Eligible Provider "Meaningful Use" Criteria

December 30, 2009 | Jack Beaudoin, President

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WASHINGTON – On Dec. 30, the Centers for Medicare and Medicaid Services issued a notice of proposed rulemaking that outlines provisions governing the Medicare and Medicaid EHR incentive programs, including a proposed definition for the central concept of “meaningful use” of EHR technology (see related story). In order for professionals and hospitals to be eligible to receive payments under the incentive programs, provided through the Recovery Act, they must be able to demonstrate meaningful use of a certified EHR system.

The following list of 25 Stage 1 Meaningful Use criteria for eligible providers was taken from the proposed rule: "Medicare and Medicaid Programs; Electronic Health Record Incentive Program." A second list, for eligible hospitals, is provided here. You can download the full 556-page document at http://www.federalregister.gov/OFRUpload/OFRData/2009-31217_PI.pdf

[1] Objective: Use CPOE
Measure: CPOE is used for at least 80 percent of all orders

[2] Objective: Implement drug-drug, drug-allergy, drug- formulary checks
Measure: The EP has enabled this functionality

[3] Objective: Maintain an up-to-date problem list of current and active diagnoses based on ICD-9-CM or SNOMED CT®
Measure: At least 80 percent of all unique patients seen by the EP have at least one entry or an indication of none recorded as structured data.

[4] Objective: Generate and transmit permissible prescriptions electronically (eRx).
Measure: At least 75 percent of all permissible prescriptions written by the EP are transmitted electronically using certified EHR technology.

[5] Objective: Maintain active medication list.
Measure: At least 80 percent of all unique patients seen by the EP have at least one entry (or an indication of “none” if the patient is not currently prescribed any medication) recorded as structured data.

[6] Objective: Maintain active medication allergy list.
Measure: At least 80 percent of all unique patients seen by the EP have at least one entry (or an indication of “none” if the patient has no medication allergies) recorded as structured data.

[7] Objective: Record demographics.
Measure: At least 80 percent of all unique patients seen by the EP or admitted to the eligible hospital have demographics recorded as structured data

[8] Objective: Record and chart changes in vital signs.
Measure: For at least 80 percent of all unique patients age 2 and over seen by the EP, record blood pressure and BMI; additionally, plot growth chart for children age 2 to 20.

[9] Objective: Record smoking status for patients 13 years old or older
Measure: At least 80 percent of all unique patients 13 years old or older seen by the EP “smoking status” recorded

[10] Objective: Incorporate clinical lab-test results into EHR as structured data.
Measure: At least 50 percent of all clinical lab tests results ordered by the EP or by an authorized provider of the eligible hospital during the EHR reporting period whose results are in either in a positive/negative or numerical format are incorporated in certified EHR technology as structured data.

[11] Objective: Generate lists of patients by specific conditions to use for quality improvement, reduction of disparities, research, and outreach.
Measure: Generate at least one report listing patients of the EP with a specific condition.

List continues on the next page...

Reader Comments (1)Login to Post a Comment

Dr Duncan says: Too much too soon

November 11, 2011 | 5:45PM GMT

If providers try to fullfil this agenda of requirements in the required time, you will be creating safety issues.

We are not all perfect so let me assume that all of us have made mistakes. Think back to the mistakes you have made. Would the old adage "Haste makes Waste" apply to those mistakes?

The Meaningful Use agenda timeline is too demanding and too short. Providers already have too much on their plate trying to provide patient care with the current financial strains, coding challenges, keeping up with government regulations, demand for information and the medical legal climate

Reworking clinic workflows and going through the EMR learning curve takes time. Yet the demand for patient care remains. In fact it is increasing with the shortage of physicians. With cuts in reimbursements, volume is important in order for a medical practice to survive financially. With government driven cuts in reimbursements and government driven increased demands for data via the EMR, something has to give. So what gives? Here's what I see. Doctors have to rush. Rush to take a history, examine the patient and still have time to do the data entry that is demanded by the Meaningful Use agenda. As workflows improve and doctors approach the end of the learning curve there will be less rushing. However, that will take longer than what the proposed Meaningful Use timeline allows. In the meantime doctors will be rushed to get through their patient visits and enter the necessary data into the EMR. That does not promote quality care and creates risks. That interferes with the art of medicine which includes spending the time sincerely listening to the patient rather than entering non-patient care related data.

EMR program developers are also rushing to meet the demands and timeline of Meaningful Use.

All of this creates a problem. What problem? Let me define it for you.

Definition - rush, haste, inappropriate motives and goals = safety issues.

What's the solution? The solution is frequently found in that definition.
Solution - adapt the timeline and redirect and prioritize goals.
Adaptations and prioritizations:
1. Slow it down. How much? To be determined, but slow it down.
2. Talk to providers -doctors, nurse practitioners, physician assistants and all other providers on the front lines of patient care. Not researchers, not other IT bureaucrats, not other policy makers, not insurance companies, not for-profit health quality measures companies who want easy data sources to mine.
3. Focus the use of the EMR first on patient care and making it a useful tool for providers to provide that patient care. In other words, help the doctor help the patient. Make it a tool to improve the efficiency with which a provider can record and share pertinent patient care information.
4. First allow time for the providers to make the EMR a useful tool for patient care, then start gradually requesting the quality reporting data, data on usage of the portal, e-prescribing, providing visit summaries and other Meaningful Use criteria.

Doug Duncan MD
dmdunc@mchsi.com