Meaningful Use Criteria
HITECH Act’s goal is not adoption alone but “meaningful use” of EHRs — that is, their use by providers to achieve significant improvements in care. The legislation ties payments specifically to the achievement of advances in health care processes and outcomes.

HITECH calls on the secretary of health and human services to develop specific “meaningful use” objectives. With the Centers for Medicare and Medicaid Services (CMS) in the lead, the Department of Health and Human Services (DHHS) has used an inclusive and open process to develop these criteria, providing an extensive opportunity for public and professional input. The department published proposed meaningful use requirements on January 16, 2010. The proposal prompted some 2000 comments. The DHHS later released final regulation for the first 2 years (2011 and 2012) of this multiyear incentive program. Subsequent rules will govern later phases.

The most important part of this regulation is what it says hospitals and clinicians must do with EHRs to be considered meaningful users in 2011 and 2012. In the final regulation, DHSS has divided these elements into two groups: a set of core objectives that constitute an essential starting point for meaningful use of EHRs and a separate menu of additional important activities from which providers will choose several to implement in the first 2 years.

Summery overview of meaningful use objectives.*
Obective
Core Set
Measure
Record patient demographics (sex, race, ethnicity, date of birth preferred language, and in the case of hospitals, date and preliminary cause of death in the event of mortality)
More than 50% of patient’s demographic data recorded as structured data
Record vital signs and chart changes (height, weight, blood pressure, body-mass indes, growth charts for children)
More than 50% of patients 2 years age or older have height, weight, and blood pressure recorded as structured data.
Maintain up-to-date problem list of current and active diagnoses
More than 80% of patient have at least one entry recorded as structured data
Maintain active medication list
More than 80% of patient have at least one entry recorded as structured data
Maintain active medication allergy list
More than 80% of patients have at least one entry recorded as structured data.
Record smoking status for patients 13 years of age or elder
More than 50% of patients 13 years of age or older have smoking status recorded as structured data.
For individual professionals, provide patients with clinical summaries for each office visit; for hospitals, provide an electronic copy of hospital discharge instructions on request.
Clinical summaries provided to patients for more than 50% of all office visits within 3 business days; more than 50% of all patients who are discharged from the inpatient department or emergency department of an eligible hospital or critical access hospital and who request an electronic copy of their discharge instructions are provided with it.
On request, provide patients with an electronic copy of their health information (include diagnostic test results, problem list, medication lists, medication allergies, and for hospitals, discharge summary and procedures)
More than 50% of requesting patients receive electronic copy within 3 business days.
Generate & Transmit permissible prescriptions electronically (does not apply to hospitals)
More than 40% are transmitted electronically using certified EHR technology
Computer provider order entry(CPOE) for medication orders
More than 30% patients with at least one medication in their medication list have at least one medication ordered through CPOE
Implement drug-drug and drug-allergy interaction checks
Functionality is enabled for these checks for the entire reporting period
Implement capability to electronically exchange key clinical information among providers and patient authorized entities
Perform at least one test of EHR’s capacity to electronically exchange information
Implement one clinical decision support rule and ability to track compliance with the rule
One clinical decision support rule implementedd
Implement systems to protect privacy and security of patient data in the EHR
Conduct or review a security risk analysis, implement security updates as necessary, and correct identified security deficiencies
Report clinical quality measures to cms or states
For 2011 provide aggregate numerator and denominator through attestation; for 2012 electronically submit measures
Menu Set
Implement drug formulary checks
Drug formulary check system is implemented and has to at least one internal or external drug formulary for the entire reporting period
Incorporate clinical laboratory test results into EHRs as structured data
More than 40% of clinical laboratory test results whose results are in positive/negative or numerical format are incorporated into EHRs as structured data
Generate lists of patients by specific conditions to use for quality improvement, reduction of disparities, research, or outreach.
Generate at least one listing of patients with a specific condition
Use HER technology to identify patient-specify education resources and provide those to the patient as appropriate.
More than 10% of patients are provided patient specific education resources
Perform medication reconciliation between care settings
Medication reconciliation is performed for more than 50% of transitions of care
Provide summary of care record for patients referred or transitioned to another provider setting
Summary of care record is provided for more than 50% of patient transitions or referrals
Submit electronic immunization data to immunization registries or immunization information systems
Perform at least one test of data submission and follow up submission (where registries can accept electronic submissions)
Submit electronic syndromic surveillance data to public health agencies.
Perform at least one test of data submission and follow-up submission (where public health agencies can accept electronic data)
Additional choices for hospitals and critical access hospitals
Record advance directives for patients 65 years of age or older
More than 50% of patient 65 years of age or older have an indication of an advance directive status recorded
Submit of electronic data on reportable laboratory results to public health agencies
Perform at least one test of data submission and follow up submission (where public health agencies can accept electronic data)
Additional choices for eligible professionals
Send reminders to patients (per patient preference) for preventive and follow up care
More than 20% or patients 65 year s of age or older or 5 years of age or younger are sent appropriate reminders
Provide patients with timely electronic access to their health information (including laboratory results, problem list, medication lists, medication allergies)
More than 10% of patients are provided electronic access to information within 4 days of its being updated in the HER)
*This over view is meant to provide a reference tool indicating the key elements of meaningful use of health information technology, it does not provide sufficient information for providers to document and demonstrate meaningful use in order to obtain financial incentives from the centers for Medicare and Medicaid services . the regulations and filing requirements that must be fulfilled to qualify for the health it financial incentive program are detailed at www.cms.gov.
These objectives are to be achieved by all eligible professionals, hospitals and critical access hospitals in order to qualify for incentive payments.
Eligible professionals, hospitals, and critical access hospitals may select any five choices from the menu set.
Core objectives comprise basic functions that enable EHRs to support improved health care. As a start, these include the tasks essential to creating any medical record, including the entry of basic data: patients’ vital signs and demographics, active medications and allergies, up-to-date problem lists of current and active diagnoses, and smoking status.

Other core objectives include using several software applications that begin to realize the true potential of EHRs to improve the safety, quality, and efficiency of care. These features help clinicians to make better clinical decisions — and avoid preventable errors. To qualify for incentive payments, clinicians must start employing such clinical decision support tools. They must also start using the capability that undergirds much of the value of EHRs: using records to enter clinical orders and, in particular, medication prescriptions. Only when providers enter orders electronically can the computer help improve decisions by applying clinical logic to those choices in light of all the recorded patient data. And to begin extending the benefits of EHRs to patients themselves, the meaningful use requirements will include providing patients with electronic versions of their health information.

In addition to the core elements, the rule creates a second group: a menu of 10 additional tasks, from which providers can choose any 5 to implement in 2011–2012. This gives providers latitude to pick their own path toward full EHR implementation and meaningful use.

For example, the menu includes capacities to perform drug-formulary checks, incorporate clinical laboratory results into EHRs, provide reminders to patients for needed care, identify and provide patient-specific health education resources, and employ EHRs to support the patient’s transitions between care settings or personnel.

For most of the core and menu items, the regulation also specifies the rates at which providers will have to use particular functions to be considered meaningful users. Reflecting the views and experiences shared during the comment period, these rates will enable significant progress toward improving care — but are also achievable by average practices and providers in the early years.