WASHINGTON – On Dec. 30,  the Centers for Medicare and Medicaid Services issued a notice of proposed rulemaking that outlines provisions governing the Medicare and Medicaid EHR incentive programs, including a proposed definition for the central concept of “meaningful use” of EHR technology (see related story).  Professionals and hospitals must be able to demonstrate meaningful use of a certified EHR system to be eligible for incentive programs provided through the American Recovery and Reinvestment Act.

The following list of 23 Stage 1 Meaningful Use criteria for eligible hospitals was taken from the proposed rule: "Medicare and Medicaid Programs; Electronic Health Record Incentive Program." A second list, for eligible providers, is provided here. You can download the full 556-page document at http://www.federalregister.gov/OFRUpload/OFRData/2009-31217_PI.pdf

[1] Objective: Use of CPOE for orders (any type) directly entered by authorizing provider (for example, MD, DO, RN, PA, NP).
Measure: CPOE is used for at least 10 percent of all orders.

[2] Objective: Implement drug-drug, drug-allergy, drug-formulary checks.
Measure: The eligible hospital has enabled this functionality.

[3] Objective: Maintain an up-to-date problem list of current and active diagnoses based on ICD-9-CM or SNOMED CT.
Measure: At least 80 percent of all unique patients admitted to the eligible hospital have at least one entry or an indication of none recorded as structured data.

[4] Hospital Objective: Maintain active medication list.
Measure: At least 80 percent of all unique patients admitted by the eligible hospital have at least one entry (or an indication of “none” if the patient is not currently prescribed any medication) recorded as structured data.

[5] Objective: Maintain active medication allergy list.
Measure: At least 80 percent of all unique patients admitted to the eligible hospital have at least one entry (or an indication of “none” if the patient has no medication allergies) recorded as structured data.

[6] Objective: Record demographics.
Measure: At least 80 percent of all unique patients admitted to the eligible hospital have demographics recorded as structured data.

[7] Objective: Record and chart changes in vital signs.
Measure: For at least 80 percent of all unique patients age 2 and over admitted to the eligible hospital, record blood pressure and BMI; additionally, plot growth chart for children age 2 to 20.

[8] Objective: Record smoking status for patients 13 years old or older.
Measure: At least 80 percent of all unique patients 13 years old or older admitted to the eligible hospital have “smoking status” recorded.

[9] Objective: Incorporate clinical lab-test results into EHR as structured data.
Measure: At least 50 percent of all clinical lab tests results ordered by an authorized provider of the eligible hospital during the EHR reporting period whose results are in either in a positive/negative or numerical format are incorporated in certified EHR technology as structured data.

[10] Objective: Generate lists of patients by specific conditions to use for quality improvement, reduction of disparities, research and outreach.
Measure: Generate at least one report listing patients of the eligible hospital with a specific condition.

[11] Objective: Report hospital quality measures to CMS or the states.
Measure: For 2011, an eligible hospital would provide the aggregate numerator and denominator through attestation as discussed in section II.A.3 of this proposed rule. For 2012, an eligible hospital would electronically submit the measures are discussed in section II.A.3. of this proposed rule.

[12] Objective: Implement five clinical decision support rules relevant to specialty or high clinical priority, including for diagnostic test ordering, along with the ability to track compliance with those rules.
Measure: Implement five clinical decision support rules relevant to the clinical quality metrics the Eligible Hospital is responsible for as described further in section II.A.3.

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