AAP Meaningful Use: Certified EHR Technology Criteria

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1 AAP Meaningful Use: Certified EHR Technology Criteria On July 13, 2010, the US Centers for Medicare and Medicaid Services (CMS) released a Final Rule establishing the criteria with which eligible pediatricians, other health providers, and hospitals must comply in order qualify for the incentive payments available through the American Recovery and Reinvestment Act. Providers are not required to begin participating in the incentive program in 2011; however, Medicaid providers must begin receiving payments no later than 2016 to be eligible for payments. The American Academy of Pediatrics is providing this resource as part of a series designed to assist pediatricians in understanding what is required to receive the incentive payments through Medicaid. To access the rest of the series, go to The following table outlines the functions that vendors of Certified EHR Technology must provide in order for pediatrician users to qualify to receive the incentive payments. The criteria will be required of Certified EHR Technology for Stage 1 (calendar years 2011 and 2012) of the incentive programs. Enhanced criteria will be released in 2013 for Stage 2 and in 2015 for Stage 3. Certification Criteria for All Complete EHRs or EHR Modules Designed for an Ambulatory Setting Objective Measure for Providers Certification Criteria Implement drug-drug and drug-allergy interaction checks. The eligible provider has enabled this functionality for the entire EHR reporting period. 1. Automatically and electronically generate and indicate in real-time, notifications at the point of care for drug-drug and drug-allergy contraindications based on medication list, medication allergy list, and Computerized Provider Order Entry (CPOE). 2. Provide certain users with the ability to adjust notifications provided for drug-drug and drugallergy interaction checks. 3. Automatically and electronically track, record, and generate reports on the number of alerts responded to by a user. Implement drugformulary checks. Maintain an up-to-date problem list of current and active diagnoses. The eligible provider has enabled this functionality and has access to at least 1 internal or external formulary for the entire EHR reporting period. More than 80% of patients seen by the provider have at least 1 entry or an indication that no problems are known for the patient recorded as Enable a user to electronically check if drugs are in a formulary or preferred drug list. retrieve a patient s problem list for longitudinal care (i.e., over multiple office visits). 1

2 Maintain active medication list. More than 80% of patients seen by the provider have at least 1 entry or an indication that no medications are currently prescribed for the patient recorded as retrieve a patient s active medication list as well as medication history for longitudinal care. Maintain active medication allergy list. Record and chart changes in vital signs: height weight blood pressure calculate and display BMI plot and display growth charts for children 2-20 years, including BMI Record smoking status for patients 13 years old or older. Incorporate clinical labtest results into EHR as More than 80% of patients seen by the provider have at least 1 entry or an indication that the patient has no known medication allergies recorded as For more than 50% of all unique patients age 2 and over seen by the provider, height, weight, and blood pressure are recorded as More than 50% of all unique patients 13 years old or older seen by the provider have smoking status recorded as More than 40% of all clinical lab tests ordered by the provider during the EHR reporting period whose results are in a positive/ negative or numerical format are incorporated into certified EHR technology as retrieve a patient s active medication allergy list as well as medication allergy history for longitudinal care (over multiple office visits). 1. retrieve a patient s vital signs including, at a minimum, the height, weight, and blood pressure. 2. Automatically calculate and display body mass index (BMI) based on a patient s height and weight. 3. Plot and electronically display, upon request, growth charts (height, weight, and BMI) for patients 2-20 years old. retrieve the smoking status of a patient. Smoking status types must include: current every day smoker, current some day smoker, former smoker, never smoker, smoker current status unknown, and unknown if ever smoked. 1. Electronically receive clinical laboratory test results in a structured format and display such results in human readable format. 2. Electronically display all the following information for a test report: a. For positive patient identification, either the patient's name and identification number, or a unique patient identifier and identification number. b. The name and address of the laboratory location where the test was performed. c. The test report date. d. The test performed. e. Specimen source, when appropriate. 2

3 Incorporate clinical labtest results into EHR as structured data, continued. Generate lists of patients by specific conditions to use for quality improvement, reduction of disparities, research, or outreach. More than 40% of all clinical lab tests ordered by the provider during the EHR reporting period whose results are in a positive/ negative or numerical format are incorporated into certified EHR technology as structured data, continued. Generate at least 1 report listing patients of a provider with a specific condition. f. The test result and, if applicable, the units of measurement or interpretation, or both. g. Any information regarding the condition and disposition of specimens that do not meet the laboratory's criteria for acceptability. 4. Electronically attribute, associate, or link a laboratory test result to a laboratory order or patient record. Enable a user to electronically select, sort, retrieve, and generate lists of patients according to, at a minimum, the data elements included in: 1. problem list; 2. medication list; 3. demographics; and 4. laboratory results. Report clinical quality measures to CMS or the States. The provider who receives a patient from another setting of care or provider of care or believes an encounter is relevant should perform medication reconciliation. Capability to submit electronic data to immunization registries and immunization information systems and actual submission in accordance with applicable law and practice. For 2011, provide aggregate numerator, denominator, and exclusions through attestation. For 2012, electronically submit the clinical quality measures. The provider performs medication reconciliation for more than 50% of transitions of care in which the patient is transitioned into the care of the provider. Perform at least 1 test of certified EHR technology s capacity to submit electronic data to immunization registries and follow up submission if the test is successful (unless none of the immunization registries to which the provider submits such information have the capacity to receive the information electronically). 1. Electronically calculate all of the core clinical quality measures specified by CMS. 2. Electronically calculate at least 3 additional clinical quality measures specified by CMS. 3. Enable a user to electronically submit the calculated clinical quality measures. Enable a user to electronically compare two or more medication lists. Electronically record, retrieve, and submit immunization information to immunization registries in accordance with the specified standard and implementation specifications. 3

4 Capability to provide electronic syndromic surveillance data to public health agencies and actual submission according to applicable law and practice. Protect electronic health information created or maintained by the certified EHR technology through the implementation of appropriate technical capabilities. Perform at least 1 test of certified EHR technology s capacity to provide electronic syndromic surveillance data to public health agencies and follow up submission if the test is successful (unless none of the public health agencies to which a provider submits such information have the capacity to receive the information electronically). Conduct or review a security risk analysis and implement security updates as necessary and correct identified security deficiencies as part of its risk management process. Electronically record, modify, retrieve, and submit syndrome-based (e.g., influenza like illness) public health surveillance information to public health agencies in accordance with the specified standard. 1. Assign a unique name and/or number for identifying and tracking user identity and establish controls that permit only authorized users to access electronic health information. 2. Permit authorized users (who are authorized for emergency situations) to access electronic health information during an emergency. 3. Terminate an electronic session after a predetermined time of inactivity. 4. Record actions related to electronic health information in accordance with the specified standard. 5. Enable a user to generate an audit log for a specific time period and to sort entries in the audit log according to any of the elements in the specified standard. 6. Create a message digest in accordance with the specified standard. 7. In accordance with the specified standard, verify upon receipt of electronically exchanged health information that such information has not been altered. 8. Detect the alteration of audit logs. 9. Verify that a person or entity seeking access to electronic health information is the one claimed and is authorized to access such information. 10. Encrypt and decrypt electronic health information in accordance with the specified standard, unless the Secretary determines that use of such an algorithm would pose a significant security risk for Certified EHR Technology. 11. Encrypt and decrypt electronic health information when exchanged in accordance with the specified standard. 12. (Optional) Record disclosures made for treatment, payment, and health care operations, in accordance with the specified standards. 4

5 Use CPOE for medication orders More than 30% of unique patients with at least 1 Enable a user to electronically record, store, retrieve, and modify, at a minimum, the following order types: directly entered by any medication in their 1. Medications licensed healthcare medication list seen by the 2. Laboratory professional who can enter orders into the medical record per state, local, and professional guidelines. provider have at least 1 medication order entered using CPOE. 3. Radiology/Imaging Generate and transmit permissible prescriptions electronically. Record demographics Preferred language Gender Race Ethnicity Date of birth Send reminders to patients per patient preference for preventive/ follow up care. More than 40% of all permissible prescriptions written by the provider are transmitted electronically using certified EHR technology. More than 50% of all unique patients seen by the provider have demographics recorded as More than 20% of all unique patients 65 years or older or 5 years old or younger were sent an appropriate reminder during the EHR reporting period. Enable a user to electronically generate and transmit prescriptions and prescription-related information in accordance with the specified standards. retrieve patient demographic data, including preferred language, gender, race, ethnicity, and date of birth. Enable race and ethnicity to be recorded in accordance with the specified standard. Enable a user to electronically generate a patient reminder list for preventive or follow-up care according to patient preferences based on, at a minimum, the data elements included in the problem list, medication list, medication allergy list, demographics, and laboratory results. Implement 1 clinical decision support rule relevant to clinical specialty or high priority along with the ability to track compliance with that rule. Provide patients with an electronic copy of their health information (including diagnostic test results, problem list, medication lists, and medication allergies) upon request. Implement 1 clinical decision support rule. More than 50% of all patients of the provider who request an electronic copy of their health information are provided it within 3 business days. 1. Implement automated, electronic clinical decision support rules (in addition to drug-drug and drugallergy contraindication checking) based on the data elements included in: problem list, medication list, demographics, and laboratory test results. 2. Automatically and electronically generate and indicate in real-time, notifications and care suggestions based upon clinical decision support rules. Enable a user to create an electronic copy of a patient s clinical information, including, at a minimum, diagnostic test results problem list, medication list, and medication allergy list in: human readable format; and on electronic media, or through some other electronic means, in accordance with specified standards. 5

6 Provide patients with timely electronic access to their health information (including lab results, problem list, medication lists, and medication allergies) within 4 business days of the information being available to the provider. More than 10% of all unique patients seen by the provider are provided timely (available to the patient within 4 business days of being updated in the certified EHR technology) electronic access to their health information subject to the provider s discretion to withhold certain information. Enable a user to provide patients with online access to their clinical information, including, at a minimum, lab test results, problem list, medication list, and medication allergy list. Provide clinical summaries for patients for each office visit Capability to exchange key clinical information (for example, problem list, medication list, medication allergies, diagnostic test results), among providers of care and patient authorized entities electronically. The provider who transitions their patient to another setting of care or provider of care or refers their patient to another provider of care should provide summary care record for each transition of care and referral. Clinical summaries are provided to patients for more than 50% of all office visits within 3 business days. Performed at least 1 test of certified EHR technology s capacity to electronically exchange key clinical information. The provider who transitions or refers their patient to another setting of care or provider of care provides a summary of care record for more than 50% of transitions of care or referrals. Enable a user to provide clinical summaries to patients for each office visit that include, at a minimum, diagnostic test results, problem list, medication list, and medication allergy list. If the clinical summary is provided electronically, it must be: 1. provided in human readable format and 2. provided on electronic media, or through some other electronic means in accordance with specified standards. 1. Electronically receive and display a patient summary record, from other providers and organizations including, at a minimum, diagnostic test results, problem list, medication list, and medication allergy list, in accordance with the specified standard. Upon receipt of a patient summary record formatted according to the alternative standard, display it in human readable format. 2. Enable a user to electronically transmit a patient summary record to other providers and organizations including, at a minimum, diagnostic test results, problem list, medication list, and medication allergy list, in accordance with the specified standards. Please visit the AAP Member Center for more information, and a summary of the changes in the Final Rule. The entire Final Rule may be viewed at If you have questions, please contact either Jen Mansour, Manager, Health Information Technology Initiatives, at 800/ , ext 4229, or or Beki Marshall, Manager, Health Information Technology Education and Implementation, at 800/ , ext 4089, or 6

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