Meaningful Use Objectives

To demonstrate Meaningful Use of an Electronic Health Record system, eligible providers need to meet certain mandatory known as the “core set” objectives as well as some, but not all, objectives from a separate list of criteria.

There are a total of 25 Meaningful Use objectives. To qualify for an incentive payment, providers must meet 20 of these 25 objectives.
Of the required 20 objectives, 15 must be from the core set of objectives.
The remaining 5 objectives may be chosen from the list of 10 menu set objectives.

Below are the specific objectives for meeting Stage 1 of Meaningful Use (2011–2012).

Core Measures

Eligible Professional Core Objective	Eligible Professional Core Measure
Use computerized provider order entry (CPOE) for medication orders directly entered by any licensed health care professional who can enter orders into the medical record per state, local, and professional guidelines.	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 or CAH have at least one medication entered using CPOE.
Implement drug-to-drug and drug-to-allergy interaction checks.	The EP/eligible hospital/CAH has enabled this functionality for the entire EHR reporting period.
Maintain an up-to-date problem list of current and active diagnoses.	More than 80% of all unique patients seen by the EP or admitted to the eligible hospital or CAH have at least one entry or an indication that no problems are known for the patient recorded as structured data.
Generate and transmit permissible prescriptions electronically (eRx).	More than 40% of all permissible prescriptions written by the EP are transmitted electronically using certified EHR technology.
Maintain an active medication list.	More than 80% of all unique patients seen by the EP or admitted to the eligible hospital or CAH have at least one entry (or an indication that the patient is not currently prescribed any medication) recorded as structured data.
Maintain an active medication allergy list.	More than 80% of all unique patients seen by the EP or admitted to the eligible hospital or CAH have at least one entry (or an indication that the patient has no known medication allergies) recorded as structured data.
Record all of the following demographics: 1. Preferred language 2. Gender 3. Race 4. Ethnicity 5. Date of birth	More than 50% of all unique patients seen by the EP or admitted to the eligible hospital or CAH have demographics recorded as structured data.
Record and chart changes in the following vital signs: 1. Height. 2. Weight. 3. Blood pressure. 4. Calculate and display body mass index (BMI). 5. Plot and display growth charts for children 2–20 years, including BMI.	For more than 50% of all unique patients age 2 and over seen by the EP or admitted to the eligible hospital or CAH, height, weight, and blood pressure are recorded as structured data.
Record smoking status for patients 13 years old or older.	More than 50% of all unique patients 13 years or older seen by the EP or admitted to the eligible hospital or CAH have smoking status recorded as structured data.
Report ambulatory clinical quality measures to CMS or, in the case of Medicaid EPs, the States.	For 2011, provide aggregate numerator, denominator, and exclusions through attestation; for 2012, electronically submit clinical quality measures,
Implement one clinical decision support rule relevant to specialty or high clinical priority and have the ability to track compliance with that rule.	Implement one clinical decision support rule.
Provide patients with an electronic copy of their health information (including diagnostics test results, a problems list, medication lists, medication allergies) upon request.	More than 50% of all unique patients of the EP, eligible hospital, or CAH who request an electronic copy of their health information are provided it within 3 business days.
Provide clinical summaries for patients for each office visit.	Clinical summaries provided to patients for more than 50% of all office visits within 3 business days.
Capability to electronically exchange key clinical information (for example, problems list, medication lists, allergies, and diagnostic test results) among providers of care and patient-authorized entities.	Performed at least one test of the certified EHR technology’s capacity to electronically exchange key clinical information.
Protect electronic health information created or maintained by the certified EHR technology through the implementation of appropriate technical capabilities.	Conduct or review a security risk analysis per 45 CFR 164.308(a)(1) and implement updates as necessary; correct identified security deficiencies as part of the EP’s, eligible hospital’s or CAH’s risk management process.

Menu Set Measures

Eligible Professional Menu Set Objective	Eligible Professional Menu Set Measure
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.
Incorporate clinical lab test results into EHR as structured data.	More than 40% of all clinical lab test results ordered by the EP, or by an authorized provider of the eligible hospital or CAH, for patients admitted during the EHR reporting period whose results are either in a positive/negative or numerical format are incorporated in certified EHR technology as structured data.
Generate patient lists by specific conditions to use for quality improvement, reduction of disparities, research, or outreach.	Generate at least one report listing patients of the EP, eligible hospital, or CAH with a specific condition.
Send patient reminders per patient preference for preventive or follow-up care.	More than 20% of all unique patients 65 years or older or 5 years old or younger were sent an appropriate patient reminder during the EHR reporting period.
Provide patients with timely electronic access to their health information (including lab results, problems list, medication lists, and allergies) within 4 business days of the information being available to the EP.	More than 10% of all unique patients seen by the EP are provided timely (available to the patient within 4 business days of being updated in the certified EHR technology) electronic access 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 unique patients seen by the EP or admitted to the eligible hospital or CAH are provided patient-specific education resources.
The EP who receives a patient from another setting of care or provider of care or believes an encounter is relevant should perform medication reconciliation.	The EP, eligible hospital, or CAH performs 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 or CAH.
The EPs who transition their patients to another setting of care or provider of care or refer their patients to another provider of care should provide a summary care record for each transition of care or referral.	The EP, eligible hospital, or CAH that transitions or refers a 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.
Capability to submit electronic data to immunization registries or immunization information systems and actual submissions according to applicable laws and practice.*	Performed at least one test of the certified EHR 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 capacity to receive such information electronically).
Capability to submit electronic syndromic surveillance data to public health agencies and actual submissions according to applicable laws and practice.*	Performed at least one test of certified EHR technology’s capacity to provide 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 the EP, eligible hospital or CAH submits such information have the capacity to receive such information electronically).

*Unless an EP has gained an exception for these two objectives and measures, they must complete at least one as part of their demonstration of the menu set in order to be a meaningful EHR user.

What are Clinical Quality Measures?

To demonstrate Meaningful Use successfully, eligible professionals are required also to report the successful implementation of clinical quality measures.

Eligible professionals must report on 6 total clinical quality measures: 3 required core measures (substituting alternate core measures where necessary) and 3 additional measures (selected from a set of 38 clinical quality measures).

Eligible Professional— Clinical Quality Measures (CQM)

Eligible professionals must report from a total of 44 clinical quality measures that includes the following: 3 core, 3 alternate core, and 38 additional CQMs.

Core CQMs—EPs must report on 3 required core CQMs, and if the denominator of 1 or more of the required core measures is 0, then EPs are required to report results for up to 3 alternate core measures.
EPs also must also select 3 additional CQMs from a set of 38 CQMs (excluding the core/alternate core measures). It is acceptable to have a ‘0’ denominator provided the EP does not have an applicable population.

In sum, EPs must report on 6 total measures: 3 required core measures (substituting alternate core measures where necessary) and 3 additional measures. A maximum of 9 measures would be reported if the EP needed to attest to the 3 required core, the 3 alternate core, and the 3 additional measures.

CMS Clinical Quality Core and Alternative Core Measures

NQF Measure Number and PQRI Implementation Number	Clinical Quality Measure Title and Description	Core/Alternate Core Clinical Quality Measure
NQF 0421 PQRI 128	Title: Adult Weight Screening and Follow-Up Description: Percentage of patients age 18 years and older with a calculated BMI in the past six months or during the current visit documented in the medical record AND if the most recent BMI is outside parameters, a follow-up plan is documented. Specialty: Primary Care	Core
NQF 0013	Title: Hypertension: Blood Pressure Measurement Description: Percentage of patient visits for patients age 18 years and older with a diagnosis of hypertension who have been seen for at least two office visits, with blood pressure (BP) recorded.	Core
NQF 0028	Title: Preventive Care and Screening Measure Pair: (a) Tobacco Use Assessment, (b) Tobacco Cessation Intervention Description: (a) Percentage of patients age 18 years and older who have been seen for at least two office visits who were queried about tobacco use one or more times within 24 months. (b) Percentage of patients age 18 years and older identified as tobacco users within the past 24 months and have been seen for at least two office visits who received cessation intervention.	Core
NQF 0041 PQRI 110	Title: Preventive Care and Screening: Influenza Immunization for Patients 50 Years Old Description: Percentage of patients age 50 years and older who received an influenza immunization during the flu season (September through February). Specialty: Primary Care	Alternate Core
NQF 0024	Title: Weight Assessment and Counseling for Children and Adolescents Description: Percentage of patients 2 to 17 years of age who had an outpatient visit with a Primary Care Physician (PCP) or OB/GYN and who had evidence of BMI percentile documentation, counseling for nutrition, and counseling for physical activity during the measurement year. Specialty: Primary Care	Alternate Core
NQF 0038	Title: Childhood Immunization Status Description: Percentage of children 2 years of age who had four diphtheria, tetanus, and acellular pertussis (DTaP); three polio (IPV), one measles, mumps and rubella (MMR); two H influenza type B (HiB); three hepatitis B (Hep B); one chicken pox (VZV); four pneumococcal conjugate (PCV); two hepatitis A (Hep A); two or three rotavirus (RV); and two influenza (flu) vaccines by their second birthday. The measure calculates a rate for each vaccine and nine separate combination rates. Specialty: Primary Care	Alternate Core

CMS Additional Clinical Quality Measures

NQF Measure Number and PQRI Implementation Number	Clinical Quality Measure Title and Description
NQF 0059 PQRI 1	Title: Diabetes: Hemoglobin A1c Poor Control Description: Percentage of patients 18 to 75 years of age with diabetes (type 1 or type 2) who had hemoglobin A1c > 9.0%. Specialty: Primary Care
NQF 0064 PQRI 2	Title: Diabetes: Low Density Lipoprotein (LDL) Management and Control Description: Percentage of patients 18 to 75 years of age with diabetes (type 1 or type 2) who had LDL-C < 100 mg/dL. Specialty: Endocrinology
NQF 0061 PQRI 3	Title: Diabetes: Blood Pressure Management Description: Percentage of patients 18 to 75 years of age with diabetes (type 1 or type 2) who had blood pressure <140/90 mmHg. Specialty: Endocrinology
NQF 0081 PQRI 5	Title: Heart Failure (HF): Angiotensin-Converting Enzyme (ACE) Inhibitor or Angiotensin Receptor Blocker (ARB) Therapy for Left Ventricular Systolic Dysfunction (LVSD) Description: Percentage of patients age 18 years and older with a diagnosis of heart failure and LVSD (LVEF < 40%) who were prescribed ACE inhibitor or ARB therapy. Specialty: Cardiology
NQF 0070 PQRI 7	Title: Coronary Artery Disease (CAD): Beta-Blocker Therapy for CAD Patients with Prior Myocardial Infarction (MI) Description: Percentage of patients age 18 years and older with a diagnosis of CAD and prior MI who were prescribed beta-blocker therapy. Specialty: Cardiology
NQF 0043 PQRI 111	Title: Pneumonia Vaccination Status for Older Adults Description: Percentage of patients 65 years of age and older who have ever received a pneumococcal vaccine. Specialty: Pulmonology
NQF 0031 PQRI 112	Title: Breast Cancer Screening Description: Percentage of women 40 to 69 years of age who had a mammogram to screen for breast cancer. Specialty: Oncology
NQF 0034 PQRI 113	Title: Colorectal Cancer Screening Description: Percentage of adults 50 to 75 years of age who had appropriate screening for colorectal cancer. Specialty: Oncology
NQF 0067 PQRI 6	Title: Coronary Artery Disease (CAD): Oral Antiplatelet Therapy Prescribed for Patients with CAD Description: Percentage of patients age 18 years and older with a diagnosis of CAD who were prescribed oral antiplatelet therapy. Specialty: Cardiology
NQF 0083 PQRI 8	Title: Heart Failure (HF): Beta-Blocker Therapy for Left Ventricular Systolic Dysfunction (LVSD) Description: Percentage of patients age 18 years and older with a diagnosis of heart failure who also have LVSD (LVEF < 40%) and who were prescribed beta-blocker therapy. Specialty: Cardiology
NQF 0105 PQRI 9	Title: Anti-Depressant Medication Management: (a) Effective Acute Phase Treatment, (b) Effective Continuation Phase Treatment Description: Percentage of patients 18 years of age and older who were diagnosed with a new episode of major depression, were treated with antidepressant medication, and remained on an antidepressant medication treatment. Specialty: Primary Care
NQF 0086 PQRI 12	Title: Primary Open Angle Glaucoma (POAG): Optic Nerve Evaluation Description: Percentage of patients age 18 years and older with a diagnosis of POAG who have been seen for at least two office visits who have an optic nerve head evaluation during one or more office visits within 12 months. Specialty: Ophthalmology
NQF 0088 PQRI 18	Title: Diabetic Retinopathy: Documentation of Presence or Absence of Macular Edema and Level of Severity of Retinopathy Description: Percentage of patients age 18 years and older with a diagnosis of diabetic retinopathy who had a dilated macular or fundus exam performed that included documentation of the level of severity of retinopathy and the presence or absence of macular edema during one or more office visits within 12 months. Specialty: Ophthalmology
NQF 0089 PQRI 19	Title: Diabetic Retinopathy: Communication with the Physician Managing Ongoing Diabetes Care Description: Percentage of patients age 18 years and older with a diagnosis of diabetic retinopathy who had a dilated macular or fundus exam performed with documented communication to the physician who manages the ongoing care of the patient with diabetes mellitus regarding the findings of the macular or fundus exam at least once within 12 months. Specialty: Ophthalmology
NQF 0047 PQRI 53	Title: Asthma Pharmacologic Therapy Description: Percentage of patients age 5 to 40 years with a diagnosis of mild, moderate, or severe persistent asthma who were prescribed either the preferred long-term control medication (inhaled corticosteroid) or an acceptable alternative treatment. Specialty: Pulmonology
NQF 0001 PQRI 64	Title: Asthma Assessment Description: Percentage of patients age 5 to 40 years with a diagnosis of asthma and who have been seen for at least two office visits, which were evaluated during at least one office visit within 12 months for the frequency (numeric) of daytime and nocturnal asthma symptoms. Specialty: Pulmonology
NQF 0002 PQRI 66	Title: Appropriate Testing for Children with Pharyngitis Description: Percentage of children 2 to 18 years of age who were diagnosed with pharyngitis, dispensed an antibiotic, and received a group A streptococcus (strep) test for the episode. Specialty: Pediatrics
NQF 0387 PQRI 71	Title: Oncology Breast Cancer: Hormonal Therapy for Stage IC-IIIC Estrogen Receptor/Progesterone Receptor (ER/PR) Positive Breast Cancer Description: Percentage of female patients age 18 years and older with Stage IC through IIIC, ER, or PR positive breast cancer who were prescribed tamoxifen or aromatase inhibitor (AI) during the 12-month reporting period. Specialty: Oncology
NQF 0385 PQRI 72	Title: Oncology Colon Cancer: Chemotherapy for Stage III Colon Cancer Patients Description: Percentage of patients age 18 years and older with Stage IIIA through IIIC colon cancer who are referred for adjuvant chemotherapy, prescribed adjuvant chemotherapy, or have previously received adjuvant chemotherapy in the 12-month reporting period. Specialty: Oncology
NQF 0389 PQRI 102	Title: Prostate Cancer: Avoidance of Overuse of Bone Scan for Staging Low-Risk Prostate Cancer Patients Description: Percentage of patients, regardless of age, with a diagnosis of prostate cancer at low risk of recurrence receiving interstitial prostate brachytherapy OR external beam radiotherapy to the prostate OR radical prostatectomy OR cryotherapy who did not have a bone scan performed at any time since diagnosis of prostate cancer. Specialty: Oncology
NQF 0027 PQRI 115	Title: Smoking and Tobacco Use Cessation, Medical Assistance: (a) Advising Smokers and Tobacco Users to Quit, (b) Discussing Smoking and Tobacco Use Cessation Medications, (c) Discussing Smoking and Tobacco Use Cessation Strategies Description: Percentage of patients 18 years of age and older, who were current smokers or tobacco users, who were seen by a practitioner during the measurement year and who received advice to quit smoking or tobacco use or whose practitioner recommended or discussed smoking or tobacco use cessation medications, methods, or strategies. Specialty: Pulmonology
NQF 0055 PQRI 117	Title: Diabetes: Eye Exam Description: Percentage of patients 18 to 75 years of age with diabetes (type 1 or type 2) who had a retinal or dilated eye exam or a negative retinal exam (no evidence of retinopathy) by an eye care professional. Specialty: Endocrinology
NQF 0062 PQRI 119	Title: Diabetes: Urine Screening Description: Percentage of patients 18 to 75 years of age with diabetes (type 1 or type 2) who had a nephropathy screening test or evidence of nephropathy. Specialty: Endocrinology
NQF 0056 PQRI 163	Title: Coronary Artery Disease (CAD): Drug Therapy for Lowering LDL-Cholesterol Description: Percentage of patients age 18 years and older with a diagnosis of CAD who was prescribed a lipid-lowering therapy (based on current ACC/AHA guidelines). Specialty: Primary Care
NQF 0074 PQRI 197	Title: Coronary Artery Disease (CAD): Drug Therapy for Lowering LDL-Cholesterol Description: Percentage of patients age 18 years and older with a diagnosis of CAD who was prescribed a lipid-lowering therapy (based on current ACC/AHA guidelines). Specialty: Primary Care
NQF 0084 PQRI 200	Title: Heart Failure (HF): Warfarin Therapy Patients with Atrial Fibrillation Description: Percentage of all patients age 18 years and older with a diagnosis of heart failure and paroxysmal or chronic atrial fibrillation that were prescribed Warfarin therapy. Specialty: Cardiology
NQF 0073 PQRI 201	Title: Ischemic Vascular Disease (IVD): Blood Pressure Management Description: Percentage of patients 18 years of age and older who were discharged alive for acute myocardial infarction (AMI), coronary artery bypass graft (CABG) or percutaneous transluminal coronary angioplasty (PTCA) from January 1 to November 1 of the year prior to the measurement year, or who had a diagnosis of ischemic vascular disease (IVD) during the measurement year and the year prior to the measurement year and whose recent blood pressure is in control (<140/90 mmHg). Specialty: Neurology
NQF 0068 PQRI 204	Title: Ischemic Vascular Disease (IVD): Use of Aspirin or Another Antithrombotic Description: Percentage of patients 18 years of age and older who were discharged alive for acute myocardial infarction (AMI), coronary artery bypass graft (CABG), or percutaneous transluminal coronary angioplasty (PTCA) from January 1 to November 1 of the year prior to the measurement year, or who had a diagnosis of ischemic vascular disease (IVD) during the measurement year and the year prior to the measurement year and who had documentation of use of aspirin or another antithrombotic during the measurement year. Specialty: Neurology
NQF 0004	Title: Initiation and Engagement of Alcohol and Other Drug Dependence Treatment: (a) Initiation, (b) Engagement Description: Percentage of adolescent and adult patients with a new episode of alcohol and other drug (AOD) dependence who initiate treatment through an inpatient AOD admission, outpatient visit, intensive outpatient encounter, or partial hospitalization within 14 days of the diagnosis and who initiated treatment and had two or more additional services with an AOD diagnosis within 30 days of the initiation visit. Specialty: Primary Care
NQF 0012	Title: Prenatal Care: Screening for Human Immunodeficiency Virus (HIV) Description: Percentage of patients, regardless of age, who gave birth during a 12-month period who were screened for HIV infection during the first or second prenatal care visit. Specialty: Obstetrics and Gynecology
NQF 0014	Title: Prenatal Care: Anti-D Immune Globulin Description: Percentage of D (Rh) negative, unsensitized patients, regardless of age, who gave birth during a 12-month period who received anti-D immune globulin at 26 to 30 weeks of gestation. Specialty: Obstetrics and Gynecology
NQF 0018	Title: Controlling High Blood Pressure Description: The percentage of patients 18 to 85 years of age who had a diagnosis of hypertension and whose BP was adequately controlled during the measurement year. Specialty: Primary Care
NQF 0032	Title: Cervical Cancer Screening Description: Percentage of women 21 to 64 years of age who received one or more Pap tests to screen for cervical cancer. Specialty: Primary Care
NQF 0033	Title: Chlamydia Screening for Women Description: Percentage of women 15 to 24 years of age who were identified as sexually active and who had at least one test for chlamydia during the measurement year. Specialty: Obstetrics and Gynecology
NQF 0036	Title: Use of Appropriate Medications for Asthma Description: Percentage of patients 5 to 50 years of age who were identified as having persistent asthma and were appropriately prescribed medication during the measurement year. Report three age stratifications (5–11 years, 12–50 years, and total). Specialty: Primary Care
NQF 0052	Title: Low Back Pain: Use of Imaging Studies Description: Percentage of patients with a primary diagnosis of low back pain who did not have an imaging study (plain x-ray, MRI, CT scan) within 28 days of diagnosis. Specialty: Primary Care
NQF 0075	Title: Ischemic Vascular Disease (IVD): Complete Lipid Panel and LDL Control Description: Percentage of patients 18 years of age and older who were discharged alive for acute myocardial infarction (AMI), coronary artery bypass graft (CABG), or percutaneous transluminal coronary angioplasty (PTCA) from January 1 to November 1 of the year prior to the measurement year, or who had a diagnosis of ischemic vascular disease (IVD) during the measurement year and the year prior to the measurement year and who had a complete lipid profile performed during the measurement year and whose LDL-C<100 mg/dL. Specialty: Primary Care
NQF 0575	Title: Diabetes: Hemoglobin A1c Control (<8.0%) Description: Percentage of patients 18 to 75 years of age with diabetes (type 1 or type 2) who had hemoglobin A1c <8.0%.