How to fulfill stage 1 of meaningful use

To fulfill Stage 1 of meaningful use, dermatologists need to complete all 13 core measures listed below — unless an exclusion applies — and select five additional measures to complete from a menu of 9 measures. Please note: All measures need to be performed on the patients listed in your EHR system, not just on Medicare patients.

Note: CMS extended the deadline for eligible professionals to attest to meaningful use for the Medicare EHR Incentive Program 2013 reporting year from 11:59 pm ET on Feb. 28, 2014 to 11:59 pm ET March 31, 2014.

This extension will allow more time for providers to submit their meaningful use data and receive an incentive payment for the 2013 program year, as well as avoid the 2015 payment adjustment.

This extension does not affect the deadlines for the Medicaid EHR Incentive Program or any other CMS program, including the electronic submission for the Physician Quality Reporting System EHR Incentive Program Pilot. 

Core measures

The 13 core measures required to fulfill stage 1 of meaningful use are detailed in the menu below. 

CMS changed the list of core and menu set objectives for Stage 1, which are detailed below:

    Deletion of Core Measure
    • Electronic copy of health information – This core measure has been removed in 2014 and beyond.
    • Electronic access to health information – This core measure has been removed in 2014 and beyond.

    1. 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.

    View information about the measure here.

    Additional details: CPOE is intrinsically linked to electronic prescribing because most EHR systems require you to electronically enter a medication order as the first step in e-prescribing. Most Mohs surgeons will be exempt from this measure because any physician who writes fewer than 100 non-controlled prescriptions during the reporting period is exempt. CMS also changed this measure in 2013 to allow providers the option of either measuring the total number of unique patients with at least one medication order entered electronically in a chart or the total number of medication orders created during the reporting period. Additionally, CMS clarified that credentialed medical assistants and scribes can be permitted to perform this measure as long as the physician reviews the order before it is submitted.

    2. Implement drug-drug and drug-allergy interaction checks.

    View information about the measure here.

    Additional details: Check with your EHR vendor to determine how to engage this functionality.

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

    View information about the measure here.

    Additional details: If a patient does not have any updates on current or active diagnoses, you must note that no problems are known.

    4. Generate and transmit permissible prescriptions electronically (eRx).

    View information about the measure here.

    Additional details: Most Mohs surgeons will be exempt from this measure because any physician who writes fewer than 100 non-controlled prescriptions during the reporting period is exempt. An additional exemption is available to physicians who do not have access to a pharmacy within 10 miles of their practice that accepts electronic prescriptions. Note: The denominator for this measure is all prescriptions written by the physician during the reporting period, so the practice will need to ensure that at least 40 percent of all prescriptions are sent electronically. Patients who request paper prescriptions and pharmacies that accept faxes only will count against this measure.

    5. Maintain active medication list.

    View information about the measure here.

    Additional details: If a patient has no updates, an entry should still be made noting that there are no active medications currently.

    6. Maintain active medication allergy list.

    View information about the measure here.

    Additional details: If a patient has no updates, an entry should still be made noting that there are no active medication allergies currently.

    7. Record all of the following demographics: preferred language, gender, race, ethnicity, and date of birth.

    View information about the measure here. 

    Additional details: Race and ethnicity have discrete definitions that should be noted by your EHR vendor. The most efficient method for collecting this measure is to include this question on your practice’s intake form so patients can simply select each of their demographic measures. If a patient wishes to not disclose any of their demographic information, this can be noted in his or her EHR record and counted as part of the numerator for this measure.

    8. Record and chart changes in the following vital signs: height, weight, blood pressure for patients age 3 years and older, calculate and display body mass index (BMI), and plot and display growth charts for children 2-20 years, including BMI.

    View information about the measure here.

    Additional details: Dermatologists can exclude themselves from this measure if they take the occasional blood pressure, height, or weight on a patient. Additionally, dermatologists can only record the blood pressure and exclude themselves from recording height and weight if they so choose.

    10. Implement one clinical decision support rule relevant to the specialty or high clinical priority along with the ability to track compliance with that rule.

    View information about the measure here. 

    Additional details: Dermatologists should consult with their EHR vendors to determine the best clinical decision support rule for their practices. One example of a clinical decision support rule used by a dermatologist is the ability of an EHR to display a notification when a patient is overdue for his or her yearly skin exam. The practice would use that notification to schedule an appointment with that patient and this would be noted in the medical record.


    11. Provide patients the ability to view online, download and transmit their health information online

    CMS made a significant change to the meaningful use program in 2014 that many providers may not be aware of. All physicians, regardless of the stage they are participating in, must have a patient portal in 2014 if they are participating in meaningful use.

    New Core Measure (was a menu set measure previously)

    • Patient electronic access – provide patients the ability to view online, download and transmit their health information within 4 business days of the information being available to the eligible professional. More than 50% of all unique patients seen by the physician during the EHR reporting period must be provided online access to their health information, with the ability to view, download, and transmit to a third party. You will most likely require a patient portal to achieve this measure.

    View information about the measure here. 

    You should contact your EHR vendor for additional information regarding patient portals and how to incorporate this measure into your meaningful use program for 2014 and beyond. For additional guidance from the Academy, please email hit@aad.org.



    12. Provide clinical summaries for patients for each office visit within three business days.

    View information about the measure here. 

    Additional details: Consult with your EHR vendor to determine how best to generate a clinical summary. Some vendors require the dermatologist to complete his or her notes before a clinical summary can be generated, which would require the physician to complete the note before the patient leaves the office. Practice staff also could upload the clinical summary to a patient portal, which the patient can then download within three business days. Physicians should not charge patients a fee for this information.

     

    13. Protect electronic health information created or maintained by the certified EHR technology through the implementation of appropriate technical capabilities.

    View information about the measure here. 

    Additional details: The Office of the National Coordinator for HIT has developed a helpful guide to meet this measure. Also, contact your EHR vendor to provide you with any details concerning security testing and assessment.

    The Office of the National Coordinator for Health Information Technology (ONC) offers a helpful guide to help practices meet the meaningful use measures on security risk assessment.



    Menu measures

    Choose five of the 9 available measures below. You must first try to perform at least five measures that are attainable without exclusions.  If you cannot perform at least five measures without exclusions, you can still successfully report by claiming exclusions on more than five measures.

    1. Implement drug formulary checks.

    View information about the measure here.

    Additional details: Check with your EHR vendor to determine how to engage this functionality.

    2. Incorporate clinical lab test results into EHR as structured data.

    View information about the measure here.

    Additional details: The dermatologist’s EHR must incorporate clinical lab test results into structured data in order to meet this measure. The act of inserting a PDF document with the clinical lab test results into the patient’s medical chart does not qualify as structured data.

    5. Use certified EHR technology to identify patient-specific education resources and provide those resources to the patient if appropriate.

    View information about the measure here.

    Additional details: The EHR should identify the patient-specific education resources; however the resources do not have to be in electronic format.

    6. The physician who receives a patient from another setting of care or provider of care or believes an encounter is relevant should perform medication reconciliation.

    View information about the measure here.

    Additional details: Medication reconciliation requires the practice to identify the most accurate list of medications for the patient based on an external list from either the patient themselves or another provider or hospital. Also, consult with your EHR vendor to determine how best to identify a patient from another provider in the electronic record.

    7. The physician who transitions their patient to another setting or care or provider of care or refers their patient to another provider of care should provide a summary care record for each transition of care or referral.

    View information about the measure here.

    Additional details: A summary of care record can be in the format of a letter which the dermatologist can either send electronically or as paper. The patient can also be given a copy of this letter to provide to the next provider. Also, consult with your EHR vendor to determine how best to identify a transition of care in the patient’s record.

     

    Report ambulatory clinical quality measures to CMS

    Dermatologists do not need to perform any clinical quality measures that are not relevant to their practices. This measure simply requires the physician to report his or her numerators and denominators for each clinical quality measure; however, the physician can report zero numerators, zero denominators or any combination thereof if a clinical quality measure does not apply. A full list of the clinical quality measures is available here.

    Please note: You should not select that you participate in the Medicare PQRS-EHR Incentive Pilot when you attest to this question on the CMS website. The AAD’s QRS registry does NOT qualify as a submission vendor for clinical quality measures for purposes of meaningful use.

    Stage 2 measures: