Abgbreviations Used:EP- Eligible ProfessionalCAH- Critical Access HospitalPOS- Point of Service (usually Codes

)

Meaningful Use Criteria - 2011 Final RuleUpdated 7/19/2010

Must Meet all Core CriteriaHospitals select 5 from the Menu

Objective Objective # 1-Core CPOE

Practice/ E Ps Enter of orders for medicationsdirectly entered by any licensed healthcare professional who can enter orders into the medical record per state, local and professional guidelines

Hospital Enter of orders for medications- directly entered by any licensed healthcare professional who can enter orders into the medical record per state, local and professional guidelines

Stage 1 Measures More than 30% of unique patients with at least one medication in their medication list seen by the EP or admitted to the eligible hospital's or Critica Access Hospital(CAH)'s inpatient or emergency Dept (POS 21 or 23) have at least one medication order entered using CPOE.

Attestation Type Calculation

Numerator

Denominator Threshold

Patients w/ at least one med entered Based on counting using CPOE actions for Patients whose records are maintained using cerified EHR technology

30%

2-Core

Drug screening

Implement drug-drug and drug-allergy Implement drug-drug and drug-allergy interaction checks interaction checks Enable e-prescribing- practices only

3-Core

Generate and transmit permissible prescriptions electronically

The EP/ Eligible Hospital/ CAH has enabled Attestation this functionality for the entire EHR reporting period. More than 40% of all permissible Calculation prescriptions written gy the EP are transmitted electronically using certified EHR technology

Yes/No Based on counting actions for Patients whose records are maintained using cerified EHR technology Patients w language, gender, race, ethnicity, # Unique Patients DOB and not regardless of whether deceased the patient's records are maintained usng certified EHR technology Patients w at least # Unique Patients one problem list regardless of whether entry or "none the patient's records known" are maintained usng certified EHR technology Patients w at least one medication # Unique Patients entry or "no regardless of whether medication" the patient's records are maintained usng certified EHR technology Patients w at least one medication # Unique Patients allergy entry or regardless of whether "none known" the patient's records are maintained usng certified EHR technology Patients ages 2 + w height, weight and bp recorded

4-Core

Record demographics

Record Demographics: - Preferred Language - Gender - Race - Ethnicity - Date of Birth

5-Core

Current Problem List

Maintain up-to-date problem list of current and active diagnoses

Record Demographics: - Preferred Language - Gender - Race - Ethnicity - Date of Birth - Date and Preliminary cause of death in event of mortality in the eligible hospital or CAH Maintain up-to-date problem list of current and active diagnoses

More than 50% of all unique patients seen by Calculation the EP or admitted to the eligible hospital or CAH's inpatient or emergency department (POS 21 or 23) have demographics recorded as structured data.

50%

More than 80% of all unique patients seen by Calculation the EP or admitted to the eligible hospital's or CAHs inpatient or Emergency department (POS 21 or 23) have at least one entry or an indication that no problems are known for the patient recorded as structured data. More than 80% of all unique patients seen by Calculation the EP or admitted to the eligible hospital's or CAHs inpatient or Emergency department (POS 21 or 23) have at least one entry or an indication that the patient is not currently prescribed any medication) recorded as structured data. More than 80% of all unique patients seen by Calculation the EP or admitted to the eligible hospital's or CAHs inpatient or Emergency department (POS 21 or 23) have at least one entry or an indication that the patient has no known medication allergies) recorded as structured data. For more than 50% of all unique patients age Calculation 2 and over seen by the EP or admitted to eligible hospital's or CAH's inpatient or emergency department (POS 21 or 23), height, weight and blood pressure are recorded as structured data.

80%

6-Core

Active Medication List

Maintain active medication list

Maintain active medication list

80%

7-Core

Active Medication Allergy List Maintain active medication allergy list Maintain active medication allergy list

80%

8- Core

Record vital signs

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

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

All patients ages 2+ 9- Core Smoking Status Age 13 and over Record smoking status for patients 13 years More than 50% of all unique patents 13 years Calculation old or older old or older seen by the EP or admitted to the eligible hospital's or CAH's inpatient or emergency department (POS 21 or 23) have smoking status recorded as structured data. Implement one clinical decision support rule relevant to specialty or high clinical priority along with the ability to track compliance to that rule Implement one clinical decision support rule. Attestation Patients ages 13+ w smoking status recorded

50%

All patients age 13+ 10- Core Clinical Decision Support - 1 Rule Implement one clinical decision support rule relevant to specialty or high clinical priority along with the ability to track compliance to that rule Report ambulatory clinical quality meaures to CMS or the States.

50%

1 Rule 11-Core Quality Measures Reporting to CMS Report ambulatory clinical quality meaures For 2011, provide aggregate numerator, Submission to CMS or the States. denominator, and exclusions through attestation as discussed in section II(A)(3) of this final rule. For 2012, electronically submit the clinical quality measures as discussed in section II(A)(3) of this final rule. Provide patients with an electronic copy of More than 50% of all patients of the EP or the Calculation their health information (including inpatient or emergency departments of the diagnostic test results, problem list, eligible hospital or CAH (POS 21 or 23) who medication lists, medication allergies) upon request an electronic copy of their health request. information are provided it within 3 business days. Provide patients with an electronic copy of More than 50% of all patients of the EP or the Calculation their discharge instructions at time of inpatient or emergency departments of the discharge, when requested. eligible hospital or CAH (POS 21 or 23) who request an electronic copy of their discharge instructions are provided it. Provide clinical summaries for patents for each office visit Clinical Summaries provided to patients for more than 50% of all office visits within 3 business days. Calculation

Submitted Patients who receive an electronic copy of health info within Patients who request 3 business days electronic copy of health information Patients who receive an electronic copy of Patients who request discharge copy of discharge instructions at instructions discharge Based on counting actions for Patients whose records are maintained using cerified EHR technology

12- Core Patient Electronic Copy of Health Information

Provide patients with an electronic copy of their health information (including diagnostic test results, problem list, medication lists, medication allergies) upon request.

50%

13- Core Patient Electronic Copy of Discharge Instructions

50%

14- Core Provide clinical summary

15- Core Improve Care Coordination/ Capability to exchange key clinical Exchange Clinical Information information (for example, problem list, medication allergies, diagnostic test results) among providers of care and patient authorized entities electronically. 16- Core Ensure adequate privacy and Protect electronic health information security protections for created or maintained by the certified personal health information. EHR technology through the implementation of appropriate technical capabilities.

Capability to exchange key clinical Performed at least one test of certified EHR information (for example, problem list, technology's capacity to electronically medication allergies, diagnostic test results) exchange key clinical information. among providers of care and patient authorized entities electronically. Protect electronic health information created or maintained by the certified EHR technology through the implementation of appropriate technical capabilities.

Attestation

Yes/No Conduct or review a security risk analysis per Attestation 45 CFR 164.308 (a)(l) and implement security updates as necessary and correct identified security deficiencies as part of its risk management process. Completed Menu Options - Hospitals Choose Five

Objective Objective # 1-Menu

Practice/ E Ps

Hospital

Stage 1 Measures

Attestation Type Attestation

Numerator Denominator Threshold

Drug-Drug Formulary Checks Implement drug-formulary checks

Implement drug-formulary checks

The EP/ eligible hospital/ CAH has enabled this functionality and has access to at least one internal or external drug formulary for the entire EHR reporting period.

Enabled 2-Menu Advance Directives Record Advance directives for patients 65 or More than 50% of all unique patients 65 years Calculation older old or older admitted to the eligible hospital's or CAH's inpatient department (POS 21) have an indication of an advance directive status recorded. Incorporate clinical lab test results into Incorporate clinical lab test results into More than 40% of all clinical lab test results Calculation certified EHR technology as structured certified EHR technology as structured data. ordered by the EP or by an authoriszed data. provider of the eligible hospital or CAH for patients admitted to its inpatient or emergency department (POS 21 or 23) during the EHR reporting period whose results are either in a positive/negative or numerical format are incorporated n a certified EHR technology as structured data. Generate lists of patients by specific conditions to use for quality improvement, reduction of disparities, research or outreach. Send reminders to patients per patient preference for preventitive/ follow-up. Generate lists of patients by specific Generate at least one report listing patients Attestation conditions to use for quality improvement, of the EP, eligible hospital or CAH wth a reduction of disparities, research or specific condition. outreach. More than 20% of all unique patients 65 years Calculation old or older or 5 years old or younger were sent an appropriate reminder during the EHR reporting period. Patients 65+ have Based on counting advance directive actions for Patients whose records are status recorded maintained using cerified EHR technology All lab results with + / - or numerical formatted results incorporated Based on counting actions for Patients whose records are maintained using cerified EHR technology

50%

3-Menu

Structured Lab Results

40%

4-Menu

Generate Patient Lists By Condition

Yes/No Based on counting actions for Patients whose records are maintained using cerified EHR technology

5-Menu

Patient Appointment Reminders

6-Menu

Patient Access to Health Information

Provide patients with timely access to their health information including lab results, problem lists, medication lists, medication allegies) within four business days of the information being available to the EP

More than 10% of all unique patients seen Calculation bgy the EP are provided timely (available to the patient within four business days of being updated in the certified EHR technology) electronic acces to their health information subject to the EP's discretion to withhold certain information. Use certified EHR technology to identify patient-specific education resources and provide those resources to the patient if appropriate More than 10% of all uniqe patients seen by Calculation the EP or admtted to the eligible hospital's or CAH's inpatient or emergency department (POS 21 or 23) are provided patient-specific education resources.

# Unique Patients regardless of whether the patient's records are maintained usng certified EHR technology Patients provided # Unique Patients patient-specific regardless of whether education the patient's records resources are maintained usng certified EHR technology Patients w med rec Based on counting actions for Patients whose records are maintained using cerified EHR technology Patients w summary of care Based on counting actions for Patients record whose records are maintained using cerified EHR technology

7-Menu

Specific Education Resources Use certified EHR technology to Identified identify patient-specific education resources and provide those resources to the patient if appropriate

10%

8-Menu

Medication Reconciliation on The EP, eligible hospital or CAH who Transfer receives a patent from another setting of care or provider of care or believes an encounter is relevant should prerform medication reconciliation

The EP, 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.

9-Menu

Summary of Care Record on Transfer

10-Menu Submission to Immunization Registries

The EP, eligible hospital or CAH who The EP, eligible hospital or CAH who transitions their patient to another transitions their patient to another setting setting of care or provider of care of of care or provider of care of refers their refers their patient to another provider patient to another provider of care should of care should provide summary of care provide summary of care record for each record for each transitionb of care or transitionb of care or referral. referral. Capability to submit electronic data to Capability to submit electronic data to immunization registries or immunization registries or Immunization Immunization Information Systems and Information Systems and actual submission actual submission in accordance with in accordance with applicable law and applicable law and practice. practice.

The EP, eligible hospital or CAH performs Calculation medication reconciliation for more than 50% of transitions of care in which the patient is transitioned into the care of the EP or admitted to the eligible hospital's or CAH's inpatient or emerency department (POS 21 or 23). The EP, eligible hospital or CAH who Calculation 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 and referrals.

50%

50%

Performed at least one test of certified EHR Attestation 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 EP, eligible hospital or CAH submits such information have the capability to receive the information electronically.) Yes/No Performed at least one test of certified EHR Attestation technology's capacityto provide electronic submission of reportable lab results to public health agencies to which eligible hospital or CAH submits such information have the capacity to receive the information electronically. Performed at least one test of certified EHR Attestation technology's capacty to provcide 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 an EP eligible hospital or CAH submits such information have the capacity to receive the information electronically.)

11-Menu Submission to Public Health Database

Capability to submit electronic data on reportable (as required by state or local law) lab results to public health agencies and actual submission in accordance with applicable law and practice.

Yes/No

12-Menu Submission of Syndromic Surveillance Data

Capability to submit electronic syndromic surveillance data to public health agencies and actual submission in accordance with applicable law and practice.

Capability to submit electronic syndromic surveillance data to public health agencies and actual submission in accordance with applicable law and practice.

Yes/No

1

Measure Identification Number

Measure Title, Description & Measure Steward

Electronic Measure Specifications Information

Emergency Department (ED)-1 NQF 0495

Title: Emergency Department Throughput- admitted patients median time from ED arrival to ED departure for admitted patients Description: median time from emergency department arrival to time of departure from the emergency room for patients http://www.cms.gov/QualityMe admitted to the facility from the emergency department asures/03_ElectronicSpecificatio Measure Developer: CMS/Oklahoma Foundation for Medical ns.asp#TopOfPage Quality (OFMQ)

ED-2 NQF 0497

Stroke-2 NQF 0435

Title: Emergency Department Throughput- admitted patients Description: median time from admit decision time to time of departure from the emergency department of emergency department patients admitted to inpatient status Measure Developer: CMS/Oklahoma Foundation for Medical Quality (OFMQ) Title: Ischemic stroke- Discharge on anti-thrombotics Description: Ischemic stroke patients prescribed antithrombotic therapy at hospital discharge Measure Developer: The Joint Commission

http://www.cms.gov/QualityMe asures/03_ElectronicSpecificatio ns.asp#TopOfPage http://www.cms.gov/QualityMe asures/03_ElectronicSpecificatio ns.asp#TopOfPage

Stroke-3 NQF 0436

Stroke-4 NQF 0437

Stroke-5 NQF 0438

Stroke-6 NQF 0439

Title: Ischemic stroke- Anticoagulation for A-fib/ flutter Description: Ischemic stroke patients with atrial fibrillation/flutter http://www.cms.gov/QualityMe who are prescribed anticoagulation therapy at hospital discharge asures/03_ElectronicSpecificatio ns.asp#TopOfPage Measure Developer: The Joint Commission Title: Ischemic stroke- Thrombolytic therapy for patients arriving within 2 hours of symptom onset Description: Acute ischemic stroke patients who arrive at this hospital within 2 hours of time last known well and for whom IV tPA was initiated at this hospital within 3 hours of time last known http://www.cms.gov/QualityMe asures/03_ElectronicSpecificatio well. ns.asp#TopOfPage Measure Developer: The Joint Commission Title: Ischemic or hemorrrhagic stroke0 Antithrombotic therapy by day 2 http://www.cms.gov/QualityMe Description: Ischemic stroke patients administered asures/03_ElectronicSpecificatio antithrombotic therapy by end of hospital day 2. ns.asp#TopOfPage Measure Developer: The Joint Commission Title: Ischemic stroke- Discharge on statins Desciption: Ischemic stroke patients with LDL > 100 mg/dL, or LDL not measured, or, who were on a lipid-lowering medication prior http://www.cms.gov/QualityMe to hospital arrival are prescrigbed statin medication at hospital asures/03_ElectronicSpecificatio discharge. Measure Developer: The Joint Commission ns.asp#TopOfPage Title: Ischemic or hemorrhagic stroke- Stroke education Description: Ischemic or hemorrhagic stroke patients or their caregivers who were given educational materials during the hospital stay addressing all of the following: activation of emergency medical system, need for follow-up after discharge, medications prescrigbed at discharge, risk factors for stroke, and http://www.cms.gov/QualityMe asures/03_ElectronicSpecificatio warning signs and symptoms of stroke. ns.asp#TopOfPage Measure Developer: The Joint Commission Title: Ischemic or hemorrhagic stroke- Rehabilitation assessment Description: Ischemic or hemorrhagic stroke patients who were assessed for rehabilitation services. Measure Developer: The Joint Commission Title: VTE prophylaxis within 24 hours of arrival Description: This measure assesses the number of patients who received VTE prophylaxis or have documentation why no VTE prophylaxs was given the day of or the day after hospital admission or surgery end date for surgeries that start the day of or the day after hospital admission. Measure Developer: The Joint Commission Title: Intensive Care Unit VTE prophylaxis Description: This measure assesses the number of patents who received VTE prophylaxis or have documentation why no VTE prophylaxis was given the day of or the day after the initial admission (or transfer) to the Intensive Care Unit (ICU) or surgery end date for sureries that start the day of or the day after ICU admission (or transfer). Measure Developer: The Joint Commission

Stroke-8 NQF 0440

Stroke-10 NQF 0441

http://www.cms.gov/QualityMe asures/03_ElectronicSpecificatio ns.asp#TopOfPage

Venous Thromboembolism (VTE)-1 NQf 0371

http://www.cms.gov/QualityMe asures/03_ElectronicSpecificatio ns.asp#TopOfPage

VTE-2 NQF 0372

http://www.cms.gov/QualityMe asures/03_ElectronicSpecificatio ns.asp#TopOfPage

VTE-3 NQF 0375

Title: Anticoagulation overlap therapy Description: This measure assesses the number of patients diagnosed with confirmed VTE who received an overlap of parnteral (intravenous (IV) or subcutaneous (subcu)) anticoagulation and warfarin therapy. For patients who received less than five days of overlap therapy, they must be discharged on both medications. overlap therapy must be administered for at least five days with an International Normalized Ratio (INR) > 2 prior to discontinuation of the parenteral anticoagulation theray http://www.cms.gov/QualityMe asures/03_ElectronicSpecificatio or the patient must be discharged on both medications. ns.asp#TopOfPage Measure Developer: The Joint Commission Title: Platelet monitoring on unfractionated heparin Description: This measure assesses the number of patients diagnosed with confirmed VTE who received intravenous (IV) UFH therapy dosages AND had their platelet counts monitored using http://www.cms.gov/QualityMe asures/03_ElectronicSpecificatio defined parameters such as a nomogram or protocol. ns.asp#TopOfPage Measure Developer: The Joint Commission Title: VTE Discharge instructions Description: This measure assesses the number of patients diagnosed with confirmed VTE that are discharged to home, to home with home health, home hospice or discharged/ transferred to court/loaw enforcement on warfarin with written discharge instructions that address all four criteria: compliance issues, dietary advice, follow-up momnitoring, and information about the potential for adverse drug reactions/ interactions. Measure Developer: The Joint Commission Title: Incidence of potentially preventable VTE Description: This measure assesses the number of patients diagnosed with confirmed VTE during hospitalization (not present on arrival) who did not receive VCTE prophylaxis between hospital admission and the day before the VTE diagnostic testing order date. Measure Developer: The Joint Commission

VTE-4 NQF 0374

VTE-5 NQF 0375

http://www.cms.gov/QualityMe asures/03_ElectronicSpecificatio ns.asp#TopOfPage

VTE-6 NQF 0376

http://www.cms.gov/QualityMe asures/03_ElectronicSpecificatio ns.asp#TopOfPage

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