Basic presentation covering core objectives addressed under HITECH and Meaningful Use Stage 1

1. Meaningful Use Stage 1
Core Requirements
Taino Consultants Inc.
Dr. Jose I. Delgado
www.TainoConsultants.com

2. Meaningful Use (MU)
• Health Information Technology for Economic and Clinical Health
(HITECH) Act
– Authorized financial incentives to Eligible Providers (EP)
– Financial Incentives require the use and implementation of a
certified electronic health record (EHR)
• Owning a certified EHR is not enough
– EHRs have tools designed to assist EPs meet MU
• EHR must be used in a way that positively affects patient
care
• Meaningful Use describes the objectives needed to be met
in order to receive financial incentives

3. Meaningful Use Measures
• EP’s must meet 25 Objectives and their corresponding measures
in order to meet Meaningful Use
– Core Objectives.
• 15 objectives that everyone must meet
• Must report on all 15 and meet thresholds
– Menu Objectives
• 10 objectives
• EPs must choose 5 of those and meet thresholds
– Clinical Quality Measures also covered as a Core Objective
• Additional reporting requirement
• No thresholds to meet

4. Core Measure 1
• Computerized provider order entry (CPOE)
– Eligible Provider (EP) must enter medication orders from a
computer or mobile device into the patient record
– The order must be documented in a digital, structured, and
computable format
– Action must take place when the order first becomes part of
the patient’s medical record and before any action can be
taken on the order
– EP must have more than 30 percent of patients with at least
one medication entered using CPOE
Exception: EP writes less than 100 prescriptions during reporting
period

5. Core Measure 2
• Drug Interaction Check
– EHR must automatically check for potentially adverse drug-
drug or drug-allergy interactions
– Functionality enabled for the entire EHR reporting period
Exception: None

6. Core Measure 3
• Maintain Problem List
– Up-to-date problem list of current and active diagnoses
– More than 80 percent of all unique patients seen must have at
least one entry or an indication that no problems are known as
structured data
Exception: None

7. Core Measure 4
• E-prescribing (e-Rx)
– Generate and transmit permissible prescriptions electronically
(eRx)
– More than 40 percent of all permissible prescriptions
transmitted electronically using certified EHR technology
– Authorizations for items such as durable medical equipment,
or other items and services that may require EP authorization
before the patient could receive them, are not included in the
definition of prescriptions
Exception: EP writes less than 100 prescriptions during reporting
period

8. Core Measure 5
• Active Medication List
– Maintain active medication list
– More than 80 percent of all patients have at least one entry (or
an indication that the patient is not currently prescribed any
medication) recorded as structured data
Exception: None

9. Core Measure 6
• Medication Allergy List
– Maintain active medication allergy list
– More than 80 percent of all patients must have at least one
entry (or an indication that the patient has no known
medication allergies) recorded as structured data.
Exception: None

10. Core Measure 7
• Record Demographics
– Record all of the following demographics:
• Preferred language
• Gender
• Race
• Ethnicity
• Date of birth
– More than 50 percent of all patients must have demographics
recorded as structured data
Exception: None

11. Core Measure 8
• Record Vital Signs
– Record and chart changes in the following vital signs:
• Height
• Weight
• Blood pressure
• Calculate and display body mass index (BMI)
• Plot and display growth charts for children 2-20 years, including
BMI
– For more than 50 percent of all patients age 2 and over
– Measures must be recorded as structured data
Exception: EP only sees patients below 2 years old, or who believes that all
three vital signs of height, weight, and blood pressure have no relevance
to their scope of practice

12. Core Measure 9
• Record Smoking Status
– Smoking status of patients 13 yrs and older must be recorded
as structured data
– More than 50 percent of all patients 13 years old or older
Exception: EP doesn’t see patients 13 years or older

13. Core Measure 10
• Clinical Quality Measures
– Report ambulatory clinical quality measures to CMS
– Successfully report to CMS ambulatory clinical quality
measures selected by CMS in the manner specified by CMS
– EPs must report on:
• 3 core clinical quality measures AND
• 3 clinical quality measures that EPs select from a list
Exception: None

14. Clinical Quality Measures
• Tools that help CMS measure and track the quality of services
• Required as a core meaningful use objective under Meaningful
Use Stage 1
• Not a core objective under Meaningful Use Stage 2; however, a
requirement in order to successfully participate in the program
• Beginning in 2014, all providers will be required to report
Note: Additional information to be provided under another presentation

15. Core Measure 11
• Clinical Decision Support (CDS) Rule
– Implement one clinical decision support rule relevant to
specialty or high clinical priority along with the ability to track
compliance with that rule
– Certified EHRs have the ability to program clinical decision
support that can trigger alerts or clinical information for
providers when they encounter patients with certain diagnoses
or treatments
– No specific CDS provided as guide
Exception: None

16. Core Measure 12
• Electronic Copy of Health Information
– Provide patients with an electronic copy of their health
information (including diagnostic test results, problem list,
medication lists, medication allergies) upon request.
– More than 50 percent of all patients who request an electronic
copy of their health information are provided it within 3
business days.
Exclusion: No patient’s request during reporting period

17. Core Measure 13
• Clinical Summaries
– Clinical summaries are provided to patients for each office visit
– Must provide copies to more than 50% of all patients after
each office visit within 3 business days
– The clinical summary can be provided through a portal on the
web site, secure e-mail, or other electronic media
• EPs must provide the patient a paper copy upon request
– Providers should not charge patients a fee to provide this
information
Exclusion: EP didn’t have any office visit during reporting period

18. Core Measure 14
• Electronic Exchange of Clinical Information
– Capability to exchange key clinical information (for example,
problem list, medication list, medication allergies, and
diagnostic test results), among providers of care
– Perform at least one test of EHR's ability to electronically
transfer information to another provider
Exception: None

19. Core Measure 15
• Protect Electronic Health Information
– Conduct or review a security risk analysis in accordance with
the requirements under 45 CFR 164.308(a)(1)
– Implement Security Updates as necessary
– Correct identified security deficiencies
Exception: None

20. Risk Analysis
• HIPAA Security Rule (45
C.F.R. §§ 164.302 – 318.)
covers the guidance as it
relates to a risk analysis
• Risk analysis requirement is
covered in § 164.308(a)(1)(ii)
(A)
• Risk analysis is an ongoing
process that should provide
the organization with a
detailed understanding of the
risks to the confidentiality,
integrity, and availability of e-
PHI

21. Reminders
• With the exception of Core measure 15 all other measures may
be achieved thru the use of Certified EHRs
– A risk analysis is a process and not a one time event
– Core Measure 15 directly relates to HIPAA Security
– Consider hiring outside assistance to meet this requirement
– Document and implement recommendations
• Be aware of other requirements in addition to the obvious
measures

22. Summary
• Meaningful use is directly related to the HITECH ACT and
financial incentives to Medicare and/or Medicaid Providers
• Meaningful Use Stage 1 encompasses 25 Objectives
– Only Core Objectives covered on this presentation
– Some objectives provide exclusions
• Meaningful Use Stage 2 requirements are not the same as
Meaningful Use stage 1
• Core objectives do not change regardless of program (Medicare
or Medicaid)