In order to qualify for federal incentive payments available under the American Recovery and Reinvestment Act of 2009 (ARRA), health care providers (referred to as Eligible Professionals or EPs in the federal regulations) must meet “Meaningful Use” (MU) requirements for the use of electronic medical records. EPs can receive as much as $44,000 over a five-year period through Medicare, and as much as $63,750 over six years through Medicaid. Providers can choose to apply for whichever program they are eligible, but not for both.

Meaningful use stage 1 is the first phase of the incentive program, followed by stage 2 and stage 3. All EPs must adopt an EMR that meets the required stage 1 criteria by the end of 2014 in order to be eligible for government incentives. For providers to receive the maximum incentive, they must have achieved MU for at least 90 days by the end of the 2012 federal fiscal year (i.e., September 30, 2012).

The list of meaningful use stage 1 criteria and regulations was established by the Centers for Medicare & Medicaid Services (CMS) and the Office of the National Coordinator for Health IT (ONC) in July 2010. Meaningful use stage 1 requirements consist of 25 objectives and 41 quality measures. EPs must meet 20 of the 25 objectives, 3 core quality measures, and 3 of 38 additional quality measures to achieve meaningful use.

Meaningful Use Stage 1 Checklist

Core Objectives

Eligible Professionals must meet all 15 of the following core meaningful use objectives:

◻EP must use computerized physician order entry for >30% of unique patients with at least one medication in their medication list

◻ Drug‐drug and drug‐allergy interaction must be enabled

◻ E-Prescribe (eRx) for >40% of the permissible prescriptions

◻ Record demographics (preferred language, gender, race, ethnicity, DOB) as structured data for >50% of all unique patients seen

◻ Maintain an up‐to‐date problem list of current and active diagnoses on >80% of all unique patients seen that has at least one entry (or an indication that no problems are known) recorded as structured data

◻ >80% of all unique patients seen have at least one entry (or an indication that the patient is not currently prescribed any medication) recorded as structured data in the medication list

◻ >80% of all unique patients seen have at least one entry (or an indication that the patient has no known medication allergies) recorded as structured data in the medication allergy list

◻ >50% of all patients age 2 and above seen with the EHR have vital signs (height, weight and blood pressure) recorded as structured data

◻ Record >50% of patients smoking status for patients 13 years or older recorded as structured data

◻ Report ambulatory clinical quality measures to CMS/States on all your patients in the EMR

◻ Implement one clinical decision support rule

◻ Provide >50% patients with an electronic copy of their health information within 3 business days, upon request

◻ Provide >50% of patients with a clinical summary within 3 business days

◻ Must perform at least one test of electronic data exchange of key clinical information

◻ Conduct or review a security risk analysis and implement security updates as necessary and correct identified security deficiencies

Menu Set Objectives

Eligible Professionals must meet five of the following ten objectives listed below:

Meet four of the following eight objectives:

◻ Implement drug-formulary checks with access to at least one internal or external drug formulary for the entire reporting period.

◻ >40% of clinical lab test results ordered by the EP must be stored as structured data

◻ Generate at least one report listing patients with a specific condition

◻ >20% of all unique patients 65 years or older or 5 years old or younger seen with the EHR were sent an appropriate reminder per patient preference for preventive/follow up care

◻ >10% of all unique patients seen are provided with timely electronic access (within four business days) to their health information

◻ >10% of all unique patients seen are provided patient-specific education resources through the use of certified EHR technology

◻ Performs medication reconciliation on >50% of transitions of care or relevant encounters for EHR patients

◻ EP who transitions or refers the patient seen with the EHR to another setting of care will provide a summary of care record for >50% of transitions and referrals

Meet one of the following two public health objectives:

◻ Perform at least one test of certified EHR technology’s capability to submit electronic data to immunization registries/systems

◻ Perform at least one test of certified EHR technology’s capability to provide electronic syndromic surveillance data to public health agencies

Required Core Quality Measures

Eligible Professionals must track the three core or alternate measures:

Core Set:

◻ Hypertension: blood pressure measurement

◻ Adult weight screening and follow-up

◻ Preventive care and screening measure pair: a) Tobacco use assessment, b) Tobacco cessation intervention

Alternate Set:

◻ Weight assessment and counseling for children and adolescents

◻ Preventive care and screening: influenza immunization for patients >50 years old

◻ Childhood immunization status

Additional Clinical Quality Measures

Eligible Professionals must track at least three of the following 38 measures:

◻ Anti-depressant medication management: (a) Effective Acute Phase Treatment, (b) Effective Continuation

◻ Phase Treatment

◻ Appropriate Testing for Children with Pharyngitis

◻ Asthma Assessment

◻ Asthma Pharmacologic Therapy

◻ Breast Cancer Screening

◻ Cervical Cancer Screening

◻ Chlamydia Screening for Women

◻ Controlling High Blood Pressure

◻ Colorectal Cancer Screening

◻ Coronary Artery Disease (CAD): Beta‐Blocker Therapy for CAD Patients w/ Prior Myocardial Infarction (MI)

◻ Coronary Artery Disease (CAD): Drug Therapy for Lowering LDL‐Cholesterol

◻ Coronary Artery Disease (CAD): Oral Anti-platelet Therapy Prescribed for Patients with CAD

◻ Diabetes: Blood Pressure Management

◻ Diabetes: Eye Exam

◻ Diabetes: Foot Exam

◻ Diabetes: Hemoglobin A1c Poor Control (<8)

◻ Diabetes: Hemoglobin A1c Poor Control

◻ Diabetes: Low Density Lipoprotein (LDL) Management and Control

◻ Diabetes: Urine Screening

◻ Diabetic Retinopathy: Communication with the Physician Managing Ongoing Diabetes Care

◻ Diabetic Retinopathy: Documentation of Presence or Absence of Macular Edema and Level of Severity of Retinopathy

◻ Heart Failure: ACE Inhibitor or ARB Therapy for Left Ventricular Systolic Dysfunction (LVSD)

◻ Heart Failure (HF): Beta‐Blocker Therapy for Left Ventricular Systolic Dysfunction (LVSD)

◻ Pneumonia Vaccination Status for Older Adults

◻ Heart Failure (HF): Warfarin Therapy Patients with Atrial Fibrillation

◻ Initiation and Engagement of Alcohol and Other Drug Dependence Treatment: (a) Initiation, (b) Engagement

◻ Ischemic Vascular Disease (IVD): Blood Pressure Management

◻ Ischemic Vascular Disease (IVD): Complete Lipid Panel and LDL Control

◻ Ischemic Vascular Disease (IVD): Use of Aspirin or Another Antithrombotic

◻ Low Back Pain: Use of Imaging Studies

◻ Oncology Breast Cancer: Hormonal Therapy for Stage ICIIIC Estrogen Receptor/Progesterone Receptor (ER/PR) Positive Breast Cancer

◻ Oncology Colon Cancer: Chemotherapy for Stage III Colon Cancer Patients

◻ Prenatal Care: Anti‐D Immune Globulin

◻ Prenatal Care: Screening for Human Immunodeficiency Virus (HIV)

◻ Primary Open Angle Glaucoma (POAG): Optic Nerve Evaluation

◻ Prostate Cancer: Avoidance of Overuse of Bone Scan for Staging Low Risk Prostate Cancer Patients

◻ Smoking and Tobacco Use Cessation, Medical assistance: Advising Smokers and Tobacco Users to Quit, Discussing Cessation Medications and Strategies

◻ Use of Appropriate Medications for Asthma