This lecture discusses the implementation of meaningful use (MU) of electronic health records as required by the HITECH Act. It outlines the three stages of MU criteria that eligible professionals and hospitals must meet to receive incentive payments for adopting electronic health records. All providers should now be in Modified Stage 2, which focuses on increased patient engagement, exchange of clinical summaries between providers, and other objectives. The goals of MU and HITECH are to advance the use of health IT and encourage nationwide health information exchange.

1. Configuring Electronic Health Records
Meaningful Use and
Implementation
Lecture a
This material (Comp 11 Unit 7) was developed by Oregon Health & Science University, funded by the
Department of Health and Human Services, Office of the National Coordinator for Health Information
Technology under Award Number 90WT00001.
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2. Meaningful Use and Implementation
Learning Objectives
• Describe the implementation of meaningful
use (MU) of electronic health records in
the context of the Health Information
Technology for Economic and Clinical
Health (HITECH) Act (Lecture a)
• Demonstrate examples of MU using the
VistA Electronic Health Record (EHR)
system (Lecture b)
2

3. Meaningful Use and HITECH
• Health Information Technology for Economic
and Clinical Health (HITECH) Act of the
American Recovery and Reinvestment Act
(ARRA)
– Provides financial incentives for “meaningful
use”(MU) of HIT and electronic health record
(EHR) adoption by physicians and hospitals
– Direct grants administered by federal agencies
– More details in Component 1, Unit 10
3

4. Three-Stage Implementation
https://www.cms.gov/Regulations-and-
Guidance/Legislation/EHRIncentivePrograms/downloads/MU_Stage1_ReqOverview.pdf 4

5. Incentive Implementation:
Increased Reimbursements - 1
• Group 1: Eligible Professionals (EPs)
– Medicare: MD, DO, DDS/DMD, DPM, OD, DC
– Medicaid: MD, DO, DDS/DMD, Certified
Nurse Midwives, Nurse Practitioners,
Physicians Assistants operating at an
FQHC/RHC
– Hospital-based EPs not eligible (>90% service
in hospital, e.g., pathologist, emergency
physician)
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6. Incentive Implementation:
Increased Reimbursements - 2
• Group 2: Eligible Hospitals (EHs)
– Medicare: Acute Care Hospitals, Critical
Access Hospitals (CAHs)
– Medicaid: Acute Care Hospitals, CAHs,
Children’s Hospitals
– Within the 50 states and DC
• Various differences in Medicare vs.
Medicaid for amount reimbursed, rules,
and other aspects
6

7. MU Operationalized - 1
Office of the National Coordinator for Health Information Technology
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8. MU Operationalized - 2
Office of the National Coordinator for Health Information Technology
8

9. MU Operationalized - 3
Office of the National Coordinator for Health Information Technology
9

10. Stage 1 MU – Core Objectives
• Computerized provider order
entry (CPOE)
• E-Prescribing (eRx)
• Report ambulatory clinical quality
measures to CMS and States
• Implement one clinical decision
support rule
• Provide patients with an
electronic copy of their health
information, upon request
• Provide clinical summaries for
patients for each office visit
• Drug-drug and drug-allergy
interaction checks
• Record demographics
• Maintain up-to-date problem list
of current and active diagnoses
• Maintain active medication and
medication allergy lists
• Record and chart changes in vital
signs
• Record smoking status for
patients 13 years or older
• Capability to exchange key
clinical information among
providers of care and patient-
authorized entities electronically
• Protect electronic health
information
10

11. Stage 1 MU – Menu Objectives - 1
• Drug formulary checks
• Incorporate clinical lab
test results as structured
data
• Generate lists of patients
by specific conditions
• Medication reconciliation
• Summary of care record
for each transition of care
or referrals
• Use certified EHR
technology to identify
patient-specific education
resources and provide to
patient, if appropriate
• Capability to submit
electronic data to
immunization
registries/systems
• Capability to provide
electronic syndromic
surveillance data to public
health agencies 11

12. Stage 1 MU – Menu Objectives - 2
• For EPs only
– Send reminders to
patients per patient
preference for
preventive/follow up
care
– Provide patients with
timely electronic
access to their
health information
• For EHs only
– Record advanced
directives for
patients 65 years or
older
– Capability to provide
electronic
submission of
reportable lab results
to public health
agencies
12

13. Stage 2: Changes from Stage 1
• Consolidated some objectives, raised
threshold for others, added new ones
– Patient engagement
o Required 50% patients be given electronic access
to health information
o 5% must view, download, or transmit information to
a third party
– HIE
o Certified EHRs must support Direct protocol
o Menu objective required exchange of clinical care
summaries for 10% of encounters
13

14. Modified Stage 2 Overview
• Protect Patient Health Information
• Clinical Decision Support (CDS)
• Computerized Provider Order Entry (CPOE)
• Electronic Prescribing (eRx)
• Health Information Exchange (HIE)
• Patient Specific Education
• Medication Reconciliation
• Patient Electronic Access
• Secure Electronic Messaging
• Public Health Reporting
14

15. Meaningful Use and Implementation
Summary – Lecture a
• The HITECH Act of ARRA legislated
incentives for the “meaningful use” (MU)
of health IT
• MU criteria are met by eligible
professionals and eligible hospitals to
receive incentive payments for use of
EHRs
• All providers should now be in Modified
Stage 2 of MU
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16. Meaningful Use and Implementation
References – 1 – Lecture a
References
Blumenthal, D., & Tavenner, M. (2010). The “meaningful use” regulation for electronic
health records. New England Journal of Medicine, 363, 501-504.
Metzger, J and Rhoads, J (2012). Summary of Key Provisions in Final Rule for Stage 2
HITECH Meaningful Use. Falls Church, VA, Computer Sciences Corp.
O'Neill, T (2015). Primer: EHR Stage 3 Meaningful Use Requirements. Washington, DC,
American Action Forum. http://americanactionforum.org/uploads/files/research/2015-
10-
20_Primer_Stage_3_Meaningful_Use_Final_Rule_%28CH_edits%29_ej_mg_sh_....p
df
Trotter, F., & Uhlman, D. (2011). Getting to Meaningful Use and Beyond. Sebastopol, CA:
O'Reilly Media.
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17. Meaningful Use and Implementation
References – 2 – Lecture a
Charts, Tables, Figures
2.1 Figure: Overview: What is Meaningful Use?, Missouri Health Information Technology
Assistance Center. Stage 1 rules set in 2010 (Blumenthal, 2010); Stage 2 rules likely
to be announced in 2012 (Drazen, 2011).
17

18. Configuring Electronic Health Records
Meaningful Use and Implementation
Lecture a
This material was developed by Oregon
Health & Science University, funded by the
Department of Health and Human Services,
Office of the National Coordinator for Health
Information Technology under Award
Number 90WT0001.
18