Meaningful Use

core objective to meet and 3 out of 6 menu objectives. Both must report on Clinical Quality Measures (CQMs). Clinical quality measures are tools that measure and track quality. CQMs measure many aspects of patient care including: health outcomes, clinical processes, patient safety, efficient use of healthcare resources, care coordination, patient engagements, population and public health, and clinical guidelines.

A List of Stage 2 Meaningful Use Guidelines

For your reference, below is a comprehensive list of tables showing Meaningful Use Measures, including

  • Eligible Professional Objectives and Measures
  • Eligible Hospital Objectives and Measures
  • Clinical Quality Measures for Hospitals
  • Clinical Quality Measure for Eligible Professionals
  • A Comparison of Stage 1 and Stage 2 Measures

Meaningful Use Measures

Stage Two Meaningful Use 23 Measures
Eligible Professionals Must meet 20 of 23
Eligible Professional Core Objectives 17 Core plus 3of 6 menu objectives
Objective Measure
(1)Use computerized provider order entry (CPOE) for medication, laboratory and radiology orders directly entered by any licensed healthcare professional who can enter orders into the medical record per state, local and professional guidelines. >60% meds, 30% lab, 30% rad recorded through CPOE
(2)Generate and transmit permissible prescriptions electronically (eRx). > 50%
(3)Record the following demographics: preferred language, sex, race, ethnicity, date of birth.  > 80%
(4)Record and chart changes in the following vital signs: height/length and weight (no age limit); blood pressure (ages 3 and over); calculate and display body mass index (BMI); and plot and display growth charts for patients 0-20 years, including BMI. 80% for height, weight all ages and blood pressure for > 3 yrs. old
(5)Record smoking status for patients 13 years old or older. > 80%
(6)Use clinical decision support to improve performance on high-priority health conditions. 1) Implement 5 interventions to 4 clinical quality measures 2)Enable, implement functionality for drug-drug,drug allergy indications
(7)Provide patients the ability to view online, download and transmit their health information within four business days of the information being available to the EP. 1) > 50% within 4 business days 2)>5% view, download, transmit
(8)Provide clinical summaries for patients for each office visit. Within one day > 50%
(9)Protect electronic health information created or maintained by the Certified EHR Technology through the implementation of appropriate technical capabilities. Conduct review, implement updates and correct deficiencies
(10)Incorporate clinical lab-test results into Certified EHR Technology as structured data. > 55%
(11)Generate lists of patients by specific conditions to use for quality improvement, reduction of disparities, research, or outreach. Generate at least one list
(12)Use clinically relevant information to identify patients who should receive reminders for preventive/follow-up care and send these patients the reminders, per patient preference. > 10% sent reminders for patients 2 or more visits in 24 months
(13)Use clinically relevant information from Certified EHR Technology to identify patient-specific education resources and provide those resources to the patient. > 10%
(14)The EP who receives a patient from another setting of care or provider of care or believes an encounter is relevant should perform medication reconciliation. > 50% of transitions
(15)The EP who transitions their patient to another setting of care or provider of care or refers their patient to another provider of care should provide a summary care record for each transition of care or referral. 1) > 50% of transmissions 2)> 10% electronically transmitted
(16)Capability to submit electronic data to immunization registries or immunization information systems except where prohibited, and in accordance with applicable law and practice. Ongoing submission for entire reporting period
(17)Use secure electronic messaging to communicate with patients on relevant health information. > 5%
Eligible Professional Menu Objectives
(1)Capability to submit electronic syndromic surveillance data to public health agencies except where prohibited, and in accordance with applicable law and practice. Ongoing submission for entire reporting period
(2)Record electronic notes in patient records. > 30%
(3)Imaging results consisting of the image itself and any explanation or other accompanying information are accessible through CEHRT. > 10%
(4)Record patient family health history as structured data. > 20%
(5)Capability to identify and report cancer cases to a public health central cancer registry, except where prohibited, and in accordance with applicable law and practice. Ongoing submission for entire reporting period
(6)Capability to identify and report specific cases to a specialized registry (other than a cancer registry), except where prohibited, and in accordance with applicable law and practice. Ongoing submission for entire reporting period

 

22 Measures
Stage Two Meaningful Use Must meet 19 of 22
Eligible Hospitals 16 Core plus 3of 6 menu objectives
Eligible Hospital and CAH Core Objectives
Objective Measure
(1)Use computerized provider order entry (CPOE) for medication, laboratory, and radiology orders directly entered by any licensed healthcare professional who can enter orders into the medical record per state, local, and professional guidelines. >60% meds, 30% lab, 30% rad recorded through CPOE
(2)Record all of the following demographics: preferred language, sex, race, ethnicity, date of birth, date and preliminary cause of death in the event of mortality in the eligible hospital or CAH. >80%
(3)Record and chart changes in the following vital signs: height/length and weight (no age limit); blood pressure (ages 3 and over); calculate and display body mass index (BMI); and plot and display growth charts for patients 0-20 years, including BMI. >80%
(4)Record smoking status for patients 13 years old or older. >80%
(5)Use clinical decision support to improve performance on high-priority health conditions. 1) Implement 5 interventions to 4 clinical quality measures 2)Enable, implement functionality for drug-drug, drug allergy indications
(6)Provide patients the ability to view online, download, and transmit information about a hospital admission. 1) > 50% within 4 business days 2)>5% view, download, transmit
(7)Protect electronic health information created or maintained by the Certified EHR Technology through the implementation of appropriate technical capabilities. Conduct review, implement updates and correct deficiencies
(8)Incorporate clinical lab test results into Certified EHR Technology as structured data. > 55%
(9)Generate lists of patients by specific conditions to use for quality improvement, reduction of disparities, research, or outreach. Generate at least one list
(10)Use clinically relevant information from Certified EHR Technology to identify patient-specific education resources and provide those resources to the patient. > 10%
(11)The eligible hospital or CAH who receives a patient from another setting of care or provider of care or believes an encounter is relevant should perform medication reconciliation. > 50%
(12)The eligible hospital or CAH who transitions their patient to another setting of care or provider of care or refers their patient to another provider of care provides a summary care record for each transition of care or referral. 1) > 50% 2)>10% electronically 3) Conduct one or more successful electronic exchange
(13)Capability to submit electronic data to immunization registries or immunization information systems except where prohibited, and in accordance with applicable law and practice. Ongoing submission for entire reporting period
(14)Capability to submit electronic reportable laboratory results to public health agencies, where except where prohibited, and in accordance with applicable law and practice. Ongoing submission for entire reporting period
(15)Capability to submit electronic syndromic surveillance data to public health agencies, except where prohibited, and in accordance with applicable law and practice. Ongoing submission for entire reporting period
(16)Automatically track medications from order to administration using assistive technologies in conjunction with an electronic medication administration record (eMAR). 1 > 10%
Eligible Hospital Menu Objectives
(1)Record whether a patient 65 years old or older has an advance directive. > 50%
(2)Record electronic notes in patient records. One note for > 30% of patients
(3)Imaging results consisting of the image itself and any explanation or other accompanying information are accessible through CEHRT. > 10%
(4)Record patient family health history as structured data. > 20%
(5)Generate and transmit permissible discharge prescriptions electronically (eRx). > 10%
(6)Provide structured electronic lab results to ambulatory providers. > 20% of lab tests sent electronically to ordering provider

Clinical Quality Measures for Hospitals

(must report 16 out of 29. Must cover at least 3 of the National Quality domains)

  • Emergency Department (ED)-1 Emergency Department Throughput – Median time from ED arrival to ED departure for admitted ED patients
  • ED-2 Emergency Department Throughput – admitted patients – Admit decision time to ED departure time for admitted patients
  • Stroke-2 Ischemic stroke – Discharged on anti-thrombotic therapy.
  • Stroke-3 Ischemic stroke – Anticoagulation Therapy for Atrial Fibrillation/Flutter
  • Stroke-4 Ischemic stroke – Thrombolytic Therapy
  • Stroke-5 Ischemic stroke – Antithrombotic therapy by end of hospital day two
  • Stroke-6 Ischemic stroke – Discharged on Statin Medication
  • Stroke-8 Ischemic or hemorrhagic stroke – Stroke education
  • Stroke-10 Ischemic or hemorrhagic stroke – Assessed for Rehabilitation
  • Venous Thromboembolism (VTE)-1 VTE prophylaxis
  • VTE-2 Intensive Care Unit (ICU) VTE prophylaxis
  • VTE-3 VTE Patients with Anticoagulation Overlap Therapy
  • VTE-4 VTE Patients Receiving Unfractionated Heparin (UFH) with Dosages/Platelet Count Monitoring by Protocol (or Nomogram)
  • VTE-5 VTE discharge instructions
  • VTE-6 Incidence of potentially preventable VTE
  • AMI-2-Aspirin Prescribed at Discharge for AMI
  • PC-01 Elective Delivery Prior to 39 Completed Weeks Gestation
  • AMI-7a Fibrinolytic Therapy Received Within 30 minutes of Hospital Arrival
  • AMI-8a Primary PCI Received Within 90 Minutes of Hospital Arrival
  • AMI-10 Statin Prescribed at Discharge
  • PN-6 Initial Antibiotic Selection for Community-Acquired Pneumonia (CAP) in Immunocompetent Patients
  • SCIP-INF-1 Prophylactic Antibiotic Received within 1 Hour Prior to Surgical Incision
  • SCIP-INF-2 Prophylactic Antibiotic Selection for Surgical Patients
  • SCIP-INF-9 Urinary catheter removed on Postoperative Day 1 (POD1) or Postoperative Day 2 (POD2) with day of surgery being day zero
  • ED-3 Median time from ED arrival to ED departure for discharged ED patients
  • Home Management Plan of Care (HMPC) Document Given to Patient/Caregiver
  • Exclusive Breast Milk Feeding
  • Healthy Term Newborn
  • EHDI-1a Hearing screening before hospital discharge

Clinical Quality Metrics for Eligible Professionals

(must report on 9 of the sixty four 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 medication in elderly
  • Weight assessment and counseling for Nutrition and Physical Activity 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 Screening
  • Use  of appropriate meds for asthma
  • Childhood Immunization Status
  • Influenza Immunization
  • Pneumonia Vaccination Status for Older Adults
  • Use of Imaging Studies for Low Back Pain
  • Diabetes: Eye Examine
  • Diabetes: Foot Examine
  • Diabetes: Hemoglobin A1c Poor Control
  • Diabetes: Hemoglobin A1c for Pediatric Patients
  • Diabetes: Urine Protein Screening
  • Diabetes: Low Density Lipoprotein (LDL) Management
  • Ischemic Vascular Disease: Use of Aspirin or Another Antithrombotic
  • Appropriate Treatment for Children with Upper Respiratory Infection (URI)
  • Coronary Artery Disease (CAD): Beta-Blocker Therapy
  • Ischemic Vascular Disease Complete Lipid Panel and LDL Control
  • Heart Failure (HF) ACE Inhibitor or Receptor blocker
  • Heart Failure (HF) Beta blocker
  • Primary Open Angel Glaucoma (POAG)
  • Diabetic Retinopathy: Documentation
  • Diabetic Retinopathy: Communication with the Physician
  • Retinopathy: Communication with the Physician
  • Falls: Screening for Future Fall Risk
  • Major Depressive Disorder: Suicide Risk
  • Assessment Anti-depressant medication management
  • (ADHD) Follow care for children
  • Bipolar Disorder and Major Depression: Appraisal for alcohol or chemical
  • Oncology: Medical and Radiation-Pain Intensity
  • Colon Cancer: Chemotherapy
  • Breast Cancer: Hormonal Therapy
  • Prostate Cancer: Avoidance of overuse
  • HIV/AIDS: Medical visit
  • HIV/AIDS: PCP
  • HIV/AIDS:RNA control
  • Preventive Care and Screening for Clinical Depression
  • Documentation of Current Medications in the Medical Record
  • Preventive Care: Body Mass Index Screening
  • Cataracts: Complications following surgery
  • Cataracts: 20/40 or better within 90 days
  • Pregnant women that had HBsAg testing
  • Depression remission at twelve months
  • Depression utilization of the PHQ-9 tool
  • Children who have dental decay
  • Child and adolescent major depression disorder: suicide risk assessment
  • Maternal depression screening
  • Primary care and screening Cholesterol
  • Primary care and screening Risk stratified cholesterol
  • Dementia: Cognitive assessment
  • Hypertension: improvement in blood pressure
  • Closing the referral loop: receipt of specialist report
  • Function status: assessment for knee replacement
  • Functional status: assessment for hip replacement
  • Functional status: assessment for complex chronic
  • ADE Prevention and Monitoring
  • Preventive Care and screening for high blood pressure

Comparing Stage 1 and Stage 2 Meaningful Use Measures

Eligible Professionals

Core Objectives

Stage 1 Stage 1 Measure Stage 2 Stage 2 Measure
(1)Use computerized provider order entry (CPOE) for medication, laboratory and radiology orders directly entered by any licensed healthcare professional who can enter orders into the medical record per state, local and professional guidelines. >30% meds recorded through CPOE >60% meds, 30% lab, 30% rad recorded through CPOE
Implement drug-drug and drug allergy checks Enabled No longer  separate objective for Stage 2 Incorporated in Clinical Decision Support
(2)Generate and transmit permissible prescriptions electronically (eRx). >40% > 50%
(3)Record the following demographics: preferred language, sex, race, ethnicity, date of birth.  > 50%  > 80%
Maintain an up-to-date problem list.  > 80% No longer  separate objective for Stage 2 Incorporated in Summary of Care
Maintain active medication list.  > 80% No longer  separate objective for Stage 2 Incorporated in Summary of Care
Maintain active medication allergy list.  > 80% No longer  separate objective for Stage 2 Incorporated in Summary of Care
(4)Record and chart changes in the following vital signs: height/length and weight (no age limit); blood pressure (ages 3 and over); calculate and display body mass index (BMI); and plot and display growth charts for patients 0-20 years, including BMI. 50% for height, weight all ages and blood pressure for > 3 yrs. Old 80% for height, weight all ages and blood pressure for > 3 yrs. old
(5)Record smoking status for patients 13 years old or older. > 50% > 80%
(6)Use clinical decision support to improve performance on high-priority health conditions. 1) Implement 1 clinical decision support rule 1) Implement 5 interventions to 4 clinical quality measures 2)Enable, implement functionality for drug-drug, drug allergy indications
(7)Provide patients the ability to view online, download and transmit their health information within four business days of the information being available to the EP. 1) > 50% within 4 business days 2)>5% view, download, transmit 1) > 50% within 4 business days 2)>5% view, download, transmit
Provide CQM measures to CMS or state Provide data No longer  separate objective for Stage 2 All CQMs submitted electronically
(8)Provide clinical summaries for patients for each office visit. Within three days > 50%  Within one day > 50%
Capability to exchange key clinical information Perform one test Eliminated in Stage 1 in 2013 and beyond
(9)Protect electronic health information created or maintained by the Certified EHR Technology through the implementation of appropriate technical capabilities. Conduct review, implement updates and correct deficiencies Conduct review, implement updates and correct deficiencies including addressing encryption/security
Implement drug formulary checks Enabled with access to formulary No longer  separate objective for Stage 2
(10)Incorporate clinical lab-test results into Certified EHR Technology as structured data. >40% > 55%
(11)Generate lists of patients by specific conditions to use for quality improvement, reduction of disparities, research, or outreach. Generate at least one list Generate at least one list
(12)Use clinically relevant information to identify patients who should receive reminders for preventive/follow-up care and send these patients the reminders, per patient preference. >20% sent reminders for patients 65 yrs. or 5 yrs. and younger > 10% sent reminders for patients 2 or more visits in 24 months
Provide timely electronic access to patients within 4 business days >10% Eliminated in Stage 1 in 2014 and beyond
(13)Use clinically relevant information from Certified EHR Technology to identify patient-specific education resources and provide those resources to the patient. > 10% > 10%
(14)The EP who receives a patient from another setting of care or provider of care or believes an encounter is relevant should perform medication reconciliation. > 50% of transitions > 50% of transitions
(15)The EP who transitions their patient to another setting of care or provider of care or refers their patient to another provider of care should provide a summary care record for each transition of care or referral. 1) > 50% of transmissions 1)> 50% of transmissions 2)> 10% electronically transmitted3)Conduct successful exchange
(16)Capability to submit electronic data to immunization registries or immunization information systems except where prohibited, and in accordance with applicable law and practice. Perform one test Ongoing submission for entire reporting period
(17)Use secure electronic messaging to communicate with patients on relevant health information. New for stage 2 > 5%
Eligible Professional Menu Objectives
Stage 1 Stage 1 Measure Stage 2 Stage 2 Measure
(1)Capability to submit electronic syndromic surveillance data to public health agencies except where prohibited, and in accordance with applicable law and practice. Conduct test Ongoing submission for entire reporting period
(2)Record electronic notes in patient records. New for Stage 2 > 30%
(3)Imaging results consisting of the image itself and any explanation or other accompanying information are accessible through CEHRT. New for Stage 2 > 10%
(4)Record patient family health history as structured data. New for Stage 2 > 20%
(5)Capability to identify and report cancer cases to a public health central cancer registry, except where prohibited, and in accordance with applicable law and practice. New for Stage 2 Ongoing submission for entire reporting period
(6)Capability to identify and report specific cases to a specialized registry (other than a cancer registry), except where prohibited, and in accordance with applicable law and practice. New for Stage 2 Ongoing submission for entire reporting period

Eligible Hospitals

Eligible Hospital and CAH Core Objectives

Stage 1 Stage 1 measure Stage 2 Stage 2 measure
(1)Use computerized provider order entry (CPOE) for medication, laboratory, and radiology orders directly entered by any licensed healthcare professional who can enter orders into the medical record per state, local, and professional guidelines. >30% meds through CPOE >60% meds, 30% lab, 30% rad recorded through CPOE
Implement drug-drug and drug allergy checks Enabled No longer  separate objective for Stage 2 Incorporated in Clinical Decision Support
(2)Record all of the following demographics: preferred language, sex, race, ethnicity, date of birth, date and preliminary cause of death in the event of mortality in the eligible hospital or CAH. >50% >80%
Maintain an up-to-date problem list.  > 80% No longer  separate objective for Stage 2 Incorporated in Summary of Care
Maintain active medication list.  > 80% No longer  separate objective for Stage 2 Incorporated in Summary of Care
Maintain active medication allergy list.  > 80% No longer  separate objective for Stage 2 Incorporated in Summary of Care
(3)Record and chart changes in the following vital signs: height/length and weight (no age limit); blood pressure (ages 3 and over); calculate and display body mass index (BMI); and plot and display growth charts for patients 0-20 years, including BMI. >50% >80%
(4)Record smoking status for patients 13 years old or older. >50% >80%
(5)Use clinical decision support to improve performance on high-priority health conditions. 1) Implement 1 clinical decision support rule 1) Implement 5 interventions to 4 clinical quality measures 2)Enable, implement functionality for drug-drug, drug allergy indications
(6)Provide patients the ability to view online, download, and transmit information about a hospital admission. 1) > 50% within 4 business days 2)>5% view, download, transmit
Provide CQM measures to CMS or state Provide data No longer  separate objective for Stage 2 All CQMs submitted electronically
Provide patients with electronic copy of discharge instructions >50% Eliminated in Stage 1 in 2014 and beyond
Capability to exchange key clinical information Perform one test Eliminated in Stage 1 in 2013 and beyond
(7)Protect electronic health information created or maintained by the Certified EHR Technology through the implementation of appropriate technical capabilities. Conduct review, implement updates and correct deficiencies Conduct review, implement updates and correct deficiencies address encryption and security
Implement drug formulary checks Enabled with access to formulary No longer  separate objective for Stage 2
(8)Incorporate clinical lab test results into Certified EHR Technology as structured data. > 40% > 55%
(9)Generate lists of patients by specific conditions to use for quality improvement, reduction of disparities, research, or outreach. Generate at least one list Generate at least one list
(10)Use clinically relevant information from Certified EHR Technology to identify patient-specific education resources and provide those resources to the patient. > 10% > 10%
(11)The eligible hospital or CAH who receives a patient from another setting of care or provider of care or believes an encounter is relevant should perform medication reconciliation. > 50% > 50%
(12)The eligible hospital or CAH who transitions their patient to another setting of care or provider of care or refers their patient to another provider of care provides a summary care record for each transition of care or referral. 1) > 50% 1) > 50% 2)>10% electronically 3) Conduct one or more successful electronic exchange
(13)Capability to submit electronic data to immunization registries or immunization information systems except where prohibited, and in accordance with applicable law and practice. Perform at  least one test Ongoing submission for entire reporting period
(14)Capability to submit electronic reportable laboratory results to public health agencies, where except where prohibited, and in accordance with applicable law and practice. Perform at  least one test Ongoing submission for entire reporting period
(15)Capability to submit electronic syndromic surveillance data to public health agencies, except where prohibited, and in accordance with applicable law and practice. Perform at  least one test Ongoing submission for entire reporting period
(16)Automatically track medications from order to administration using assistive technologies in conjunction with an electronic medication administration record (eMAR). New for Stage 2 > 10%Eligible Hospital Menu Objectives
(1)Record whether a patient 65 years old or older has an advance directive. > 50% > 50%
(2)Record electronic notes in patient records. New for Stage 2 One note for > 30% of patients
(3)Imaging results consisting of the image itself and any explanation or other accompanying information are accessible through CEHRT. New for Stage 2 > 10%
(4)Record patient family health history as structured data. New for Stage 2 > 20%
(5)Generate and transmit permissible discharge prescriptions electronically (eRx). New for Stage 2 > 10%
(6)Provide structured electronic lab results to ambulatory providers. New for Stage 2 > 20% of lab tests sent electronically to ordering provider

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