America’s healthcare system is transforming to improve quality, safety and efficiency of care from the upgrade to ICD-10 to information exchanges of EHR technology. The transformation to a EHR system is designed to provide medical practitioners and medical facilities with several benefits related to health and efficiency including a reduction in errors, availability of records and data, reminders and alerts, clinical decision support, e-Prescribing/refill automation, and several other benefits.

Medicare and Medicaid EHR incentive Programs have been established to provide financial incentives to medical providers during this period of transition. The financial incentives are available for those who implement a solution that meets the “Meaningful Use” of qualified, certified EHRs.
Qualifications for EHR Incentive Programs
In order to qualify for the incentive, meaningful use requirements must be met in the following ways as defined by the Department for Health and Human Services:

• Medicare EHR incentive program - Eligible professionals and hospitals 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 hospitals may qualify for incentive payments for the adoption, implementation, upgrade or the demonstration of meaningful use in their first year of participation. They must successfully demonstrate meaningful use for the remaining years they participate in the program.

The three main components of Meaningful Use (as defined in the Recovery Act) are:

• The use of a certified EHR in a meaningful manner (e.g.: e-Prescribing);
• The use of certified EHR technology for electronic exchange of health information to improve quality of health care; and
• The use of certified EHR technology to submit clinical quality and other measures.

Meaningful Use Requirements

The requirements of meaningful use were announced on July 13, 2010. The final rule specifically outlines Stage 1 Meaningful Use and clinical quality measure reporting (see below). Meaningful Use requirements are divided into three stages and timeframes:

Stage 1: 2011 and 2012
Stage 2: 2013 (estimated)
Stage 3: 2015 (estimated)

Stage 1 Meaningful Use Requirements (2011 and 2012)

Meaningful Use is a core set AND menu set of objectives that eligible professionals and hospitals must meet. “Demonstrating Meaningful Use” is the key to receiving the incentive payments. The following information defines the criteria and both sets of objectives.

Eligible Professionals:

• 25 meaningful use objectives
• 20 of the objectives must be completed to qualify for an incentive payment
• 15 are core objectives that are required, and the remaining 5 objectives may be chosen from the list of 10 menu set objectives

Hospitals:

• 24 meaningful use objectives
• 14 are core objectives are required
• 5 objectives may be chosen from the list of 10 menu set objectives.

1	Computerized physician order entry (CPOE) of medications	More than 30% of unique patients with at least one medication in their medication list seen by the EP have at least one medication order entered using CPOE
2	Generate and transmit permissible prescriptions electronically (eRx)	More than 40% of all permissible prescriptions written by the EP are transmitted electronically
3	Report a total of 6 ambulatory clinical quality measures to CMS (Medicare EHR Incentive Program) or States (Medicaid EHR Incentive Program)	For 2011, provide aggregate numerator, denominator, and exclusions through attestation For 2012, electronically submit the clinical quality measures
4	Implement one clinical decision support rule	Implement one clinical decision support rule relevant to specialty or high clinical priority along with the ability to track compliance for that rule
5	Provide patients with an electronic copy of their health information, upon request	More than 50% of all patients of the EP who request an electronic copy of their health information are provided it within three business days
6	Provide clinical summaries for patient for each office visit	Clinical summaries provided to patients for more than 50% of all office visits within three business days
7	Drug-drug and drug-allergy interaction checks	The EP has enabled this functionality for the entire EHR reporting period
8	Enable a user to electronically record, modify, and retrieve patient demographic data including preferred language, insurance type, gender, race, ethnicity, and date of birth.	More than 50% of all unique patients seen by the EP have demographics recorded as structured data
9	Maintain an up-to-date problem list of current and active diagnoses based on ICD–9–CM or SNOMED CT®.	More than 80% of all unique patients seen by the EP have at least one entry or an indication that no problems are known for the patient recorded as structured data
10	Maintain the patient’s active medication list	More than 80% of all unique patients seen by the EP have at least one entry (or an indication that the patient is not currently prescribed any medication) recorded as structured data
11	Maintain the patient’s active medication allergy list	More than 80% of all unique patients seen by the EP have at least one entry (or an indication that the patient has no known medication allergies) recorded as structured data
12	Record and chart changes in vital signs: Height, Weight, Blood pressure, Calculate and display: BMI, Plot and display growth charts for children 2–20 years, including BMI.	For more than 50% of all unique patients age 2 and over seen by the EP, the height, weight and blood pressure are recorded as structured data
13	Record smoking status for patients 13 years old or older.	More than 50% of all unique patients 13 years old or older seen by the EP have smoking status recorded as structured data
14	Capability to exchange key clinical information among providers of care and patient-authorized entities electronically	Performed at least one test to electronically exchange key clinical information
15	Protect electronic health information created or maintained by the certified EHR technology through the implementation of appropriate technical capabilities.	Conduct or review a security risk analysis per 45 CFR 164.308 (a)(1) and implement security updates as necessary and correct identified security deficiencies as part of its risk management process

(must meet 5 with at least 1 public health objective stated)

1	Drug-formulary checks	The EP has enabled this functionality and has access to at least one internal or external drug formulary for the entire EHR reporting period
2	Document clinical lab test results as structured data	More than 40% 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
3	Generate lists of patients by specific conditions	Generate at least one report listing patients of the EP with a specific condition
4	Send reminders to patients per patient preference for preventive/follow-up care	More than 20% of all unique patients 65 years or older or 5 years old or younger were sent an appropriate reminder during the EHR reporting period
5	Provide patients with timely electronic access to their health information	More than 10% of all unique patients seen by the EP are provided timely (available to the patient within four business days of being updated in the certified EHR technology) electronic access to their health information subject to the EP’s discretion to withhold certain information
6	Use certified EHR technology to identify patient-specific education resources and provide to patient	More than 10% of all unique patients seen by the EP are provided patient-specific education resources
7	Medication reconciliation	The EP performs medication reconciliation for more than 50% of transitions of care in which the patient is transitioned into the care of the EP.
8	Summary of care record for each transition of care/referrals	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% of transitions of care and referrals
9	Capability to submit electronic data to immunization registries/systems (public health objective)	Performed at least one test to submit electronic data to immunization registries and follow up submission if the test is successful where accepted and required.
10	Capability to provide electronic syndromic surveillance data to public health agencies (public health objective)	Performed at least one test to provide electronic syndromic surveillance data to public health agencies and follow-up submission if the test is successful where accepted and required.

To learn more about EMR Meaningful Use criteria, visit one of the websites below.

• The Official Web Site for the Medicare and Medicaid EHR Incentive Program
• Meaningful Use Final Rules Webinar Series

Additional information on the final rule and fact sheets regarding meaningful use are available below.

• Download the Medicare and Medicaid HER Incentive Program
• Download the Full Fact Sheet
• Download the Electronic Health Records at a Glance

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