EHR
technologies are those that can achieve certification and operate independently of other certified EHR
technologies. The exchange of information requires that the eligible professional must use the standards
of certified EHR technology as specified by the Office of the National Coordinator for Health IT, not the
capabilities of uncertified or other vendor-specific alternative methods for exchanging clinical
information.
Patient Authorized Entities – Any individual or organization to which the patient has granted access to
their clinical information. Examples would include an insurance company that covers the patient, an
entity facilitating health information exchange among providers, or a personal health record vendor
identified by the patient. A patient would have to affirmatively grant access to these entities.
Attestation Requirements
YES / NO Eligible professionals (EPs) must attest YES to having performed at least one test of certified EHR
technology‘s capacity to electronically exchange key clinical information during the EHR reporting period to meet
this measure.
Additional Information
The test of electronic exchange of key clinical information must involve the transfer of information to
another provider of care with distinct certified EHR technology or other system capable of receiving the
information. Simulated transfers of information are not acceptable to satisfy this objective.
The transmission of actual patient information is not required for the purposes of a test. The use of test
information about a fictional patient that would be identical in form to what would be sent about an
actual patient would satisfy this objective.
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When the clinical information is available in a structured format it should be transferred in a structured
format. However, if the information is unavailable in a structured format, the transmission of
unstructured data is permissible.
EPs can use their clinical judgment to identify what clinical information is considered key clinical
information for purposes of exchanging clinical information about a patient at a particular time with
other providers of care. A minimum set of information is identified in the HIT Standards and Criteria
rule at 45 CFR 170.304(i), and is generally outlined in this objective as: problem list, medication list,
medication allergies, and diagnostic test results. An EP‘s determination of key clinical information could
include some or all of this information, as well as information not included here.
An EP should test their ability to send the minimum information set in the HIT Standards and Criteria
rule at 45 CFR 170.304(i). If the EP continues to exchange information beyond the initial test, then the
provider may decide what information should be exchanged on a case-by-case basis.
EPs must test their ability to electronically exchange key clinical information at least once prior to the
end of the EHR reporting period. Testing may also occur prior to the beginning of the EHR reporting
period. Every payment year requires its own, unique test. If multiple EPs are using the same certified
EHR technology in a shared physical setting, testing would only have to occur once for a given certified
EHR technology.
An unsuccessful test of electronic exchange of key clinical information will be considered valid for
meeting the measure of this objective.
Related IMS Function
IMS provides functionality for the Import and Export of Continuity of Care Documents (CCD). The Export (CCD)
utility provides options for exporting Payer, Diagnosis, Allergy, Vitals, Medication/Rx, Lab Results, Immunization,
Procedures, Family History, and Social History information. The file is created in XML format to share with other
authorized entities. The Import (CCR) utility allows the EP to import patient information from XML files and then
assign to the appropriate patient for view as a Document. A separate guide for this utility is available.
Providers Guide to Meaningful Use
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CR15 - Protect Electronic Health Information
Objective: Protect electronic health information created or maintained by the certified EHR technology
through the implementation of appropriate technical capabilities.
Measure: 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.
Exclusion: No exclusion.
Definition of Terms
Appropriate Technical Capabilities – A technical capability would be appropriate if it protected the
electronic health information created or maintained by the certified EHR technology. All of these
capabilities could be part of the certified EHR technology or outside systems and programs that support
the privacy and security of certified EHR technology.
Attestation Requirements
YES / NO Eligible professionals (EPs) must attest YES to having conducted or reviewed a security risk analysis in
accordance with the requirements under 45 CFR 164.308(a)(1) and implemented security updates as necessary and
corrected identified security deficiencies prior to or during the EHR reporting period to meet this measure.
Additional Information
EPs must conduct or review a security risk analysis of certified EHR technology and implement updates
as necessary at least once prior to the end of the EHR reporting period and attest to that conduct or
review. The testing could occur prior to the beginning of the first EHR reporting period. However, a new
review would have to occur for each subsequent reporting period.
A security update would be required if any security deficiencies were identified during the risk analysis.
A security update could be updated software for certified EHR technology to be implemented as soon as
available, changes in workflow processes or storage methods, or any other necessary corrective action
that needs to take place to eliminate the security deficiency or deficiencies identified in the risk analysis.
Related IMS Function
IMS Security Features and Clinic Expectations
Within IMS, the Security feature manages access to patient data at a User and Group level. Users are provided access
via Username/Password. IMS provides parameters within the utility to increase the security of such access by
requiring: 1) minimum characters for password, 2) case sensitivity, 3) enforced alpha-numeric passwords, 4) lockouts
after number of failed login attempts, 5) password resets every set number of days and 6) historically unique
passwords. Through the use of Grouping and Grants, users can be further limited to the activities and data within
IMS that they are capable of accessing. In addition, IMS has a Lock Session feature for use when a user must step
away from the terminal in order to protect patient data. IMS also provides an Audit Log utility. This utility allows
the EP to determine when specific patient related data elements were accessed or modified within the database and by
which specific user. The security within the EHR depends a great deal on the security practices within the clinic
setting. Please refer to http://edocket.access.gpo.gov/cfr_2010/octqtr/45cfr164.308.htm for other EP requirements
outside of the EHR such as defining security management processes, assigning a security official, limiting personnel
and information access, providing security awareness training, handling security incidents, establishing contingency
plans, and periodically evaluating security policies and procedures.
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Security
Lock Session Screen
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Audit Log
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8. Meaningful Use Menu Requirements
MN01 - Drug Formulary Checks
Objective: Implement drug formulary checks.
Measure: The EP has enabled this functionality and has access to at least one internal or external
formulary for the entire EHR reporting period.
Exclusion: Any EP who writes fewer than 100 prescriptions during the EHR reporting period.
Attestation Requirements
YES / NO / EXCLUSION Eligible professionals (EPs) must attest YES to having enabled this functionality and
having had access to at least one internal or external formulary for the entire EHR reporting period to meet this
measure. An EP who writes fewer than 100 prescriptions during the EHR reporting period can be excluded from this
objective and associated measure. EPs must enter ‗0‘ in the Exclusion box to attest to exclusion from the requirement.
Additional Information At a minimum an EP must have at least one formulary that can be queried. This may be an internally developed
formulary or an external formulary. The formularies should be relevant for patient care during the prescribing process.
Related IMS Function
Formulary Setup
To ensure Formulary checks are in use within IMS, the following setup is required (image on next page):
1. Within IMS, select ―Setup‖ from the application menu (A)
2. Choose ―Prescription‖ from the left panel (B)
3. Within Prescription, select ―Formulary‖ (C). Each formulary will be associated with one or more Insurance
Carriers or Plans. When creating, make sure that the drug associations made are applicable to Plans. If they
do not apply to all, a separate formulary will be needed.
4. Enter details of the Formulary (D)
a. Enter a meaningful ―Description‖ for the Formulary
b. If desired, enter a ―Note‖ that further describes the formulary
c. Enter the specific Drugs or Drug Groups relevant to the formulary
i. Type: specify whether a specific drug or drug group
ii. Drug/Drug Group: search for and list the related drug or drug group
iii. Rule: specify if drug or drug group is:
a) Not Covered –Plan to be associated will not cover the med
b) Prior Auth Req –Plan requires prior authorization before prescribing
c) Sp Instructions – Med requires special instructions when prescribing. Special
Instructions should be entered in the ―Note‖ field for this drug.
iv. Note: Used to enter ―Special Instructions‖
v. Select Alternate Drug(s): If a drug is not covered by the Plan, this option creates a list of
alternate drugs that the provider will be presented with on conflict during the prescription
creation phase.
d. Click the ―Insurance‖ icon in top right corner to enter formula related Carrier or Plan(s).
5. Save the Formulary (E)
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Formulary Usage (Test Formulary Setup)
1. Select a Test patient and set the patient Insurance to match a Plan selected in the Formulary setup
2. Create a ―Prescription‖ for a med selected in the Formulary setup
3. When ―Save‖ is clicked, the user will be prompted with Formulary information as specified in Formulary Setup
A
B
C
D
E
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MN02 - Clinical Lab Test Results
Objective: Incorporate clinical lab test results into EHR as structured data.
Measure: 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.
Exclusion: An EP who orders no lab tests whose results are either in a positive/negative or numeric
format during the EHR reporting period.
Attestation Requirements
DENOMINATOR: Number of lab tests ordered during the EHR reporting period by the EP whose
results are expressed in a positive or negative affirmation or as a number.
NUMERATOR: Number of lab test results whose results are expressed in a positive or negative
affirmation or as a number which are incorporated as structured data.
EXCLUSION: If an EP orders no lab tests whose results are either in a positive/negative or numeric
format during the EHR reporting period they would be excluded from this requirement. EPs must select
NO next to the appropriate exclusion, then click the APPLY button in order to attest to the exclusion.
The resulting percentage (Numerator ÷ Denominator) must be more than 40 percent in order for an EP to meet this
measure.
Additional Information The provider is permitted, but not required, to limit the measure of this objective to labs ordered for
those patients whose records are maintained using certified EHR technology.
Structured data does not need to be electronically exchanged in order to qualify for the measure of this
objective. The EP is not limited to only counting structured data received via electronic exchange, but
may count in the numerator all structured data entered through manual entry through typing, option
selecting, scanning, or other means.
Lab results are not limited to any specific type of laboratory or to any specific type of lab test.
The Medicare and Medicaid EHR Incentive Programs do not specify the use of code set standards in
meeting the measure for this objective. However, the Office of the National Coordinator for Health
Information Technology (ONC) has adopted Logical Observation Identifiers Names and Codes
(LOINC®) version 2.27, when such codes were received within an electronic transaction from a
laboratory, for the entry of structured data for this measure and made this a requirement for EHR
technology to be certified.
Related IMS Function
Although incorporation of an HL7 interface with compatible lab companies will help to ensure the successful input of the
required Lab Result data, it is not required. Essentially, the EP should ensure that any Labs defined within IMS have results
entered as structured data. Linking a faxed results page to a Lab Order will not qualify for this requirement. The EP or a staff
member must associate the returned results to the order by entering the values manually.
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MN03 - Patient Lists
Objective: Generate lists of patients by specific conditions to use for quality improvement, reduction of
disparities, research, or outreach.
Measure: Generate at least one report listing patients of the EP with a specific condition.
Exclusion: No exclusion.
Definition of Terms
Specific Conditions - Those conditions listed in the active patient problem list.
Attestation Requirements
YES / NO Eligible professionals (EPs) must attest YES to having generated at least one report listing patients of the
EP with a specific condition to meet this measure.
Additional Information
This objective does not dictate the report(s) which must be generated. An EP is best positioned to
determine which reports are most useful to their care efforts.
The report generated could cover every patient whose records are maintained using certified EHR
technology or a subset of those patients at the discretion of the EP.
The report generated is required to include only patients whose records are maintained using certified
EHR technology.
Related IMS Function
Patient Special Search
Within IMS, the Patient Special Search feature allows real-time generation of patient lists by specific conditions.
The Patient Special Search is found within the Utilities menu.
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Within the Patient Special Search window, set the desired search criteria within the left panel (A). When criteria has
been selected, click on ―Search‖ (B) to query the database. Results will appear in the panel to the right (C).
Administrative options such as Reminders, Label printing, Faxing or Emailing letters, Exporting or Printing the list
are available in the bottom portion of the right panel (D).
EMR Reports
IMS also provides specific EMR reports that will also generate the conditions requested. Access to the reports is
obtained by:
1. Click on ―Reports‖ from Application Menu (A)
2. Select ―EMR‖ from list (B)
3. Click the ―+‖ sign next to ―Visit Note‖ (C)
Several related reports (D) are listed in the image on the next page, including:
Patient Visit Summary by Diagnosis – This report generates a summary list of patients grouped by
Office and desired diagnosis range. The list does not specify visit date or provider seen.
Visit Note by Diagnosis - This report will generate a list of patients grouped by Office and then Provider
for the desired diagnosis range as filtered by date, office, and/or Provider. Details of report include visit
date, time of visit, related case info and place of service.
Patient Visit Detail by Diagnosis – This report will generate a list of patients grouped by Office and
desired diagnosis range. The list specifies visit date, provider seen, case info and reason for visit.
A
B
C
D
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A B
C
D
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MN04 -Patient Reminders
Objective: Send reminders to patients per patient preference for preventive/follow-up care.
Measure: 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.
Exclusion: An EP who has no patients 65 years old or older or 5 years old or younger with records
maintained using certified EHR technology.
Definition of Terms
Unique Patient – If a patient is seen by an EP more than once during the EHR reporting period, then for
purposes of measurement that patient is only counted once in the denominator for the measure. All the
measures relying on the term ‗‗unique patient‘‘ relate to what is contained in the patient‘s medical
record. Not all of this information will need to be updated or even be needed by the provider at every
patient encounter. This is especially true for patients whose encounter frequency is such that they would
see the same provider multiple times in the same EHR reporting period.
Attestation Requirements
DENOMINATOR: Number of unique patients 65 years old or older or 5 years older or younger.
NUMERATOR: Number of patients in the denominator who were sent the appropriate reminder.
EXCLUSION: If an EP has no patients 65 years old or older or 5 years old or younger with records
maintained using certified EHR technology that EP is excluded from this requirement. EPs must select
NO next to the appropriate exclusion, then click the APPLY button in order to attest to the exclusion.
The resulting percentage (Numerator ÷ Denominator) must be more than 20 percent in order for an EP to meet this
measure.
Additional Information
The provider is permitted, but not required, to limit the measure of this objective to those patients whose
records are maintained using certified EHR technology.
EPs meet the aspect of ‗‗per patient preference‘‘ of this objective if they are accommodating reasonable
requests in accordance with the HIPAA Privacy Rule, as specified at 45 CFR 164.522(b), which is the
guidance established for accommodating patient requests.
EP has the discretion to determine the frequency, means of transmission, and form of the reminder
limited only by the requirements the HIPAA Privacy Rule, as specified at 45 CFR 164.522(b), and any
other applicable federal, state or local regulations that apply to them.
Related IMS Function
MN04 - Meaningful Use Report Setup
1. EP shall create a Document Sub-Category specific to this purpose that will contain all Patient Reminder letters
that apply to the preventative/follow-up needs associated with patients 5 and under or 65 and older. Document
Sub-Category can be aptly named ―MN04 Patient Preventative Reminder Letters‖ within IMS for ease of
identification. (NOTE: For Meaningful Use, only one sub-category will be reported on, so it is important that
ONLY letters meeting requirements for this measure are stored within this sub-category. It is equally
important that ALL relevant letters are stored within this sub-category. If the letters are not assigned to this
sub-category, they will not be factored into the objective requirements.)
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2. Within the Meaningful Use Report window, ensure that the EP has defined the appropriate Letter sub-category
for Patient Preventative Reminder letters.
a. Open the Meaningful Use Report window
b. Click on the ―Set Parameter‖ button in bottom left
c. Within the Parameter window, click on the pull-down menu button for ―Letter Category for MN04‖
d. From the list, select the pre-defined Document Sub-Category that pertains to Patient Preventative
Reminder letters. (NOTE: Only one sub-category may be selected as indicated in step 1 above.)
e. Once the proper category has been selected, click ―OK‖ to exit the Parameter window
The above should be set for all clients as the functionality is available within IMS by default.
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Letter Focus
Letters to be generated from Scheduler, CheckIn, or Patient Special Search should be created as
―Scheduler‖ type letters and assigned to the ―MN04 Patient Preventative Reminder Letters‖ sub-
category.
Letters to be generated from within a Visit Note or at Checkout should be created as ―Visit Note‖ type
letters and assigned to the ―MN04 Patient Preventative Reminder Letters‖ sub-category.
Letters to be generated from Health Maintenance or Reminders should be created as ―Reminder/Note‖
type letters and assigned to the ―MN04 Patient Preventative Reminder Letters‖ sub-category.
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MN05 - Patient Electronic Access
Objective: 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.
Measure: 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.
Exclusion: Any EP that neither orders nor creates lab tests or information that would be contained in the
problem list, medication list, medication allergy list (or other information as listed at 45 CFR
170.304(g)) during the EHR reporting period.
Definition of Terms
Business Days – Business days are defined as Monday through Friday excluding federal or state
holidays on which the EP or their respective administrative staffs are unavailable.
Unique Patient – If a patient is seen by an EP more than once during the EHR reporting period, then for
purposes of measurement that patient is only counted once in the denominator for the measure. All the
measures relying on the term ‗‗unique patient‘‘ relate to what is contained in the patient‘s medical
record. Not all of this information will need to be updated or even be needed by the provider at every
patient encounter. This is especially true for patients whose encounter frequency is such that they would
see the same provider multiple times in the same EHR reporting period.
Attestation Requirements
DENOMINATOR: Number of unique patients seen by the EP during the EHR reporting period.
NUMERATOR: Number of patients in the denominator who have timely (available to the patient within
four business days of being updated in the certified EHR technology) electronic access to their health
information online.
EXCLUSION: If an EP neither orders nor creates lab tests or information that would be contained in the
problem list, medication list, medication allergy list (or other information as listed at 45 CFR
170.304(g)) during the EHR reporting period, they would be excluded from this requirement. EPs must
select NO next to the appropriate exclusion, then click the APPLY button in order to attest to the
exclusion. The resulting percentage (Numerator ÷ Denominator) must be at least 10 percent in order for
an EP to meet this measure.
Additional Information
Online electronic access through either a patient portal or personal health record (PHR) will satisfy the
measure of this objective.
An EP may decide that electronic access to a portal or PHR is not the best forum to communicate
results. Within the confines of laws governing patient access to their medical records, we would defer to
EP‘s judgment as to whether to hold information back in anticipation of an actual encounter between the
provider and the patient.
Information that must be provided electronically is limited to that information that exists electronically
in or is accessible from the certified EHR technology and is maintained by or on behalf of the EP. At a
minimum, certified EHR technology makes available lab test results, problem list, medication list, and
medication allergy list.
An EP may withhold information from the electronic copy of a patient‘s health information in
accordance with the HIPAA Privacy Rule, as specified at 45 CFR 164.524.
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The objective and measure focus on the availability of access and the timeliness of data, not utilization.
The EP is not responsible for ensuring that 10 percent request access or have the means to access, only
that 10 percent of all unique patients seen by the EP could access the information if they so desired.
Related IMS Function
IMS Patient Portal is designed to meet these requirements. If the EP is not using Patient Portal, this Menu
Requirement is not an available option. For those EP‘s who are using the Patient Portal, be sure to create a login to
the portal for each patient. This will ensure that access is afforded to the patient even if they choose not to use that
access. Creating and providing the account information to the patient will satisfy this requirement.
1) Within Patient Master, click on ―Other Options‖ (A) and then select ―Portal Login‖ (B) to create user login
for portal.
A
B
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2) Define a ―User ID‖ (A) for the patient and enter a valid email address for the patient (B). Click ―Next‖
(C).
3) Select an appropriate letter to generate for the patient (A) and a label if desired (B). Click ―OK‖ (C).
This will activate the login and the patient shall be provided with the proper login criteria.
A
B
C
A
B
C
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MN06 - Patient-specific Education Resources
Objective: Use certified EHR technology to identify patient-specific education resources and provide
those resources to the patient if appropriate.
Measure: More than 10 percent of all unique patients seen by the EP are provided patient-specific
education resources.
Exclusion: No exclusion.
Definition of Terms
Patient-Specific Education Resources – Resources identified through logic built into certified EHR
technology which evaluates information about the patient and suggests education resources that would
be of value to the patient.
Unique Patient – If a patient is seen by an EP more than once during the EHR reporting period, then for
purposes of measurement that patient is only counted once in the denominator for the measure. All the
measures relying on the term ‗‗unique patient‘‘ relate to what is contained in the patient‘s medical
record. Not all of this information will need to be updated or even be needed by the provider at every
patient encounter. This is especially true for patients whose encounter frequency is such that they would
see the same provider multiple times in the same EHR reporting period.
Attestation Requirements
DENOMINATOR: Number of unique patients seen by the EP during the EHR reporting period.
NUMERATOR: Number of patients in the denominator who are provided patient-specific education
resources.
The resulting percentage (Numerator ÷ Denominator) must be more than 10 percent in order for an EP to meet this
measure.
Additional Information
Certified EHR technology is certified to use either the patient‘s problem list, medication list, or
laboratory test results to identify the patient-specific educational resources. These or additional elements
can be used in the identification of educational resources that are specific to the patients needs.
Education resources or materials do not have to be stored within or generated by the certified EHR.
However, the provider should utilize certified EHR technology in a manner where the technology
suggests patient-specific educational resources based on the information stored in the certified EHR
technology. The provider can make a final decision on whether the education resource is useful and
relevant to a specific patient.
Related IMS Function
EP‘s who are using the Micromedix companion in conjunction with IMS ―Link with‖ functionality will meet this
requirement. With ―Link with‖ technology, care plan information is presented when relevant diagnosis, lab,
prescription, examination findings or procedures are encountered during a patient visit.
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MN07 - Medication Reconciliation
Objective: 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.
Measure: 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.
Exclusion: An EP who was not the recipient of any transitions of care during the EHR reporting period.
Definition of Terms
Medication Reconciliation - The process of identifying the most accurate list of all medications that the
patient is taking, including name, dosage, frequency, and route, by comparing the medical record to an
external list of medications obtained from a patient, hospital, or other provider.
Relevant Encounter – An encounter during which the EP performs a medication reconciliation due to
new medication or long gaps in time between patient encounters or for other reasons determined
appropriate by the EP. Essentially an encounter is relevant if the EP judges it to be so. (Note: Relevant
encounters are not included in the numerator and denominator of the measure for this objective.)
Transition of Care – The movement of a patient from one setting of care (hospital, ambulatory primary
care practice, ambulatory specialty care practice, long-term care, home health, rehabilitation facility) to
another.
Attestation Requirements
DENOMINATOR: Number of transitions of care during the EHR reporting period for which the EP was
the receiving party of the transition.
NUMERATOR: Number of transitions of care in the denominator where medication reconciliation was
performed.
EXCLUSION: If an EP was not on the receiving end of any transition of care during the EHR reporting
period they would be excluded from this requirement. EPs must select NO next to the appropriate
exclusion, then click the APPLY button in order to attest to the exclusion.
The resulting percentage (Numerator ÷ Denominator) must be more than 50 percent in order for an EP to meet this
measure.
Additional Information
Only patients whose records are maintained using certified EHR technology should be included in the
denominator for transitions of care.
In the case of reconciliation following transition of care, the receiving EP should conduct the medication
reconciliation.
The measure of this objective does not dictate what information must be included in medication
reconciliation. Information included in the process of medication reconciliation is appropriately
determined by the provider and patient.
Related IMS Function
To comply with the Medication Reconciliation requirements, EP must ensure that the referring provider is recorded
within the Case associated with the transitioning patient. EP must also ensure that the status of the patient‘s current
medication is recorded within IMS. Although not specifically stated that current medications must be recorded on the
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first visit, it is highly recommended that the EP do this to ensure the information is in the chart and so that compliance
is achieved.
1) Properly recorded referring physician is shown in the Case image below:
2) Properly recorded Current Medications are shown in the image below:
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MN08 - Transition of Care Summary
Objective: 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.
Measure: 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.
Exclusion: An EP who neither transfers a patient to another setting nor refers a patient to another
provider during the EHR reporting period.
Definition of Terms
Transition of Care – The movement of a patient from one setting of care (hospital, ambulatory primary
care practice, ambulatory specialty care practice, long-term care, home health, rehabilitation facility) to
another.
Attestation Requirements
DENOMINATOR: Number of transitions of care and referrals during the EHR reporting period for
which the EP was the transferring or referring provider.
NUMERATOR: Number of transitions of care and referrals in the denominator where a summary of
care record was provided.
EXCLUSION: If an EP does not transfer a patient to another setting or refer a patient to another
provider during the EHR reporting period then they would be excluded from this requirement. EPs must
select NO next to the appropriate exclusion, then click the APPLY button in order to attest to the
exclusion.
The resulting percentage (Numerator ÷ Denominator) must be more than 50 percent in order for an EP to meet this
measure.
Additional Information
Only patients whose records are maintained using certified EHR technology should be included in the
denominator for transitions of care.
The transferring party must provide the summary care record to the receiving party.
The EP can send an electronic or paper copy of the summary care record directly to the next provider or
can provide it to the patient to deliver to the next provider, if the patient can reasonably be expected to
do so.
If the provider to whom the referral is made or to whom the patient is transitioned to has access to the
medical record maintained by the referring provider then the summary of care record would not need to
be provided, and that patient should not be included in the denominator for transitions of care.
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Related IMS Function
IMS provides a Referral Tracking utility for this purpose. Within the Referral Tracking utility, the printing or faxing
of a letter or form signifies that a Transition of Care Record has been provided for that patient. Generally, a patient
will be referred during the course of the office visit and documented as such within the Visit Note. Alternatively, a
patient may be added to the Referral Tracking utility manually via the Add option within the Referral Tracking utility.
Once the patient is on the list, the EP must ensure that one of the following actions occurs:
a) Select the patient from the Referral Tracking list (A). Choose either Letter or Form as transmit option (B).
If ―Form‖ is selected, first ―Fill Form‖ (C) and click ―OK‖ from the ―Forms to be Filled‖ window. Click
Fax‖ (D) and complete the fax transmission process until ―Fax sent successfully‖ message is received.
b) Select the proper patient (A) and Print (B) the Letter via the associated print process. Once the print
process is complete, right-click the patient and select ―Followup‖ (C). Within the Follow-up window,
select Type as ―Fax/Sent‖ (D) and enter a Note (E) that letter was printed. Click ―Save‖ and ―Close‖ (F).
A
D
A
B
C
E
D
F
B
C
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MN09 - Immunization Registries Data Submission
Objective: Capability to submit electronic data to immunization registries or immunization information
systems and actual submission according to applicable law and practice.
Measure: 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).
Exclusion: An EP who administers no immunizations during the EHR reporting period or where no
immunization registry has the capacity to receive the information electronically.
Attestation Requirements
Eligible professionals (EPs) must attest YES to having 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 was successful (unless none of the immunization registries to which the EP submits such
information has the capacity to receive the information electronically) to meet this measure.
EXCLUSION: If an EP does not perform immunizations during the EHR reporting period, or if there is
no immunization registry that has the capacity to receive the information electronically, then the EP
would be excluded from this requirement. EPs must select NO next to the appropriate exclusion(s), then
click the APPLY button in order to attest to the exclusion(s).
Additional Information
The test to meet the measure of this objective must involve the actual submission of information to a
registry or immunization information system, if one exists that will accept the information. Simulated
transfers of information are not acceptable to satisfy this objective.
The transmission of actual patient information is not required for the purposes of a test. The use of test
information about a fictional patient that would be identical in form to what would be sent about an
actual patient would satisfy this objective.
If multiple EPs are using the same certified EHR technology in a shared physical setting, testing would
only have to occur once for a given certified EHR technology.
An unsuccessful test to submit electronic data to immunization registries or immunization information
systems will be considered valid and would satisfy this objective.
If the test is successful, then the EP should institute regular reporting with the entity with whom the
successful test was conducted, in accordance with applicable law and practice. There is not a
measurement associated with this reporting.
The transmission of immunization information must use the standards at 45 CFR 170.302(k).
Related IMS Function
This menu option is currently not available in all areas. A status of Registries associated with IMS follows:
Currently available registries include: GRITS (Georgia), FL Shots (Florida), NYSIIS (New York), and CAIR
(California).
Registries under development: NCIR Import (North Carolina), PA-SIIS (Pennsylvania), AZ-SIIS (Arizona) and
Texas.
If a Registry is required that is not on the list, a request can be made.
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MN10 - Syndromic Surveillance Data Submission
Objective: Capability to submit electronic syndromic surveillance data to public health agencies and
actual submission according to applicable law and practice.
Measure: 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 can receive
information electronically).
Exclusion: An EP who does not collect any reportable syndromic information on their patients during
the EHR reporting period or does not submit such information to any public health agency that has the
capacity to receive the information electronically.
Definition of Terms
Public Health Agency - An entity under the jurisdiction of the U.S. Dept of Health and Human Services,
tribal organization, State and/or city/county level administration that serves a public health function.
Attestation Requirements
Eligible professionals (EPs) must attest YES to having performed at least one test of certified EHR
technology‘s capacity to submit electronic syndromic surveillance data to public health agencies and
follow up submission if the test was successful (unless none of the public health agencies to which the
EP submits information has the capacity to receive information electronically) to meet this measure.
EXCLUSION: If an EP does not collect any reportable syndromic information on their patients during
the EHR reporting period or if no public health agency that has the capacity to receive the information
electronically, then the EP is excluded from this requirement. EPs must select NO next to the
appropriate exclusion, then click the APPLY button in order to attest to the exclusion.
Additional Information
The test to meet the measure of this objective must involve the actual submission of electronic
syndromic surveillance data to public health agencies, if one exists that will accept the information.
Simulated transfers of information are not acceptable to satisfy this objective.
The transmission of electronic syndromic surveillance data is not required for the purposes of a test.
The use of test information about a fictional patient that would be identical in form to what would be
sent about an actual patient would satisfy this objective.
An unsuccessful test to submit electronic syndromic surveillance data to public health agencies will be
considered valid and would satisfy this objective.
If the test is successful, the EP should institute regular reporting with the entity with whom the
successful test was conducted, in accordance with applicable law and practice. No reportable measure.
EPs must test their ability to submit electronic syndromic surveillance data to public health agencies at
least once prior to the end of the EHR reporting period. Testing may also occur prior to the beginning of
the EHR reporting period. Each payment year requires it own unique test.
If multiple EPs are using the same certified EHR technology in a shared physical setting, testing would
only have to occur once for a given certified EHR technology.
The transmission of syndromic surveillance information must use the standards at 45 CFR 170.302(l).
Related IMS Function
This is not currently an IMS option available to EP‘s.
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9. Summary IMS Core and Menu Set Requirements Checklist
ID Objective Required IMS Element
Setup /
Usage
Verified
CR01 CPOE for
Medication Orders
1) Current Medications within the Visit Note must include at least
one medication
2) Patient must have been prescribed a medication from within IMS
during the reporting period. Chart history should show that a
prescription was given to the patient on the specific date.
(NOTE: Prescription does not have to be sent electronically to
meet this requirement)
CR02 Drug Interaction
Checks
User Parameters for Prescription set to ―Yes‖ for:
Patient Allergy Check Required
o Cross Sensitive Allergy Check
o Inactive ingredient based Allergy Check
Drug Drug Interaction Check Required
o Medium Severity Interaction Check
o Low Severity Interaction Check
Drug Validation (NOTE: If this is not set to yes,
interactions will not be checked)
CR03 Transmit
Permissible
Prescriptions
Electronically
Prescriptions should be sent by the EP to pharmacy electronically
when prescribed. Currently, this means a client must be registered for
and using either New Crop or Surescripts.
CR04 Record
Demographics
Patient demographics are created for every patient in IMS. Date of
Birth (DOB) and Gender are required fields. EP should verify that
Race, Ethnicity, and Language have been captured or documented as
―Patient declined‖.
CR05 Maintain Problem
List
Patient Diagnosis must either:
a) Be entered within the Visit Note for the specific encounter and
be visible within the ―Active Diagnosis‖ tab in the Diagnosis
Visit Note Template and also within Chart View on the Dx tab.
Or
b) Be entered within the Visit Note for the specific encounter and
recorded with the ―Mark as No Known Problem‖ button if the
patient does not have any current problems.
CR06 Active Medication
List
Current Medications within the Visit Note should include the
following:
a) A list of all active medications that the patient is currently taking
Or
b) It must be documented that the ―Patient is not taking any
medication.‖
CR07 Medication Allergy
List
Drug Allergy within the Visit Note should include the following:
a) A list of all known drugs that patient is allergic to
Or
b) It must be specifically documented that patient has ―No Known
Drug Allergies‖
CR08 Record Vital Signs Vital Signs template must be completed for a minimum of Height,
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ID Objective Required IMS Element
Setup /
Usage
Verified
Weight and Blood Pressure. If any one or more of the elements are
missing, the requirement will not be met.
CR09 Record Smoking
Status
1) Within the Meaningful Use Report window, ensure that the EP
has defined the appropriate Social History value to be recorded as
capturing this data.
2) For all patients over 13 years of age, Social History within the
Visit Note should include the following:
a) Smoking Status recorded as positive within the Question
selected in Parameter
Or
b) Smoking Status recorded as negative within the Question
selected in Parameter
CR10 Clinical Decision
Support Rule
Within IMS, there are a number of features available that qualify as
clinical decision support rules. Essentially, this means that based on
findings during a patient visit, IMS will offer diagnostic or treatment
options to the provider. The ―link with‖ functionality within IMS can
be configured to assist EP‘s by providing reference information and
other tools to support decisions within clinical workflow. Proper use
of alerts and reminders qualify as CDS rules. Incorporating clinical
guidelines or protocols into IMS workflow would also qualify.
Defining appropriate Health Maintenance rules for specific patient
populations is another option. EP‘s may use order sets to improve
CPOE. The use of reports and dashboards to aid in clinical decision
support would also qualify. Within IMS, the Visit Note dashboard is
customizable to allow the EP to be presented with patient specific data
pertinent to decision making and care. As mentioned above, it is up to
the EP to determine which CDS rules to incorporate into their clinical
setting.
CR11 Clinical Quality
Measures (CQM)
IMS provides a PQRI/NFQ reporting tool for tracking of quality measures.
This tool allows each EP to define clinical quality measures relevant to their
specialty for reporting. Please view the recently conducted PQRI webinars
for additional information on how to configure PQRI reporting within IMS.
Additionally, a PQRI Help guide is available to clients on MOT and to
resellers on the VAR portal.
CR12 Electronic Copy of
Health Information
i. EP shall create a Reminder Category specific to this purpose.
Reminder Category shall contain all Reminder Tasks that inform
staff that patient requires a copy of their health information in
electronic format (CD, USB drive, portal, etc). (NOTE: For
Meaningful Use, only one category will be reported on, so it is
important that ONLY health information request related reminders
are stored within this category.)
ii. EP shall create required Reminder Tasks within defined Reminder
Category.
iii. EP must set the parameter for ―Reminder Category for CR12‖ in
Meaningful Use Report
iv. Reminder must be created on date of request and marked ―Done‖
on date completed to ensure proper tracking.
CR13 Clinical Summaries 1) EP shall create a Document Category specific to this purpose that
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ID Objective Required IMS Element
Setup /
Usage
Verified
will contain all clinical summary letter options. Document
Category can be aptly named ―CR13 Clinical Summary Letters‖
within IMS for ease of identification. (NOTE: For Meaningful
Use, only one category will be reported on, so it is important that
ONLY clinical summary letters are stored within this category. It
is equally important that ALL clinical summary letters are stored
within this category. If the letters are not assigned to this category,
they will not be factored into the objective requirements.)
2) Within the Meaningful Use Report window, ensure that the EP has
defined the appropriate Letter Category for clinical summary
letters.
i. Open the Meaningful Use Report window
ii. Click on the ―Set Parameter‖ button in bottom left
iii. Within the Parameter window, click on the pull-down menu
button for ―Letter Category for CR13 ‖
iv. From the list, select the pre-defined Document Category that
pertains to clinical summary letters. (NOTE: Only one
category may be selected as indicated in step 1 above.)
v. Once the proper category has been selected, click ―OK‖ to
exit the Parameter window
The above should be set for all clients as the functionality is available
within IMS by default. For other methods such as patient portal or
secure email, the clinical summary letter will still be generated first
and the method of transmission to the patient will be the only variance.
CR14 Electronic
Exchange of
Clinical
Information
IMS provides functionality for the Import and Export of Continuity of
Care Documents (CCD). The Export (CCD) utility provides options
for exporting Payer, Diagnosis, Allergy, Vitals, Medication/Rx, Lab
Results, Immunization, Procedures, Family History, and Social History
information. The file is created in XML format to share with other
authorized entities. The Import (CCR) utility allows the EP to import
patient information from XML files and then assign to the appropriate
patient for view as a Document.
CR15 Protect Electronic
Health Information
Within IMS, the Security feature manages access to patient data at a
User and Group level. Users are provided access via
Username/Password. IMS provides parameters within the utility to
increase the security of such access by requiring: 1) minimum
characters for password, 2) case sensitivity, 3) enforced alpha-numeric
passwords, 4) lockouts after number of failed login attempts, 5)
password resets every set number of days and 6) historically unique
passwords. Through the use of Grouping and Grants, users can be
further limited to the activities and data within IMS that they are
capable of accessing. In addition, IMS has a Lock Session feature for
use when a user must step away from the terminal in order to protect
patient data. IMS also provides an Audit Log utility. This utility
allows the EP to determine when specific patient related data elements
were accessed or modified within the database and by which specific
user. The security within the EHR depends a great deal on the security
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ID Objective Required IMS Element
Setup /
Usage
Verified
practices within the clinic setting. Please refer to
http://edocket.access.gpo.gov/cfr_2010/octqtr/45cfr164.308.htm for
other EP requirements outside of the EHR such as defining security
management processes, assigning a security official, limiting personnel
and information access, providing security awareness training,
handling security incidents, establishing contingency plans, and
periodically evaluating security policies and procedures.
MN01 Drug Formulary
Checks
To ensure Formulary checks are in use within IMS, the following setup
is required:
1) Within IMS, select ―Setup‖ from the application menu
2) Choose ―Prescription‖ from the left panel
3) Within Prescription, select ―Formulary‖. Each formulary will be
associated with one or more Insurance Carrier or Plan. When
creating, make sure that the drug associations made are
applicable to Plans. If they do not apply to all, a separate
formulary will be needed.
a) Enter a meaningful ―Description‖ for the Formulary
b) If desired, enter a ―Note‖ that further describes the
formulary
c) Enter the specific Drugs or Drug Groups relevant to the
formulary
i. Type: specify whether a specific drug or drug
group
ii. Drug/Drug Group: search for and list the related
drug or drug group
iii. Rule: specify if drug or drug group is:
a) Not Covered –Plan to be associated will not
cover the med
b) Prior Auth Req –Plan requires prior
authorization before prescribing
c) Sp Instructions – Med requires special
instructions when prescribing. Special
Instructions should be entered in the ―Note‖
field for this drug.
d) Note: Used to enter ―Special Instructions‖
e) Select Alternate Drug(s): If a drug is not
covered by the Plan, this option creates a
list of alternate drugs that the provider will
be presented with on conflict during the
prescription creation phase.
iv. Click the ―Insurance‖ icon in top right corner to
enter formulary related Carrier or Plan(s).
4) Save the Formulary
Formulary Usage (Test Formulary Setup)
1) Select a Test patient and set the patient Insurance to match a Plan
selected in the Formulary setup
2) Create a ―Prescription‖ for a med selected in the Formulary setup
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ID Objective Required IMS Element
Setup /
Usage
Verified
3) When ―Save‖ is clicked, the user will be prompted with
Formulary information as specified in Formulary Setup
MN02 Clinical Lab Test
Results
Although incorporation of an HL7 interface with compatible lab companies
will help to ensure the successful input of the required Lab Result data, it is
not required. Essentially, the EP should ensure that any Labs defined within
IMS have results entered as structured data. Linking a faxed results page to a
Lab Order will not qualify for this requirement. The EP or a staff member
must associate the returned results to the order by entering the values
manually.
MN03 Patient Lists Patient Special Search
Within IMS, the Patient Special Search feature allows real-time
generation of patient lists by specific conditions. The Patient Special
Search is found within the Utilities menu.
EMR Reports
IMS also provides specific EMR reports that will also generate the
conditions requested. Access to the reports is obtained by:
1. Click on ―Reports‖ from Application Menu
2. Select ―EMR‖ from list
3. Click the ―+‖ sign next to ―Visit Note‖
Several related reports within are:
Patient Visit Summary by Diagnosis – This report
generates a summary list of patients grouped by Office
and desired diagnosis range. The list does not specify
visit date or provider seen.
Visit Note by Diagnosis - This report will generate a list
of patients grouped by Office and then Provider for the
desired diagnosis range as filtered by date, office, and/or
Provider. Details of report include visit date, time of
visit, related case info and place of service.
Patient Visit Detail by Diagnosis – This report will
generate a list of patients grouped by Office and desired
diagnosis range. The list specifies visit date, provider
seen, case info and reason for visit.
MN04 Patient Reminders 1) EP shall create a Document Sub-Category specific to this purpose
that will contain all Patient Reminder letters that apply to the
preventative/follow-up needs associated with patients 5 and under
or 65 and older. Document Sub-Category can be aptly named
―MN04 Patient Preventative Reminder Letters‖ within IMS for
ease of identification. (NOTE: For Meaningful Use, only one sub-
category will be reported on, so it is important that ONLY letters
meeting requirements for this measure are stored within this sub-
category. It is equally important that ALL relevant letters are
stored within this sub-category. If the letters are not assigned to
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ID Objective Required IMS Element
Setup /
Usage
Verified
this sub-category, they will not be factored into the objective
requirements.)
2) Within the Meaningful Use Report window, ensure that the EP has
defined the appropriate Letter sub-category for Patient Preventative
Reminder letters.
a) Open the Meaningful Use Report window
b) Click on the ―Set Parameter‖ button in bottom left
c) Within the Parameter window, click on the pull-down
menu button for ―Letter Category for MN04‖
d) From the list, select the pre-defined Document Sub-
Category that pertains to Patient Preventative Reminder
letters. (NOTE: Only one sub-category may be
selected as indicated in step 1 above.)
e) Once the proper category has been selected, click ―OK‖
to exit the Parameter window
Letter Focus
Letters to be generated from Scheduler, CheckIn, or
Patient Special Search should be created as ―Scheduler‖
type letters and assigned to the ―MN04 Patient
Preventative Reminder Letters‖ sub-category.
Letters to be generated from within a Visit Note or at
Checkout should be created as ―Visit Note‖ type letters
and assigned to the ―MN04 Patient Preventative
Reminder Letters‖ sub-category.
Letters to be generated from Health Maintenance or
Reminders should be created as ―Reminder/Note‖ type
letters and assigned to the ―MN04 Patient Preventative
Reminder Letters‖ sub-category.
MN05 Patient Electronic
Access
IMS Patient Portal is designed to meet these requirements. If the EP is
not using Patient Portal, this Menu Requirement is not an available
option. For those EP‘s who are using the Patient Portal, ensure that a
login to the portal is created for each patient. This will ensure that
access is afforded to the patient even if they choose not to use that
access. Creating and providing the account information to the patient
will satisfy this requirement.
MN06 Patient Specific
Education
Resources
EP‘s who are using the Micromedix companion in conjunction with
IMS ―Link with‖ functionality will meet this requirement. With ―Link
with‖ technology, care plan information is presented when relevant
diagnosis, lab, prescription, examination findings or procedures are
encountered during a patient visit.
MN07 Medication
Reconciliation
EP should ensure that Current Medications is updated for every new
patient that is seen. New clients to EMR should ensure that Current
Medications are reviewed for every patient during each initial EMR
encounter. This will ensure a review of the accuracy of converted data
(if applicable) and also ensure that initial data is entered for the new
patient.
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ID Objective Required IMS Element
Setup /
Usage
Verified
MN08 Transition of Care
Summary
IMS provides a Referral Tracking utility for this purpose. Within the
Referral Tracking utility, the printing or faxing of a letter or form
signifies that a Transition of Care Record has been provided for that
patient. Generally, a patient will be referred during the course of the
office visit and documented as such within the Visit Note.
Alternatively, a patient may be added to the Referral Tracking utility
manually via the Add option within the Referral Tracking utility.
Once the patient is on the list, the EP must ensure that one of the
following actions occurs:
a) Select the patient from the Referral Tracking list. Choose
either Letter or Form as transmit option. If ―Form‖ is
selected, first ―Fill Form‖ and click ―OK‖ from the ―Forms
to be Filled‖ window. Click Fax‖ and complete the fax
transmission process until ―Fax sent successfully‖ message
is received.
b) Select the proper patient and Print the Letter via the
associated print process. Once the print process is
complete, right-click the patient and select ―Followup‖.
Within the Follow-up window, select Type as ―Fax/Sent‖
and enter a Note that letter was printed. Click ―Save‖ and
―Close‖.
MN09 Immunization
Registries Data
Submission
This menu option is currently not available in all areas. A status of
Registries associated with IMS follows:
Currently available registries include: GRITS (Georgia), FL Shots
(Florida), NYSIIS (New York), and CAIR (California).
Registries under development: NCIR Import (North Carolina), PA-
SIIS (Pennsylvania), AZ-SIIS (Arizona) and Texas.
If a Registry is required that is not on the list, a request can be made.
MN10 Syndromic
Surveillance Data
Submission
This is not currently an IMS option available to EP‘s.
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10. Referenced and Additional Resources
CMS Website Resources
EHR Incentive Programs – http://www.cms.gov/EHRIncentivePrograms/
Eligibility – http://www.cms.gov/EHRIncentivePrograms/15_Eligibility.asp#TopOfPage
Registration – http://www.cms.gov/EHRIncentivePrograms/20_RegistrationandAttestation.asp#TopOfPage
Meaningful Use – http://www.cms.gov/EHRIncentivePrograms/30_Meaningful_Use.asp#TopOfPage
Attestation – http://www.cms.gov/EHRIncentivePrograms/32_Attestation.asp#TopOfPage
Medicare and Medicaid EHR Incentive Programs Overview –
http://www.cms.gov/EHRIncentivePrograms/35_Basics.asp#TopOfPage
Medicaid State Information (including registration dates) –
http://www.cms.gov/EHRIncentivePrograms/40_MedicaidStateInfo.asp#TopOfPage
EHR Incentive Programs Educational Materials (Highly Recommended) –
http://www.cms.gov/EHRIncentivePrograms/55_EducationalMaterials.asp#TopOfPage
Latest Information about Medicare and Medicaid EHR Incentive Programs –
http://www.cms.gov/EHRIncentivePrograms/50_Spotlight.asp#TopOfPage
Supplementary CMS Documentation (Number corresponds to document in Zip file)
1) EHR Medicare Registration User Guide –
http://www.cms.gov/EHRIncentivePrograms/Downloads/EHRMedicareEP_RegistrationUserGuide.pdf
2) EHR Medicaid Registration User Guide –
http://www.cms.gov/EHRIncentivePrograms/Downloads/EHRMedicaidEP_RegistrationUserGuide.pdf
3) Attestation User Guide for Medicare Eligible Professionals –
http://www.cms.gov/EHRIncentivePrograms/Downloads/EP_Attestation_User_Guide.pdf
4) Medicaid State Level Launch Information –
http://www.cms.gov/apps/files/statecontacts.pdf
5) Guide for Reading the EHR Incentive Program EP Measures –
http://www.cms.gov/QualityMeasures/Downloads/QMGuideForReadingEHR.pdf
6) Zip File with Core CQM Specifications –
http://www.cms.gov/apps/ama/license.asp?file=/QualityMeasures/Downloads/EP_MeasureSpecifications.zip
7) Zip File with Supplemental CQM Specifications –
http://www.cms.gov/apps/ama/license.asp?file=/QualityMeasures/Downloads/QMEPSupplemental.zip