Meaningful Use
Content
Overview for 2014 Participation
Payments and Adjustments
Incentive Payments
Up to $43,720.00 over five years Subject to annual limit equal to 75% of providers allowed charges Report for first year in 2014 and may earn payment for three years 2% reduction to all reporting periods ending on or after 4/1/2013
Maximum Payment by Start Year
2011
1
2012
1
2013
1 $7,840
Reduction $160
2014
2 $3,920
Reduction $80
2015
2 $1,960
Reduction $40
2016
2
2011
$43,720 2012
$43,480 2013 $38,220 2014 $23,520
$18,000
$12,000 1
$18,000
1 $11,760
Reduction $240
2 $7,840
Reduction $160
2 $3,920
Reduction $80
2 $1,960
Reduction $40
1
1
2 $7,840
Reduction $160
2 $3,920
Reduction $80
1 $11,760
Reduction $240
1 $7,840
Reduction $160
2 $3,920
Reduction $80
Payments and Adjustments
Penalties
Begin 1/1/2015 for all EP’s who have not attested by 10/1/2014 Cumulative maximum of 5% of Medicare payments 1% in 2015 2% in 2016 3% in 2017 If in 2018 less than 75% of EPs are meaningful users the
penalties will continue to increase 1% each year to a maximum of 5% in 2019
Who is eligible for Stage 2?
Any Eligible Professional who has already attested to
Meaningful Use Stage 1 for a minimum of two years
1st Year 2011 2012 2013 2014 2015 2016 2017 Stage of Meaningful Use
2011 2012 2013 2014 2015 2016 2017 2018 2019 2020 2021
1
1 1
1 1 1
2 2 1 1
2 2 2 1 1
2 2 2 2 1 1
3 3 3 2 2 1 1
3 3 3 3 2 2 1
TBD TBD TBD 3 3 2 2
TBD TBD TBD TBD 3 3 2
TBD TBD TBD TBD TBD 3 3
Reporting Period in 2014
Stage 1 - 1st Year
90 day reporting period Any 90 day period that the provider wishes Must attest by 10/1/2014 to avoid 2015 payment reduction
Stage 1 - 2nd Year 90 day reporting period Must align with a calendar quarter Must attest by 2/28/2015
Stage 2
90 day reporting period
Must align with a calendar quarter Must attest by 02/28/2015
Stage 1 vs Stage 2 Stage 2 Core Objectives Stage 2 Menu Objectives Clinical Quality Measures
Objectives
Stage 1 Objectives will remain the same under the 2013
requirements Stage 2 has a total of 20 modified objectives and 9 clinical quality measures
Stage 2 Core Objectives
#1 CPOE More than 60% of medication, 30% of laboratory, and 30% of radiology orders created by the EP during the EHR reporting period are recorded using CPOE.
Numerator 1: The number of orders in the denominator recorded using CPOE Denominator 1: Number of medication orders created by the EP during the EHR reporting period. Numerator 2: The number of orders in the denominator recorded using CPOE Denominator 2: Number of laboratory orders created by the EP during the EHR reporting period. Numerator 3: The number of orders in the denominator recorded using CPOE Denominator 3: Number of radiology orders created by the EP during the EHR reporting period.
Changes from Stage 1 Core 1:
Increase Medication CPOE requirement from 30% to 60% Add Laboratory CPOE requirement at 30% Add Radiology CPOE requirement at 30%
Stage 2 Core Objectives
#2 eRx More than 50 percent of all permissible prescriptions, or all prescriptions, written by the EP are queried for a drug formulary and transmitted electronically using CEHRT.
Numerator: The number of prescriptions in the denominator generated, queried for a drug formulary and transmitted electronically using CEHRT. Denominator: Number of prescriptions written for drugs requiring a prescription in order to be dispensed other than controlled substances during the EHR reporting period; or Number of prescriptions written for drugs requiring a prescription in order to be dispensed during the EHR reporting period.
Changes from Stage 1 Core 4:
Increase e-prescribed requirement from more 40% to more 50% (must
be at least 51%)
Stage 2 Core Objectives
#3 Demographics
More than 80 percent of all unique patients seen by
the EP have demographics recorded as structured data.
Numerator: The number of patients in the denominator who have all the elements of
demographics (or a specific notation if the patient declined to provide one or more elements or if recording an element is contrary to state law) recorded as structured data. Denominator: Number of unique patients seen by the EP during the EHR reporting period.
Changes from Stage 1 Core 7: Increase demographic requirement from 50% to 80%
Stage 2 Core Objectives
#4 Vitals
More than 80 percent of all unique patients seen by the EP have blood pressure (for patients age 3 and over only) and/or height and weight (for all ages) recorded as structured data.
Numerator: Number of patients in the denominator who have at least one entry of their height/length and weight (all ages) and/or blood pressure (ages 3 and over) recorded as structured data. Denominator: Number of unique patients seen by the EP during the EHR reporting period.
Changes from Stage 1 Core 8:
Increase vitals requirement from 50% to 80%. Increase minimum age from 2 years old to three years old. Increase age range for plot and chart growth from 2-20 years to 0-20 years. Modified Exclusions now include:
(1) Sees no patients 3 years or older is excluded from recording blood pressure. (2) Believes that all 3 vital signs of height/length, weight, and blood pressure have no relevance to their scope of practice is excluded from recording them. (3) Believes that height/length and weight are relevant to their scope of practice, but blood pressure is not, is excluded from recording blood pressure. (4) Believes that blood pressure is relevant to their scope of practice, but height/length and weight are not, is excluded from recording height/length and weight.
Stage 2 Core Objectives
#5 Smoking Status
More than 80 percent of all unique patients 13 years old or older seen by the EP have smoking status recorded as structured data.
Numerator: The number of patients in the denominator with smoking status recorded as structured data. Denominator: Number of unique patients age 13 or older seen by the EP during the EHR reporting period.
Changes from Stage 1 Core 9:
Increase smoking status requirement from 50% to 80% Smoking status must be coded in one of the following SNOMED CT® codes:
(1) Current every day smoker. 449868002 (2) Current some day smoker. 428041000124106 (3) Former smoker. 8517006 (4) Never smoker. 266919005 (5) Smoker, current status unknown. 77176002 (6) Unknown if ever smoked. 266927001 (7) Heavy tobacco smoker. 428071000124103 (8) Light tobacco smoker. 428061000124105
Stage 2 Core Objectives
#6 Clinical Decision Support
Implement five clinical decision support interventions related to four or more clinical quality measures at a relevant point in patient care for the entire EHR reporting period. Absent four clinical quality measures related to an EP’s scope of practice or patient population, the clinical decision support interventions must be related to high-priority health conditions. The EP has enabled and implemented the functionality for drug-drug and drug-allergy interaction checks for the entire EHR reporting period.
Attestation: Yes/No for each measure
Changes from Stage 1 Core 11:
Increase support rule requirement from 1 to 5 Require support rule relate to at least 4 CQMs Include stage 1 menu objective 1 (drug formulary checks)
Stage 2 Core Objectives
#7 Patient Electronic Access
More than 50 percent of all unique patients seen by the EP during the EHR reporting period are provided timely (available to the patient within 4 business days after the information is available to the EP) online access to their health information. More than 5 percent of all unique patients seen by the EP during the EHR reporting period (or their authorized representatives) view, download, or transmit to a third party their health information.
Numerator 1: The number of patients in the denominator who have timely (within 4 business days after the information is available to the EP) online access to their health information. Denominator 1: Number of unique patients seen by the EP during the EHR reporting period. Numerator 2: The number of unique patients (or their authorized representatives) in the denominator who have viewed online, downloaded, or transmitted to a third party the patient's health information. Denominator 2: Number of unique patients seen by the EP during the EHR reporting period.
Changes from Stage 1 Menu 5:
Now required as a core objective Increase access requirement from 10% to 50% Include requirement for 5% of patients to utilize electronic access
Stage 2 Core Objectives
#8 Clinical Summaries
Clinical summaries provided to patients or patient-authorized
representatives within one business day for more than 50 percent of office visits.
Numerator: Number of office visits in the denominator where the patient or a patient-authorized representative is provided a clinical summary of their visit within one (1) business day. Denominator: Number of office visits conducted by the EP during the EHR reporting period.
Changes from Stage 1 Core 13:
Decrease timeframe from 3 days to 1 business day after visit. Add the requirement for the clinical summary to include:
Demographic information maintained within certified electronic health record technology (CEHRT) (sex, race, ethnicity, date of birth, preferred language). Smoking status. Care plan field(s), including goals and instructions. Recommended patient decision aids (if applicable to the visit).
Stage 2 Core Objectives
#9 Protect Electronic Health Information
Conduct or review a security risk analysis in accordance with the requirements under 45 CFR 164.308(a) (1), including addressing the encryption/security of data stored in CEHRT in accordance with requirements under 45 CFR 164.312 (a)(2)(iv) and 45 CFR 164.306(d)(3), and implement security updates as necessary and correct identified security deficiencies as part of the provider's risk management process for EPs.
Attestation: Yes/No
Changes from Stage 1 Core 15:
Include the following standards for EHR: Record actions related to electronic health information, audit log status, and encryption status Encryption and decryption of electronic health information Create message digest Record treatment, payment, and health care operations disclosures
Stage 2 Core Objectives
#10 Clinical Lab Test Results More than 55 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.
Numerator: Number of lab test results which are expressed in a positive or negative affirmation or as a numeric result which are incorporated in CEHRT as structured data. Denominator: Number of lab tests ordered during the EHR reporting period by the EP whose results are expressed in a positive or negative affirmation or as a number.
Changes from Stage 1 Menu 2: Now required as a core objective Increase lab result requirement from 40% to 55%
Stage 2 Core Objectives
#11 Patient Lists
Generate at least one report listing patients of the EP with
a specific condition.
Attestation: Yes/No
Changes from Stage 1 Menu 3:
Now required as a core objective
Stage 2 Core Objectives
#12 Preventative / Follow Up Care Reminders
More than 10 percent of all unique patients who have had 2 or more office visits with the EP within the 24 months before the beginning of the EHR reporting period were sent a reminder, per patient preference when available.
Numerator: Number of patients in the denominator who were sent a reminder per
patient preference when available during the EHR reporting period. Denominator: Number of unique patients who have had two or more office visits with the EP in the 24 months prior to the beginning of the EHR reporting period.
Changes from Stage 1 Menu 4:
Now required as a core objective Decrease requirement from 20% to 10% Include requirement that reminder not be related to already scheduled
appointments/treatment
Stage 2 Core Objectives
#13 Patient Education
Patient-specific education resources identified by Certified EHR Technology are provided to patients for more than 10 percent of all unique patients with office visits seen by the EP during the EHR reporting period.
Numerator: Number of patients in the denominator who were provided patient-
specific education resources identified by the Certified EHR Technology. Denominator: Number of unique patients with office visits seen by the EP during the EHR reporting period.
Changes from Stage 1 Menu 6:
Now required as a core objective Cannot include items provided to the patient, but not identified by CEHRT
Stage 2 Core Objectives
#14 Medication Reconciliation
The EP who performs medication reconciliation for more than
50 percent of transitions of care in which the patient is transitioned into the care of the EP.
Numerator: The number of transitions of care in the denominator
where medication reconciliation was performed. Denominator: Number of transitions of care during the EHR reporting period for which the EP was the receiving party of the transition.
Changes from Stage 1 Menu 7:
Now required as a core objective The medication list should include the Name, Dosage, Frequency, and
Route
Stage 2 Core Objectives
#15 Summary of Care Record
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. Numerator 1: The number of transitions of care and referrals in the denominator where a summary of care record was provided. Denominator 1: Number of transitions of care and referrals during the EHR reporting period for which the EP was the transferring or referring provider. 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 10 percent of such transitions and referrals either (a) electronically transmitted using CEHRT to a recipient or (b) where the recipient receives the summary of care record via exchange facilitated by an organization that is a NwHIN Exchange participant or in a manner that is consistent with the governance mechanism ONC establishes for the NwHIN. Numerator 2: The number of transitions of care and referrals in the denominator where a summary of care record was a) electronically transmitted using CEHRT to a recipient or b) where the recipient receives the summary of care record via exchange facilitated by an organization that is a NwHIN Exchange participant or in a manner that is consistent with the governance mechanism ONC establishes for the nationwide health information network. The organization can be a third-party or the sender's own organization. Denominator 2: Number of transitions of care and referrals during the EHR reporting period for which the EP was the transferring or referring provider.
Stage 2 Core Objectives
#15 Summary of Care Record continued
An EP must satisfy one of the following criteria:
Conducts one or more successful electronic exchanges of a summary of care
document, as part of which is counted in "measure 2" (for EPs the measure at §495.6(j)(14)(ii)(B) with a recipient who has EHR technology that was developed designed by a different EHR technology developer than the sender's EHR technology certified to 45 CFR 170.314(b)(2). Conducts one or more successful tests with the CMS designated test EHR during the EHR reporting period.
Attestation: Yes/No
Changes from Stage 1 Menu 8:
Now required as a core objective Exclusion for those who transition less than 100 patients during the reporting period Include the requirement to transfer SOCR electronically or test with CMS Include requirement to exchange electronically 10% of the time
Stage 2 Core Objectives
#16 Immunization Registries
Successful ongoing submission of electronic immunization data from CEHRT to an immunization registry or immunization information system for the entire
EHR reporting period.
Attestation: Yes/No
Changes from Stage 1 Menu 9:
Now required as a core objective
Stage 2 Core Objectives
#17 Use Secure Electronic Messaging
A secure message was sent using the electronic messaging function of CEHRT by more than 5 percent of unique patients (or their authorized representatives) seen by the EP during the EHR reporting period.
Numerator: The number of patients or patient-authorized representatives in the
denominator who send a secure electronic message to the EP that is received using the electronic messaging function of CEHRT during the EHR reporting period. Denominator: Number of unique patients seen by the EP during the EHR reporting period.
Changes from Stage 1:
This is a new Objective which defines a secure message as “any electronic communication
between a provider and patient that ensures only those parties can access the communication. This electronic message could be email or the electronic messaging function of a PHR, an online patient portal, or any other electronic means”.
Stage 2 Menu Objectives
#1 Syndromic Surveillance
Successful ongoing submission of electronic syndromic surveillance data from CEHRT to a public health agency for the entire EHR reporting period.
Attestation: Yes/No
Changes from Stage 1 Menu 10:
Change from one test to ongoing submission Include additional exclusions for: EP operates in a jurisdiction for which no public health agency is capable of receiving electronic syndromic surveillance data in the specific standards required by CEHRT at the start of their EHR reporting period; EP operates in a jurisdiction where no public health agency provides information timely on capability to receive syndromic surveillance data; or EP operates in a jurisdiction for which no public health agency that is capable of accepting the specific standards required by CEHRT at the start of their EHR reporting period can enroll additional EPs.
Stage 2 Menu Objectives
#2 Electronic Note
Enter at least one electronic progress note created, edited and signed by an EP for more than 30 percent of unique patients with at least one office visit during the EHR reporting period. The text of the electronic note must be text searchable and may contain drawings and other content
Numerator: The number of unique patients in the denominator who have at least one electronic progress note from an eligible professional recorded as text searchable data. Denominator: Number of unique patients with at least one office visit during the EHR reporting period for EPs during the EHR reporting period.
Changes from Stage 1:
New Objective
Stage 2 Menu Objectives
#3 Imaging Results
More than 10 percent of all tests whose result is one or more images
ordered by the EP during the EHR reporting period are accessible through CEHRT.
Numerator: The number of results in the denominator that are accessible through CEHRT. Denominator: Number of tests whose result is one or more images ordered by the EP during the EHR reporting period.
Changes from Stage 1:
New Objective
Accessible is defined as either stored in the CEHRT or indication of the study with a link to the image
Stage 2 Menu Objectives
#4 Family Health History
More than 20 percent of all unique patients seen by the EP during the
EHR reporting period have a structured data entry for one or more first-degree relatives.
Numerator: The number of patients in the denominator with a structured data
entry for one or more first-degree relatives. Denominator: Number of unique patients seen by the EP during the EHR reporting period.
Changes from Stage 1:
New Objective This is not limited to first degree relatives, but merely a minimum.
Stage 2 Menu Objectives
#5 Report Cancer Cases
Successful ongoing submission of cancer case information from
CEHRT to a public health central cancer registry for the entire EHR reporting period.
Attestation: Yes/No
Changes from Stage 1: New Objective
Exclusion is available for providers that do not diagnose/treat cancer.
Stage 2 Menu Objectives
#6 Report Specific Cases
Successful ongoing submission of specific case information from
CEHRT to a specialized registry for the entire EHR reporting period.
Attestation: Yes/No
Changes from Stage 1: New Objective
Exclusion is available for providers that do not diagnose/treat cancer. Defines specialized registries as those that are sponsored by national specialty societies and specialized registries maintained by public health agencies.
Clinical Quality Measures
Stage 1 and Stage 2
Must report on 9 measures Must electronically report to Must cover 3 of the NQS
Domains
Patient and Family
CMS No longer have core measure, only recommended measures May report for entire calendar year , not just 90 days required May satisfy PQRS if EP has previously demonstrated MU
Engagement Patient Safety Care Coordination Population and Public Health Efficient use of healthcare resources Clinical Process Effectiveness
Clinical Quality Measures
CMS Measure ID CMS166v1 CMS138v1 CMS69v1 CMS155v1 CMS123v1 CMS147v1 CMS66v1 CMS56v1 CMS68v1 CMS139v1 CMS50v1 CMS156v1 Adult Core YES YES YES no no no no no YES no YES YES Pediatric Core no no no YES no no no no no no no no Domain Efficient Use of Healthcare Resources Population/ Public Health Population/ Public Health Population/ Public Health Clinical Process/ Effectiveness Population/ Public Health Patient and Family Engagement Patient and Family Engagement Patient Safety Patient Safety Care Coordination Patient Safety Title Use of Imaging Studies for Low Back Pain Preventive Care and Screening: Tobacco Use: Screening and Cessation Intervention Preventive Care and Screening: Body Mass Index (BMI) Screening and Follow-Up Weight Assessment and Counseling for Nutrition and Physical Activity for Children and Adolescents Diabetes: Foot Exam Preventative Care and Screening: Influenza Immunization Functional status assessment for knee replacement Functional status assessment for hip replacement Documentation of Current Medications in the Medical Record Falls: Screening for Future Fall Risk Closing the referral loop: receipt of specialist report Use of High-Risk Medications in the Elderly
Payments and Adjustments
Incentive Payments
Up to $43,720.00 over five years Subject to annual limit equal to 75% of providers allowed charges Report for first year in 2014 and may earn payment for three years 2% reduction to all reporting periods ending on or after 4/1/2013
Maximum Payment by Start Year
2011
1
2012
1
2013
1 $7,840
Reduction $160
2014
2 $3,920
Reduction $80
2015
2 $1,960
Reduction $40
2016
2
2011
$43,720 2012
$43,480 2013 $38,220 2014 $23,520
$18,000
$12,000 1
$18,000
1 $11,760
Reduction $240
2 $7,840
Reduction $160
2 $3,920
Reduction $80
2 $1,960
Reduction $40
1
1
2 $7,840
Reduction $160
2 $3,920
Reduction $80
1 $11,760
Reduction $240
1 $7,840
Reduction $160
2 $3,920
Reduction $80
Payments and Adjustments
Penalties
Begin 1/1/2015 for all EP’s who have not attested by 10/1/2014 Cumulative maximum of 5% of Medicare payments 1% in 2015 2% in 2016 3% in 2017 If in 2018 less than 75% of EPs are meaningful users the
penalties will continue to increase 1% each year to a maximum of 5% in 2019
Who is eligible for Stage 2?
Any Eligible Professional who has already attested to
Meaningful Use Stage 1 for a minimum of two years
1st Year 2011 2012 2013 2014 2015 2016 2017 Stage of Meaningful Use
2011 2012 2013 2014 2015 2016 2017 2018 2019 2020 2021
1
1 1
1 1 1
2 2 1 1
2 2 2 1 1
2 2 2 2 1 1
3 3 3 2 2 1 1
3 3 3 3 2 2 1
TBD TBD TBD 3 3 2 2
TBD TBD TBD TBD 3 3 2
TBD TBD TBD TBD TBD 3 3
Reporting Period in 2014
Stage 1 - 1st Year
90 day reporting period Any 90 day period that the provider wishes Must attest by 10/1/2014 to avoid 2015 payment reduction
Stage 1 - 2nd Year 90 day reporting period Must align with a calendar quarter Must attest by 2/28/2015
Stage 2
90 day reporting period
Must align with a calendar quarter Must attest by 02/28/2015
Stage 1 vs Stage 2 Stage 2 Core Objectives Stage 2 Menu Objectives Clinical Quality Measures
Objectives
Stage 1 Objectives will remain the same under the 2013
requirements Stage 2 has a total of 20 modified objectives and 9 clinical quality measures
Stage 2 Core Objectives
#1 CPOE More than 60% of medication, 30% of laboratory, and 30% of radiology orders created by the EP during the EHR reporting period are recorded using CPOE.
Numerator 1: The number of orders in the denominator recorded using CPOE Denominator 1: Number of medication orders created by the EP during the EHR reporting period. Numerator 2: The number of orders in the denominator recorded using CPOE Denominator 2: Number of laboratory orders created by the EP during the EHR reporting period. Numerator 3: The number of orders in the denominator recorded using CPOE Denominator 3: Number of radiology orders created by the EP during the EHR reporting period.
Changes from Stage 1 Core 1:
Increase Medication CPOE requirement from 30% to 60% Add Laboratory CPOE requirement at 30% Add Radiology CPOE requirement at 30%
Stage 2 Core Objectives
#2 eRx More than 50 percent of all permissible prescriptions, or all prescriptions, written by the EP are queried for a drug formulary and transmitted electronically using CEHRT.
Numerator: The number of prescriptions in the denominator generated, queried for a drug formulary and transmitted electronically using CEHRT. Denominator: Number of prescriptions written for drugs requiring a prescription in order to be dispensed other than controlled substances during the EHR reporting period; or Number of prescriptions written for drugs requiring a prescription in order to be dispensed during the EHR reporting period.
Changes from Stage 1 Core 4:
Increase e-prescribed requirement from more 40% to more 50% (must
be at least 51%)
Stage 2 Core Objectives
#3 Demographics
More than 80 percent of all unique patients seen by
the EP have demographics recorded as structured data.
Numerator: The number of patients in the denominator who have all the elements of
demographics (or a specific notation if the patient declined to provide one or more elements or if recording an element is contrary to state law) recorded as structured data. Denominator: Number of unique patients seen by the EP during the EHR reporting period.
Changes from Stage 1 Core 7: Increase demographic requirement from 50% to 80%
Stage 2 Core Objectives
#4 Vitals
More than 80 percent of all unique patients seen by the EP have blood pressure (for patients age 3 and over only) and/or height and weight (for all ages) recorded as structured data.
Numerator: Number of patients in the denominator who have at least one entry of their height/length and weight (all ages) and/or blood pressure (ages 3 and over) recorded as structured data. Denominator: Number of unique patients seen by the EP during the EHR reporting period.
Changes from Stage 1 Core 8:
Increase vitals requirement from 50% to 80%. Increase minimum age from 2 years old to three years old. Increase age range for plot and chart growth from 2-20 years to 0-20 years. Modified Exclusions now include:
(1) Sees no patients 3 years or older is excluded from recording blood pressure. (2) Believes that all 3 vital signs of height/length, weight, and blood pressure have no relevance to their scope of practice is excluded from recording them. (3) Believes that height/length and weight are relevant to their scope of practice, but blood pressure is not, is excluded from recording blood pressure. (4) Believes that blood pressure is relevant to their scope of practice, but height/length and weight are not, is excluded from recording height/length and weight.
Stage 2 Core Objectives
#5 Smoking Status
More than 80 percent of all unique patients 13 years old or older seen by the EP have smoking status recorded as structured data.
Numerator: The number of patients in the denominator with smoking status recorded as structured data. Denominator: Number of unique patients age 13 or older seen by the EP during the EHR reporting period.
Changes from Stage 1 Core 9:
Increase smoking status requirement from 50% to 80% Smoking status must be coded in one of the following SNOMED CT® codes:
(1) Current every day smoker. 449868002 (2) Current some day smoker. 428041000124106 (3) Former smoker. 8517006 (4) Never smoker. 266919005 (5) Smoker, current status unknown. 77176002 (6) Unknown if ever smoked. 266927001 (7) Heavy tobacco smoker. 428071000124103 (8) Light tobacco smoker. 428061000124105
Stage 2 Core Objectives
#6 Clinical Decision Support
Implement five clinical decision support interventions related to four or more clinical quality measures at a relevant point in patient care for the entire EHR reporting period. Absent four clinical quality measures related to an EP’s scope of practice or patient population, the clinical decision support interventions must be related to high-priority health conditions. The EP has enabled and implemented the functionality for drug-drug and drug-allergy interaction checks for the entire EHR reporting period.
Attestation: Yes/No for each measure
Changes from Stage 1 Core 11:
Increase support rule requirement from 1 to 5 Require support rule relate to at least 4 CQMs Include stage 1 menu objective 1 (drug formulary checks)
Stage 2 Core Objectives
#7 Patient Electronic Access
More than 50 percent of all unique patients seen by the EP during the EHR reporting period are provided timely (available to the patient within 4 business days after the information is available to the EP) online access to their health information. More than 5 percent of all unique patients seen by the EP during the EHR reporting period (or their authorized representatives) view, download, or transmit to a third party their health information.
Numerator 1: The number of patients in the denominator who have timely (within 4 business days after the information is available to the EP) online access to their health information. Denominator 1: Number of unique patients seen by the EP during the EHR reporting period. Numerator 2: The number of unique patients (or their authorized representatives) in the denominator who have viewed online, downloaded, or transmitted to a third party the patient's health information. Denominator 2: Number of unique patients seen by the EP during the EHR reporting period.
Changes from Stage 1 Menu 5:
Now required as a core objective Increase access requirement from 10% to 50% Include requirement for 5% of patients to utilize electronic access
Stage 2 Core Objectives
#8 Clinical Summaries
Clinical summaries provided to patients or patient-authorized
representatives within one business day for more than 50 percent of office visits.
Numerator: Number of office visits in the denominator where the patient or a patient-authorized representative is provided a clinical summary of their visit within one (1) business day. Denominator: Number of office visits conducted by the EP during the EHR reporting period.
Changes from Stage 1 Core 13:
Decrease timeframe from 3 days to 1 business day after visit. Add the requirement for the clinical summary to include:
Demographic information maintained within certified electronic health record technology (CEHRT) (sex, race, ethnicity, date of birth, preferred language). Smoking status. Care plan field(s), including goals and instructions. Recommended patient decision aids (if applicable to the visit).
Stage 2 Core Objectives
#9 Protect Electronic Health Information
Conduct or review a security risk analysis in accordance with the requirements under 45 CFR 164.308(a) (1), including addressing the encryption/security of data stored in CEHRT in accordance with requirements under 45 CFR 164.312 (a)(2)(iv) and 45 CFR 164.306(d)(3), and implement security updates as necessary and correct identified security deficiencies as part of the provider's risk management process for EPs.
Attestation: Yes/No
Changes from Stage 1 Core 15:
Include the following standards for EHR: Record actions related to electronic health information, audit log status, and encryption status Encryption and decryption of electronic health information Create message digest Record treatment, payment, and health care operations disclosures
Stage 2 Core Objectives
#10 Clinical Lab Test Results More than 55 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.
Numerator: Number of lab test results which are expressed in a positive or negative affirmation or as a numeric result which are incorporated in CEHRT as structured data. Denominator: Number of lab tests ordered during the EHR reporting period by the EP whose results are expressed in a positive or negative affirmation or as a number.
Changes from Stage 1 Menu 2: Now required as a core objective Increase lab result requirement from 40% to 55%
Stage 2 Core Objectives
#11 Patient Lists
Generate at least one report listing patients of the EP with
a specific condition.
Attestation: Yes/No
Changes from Stage 1 Menu 3:
Now required as a core objective
Stage 2 Core Objectives
#12 Preventative / Follow Up Care Reminders
More than 10 percent of all unique patients who have had 2 or more office visits with the EP within the 24 months before the beginning of the EHR reporting period were sent a reminder, per patient preference when available.
Numerator: Number of patients in the denominator who were sent a reminder per
patient preference when available during the EHR reporting period. Denominator: Number of unique patients who have had two or more office visits with the EP in the 24 months prior to the beginning of the EHR reporting period.
Changes from Stage 1 Menu 4:
Now required as a core objective Decrease requirement from 20% to 10% Include requirement that reminder not be related to already scheduled
appointments/treatment
Stage 2 Core Objectives
#13 Patient Education
Patient-specific education resources identified by Certified EHR Technology are provided to patients for more than 10 percent of all unique patients with office visits seen by the EP during the EHR reporting period.
Numerator: Number of patients in the denominator who were provided patient-
specific education resources identified by the Certified EHR Technology. Denominator: Number of unique patients with office visits seen by the EP during the EHR reporting period.
Changes from Stage 1 Menu 6:
Now required as a core objective Cannot include items provided to the patient, but not identified by CEHRT
Stage 2 Core Objectives
#14 Medication Reconciliation
The EP who performs medication reconciliation for more than
50 percent of transitions of care in which the patient is transitioned into the care of the EP.
Numerator: The number of transitions of care in the denominator
where medication reconciliation was performed. Denominator: Number of transitions of care during the EHR reporting period for which the EP was the receiving party of the transition.
Changes from Stage 1 Menu 7:
Now required as a core objective The medication list should include the Name, Dosage, Frequency, and
Route
Stage 2 Core Objectives
#15 Summary of Care Record
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. Numerator 1: The number of transitions of care and referrals in the denominator where a summary of care record was provided. Denominator 1: Number of transitions of care and referrals during the EHR reporting period for which the EP was the transferring or referring provider. 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 10 percent of such transitions and referrals either (a) electronically transmitted using CEHRT to a recipient or (b) where the recipient receives the summary of care record via exchange facilitated by an organization that is a NwHIN Exchange participant or in a manner that is consistent with the governance mechanism ONC establishes for the NwHIN. Numerator 2: The number of transitions of care and referrals in the denominator where a summary of care record was a) electronically transmitted using CEHRT to a recipient or b) where the recipient receives the summary of care record via exchange facilitated by an organization that is a NwHIN Exchange participant or in a manner that is consistent with the governance mechanism ONC establishes for the nationwide health information network. The organization can be a third-party or the sender's own organization. Denominator 2: Number of transitions of care and referrals during the EHR reporting period for which the EP was the transferring or referring provider.
Stage 2 Core Objectives
#15 Summary of Care Record continued
An EP must satisfy one of the following criteria:
Conducts one or more successful electronic exchanges of a summary of care
document, as part of which is counted in "measure 2" (for EPs the measure at §495.6(j)(14)(ii)(B) with a recipient who has EHR technology that was developed designed by a different EHR technology developer than the sender's EHR technology certified to 45 CFR 170.314(b)(2). Conducts one or more successful tests with the CMS designated test EHR during the EHR reporting period.
Attestation: Yes/No
Changes from Stage 1 Menu 8:
Now required as a core objective Exclusion for those who transition less than 100 patients during the reporting period Include the requirement to transfer SOCR electronically or test with CMS Include requirement to exchange electronically 10% of the time
Stage 2 Core Objectives
#16 Immunization Registries
Successful ongoing submission of electronic immunization data from CEHRT to an immunization registry or immunization information system for the entire
EHR reporting period.
Attestation: Yes/No
Changes from Stage 1 Menu 9:
Now required as a core objective
Stage 2 Core Objectives
#17 Use Secure Electronic Messaging
A secure message was sent using the electronic messaging function of CEHRT by more than 5 percent of unique patients (or their authorized representatives) seen by the EP during the EHR reporting period.
Numerator: The number of patients or patient-authorized representatives in the
denominator who send a secure electronic message to the EP that is received using the electronic messaging function of CEHRT during the EHR reporting period. Denominator: Number of unique patients seen by the EP during the EHR reporting period.
Changes from Stage 1:
This is a new Objective which defines a secure message as “any electronic communication
between a provider and patient that ensures only those parties can access the communication. This electronic message could be email or the electronic messaging function of a PHR, an online patient portal, or any other electronic means”.
Stage 2 Menu Objectives
#1 Syndromic Surveillance
Successful ongoing submission of electronic syndromic surveillance data from CEHRT to a public health agency for the entire EHR reporting period.
Attestation: Yes/No
Changes from Stage 1 Menu 10:
Change from one test to ongoing submission Include additional exclusions for: EP operates in a jurisdiction for which no public health agency is capable of receiving electronic syndromic surveillance data in the specific standards required by CEHRT at the start of their EHR reporting period; EP operates in a jurisdiction where no public health agency provides information timely on capability to receive syndromic surveillance data; or EP operates in a jurisdiction for which no public health agency that is capable of accepting the specific standards required by CEHRT at the start of their EHR reporting period can enroll additional EPs.
Stage 2 Menu Objectives
#2 Electronic Note
Enter at least one electronic progress note created, edited and signed by an EP for more than 30 percent of unique patients with at least one office visit during the EHR reporting period. The text of the electronic note must be text searchable and may contain drawings and other content
Numerator: The number of unique patients in the denominator who have at least one electronic progress note from an eligible professional recorded as text searchable data. Denominator: Number of unique patients with at least one office visit during the EHR reporting period for EPs during the EHR reporting period.
Changes from Stage 1:
New Objective
Stage 2 Menu Objectives
#3 Imaging Results
More than 10 percent of all tests whose result is one or more images
ordered by the EP during the EHR reporting period are accessible through CEHRT.
Numerator: The number of results in the denominator that are accessible through CEHRT. Denominator: Number of tests whose result is one or more images ordered by the EP during the EHR reporting period.
Changes from Stage 1:
New Objective
Accessible is defined as either stored in the CEHRT or indication of the study with a link to the image
Stage 2 Menu Objectives
#4 Family Health History
More than 20 percent of all unique patients seen by the EP during the
EHR reporting period have a structured data entry for one or more first-degree relatives.
Numerator: The number of patients in the denominator with a structured data
entry for one or more first-degree relatives. Denominator: Number of unique patients seen by the EP during the EHR reporting period.
Changes from Stage 1:
New Objective This is not limited to first degree relatives, but merely a minimum.
Stage 2 Menu Objectives
#5 Report Cancer Cases
Successful ongoing submission of cancer case information from
CEHRT to a public health central cancer registry for the entire EHR reporting period.
Attestation: Yes/No
Changes from Stage 1: New Objective
Exclusion is available for providers that do not diagnose/treat cancer.
Stage 2 Menu Objectives
#6 Report Specific Cases
Successful ongoing submission of specific case information from
CEHRT to a specialized registry for the entire EHR reporting period.
Attestation: Yes/No
Changes from Stage 1: New Objective
Exclusion is available for providers that do not diagnose/treat cancer. Defines specialized registries as those that are sponsored by national specialty societies and specialized registries maintained by public health agencies.
Clinical Quality Measures
Stage 1 and Stage 2
Must report on 9 measures Must electronically report to Must cover 3 of the NQS
Domains
Patient and Family
CMS No longer have core measure, only recommended measures May report for entire calendar year , not just 90 days required May satisfy PQRS if EP has previously demonstrated MU
Engagement Patient Safety Care Coordination Population and Public Health Efficient use of healthcare resources Clinical Process Effectiveness
Clinical Quality Measures
CMS Measure ID CMS166v1 CMS138v1 CMS69v1 CMS155v1 CMS123v1 CMS147v1 CMS66v1 CMS56v1 CMS68v1 CMS139v1 CMS50v1 CMS156v1 Adult Core YES YES YES no no no no no YES no YES YES Pediatric Core no no no YES no no no no no no no no Domain Efficient Use of Healthcare Resources Population/ Public Health Population/ Public Health Population/ Public Health Clinical Process/ Effectiveness Population/ Public Health Patient and Family Engagement Patient and Family Engagement Patient Safety Patient Safety Care Coordination Patient Safety Title Use of Imaging Studies for Low Back Pain Preventive Care and Screening: Tobacco Use: Screening and Cessation Intervention Preventive Care and Screening: Body Mass Index (BMI) Screening and Follow-Up Weight Assessment and Counseling for Nutrition and Physical Activity for Children and Adolescents Diabetes: Foot Exam Preventative Care and Screening: Influenza Immunization Functional status assessment for knee replacement Functional status assessment for hip replacement Documentation of Current Medications in the Medical Record Falls: Screening for Future Fall Risk Closing the referral loop: receipt of specialist report Use of High-Risk Medications in the Elderly
