Meaningful Use Stage 1 Requirements

Eligible professionals who demonstrate meaningful use of certified electronic health record (EHR) technology qualify for incentive payments under the Meaningful Use program, but what are the Meaningful Use Stage 1 requirements? What must be done to demonstrate compliance with Meaningful Use to ensure incentive payments are paid?

The Meaningful Use Program

The Health Information Technology for Economic and Clinical Health (HITECH) Act was signed into law on February 17, 2009. One of the main aims of the HITECH Act is to encourage healthcare providers to switch from paper records to EHRs.

Starting in 2011, two years after the HITECH Act was signed into law, incentive payments could be claimed by eligible professionals under the Meaningful Use program. Those payments could be claimed until 2015, after which, eligible professional taking part in the program that failed to demonstrate meaningful use of EHRs could be fined.

While early adoption of EHRs was encouraged, it was possible to adopt EHRs as late as 2014 and still qualify for incentive payments under the Meaningful Use program.

Meaningful Use Stages

The Meaningful Use program consists of three stages. Providers are required to demonstrate two years in each stage before being allowed to progress to the next stage.

  • Stage 1 – Data Capture and Sharing – The promotion of basic EHR adoption and data collection
  • Stage 2 – Advanced Clinical Processes – Coordination of care and the exchange of patient health information
  • Stage 3 – Improved Patient Outcomes – Demonstrate improved outcomes as a result of EHR adoption

What are the Meaningful Use Stage 1 Requirements?

The Meaningful Use Stage 1 requirements are divided into core objectives, menu set objectives, clinical quality measures, and additional clinical quality care measures.

Providers do not need to demonstrate completing every objective but, as a minimum, they must complete all 15 core objectives, five out of the 10 requirements from the primary menu set, a minimum of three core clinical quality measures, and at least 3 additional quality care measures and meet the required threshold for each objective.

Meaningful Use Stage 1 Requirements – Core Objectives (15/15)

Number Core Objectives
1 Computerized Provider Order Entry (CPOE)
2 E-Prescribing
3 Report ambulatory clinical quality measures to CMS/States
4 Implement one clinical decision support rule
5 Provide patients with electronic copies of health information on request
6 Provide clinical summaries for patients for each office visit
7 Drug-drug and drug-allergy checks
8 Record demographics
9 Maintain an up-to-date problem list of current and active diagnoses
10 Maintain active medication list
11 Maintain active medication allergy list
12 Record/chart changes in vital signs
13 Record smoking status for patients 13 years and above
14 Exchange key clinical information with providers of care
15 Protect electronic health information


Meaningful Use Stage 1 Requirements – Menu Set (5/10)

Number Menu Objectives
1 Submit electronic data to immunization registries/systems
2 Provide electronic syndromic surveillance data to public health agencies
3 Drug-formulary checks
4 Incorporate clinical lab test results as structured data
5 Generate lists of patients by specific conditions
6 Send reminders to patients per patient preference for preventive/follow up care
7 Provide patients with timely electronic access to their health information
8 Use certified EHR technology to identify patient-specific education resources and provide them to patients
9 Medication reconciliation
10 Summary of care record for each transition of care/referrals

For items 1 and 2, at least one public health objective must be completed.

Meaningful Use Stage 1 Requirements – Core Clinical Quality Measures (3/6)

Number Core Clinical Quality Measures
1 Blood pressure measurement (Hypertension)
2 Preventative care and screening (Tobacco usage & Tobacco cessation intervention)
3 Adult weight screening
4 Weight assessment and counseling for children/adolescents
5 Preventative care and screening (Influenza immunizations for the over 50s)
6 Childhood immunization status

Meaningful Use Stage 1 Requirements – Additional Clinical Quality Measures (3/38)

Number Additional Clinical Quality Measures
1 Diabetes: Hemoglobin A1c Poor Control
2 Diabetes: Low Density Lipoprotein (LDL) Management and Control
3 Diabetes: Blood Pressure Management
4 Heart Failure (HF): Angiotensin-Converting Enzyme (ACE) Inhibitor or Angiotensin Receptor Blocker (ARB) Therapy for Left Ventricular Systolic Dysfunction (LVSD)
5 Coronary Artery Disease (CAD): Beta-Blocker Therapy for CAD Patients with Prior Myocardial Infarction (MI)
6 Pneumonia Vaccination Status for Older Adults
7 Breast Cancer Screening
8 Colorectal Cancer Screening
9 Coronary Artery Disease (CAD): Oral Antiplatelet Therapy Prescribed for Patients with CAD
10 Heart Failure (HF): Beta-Blocker Therapy for Left Ventricular Systolic Dysfunction (LVSD)
11 Anti-depressant medication management: (a) Effective Acute Phase Treatment, (b) Effective Continuation Phase Treatment
12 Primary Open Angle Glaucoma (POAG): Optic Nerve Evaluation
13 Diabetic Retinopathy: Documentation of Presence or Absence of Macular Edema and Level of Severity of Retinopathy
14 Diabetic Retinopathy: Communication with the Physician Managing Ongoing Diabetes Care
15 Asthma Pharmacologic Therapy
16 Asthma Assessment
17 Appropriate Testing for Children with Pharyngitis
18 Oncology Breast Cancer: Hormonal Therapy for Stage IC-IIIC Estrogen Receptor/Progesterone Receptor (ER/PR) Positive Breast Cancer
19 Oncology Colon Cancer: Chemotherapy for Stage III Colon Cancer Patients
20 Prostate Cancer: Avoidance of Overuse of Bone Scan for Staging Low Risk Prostate Cancer Patients
21 Smoking and Tobacco Use Cessation, Medical Assistance: a) Advising Smokers and Tobacco Users to Quit, b) Discussing Smoking and Tobacco Use Cessation Medications, c) Discussing Smoking and Tobacco Use Cessation Strategies
22 Diabetes: Eye Exam
23 Diabetes: Urine Screening
24 Diabetes: Foot Exam
25 Coronary Artery Disease (CAD): Drug Therapy for Lowering LDL-Cholesterol
26 Heart Failure (HF): Warfarin Therapy Patients with Atrial Fibrillation
27 Ischemic Vascular Disease (IVD): Blood Pressure Management
28 Ischemic Vascular Disease (IVD): Use of Aspirin or Another Antithrombotic
29 Initiation and Engagement of Alcohol and Other Drug Dependence Treatment: a) Initiation, b) Engagement
30 Prenatal Care: Screening for Human Immunodeficiency Virus (HIV)
31 Prenatal Care: Anti-D Immune Globulin
32 Controlling High Blood Pressure
33 Cervical Cancer Screening
34 Chlamydia Screening for Women
35 Use of Appropriate Medications for Asthma
36 Low Back Pain: Use of Imaging Studies
37 Ischemic Vascular Disease (IVD): Complete Lipid Panel and LDL Control
38 Diabetes: Hemoglobin A1c Control (<8.0%)


Meaningful Use Stage 1 Incentive Payments

In order to qualify for incentive payments, all providers must demonstrate they have met Meaningful Use Stage 1 requirements and must have adopted certified EHR technology that meets the necessary criteria by the end of 2014 at the very latest. If the deadline is missed, the provider will not be eligible to receive incentive payments.

Medicare eligible professionals must demonstrate having met the Meaningful Use Stage 1 requirements for 90 days in the first year and for the entire second year. All Medicare eligible professionals must adopt EHR technology in year one, demonstrate having met the Meaningful Use Stage 1 requirements for 90 days in year 2, and report meeting requirements for the entire following year.

In order to obtain the maximum possible incentive payments, providers must have demonstrated meaningful use of EHRs for at least 90 days prior to the end of the 2012 fiscal year and for all following years under the program.

Author: Steve Alder has many years of experience as a journalist, and comes from a background in market research. He is a specialist on legal and regulatory affairs, and has several years of experience writing about HIPAA. Steve holds a B.Sc. from the University of Liverpool.