Meaningful use

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== Meaningful use for physicians. ==

The term “meaningful use” came to the public’s attention in the HITECH provisions of the American Recovery and Re-investment act of 2009.(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. In order for eligible providers and hospitals to qualify for federal stimulus dollars under this act, they must 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.(2) Even though the specific details are still in the proposed stage, the effect has been dramatic. Most health care organizations are trying to achieve meaningful use although there are struggles.(3,4) 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

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

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

Third initiative. Improve care coordination

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

Fourth initiative. Improve Population and Public Health

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

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

25. 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. 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. Small, Mid-Sized, Physician practices Could Face Barriers in Meeting 'Meaningful Use' Criteria. . iHealthBeat 2010:1.

Submitted by Tom Yaeger, MD