As a follow-up to last month’s article (August 2010, p. 11) about the final rule for the electronic health record (EHR) stimulus program—which offers up to $64,000 to eligible providers who are meaningful users of an EHR system—this month we will explore the minimum requirements for successful meaningful use, which take effect in 2011 and will build gradually each year of the program.
For stage one, meaningful-use requirements include 25 EHR functionality measures divided into the two categories of 15 core objective measures and a set of 10 menu measures from which the eligible provider must choose five to report on. Table 1 (below) lists the measures from both of these sets.
Additionally, the program criteria call for the eligible provider to report on a set of clinical quality measures, which are divided into three core measures and an additional list of alternative measures from which the three most relevant must be selected. The core measures and alternatives include:
- Blood-pressure level;
- Tobacco-use status;
- Adult weight screening and follow-up;
- Influenza immunizations for patients over 50 years;
- Weight assessment and counseling for children and adolescents; and
- Childhood immunizations.
Providers must also choose three other measures from a subset of clinical measures most appropriate given the eligible provider’s specialty.
For more information on criteria for participation and successful reporting for the Centers for Medicare and Medicaid Services EHR Stimulus Program, please visit www.rheumatology.org/practice or contact Itara Barnes in the ACR’s Quality and Health Informatics department at ibarnes@rheumatology.org.
TABLE 1: EHR Functionality Measures
Core Objective Measures
- 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)
- Record vital signs and chart changes (height, weight, blood pressure, body mass index, and growth charts for children)
- Maintain up-to-date problem list of current and active diagnoses
- Maintain active medication list
- Maintain active medication allergy list
- Record smoking status for patients 13 years of age or older
- For individual professionals, provide patients with clinical summaries for each office visit; for hospitals, provide an electronic copy of hospital discharge instructions on request
- On request, provide patients with an electronic copy of their health information (including diagnostic test results, problem lists, medication lists, medication allergies, and, for hospitals, discharge summary and procedures)
- Generate and transmit permissible prescriptions electronically (does not apply to hospitals)
- Computer provider order entry for medication orders
- Implement drug–drug and drug–allergy interaction checks
- Implement capability to electronically exchange key clinical information among providers and patient-authorized entities
- Implement one clinical decision support rule and the ability to track compliance with the rule
- Implement systems to protect privacy and security of patient data in the EHR
- Report clinical quality measures to CMS or states
Menu Measures
- Implement drug formulary checks
- Incorporate clinical laboratory test results into EHRs as structured data
- Generate lists of patients by specific conditions to use for quality improvement, reduction of disparities, research, or outreach
- Use EHR technology to identify patient-specific education resources and provide those to the patient as appropriate
- Perform medication reconciliation between care settings
- Provide summary of care record for patients referred or transitioned to another provider or setting
- Submit electronic immunization data to immunization registries or immunization information systems
- Submit electronic syndromic surveillance data to public health agencies
Additional Choices for Hospitals and Critical Access Hospitals
- Record advance directives for patients 65 years of age or older
- Submit electronic data on reportable laboratory results to public health agencies
Additional Choices for Eligible Professionals
- Send reminders to patients (per patient preference) for preventive and follow-up care
- Provide patients with timely electronic access to their health information (including laboratory results, problem lists, medication lists, and medication allergy lists)