Objectives

My facility does not perform many immunizations. Do we still have to report this data?

According to the final rule, an Eligible Hospital or Critical Access Hospital may be exempt if they do not administer any of the immunizations to any of the populations for which data is collected by their jurisdiction’s immunizations registry or immunization information system during the EHR reporting period. Evident recommends each facility contact the state public health agency for confirmation of exclusion - and to request a letter of exclusion (for auditing purposes).

Where will the Meaningful Use Stage 1 and Stage 2 Statistics Report be located?

The Meaningful Use Stage 1-2011, Stage 1-2014 and the Meaningful Use Stage 2 Statistics Reports are now found under the following path: Hospital Base Menu > Other Applications And Functions > Word Processing > AdHoc Report
These new reports will now be listed under the middle column.

If my facility is in year 2 of Stage 1 in in 2014, do I have to meet the View, Download & Transmit objective?

Yes, if your facility is attesting for year 2 of Stage 1 in 2014, your facility will have to meet measure A of View, Download & Transmit. This objective will replace the previous Stage 1 objectives of Provide patients with an electronic copy of their health information, upon request and Provide patients with an electronic copy of their discharge instructions at the time of discharge, upon request. The new objective is: Provide patients the ability to view online, download and transmit information about a hospital admission.
The new measure is: More than 50% of all patients who are discharged from the inpatient or emergency department (POS 21 or 23) of an EH or CAH have their information available online within 36 hours of discharge.
In Stage 2, an additional measure will be added. This states that more than 5% of all patients (or authorized representatives) who are discharged from the IP/ED (POS 21 or 23) of an EH/CAH view, download or transmit to a 3rd party their information during the EHR reporting period.

With Stage 1 in 2014, there is a change to the CPOE denominator. Does my facility have to use the old denominator or the new denominator?

In 2014, there will be an optional alternate measure to the objective for CPOE. The current measure for CPOE is based on the number of unique patients with a medication in their medication list that was entered using CPOE. The new, alternate measure is based on the total number of medication orders created during the EHR reporting period. An EP, EH or CAH may select either measure for this objective in Stage 1 in order to achieve Meaningful Use. (Note that this alternative measure will be required for all providers in Stage 2.) Alternate Measure:
More than 30 percent of medication orders created by the EP or authorized providers of the EH's or CAH's inpatient or emergency department (POS 21 or 23) during the EHR reporting period are recorded using CPOE.

Should swing bed patients be counted in the denominators of Meaningful Use measures for the hospital?

Unique swing bed patients who receive inpatient care should be included in the denominator of Meaningful Use measures. However if the EH or CAH cannot readily identify and include unique swing bed patients who have received inpatient care, those patients may be excluded from the calculations for the denominators of Meaningful Use measures.

Who can enter in medication orders to meet the measure for CPOE?

Any licensed healthcare professional can enter orders into the medical record for purposes of including the order in the numerator for the measure of the CPOE objective if they can enter the order per state, local and professional guidelines. The order must be entered by someone who could exercise clinical judgment in the case that the entry generates any alerts about possible interactions or other clinical decision support aides. This necessitates that CPOE occurs when the order first becomes part of the patient's medical record and before any action can be taken on the order. Each provider will have to evaluate on a case-by-case basis whether a given situation is entered according to state, local and professional guidelines, allows for clinical judgment before the medication is given, and is the first time the order becomes part of the patient's medical record.

What patient types are to be included for Meaningful Use?

There are two methods for calculating ED admissions for the denominators for measures associated with Stage 1 and Stage 2 of Meaningful Use objectives. EHs and CAHs must select one of the methods below for calculating ED admissions to be applied consistently to all denominators for the measures. That is, EHs and CAHs must choose either the “Observation Services method” or the “All ED Visits method” to be used with all measures.

Observation Services method: The patient is admitted to the inpatient setting (place of service (POS) 21) through the ED. The patient initially presented to the ED and is treated in the ED’s observation unit or otherwise receives observation services. Details on observation services can be found in the Medicare Benefit Policy Manual, Chapter 6, Section 20.6. Patients who receive observation services under both POS 22 and POS 23 should be included in the denominator.

All ED Visits method: An alternate method for computing admissions to the ED is to include all ED visits (POS 23 only) in the denominator for all measures requiring inclusion of ED admissions. All actions taken in the inpatient or emergency departments (POS 21 and 23) of the hospital would count for purposes of determining meaningful use.

My facility is an EH (not a CAH). When is the last date I can apply for Meaningful Use Stage 1, year 1 and avoid the payment adjustment?

Eligible hospitals must attest to Meaningful Use no later than April 1, 2014, to avoid the payment adjustment in Federal Fiscal Year (FFY) 2015.

What is a “unique” patient?

CMS defines a unique patient as “a patient admitted to the hospital inpatient or emergency department more than once during the EHR reporting period.” Per CMS, “for the purpose of measurement, that patient is only counted once in the denominator for the measure.”

When will the Meaningful Use payment adjustments start?

Payment adjustments will be applied beginning Oct. 1, 2014, for Medicare-eligible hospitals. CAHs will be applied beginning with the fiscal year 2015 cost reporting period.

If my hospital can only participate in the Medicaid EHR incentive program, are we excluded from the payment adjustments starting in FFY 2015?

Yes. If your hospital is only eligible to participate in the Medicaid Incentive program and you do not bill Medicare, you are excluded from the Federal Fiscal Year (FFY) 2015 payment adjustments.

Does my facility still have to perform the Key Clinical Information Exchange in 2014?

Beginning in 2013, the objective for electronic exchange of key clinical information will no longer be required for Stage 1 for EPs, EHs and CAHs. CMS is moving instead to a more robust requirement for electronic health information exchange as a part of the Stage 2 objective for providing a summary of care record following a transition of care or referral.

Transition of Care: When a patient moves from say ER to Inpatient to Skilled all in-house with all areas having full access to the EHR, do we need to create a Patient Summary with each?

No. Patients who transition within the same facility that shares the same certified EHR should not be included in the numerator or denominator of this objective. Additional software set-up is required. Please contact Software Support.

For the objective Record Demographics, is the final cause of death needed to meet this objective?

No, EHs and CAHs must record in the patient's EHR the preliminary assessment/impression of the cause of death. No further documentation is required. This measure does not require cause of death to be updated if the case is referred to the Department of Health or the coroner’s office.