Meaningful Use (MU)
July 2010
Meaningful Use Objectives
To improve the quality, safety, and efficiency of care while reducing disparities;
To engage patients and families in their care;
To promote public and population health;
To improve care coordination; and
To promote the privacy and security of EHRs.
Final Rule Overview American Recovery & Reinvestment Act (Recovery Act) –February
2009
Medicare & Medicaid Electronic Health Record (EHR) Incentive Program Notice of Proposed Rulemaking (NPRM) Publication – January 13, 2010 NPRM Comment Period Closed March 15, 2010 CMS received 2,000+ comments
Final Rule on Display –July 13, 2010
Final Rule Published –July 28, 2010
http://www.ofr.gov/OFRUpload/OFRData/2010-17207_PI.pdf
EHR Incentive Final Rule Content Definition of Meaningful Use (MU)
Clinical Quality Measures (CQM) Definition of Eligible Professional (EP) and Eligible Hospital/Critical
Access Hospital (CAH)
Definition of Hospital-based EP
Medicare Fee-For-Service (FFS) EHR Incentive Program
Medicare Advantage (MA) EHR Incentive Program
Medicaid EHR Incentive Program Collection of Information Analysis
(Paperwork Reduction Act)
Regulatory Impact Analysis
Eligible Providers (EP) Medicare
*Subsection (d) hospitals that are paid under the PPS and are located in the 50 States or Washington, DC (including Maryland)
Eligible Providers (EP) Medicare Advantage
Eligible Providers (EP) Medicaid
What an EP Needs to Know
Providers will need to understand the meaningful use objectives and metrics, and to determine whether they’re on an EHR adoption path that will lead to Stage 1 meaningful use and beyond.
Providers will need to understand the quality metric requirements, and the additional data elements their certified EHR will ultimately need to capture in order to calculate quality measure results.
Providers will need to understand which incentives (Medicare, Medicaid, or both) they qualify for, and how the timing of implementations may affect their incentive value.
Providers will need to know when they can expect to receive their incentive payments.
EP Schedule Medicare
EP Schedule Medicaid
Incentive Payments for Eligible Hospitals
Federal Fiscal Year $2M base + per discharge amount (based on Medicare/Medicaid share) There is no maximum incentive amount Hospitals meeting Medicare MU requirements may be deemed eligible
for Medicaid payments Payment adjustments for Medicare begin in 2015 No Federal Medicaid payment adjustments Medicare hospitals: No payments after 2016 Medicaid hospitals: Cannot initiate payments after 2016
“Other” Medicare Incentive Programmes
Difference Between Medicare & Medicaid
MU Modifications from Interim Rule to Final Rule 1 of 2
NPRM vs Final Rule
States could propose requirements above/beyond MU floor, but not with additional EHR functionality States’ flexibility with Stage 1 MU is limited to seeking CMS approval to require 4 public
health-related objectives to be core instead of menu Core clinical quality measures (CQM) and specialty measure groups for EPs
Modified Core CQM and removed specialty measure groups for EPs 90 CQM total for EPs
44 CQM total for EPs –must report total of 6 CQM not all electronically specified at time of NPRM
All final CQM have electronic specifications at time of final rule publication 35 CQM total for eligible hospitals and 8 alternate Medicaid CQM
15 CQM total for eligible hospitals 5 CQM overlap with CHIPRA initial core set
4 CQM overlap with CHIPRA initial core set
MU Modifications from Interim Rule to Final Rule 2 of 2
NPRM vs Final Rule
Meet all MU reporting objectives (“all or nothing”) Must meet “coreset”/can defer 5 from optional “menu set” (flexibility)
25 measures for EPs/23 measures for eligible hospitals 25 measures for EPs/24 for eligible hospitals Measure thresholds range from 10% to 80% of patients or orders (most at higher range) Measure thresholds range from 10% to 80% of patients or orders (most at lower to
middle range) Denominators –To calculate the threshold, some measures required manual chart review
Denominators –No measures require manual chart review to calculate threshold Administrative transactions (claims and eligibility) included
Administrative transactions removed Measures for Patient-Specific Education Resources and Advanced Directives discussed but
not proposed Measures for Patient-Specific Education Resources and Advanced Directives (for
hospitals) included
MU Core Set Objectives (EP)EPs –15 Core Objectives Computerized physician order entry (CPOE) E-Prescribing (eRx) Report ambulatory clinical quality measures to CMS/States Implement one clinical decision support rule Provide patients with an electronic copy of their health information, upon request Provide clinical summaries for patients for each office visit Drug-drug and drug-allergy interaction checks Record demographics Maintain an up-to-date problem list of current and active diagnoses Maintain active medication list Maintain active medication allergy list Record and chart changes in vital signs Record smoking status for patients 13 years or older Capability to exchange key clinical information among providers of care and patient-
authorized entities electronically Protect electronic health information
MU Core Set Objectives (Hosp)Eligible Hospitals –14 Core Objectives CPOE Drug-drug and drug-allergy interaction checks Record demographics Implement one clinical decision support rule Maintain up-to-date problem list of current and active diagnoses Maintain active medication list Maintain active medication allergy list Record and chart changes in vital signs Record smoking status for patients 13 years or older Report hospital clinical quality measures to CMS or States Provide patients with an electronic copy of their health information, upon request Provide patients with an electronic copy of their discharge instructions at time of
discharge, upon request Capability to exchange key clinical information among providers of care and patient-
authorized entities electronically Protect electronic health information
MU Objective Core Set MU Objective Measure
Record patient demographics (sex, race, ethnicity, date of birth, preferred language, and in the case of hospitals, date and preliminary cause of death in the event of mortality)
More than 50% of patients’ demographic data recorded as structureddata
Record vital signs and chart changes (ht, wt, BP, BMI, growth charts for children)
More than 50% of patients 2 years of age or older have ht, wt, and BP recorded as structured data
Maintain up-to-date problem list of current and active diagnoses
More than 80% of patients have at least one entry recorded as structured data
Maintain active medication list More than 80% of patients have at least one entry recorded as structured data
Maintain active medication allergy list More than 80% of patients have at least one entry recorded as structured data
Record smoking status for patients 13 yrs of age or older
More than 50% of patients 13 years of age or older have smoking status recorded as structured data
For individual professionals, provide patients with clinical summaries for each office visit; for hospitals, provide an electronic copy of hospital discharge instructions on request
Clinical summaries provided to patients for more than 50% of all office visits within 3 business days; more than 50% of all patients who are discharged from the inpatient department or emergency department of an eligible hospital or critical access hospital and who request an electronic copy of their discharge instructions are provided with it
Core Sets & Measurements 1 of 4
MU Objective Core Set MU Objective Measure
On request, provide patients with an electronic copy of their health information (including diagnostic test results, problem list, medication lists, medication allergies, and for hospitals, discharge summary and procedures)
More than 50% of requesting patients receive electronic copy within 3 business days
Generate and transmit permissible prescriptions electronically (does not apply to hospitals)
More than 40% are transmitted electronically using certified EHR technology
Computer provider order entry (CPOE) for medication orders
More than 30% of patients with at least one medication in their medication list have at least one medication ordered through CPOE
Implement drug–drug and drug–allergy interaction checks
Functionality is enabled for these checks for the entire reporting period
Implement capability to electronically exchange key clinical information among providers and patient-authorized entities
Perform at least one test of EHR’s capacity to electronically exchange information
Implement one clinical decision support rule and ability to track compliance with the rule
One clinical decision support rule implemented
Implement systems to protect privacy and security of patient data in the EHR
Conduct or review a security risk analysis, implement security updates as necessary, and correct identified security deficiencies
Core Sets & Measurements 2 of 4
MU Objective Core Set MU Objective Measure
Report clinical quality measures to CMS or states For 2011, provide aggregate numerator and denominator through attestation; for 2012, electronically submit measures
Implement drug formulary checks Drug formulary check system is implemented and has access to at least one internal or external drug formulary for the entire reporting period
Incorporate clinical laboratory test results into EHRs as structured data
More than 40% of clinical laboratory test results whose results are in positive/negative or numerical format are incorporated into EHRs as structured data
Generate lists of patients by specific conditions to use for quality improvement, reduction of disparities, research, or outreach
Generate at least one listing of patients with a specific condition
Use EHR technology to identify patient-specific education resources and provide those to the patient as appropriate
More than 10% of patients are provided patient-specific education resources
Perform medication reconciliation between care settings
Medication reconciliation is performed for more than 50% of transitions of care
Provide summary of care record for patients referred or transitioned to another provider or setting
Summary of care record is provided for more than 50% of patient transitions or referrals
Core Sets & Measurements 3 of 4
MU Objective Core Set MU Objective Measure
Submit electronic immunization data to immunization registries or immunization information systems
Perform at least one test of data submission and follow-up submission (where registries can accept electronic submissions)
Submit electronic syndromic surveillance data to public health agencies
Perform at least one test of data submission and follow-up submission (where public health agencies can accept electronic data)
Additional choices for hospitals and critical access hospitals
Record advance directives for patients 65 years of age or older
More than 50% of patients 65 years of age or older have an indication of an advance directive status recorded
Submit of electronic data on reportable laboratory results to public health agencies
Perform at least one test of data submission and follow-up submission (where public health agencies can accept electronic data)
Additional choices for eligible professionals
Send reminders to patients (per patient preference) for preventive and follow-up care
More than 20% or patients 65 years of age or older or 5 years of age or younger are sent appropriate reminders
Provide patients with timely electronic access to their health information (including laboratory results, problem list, medication lists, medication allergies)
More than 10% of patients are provided electronic access to information within 4 days of its being updated in the EHR
Core Sets & Measurements 4 of 4
Stage 1 Meaningful Use Requires 7 different HIE interactions (in bold)and implies at least 10 others
Core (14 “must meet” requirements for Hospitals, 15 for other “Eligible Providers”)Use CPOE for medication orders Implied (especially for EPs - otherwise order would not be transmitted)Implement drug-drug, drug-allergy checking No requirement, but easier with HIE ServicesGenerate and transmit e-Rx (not required for hospitals) E-prescribing, direct or third partyRecord demographicsMaintain up-to-date problem/diagnosis listMaintain active medication list No requirement, but easier with HIEMaintain active medication allergy listRecord and chart vital signsRecord smoking statusImplement 1 clinical decision support ruleReport ambulatory quality measures to CMS Submission required in 2012Provide patients w/electronic copy of records on request Not specified, but implied for non-tethered PHRProvide patients w/visit summaries / discharge instructions Not specified, but implied for non-tethered PHRCapability to exchange key clinical info Perform a single valid testProtect EHR information / conduct a security risk analysis
Menu (all providers must select 5 to meet from a list of 10)Implement drug formulary checks No requirement, but easier with e-prescribingRecord advance directives for patients 65 or olderIncorporate clinical lab test results into EHR No requirement, but easier with HIEGenerate patient lists by conditionSend patient reminders Implied (based on patient preference)Provide patients with timely electronic access to their health records Not specified, but implied for non-tethered PHRProvide patient-specific education resourcesPerform medication reconciliation No requirement, but easier with HIEProvide summary care record for transition/referral Send, receive and display readable CCD/CCRCapability to submit immunizations Perform a valid test if enabled by registryCapability to submit reportable lab results Perform a valid test if enabled by public health agencyCapability to provide syndromic surveillance Perform a valid test if enabled by public health agency
MU / HIE
Meaningful Use Summary 1 of 5
Computer Provider Order Entry (CPOE)Supports the management of medication orders, provider referrals, blood bank orders, provider consults and more.
Drug/allergy checksSupports real-time alerts at the point of care for drug contraindications; formulary or preferred drug list checks; modifiable user rights; and tracking user actions.
Maintain a problem list of diagnoses Records, modifies, and retrieves a patient’s problem list (based on ICD-9-CM “ICD-10-CM 2013” or SNOMED CT®) over multiple visits.
E-prescribing Enables the provider to electronically transmit prescriptions.
Medication list Records, modifies, and retrieves a patient’s active medication list.
Meaningful Use Summary 2 of 5
Allergy list Records, modifies, and retrieves a patient’s active allergy list.
Record demographics Supports electronically recording, modifying, and retrieving patient demographic data.
Record and chart vital signsEnables a user to electronically record, modify, and retrieve a patient’s vital signs; automatically calculate BMI; and plot growth charts for patients 2-20 years old.
Smoking status Records, modifies, and retrieves the smoking status for patients 13 years old or older.
Incorporate clinical lab-test results Enables the provider to receive clinical lab test results; display test reports and tests that have been received with LOINC® codes; and update a patient's record based upon lab results.
Meaningful Use Summary 3 of 5
Patient listsAllows the provider to create a list of patients and patients’ clinical information based on specific conditions.
Ambulatory quality measuresSupports the calculation and display of quality measure results and electronically submit calculated quality measures.
Patient reminders Generates a patient reminder list for preventive or follow-up care.
Clinical decision support rules Supports the implementation of clinical decision support rules by specialty; generates real-time alerts based upon those rules; and generates a list of alerts responded to by user.
Insurance eligibility Electronically records and displays patients’ insurance eligibility and submits insurance eligibility queries.
Meaningful Use Summary 4 of 5
Electronic claims submission Allows a provider to electronically submit claims.
Patient health informationEnables a user to create an electronic copy of a patient’s clinical information and provide it through electronic means.
Electronic access to health information Provides patients with online access to their clinical information within 96 hours of the information being available.
Clinical summaries Provides patients with clinical summaries of each office visit in paper or electronic form.
Receive clinical informationEnables a provider to electronically receive a patient summary record from other providers and organizations.
Meaningful Use Summary 5 of 5
Transmit clinical information Enables a provider to electronically transmit a patient summary record to other providers and organizations.
Medication reconciliation Generates complete medication reconciliation of two or more medication lists into a single medication list that can be displayed in real-time.
Electronic submission to immunization registries
Supports the record, retrieval, and transmission of immunization information to immunization registries.
Electronic syndromic surveillance data Supports the recording, retrieval, and transmission of syndrome-based (e.g., influenza like illness) public health surveillance information.
Electronic health information security
Allows verified users access to health information in an emergency; terminates after inactivity; encrypts and decrypts information; tracks a user's actions.
January 2011 –Registration for the EHR Incentive Programs begins January 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 begin November 30, 2011 –Last day for eligible hospitals and CAHs to register and attest to
receive an incentive payment for FFY 2011
February 29, 2012 –Last day for EPs to register and attest to receive an incentive payment for CY 2011
2015 –Medicare payment adjustments begin for EPs and eligible hospitals that are not meaningful users of EHR technology
2016 –Last year to receive a Medicare EHR incentive payment; Last year to initiate participation in Medicaid EHR Incentive Program
2021 –Last year to receive Medicaid EHR incentive payment
EHR Incentive Timeline
Acronyms ACA –Patient Protection and Affordable Care Act A/I/U –Adopt, implement, or upgrade CAH –Critical Access Hospital CCN –CMS Certification Number CHIPRA –Children's Health Insurance Program
Reauthorization Act of 2009 CMS –Centers for Medicare & Medicaid Services CNM –Certified Nurse Midwife CPOE –Computerized Physician Order Entry CQM –Clinical Quality Measures CY –Calendar Year EHR –Electronic Health Record EP –Eligible Professional eRx –E-Prescribing FFS –Fee-for-service FQHC –Federally Qualified Health Center FFY –Federal Fiscal Year HHS –U.S. Department of Health and Human Services HIT –Health Information Technology HITECH Act –Health Information Technology for Economic
and Clinical Health Act HITPC –Health Information Technology Policy Committee HIPAA –Health Insurance Portability and Accountability
Act of 1996
HPSA –Health Professional Shortage Area MA –Medicare Advantage MCMP –Medicare Care Management Performance
Demonstration MU –Meaningful Use NCVHS –National Committee on Vital and Health
Statistics NP –Nurse Practitioner NPI –National Provider Identifier NPRM –Notice of Proposed Rulemaking OMB –Office of Management and Budget ONC –Office of the National Coordinator of Health
Information Technology PA –Physician Assistant PECOS –Provider Enrollment, Chain, and Ownership
System PPS –Prospective Payment System (Part A) PQRI –Medicare Physician Quality Reporting Initiative Recovery Act –American Reinvestment & Recovery Act of
2009 RHC –Rural Health Clinic RHQDAPU –Reporting Hospital Quality Data for Annual
Payment Update TIN –Taxpayer Identification Number