Meaningful Use Stage 1 Requirements
The following chart is from the Final Ruling. This covers Stage 1 criteria for Eligible Professionals (EP). For information on Eligible Hospitals, Critical Access Hospitals, or Medicare Advantage, please read the final ruling.
Core Objectives
Each Eligible Professional must demonstrate use of all 15 Core Objectives (some exceptions are allowed based on patient population).
| Number | Section | Eligible Professional | Measurement |
|---|---|---|---|
| 1 | §170.304(a) | 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 percent of all unique patients with at least one medication in their medication list seen by the EP have at least one medication order entered using CPOE. |
| 2 | §170.302(a) | Implement drug-drug and drug-allergy interaction checks. | The EP has enabled this functionality for the entire EHR reporting period. |
| 3 | §170.302(c) | Maintain an up-to-date problem list of current and active diagnoses. | More than 80 percent of all unique patients seen by the EP have at least one entry or an indication that no problems are known for the patient recorded as structured data. |
| 4 | §170.304(b) | Generate and transmit permissible prescriptions electronically (eRx). | More than 40 percent of all permissible prescriptions written by the EP are transmitted electronically using certified EHR technology. |
| 5 | §170.302(d) | Maintain active medication list. | More than 80 percent of all unique patients seen by the EP have at least one entry (or an indication that the patient is not currently prescribed any medication) recorded as structured data. |
| 6 | §170.302(e) | Maintain active medication allergy list. | More than 80 percent of all unique patients seen by the EP have at least one entry (or an indication that the patient has no known medication allergies) recorded as structured data. |
| 7 | §170.304(c) | Record all of the following demographics: a. Preferred language. b. Gender. c. Race. d. Ethnicity. e. Date of birth. |
More than 50 percent of all unique patients seen by the EP have demographics recorded as structured data. |
| 8 | §170.302(f) | Record and chart changes in the following vital signs: a. Height. b. Weight. c. Blood pressure. d. Calculate and display body mass index (BMI). e. Plot and display growth charts for children 2 – 20 years, including BMI. |
More than 50 percent of all unique patients age 2 and over seen by the EP, height, weight and blood pressure are recorded as structured data. |
| 9 | v170.302(g) | Record smoking status for patients 13 years old or older. | More than 50 percent of all unique patients 13 years old or older seen by the EP have smoking status recorded as structured data. |
| 10 | §170.304(j) | Report ambulatory clinical quality measures to CMS or, in the case of Medicaid EPs, the States. | Successfully report to CMS (or, in the case of Medicaid EPs, the States) ambulatory clinical quality measures selected by CMS in the manner specified by CMS (or in the case of Medicaid EPs, the States). |
| 11 | §170.304(e) | Implement one clinical decision support rules relevant to specialty or high clinical priority along with the ability to track compliance with that rule. | Implement one clinical decision support rule. |
| 12 | §170.304(f) | Provide patients with an electronic copy of their health information (including diagnostics 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 3 business days. |
| 13 | §170.304(h) | 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. |
| 14 | §170.304(i) | Capability to exchange key clinical information (for example, problem list, medication list, allergies, and diagnostic test results), among providers of care and patient authorized entities electronically. | Performed at least one test of certified EHR technology’s capacity to electronically exchange key clinical information. |
| 15 | §170.302(o-v) | 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. |
Menu Set Objectives
Each eligible professional must demonstrate meaningful use of at least 5 of the 10 menu set objectives.
| Number | Section | Eligible Professional | Measurement |
|---|---|---|---|
| 1 | §170.302(b) | Implement drug-formulary checks. | The EP has enabled this functionality and has access to at least one internal or external formulary for the entire EHR reporting period. |
| 2 | §170.302(h) | Incorporate clinical lab-test results into EHR as structured data. | More than 40 percent of all clinical lab tests 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. |
| 3 | §170.302(i) | 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 | §170.304(d) | Send reminders to patients per patient preference for preventive/followup care. | More than 20 percent of all patients 65 years or older or 5 years old or younger were sent an appropriate reminder during the EHR reporting period. |
| 5 | §170.304(g) | Provide patients with timely electronic access to their health information (including lab results, problem list, medication lists, and allergies) within 4 business days of the information being available to the EP. | At least 10 percent 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 EP’s discretion to withhold certain information. |
| 6 | §170.302(m) | Use certified EHR technology to identify patient-specific education resources and provide those resources to the patient if appropriate. | More than 10 percent of all unique patients seen by the EP are provided patient-specific education resources. |
| 7 | §170.302(j) | 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. |
| 8 | §170.304(i) | The EP 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 care record for each transition of care or referral. | The EP who transitions or refers their patient to another setting of care or provider of care provides a summary of care record for more than 50 percent of transitions of care and referrals. |
| 9 | §170.302(k) | Capability to submit electronic data to immunization registries or immunization information systems and actual submission according to applicable law and practice. | 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 has the capacity to receive the information electronically). |
| 10 | §170.302(l) | Capability to submit electronic syndromic surveillance data to public health agencies and actual submission according to applicable law and practice. | 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 has the capacity to receive the information electronically). |
With the release of the final ruling for stage 2, CMS made a few changes to stage 1. Some of these changes will take effect January 1, 2013, for EPs. Other Stage 1 changes will not take effect until the 2014 fiscal or calendar year and will be optional in 2013. The following tables summarize these changes.
| New Objectives and Measures |
|---|
| New EP Objective: Provide patients the ability to view online, download and transmit their health information within 4 business days of the information being available to the EP. |
| New EP Measure: More than 50 percent of all unique patients seen by the EP during the EHR reporting period are provided timely (within 4 business days after the information is available to the EP) online access to their health information subject to the EP’s discretion to withhold certain information. |
| New Hospital Objective: Provide patients the ability to view online, download and transmit information about a hospital admission. |
| New Hospital Measure: More than 50 percent of all patients who are discharged from the inpatient or emergency department (POS 21 or 23) of an eligible hospital or CAH have their information available online within 36 hours of discharge. |
| Stage 1 Objective | Changes To Objective | Effective Year (CY/FY) |
|---|---|---|
| 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 | Change: Addition of an alternative measure | 2013 – Onward (Optional) |
| More than 30 percent of medication orders created by the EP or authorized providers of the eligible hospital’s or CAH’s inpatient or emergency department (POS 21 or 23) during the EHR reporting period are recorded using CPOE | ||
| Generate and transmit permissible prescriptions electronically (eRx) | Change: Addition of an additional exclusion | 2013 – Onward (Required) |
| 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. | ||
| Record and chart changes in vital signs | Change: Age Limitations on Growth Charts and Blood Pressure | 2013 Only (Optional) |
| More than 50 percent of all unique patients seen by the EP or admitted to the eligible hospital’s or CAH’s inpatient or emergency department (POS 21 or 23) 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 | 2014 – Onward (Required) | |
| Public Health Objectives: | Change: Addition of “except where prohibited” to the objective regulation text for the public health objectives under § 495.6 | 2013 – Onward (Required) |
| Record and chart changes in vital signs | Change: Changing the age and splitting the EP exclusion 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, weight, and blood pressure have no relevance to their scope of practice is excluded from recording them; (3) Believes that height and weight 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.  |
2013 Only (Optional) |
| 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, weight, and blood pressure have no relevance to their scope of practice is excluded from recording them; (3) Believes that height and weight 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. |
2014 – Onward (Required) | |
| Capability to exchange key clinical information (for example, problem list, medication list, medication allergies, and diagnostic test results), among providers of care and patient authorized entities electronically | Change: Objective is no longer required | 2013 – Onward (Required) |
| Report ambulatory/hospital clinical quality measures to CMS or the States | Change: Objective is incorporated directly into the definition of a meaningful EHR user and eliminated as an objective | 2013 – Onward (Required) |
| EP and Hospital Objectives: Provide patients with an electronic copy of their health information (including diagnostics test results, problem list, medication lists, medication allergies, discharge summary, procedures) upon request. | Change: Replace these four objectives with the Stage 2 objective and one of the two Stage 2 measures. | 2014 – Onward (Required) |
| EP Objective: Provide patients with timely electronic access to their health information (including lab results, problem list, medication lists, and allergies) within 4business days of the information being available to the EP. | EP Objective: Provide patients the ability to view online, download and transmit their health information within 4 business days of the information being available to the EP.
EP Measure: More than 50 percent of all unique patients seen by the EP during the EHR reporting period are provided timely (within 4 business days after the information is available to the EP) online access to their health information subject to the EP’s discretion to withhold certain information. |
|
| Hospital Objective: Provide patients with an electronic copy of their discharge instructions at time of discharge, upon request. | Hospital Objective: Provide patients the ability to view online, download and transmit information about a hospital admission.
Hospital Measure: More than 50 percent of all patients who are discharged from the inpatient or emergency department (POS 21 or 23) of an eligible hospital or CAH have their information available online within 36 hours of discharge. |
