Meaningful Use

CMS Definition of Meaningful

Meaningful Use is a CMS Medicare and Medicaid program that awards incentives for using certified electronic health records (EHRs) to improve patient care. To achieve Meaningful Use and avoid penalties, providers must follow a set of criteria that serve as a roadmap for effectively using an EHR.

What does it do?

Meaningful Use encourages provider to switch from paper charts to electronic records to provide better care to their patients. Using certified EHR will also increase practices efficiency, and will earn incentives.

Meaningful Use Stage 1 Requirements

Eligible Professionals (EP) must complete:

15 Core Objectives
5 objectives out of 10 from Menu Set
6 total Clinical Quality Measures (CQM)
3 core
3 out of 38 from Additional Set
Reporting of CQM

1. Core Objectives

Eligible Professionals must complete all 15:

Computerized Provider 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
Protect electronic health information

2. Menu Set

Eligible Professionals must complete 5 out of 10:

Drug-formulary checks
Incorporate clinical lab test results as structured data
Generate lists of patients by specific conditions
Send reminders to patients per patient preference for preventive/follow up care
Provide patients with timely electronic access to their health information
Use certified EHR technology to identify patient-specific education resources and provide to patient, if appropriate
Medication reconciliation
Summary of care record for each transition of care/referrals
Capability to submit electronic data to immunization registries/systems*
Capability to provide electronic syndromic surveillance data to public health agencies*

* At least 1 public health objective must be selected

3. Clinical Quality Measures (CQM)

Core CQM

Eligible Professionals must complete 3 of the following:

Hypertension Blood Pressure Measurement
Preventive Care and Screening Measure Pair

a. Tobacco Use Assessment

b. Tobacco Cessation Intervention

Adult Weight Screening and Follow up
Weight Assessment and Counseling for Children and Adolescents
Preventive Care and Screening

a. Influenza Immunization for Patients > 50 Years old

Childhood Immunization Status

Additional Set of CQMs

Eligible Professionals must complete 3 out of 38:

Diabetes: Hemoglobin A1c Poor Control
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
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
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 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
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%)

(Check List Stage One)

Meaningful Use Stage 2 for 2015 – 2017

CMS has amended Stage 2 for the 2015 reporting period and beyond. The 17 core and 6 menu measures have been reduced to 10 objectives.

Practices that are reporting for Stage 2 in 2015 will now report on the reduced Stage 2 objectives based on the new CMS requirements.

10 objectives

Objective 1: Patient Health Information

Objective 2: Clinical Decision Support

Objective 3: Computerized Provider Order Entry (CPOE)

Objective 4: e-Prescribing

Objective 5: Health Information Exchange

Objective 6: Patient-Specific Education

Objective 7: Medication Reconciliation

Objective 8: Patient Electronic Access (VDT)

Objective 9: Secure Messaging

Objective 10: Public Health

Meaningful Use Stage 2: Measures for 2014

Core and menu measures have been adjusted for 2015 and beyond. You are no longer required to report on core measures 3, 4, 5, 8, 10, 11, 12 and menu measures 2, 3, 4 for Meaningful Use.

Core 1: CPOE for Medication, Lab and Radiology Orders
Core 2: e-Prescribing
Core 3: Record Demographics
Core 4: Record Vital Signs
Core 5: Record Smoking Status
Core 6: Clinical Decision Support Rule
Core 7: Patient Electronic Access
Core 8: Clinical Summaries
Core 9: Protect Electronic Health Information
Core 10: Clinical Lab Test Results
Core 11: Patient Lists
Core 12: Preventative Care
Core 13: Patient-Specific Education Resources
Core 14: Medication Reconciliation
Core 15: Summary of Care
Core 16: Immunization Registries Data Submission
Core 17: Use Secure Electronic Messaging
Menu 1: Syndromic Surveillance Data Submission
Menu 2: Electronic Notes
Menu 3: Imaging Results
Menu 4: Family Health History
Menu 5: Report Cancer Cases
Menu 6: Report Specific Cases

(Check List Stage Two)

Meaningful use stage 3

Meaningful use stage 3 is the third phase of the meaningful use EHR incentive program. The Centers for Medicare & Medicaid Services (CMS) and the Office of the National Coordinator for Health IT (ONC) published the final rule on meaningful use stage 3 on October 6, 2015.

Despite the requirements set by stage 3, there are important upcoming changes through a new law called MACRA — or the Medicare Access and CHIP (Children’s Health Insurance Program) Reauthorization Act. MACRA will eventually modify the meaningful use program as a means to push forward with value-based reimbursement.

As things stand, in summer 2016, meaningful use stage 3 will be optional for providers in 2017 and mandatory for all participants in 2018. Objectives and measures for all providers, regardless of prior participation, are finalized for the 2018 reporting period with this rule.

Along with meaningful use stage 1 and meaningful use stage 2, the third list of criteria and requirements mandates that all hospitals and eligible healthcare professionals use certified electronic health record (EHR) systems.

Meaningful use program requirements

Meaningful use stage 3: The following objectives and corresponding measures will be used for evaluating whether or not a provider has met the necessary requires for attestation to Stage 3 in 2017 and subsequent years. All CEHRT must be able to perform the necessary functions to meet these objectives, including recording and reporting all necessary data electronically.

1. Protect Electronic Patient Health Information (ePHI) Created or Maintained by the CEHRT through the Implementation of Appropriate Technical, Administrative, and Physical Safeguards	a. A security risk analysis must be conducted, including addressing the security (including encryption) of data created or maintained by the CEHRT b. Security updates must be implemented as necessary c. Identified security deficiencies must be corrected as part of the providers risk management process
2. Electronic Prescribing: Generate and Transmit Permissible Prescriptions Electronically (eRx)	a. For Providers: more than 60 percent of prescriptions must be transmitted electronically using CEHRT b. For Hospitals/CAHs: More than 25 percent of hospital discharge medication orders must be transmitted electronically
3. Implement Clinical Decision Support (CDS) Interventions Focused on Improving Performance on High-Priority Health Conditions	a. 5 CDS interventions related to 4 or more CQMs must be used at a relevant point in careb. Drug-drug and drug-allergy interaction checks must be enabled and implemented
4. Use Computerized Provider Order Entry (CPOE) for Medication, Laboratory, and Diagnostic Imaging OrdersCPOE must be used for	a. More than 60 percent of medication orders b. More than 60 percent of laboratory orders c. More than 60 percent of diagnostic imaging orders
5. Provide Patient with Timely Electronic Access to Health Information and Patient Specific Education Materials	a. More than 80 percent of all unique patients seen or discharged: i. Must be provided timely access to view online, download, and transmit his or her health information; and ii. The provider must ensure the patient’s health information is available for the patient to access using any application of their choice that is configured to interact with the providers CEHRT b. Provider must use clinically relevant information from CEHRT to identify patient-specific educational resources and provide electronic access to those materials to more than 35 percent of unique patients
6.Patient Engagement and Coordination of Care: Use CEHRT to Engage with Patients or their Authorized Representatives for Improved Coordination of Care	a. More than 10 percent of all unique patients (or their authorized representative) must actively engage with the EHR and either: i. View, download, or transmit to a third party their health information; or ii. Access their health information through the use of an application in the providers CEHRT; or iii. A combination of (i) and (ii) b. More than 25 percent of all unique patients must receive an electronic message using the CEHRT Patient generated health data or data from a nonclinical setting must be incorporated into the CEHRT for more than 5 percent of all unique patients
7. Health Information Exchange (HIE): A Summary of Care Record is Provided when Transitioning or Referring a Patient to Another Setting of Care and Incorporates Summary of Care Information from Other Providers into their EHR Using the Functions of CEHRT	a. For more than 50 percent of transitions and referrals, the provider that transitions or refers their patient must create a summary of record using CEHRT and electronically transmit the record. b. For more than 40 percent of transitions received and new patients, the provider must incorporate into the patients EHR an electronic summary of care document c. For more than 80 percent of transitions or referrals received and new patients, the provider must perform a clinical information reconciliation for medication, medication allergies, and a current problem list
8. Public Health and Clinical Data Registry Reporting: The Provider Actively Engages with a Public Health Agency or Clinical Data Registry to Submit Electronic Public Health Data in a Meaningful Way Using CEHRTProviders must report the following information to the appropriate setting:	a. Immunization data b. Syndromic surveillance data c. Electronic case reporting d. Public health registry reports e. Clinical data registry reports f. Electronic reportable laboratory result reports

Stage 3 also promotes the use of APIs to bridge the gaps between health IT systems and to provide increased data access.

Meaningful Use and MACRA

MACRA is federal legislation signed into law on April 16, 2015 that establishes ways to pay physicians for caring for Medicare beneficiaries and includes funding for technical assistance for providers and related measure development. The law also sets requirements for data sharing.

Clinical Quality Measures

Clinical Quality Measures (CQMs) enable providers to track various aspects of patient care. As part of Meaningful Use, all providers must report on the required number of CQMs to meet the program requirements.

CQMs fall under one of six National Quality Strategy areas:

- Patient and Family Engagement
- Efficient Use of Healthcare Resources
- Clinical Processes and Effectiveness
- Patient Safety
- Population and Public Health
- Care Coordination

Meaningful Use:

The Medicare and Medicaid Electronic Health Care Record (EHR) Incentive Program is commonly known as the Meaningful Use program, it provides incentive payments to eligible professionals, eligible hospitals, and critical access hospitals (CAHs) as they adopt, implement, upgrade or demonstrate meaningful use of certified EHR technology.

Who is Eligible?

A Medicare Eligible Provider (EP) is defined as a doctor of medicine or osteopathy, doctor of dental surgery or dental medicine, doctor of podiatry, doctor of optometry or a chiropractor who is not hospital-based. A Medicare EP is considered hospital-based if 90% or more of the EP’s services are performed in a hospital inpatient or emergency room setting.