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Meaningful Use Criteria Electronic Health Record (EHR) Incentive Programs

Update as of Jan 2012

Raja Ismail
Founder

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NOTICE OF DISCLAIMER
This document is not intended to be a legal opinion on the American Recovery and Reinvestment Act of 2009 (ARRA), and is not intended to be a legal opinion on the EHR Incentive Programs, or any other programs under the ARRA. It is also not intended to be a legal opinion on any other statutes, or any programs under any other statutes. Software Quality Solutions LLC (SQS) does not guarantee the accuracy of the information in the document. SQS has made sincere attempts to understand the complex laws, rules and regulations that govern the EHR Incentive programs, and has made a sincere attempt to provide a basic understanding of the EHR Incentive Programs to Healthcare professionals, through this document. SQS is not responsible for inaccuracy of any information contained in the document. SQS makes it clear that there maybe information, references, links, rules, etc., that may have been modified, deleted or become obsolete or inactive since the creation of this document in Oct 2011, and as modified in Jan 2012. Consult a legal attorney or a general counsel or any other professional in the field of law, healthcare, government, or an appropriate profession, as may apply to your needs, to act in a such way to benefit you, your business, or your profession with regard to the EHR Incentive Program under the ARRA. SQS LLC is not a law firm, and it is not a company that deals exclusively in the healthcare industry.

CONTENTS
1. 2. 3. 4. 5. 6. 7. 8. 9. 10. 11. 12. 13. 14. 15. 16. 17. 18. 19. 20. 21. 22. 23. American Recovery and Reinvestment Act 2009 (ARRA) . 5 HITECH Act (a part of ARRA) . 6 US Department of Health and Human Services (HHS) ... . 7 Meaningful Use (MU) 8 MU Stage 1 Criteria ... 9 MU Stage 1, 2 and Stage 3 Criteria Timeline ..10 Certified EHR Technology and Meaningful Use ... . 11 Medicare Incentive Payments ... . 12 Medicare - Eligible Professionals (EPs) Incentive Payments . 13 Medicare Eligible Hospitals Incentive Payments ... .14 Medicare Critical Access Hospitals (CAHs) ... 15 Medicaid Incentive Payments ... 16 Medicaid Eligible Professionals (EPs) Incentive Payments 17 Medicaid Eligible Hospitals Incentive Payments ... . 18 Medicaid Critical Access Hospitals (CAHs) Incentive Payments ... 19 Industry Adoption EHR Incentive Payments ... 20 MU Stage 1 Criteria - Core Set of Objectives .. ..21 MU Stage 1 Criteria - Core Set of Objectives (1-5) ..22 MU Stage 1 Criteria - Core Set of Objectives (6-10) 23 MU Stage 1 Criteria - Core Set of Objectives (11-16) . 24 MU Stage 1 Criteria Menu Set of Objectives .. . 25 MU Stage 1 Criteria Menu Set of Objectives (1-5) .. 26 MU Stage 1 Criteria Menu Set of Objectives (6-9) .. 27

ctd

CONTENTS
24. 25. 26. 27. 28. 29. 30. 31. 32. 33. MU Stage 1 Criteria Menu Set of Objectives (10-12) .. 28 MU Stage 1 Criteria Clinical Quality Measures (CQMS) for EPs ... 29 MU Stage 1 Criteria CQMS for EPs (Core Set and Alternate Core Set) . 30 MU Stage 1 Criteria CQMS for EPs (Additional Set 1-14) 31 MU Stage 1 Criteria CQMS for EPs (Additional Set 15-28) . 32 MU Stage 1 Criteria CQMS for EPs (Additional Set 29-38) . 33 MU Stage 1 Criteria CQMS for Eligible Hospitals .. . . 34 MU Stage 1 Criteria CQMS for Eligible Hospitals (1 -15 End) . . 35 EHR Incentive Program - Information Resource Links (1-25) 36 EHR Incentive Program - Information Resource Links (25-30) . 37
For questions, suggestions, or feedback please contact via email to manager@sqssolutions.com

The American Recovery and Reinvestment Act of 2009 (ARRA)

The American Recovery and Reinvestment Act of 2009 (ARRA)
Popularly know as The Stimulus Bill Objective To spur economic growth, and breakout of the recession Enacted by the United States Congress on February 2009 Signed into law on February 16, 2009 by the President of the United States of America

Approximate cost of the stimulus package - $787 billion, at the time of passage
Includes, spending in infrastructure, education, energy, health and human services, federal tax incentives, and expansion of unemployment benefits and social welfare provisions About $153 billion was allocated for Health and Human Services spending (out of which $22.6 billion for health information technology investments, and incentive payments)
Not to be mistaken with the Patient Protection and Affordable Care Act, that was passed a year later in March 2010 (also called as Health Care Reform Bill, or by some as Obama Care)
5

HITECH Act (part of ARRA)

Title IV of Division B of ARRA & Title XIII of Division A of ARRA

HITECH Act
(Health Information Technology for Economic and Clinical Health Act)

Objective: Reform the healthcare infrastructure and improve healthcare quality, healthcare efficiency, and patient safety HITECH Act establishes incentive payments under Medicare and Medicaid programs, for the following participants in the programs: Eligible professionals (EPs); Eligible hospitals; and Critical access hospitals (CAHs) to promote the adoption, and meaningful use of certified EHR technology. Incentives will be distributed through Medicare and Medicaid payments to the participants who are meaningful EHR users. Payment adjustments will be applied under Medicare program, if the participants do not demonstrate meaningful use of certified EHR technology. No payment adjustments in Medicaid program
6

US Department of Health and Human Services (HHS) (Agency: CMS, ONC)

The HITECH Act authorizes the Secretary, Department of Health and Human Services (HHS): To frame rules, set standards, and define certification criteria, to implement the incentive programs established under the HITECH Act The two agencies of HHS (of the several agencies) that play an important role in the implementation of the incentive programs are: Centers for Medicare & Medicaid Services (CMS) The Office of the National Coordinator for Health Information Technology (ONC) CMS: specifies the criteria for meaningful use, that EPs, eligible hospitals, and CAHs must demonstrate, in order to qualify for incentive payments; specifies the calculation of incentive payment, and payment adjustments; and specifies other program participation requirements ONC: identifies Authorized Testing Bodies (ONC-ATBs), and the methods to be followed to test and certify an EHR technology identifies the capabilities, standards, and implementation specifications, that an electronic health record technology need to comply, to support the achievement of meaningful use as defined by CMS 7

Meaningful Use (MU)

To avoid excessive burden on health care providers in adoption of EHR technology in a short time available under the HITECH Act, CMS decided to specify the criteria for Meaningful Use (MU) in three stages CMS issued Stage 1 Criteria for meaningful use, on July 28, 2010 CMS originally planned to issue Stage 2 Criteria for meaningful use by the end of 2011, however it has been delayed to mid 2012.

CMS is yet to decide the timeline for issuing Stage 3 Criteria for meaningful use. However, the goal is to align all three stage s of meaningful use criteria by 2015.
ONC issued a certification program on June 24, 2010, that: identified the ONC Authorized Testing And Certification Bodies (ONC-ATCBs), and laid out the process to be followed by ONC-ATCBs to test and certify an EHR technology ONC issued a final rule on July 28, 2010, that : specified a set of standards, implementation specifications, and certification criteria that an EHR technology needs to comply, to be recognized as a Certified EHR Technology These testing standards and criteria issued by the ONC are in alignment with Stage 1 Criteria for meaningful use, defined by the CMS 8

MU- Stage 1 Criteria (Objectives and Clinical Quality Measures)

The Stage 1 Criteria for Meaningful Use issued by CMS identifies: a set of objectives, and a set of clinical quality measures (reporting to CMS) that an EP, Eligible Hospital or CAH must comply, using a certified EHR technology, to receive the incentive payments Eligible Professionals must complete: 15 core objectives (Slides 21 24)

5 objectives out of 10 from menu set (Slides 25 28)

6 total Clinical Quality Measures (3 core, or alternate core, and 3 out of 38 in additional set) (Slides 29 - 33) Eligible Hospitals must complete: 14 core objectives (Slides 21 24) 5 objectives out of 10 from menu set (Slides 25 28) 15 Clinical Quality Measures (Slides 34 35) Stage 1 Criteria allows exclusions from some objectives, that may not be applicable to the nature of practice of an EP, Eligible Hospitals or CAH.
9

MU- Stage 1, 2, and Stage 3 Criteria- Timeline

Stage 1 Criteria: Status Has been defined in July 2010, by final rules issued by CMS. For the year 2011 or 2012, CMS expects an EP, eligible hospital or CAH to:
(See previous slide.)

Demonstrate Stage 1 criteria for meaningful use of a certified EHR technology.

Stage 2 Criteria: Status Very likely to be defined in mid 2012 (pushed from end of 2011). For the year 2013, CMS expects an EP, eligible hospital or CAH to: Repeat demonstration of Stage 1 criteria for meaningful use

Or, Start demonstration of Stage 1 criteria for meaningful use, if they have not demonstrated Stage 1 criteria any year before. For the year 2014, CMS expects an EP, eligible hospital or CAH to: Start demonstration of Stage 2 criteria, if they only demonstrated Stage 1 criteria in 2013.

Or, demonstrate Stage 1 criteria, if they have not demonstrated any meaningful use criteria at all, till then. Stage 3 Criteria: Status Yet to be determined. Will be defined in future rule making. For the year 2015, CMS expectation from EP, eligible hospital and CAH is yet to be determined. The goal is to align all 3 stages of meaningful use criteria by 2015.
10

Certified HER Technology And Meaningful Use

The ONC, through ONC-ATCBs, test and certify an EHR technology.

A Certified EHR Technology means:

(1) A Complete EHR that has been tested and certified, as having met all applicable certification criteria laid down by the ONC. The certification recognizes the readiness of the EHR technology to accomplish all the objectives for meaningful use (Stage 1 criteria, for now) as established by CMS. (OR) (2) A combination of EHR Modules, in which each constituent EHR Module has been tested and certified as having met one or more criteria (but, not all the criterion). And , the combination meets all the applicable certification criteria. The certification recognizes the preparedness of the EHR technology to accomplish all the objectives for meaningful use (Stage 1 criteria, for now) as established by CMS. Eligible Professionals, Eligible Hospitals and CAHs must use the certified EHR technology, and demonstrate the meaningful use of the technology, i.e. meet all the objectives (in Stage 1 criteria, for now) in order to receive incentive payments, and to avoid payment adjustments.
11

Medicare Incentive Payments Medicare Incentive Payments

Medicare Incentive Payments >>

12

Medicare Eligible Professionals (EPs) Incentive Payments

A qualifying EP can receive EHR incentive payments for up to five years starting from 2011. If EPs demonstrate meaningful use, starting : 2011 or 2012, they can receive payments until 2015 or 2016, totaling $44,000. 2013 or 2014, the total incentives received will be $39,000 or $24,000, accordingly. 2015, no incentive payments is awarded. The incentive payments are as follows:
2011 - $18,000 -> 2012 - $12,000 -> 2013 - $8,000 -> 2014 - $4,000-> (First Year) 2012 - $18,000 -> 2013 - $12,000-> 2014 - $8,000-> (First Year) 2013 - $15,000-> 2014 - $12,000-> (First Year) 2014 - $12,000-> (First Year) 2015- $2,000-> 2016- N/A -> Total: $44,000 2015- $4,000-> 2016- $2,000-> Total: $44,000 2015- $8,000-> 2016- $4,000-> Total: $39,000 2015- $8,000-> 2016-$ 4,000-> Total: $24,000

Payment adjustments will be applied , if the EPs do not demonstrate a meaningful use of certified EHR technology in the year 2015 and thereafter. EPs eligible to participate in Medicare and Medicaid EHR Incentive Programs, must choose one they would like to participate. After a payment is made, EPs will be allowed to change once before 2015. EPs serving in a geographic Health Professional Shortage Area (HPSA) are eligible for a 10 percent increase, and the maximum incentive payment they can receive is $48,400.
13

Medicare- Eligible Hospitals Incentive Payments

Eligible Hospitals can receive incentive payments for up to four years starting fiscal year (FY) 2011, for demonstrating meaningful use of certified EHR technology. They may qualify to receive payments from both the Medicare and Medicaid EHR Incentive Programs. Incentive payment for eligible hospital is calculated as: Initial Amount x Medicare Share x Factor. I - Initial Amount:[$2 Million + ($200 x number of discharges (for discharges between 1150 & 23,000 discharges) ] M - Medicare Share: [1.Medicare/(2.Total x 3.Charges)] 1.Medicare: number of acute care inpatient bed
days (beneficiaries under Part A payment, and MA Part C Beneficiaries). 2. Total: number of Total Acute Care Inpatient Bed Days. 3.Charges: [(Total Charges for such period, minus Charges for Charity Care) divided by (Total Charges)] F- Factor: [A transition factor which phases down the incentive payments over the four year period. (1, , , )]

The incentive payments are as follows:

2011- I*M*1-> (First Year) 2012- I*M* -> 2012 - I*M*1--> (First Year) 2013- I*M*-> 2013 - I*M* > 2013 - I*M*1--> (First Year) 2014-I*M*-> 2014 -I*M* -> 2014 - I*M* > 2014 - I*M* > (First Year) 2015 - N/A 2015-I*M*-> 2015-I*M*> 2015-I*M*> 2015-I*M*> (First Year) 2016 - N/A 2016- - N/A 2016-I*M* 2016-I*M* 2016-I*M*

Payment adjustments will be applied if the eligible hospitals do not demonstrate a meaningful use of certified EHR technology in the year 2015 or thereafter. 14

Medical Critical Access Hospitals (CAHs) Incentive Payments

Critical Access Hospitals (CAHs) can receive incentive payments for up to four years starting fiscal year (FY) 2011. They may qualify to receive payments from both the Medicare and Medicaid EHR Incentive Programs. The incentive payment is calculated as: Allowable Cost Amount * Medicare Share

A - Allowable Cost Amount: The allowable cost amount equals the costs of depreciable assets purchased,
such as computers and associated software, excluding any depreciation and interest expenses associated with the acquisition of certified EHR technology. Any previous cost that has not been fully depreciated. M - Medicare Share: [1.Medicare/(2.Total x 3.Charges)] 1.Medicare: number of acute care inpatient bed days (beneficiaries under Part A payment, and MA Part C Beneficiaries). 2. Total: number of Total Acute Care Inpatient Bed Days. 3.Charges: [(Total Charges for such period, minus Charges for Charity Care) divided by (Total Charges)] + a 20 percentage points [added to the Medicare Share calculation (not to exceed 100 percent)]. The incentive payments are as follows: 2011- A * M-> (First Year) 2012- A * M-> 2012- A * M-> (First Year) 2013- A * M-> 2013- A * M-> 2013- A * M-> (First Year) 2014-A * M-> 2014-A * M-> 2014-A * M-> 2014-A * M-> (First Year) 2015 - N/A 2015-A * M 2015-A * M 2015-A * M 2015-A * M (First Year) 2016 - N/A 2016 - N/A 2016 - N/A 2016 - N/A 2016 - N/A

Payment adjustments will be applied if a CAH does not demonstrate a meaningful use of certified EHR technology in the year 2015 or thereafter.

15

Medicaid Incentive Payments

Medicaid Incentive Payments >>

16

Medicaid- Eligible Professionals (EPs) Incentive Payments

The Medicaid EHR Incentive Program is offered and administered voluntarily by the states Starts as early as 2011, and continues through 2021 Eligible professionals can participate for 6 years through the duration of the program The last year to begin participation in the Medicaid EHR Incentive Program is 2016 Medicaid eligible professionals must adopt, implement, and upgrade (AIU) to a certified EHR technology, in the first year of participation Must successfully demonstrate meaningful use in subsequent participation years EPs can receive up to $63,750 over 6 years Must choose between Medicare and Medicaid EHR Incentive Programs if qualified for both
2011 - $21,250 2012 - $8,500 2014- $8,500 (First Year) 2013- $8,500 2015- $8,500 2012 - $21,250 2013- $8,500 2015- $8,500 (First Year) 2014 - $8,500 2016- $8,500 2013 - $21,250 2014- $8,500 2016- $8,500 (First Year) 2015- $8,500 2017- $8,500 2014- $21,250 2015- $8,500 2017- $8,500 (First Year) 2016- $8,500 2018- $8,500 2015- $21,250 2016- $8,500 2018- $8,500 (First Year) 2017- $8,500 2019- $8,500 2016- $21,250 2017- $8,500 2019- $8,500 (First Year) 2018- $8,500 2020- $8,500 2016- $8,500 2018- N/A 2017- N/A 2019- N/A 2017- $8,500 2019- N/A 2018- N/A 2020- N/A 2018- $8,500 2020- N/A 2019- N/A 2021- N/A 2019- $8,500 2020- N/A 2021- N/A 2020- $8,500 2021- N/A N/A 2020- N/A 2021- N/A Total: $63,750 2021- N/A Total: $63,750 N/A Total: $63,750

N/A

Total: $63,750

N/A

Total: $63,750

2021- $8,500 N/A N/A N/A Total: $63,750 No payment adjustments if EPs do not demonstrate meaningful use of certified EHR technology.

17

Medicaid- Eligible Hospitals Incentive Payments

The Medicaid EHR Incentive Program is offered and administered voluntarily by the states Starts as early as 2011, and continues through 2021 States can pay eligible hospitals the aggregate EHR incentive amount, spread over a minimum of 3 years, or maximum of 6 years The latest year to start receiving Medicaid EHR Incentive Program is 2016 Must adopt, implement, and upgrade (AIU) to a certified EHR technology, in the first year Must successfully demonstrate meaningful use in subsequent participation years The aggregate Incentive payment is calculated as: Overall EHR Amount x Medicare Share O - Overall EHR Amount = Sum of 4 years of EHR Amount. Note: 4 years is a theoretical period applied.
. EHR Amount for 1year : (Base Amount * Transition Factor) Base Amount: [$2 Million + ($200 x number of discharges (for discharges between 1150 & 23,000 discharges) )] Transition Factor: 1, , , , respectively, for 4 years M - Medicare Share: [1.Medicare/(2.Total x 3.Charges)] 1.Medicare: number of acute care inpatient bed days (Part A and MA Beneficiaries). 2. Total: number of Total Acute Care Inpatient Bed Days. 3.Charges: [(TotalCharges minus Charges for Charity Care) divided by (Total Charges)]

The aggregate incentive payment spread over 6 years:

2011 2012 2013 2014 2015 2016 2017 2018 2019 2020 2021 (O *M)/6-> (O *M)/6-> (O *M)/6-> (O *M)/6-> (O *M)/6-> (O *M)/6 N/A N/A N/A N/A N/A (First Year) (O *M)/6-> (O *M)/6-> (O *M)/6-> (O *M)/6-> (O *M)/6-> (O *M)/6 N/A N/A N/A N/A (First Year) (O *M)/6-> (O *M)/6-> (O *M)/6-> (O *M)/6-> (O *M)/6-> (O *M)/6 N/A N/A N/A (First Year) (O *M)/6-> (O *M)/6-> (O *M)/6-> (O *M)/6-> (O *M)/6-> (O *M)/6 N/A N/A (First Year) (O *M)/6-> (O *M)/6-> (O *M)/6-> (O *M)/6-> (O *M)/6-> (O *M)/6 N/A (O *M)/6 (First Year) (O *M)/6-> (O *M)/6-> (O *M)/6-> (O *M)/6-> (O *M)/6->
(First Year)

No payment adjustments if eligible hospitals do not demonstrate meaningful use of certified EHR technology.

18

Medicaid Critical Access Hospitals (CAHs) Incentive Payments

The Medicaid Incentive Payments to CAHs, are based on the same methodology as Medicaid Eligible Hospital Incentive Payments. (Please see previous slide 17 for Medicaid Eligible Hospitals Incentive Payment)

19

Industry Adoption- EHR Incentive Payments

American Hospital Association (AHA) Survey, Feb 2011 95% of hospitals participating in the survey reported they plan to pursue meeting the meaningful use and certification requirements for the program Fewer than 2% of hospitals currently meet the specific requirements of meaningful use and have a certified EHR, and only 0.8% of rural hospitals report they currently meet both the requirement to have a certified EHR, and the specific meaningful use objectives Work Group Recommends Delay for Stage 2 of Meaningful Use Texas Health Resources CMIO tells how the system earned $19M for Stage 1 The government has paid nearly $400 million in meaningful use incentives to physicians and hospitals so far, a Centers for Medicare and Medicaid Services official told Health IT Policy Committee Aug. 3.

20

MU Stage 1 Criteria- Core of Set Objectives

MU Stage 1 Criteria Core Set of Objectives >>

21

MU- Stage 1 Criteria- Core Set of Objectives

Eligible Professionals 1
Use CPOE for medication orders directly entered by any licensed healthcare professional who can enter orders into the medical record per state, local and professional guidelines

Eligible Hospitals and CAHs

Use CPOE for medication orders directly entered by any licensed healthcare professional who can enter orders into the medical record per state, local and professional guidelines

Measure of Compliance
More than 30% of unique patients with at least one medication in their medication list seen by the EP or admitted to the eligible hospitals or CAHs inpatient or emergency department (POS 21 or 23) have at least one medication order entered using CPOE

2
3

Implement drug-drug and drugallergy interaction checks

Implement drug-drug and drug-allergy interaction checks

The EP/eligible hospital/CAH has enabled this functionality

Generate and transmit permissible prescriptions electronically (eRx) Record demographics: Preferred Language; Gender; Race; Ethnicity ; and Date of Birth

N/A

Record demographics: Preferred Language; Gender; Race; Ethnicity ; Date of Birth; and Date and preliminary cause of death in the event of mortality in the eligible hospital or CAH Maintain an up-to-date problem list of current and active diagnoses

More than 40% of all permissible prescriptions written by the EP are transmitted electronically using certified EHR technology More than 50% of all unique patients seen by the EP or admitted to the eligible hospitals or CAHs inpatient or emergency department (POS 21 or 23) have demographics recorded as structured data More than 80% of all unique patients seen by the EP or admitted to the eligible hospitals or CAHs inpatient or emergency department (POS 21 or 23) have at least one entry or an indication that no problems are known for the patient recorded as 22

Maintain an up-to-date problem list of current and active diagnoses

MU Stage 1 Criteria- Core Set of Objectives- Ctd

Eligible Professionals
6 Maintain active medication list

Eligible Hospitals and CAHs

Maintain active medication list

Measure of Compliance More than 80% of all unique patients seen by the EP or admitted to the eligible hospitals or CAHs inpatient or emergency department (POS 21 or 23)have at least one entry (or an indication that the patient is not currently prescribed any medication) recorded as structured data
More than 80% of all unique patients seen by the EP or admitted to the eligible hospitals or CAHs inpatient or emergency department (POS 21 or 23) have at least one entry (or an indication that the patient has no known medication allergies) recorded as structured data More than 50% of all unique patients age 2 and over seen by the EP or admitted to eligible hospitals or CAHs inpatient or emergency department (POS 21 or 23), height, weight and blood pressure are recorded as structured data More than 50% of all unique patients 13 years old or older seen by the EP or admitted to the eligible hospitals or CAHs inpatient or emergency department (POS 21 or 23) have smoking status recorded as structured data Implement one clinical decision support rule 23

Maintain active medication allergy list

Maintain active medication allergy list

Record and chart changes in vital signs: Height; Weight; Blood Pressure; Calculate and display BMI Plot and display growth chart for 220 years, including BMI Record smoking status for patients 13 years old or older

Record and chart changes in vital signs: Height; Weight; Blood Pressure; Calculate and display BMI Plot and display growth chart for 220 years, including BMI Record smoking status for patients 13 years old or older

10

Implement one clinical decision support rule relevant to specialty or high clinical priority along with the ability to track compliance that rule

Implement one clinical decision support rule relevant to specialty or high clinical priority along with the ability to track compliance that rule

MU Stage 1 Criteria- Core of Set Objectives- End

Eligible Professionals
11 Report ambulatory clinical quality measures to CMS or the States

MU Stage 1 Criteria Core Set of Objectives - End

Eligible Hospitals and CAHs
Report hospital clinical quality measures to CMS or the States Provide patients with an electronic copy of their health information (including diagnostic test results, problem list, medication lists, medication allergies), upon request Provide patients with an electronic copy of their discharge instructions at time of discharge, upon request

Measure of Compliance
For 2011, provide aggregate numerator and denominator, and exclusions through attestation. For 2012, electronically submit the clinical quality measures. More than 50% of all patients who request an electronic copy of their health information are provided it within 3 business days

12

Provide patients with an electronic copy of their health information (including diagnostic test results, problem list, medication lists, medication allergies), upon request N/A

13

14 15

Provide clinical summaries for patients for each office visit Capability to exchange key clinical information (for example, problem list, medication list, medication allergies, diagnostic test results), among providers of care and patient authorized entities electronically Protect electronic health information created or maintained by the certified EHR technology through the implementation of appropriate technical capabilities

N/A Capability to exchange key clinical information (for example, discharge summary, procedures, problem list, medication list, medication allergies, diagnostic test results), among providers of care and patient authorized entities electronically Protect electronic health information created or maintained by the certified EHR technology through the implementation of appropriate technical capabilities

More than 50% of all patients who are discharged from an eligible hospital or CAHs inpatient department or emergency department (POS 21 or 23) and who request an electronic copy of their discharge instructions are provided it at discharge Clinical summaries provided to patients for more than 50% of all office visits within 3 business days Performed at least one test of certified EHR technology's capacity to electronically exchange key clinical information

16

Conduct or review a security risk analysis per 45 CFR 164.308 (a)(1) and implement security updates as necessary and correct identified security deficiencies as part of its risk 24 management process

MU Stage 1 Criteria- Menu Set Objectives

MU Stage 1 Criteria Menu Set of Objectives >>

25

MU Stage 1 Criteria- Menu Set Objectives

Eligible Professionals
1 Implement drug-formulary checks

Eligible Hospitals and CAHs

Implement drug-formulary checks

Measure of Compliance
The EP/eligible hospital/CAH has enabled this functionality and has access to at least one internal or external drug formulary More than 50% of all unique patients 65 years old or older admitted to the eligible hospitals or CAHs inpatient department (POS 21) have an indication of an advance directive status recorded More than 40% of all clinical lab tests results ordered by the EP or by an authorized provider of the eligible hospital or CAH for patients admitted to its inpatient or emergency department (POS 21 or 23) during the EHR reporting period whose results are either in a positive/negative or numerical format are incorporated in certified EHR technology as structured data Generate at least one report listing patients of the EP, eligible hospital or CAH with a specific condition.

N/A

Record advance directives for patients 65 years old or older

Incorporate clinical lab-test results into certified EHR technology as structured data

Incorporate clinical lab-test results into certified EHR technology as structured data

Generate lists of patients by specific conditions to use for quality improvement, reduction of disparities, research or outreach Send reminders to patients per patient preference for preventive/ follow up care

Generate lists of patients by specific conditions to use for quality improvement, reduction of disparities, research or outreach N/A

More than 20% of all unique patients 65 years or older or 5 years old or younger were sent an appropriate reminder during the EHR reporting period

26

MU Stage 1 Criteria- Menu Set Objectives- ctd

Eligible Professionals
6 Provide patients with timely electronic access to their health information (including lab results, problem list, medication lists, medication allergies) within four business days of the information being available to the EP Use certified EHR technology to identify patient-specific education resources and provide those resources to the patient if appropriate The EP, eligible hospital or CAH who receives a patient from another setting of care or provider of care or believes an encounter is relevant should perform medication reconciliation The EP, eligible hospital or CAH who transitions their patient to another setting of care or provider of care or refers their patient to another provider of care should provide summary of care record for each transition of care or referral

Eligible Hospitals and CAHs

N/A

Measure of Compliance
More than 10% of all unique patients seen by the EP are provided timely (available to the patient within four business days of being updated in the certified EHR technology) electronic access to their health information subject to the EPs discretion to withhold certain information

Use certified EHR technology to identify patient-specific education resources and provide those resources to the patient if appropriate The EP, eligible hospital or CAH who receives a patient from another setting of care or provider of care or believes an encounter is relevant should perform medication reconciliation The EP, eligible hospital or CAH who transitions their patient to another setting of care or provider of care or refers their patient to another provider of care should provide summary of care record for each transition of care or referral

More than 10% of all unique patients seen by the EP or admitted to the eligible hospitals or CAHs inpatient or emergency department (POS 21 or 23) during the EHR reporting period are provided patient-specific education resources The EP, eligible hospital or CAH performs medication reconciliation for more than 50% of transitions of care in which the patient is transitioned into the care of the EP or admitted to the eligible hospitals or CAHs inpatient or emergency department (POS 21 or 23).

The EP, eligible hospital or CAH who transitions their patient to another setting of care or provider of care provides a summary of care record for more than 50% of transitions of care and referrals.

27

MU Stage 1 Criteria- Menu Set Objectives- End

Eligible Professionals
10 Capability to submit electronic data to immunization registries or Immunization Information Systems and actual submission in accordance with applicable law and practice

Eligible Hospitals and CAHs

Capability to submit electronic data to immunization registries or Immunization Information Systems and actual submission in accordance with applicable law and practice

Measure of Compliance
Performed at least one test of certified EHR technology's capacity to submit electronic data to immunization registries and follow up submission if the test is successful (unless none of the immunization registries to which the EP, eligible hospital or CAH submits such information have the capacity to receive the information electronically) Performed at least one test of certified EHR technology capacity to provide electronic submission of reportable lab results to public health agencies and follow-up submission if the test is successful (unless none of the public health agencies to which eligible hospital or CAH submits such information have the capacity to receive the information electronically) Performed at least one test of certified EHR technology's capacity to provide electronic syndromic surveillance data to public health agencies and follow-up submission if the test is successful (unless none of the public health agencies to which an EP, eligible hospital or CAH submits such information have the capacity to receive the information electronically)

11

N/A

Capability to submit electronic data on reportable (as required by state or local law) lab results to public health agencies and actual submission in accordance with applicable law and practice

12

Capability to submit electronic syndromic surveillance data to public health agencies and actual submission in accordance with applicable law and practice

Capability to submit electronic syndromic surveillance data to public health agencies and actual submission in accordance with applicable law and practice

28

MU Stage 1 Criteria- Clinical Quality Measures (CQMS) Eligible Professionals (Eps)

MU Stage 1 Criteria Clinical Quality Measures (CQMS) - Eligible Professionals (EPs) >>

29

MU Stage 1 Criteria- Clinical Quality Measures (CQMS) For Eligible Professionals (EPs)
Core Set of CQMS
NQF Measure Number & PQRI Implementation Number
1 NQF 0013

Clinical Quality Measure Title

Hypertension: Blood Pressure Measurement Preventive Care and Screening Measure Pair: a) Tobacco Use Assessment, b) Tobacco Cessation Intervention Adult Weight Screening and Follow-up

NQF 0028

NQF 0421 PQRI 128

Alternate Core Set of CQMS

NQF Measure Number & PQRI Implementation Number
1 NQF 0024 2 NQF0041 PQRI 110 3 NQF 0038

Clinical Quality Measure Title

Weight Assessment and Counseling for Children and Adolescents Preventive Care and Screening: Influenza Immunization for Patients 50 Years Old or Older Childhood Immunization Status 30

MU- Stage 1 Criteria CQMS- Additional Set (1-14) For Eligible Professionals (EPs)
Additional Set of 38 CQMS
NQF Measure Number & PQRI Implementation Number
1 NQF 0059; PQRI 1

Clinical Quality Measure Title

Diabetes: Hemoglobin A1c Poor Control

2
3 4 5 6 7 8

NQF 0064; PQRI 2

NQF 0061; PQRI 3 NQF 0081; PQRI 5 NQF 0070; PQRI 7 NQF 0043; PQRI 111 NQF 0031; PQRI 112 NQF 0034; PQRI 113

Diabetes: Low Density Lipoprotein (LDL) Management and Control

Diabetes: Blood Pressure Management Heart Failure (HF): Angiotensin-Converting Enzyme (ACE) Inhibitor or Angiotensin Receptor Blocker (ARB) Therapy for Left Ventricular Systolic Dysfunction (LVSD) Coronary Artery Disease (CAD): Beta-Blocker Therapy for CAD Patients with Prior Myocardial Infarction (MI) Pneumonia Vaccination Status for Older Adults Breast Cancer Screening Colorectal Cancer Screening

9
10 11 12 13 14

NQF 0067; PQRI 6

NQF 0083; PQRI 8 NQF 0105; PQRI 9 NQF 0086; PQRI 12 NQF 0088; PQRI 18 NQF 0089; PQRI 19

Coronary Artery Disease (CAD): Oral Antiplatelet Therapy Prescribed for Patients with CAD
Heart Failure (HF): Beta-Blocker Therapy for Left Ventricular Systolic Dysfunction (LVSD) Anti-depressant medication management: (a) Effective Acute Phase Treatment, (b)Effective Continuation Phase Treatment Primary Open Angle Glaucoma (POAG): Optic Nerve Evaluation Diabetic Retinopathy: Documentation of Presence or Absence of Macular Edema and Level of Severity of Retinopathy Diabetic Retinopathy: Communication with the Physician Managing Ongoing Diabetes Care 31

MU Stage 1 Criteria- CQMS- Additional Set (15-28) For Eligible Professionals

Additional Set of CQMS
NQF Measure Number & PQRI Implementation Number
15 16 17 18 19 20 21 NQF 0047; PQRI 53 NQF 0001; PQRI 64 NQF 0002; PQRI 66 NQF 0387; PQRI 71 NQF 0385; PQRI 72 NQF 0389; PQRI 102 NQF 0027; PQRI 115

Clinical Quality Measure Title

Asthma Pharmacologic Therapy Asthma Assessment Appropriate Testing for Children with Pharyngitis Oncology Breast Cancer: Hormonal Therapy for Stage IC-IIIC Estrogen Receptor/Progesterone Receptor (ER/PR) Positive Breast Cancer Oncology Colon Cancer: Chemotherapy for Stage III Colon Cancer Patients Prostate Cancer: Avoidance of Overuse of Bone Scan for Staging Low Risk Prostate Cancer

22
23 24

NQF 0055; PQRI 117

NQF 0062; PQRI 119 NQF 0056; PQRI 163

Patients Smoking and Tobacco Use Cessation, Medical Assistance: a) Advising Smokers and Tobacco Users to Quit, b) Discussing Smoking and Tobacco Use Cessation Medications, c) Discussing Smoking and Tobacco Use Cessation Strategies Diabetes: Eye Exam
Diabetes: Urine Screening Diabetes: Foot Exam Coronary Artery Disease (CAD): Drug Therapy for Lowering LDL-Cholesterol Heart Failure (HF): Warfarin Therapy Patients with Atrial Fibrillation Ischemic Vascular Disease (IVD): Blood Pressure Management Ischemic Vascular Disease (IVD): Use of Aspirin or Another Antithrombotic 32

25
26 27

NQF 0074; PQRI 197

NQF 0084; PQRI 200 NQF 0073; PQRI 201

28

NQF 0068; PQRI 204

MU Stage 1 Criteria- CQMS- Additional Set (29-38) For Eligible Professionals

Additional Set of CQMS
NQF Measure Number & PQRI Implementation Number
29 30 31

Clinical Quality Measure Title

Initiation and Engagement of Alcohol and Other Drug Dependence Treatment: a) Initiation, b) Engagement Prenatal Care: Screening for Human Immunodeficiency Virus (HIV)
Prenatal Care: Anti-D Immune Globulin Controlling High Blood Pressure Cervical Cancer Screening Chlamydia Screening for Women Use of Appropriate Medications for Asthma Low Back Pain: Use of Imaging Studies Ischemic Vascular Disease (IVD): Complete Lipid Panel and LDL Control Diabetes: Hemoglobin A1c Control (<8.0%)

NQF 0004
NQF 0012 NQF 0014

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33 34 35 36 37 38

NQF 0018
NQF 0032 NQF 0033 NQF 0036 NQF 0052 NQF 0075 NQF 0575

33

MU Stage 1 Criteria- Clinical Quality Measures- (Eligible Hospitals)

MU Stage 1 Criteria Clinical Quality Measures (CQMS)- Eligible Hospitals >>

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MU Stage 1 Criteria- Clinical Quality Measures For Eligible Hospitals- 15 CQMS

NQF Measure Number
1 2 3 4 5 6 7 8 Emergency Department (ED) -1 NQF 0495 ED-2 NQF 0497 Stoke-2 NQF 0435 Stoke-3 NQF 0436 Stoke-4 NQF 0437 Stoke-5 NQF 0438 Stoke-6 NQF 0439 Stoke-8 NQF 0440

Clinical Quality Measure Title

Emergency Department Throughput admitted patients Median time from ED arrival to ED departure for admitted patients Emergency Department Throughput admitted patients Admission decision time to ED departure time for admitted patients Ischemic stroke Discharge on anti-thrombotics Ischemic stroke Anticoagulation for A-fib/flutter Ischemic stroke Thrombolytic therapy for patients arriving within 2 hours of symptom onset Ischemic or hemorrhagic stroke Antithrombotic therapy by day 2 Ischemic stroke Discharge on statins Ischemic or hemorrhagic stroke Stroke education

9
10 11 12 13 14 15

Stoke-10 NQF 0441

Venous Thromboembolism (VTE)-1 NQF 0371 VTE-2 NQF 0372 VTE-3 NQF 0373 VTE-4 NQF 0374 VTE-5 NQF 0375 VTE-6 NQF 0376

Ischemic or hemorrhagic stroke Rehabilitation assessment

VTE prophylaxis within 24 hours of arrival Intensive Care Unit VTE prophylaxis Anticoagulation overlap therapy Platelet monitoring on unfractionated heparin VTE discharge instructions Incidence of potentially preventable VTE 35

EHR Incentive Program- Information Resource (Links)

1. 2. 3. 4. 5. 6. 7. 8. 9. 10. 11. 12. 13. 14. 15. 16. 17. 18. 19. 20. 21. 22. 23. 24. Overview of Medicare and Medicaid EHR Incentive Programs Medicare and Medicaid EHR Incentive Program Basics CMS EHR Meaningful Use Overview Medicare & Medicaid Meaningful Use Stage 1 Requirements Summary HIMSS has developed the Meaningful Use OneSource HIMSS 2010- 2011 Health Information Exchange Committee - HIE Implications in Meaningful Use Stage 1 Requirements CMS Medicare and Medicaid EHR Incentive Programs Milestone Timeline CMS Finalizes Requirements for the Medicare Electronic Health Records (EHR) Incentive Program CMS Finalizes Requirements for the Medicaid Electronic Health Records (EHR) Incentive Program Notable Differences between the Medicare and Medicaid EHR Incentive Programs Stage 1 EHR Meaningful Use Specification Sheets for Eligible Professionals Eligible Professional Meaningful Use Table of Contents Core and Menu Set Measures Medicaid Electronic Health Record Incentive Payments for Eligible Professionals Medicaid Hospital Incentive Payment Calculation Stage 1 EHR Meaningful Use Specification Sheets for Eligible Hospitals Eligible Hospital and CAH Meaningful Use Table of Contents Core Objectives and Menu Set Objectives List of certified EHR Technology ONC Certification Program Jun 24, 2010 Temporary Certification Program ONC Certification Program Jan 7,2011 Permanent Certification Program ONC-Authorized Testing and Certification Bodies HIT Policy Committee: Meaningful Use Workgroup Request for Comments Regarding Meaningful Use Stage 2 AHA recommends that stage 2 of meaningful use should not start until at least 75 percent of all eligible hospitals and physicians/professionals have successfully reached Stage 1, and not before FY 2014. Work Group Recommends Delay for Stage 2 of Meaningful Use 36 Vendors air reservations about Stage 2

EHR Incentive Program- Information Resource (Links)

25. 26. 27. 28. 29. 30. 31. Federal panel votes to delay Stage 2 meaningful use by a year ARRA Funding for HHS (Including Health Information Technology) Spotlight and Upcoming Events AHA Survey on Hospitals Ability to Meet Meaningful Use Requirements $400M in EHR incentives delivered Texas Health Resources CMIO tells how the system earned $19M for Stage 1 National Health Information Technology Week, 2011- A Proclamation by the President For questions, suggestions, or feedback please contact via email to manager@sqssolutions.com

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