Medicare has announced final standards and measures for “meaningful use” of electronic health records (EHR) that medical practices must meet to receive payment bonuses beginning in 2011.
To qualify in 2011 and 2012, medical practices will have to meet 15 core requirements as well as five additional measures selected from a menu of 10 measures. Additional rules will be released for the remaining years of the incentive payments.
The original rule would have required physicians to meet 25 objectives over a 90-day reporting period in 2011, but the Department of Health and Human Services (DHHS) received many comments that meeting all of these objectives was too “demanding and inflexible,” wrote David Blumenthal, national coordinator for health information technology at the DHHS.
To qualify for incentives, practices also will have to attest that they are using a certified EHR and specify which system they are using.
Practices also will have to report on three quality measures in 2011 and 2012—blood pressure level, tobacco status, and adult weight screening and follow-up.
Listed below are the measures that must be met by individual providers. Different measures apply to hospitals.
| Meaningful Use Objectives |
| Core objective | Measure |
| Record patient demographics (sex, race, ethnicity, date of birth, and preferred language) | For more than 50 percent of patients |
| Record vital signs and chart changes for height, weight, blood pressure, body mass index, and growth charts for children | Height, weight, and blood pressure for at least 50 percent of patients 2 years or older |
| Maintain an up-to-date problem list of current and active diagnoses | At least one entry for at least 80 percent of patients |
| Maintain active medication list | At least one entry for at least 80 percent of patients |
| Maintain active medication allergy list | At least one entry for at least 80 percent of patients |
| Record smoking status for patients 13 years old and older | For at least 50 percent of patients 13 years old and older |
| Provide patients with clinical summaries for each office visit | Provided within three business days for at least 50 percent of all office visits |
| On request, provide patients with an electronic copy of their health information, including diagnostic test results, problem list, medication list, and medication allergies | More than 50 percent of requesting patients receive electronic copy within three business days |
| Generate and transmit permissible prescriptions electronically | At least 40 percent are electronically submitted |
| Use computerized provider order entry (CPOE) for medication orders | More than 30 percent of patients with at least one medication on their list have one medication ordered through CPOE |
| Implement drug-drug and drug-allergy interaction checks | Enable functionality for these checks for the entire reporting period |
| Electronically exchange clinical information among provider and patient-authorized entities | Perform at least one test of EHR capacity to electronically exchange information |
| Implement at least one decision support rule, along with the ability to track compliance with those rules | One clinical decision support rule implemented |
| 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 |
| Report clinical quality measures to CMS or state | For 2011, physician can attest in writing that measure has been achieved; for 2012, electronically submit measures |
| Menu of objectives (pick five) | Measure |
| Implement drug formulary checks | Drug formulary check implemented and has access to at least one internal or external drug formulary for entire reporting period |
| Incorporate clinical laboratory test results | More than 40 percent of clinical laboratory test results are in positive/negative or numerical format |
| Generate list of patients by specific condition to use for quality improvement, reduction of disparities, research, or outreach | Generate at least one listing |
| Use EHR technology to identify patient-specific education resources and provide those to the patient | Provide to more than 10 percent of patients |
| Perform medication reconciliation between care settings | For more than 50 percent of transitions of care |
| Provide summary of care record for patients referred or transitioned to another provider/setting | For more than 50 percent of patient transitions or referrals |
| Submit electronic immunization data to immunization data registries or immunization information systems | Perform at least one test of data submissions and follow-up submission |
| Submit electronic syndromic surveillance data to public health agencies | Perform at least one test of data submission and follow-up submission |
| Send reminders to patients for preventive and follow-up care | For more than 20 percent of patients 65 years of age and older or five years of age and younger |
| Provide patients with timely electronic access to their health information (laboratory results, problem list, medication list, medication allergies) | Provide electronic access to more than 10 percent of patients within four days of it being updated in the EHR |