Meaningful Use
CRITERIA
To get full credit for using their EHR, eligible providers must meet 25 total measures: 15 from a "core set" and 5 out of 10 options from a "menu set." In addition, they must report on 6 clinical quality measures: 3 core quality measures and an additional 3 from a set of 38.
The measures below have been updated to reflect the changes CMS made starting January 1, 2013. The original list is listed below and the last column highlights any changes that have taken effect in 2013. Official CMS announcement can be found here. A reader-friendly PDF is also available for download.
Meaningful Use Core Measures: Must meet all 15 measures
| Core Measure Number | Objective | Measure | Change Beginning 2013 |
|---|---|---|---|
| 1 | Use computerized provider 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% of patients with at least one medication in their medication list have at least one medication ordered through CPOE | Either the original measure or the alternate measure will be accepted in 2013. In Stage 2, this alternate measure will be required. Alternate Measure: More than 30% of medication orders created by the EP during the EHR reporting period are recorded using CPOE. |
| 2 | Implement drug-drug and drug-allergy interaction checks | Functionality is enabled for these checks for the entire reporting period. | N/A |
| 3 | Maintain up-to-date problem list of current and active diagnoses | More than 80% of all unique patients have at least one entry or inclusion that no problems are known for the patient recorded as structured data | N/A |
| 4 | Generate and transmit permissible prescriptions electronically (eRx). | More than 40% of all permissible prescriptions are transmitted electronically using certified EHR technology | An additional exclusion has been added. New Additional Exclusion: Any EP who does not have a pharmacy within their organization and there are no pharmacies that accept electronic prescriptions within 10 miles of the EP’s practice location at the start of his/her EHR reporting period. |
| 5 | Maintain an active medication list | More than 80% of all unique patients have at least one entry or inclusion that no problems are known for the patient recorded as structured data | N/A |
| 6 | Maintain an up-to-date medication allergy list | More than 80% of patients have at least one entry or inclusion that no known problems are known for the patients recorded as structured data. | N/A |
| 7 | Record patient demographics (preferred language, gender, race, ethnicity, date of birth) | More than 50% of all unique patients have demographic data recorded as structured data. | N/A |
| 8 | Record vital signs and chart changes (height, weight, blood pressure, calculate and display body-mass index, plot and display growth charts for children) | More than 50% of patients two years of age or older have height, weight, and blood pressure recorded as structured data. | Either the original measure or the alternate measure will be accepted in 2013. Starting in 2014, this alternate measure will be required. Alternate Measure: More than 50 percent of all unique patients seen by the EP during the EHR reporting period have blood pressure (for patients age 3 and over only) and height and weight (for all ages) recorded as structured data. Three new exclusions for this measure have been added. The exclusions are based on the vitals’ relevancy to the scope of the practice by blood pressure or height and weight. New Exclusions: Any EP who: 1. Sees no patients 3 years or older is excluded from recording blood pressure; 2. Believes that all three vital signs of height, weights, and blood pressure have no relevance to their scope of practice is excluded from recording them; 3. Believes that height and weights are relevant to their scope of practice, but blood pressure is not, is excluded from recording blood pressure; or 4. Believes that blood pressure is relevant to their scope of practice, but height and weight are not, is excluded from recording height and weight. |
| 9 | Record smoking status for patients 13 years of age or older | More than 50% of patients 13 years of age or older have smoking status recorded as structured data | N/A |
| 10 | Report ambulatory clinical quality measures to CMS | For 2011, provide aggregate numerator and denominator through attestation; for 2012, electronically submit measures | This objective is incorporated directly into the definition of a Meaningful User and has been eliminated as an individual objective. Please note: EPs is still required to electronically report 9 out of 64 clinical quality measures in order to achieve meaningful use. |
| 11 | Implement one clinical decision support rule relevant to specialty or high clinical priority along with the ability to track compliance with this rule | One clinical decision support rule implemented | N/A |
| 12 | On request, provide patients with an electronic copy of their health information (including diagnostic test results, problem list, medication lists, medication allergies) | More than 50% of all patients who request the electronic copy of their health record receive it within three business days | N/A |
| 13 | Provide patients with clinical summaries for each office visit | Clinical summaries provided to patients for more than 50% of all office visits within three business days | N/A |
| 14 | Implement capability to electronically exchange key clinical information (for example, problem lists, medication list, medication allergies, and diagnostic test results), among providers and patient-authorized entities | Perform at least one test of EHR’s capacity to electronically exchange information | The objective for electronic exchange of key clinical information will no longer be required for Stage 1 for EPs. |
| 15 | 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 in accordance with the requirements under 45 CFR 164.308(a)(1) and implement security updates as necessary and correct identified security deficiencies as part of its risk management process | N/A |
| Menu Measure Number | Objective | Measure |
|---|---|---|
| 1 | 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 |
| 2 | Incorporate clinical laboratory test results into EHRs as structured data | More than 40% of clinical laboratory test results order by the EP during the EHR reporting period whose results are in positive/negative or numerical format are incorporated into EHR technology as structured data |
| 3 | Generate lists of patients by specific conditions to use for quality improvement, reduction of disparities, research, or outreach | Generate at least one report listing patients of the EP with a specific condition |
| 4 | Send reminders to patients (per patient preference) for preventive/follow-up care | More than 20% of all patients 65 years of age or older or five years of age or younger are sent appropriate reminders during the EHR reporting period |
| 5 | Provide patients with timely electronic access to their health information (including laboratory results, problem list, medication lists, medication allergies) within four business days of the information being available to the EP | More than 10% of all unique patients are provided electronic access to information within four days of it being updated in the EHR |
| 6 | Use certified EHR technology to identify patient-specific education resources and provide those to the patient as appropriate | More than 10% of all unique patients are provided patient-specific education resources |
| 7 | Perform medication reconciliation between care settings | Medication reconciliation is performed for more than 50% of transitions of care in which the patient is transitioned into the care of the EP |
| 8 | Provide summary of care record for patients referred or transitioned to another provider or setting | Summary of care record is provided for more than 50% of patient transitions or referrals |
| 9 *PH |
Submit electronic immunization data to immunization registries or immunization information systems and actual submission according to applicable law and practice | Perform at least one test of data submission and follow-up submission (where registries can accept electronic submissions) |
| 10 *PH |
Submit electronic syndromic surveillance data to public health agencies | Perform 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 has the capacity to receive the information electronically) |
* Prior to 2013, EPs could be excluded from one of these measures. However, EPs must be able to exclude from both public health measures in order to use the exclusion criteria to satisfy the measure Thus, EPs are required to meet one of two public health measures
Meaningful Use Clinical Quality Core Measures
Must meet all 3 core measures under the CQM core measures set. You may substitute measures with an alternate core measure where necessary.
| CQM Core Measure | CQM Core Measure Description | Source – PQRI | Source – NQF |
|---|---|---|---|
| Hypertension: Blood Pressure Measurement | Percentage of patient visits for patients aged 18 years and older with a diagnosis of hypertension who have been seen for at least two office visits, with blood pressure (BP) recorded | 0013 | |
| Preventive Care and Screening Measure Pair: (a) Tobacco Use Assessment, (b) Tobacco Cessation Intervention | Percentage of patients 18 years of age and older who were current smokers or tobacco users, who were seen by a practitioner during the measurement year and who received advice to quit smoking or tobacco use or whose practitioner recommended or discussed smoking or tobacco use cessation medications, methods or strategies | 0028 | |
| Adult Weight Screening and follow-up | Percentage of patients aged 18 years and older with a calculated BMI in the past six months or during the current visit documented in the medical record. If the most recent BMI is outside parameters, a follow-up plan is documented. | 128 | 0421 |
| Alternate Core Measure | Alternate CQM Core Measure Description | Source – PQRI | Source – NQF |
|---|---|---|---|
| Weight Assessment and Counseling for Children and Adolescents | Percentage of patients 2-17 years of age who had an outpatient visit with a PCP or OB/GYN and who had evidence of BMI percentile documentation, counseling for nutrition and counseling for physical activity during the measurement year | 0024 | |
| Preventive Care and Screening: Influenza Vaccination for Patients 50 Years Old or Older | Percentage of patients aged 50 years and older who received an influenza immunization during the flu season (September through February) | 110 | 0041 |
| Childhood Immunization Status | Percentage of children 2 years of age who had four diphtheria, tetanus and a cellular pertussis (DTaP); three polio (IPV); one measles, mumps and rubella (MMR); two H influenza type B (HiB); three hepatitis B (Hep B), one chicken pox (VZV); four pneumococcal conjugate (PCV); two hepatitis A (Hep A); two or three rotavirus (RV); and two influenza (flu) vaccines by their second birthday. The measure calculates a rate for each vaccine and two separate combination rates. | 0038 |
Meaningful Use Clinical Quality Measures: Additional Specialty
Must meet 3 of the measures under the CQM additional specialty measure menu set.
| Additional Specialty Measure | CQM Additional Specialty Measure Description | Source – PQRI | Source – NQF |
|---|---|---|---|
| Diabetes: Hemoglobin A1c Poor Control | Percentage of patients 18–75 years of age with diabetes (type 1 or type 2) who had HbA1c >9.0% | 1 | 0059 |
| Diabetes: Low Density Lipoprotein (LDL) Management and Control | Percentage of patients 18 to 75 years of age with diabetes (type 1 or type 2) who had LDL-C <100mg/dL | 2 | 0064 |
| Diabetes: Blood Pressure Management | Percentage of patients 18 to 75 years of age with diabetes (type 1 or type 2) who had BP <140/90 mmHg | 3 | 0061 |
| Heart Failure (HF): Angiotensein-Converting Enzyme (ACE) Inhibitor or Angiotensin Receptor Block (ARB) for Left Ventricular Dysfunction (LVSD) | Percentage of patients aged 18 years and older with a diagnosis of heart failure and LVSD (LVEF < 40%) who were prescribed ACE inhibitor or ARB therapy | 5 | 0081 |
| Coronary Artery Disease (CAD): Beta-Blocker Therapy for CAD Patients with Prior MI | Percentage of patients aged 18 years and older with a diagnosis of CAD and prior MI who were prescribed betablocker therapy | 7 | 0070 |
| Pneumonia Vaccination Status for Older Adults | Percentage of patients 65 years of age and older as of January 1 of the measurement year who have ever received a pneumococcal vaccine | 111 | 043 |
| Breast Cancer Screening | Percentage of women 40 to 69 years of age who had a mammogram to screen for breast cancer | 112 | 0031 |
| Colorectal Cancer Screening | Percentage of adults 50 to 75 years of age who had appropriate screening for colorectal cancer | 113 | 0034 |
| Coronary Artery Disease (CAD): Oral Antiplatelet Therapy Prescribed for Patients with CAD | Percentage of patients aged 18 years and older with a diagnosis of CAD who were prescribed oral antiplatelet therapy | 6 | 0067 |
| Heart Failure (HF): Beta-Blocker Therapy for Left Ventricular Systolic Dysfunction (LVSD) | Percentage of patients aged 18 years and older with a diagnosis of heart failure who also have LVSD (LVEF < 40%) and who were prescribed beta-blocker therapy | 8 | 0083 |
| Anti-depressant Medication Management: (a) Effective Acute Phase Treatment, (b) Effective Continuation Phase Treatment | Percentage of patients 18 years of age and older who were diagnosed with a new episode of major depression, treated with antidepressant medication, and who remained on an antidepressant medication treatment. | 9 | 0105 |
| Primary Open Angle Glaucoma (POAG): Optic Nerve Evaluation | Percentage of patients aged 18 years and older with a diagnosis of POAG who have been seen for at least two office visits, who have an optic nerve head evaluation during one or more office visits within 12 months. | 12 | 0086 |
| Diabetic Retinopathy: Documentation of Presence or Absence of Macular Edema and Level of Severity of Retinopathy | Percentage of patients aged 18 years and older with a diagnosis of diabetic retinopathy who had a dilated macular or fundus exam performed which included documentation of the level of severity of retinopathy and the presence or absence of macular edema during one or more office visits within 12 months. | 18 | 0088 |
| Diabetic Retinopathy: Communication with the Physician Managing Ongoing Diabetes Care | Percentage of patients aged 18 years and older with a diagnosis of diabetic retinopathy who had a dilated macular or fundus exam performed with documented communication to the physician who manages the ongoing care of the patient with diabetes mellitus regarding the findings of the macular or fundus exam at least once within 12 months. | 19 | 0089 |
| Asthma Pharmacologic Therapy | Percentage of patients aged 5 through 40 years with a diagnosis of mild, moderate, or severe persistent asthma who were prescribed either the preferred long-term control medication (inhaled corticosteroid) or an acceptable alternative treatment | 53 | 0047 |
| Asthma Assessment | Percentage of patients aged 5 through 40 years with a diagnosis of asthma and who have been seen for at least 2 office visits, who were evaluated during at least one office visit within 12 months for the frequency (numeric) of daytime and nocturnal asthma symptoms | 64 | 0001 |
| Appropriate Testing for Children with Pharyngitis | Percentage of children 2 to18 years of age who were diagnosed with Pharyngitis, dispensed an antibiotic and received a group A streptococcus (strep) test for the episode. | 66 | 0002 |
| Oncology Breast Cancer: Hormonal Therapy for Stage IC-IIIC Estrogen Receptor/Progesterone Receptor (ER/PR) Positive Breast Cancer | Percentage of female patients aged 18 years and older with Stage IC through IIIC, ER or PR positive breast cancer who were prescribed tamoxifen or aromatase inhibitor (AI) during the 12-month reporting period. | 71 | 0387 |
| Oncology Colon Cancer: Chemotherapy for Stage III Colon Cancer Patients | Percentage of patients aged 18 years and older with Stage IIIA through IIIC colon cancer who are referred for adjuvant chemotherapy, prescribed adjuvant chemotherapy, or have previously received adjuvant chemotherapy within the 12-month reporting period. | 72 | 0385 |
| Prostate Cancer: Avoidance of Overuse of Bone Scan for Staging Low Risk Prostate Cancer Patients | Percentage of patients, regardless of age, with a diagnosis of prostate cancer at low risk of recurrence receiving interstitial prostate brachytherapy, OR external beam radiotherapy to the prostate, OR radical prostatectomy, OR cryotherapy who did not have a bone scan performed at any time since diagnosis of prostate cancer | 102 | 0389 |
| Smoking and Tobacco Use Cessation, Medical Assistance: (a) Advising Smokers and Tobacco Users to Quit, (B) Discussing Smoking and Tobacco Use Cessation Medications | Percentage of patients 18 years of age and older who were current smokers or tobacco users, who were seen by a practitioner during the measurement year and who received advice to quit smoking or tobacco use or whose practitioner recommended or discussed smoking or tobacco use cessation medications, methods or strategies | 115 | 0027 |
| Diabetes: Eye Exam | Percentage of patients 18 to 75 years of age with diabetes (type 1 or type 2) who had a retinal or dilated eye exam or a negative retinal exam (no evidence of retinopathy) by an eye care professional | 117 | 0055 |
| Diabetes Urine Screening | Percentage of patients 18 to 75 years of age with diabetes (type 1 or type 2) who had a nephropathy screening test or evidence of nephropathy | 119 | 0062 |
| Diabetes: Foot Exam | Percentage of patients aged 18 to 75 years with diabetes (type 1 or type 2) who had a foot exam (visual inspection, sensory exam with monofilament, or pulse exam) | 163 | 0056 |
| Coronary Artery Disease (CAD): Drug Therapy for Lowering LDL-Cholesterol | Percentage of patients aged 18 years and older with a diagnosis of CAD who were prescribed a lipid-lowering therapy (based on current ACC/AHA guidelines) | 197 | 0073 |
| Heart Failure (HF): Warfarin Therapy Patients with Atrial Fibrillation | Percentage of all patients aged 18 and older with a diagnosis of heart failure and paroxysmal or chronic atrial fibrillation who were prescribed warfarin therapy | 200 | 0084 |
| Ischemic Vascular Disease (IVD): Blood Pressure Management | Percentage of patients 18 years of age and older who were discharged alive for acute myocardial infarction (AMI), coronary artery bypass graft (CABG) or percutaneous transluminal coronary angioplasty (PTCA) from January 1–November 1 of the year prior to the measurement year, or who had a diagnosis of ischemic vascular disease (IVD) during the measurement year and the year prior to the measurement year and whose most recent blood pressure is in control (<140/90 mmHg) | 201 | 0073 |
| Ischemic Vascular Disease (IVD): Use of Aspirin or Another Antithrombotic | Percentage of patients 18 years of age and older who were discharged alive for acute myocardial infarction (AMI), coronary artery bypass graft (CABG) or percutaneous transluminal coronary angioplasty (PTCA) from January 1– November 1 of the year prior to the measurement year, or who had a diagnosis of ischemic vascular disease (IVD) during the measurement year and the year prior to the measurement year and who had documentation of use of aspirin or another antithrombotic during the measurement year | 204 | 0068 |
| Initiation and Engagement of Alcohol and Other Drug Dependence Treatment: (a) Initiation, (b) Engagement | Percentage of adolescent and adult patients with a new episode of alcohol and other drug (AOD) dependence who initiate treatment through an inpatient AOD admission, outpatient visit, intensive outpatient encounter or partial hospitalization within 14 days of the diagnosis and who initiated treatment and who had two or more additional services with an AOD diagnosis within 30 days of the initiation visit | NA | 0004 |
| Prenatal Screening for Human Immunodeficiency Virus (HIV) | Percentage of patients, regardless of age, who gave birth during a 12-month period who were screened for HIV infection during the first or second prenatal visit | 0012 | |
| Prenatal Anti-D Immune Globulin | Percentage of D (Rh) negative, unsensitized patients, regardless of age, who gave birth during a 12-month period who received anti-D immune globulin at 26-30 weeks gestation | 0014 | |
| Controlling High Blood Pressure | Percentage of patients 18 to 85 years of age who had a diagnosis of hypertension and whose BP was adequately controlled during the measurement year | 0018 | |
| Cervical Cancer Screening | Percentage of women 21 to 64 years of age who received one or more Pap tests to screen for cervical cancer | 0032 | |
| Chlamydia Screening in Women | Percentage of women 15 to 24 years of age who were identified as sexually active and who had at least one test for chlamydia during the measurement year | 0033 | |
| Use of Appropriate Medications for Asthma | Percentage of patients 5 to 50 years of age during the measurement year who were identified as having persistent asthma and were appropriately prescribed medication during the measurement year. Report three age stratifications (5-11 years, 12 to 50 years, and total) | 0036 | |
| Low Back Pain: Use of Imaging Studies | Percentage of patients with a primary diagnosis of low back pain who did not have an imaging study (plain X-ray, MRI, CT scan) within 28 days of diagnosis | 0052 | |
| Ischemic Vascular Disease (IVD): Complete Lipid Panel and LDL Control | Percentage of patients 18 years of age and older who were discharged alive for acute myocardial infarction (AMI), coronary artery bypass graft (CABG) or percutaneous transluminal coronary angioplasty (PTCA) from January 1-November 1 of the year prior to the measurement year, or who had a diagnosis of ischemic vascular disease (IVD) during the measurement year and the year prior to the measurement year and who had a complete lipid profile performed during the measurement year and whose LDL-C was 0075 | ||
| Diabetes Care: Hemoglobin A1c Control (<8.0%) | Percentage of patients 18 to 75 years of age with diabetes (type 1 or type 2) who had HbA1c <8.0% | NA | 0575 |
