The document discusses the objectives and requirements of Meaningful Use (MU), an incentive program that promotes the adoption and meaningful use of electronic health records (EHRs). It outlines the core objectives that eligible professionals and hospitals must meet, such as computerized provider order entry, maintaining active medication lists, and exchanging key clinical information. The document also details the measure thresholds associated with each objective that providers must meet to qualify for MU incentive payments.

1. Meaningful Use (MU)
July 2010

2. 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.

3. 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

4. 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

5. 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)

6. Eligible Providers (EP) Medicare
Advantage

7. Eligible Providers (EP) Medicaid

8. 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.

9. EP Schedule Medicare

10. EP Schedule Medicaid

11. 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

12. “Other” Medicare Incentive
Programmes

13. Difference Between
Medicare & Medicaid

14. 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

15. 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

16. 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

17. 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

18. Core Sets & Measurements 1 of 4
MU Objective Core Set MU Objective Measure
Record patient demographics (sex, race, ethnicity, More than 50% of patients’ demographic data recorded
date of birth, preferred language, and in the case as structured
of hospitals, date and preliminary cause of death data
in the event of mortality)
Record vital signs and chart changes (ht, wt, BP, More than 50% of patients 2 years of age or older have
BMI, growth charts for children) ht, wt, and BP recorded as structured data
Maintain up-to-date problem list of current and More than 80% of patients have at least one entry
active diagnoses 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 More than 50% of patients 13 years of age or older
or older have smoking status recorded as structured data
For individual professionals, provide patients with Clinical summaries provided to patients for more than
clinical summaries for each office visit; for 50% of all office visits within 3 business days; more than
hospitals, provide an electronic copy of hospital 50% of all patients who are discharged from the
discharge instructions on request 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

19. Core Sets & Measurements 2 of 4
MU Objective Core Set MU Objective Measure
On request, provide patients with an electronic More than 50% of requesting patients receive
copy of their health information (including electronic copy within 3 business days
diagnostic test results, problem list, medication
lists, medication allergies, and for hospitals,
discharge summary and procedures)
Generate and transmit permissible prescriptions More than 40% are transmitted electronically using
electronically (does not apply to hospitals) certified EHR technology
Computer provider order entry (CPOE) for More than 30% of patients with at least one medication
medication orders in their medication list have at least one medication
ordered through CPOE
Implement drug–drug and drug–allergy Functionality is enabled for these checks for the entire
interaction checks reporting period
Implement capability to electronically exchange Perform at least one test of EHR’s capacity to
key clinical information among providers and electronically exchange information
patient-authorized entities
Implement one clinical decision support rule and One clinical decision support rule implemented
ability to track compliance with the rule
Implement systems to protect privacy and security Conduct or review a security risk analysis, implement
of patient data in the EHR security updates as necessary, and correct identified
security deficiencies

20. Core Sets & Measurements 3 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 More than 40% of clinical laboratory test results whose
EHRs as structured data results are in positive/negative or numerical format are
incorporated into EHRs as structured data
Generate lists of patients by specific conditions to Generate at least one listing of patients with a specific
use for quality improvement, reduction of condition
disparities, research, or outreach
Use EHR technology to identify patient-specific More than 10% of patients are provided patient-specific
education resources and provide those to the education resources
patient as appropriate
Perform medication reconciliation between care Medication reconciliation is performed for more than
settings 50% of transitions of care
Provide summary of care record for patients Summary of care record is provided for more than 50%
referred or transitioned to another provider or of patient transitions or referrals
setting

21. Core Sets & Measurements 4 of 4
MU Objective Core Set MU Objective Measure
Submit electronic immunization data to Perform at least one test of data submission and follow-
immunization registries or immunization up submission (where registries can accept electronic
information systems submissions)
Submit electronic syndromic surveillance data to Perform at least one test of data submission and follow-
public health agencies 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 More than 50% of patients 65 years of age or older
age or older have an indication of an advance directive status
recorded
Submit of electronic data on reportable laboratory Perform at least one test of data submission and follow-
results to public health agencies up submission (where public health agencies can accept
electronic data)
Additional choices for eligible professionals
Send reminders to patients (per patient More than 20% or patients 65 years of age or older or 5
preference) for preventive and follow-up care years of age or younger are sent appropriate reminders
Provide patients with timely electronic access to More than 10% of patients are provided electronic
their health information (including laboratory access to information within 4 days of its being updated
results, problem list, medication lists, medication in the EHR
allergies)

22. MU / HIE
Requires 7 different HIE interactions (in bold)
Stage 1 Meaningful Use
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 Services
Generate and transmit e-Rx (not required for hospitals) E-prescribing, direct or third party
Record demographics
Maintain up-to-date problem/diagnosis list
Maintain active medication list No requirement, but easier with HIE
Maintain active medication allergy list
Record and chart vital signs
Record smoking status
Implement 1 clinical decision support rule
Report ambulatory quality measures to CMS Submission required in 2012
Provide patients w/electronic copy of records on request Not specified, but implied for non-tethered PHR
Provide patients w/visit summaries / discharge instructions Not specified, but implied for non-tethered PHR
Capability to exchange key clinical info Perform a single valid test
Protect 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-prescribing
Record advance directives for patients 65 or older
Incorporate clinical lab test results into EHR No requirement, but easier with HIE
Generate patient lists by condition
Send patient reminders Implied (based on patient preference)
Provide patients with timely electronic access to their health records Not specified, but implied for non-tethered PHR
Provide patient-specific education resources
Perform medication reconciliation No requirement, but easier with HIE
Provide summary care record for transition/referral Send, receive and display readable CCD/CCR
Capability to submit immunizations Perform a valid test if enabled by registry
Capability to submit reportable lab results Perform a valid test if enabled by public health agency
Capability to provide syndromic surveillance Perform a valid test if enabled by public health agency

23. Meaningful Use Summary 1 of 5
Supports the management of medication orders,
Computer Provider Order Entry (CPOE) provider referrals, blood bank orders, provider consults
and more.
Supports real-time alerts at the point of care for drug
contraindications; formulary or preferred drug list
Drug/allergy checks
checks; modifiable user rights; and tracking user
actions.
Records, modifies, and retrieves a patient’s problem list
Maintain a problem list of diagnoses (based on ICD-9-CM “ICD-10-CM 2013” or SNOMED
CT®) over multiple visits.
Enables the provider to electronically transmit
E-prescribing
prescriptions.
Records, modifies, and retrieves a patient’s active
Medication list
medication list.

24. Meaningful Use Summary 2 of 5
Records, modifies, and retrieves a patient’s active
Allergy list
allergy list.
Supports electronically recording, modifying, and
Record demographics
retrieving patient demographic data.
Enables a user to electronically record, modify, and
Record and chart vital signs retrieve a patient’s vital signs; automatically calculate
BMI; and plot growth charts for patients 2-20 years old.
Records, modifies, and retrieves the smoking status for
Smoking status
patients 13 years old or older.
Enables the provider to receive clinical lab test results;
display test reports and tests that have been received
Incorporate clinical lab-test results
with LOINC® codes; and update a patient's record based

25. Meaningful Use Summary 3 of 5
Allows the provider to create a list of patients and
Patient lists patients’ clinical information based on specific
conditions.
Supports the calculation and display of quality measure
Ambulatory quality measures results and electronically submit calculated quality
measures.
Generates a patient reminder list for preventive or
Patient reminders
follow-up care.
Supports the implementation of clinical decision
support rules by specialty; generates real-time alerts
Clinical decision support rules
based upon those rules; and generates a list of alerts
responded to by user.
Electronically records and displays patients’ insurance
Insurance eligibility
eligibility and submits insurance eligibility queries.

26. Meaningful Use Summary 4 of 5
Electronic claims submission Allows a provider to electronically submit claims.
Enables a user to create an electronic copy of a patient’s
Patient health information clinical information and provide it through electronic
means.
Provides patients with online access to their clinical
Electronic access to health information information within 96 hours of the information being
available.
Provides patients with clinical summaries of each office
Clinical summaries
visit in paper or electronic form.
Enables a provider to electronically receive a patient
Receive clinical information summary record from other providers and
organizations.

27. Meaningful Use Summary 5 of 5
Enables a provider to electronically transmit a patient
Transmit clinical information
summary record to other providers and organizations.
Generates complete medication reconciliation of two or
Medication reconciliation more medication lists into a single medication list that
can be displayed in real-time.
Electronic submission to immunization Supports the record, retrieval, and transmission of
registries immunization information to immunization registries.
Supports the recording, retrieval, and transmission of
Electronic syndromic surveillance data syndrome-based (e.g., influenza like illness) public
health surveillance information.
Allows verified users access to health information in an
emergency; terminates after inactivity; encrypts and
Electronic health information security
decrypts information; tracks a user's actions.

28. EHR Incentive Timeline
 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

29. Acronyms
 ACA –Patient Protection and Affordable Care Act
 A/I/U –Adopt, implement, or upgrade
 CAH –Critical Access Hospital  HPSA –Health Professional Shortage Area
 MA –Medicare Advantage
 CCN –CMS Certification Number  MCMP –Medicare Care Management Performance
 CHIPRA –Children's Health Insurance Program Demonstration
Reauthorization Act of 2009  MU –Meaningful Use
 CMS –Centers for Medicare & Medicaid Services  NCVHS –National Committee on Vital and Health
 CNM –Certified Nurse Midwife Statistics
 CPOE –Computerized Physician Order Entry  NP –Nurse Practitioner
 NPI –National Provider Identifier
 CQM –Clinical Quality Measures  NPRM –Notice of Proposed Rulemaking
 CY –Calendar Year  OMB –Office of Management and Budget
 EHR –Electronic Health Record  ONC –Office of the National Coordinator of Health
 EP –Eligible Professional Information Technology
 eRx –E-Prescribing  PA –Physician Assistant
 PECOS –Provider Enrollment, Chain, and Ownership
 FFS –Fee-for-service System
 FQHC –Federally Qualified Health Center  PPS –Prospective Payment System (Part A)
 FFY –Federal Fiscal Year  PQRI –Medicare Physician Quality Reporting Initiative
 HHS –U.S. Department of Health and Human Services  Recovery Act –American Reinvestment & Recovery Act of
 HIT –Health Information Technology 2009
 RHC –Rural Health Clinic
 HITECH Act –Health Information Technology for Economic  RHQDAPU –Reporting Hospital Quality Data for Annual
and Clinical Health Act Payment Update
 HITPC –Health Information Technology Policy Committee  TIN –Taxpayer Identification Number
 HIPAA –Health Insurance Portability and Accountability
Act of 1996