What is EHR – Meaningful use

The American Recovery and Reinvestment Act of 2009 specifies three main components of Meaningful Use:

1. The use of a certified EHR in a meaningful manner, such as e-prescribing.

2. The use of certified EHR technology for electronic exchange of health information to improve quality of health care.

3. The use of certified EHR technology to submit clinical quality and other measures.

Simply put, “meaningful use” means providers need to show they’re using certified EHR technology in ways that can be measured significantly in quality and in quantity.

The meaningful use criteria is the culmination of an intensive process that involved input from several Federal Advisory Committees (the National Center for Vital Health Statistics, the HIT Policy Committee, and the HIT Standards Committee) and a notice of proposed rulemaking (NPRM) published on January 13, 2010.

Meaningful Use Stage 1 (2011 and 2012) sets the baseline for electronic data capture and information sharing.

The Stage 1 criteria for meaningful use focus on electronically capturing health information in a coded format, using that information to track key clinical conditions, communicating that information for care coordination purposes, and initiating the reporting of clinical quality measures and public health information.

The criteria for meaningful use are based on a series of specific objectives, each of which is tied to a measure that allows EPs and hospitals to demonstrate that they are meaningful users of certified EHR technology.

For Stage 1, which begins in 2011, there will be 25 objectives/measures for EPs and 24 objectives/measures for eligible hospitals. The objectives/measures have been divided into a core set and menu set. EPs and eligible hospitals must meet all objectives/measures in the core set (15 for EPs and 14 for eligible hospitals). They can choose to defer up to five remaining objectives/measures. Each objective/measure was evaluated for its potential applicability to all EPs and eligible hospitals. Where it is impossible for an EP or eligible hospital to meet a specific measure, an exclusion is defined in the final rule. If an exclusion applies to an EP or eligible hospital, then such professional or hospital does not have to meet that objective/measure in order to be determined a meaningful EHR user.

For example, if an EP has two exceptions (one for a core objective/measure and one for a menu objective/measure), the EP would need to meet the remaining 14 objectives/measures in the core set and four of the remaining nine objectives/measures in the menu set.

In 2011, EPs, eligible hospitals and CAHs seeking to demonstrate Meaningful Use are required to submit aggregate clinical quality measure numerator, denominator, and exclusion data to CMS or the States by attestation.

In 2012, EPs, eligible hospitals and CAHs seeking to demonstrate meaningful use must electronically submit clinical quality measures selected by CMS directly to CMS (or the States) through certified EHR technology.

Requirements for Stage 1 of Meaningful Use

Meaningful use includes both a core set and a menu set of objectives that are specific to eligible professionals or eligible hospitals and CAHs.

For eligible professionals, there are a total of 25 meaningful use objectives. To qualify for an incentive payment, 20 of these 25 objectives must be met.

There are 15 required core objectives.

The remaining 5 objectives may be chosen from the list of 10 menu set objectives.

For eligible hospitals and CAHs, there are a total of 24 meaningful use objectives. To qualify for an incentive payment, 19 of these 24 objectives must be met.

There are 14 required core objectives.

The remaining 5 objectives may be chosen from the list of 10 menu set objectives.

Use this link to view/download individual Measures: http://www.cms.gov/EHRIncentivePrograms/Downloads/EP-MU-TOC.pdf

Meaningful Use Stage 2 (expected to be implemented in 2013)

Stage 2 would expand upon the Stage 1 criteria in the areas of disease management, clinical decision support, medication management support for patient access to their health information, transitions in care, quality measurement and research, and bi-directional communication with public health agencies. These changes will be reflected by a larger number of core objective requirements for Stage 2. CMS may also consider applying the criteria more broadly to the outpatient hospital settings (and not just the emergency department).

Meaningful Use Stage 3 (expected to be implemented in 2015)

Stage 3 would focus on achieving improvements in quality, safety and efficiency, focusing on decision support for national high priority conditions, patient access to self management tools, access to comprehensive patient data, and improving population health outcomes.