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(1) Centers for Medicare and Medicaid – EHR Incentive Program
This ruling sets the guidelines for the incentive programs made available through the American Recovery and Reinvestment Act of 2009 (ARRA). It defines who is eligible for incentive dollars through three programs:

• Medicare Fee-for-Service (FFS) Program
• Medicare Advantage Program
• Medicaid Program

Within each of these programs there are guidelines set as to how providers are to use electronic health record technology in order to qualify to receive the incentive dollars supporting their adoption of an EHR. This phase of meaningful use adoption is referred to as Stage 1. Providers will be required to report to CMS data that demonstrates their usage of an EHR system.

Click here to review the Meaningful Use Stage 1 Objectives and Measures and preview eClinicalWorks functionality supporting the objective.

Review the CMS EHR Incentive Program website for a detailed understanding of the program.

Visit the eClinicalWorks Meaningful Use Resource Center for quick links to fact sheets produced by CMS.


(2) Office of the National Coordinator – Health Information Technology: Initial Set of Standards, Implementation Specifications, and Certification Criteria for Electronic Health Record Technology
To support the success of meaningful use, and the effective adoption of EHR technology, the ONC was tasked to establish requirements for Electronic Health Record vendors. This ruling was released in coordination with the CMS EHR Incentive Program to ensure that vendors comply with minimum product capabilities and standards to support Stage 1 objectives and measures. EHR vendors are expected to enhance their products, and make the required functionality available to providers.


(3) Office of the National Coordinator – Temporary Certification Program for Health Information Technology
With standards in place for meaningful use, it is also necessary to qualify the EHR technologies that meet the criteria established. This builds further confidence for providers and patients that the technology being used to support their records is compliant.

The ruling established is the first phase of the certification program designed to accelerate the formation of ONC – Authorized Testing and Certification Bodies (ONC-ATCBs). The ONC-ATCBs will be responsible for testing and certifying EHR vendors.

In order for healthcare providers to achieve meaningful use they must be using a product and version that is certified according to the meaningful use criteria. It is anticipated that ONC-ATCBs will be identified by late summer, and that EHR vendors will begin certification in the fall of 2010.

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Stage 1 of Meaningful Use sets the foundation for healthcare providers using EHR technology, and serves as a launch point for building a healthcare network across the United States. There will be future rulings to define the requirements for Stage 2 (est. 2013) and Stage 3 (est. 2015).

For Stage 1, eligible professionals are required to meet 15 core objectives, and 5 out of 10 menu set objectives. With each objective, there is a threshold or measure that defines the minimum usage for each objective. With each stage of meaningful use, these thresholds will increase in addition to new objectives. Beginning with Stage 2 of meaningful use, the menu set objectives will all become core objectives, thus it is important to plan full adoption of these objectives as time progresses.

Eligible Professionals: 15 Core Objectives		eClinicalWorks EHR Solution
(1)	Computerized physician order entry (CPOE) of medications	Medication Orders in EMR and eClinicalMobile
(2)	e-Prescribing (eRX)	EMR with e-Prescribing Activated
(3)	Report a total of 6 ambulatory clinical quality measures to CMS (Medicare EHR Incentive Program) or States (Medicaid EHR Incentive Program)	Data Capture in EMR
(4)	Implement one clinical decision support rule	Alerts and CDSS in EHR
(5)	Provide patients with an electronic copy of their health information, upon request	Medical Record with CCD/CCR Share
(6)	Provide clinical summaries for patient for each office visit	Visit Summary and CCD/CCR Share
(7)	Drug-drug and drug-allergy interaction checks	Progress Note
(8)	Record Demographics	Patient Information
(9)	Maintain an up-to-date problem list	Progress Note, Chart Panel
(10)	Maintain the patient’s active medication list	Progress Note
(11)	Maintain the patient’s active medication allergy list	Progress Note
(12)	Record and chart changes in vital signs	Progress Note
(13)	Record smoking status for patients 13 years or older	Progress Note
(14)	Capability to exchange key clinical information among providers of care and patient-authorized entities electronically	P2P and/or eEHX
(15)	Protect electronic health information	All Products

Eligible Professionals: 10 Menu Set Objectives (must meet 5 with at least 1 public health objective selected)		eClinicalWorks EHR Solution
(1)	Drug-formulary checks	Medication ordering with e-Prescribing Activated
(2)	Document clinical lab test results as structured data	Lab and Diagnostic – Lab interface optional
(3)	Generate lists of patients by specific conditions	Registry
(4)	Send reminders to patients per patient preference for preventive/follow-up care	Patient Information, Recall Letters, Patient Portal, eClinicalMessenger
(5)	Provide patients with timely electronic access to their health information	Patient Portal
(6)	Use certified EHR technology to identify patient-specific education resources and provide to patient	EMR with partner patient education service implemented
(7)	Medication reconciliation	Current Medications, Rx History, and Medication History Check via e-Prescribing
(8)	Summary of care record for each transition of care/referrals	CCD/CCR Share, P2P and/or eEHX
(9)	Capability to submit electronic data to immunization registries/systems (public health objective)	EMR with state immunization registry or IIS configured
(10)	Capability to provide electronic syndromic surveillance data to public health agencies (public health objective)	EMR, specific public health agencies to be announced

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This section of the eClinicalWorks Meaningful Use website provides an overview for eligible professionals (EPs). For a detailed review of all eligibility criteria, including Medicare Advantage and eligible hospitals, refer to the CMS EHR Incentive Program website.

Eligible Professionals (EPs) by Incentive Program
Medicare Fee-For-Service Incentives up to $44,000	Medicaid* Incentives up to $63,750
Doctor of Medicine or Osteopathy	Physicians
Doctor of Dental Surgery or Dental Medicine	Nurse Practitioners (NPs)
Doctor of Podiatric Medicine	Physician Assistants (PAs) working in a Federally Qualified Health Center or Rural Health Clinic that is led by a PA
Doctor of Optometry	Certified Nurse-Midwives (CNMs)
Chiropractor	Dentists
Eligible providers must not be hospital-based. A provider is considered hospital-based if 90% or more of their services are performed in inpatient or emergency room settings.
An EP may participate in either the Medicare FFS or Medicaid program. The EP may switch between programs once during the course of the incentive program (following the first payment).

* In addition to the above, to qualify for the Medicaid program, the EP must meet at least one of the following:

• 30% or more Medicaid patient volume (excluding CHIP patients)
• A pediatrician with 20% or more Medicaid patient volume (excluding CHIP patients)
• An EP that practices predominately in a FQHC or RHC with a minimum of 30% of patients being needy individuals

Important Facts and Timelines
Medicare Fee-For-Service Incentives up to $44,000*	Medicaid Incentives up to $63,750
Registration launches in January, 2011	States have the option to launch in January, 2011
Must demonstrate meaningful use in the first year. Click here for more information.	Can qualify for payment for the first year if adopt, implement, upgrade, or demonstrate meaningful use in the first year. Subsequent years require demonstration of meaningful use.
Must demonstrate meaningful use for 90 days in the first year; subsequent years require 365 days	By the second year, must demonstrate meaningful us for 90 days; subsequent years require 365 days
Must begin participation by 2012 to be eligible to receive the maximum incentive dollars	Must begin participation by 2016 to be eligible to receive the maximum incentive dollars
April 2011 – attestation begins	The last year to begin participation is 2016
May 2011 – incentive payments begin	2021 is the last year that Medicaid will distribute an incentive payment
February 28, 2012 – last day an EP may register and attest to receive an incentive payment for CY 2011
2016 is the last year incentive payments can be received

* Health Provider Shortage Areas qualify for an additional $4,400.

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Buzzwords
There is a lot of buzz in the healthcare industry surrounding the term “meaningful use.” It is a term that has become one of the most frequently used buzzwords in the industry. Along with it there are many more acronyms and jargon terms that may be difficult to decipher.

Be sure to check out our Industry Buzzwords page to brush up on meaningful use lingo.

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eClinicalWorks would like to gain a better sense of your views on Meaningful Use. We are in the process of building education programs, tools, and outreach mechanisms to support our clients, and your answers to a short survey will aid our thought process.

This survey can be completed by multiple providers (or a staff member on the behalf of their provider) in a practice or organization. Click here to give us your feedback regarding Meaningful Use and how if affects you and your practice. Please keep in mind, this survey is voluntary and completely anonymous.