Centers for Medicare & Medicaid Services (CMS) established the Electronic Health Records Incentive Programs to promote meaningful use of certified EHR technology (CEHRT) among eligible professionals (EPs), eligible hospitals (EHs), and critical access hospitals (CEHRT).

 

To qualify for the EHR Incentive Programs, EPs has to achieve objectives of Meaningful Use. MU has three stages. Stage 1 outlined requirements for the electronic data capture. Stage 2 promoted the use of the CEHRT to continuously improve point of care and exchange structurally formatted information. CMS released Stage 3 as a final rule that modified Stage 2. This last one concentrated on CEHRT to improve health outcomes.

 

MU has five patient-drive objectives:

  • Improve quality, safety, and efficiency.
  • Engage patients and their families.
  • Improve care coordination.
  • Improve public and population health.
  • Ensure privacy and security for personal health information.

It is meant to result in better clinical outcomes, improved population health outcomes, increased transparency and efficiency, empowered individuals, and more robust research data on health systems.

 

The MU Stage 1

The MU Stage 1 was introduced in 2011-2012. During the EHR reporting period, it requires from EPs:

 

Core Objectives:

  • to use computerized provider order entry (CPOE) for medication orders (more than 30 percent of unique patients with at least one medication and at least one medication order entered through CPOE);
  • to implement drug-drug and drug-allergy check ;
  • to keep a continuously updated problem list of current and active diagnoses (minimum 80 percent of unique patients with corresponding notes recorded as structured data);
  • to create and transmit electronic permissible prescriptions (eRx) (more than 40 percent of permissible prescriptions electronically transmitted);
  • to keep active medication and medication allergy list (minimum 80 percent of unique patients with medication info and allergy info recorded as structured data);
  • to record such demographics information as preferred language, gender, race, ethnicity, and date of birth (more than 50 percent of unique patients with demographic records as structured data);
    to follow and record such vital signs changes as height, weight, blood pressure, body mass index, growth charts for children 2-20 years (more than 50 percent of unique patients with vital signs records as structured data);
  • to record smoking status for patients older than 13 years (more than 50 percent of unique patients with smoking status recorded as structured data);
  • to report ambulatory clinical measurements to CMS;
  • to implement one clinical decision support rule;
  • to provide patients with electronic copy of their health information upon request (more than 50 unique patients requested get such a copy within three business days);
  • to provide patients with clinical summary of their office visits (clinical summaries provided for over 50 percent of office visits);
  • to protect EHR information by conducting security risk analysis under 45 CFR 164.308(a)(1);

Menu Objectives:

  • to implement drug formulary checks;
  • to incorporate lab test results into EHR as structured data (more than 40 percent of lab results);
  • to generate lists of patients according to their specific conditions;
  • to send reminders to patients (65 years or older or 5 years of younger) for preventive/follow-up care (more than 20 percent of appropriate patients);
  • to provide patients with access to their health information within 4 business days (at least than 10 percent of unique patients);
  • to identify patient-specific education resources through certified EHR and provide patients with it if necessary (more that 10 percent of all unique users);
  • to perform medication reconciliation if a patient comes from another point of care (for more than 50 percent of care transitions);
  • to provide care record summary when transiting a patient (more than 50 percent of transitions and follow-up submission if successful);
  • to be able to submit electronic data to immunization information systems and do it when applicable by law and practice (at least one test performed);
  • to be able to submit electronic syndromic surveillance data to public health agencies and do it when applicable by law and practice (at least one test performed and follow-up submission if successful).

The MU Stage 2

The MU Stage 2 was introduced in October 2012. During the EHR reporting period, it requires from EPs:

 

Core Objectives:

  • to use computerized provider order entry (CPOE) for medication, laboratory, and radiology orders (more than 60 percent of medication, 30 percent of laboratory, and 20 percent of radiology order entries);
  • to create and transmit electronic permissible prescriptions (eRx) (more than 50 percent of permissible prescriptions electronically transmitted are compared to at least one formulary);
  • to record such demographics information as preferred language, sex, race, ethnicity, and date of birth (more than 80 percent of unique patients with demographic records as structured data);
  • to follow and record such vital signs changes as height/length and weight (no age limit), blood pressure (years 3 and older), body mass index, growth charts for children 0-20 years (more than 80 percent of unique patients with vital signs records as structured data);
  • to record smoking status for patients older than 13 years (more than 80 percent of unique patients with smoking status recorded as structured data);
  • to implement clinical decision support rules (5 clinical support interventions related to 4 or more clinical quality measures; the EP has drug-drug and drug-allergy interaction functionality enabled);
  • to provide patients with the ability to electronically view, download, and transmit health information within 4 business days (more than 50 percent of unique patients are timely provided with access to health information; more than 5 percent of unique patients can view, download, or transmit their health information);
  • to provide patients with clinical summary of their office visits (clinical summaries provided for over 50 percent of office visits within one business day);
  • to protect EHR information by conducting security risk analysis under 45 CFR 164.308(a)(1), including addressing the encryption/security of data at rest;
  • to incorporate lab test results into EHR as structured data (more than 55 percent of lab results);
  • to generate lists of patients according to their specific conditions (became the core objective);
  • to identify patients using clinically relevant info who should get reminders for preventive/follow-up care (more than 10 percent of all unique patients who have had 2 or more office visits within the EP within 24 months before the beginning of EHR reporting period);
  • to identify patient-specific education resources through certified EHR and provide patients with it if necessary (more that 10 percent of all unique users) (became the core objective);
  • to perform medication reconciliation if a patient comes from another point of care (for more than 50 percent of care transitions) (became the core objective);
  • to provide care record summary when transitioning a patient (more than 50 percent of transitions and follow-up submission if successful; more than 10 percent of such transitions are electronically transmitted with CEHRT; the recipient receives a summary record via exchange facilitated by organization participating in NwHIN Exchange or in a way consistent with the governance mechanism ONC establishes for the NwHIN) (became the core objective);
  • to be able to submit electronic data to immunization information systems and do it when applicable by law and practice (successful ongoing submission of electronic immunization data from CEHRT to immunization information system for the entire EHR reporting period) (became the core objective);
  • to use secure electronic messaging (more than 5 percent of unique patients sent a secure message using CEHRT);

Menu Objectives:

  • to be able to submit electronic syndromic surveillance data to public health agencies and do it when applicable by law and practice (successful ongoing submission for the entire EHR reporting period);

New

  • to record electronic notes in patient records (at least one created, edited, signed electronic note for more than 30 percent of unique patients; the text sent must be searchable and may contain drawings and other content);
  • to include imaging results with image and supporting and explaining content to the CEHRT (more than 10 percent of tests with image results accessible through CEHRT);
  • to record patient family health history as structured data (more than 20 percent of unique patients have a structured data entry for one or more first-degree relatives);
  • to identify and report cancer cases and transfer them to a public health central cancer registry (successful ongoing submission for the entire EHR reporting period);
    to identify and report specific cases and transfer them to a specialized registry (successful ongoing submission for the entire EHR reporting period).

The MU Stage 3

The MU Stage 3 was introduced in November 2016. During the EHR reporting period, it requires from EPs:

  • to protect electronic protected health information in CEHRT with technical, administrative, physical safeguards ( a security risk analysis in accordance with the requirements under 45 CFR 164.308(a)(1), 45 CFR 164.312(a)(2)(iv) and 45 CFR 164.306(d)(3));
  • to generate and transmit permissible prescriptions electronically (eRx) (more than 60 percent of prescriptions queried for a drug formulary and transmitted electronically using CEHRT);
  • to implement clinical decision support rules (5 clinical support interventions related to 4 or more clinical quality measures; if less than four — support intervention must be related to high-priority health conditions the EP has drug-drug and drug-allergy interaction functionality enabled);
  • to use CPOE for medication, laboratory, and diagnostic imaging orders (more than 60 percent of medication, laboratory, diagnostic imaging orders);
  • to provide patients with timely electronic access to their health information and patient-centric education (more than 80 percent of unique patients are timely provided with access to health information; the information must be available on any application of patient choice if it meets technical configurations of CEHRT API;
    more than 35 percent of unique patients must get access to patient-specific educational resources identified by relevant information from CEHRT);
  • to use CEHRT to engage with patients about their care (more than 5 percent of unique patients can view/download/transmit their health information, access health information through API with application of their choice; for 2018 – more than 10 percent;
  • more than 5 percent of unique patients got secure message through the corresponding function in CEHRT for 2018 – more than 25 percent;
    more than 5 percent of unique patients have patient generated health data or data from a nonclinical setting incorporated in CEHRT);
  • to provide care record summary when transitioning a patient and receive and incorporate a summary of care record after receipt of new patient (more than 50 percent of transitions and follow-up submission if successful;
    more than 40 percent of transitions and new patients have their electronic summary of care document incorporated into EHR;
    more than 80 percent of transitions and new patients have their clinical information reconciled, such as medication, medication allergy, and current problem list.
  • to actively engage with a public health agency or clinical data registry to submit electronic public health data in a meaningful way using certified EHR technology. Public health agencies and clinical data registries: immunization registry, syndromic surveillance, electronic case reporting, public health registry, clinical data registry.

The MU main goal is to reach high-quality healthcare service. And we are proud to be involved in the process of making healthcare more digitally efficient.

More healthcare legislation in the US can be found here: https://gloriumtech.com/blog/digital-health-regulations