American College Of Surgeons - Inspiring Quality: Highest Standards, Better Outcomes

Final Criteria of Stage 1 EHR Use

To show Stage 1 meaningful use of certified electronic health record (EHR) technology, eligible professionals (EPs) are required to meet:

  1. 15 Core Meaningful Use Measures
  2. 5 of the 10 Menu Meaningful Use Measures
  3. Certain Clinical Quality Measures

Core Meaningful Use Measure Set (must meet all 15)

Core Measure Set

Objective

Measures

Computerized Physician Order Entry (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

More than 30 percent of unique patients with at least one medication in their medication list have at least 1 order entered using CPOE

Exclusion: Any EP who writes fewer than 100 prescriptions during the EHR reporting period

Implement drug-drug and drug-allergy interaction checks

Functionality is enabled for these checks for the entire EHR reporting period

Generate and transmit permissible prescriptions electronically (eRx)

More than 40 percent of all permissible prescriptions are transmitted electronically using certified EHR technology

Record patient demographics, including: preferred language, gender, race, ethnicity, date of birth

More than 50 percent of all unique patients have demographics recorded as structured data

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

More than 80 percent of all unique patients have at least one entry or an indication that no problems are known for the patient recorded as structured data

Maintain active medication list

More than 80 percent of all unique patients have at least one entry (or an indication that the patient is not currently prescribing any medication) recorded as structured data

Maintain active medication allergy list

More than 80 percent of all unique patients have at least one entry (or an indication that the patient has no known medication allergies) recorded as structured data

Vital signs – record and chart changes in height, weight, blood pressure; calculate and display BMI; plot and display growth charts for children 2-20 years including BMI

For more than 50 percent of all unique patients age 2 and over, height, weight, and BP are recorded as structured data

Exclusion: Any EP who sees no patients 2 years or older, or who believes that all three vital signs of height, weight, and blood pressure of their patients have no relevance to their scope of practice.

Smoking status – recorded for patients 13 years of age or older

More than 50 percent of all unique patients age 13 or over have smoking status recorded as structured data
Exclusion: Any EP who sees no patients 13 years or older

Implement 1 clinical decision support rule relevant to specialty or high clinical priority, along with ability to track compliance with that rule

Implement 1 clinical decision support rule

Report ambulatory clinical quality measures to CMS or the States

For 2011, provide aggregate numerator, denominator, and exclusions through attestation; for 2012, submit clinical quality measures electronically

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

More than 50 percent of all patients who request an electronic copy of their health information are provided it within three business days

Exclusion: Any EP that has no requests from patients or their agents for an electronic copy of patient health information during the EHR reporting period

Provide clinical summaries for patients for each office visit

Clinical summaries provided to patients for more than 50 percent of all office visits within 3 business days

Exclusion: Any EP who has no office visits during the reporting period

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

Perform at least one test of certified EHR technology’s capacity to electronically exchange key clinical information

Protect electronic health information created or maintained by the certified EHR technology through the implementation of appropriate technical capabilities

Conduct or review a security risk analysis, implement security updates as necessary, and correct identified security deficiencies as part of its risk management process

Menu Meaningful Use Measure Set (must meet any 5 of 10)

Menu Measure Set

Objective

Measures

Implement drug-formulary checks

This functionality is enabled and the EP has access to at least 1 internal or external drug formulary for the entire EHR reporting period

Incorporate clinical lab-test results into certified EHR structured data

More than 40 percent of all clinical lab test results ordered by the EP 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

Exclusion: An EP who orders no lab tests whose results are either in a positive/negative or numeric format during the EHR reporting period

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

Generate at least one reporting listing patients with a specific condition

Send reminders to patients per patient preference for preventive/follow-up care

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

Exclusion: An EP who has no patients 65 years or older or 5 years or younger with records maintained using certified EHR technology

Provide patients with timely electronic access to their health information (including lab results, problem list, medication lists, medication allergies) within 4 business days of the information being available to the EP

More than 10 percent of all unique patients are provided timely (available to the patient within four business days of being updated in the EHR) electronic access to their health information, subject to the EP’s discretion to withhold certain information

Exclusion: Any EP that neither orders nor creates any lab results, problem lists, medication lists, or medication allergies during the EHR reporting period

Use certified EHR technology to identify patient-specific education resources and provide those resources to patient if appropriate

More than 10 percent of all unique patients are provided patient-specific education resources

The EP 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 performs medication reconciliation for more than 50 percent of transitions of care in which the patient is transitioned into the care of the EP

Exclusion: Any EP who was not the recipient of any transitions of care during the EHR reporting period

Transition/referral of patient to another setting or provider of care – EP should provide summary of care record for each transition of care or referral

Summary of care record provided for more than 50 percent of transitions of care and referrals

Exclusion: An EP who neither transfers a patient to another setting nor refers a patient to another provider during the EHR reporting period

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

 

 

 

*Population and public health measure

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 submits such information have the capacity to receive the information electronically)

Exclusion: An EP who administers no immunizations during the EHR reporting period, or where no immunization registry has the capacity to receive the information electronically

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

 

 

*Population and public health measure

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 submits such information have the capacity to receive the information electronically)

Exclusion: An EP who does not collect any reportable syndromic information

*EPs must choose at least one of the population and public health measures from the menu set.

Clinical Quality Measures

Clinical Quality Measures

Core Clinical Quality Measures:
EPs must meet all three (or alternate core measures if these do not apply)

Blood pressure level

Tobacco status

Adult weight screening and follow-up

Alternate Core Clinical Quality Measures

Influenza immunization for patients over 50 years

Weight assessment and counseling for children and adolescents

Childhood immunizations

If all six core and alternate core measures are inapplicable, an EP may report zeros for all six denominators.

In addition to the three core measures (and alternate core measures, if applicable), EPs will also have to select and report on three additional measures from a subset of clinical measures most appropriate given the EP’s specialty. If these three additional selected measures have a value of zero in the denominator, then the EP will have to attest that all of the other clinical quality measures, if calculated by the certified EHR technology, would also have a value of zero in order to be exempt from reporting on additional measures. At this point, the clinical quality measure requirements are simply a reporting requirement, and do not require a particular performance standard.

If you have further questions about the Medicare and Medicaid EHR Incentive Program, please contact Sana Gokak at sgokak@facs.org or 202-672-1517.