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, and all EPs must adopt an EMR that meets the required 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). Stage 1 MU consists 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.

On September 4 2012, CMS published its final rule on meaningful use stage 2 criteria that eligible professionals (EPs) must meet in order to continue to participate in government incentive programs. All providers must achieve MU under the stage 1 criteria before moving to meaningful use stage 2. The list of criteria and regulations was established by the Centers for Medicare & Medicaid Services (CMS) and the Office of the National Coordinator for Health IT (ONC) and consists of 23 objectives and 64 quality measures. EPs must meet 20 of the 23 objectives and 9 of the 64 quality measures to achieve meaningful use.

Meaningful Use Stage 2 Checklist

Core Objectives

Eligible Professionals must meet all 17 of the following core meaningful use objectives:

◻ EP must use computerized physician order entry for medication (>60% of patients), laboratory (>30% of patients), and radiology orders (>30%)

◻ E-Prescribe (eRx) for >50% of the permissible prescriptions

◻ Record demographics (preferred language, gender, race, ethnicity, DOB) as structured data for >80% of all unique patients seen

◻ Record and chart changes in blood pressure for 80% of patients (age 3 and above) and  height/weight (all ages) as structured data

◻ Record >80% of patients smoking status for patients 13 years or older recorded as structured data

◻ Use clinical decision support to improve performance on high-priority health conditions (1. Implement 5 clinical decision support interventions related to 4 or more clinical quality measures, if applicable, at a relevant point in patient care for the entire EHR reporting period, and 2. The EP must enable the functionality for drug and drug-allergy interaction checks for the entire EHR reporting period.)

◻ Use secure electronic messaging to communicate with patients on relevant health information (>5% of unique patients)

◻ Provide patients the ability to view online, download and transmit their health information (1. Provide >50% patients with online access to their health information within 4 business days, and 2. Allow >5% of all unique patients seen by the EP during the EHR reporting period (or their authorized representatives) to view, download, or transmit to a third party their health information)

◻ Provide clinical summaries of each office visit for >50% of patients, within 1 business day

◻ Protect electronic health information created or maintained by the Certified EHR Technology  (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 and implement security updates as necessary and correct identified security deficiencies as part of the EP’s risk management process)

◻ Incorporate clinical lab-test results into Certified EHR Technology for >55% of all lab tests ordered by the EP (recorded as structured data)

◻ Generate lists of patients by specific conditions to use for quality improvement, reduction of disparities, research, or outreach (At least one report)

◻ Perform medication reconciliation (The EP performs medication reconciliation for > 50% of transitions of care in which the patient is transitioned into the care of the EP)

◻ Submit electronic data to immunization registries

◻ Use clinically relevant information to identify patients who should receive reminders for preventive/follow-up care (>10% of all unique patients who have had two 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)

◻ Use certified EHR technology to identify patient-specific education resources (Patient-specific education resources identified by CEHRT are provided to patients for >10% of all unique patients with office visits seen by the EP during the EHR reporting period)

◻ Provide summary of care record for each transition of care or referral (1. The EP who transitions or refers their patient to another setting of care or provider of care provides a summary of care record for >50% of transitions of care and referrals; 2. The EP who transitions or refers their patient to another setting of care or provider of care provides a summary of care record either a) electronically transmitted to a recipient using CEHRT or b) where the recipient receives the summary of care record via exchange facilitated by an organization that is a NwHIN Exchange participant or is validated through an ONC-established governance mechanism to facilitate exchange for 10% of transitions and referrals; 3. The EP who transitions or refers their patient to another setting of care or provider of care must either a) conduct one or more successful electronic exchanges of a summary of care record with a recipient using technology that was designed by a different EHR developer than the sender’s, or b) conduct one or more successful tests with the CMS-designated test EHR during the EHR reporting period.)


Menu Set Objectives

Eligible Professionals must meet three of the following six objectives listed below:

◻ Submit electronic syndromic surveillance data to public health agencies for the entire reporting period

◻ Record electronic notes in patient records (Enter at least one electronic progress note created, edited and signed by an EP for > 30% 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)

◻ Imaging results accessible through CEHRT (>10% of all tests whose result is one or more images ordered by the EP during the EHR reporting period are accessible through Certified EHR Technology)

◻ Record patient family health history (>20% of all unique patients seen by the EP during the EHR reporting period recorded as structured data)

◻ Identify and report cancer cases to a State cancer registry

◻ Identify and report specific cases to a specialized registry (other than a cancer registry)


Core Quality Measures

Stage 2 Meaningful Use requires that Eligible Professionals report on 9 from a list of 64 core quality measures covering no less than 3 of these 6 National Quality Strategy domains:

1. Patient and Family Engagement

2. Patient Safety

3. Care Coordination

4. Population and Public Health

5. Efficient Use of Healthcare Resources

6. Clinical Processes/Effectiveness


Eligible Professionals must report on 9 of these 64 core quality measures:

◻ Appropriate Testing for Children with Pharyngitis

◻ Initiation and Engagement of Alcohol and Other Drug Dependence Treatment

◻ Controlling High Blood Pressure

◻ Use of High-Risk Medications in the Elderly

◻ Weight Assessment and Counseling for Nutrition and Physical Acitivity for Children and Adolescents

◻ Preventive Care and Screening: Tobacco Use: Screening and Cessation Intervention

◻ Breast Cancer Screening

◻ Cervical Cancer Screening

◻ Chlamydia Screening for Women

◻ Colorectal Cancer Screening

◻ Use of Appropriate Medications for Asthma

◻ Childhood Immunization Status

◻ Preventive Care and Screening: Influenza Immunization

◻ Pneumonia Vaccination Status for Older Adults

◻ Use of Imaging Studies for Low Back Pain

◻ Diabetes: Eye Exam

◻ Diabetes: Foot Exam

◻ Diabetes: Hemoglobin A1c Poor Control (% of patients 18-75 years of age with A1c>9%)

◻ Diabetes: Hemoglobin A1c Poor Control (% of patients 5-17 years of age with an HbA1c test)

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

◻ Diabetes: Urine Screening

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

◻ Appropriate Treatment for children with Upper Respiratory Infection (URI)

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

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

◻ 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)

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

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

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

◻ Falls: Screening for Future Fall Risk

◻ Major Depressive Disorder (MDD): Suicide Risk Assessment

◻ Anti-depressant Medication Management

◻ ADHD: Follow-up Care for Children Prescribed ADHD Medication

◻ Bipolar Disorder and Major Depression: Appraisal for alcohol and chemical substance abuse

◻ Oncology: Medical and Radiation – Pain Intensity Quantified

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

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

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

◻ HIV/AIDS Medical Visit

◻ HIV/AIDS: Pneumocystis jroveci pneumonia (PCP) Prophylaxis

◻ HIV/AIDS: RNA control for Patients with HIV

◻ Preventive Care and Screening: Screening for Clinical Depression and Follow-up Plan

◻ Documentation of Current Medications in the Medical Record

◻ Preventive Care and Screening: BMI Screening and Follow-up

◻ Cataracts: Complications within 30 Day Following Cataract Surgery Requiring Additional Surgical Procedures

◻ Cataracts: 20/40 or Better Visual Acuity within 90 Days Following Cataract Surgery

◻ Pregnant women that had HBsAg testing

◻ Depression Remission at Twelve Months

◻ Depression Utilization of the PHQ-9 Tool

◻ Children who have dental decay or cavities

◻ Child and Adolescent Major Depressive Disorder: Suicide Risk Assessment

◻ Maternal Depression Screening

◻ Primary Care Prevention and Intervention as Offered by Primary Care Providers, including Dentists

◻ Preventive Care and Screening: Cholesterol – Fasting LDL-C test performed

◻ Preventive Care and Screening: Risk-Stratified Cholesterol – Fasting LDL-C

◻ Dementia: Cognitive Assessment

◻ Hypertension: Improvement in blood pressure

◻ Closing the referral loop: receipt of specialist report

◻ Functional status assessment for knee replacement

◻ Functional status assessment for hip replacement

◻ Functional status assessment for complex chronic conditions

◻ ADE Prevention and Monitoring: Warfarin Time in Therapeutic Range

◻ Preventive Care and Screening: Screening for High Blood Pressure and Follow-up Documented