“Meaningful Use” for Ambulatory Care Medical Practices

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EHR Objectives and Measures

By Shahid N. Shah MS  

For ambulatory care practices and physicians there are about 25 objectives and measures that must be met to become a “meaningful user”. Keep in mind that meaningful use is not tied to a certified EHR alone; in fact, unless you use the EHR properly and in all the ways the government wants you to, you will not be a “meaningful user”.

Don’t be fooled by EHR vendors guaranteeing that they will make you a “meaningful user” – no vendor’s software, no matter how nice, can get your staff to use the software in the way the government wants. You, as the CIO of your practice, are the only one that can guarantee that. In fact, you don’t even need an EHR from a vendor to meet the requirements – you can even roll your own, use open source, or find any other means.

Fear and Promises

In general, as long as you can attest and send data to the government that they require you can do it in any way that you want. Be aware that some unscrupulous vendors are scaring practices and making promises that they cannot keep.

Final MU Rules

The final Meaningful Use (MU) Rule was published by HHS on July 13, 2010. It defines 24 objectives for and measures eligible hospitals that could be met to become a meaningful user and qualify for incentive funding. There is a “core set” that must be met by all institutions and a “menu set” of from which organizations must implement at least 5 objectives.

Core Set Objectives

These are the “core set” of 14 objectives that must be met by all institutions and a “menu set” of 10 from which organizations must implement at least 5 objectives (at least 1 public health objective must be chosen from that set).

  1. Use Computer Provider Order Entry (CPOE).
  2. Implement drug-drug, drug-allergy, and drug-formulary checks.
  3. Record demographics.
  4. Implement one clinical decision support rule.
  5. Maintain an up-to-date problem list of current and active diagnoses based on ICD-9-CM or SNOMED CT.
  6. Maintain active medication list.
  7. Maintain active medication allergy list.
  8. Record and chart changes in vital signs.
  9. Record smoking status for patients 13 years or older.
  10. Report hospital clinical quality measures to CMS or States.
  11. Provide patients with an electronic copy of their health information, upon request.
  12. Provide patients with an electronic copy of their discharge instructions at time of discharge, upon request.
  13. Capability to exchange key clinical information among providers of care and patient-authorized entities electronically.
  14. Protect electronic health information.

Menu Set Objectives

These are the “menu set” of 10 objectives from which organizations must implement at least 5. At least one public health objective must be chosen from this set as well (numbers 8 or 9). Drug-formulary checks.

  1. Record advanced directives for patients 65 years or older.
  2. Incorporate clinical lab test results as structured data.
  3. Generate lists of patients by specific conditions.
  4. Use certified EHR technology to identify patient-specific education resources and provide to patient, if appropriate.
  5. Medication reconciliation.
  6. Summary of care record for each transition of care/referrals.
  7. Capability to submit electronic data to immunization registries/systems.
  8. Capability to provide electronic submission of reportable lab results to public health agencies.
  9. Capability to provide electronic syndromic surveillance data to public health agencies.

Government Agencies and Participants Involved in MU

As you can see in the Figure, the Office of the National Coordinator for Healthcare IT (ONCHIT) is a component of the Department of Health and Human Services (HHS). ONCHIT, usually abbreviated just ONC, is the principal policy group of the Federal Government that defines and manages NHIN.

Figure Link: Figure 

* ONC is responsible for coordinating with the Department of Commerce’s National Institute of Standards and Technology (NIST) on the specifications for the NHIN standards.

* The HIT Policy and HIT Standards Committees are the working groups that advise ONC on what to put in the standards.

* NIST is responsible for coming up with the test materials (assertions, procedures, methods, tools, data, and so on) that will be used to certify working systems 


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7 Responses

  1. Advocates now want EHR incentives for mental and behavioral health providers

    Advocates are asking Congress to include mental and behavioral health providers in qualifying for EHR incentives, via “meaningful use”. They say having interoperable healthcare IT systems would benefit their patients and their profession.

    What do you think?



  2. EHR Incentive Payments Doubled in Last Three Months of 2011

    Total payments to hospitals through the Medicare and Medicaid electronic health-record system incentive programs more than doubled from October through December to more than $1.9 billion, according to the CMS’s latest monthly report on payment and registration support. Combined payments to physicians and other so-called eligible professionals jumped 99% over the same period to nearly $570.4 million.

    There were 176,049 active registrants in the programs by the end of December, up 27% since October, according to the CMS’ data. Among them, 98% were eligible professionals; 2% were hospitals. About 75% of eligible professionals receiving payments—10,530 of them—are physicians, with nurse practitioners, dentists, certified nurse midwives, and physician assistants accounting for the rest, according to the CMS.

    Source: Joseph Conn, Modern Healthcare [1/18/12]


  3. Maintaining Criteria for CMS Incentives

    If you qualified for year one … you qualified for year one. Deposit the check and pat yourself on the back. I too worked myself ragged, added a couple of hours to my charting each day … and collected $18,000 for 90 days (actually 6 months) of added stress. But, I have opted NOT TO continue into year 2 … as $1,000 per month for 365 straight days of compliance is too much to bear. There is no mandatory need to comply until 2015.

    I plan to use my software, comply as much as possible, not pull my hair out until 2015 when we have to be 100% compliant, 100% of the time. I know there are those with big staffs, and big overhead who will disagree, and have their assistants do all the charting. For those of us in solo practice struggling to make ends meet, this burden is NOT WORTH carrying into year #2.

    Ann Miller RN MHA
    via Name Withheld (FL)
    PM Mews #4,382


  4. Do Docs have little control over Meanng Use Stage 2 incentives?

    According to attorney Elizabeth Litten, of Princeton NJ based lawfirm Fox Rothschild, many medical providers who want to demonstrate that they are using their electronic health records in a meaningful way under Stage 2 of the EHR incentive program, will find it much harder to meet the thresholds when some of the criteria are beyond their direct control.


    Any thoughts?



  5. CMS Extends Deadline to Appeal EHR Incentive Eligibility

    Physicians and other so-called eligible professionals still wanting to appeal their eligibility determinations for the 2011 Medicare electronic health-record incentive payment program will have an extra month to file those appeals, the CMS announced. The new deadline is April 30th.

    The eligibility period for the first round, or Stage 1, of the program, in which providers needed to attest to having met 90 consecutive days of meaningful use of an EHR, began Jan. 1, 2011, and ended December 31, 2011. Appeals allow providers an opportunity to show they have met all the requirements for the incentive payment program under the American Recovery and Reinvestment Act of 2009, according to the CMS.

    Source: Joseph Conn, Modern Healthcare [4/3/12]


  6. CMS Contractor Begins Meaningful-Use Audits

    A contractor working for the CMS has begun the promised audits of Medicare providers and dual-eligible Medicare and Medicaid hospitals that have received federal electronic health-record system incentive payments, the agency confirmed. The CMS hired Figliozzi & Company of Garden City, NY to perform the audits of providers that have attested to having achieved meaningful use of an EHR under the programs created by the American Recovery and Reinvestment Act of 2009.

    The CMS, other than confirming that the audits were under way, declined to elaborate on the extent of the audit program. According to the CMS’ website, those being audited will receive a letter from Figliozzi & Company with the CMS logo on the letterhead. The CMS, in audit guidelines posted online, advises providers to “save the supporting electronic or paper documentation that support your attestation,” including documentation that will back up their payment calculations.

    Source: Joseph Conn, Modern Healthcare [7/24/12]


  7. Few Hospitals, Docs at Stage 2 Meaningful Use, CMS Official Says

    Only four hospitals have achieved Stage 2 meaningful use of electronic health records seven months into the reporting period for hospitals enrolled in the federal EHR incentive-payment program, a CMS official reported today. Among physicians and other eligible professionals—who are four months into their reporting year—only 50 have attested to Stage 2 meaningful use, said Elizabeth Myers, policy and outreach lead at the CMS’ Office of eHealth Standards and Services, during a presentation to the agency’s Health Information Technology Policy Committee.

    Those low numbers mean that many hospitals and vendors will be under tremendous pressure in the closing months of their incentive payment years to hit Stage 2 or suffer lower Medicare reimbursements. Physicians and other eligible professionals who have attested to two or more years at Stage 1 of the Medicare EHR incentive program also must step up to Stage 2, but must do so by the end of 2014. The payment year for physicians and other professionals is measured by the calendar year; consequently, their first 90-day attestation period began Jan. 1, 2014.

    Source: Joseph Conn, Modern Healthcare [5/6/14]


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