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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.