A First Look at Meaningful UMeaningful UA First Look at

ul Use Stage 2ul Use Stage 2

Overall requirements

EPs must meet or qualify for an eof 5 menu objectives. (Stage 1 was 15/5 of 10)

Eligible hospitals and Critical Accfor an exclusion to 16 core objecti(Stage 1 was 14/5 of 10)

EPs to report 12 CQMs (Stage 1 was 6)

Eligible hospitals and CAHs to report 24 CQMs (Stage 1 was 15)

Alignment with other Quality Measurement initiatives

Overall requirements

n exclusion to 17 core objectives and of 5 menu objectives. (Stage 1 was 15/5 of 10)

Access Hospitals must meet or qualiectives and 2 of 4 menu objectives.

EPs to report 12 CQMs (Stage 1 was 6)

Eligible hospitals and CAHs to report 24 CQMs (Stage 1 was 15)

Alignment with other Quality Measurement initiatives

Improving quality, safety, efficiency, and reducing health disparities

More than 60 percent (Stage 1 was 3radiology orders created by the EP ohospital's or CAH's inpatient or emeduring the EHR reporting period are recorded using CPOE.

More than 65 percent (Stage 1 was 4written by the EP are compared to atransmitted electronically using Certified EHR Technology.

More than 80 percent (Stage 1 was 5EP or admitted to the eligible hospitdepartment (POS 21 or 23) have demdata.

Improving quality, safety, efficiency, and reducing health disparities

as 30%) of medication, laboratory, anP or authorized providers of the elig

emergency department (POS 21 or 23during the EHR reporting period are recorded using CPOE.

as 40%) of all permissible prescriptioto at least one drug formulary and

transmitted electronically using Certified EHR Technology.

as 50%) of all unique patients seen bspital's or CAH's inpatient or emergedemographics recorded as structured

Improving quality, safety, efficiency, and reducing health disparities

� More than 80 percent (Stage 1 was 5EP or admitted to the eligible hospiEP or admitted to the eligible hospidepartment (POS 21 or 23) have bloonly) and height/length and weighdata

� More than 80 percent (Stage 1 was 5or older seen by the EP or admitted to the eligible hospital's or CAH's inpatient or emergency departmenrecorded as structured data

� Implement 5 clinical decision support interventions (Stage 1 was one) � Implement 5 clinical decision support interventions (Stage 1 was one) related to 5 or more clinical qualitycare for the entire EHR reporting period.

� The EP, eligible hospital or CAH has enabled and implemented the functionality for drug-drug and drugentire EHR reporting period. (Stage 1 required implementation)

Improving quality, safety, efficiency, and reducing health disparities

as 50%) of all unique patients seen by the ospital's or CAH's inpatient or emergency ospital's or CAH's inpatient or emergency blood pressure (for patients age 3 and over ight (for all ages) recorded as structured

as 50%) of all unique patients 13 years old or older seen by the EP or admitted to the eligible hospital's or CAH's

ent (POS 21 or 23) have smoking status

Implement 5 clinical decision support interventions (Stage 1 was one) Implement 5 clinical decision support interventions (Stage 1 was one) lity measures at a relevant point in patient

care for the entire EHR reporting period.

The EP, eligible hospital or CAH has enabled and implemented the drug and drug- allergy interaction checks for the

entire EHR reporting period. (Stage 1 required implementation)

Improving quality, sand reducing health disparities

� More than 55 percent (Stage 1 was 40%ordered by the EP or by authorized proordered by the EP or by authorized propatients admitted to its inpatient or emthe EHR reporting period whose results are either in a positive/negative or numerical format are incorporated in data

� Generate at least one report listing patwith a specific condition. (Stage 1 was same)

� More than 10 percent of all unique patEP within the 24 months prior to the bsent a reminder, per patient preference (Stage 1 was 20%, menu set)sent a reminder, per patient preference (Stage 1 was 20%, menu set)

� More than 10 percent of medication oreligible hospital's or CAH's inpatient oduring the EHR reporting period are tracked using eMAR. (New)

ty, safety, efficiency, and reducing health disparities

40%, menu set) of all clinical lab tests results providers of the eligible hospital or CAH for providers of the eligible hospital or CAH for r emergency department (POS 21 or 23 during

the EHR reporting period whose results are either in a positive/negative or in Certified EHR Technology as structured

patients of the EP, eligible hospital or CAH with a specific condition. (Stage 1 was same)

patients who have had an office visit with the he beginning of the EHR reporting period were

sent a reminder, per patient preference (Stage 1 was 20%, menu set)sent a reminder, per patient preference (Stage 1 was 20%, menu set)

n orders created by authorized providers of the nt or emergency department (POS 21 or 23)

during the EHR reporting period are tracked using eMAR. (New)

Engage patients and health care

More than 50 percent of all unique patientsMore than 50 percent of all unique patientsare provided timely (within 4 business daysonline access to their health information suinformation (Stage 1 was 10%, menu set)

More than 10 percent of all unique patients (or their authorized representatives) view, dhealth information (New)

More than 50 percent of all patients who aredepartment (POS 21 or 23) of an eligible hosonline within 36 hours of discharge (Stage 1 was 10%, menu set)online within 36 hours of discharge (Stage 1 was 10%, menu set)

More than 10 percent of all patients who aredepartment (POS 21 or 23) of an eligible hosthird party their information during the reporting period (New)

and families in their

nts seen by the EP during the EHR reporting pents seen by the EP during the EHR reporting peays after the information is available to the EP) subject to the EP's discretion to withhold certa

nts seen by the EP during the EHR reporting perw, download , or transmit to a third party their

are discharged from the inpatient or emergenc hospital or CAH have their information availab

online within 36 hours of discharge (Stage 1 was 10%, menu set)online within 36 hours of discharge (Stage 1 was 10%, menu set)

are discharged from the inpatient or emergency hospital or CAH view, download or transmit to

third party their information during the reporting period (New)

Engage patients and families in their health care

Clinical summaries provided to� Clinical summaries provided tothan 50 percent of office visits. (Stage 1 was 3 days)

� Patient-specific education resoTechnology are provided to patall office visits by the EP. More than 10 percent of all unique patients admitted to the eligiblemergency departments (POS 21 or 23) are provided patientspecific education resources identified by Certified EHR specific education resources identified by Certified EHR Technology (Stage 1 was menu set)

� A secure message was sent using the electronic messaging function of Certified EHR Techunique patients seen during the EHR reporting period (New)

Engage patients and families in their health care

d to patients within 24 hours for more d to patients within 24 hours for more than 50 percent of office visits. (Stage 1 was 3 days)

esources identified by Certified EHR patients for more than 10 percent of

all office visits by the EP. More than 10 percent of all unique gible hospital's or CAH's inpatient or

emergency departments (POS 21 or 23) are provided patient-specific education resources identified by Certified EHR specific education resources identified by Certified EHR Technology (Stage 1 was menu set)

A secure message was sent using the electronic messaging echnology by more than 10 percent of

unique patients seen during the EHR reporting period (New)

Improve Care CoordinationThe EP, eligible hospital or CAH performs medication reconciliation for The EP, eligible hospital or CAH performs medication reconciliation for more than 65 percent of transitions of care in which the patient is transitioned into the care of the EP or CAH's inpatient or emergency departmmenu set)

The EP, eligible hospital, or CAH that another setting of care or provider of cfor more than 65 percent of transition50%, menu set)

The EP, eligible hospital, or CAH that another setting of care or provider of care electronically transmits a summary of care record using certifiedno organizational affiliation and usingvendor than the sender for more than referrals. (Stage 1 was one test)

Improve Care CoordinationThe EP, eligible hospital or CAH performs medication reconciliation for The EP, eligible hospital or CAH performs medication reconciliation for more than 65 percent of transitions of care in which the patient is

or admitted to the eligible hospital's or artment (POS 21 or 23). (Stage 1 was 50%,

at transitions or refers their patient to of care provides a summary of care record ions of care and referrals. (Stage 1 was

at transitions or refers their patient to another setting of care or provider of care electronically transmits a

fied EHR technology to a recipient with sing a different Certified EHR Technology an 10 percent of transitions of care and

Improve Population and Public Health

Hospital and EP - Successful ongimmunization data from Certified EHR Technology to an immunization data from Certified EHR Technology to an immunization registry or immunentire EHR reporting period (Sta

Hospital - Successful ongoing sublaboratory results from Certified agencies for the entire EHR reporwas a single test, menu set)

Hospital - Successful ongoing subsurveillance data from Certified Eagency for the entire EHR reportimenu set)

Improve Population and Public

ongoing submission of electronic immunization data from Certified EHR Technology to an immunization data from Certified EHR Technology to an

unization information system for thStage 1 was a single test, menu set)

submission of electronic reportable ied EHR Technology to public healthporting period as authorized. (Stage

submission of electronic syndromiced EHR Technology to a public healthorting period (Stage 1 was a single tes

Ensure adequate privacy and security protections for personal health information� Conduct or review a security risk analysis in accordance

with the requirements under 45 CFR 164.308(a)(1), including addressing the encryption/security of data at rest in accordance with requirements under 45 CFR 164.312 (a)(2)(iv) and 45 CFR 164.306(d)(3), and implement security updates as necessary and correct identified security deficiencies as part of the provider's identified security deficiencies as part of the provider's risk management process. (added data at rest)

Ensure adequate privacy and security protections for personal health

Conduct or review a security risk analysis in accordance with the requirements under 45 CFR 164.308(a)(1), including addressing the encryption/security of data at rest in accordance with requirements under 45 CFR 164.312 (a)(2)(iv) and 45 CFR 164.306(d)(3), and implement security updates as necessary and correct identified security deficiencies as part of the provider's identified security deficiencies as part of the provider's risk management process. (added data at rest)

Menu Set - Improving quality, safety, efficiency, and reducin

More than 50 percent of all unique patients 65 years old or older admitted to the More than 50 percent of all unique patients 65 years old or older admitted to the eligible hospital's or CAH's inpatient departmperiod have an indication of an advance dire(Stage 1 was advance directive indicator only)

More than 40 percent of all scans and tests wor by an authorized provider of the eligible hinpatient or emergency department (POS 21 are accessible through Certified EHR Technology (New)

More than 20 percent of all unique patients shospital or CAH's inpatient or emergency dehospital or CAH's inpatient or emergency dereporting period have a structured data entry for one or more first(New)

More than 10 percent of hospital discharge medication orders for permissible prescriptions (for new or changed prescriptions) are compared to at least one drug formulary and transmitted electronically using Certified EHR Technology (New)

Improving quality, safety, ucing health disparities

More than 50 percent of all unique patients 65 years old or older admitted to the More than 50 percent of all unique patients 65 years old or older admitted to the artment (POS 21) during the EHR reporting irective status recorded as structured data.

(Stage 1 was advance directive indicator only)

ts whose result is an image ordered by the EP le hospital or CAH for patients admitted to its 21 and 23) during the EHR reporting period

are accessible through Certified EHR Technology (New)

ts seen by the EP or admitted to the eligible department (POS 21 or 23) during the EHR department (POS 21 or 23) during the EHR

reporting period have a structured data entry for one or more first- degree relatives

More than 10 percent of hospital discharge medication orders for permissible prescriptions (for new or changed prescriptions) are compared to at least one drug formulary and transmitted electronically using Certified EHR Technology (New)

Menu Set - Improve PPublic Health

EP - Successful ongoing submission of electronic syndromic surveillance data from Certified Eagency for the entire EHR reporti

Successful ongoing submission oCertified EHR Technology to a careporting period (New)

Successful ongoing submission oSuccessful ongoing submission oCertified EHR Technology to a spreporting period (New)

ve Population and

Successful ongoing submission of electronic syndromic ed EHR Technology to a public healthorting period (Stage 1 was a single tes

n of cancer case information from a cancer registry for the entire EHR

n of specific case information from n of specific case information from a specialized registry for the entire EH

Quality Measures for Eligible Professionals

Option 1a - EPs would report 12 clinical quality measures fromthe 6 domains:

� Patient and Family Engagement.

� Patient Safety.

� Care Coordination.

� Population and Public Health.

� Efficient Use of Healthcare Resources.

� Clinical Process/Effectiveness.

Option 1b- EPs would report 11 "core" clinical quality measure

Option 2: Submit and satisfactorily report clinical quality meaReporting Option."

Table 6 is based upon analysis of several factors that include: beneficiaries' morbidity and mortality; conditions that represcommon to health disparities; those conditions that dispropoquality measurement; measures that would enable CMS, Statdimensions with a stronger focus on parsimonious measuremengagement.

Table 8 lists all of the clinical quality measures that we are conbeginning with CY 2014.

Quality Measures for Eligible

rom those listed in Table 8, including at least 1 measure from

ures listed in Table 6 plus 1 "menu" clinical quality measure fr

measures under the Physician Quality Reporting System's EH

de: conditions that contribute the most to Medicare and Medresent national public/population health priorities; conditio

oportionately drive healthcare costs that could improve with btates, and the provider community to measure quality of care

rement; and those measures that include patient and/or careg

considering for EPs to report for the EHR Incentive Programs

Quality Measures for HospitalsRequires eligible hospitals and CAHs to report 24 clinical quality measures from a menu of 49 clinical quality measurmeasure from each of the 6 domains:measure from each of the 6 domains:

Clinical Process/Effectiveness.

Patient Safety.

Care Coordination.

Efficient Use of Healthcare Resources

Patient & Family Engagement.

Population & Public Health.

The measures in Table 9 are based on statutory requirements, the HITPC's recommendations, alignment with other CMS and national hospital quality measurement programs such as the Joint CInpatient Quality Reporting Program and Hospital ValueProgram, and the National Quality Strategy.

Quality Measures for HospitalsRequires eligible hospitals and CAHs to report 24 clinical quality measures

sures, including at least 1 clinical quality

Efficient Use of Healthcare Resources

The measures in Table 9 are based on statutory requirements, the HITPC's recommendations, alignment with other CMS and national hospital quality

int Commission, the Medicare Hospital Inpatient Quality Reporting Program and Hospital Value-Based Purchasing Program, and the National Quality Strategy.