interim final rule

electronic medical records

Meaningful Use
Federal stimulus HITECH ACT - hospital overview

Monday, January 11, 2010

 EMR Meaningful use
goals
1. Improve quality, safety, efficiency, and reduce
health disparities
2. Engage Patients and Families
3. Improve Care Coordination
4. Ensure adequate privacy and security
protections for Personal Health Info
5. Improve Population and Public Health

Monday, January 11, 2010

Monday, January 11, 2010
 Broad definitions of
Meaningful EMR use
• An EP and an eligible hospital shall be considered a meaningful
EHR user for an EHR reporting period for a payment year if they
meet the following three requirements:

• – Use certified EHR in a meaningful manner (ex. E-Prescribing)

• – Utilize certified EHR technology that is connected in a manner

that provides for the electronic exchange of health information
to improve the quality of healthcare such as promoting care
coordination

• – Submit information on clinical quality measures and other

measures in a form and manner specified by the Secretary

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 3 Stages of
Qualifications
• Stage I – Electronic capture of health information in a coded format;
tracking key clinical conditions and communicating outcomes for care
coordinating; implementing clinical decision support tools to facilitate
disease and medication management; and reporting outcomes for
public health purposes.

• Stage II – Expands on stage I. Encourages the use of health IT to

enhance computerized provider order entry; transitions in care;
electronic transmission of diagnostic test results; and, research.

• Stage III – Expands on stage II. Promotes improvements to quality and

safety; focuses on clinical decision support at a national level by
encouraging patient access and involvement; and, improved population
health data.

Monday, January 11, 2010

 meaningful EHR users before 2015. Please note that nothing in this discussion limits us

to proposed changes to meaningful use beyond Stage 3 through future rulemaking.

TABLE 1: Stage of Meaningful Use Criteria by Payment Year

Payment Year
First 2011 2012 2013 2014 2015
Payment Year +**
2011 Stage 1 Stage 1 Stage 2 Stage 2 Stage 3
2012 Stage 1 Stage 1 Stage 2 Stage 3
2013 Stage 1 Stage 2 Stage 3
2014 Stage 1 Stage 3
2015+* Stage 3
* Avoids payment adjustments only for EPs in the Medicare EHR Incentive Program.
** Stage 3 criteria of meaningful use or a subsequent update to the criteria if one is established
through rulemaking.

Please note that the number of payment years available and the last payment year

that can be the first payment year for an EP or eligible hospital varies between the EHR

incentive programs. The applicable payment years for each program are discussed in
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 Summary of Stage 1
Hospital EMR requirements
• Use of CPOE for orders (any type) directly entered by
authorizing provider (for example, MD, DO, RN, PA, NP)
(10% for stage 1)

• Implement 5 clinical decision support rules related to a

high priority hospital condition, including diagnostic test
ordering, along with the ability to track compliance with
those rules

• Implement drug-drug, drug-allergy, drug- formulary

checks

• Report hospital quality measures to CMS or the States

*Not a complete list- summarized
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 Summary of Stage 1
Hospital EMR requirements
• Maintain an up-to-date problem list of current and active diagnoses
based on ICD-9-CM or SNOMED

• Maintain Active medication, and medication allergy list

• Provide patients with an electronic copy of their health information

• Provide patients with an electronic copy of their discharge

instructions and procedures at time of discharge, upon request

• Provide summary care record for each transition of care and

referral

• Protect electronic health information created or maintained by the

certified EHR technology through the implementation of
appropriate technical capabilities
*Not a complete list- summarized

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 TABLE 2: Stage 1 Criteria for Meaningful Use

Stage 1 Objectives
Health Outcomes Eligible
Policy Priority Care Goals Professionals Hospitals Stage 1 Measures
Improving quality, Provide access to Use CPOE Use of CPOE for orders For EPs, CPOE is
safety, efficiency, comprehensive (any type) directly used for at least 80%
and reducing health patient health data entered by authorizing of all orders
disparities for patient's health provider (for example,
care team MD, DO, RN, PA, NP) For eligible hospitals,
CPOE is used for
Use evidence-based 10% of all orders
order sets and Implement drug-drug, Implement drug-drug, The EP/eligible
CPOE drug-allergy, drug- drug-allergy, drug- hospital has enabled
formulary checks formulary checks this functionality
Apply clinical Maintain an up-to- Maintain an up-to-date At least 80% of all
decision support at date problem list of problem list of current unique patients seen
the point of care current and active and active diagnoses by the EP or
diagnoses based on based on ICD-9-CM or admitted to the
Generate lists of ICD-9-CM or SNOMED CT ® eligible hospital have
patients who need SNOMED CT ® at least one entry or
care and use them an indication of none
to reach out to recorded as
patients structured data
Generate and transmit At least 75% of all
Report information permissible permissible
for quality prescriptions prescriptions written
improvement and electronically (eRx) by the EP are
public reporting

excerpt of complete table

transmitted
electronically using
certified EHR
technology
Maintain active Maintain active At least 80% of all
medication list medication list unique patients seen
by the EP or
admitted to the
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eligible hospital have