Meaningful use

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Meaningful use is prominently used in Health Information Technology Economy and Clinical Health Act (HITECH) provisions of the American Recovery and Reinvestment Act (ARRA) [1]. It was further defined by the Center for Medicare and Medicaid Services in a way that describes the use of health information technology for use among professionals.

The American Recovery and Reinvestment Act of 2009 authorized the Centers for Medicare & Medicaid Services (CMS) to provide financial incentives to providers and hospitals for adopting meaningful use of certified electronic health record (EHR) technology.

Under this authority the Office of the National Coordinator for Health Information Technology (ONC) has begun to setup standards, implementation specifications, and certification criteria for electronic medical record technology. The final rules should be completed by the end of 2010.


The Office of the National Coordinator for Health Information Technology (ONC) has listed the following goals as a guide [2]:

  1. Promote interoperability and where necessary be specific about certain content exchange and vocabulary standards to establish a path forward toward semantic interoperability.
  2. Support the evolution and timely maintenance of adopted standards
  3. Promote technical innovation using adopted standards
  4. Encourage participation and adoption by all vendors, including small businesses
  5. Keep implementation costs as low as reasonably possible
  6. Consider best practices, experiences, policies, frameworks, and the input of the HIT Policy Committee and HIT Standards Committee in current and future standards
  7. Enable mechanisms such as the Nationwide Health Information Network (NHIN) to serve as a test-bed for innovation and as an open-source reference implementation of best practices
  8. To the extent possible, adopt standard that are modular and not interdependent.

The standards to be adopted are based on current industry practices and rely on the following: Health Level 7, Inc (HL-7); National Institute of Standards and Technology (NIST) and Integrating the Health care Enterprise (IHE); SNOMED CT; International Statistical Classification of Diseases (ICD), LOINC, NCPDP and RxNorm.

You may view the entire proposed Electronic Health Record Incentive Program by opening the following pdf file[3] or link[4].


In order for eligible providers and hospitals to qualify for federal stimulus dollars, they must use certified electronic health technology in order to measure clinical quality. The United States federal government outlined the proposed criteria to achieve meaningful use in the Medicare and Medicaid Programs; Electronic Health Record Incentive Program; Proposed Rule of January 13, 2010. [5] Most health care organizations are trying to achieve meaningful use although there are struggles. [6] [[7]

Measures of clinical quality

The 25 measures involved in using health information technology for physicians, are separated into 5 initiatives. In order to qualify for stimulus dollars, the eligible provider must meet all the targets specified in the rule during a 90 day reporting period.


The Centers for Medicare and Medicaid Services (CMS) has stated meaningful use is can reform the health care system and improve health care quality, efficiency, and patient safety in three stages. [8]

Stage 1

  1. Electronic capture of health information in a coded format
  2. Tracking key clinical conditions
  3. Effective communication and care coordination
  4. Reporting of clinical quality measures
  5. Reporting public health information

Stage 2

will expand on the above by focusing on disease management, clinical decision support, medication management, support for patient access to their health information, transitions in care quality measurement and research and direct communication with public health agencies.

Stage 3

achieving improvement in quality, safety and efficiency, focusing on decision support for national priority conditions, patient access to self management tools, access to comprehensive patient data and improving health outcomes.

As of August 2009 the HIT Policy Council has provided a Matrix defining the time-line and recommendations of Meaningful Use. [9]. They have also recommended that systems be certified, currently the only recognized certification body is the Certification Commission for Health Information Technology (CCHIT).

First Initative: Improve quality, safety, efficiency, and reduce health disparities

  1. Use CPOE for all orders for 80% of orders
  2. Enable drug based alerts
  3. Maintain an up-to-date problem list of current and active diagnoses for 80% of patients
  4. E-prescribe for 75% of prescriptions
  5. Maintain an active medication list for 80% of patients
  6. Maintain an active allergy list for 80% of patients
  7. Record structured demographic data for 80% of patient
  8. record vital signs in the EMR for 80% of patients
  9. Record smoking status of 80% of patients
  10. Incorporate laboratory testing as structured data 50% of the time
  11. Generate a list of patients for quality improvement or outreach
  12. Report ambulatory quality data to the Center for Medicaid and Medicare services
  13. Send reminders to patients per their preference for 50% of patients
  14. Implement 5 clinical decision support rules
  15. check insurance eligibility electronically for 80% of patients
  16. Submit claims electronically for 80% of patients

Second initiative: Engage patients and their families

  1. Provide 80% of patients who request it, a copy of their health information within 48 hours
  2. Provide 10% of all patients with electronic access to to their health data within 96 hours of its availability.
  3. Provide 80% of patients a clinical summary of their visit

Third initiative :Improve care coordination

  1. Demonstrate the ability to electronically share clinical information between organizations
  2. Perform medication reconciliation for 80% of encounters
  3. Provide a summary of care record for 80% of referrals and transitions in care

Fourth initiative: Improve Population and Public Health

  1. Demonstrate electronic submission of immunization to state immunization registries
  2. Demonstrate the ability to exchange information with public health agencies

Fifth Initiative: Ensure Adequate Privacy and Security Protections for Personal Health Information

  1. Protect electronic health information by implementing appropriate technologies.

The interim rule goes on to state that physicians will be required to report on a subset of 90 clinical quality measures related to specialty.(5) The exact quality measures to be selected, and modifications to the use metrics will be available late in the spring of 2010 when the final rule is published.


  1. Stimulus : American Recovery and Reinvestment Act of 2009 Public Law 111-5 Official Text. Lanham, MD: Government Institutes / Bernan Press; 2009.
  2. CMS. Medicare and Medicaid Programs; Electronic Health Record Incentive Program. Proposed Rule. Fed Regist; 2010. p. 1844-2011
  3. Lewis P. "Meaningful Use" takes time (HIMSS 2010 conference). In: amednews: American Medical News; 2010.
  4. Kennedy D. [10] Small, Mid-Sized, Physician practices Could Face Barriers in Meeting 'Meaningful Use' Criteria. iHealthBeat 2010:1.
  5. Heubusch. [11] Clinical Quality Measures for Providers. J AHIMA 2010.