Stage 1 Meaningful Use Requirements for Eligible Professionals (EPs)

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1 Stage 1 Meaningful Use Requirements for Eligible Professionals (EPs) The information contained in the public health measure specifications, menu-set measures nine and ten, was created in collaboration with HEALTH. All other information contained in this grid was taken from CMS' EHR Incentive Program Measure Specifications available at: https://www.cms.gov/ehrincentiveprograms/downloads/ep--toc.pdf Objectives (Complete ALL) Measure Measure Specifications The Objectives measure six key aspects of EHR use, which call for users to record, maintain, provide, prevent, report, and ensure security. 1 Record patient demographics (sex, race, ethnicity, DOB, preferred language). 2 Record vital signs and chart changes (height, weight, BP, BMI, growth chart). 3 Record smoking status for patients aged 13 and older. Record >50% of patients demographic data must be recorded as structured data. >50% of patients aged 2 and older have height, weight and BP recorded as structured data. >50% of patients aged 13 and older have smoking status recorded as structured data. EP must submit Numerator/Denominator data for attestation. Denominator: Number of unique patients seen by EP during the Numerator: Number of patients in the denominator who have all the elements of demographics (or a specific exclusion if the patient declined to provide elements/if recording the element is contrary to state law) recorded as structured data. attestation. Denominator: Number of unique patients aged 2 and older seen by the EP during the Numerator: Number of patients in the denominator who have at least one entry of their height, weight, and blood pressure recorded as structured data. Exclusion: An EP who sees NO patients aged 2 and older; an EP who believes that all three vital signs have no relevance to the scope of their practice. EPs must submit Numerator/Denominator/Exclusion data for attestation. Denominator: Number of unique patients aged 13 and older seen by the EP during the Numerator: Number of patients in the denominator with smoking status recorded as structured data. Exclusion: An EP who sees no patients aged 13 and older.

2 3 4 Maintain up-to-date problem list of current and active diagnoses. Maintain >80% of patients have at least EP must submit Numerator/Denominator data for one entry recorded as structured Denominator: Number of unique patients seen by the EP during data. the Numerator: Number of patients in the denominator who have at least one entry (or an indication that no problems are known) recorded as structured data in their problem list Maintain active medication list. >80% of patients must have at least one entry recorded as structured data. 6 Maintain active medication-allergy list. >80% of patients must have at least one entry recorded as structured data EP must submit Numerator/Denominator data for Denominator: Number of unique patients seen by EP during the Numerator: Number of patients in the denominator who have a medication (or indication that patient is not currently prescribed medication) recorded as structured data. EP must submit Numerator/Denominator data for Denominator: Number of unique patients seen by the EP during the Numerator: Number of unique patients in the denominator who have at least one entry (or an indication that the patient has no known medication allergies) recorded as structured data in their medication allergy list. Mu 13 7 Provide patients with clinical summaries for each office visit. A clinical summary provides the patient with relevant and actionable information and instructions. This information must include, at a minimum, an updated problem list, updated medication list, updated medication allergy list, and diagnostic test results lab or diagnostic test results. Provide Must be able to provide clinical summaries for >50% of patients within 3 business days. EPs must submit Numerator/Denominator/Exclusion data for Denominator: Number of unique patients seen by the EP for an office visit during the Numerator: Number of patients in the denominator who are provided a clinical summary of their visit within three business days. Exclusion: EPs who have no office visits during the reporting

3 Provide patients with electronic copy of their health information upon request (test results, problem/medication lists). Media may be in any electronic form, including patient portal, PHR, CD, or USB. 9 Generate and transmit prescriptions electronically. Any prescriptions transmitted through a certified- EHR are acceptable, including prescriptions that are sent to the pharmacy via a computer-based fax. Computer provider-order entry (CPOE) for medication orders. Must be able to provide electronic copy of patient health information within 3 business days, if requested. Prevent >40% of ordered prescriptions are transmitted electronically using certified EHR technology. >30% of patients with at least one medication in their medication list have medication ordered through CPOE. EPs must submit Numerator/Denominator/Exclusion data for Denominator: Number of the EPs' patients who request an electronic copy of their health information four business days prior to the end of the Numerator: Number of patients in the denominator who receive an electronic copy of their health information within three business days. Exclusion: An EP who has no requests from patients for an electronic copy of their health information during the reporting Denominator: Number of prescriptions written for medications requiring a prescription in order to be dispensed, other than controlled substances, during the This does NOT exclude instances where patients specifically request a written prescription. Numerator: Number of prescriptions in the denominator generated and transmitted electronically. Exclusion: An EP who writes fewer than 0 prescriptions during the Denominator: Number of unique patients with at least one medication in their medication list who are seen by the EP during the Numerator: Number of patients in the denominator who have at least one medication order entered using CPOE. Exclusion: EPs who write fewer than 0 prescriptions during the 2 11 Implement drug-drug and drug-allergy interaction checks. Checks must be implemented during reported EP must submit Yes/No attestation indicating whether these checks have been enabled for the length of the

4 Implement one clinical decision support rule and have ability to track compliance. Drug-drug and drug-allergy alerts cannot be used to meet this objective. Alerts for recommended testing (i.e., mammogram, HbA1c) are examples of clinical decision support rules. 13 Report clinical quality measures to CMS/ States. EPs must submit 3 core measures : NQF 0013 Hypertension/ BP Management, NQF 0028 Tobacco Use/Cessation Assessment, and NQF 0421/PQRI 128 Adult Weight Screening. EPs must select one alternate core measure from the following list for each core measure with a result of 0: NQF 0024 Weight Assessment (Children/Adolescents), NQF 0041/PQRI 1 Influenza Immunization for patients >50 years, and NQF 0028 Childhood Immunizations. EPs must also select 3 additional clinical quality measures from a list of 38, as provided below. One clinical decision support rule must be implemented during Report For first reporting period, provide aggregate numerator and denominator through attestation; for subsequent reporting periods, electronically submit reports on previously selected measures. EP must submit Yes/No attestation indicating s/he has implemented one clinical decision support rule for the length of the EPs must submit Yes/No attestation indicating if s/he will submit complete ambulatory clinical quality measure information. EPs who indicate they will submit this information must also attest to the numerators, denominators, and exclusions for the individual measures selected. All three core measures must be submitted; if the result of a core measure is 0, both the core measure and an alternate core measure must be submitted. Clinical Quality Measure - Measure Specifications available for download from CMS Please select "Accept" at the bottom of the page to view measure specifications available for download directly from the CMS website. 14 Implement systems to protect privacy and security of patient data in EHR. Ensure Security Perform security risk analysis, implement security updates, correct possible deficiencies during 15 Capability to electronically exchange key clinical Perform a minimum of one test of information among patient-authorized entities and the EHR capability to providers. There are local community resources electronically exchange available that may be able to provide assistance information during reporting in meeting this measure. For example, the RI Regional Extension Center (REC) can assist PCPs in achieving this measure through a pointto-point direct messaging project. EP must submit Yes/No attestation indicating that s/he has conducted or reviewed a security risk analysis (in accordance with the requirements under 45 CFR (a)(1)), implemented updates, and corrected any identified deficiencies prior to or during the EPs must submit Yes/No attestation indicating that at least one test of his/her certified EHR technology's capacity to electronically exchange key clinical information was performed during the RI Regional Extension Center - Direct Project

5 -Set Objectives Select Five* Measure Measure Specifications The -Set Objectives focus on three main aspects: engaging the patient in their healthcare, improving the quality, safety, and efficiency of care provided, and improving the health of the EPs' patient population and, ultimately, public health. Set 8 1 Provide summary of care record for patients referred or transitioned to another provider or setting. Engage Patient Summary of care record is provided to >50% of patients referred or transitioned during Denominator: Number of transitions of care and referrals during the reporting period for which the EP was the transferring or referring provider. Numerator: Number of transitions of care and referrals in the denominator where a summary of care record was provided. Exclusion: An EP who does not transfer a patient to another setting or refer a patient to another provider during the reporting Set 5 2 Provide patient with timely electronic access to health information (e.g., lab result, problem list, medication list, allergy list). >% of patients are provided with electronic access to information within 4 days of update in EHR. Denominator: Number of unique patients seen by the EP during the Numerator: Number of patients in the denominator who have timely (available to the patient within four business days of being updated in the EHR) electronic access to their health information online. Exclusion: An EP who does not order or create lab tests or information that would be stored in the problem, medication, or medication allergy lists during the Set 6 3 Use EHR technology to identify patient-specific >% of patients are provided education resources to be provided to the patient. patient-specific education Patient-specific education resources are resources during the reporting identified through logic that evaluates information about the patient and suggests educational resources based on diagnosis (i.e., allergies, arthritis, diabetes, hypertension, etc.) EP must submit Numerator/Denominator data for Denominator: Number of unique patients seen by EP during Numerator: Number of patients in the denominator who are provided patient-specific education resources.

6 Set 1 Set 2 4 Implement drug-formulary checks. 5 Incorporate clinical laboratory test results into EHR. Improve: Quality, Safety, Efficiency Checks are implemented, and EHR has access to at least one drug formulary during the entire >40% of clinical lab test results, in a negative/positive or numerical format, are incorporated into EHR as structured data. EP must submit Yes/No/Exclusion attestation that s/he has enabled this functionality and had access to at least one formulary for the entire An EP who writes fewer than 0 prescriptions during the reporting period can be excluded from this objective. Denominator: Number of lab tests, ordered during the reporting period by the EP, whose result are expressed in a positive/ negative or numeric format. Numerator: Number of lab test results whose results are expressed in a positive/negative or numeric format in the denominator that are incorporated as structured data. Exclusion: An EP orders no lab test whose results are either in a positive/negative or numeric format during the EHR reporting Set 7 Set 3 6 Perform medication reconciliation between care settings. Medication reconciliation is the process of identifying the most accurate list of all medications that the patient is taking, including name, dosage, frequency, and route, by comparing the medical record to an external list of medications obtained from a patient, hospital, or other provider. 7 Generate lists of patients by specific conditions. Medication reconciliation is performed for >50% transitions of care. Generate at least one listing of patients with a specific condition, for use in quality improvement, reduction of disparities, research, or outreach. Denominator: Number of transitions of care during the reporting period for which the EP was the receiving party of the transition. Numerator: Number of transitions of care in the denominator where medication reconciliation was performed. Exclusion: An EP who was not on the receiving end of any transition of care during the EP must submit Yes/No attestation indicating s/he has generated at least one report listing patients of the EP with a specific condition. Set 4 8 Send reminders to patients for preventive and follow-up care, per patient preference. >20% of patients, aged 5 and under or 65 and older, are sent appropriate reminders Denominator: Number of unique patients age 5 and under or age 65 and older. Numerator: Number of patients in the denominator who were sent the appropriate reminder. Exclusion: If an EP has no patients age 5 and under or age 65 and older with an active record being maintained in the EHR.

7 Set 9 Set 9 RI 9 M A RI M A Capability to submit electronic data to immunization registries/ systems.* Capability to provide electronic syndromic surveillance data to public health agencies.* Improve: Population & Public Health* Perform at least one test of data submission and follow-up submission. Perform at least one test of data submission and follow-up submission. Rhode Island: KIDSNET is Rhode Island's immunization registry. KIDSNET presently accepts current and historical immunization data for children through age 18. An EP with a pediatric patient population can contact Kim Salisbury-Keith at or (401) to begin the process of testing immunization files. The capacity for KIDSNET to accept adult immunization data is being developed. An EP who practices adult medicine only OR who did not perform any immunizations during the reporting period is currently excluded from this measure. The Department of Health website, will be updated as new information becomes available on the capacity to receive adult immunization data. Massachusetts: Lifespan immunization registry, Massachusetts Immunization Information System (MIIS), currently accepts immunization data on patients of all ages. The Massachusetts Department of Public Health has begun testing the exchange of this data. Visit the MIIS website, for updates regarding when the testing phase will be complete and this system will begin accepting HL7 files in compliance with this measure. Rhode Island: A Rhode Island EP is excluded from this measure. Rhode Island Department of Health (HEALTH) is currently working on how best to implement this measure. EPs will be notified when the HEALTH can accept electronic syndromic surveillance data from them. The Department of Health website, will be updated as new information becomes available. Massachusetts: A Massachusetts EP is excluded from having to meet this measure. The Massachusetts Department of Public Health does not currently accept this data from the ambulatory setting and has not yet identified future resources or a timeframe in which this data will be collected from EPs. * Must select at least ONE Public Health objective to be submitted.

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