Overview of Meaningful Use for EMR / EHR

Federal EMR incentive payments are available under the American Recovery and Reinvestment Act of 2009 (ARRA) for qualifying health care providers (referred to as Eligible Professionals or EPs in the federal regulations) who install and use of EMR systems.

Federal EMR incentive payments are available under the American Recovery and Reinvestment Act of 2009 (ARRA) for qualifying health care providers (referred to as Eligible Professionals or EPs in the federal regulations) who install and use of EMR systems.

While a maximum of $21,250 of Medicaid EMR incentive payments are independent of EMR use, the bulk of payments under Medicaid and all payments under Medicare require “meaningful use” by an EP of an EMR system accredited by a proper certification authority. These regulations are designed to encourage widespread adoption of EMR technology and integration of these capabilities into the health care system. Rules under these two programs are the same.

Eligible Professionals can receive as much as $44,000 in Meaningful Use incentive payments over a five-year period through Medicare. Under Medicaid, Eligible Professionals (EP) can receive as much as $63,750 in EMR incentive payments over six years. Providers can choose to apply for whichever program they are eligible, but not for both.

It’s important to note that there are three stages of meaningful use, only one of which has been formalized as of January, 2012. For Meaningful Use Stage 1, which began in 2011, there are 25 objectives / measures for EPs. These have been divided into a core set and menu set, with differing requirements for hospitals and ambulatory care providers.

EPs must meet all 15 objectives/measures in the Phase 1 Meaningful Use core measures and can choose to defer up to five of 10 remaining objectives/measures. Where it is not possible for an EP to meet a specific measure, an exclusion is defined in the Meaningful Use final rule. If an exclusion applies to an EP, then that professional does not have to meet that particular objective / measure in order to be determined a meaningful EMR user.

The U.S. Department of Health and Human Services (HHS) made Meaningful Use requirements changes in late 2011 postponing deadlines for meeting standards for Meaningful Use Stage 2 until calendar year 2014. Comments for these Phase 2 rules are being accepted through February, 2012, with final rules expected to be issued mid-2012. Meaningful use reimbursements and EMR incentive payments under either Medicare or Medicaid will require ongoing evidence or attestation from health care providers.

Meaningful Use Stage 1 for EMR Core Measures

(EPs must meet all, subject to exclusions)

  • Demographics Reporting
  • Vital signs/chart changes*
  • Problem list/active diagnoses
  • Medication list
  • Allergy list
  • Computerized physician order entry (CPOE)*
  • Electronic prescriptions*
  • Drug-drug/drug-allergy interaction checks
  • Adult smoking status*
  • Clinical summaries*
  • Electronic copy of health information*
  • Exchange electronic clinical information
  • Clinical decision support rule
  • Data privacy and security
  • Clinical quality measures
  • Exclusion available
Stage 1 EMR Menu Measures

(EPs must meet five, subject to exclusions)

  • Drug formulary checks
  • Clinical lab test results*
  • Patient lists by condition
  • Patient-specific education resources
  • Medication reconciliation*
  • Summary of care for transferred patients*
  • Electronic immunization data*
  • Electronic epidemiology data*
  • Patient care reminders*
  • Provide electronic access to health information*
  • Exclusion available

Meaningful Use Stage 2 and Stage 3 rules are expected to emphasize health information exchange, including requirements for incorporation of laboratory results, and the expectation that providers will electronically transmit patient care summaries across unaffiliated providers and EMR systems.