Meaningful Use Stage 1 has certain exclusions…and it is very important for you to understand what they are.

It is also important to understand this note from the CMS “Eligible Professional (EP) Attestation Worksheet for the Medicare Electronic Health Record (EHR) Incentive Program” which states:

Note: Claiming an exclusion for a specific measure qualifies as submission of that measure. If an EP claims an exclusion for which they qualify, indicate this in the Attestation System by clicking “yes” under the exclusion part of the measure question.

This is important because you want to make sure you know exactly what your exclusions are so you don’t do extra work.

As it says above, an exclusion qualifies as a submission.

Core Objectives

You have 15 to deal with.  6 of those 15 items have exclusions.

  1. Objective: Use computerized provider order entry (CPOE) for medication orders directly entered by a licensed healthcare professional who can enter orders into the medical record per state, local and professional guidelines.
    • Exclusion: Any EP who writes fewer than 100 prescriptions during the EHR reporting period would be excluded from this requirement
  2. Objective: Implement drug-drug and drug-allergy interaction checks.
    • Exclusion: None
  3. Objective: Maintain an up-to-date problem list of current and active diagnoses.
    • Exclusion: None
  4. Objective: Generate and transmit permissible prescriptions electronically (eRx)
    • Exclusion: Any EP who writes fewer than 100 prescriptions during the EHR reporting period would be excluded from this requirement
  5. Objective: Maintain active medication list
    • Exclusion: None
  6. Objective: Maintain active medication allergy list
    • Exclusion: None
  7. Objective: Record all of the following demographics: preferred language, gender, race, ethnicity, and date of birth.
    • Exclusion: None
  8. Objective: Record and chart changes in vital signs: height, weight, blood pressure, calculate and display body mass index (BMI), plot and display growth charts for children 2-20, including BMI.
    • Has 2 potential exclusions:
      • Exclusion 1: Any EP who does not see patients 2 years or older would be excluded from this requirement
      • Exclusion 2: An EP who believes that all three vital signs of height, weight, and blood pressure have no relevance to scope of practice would be excluded from this requirement
  9. Objective: Record smoking status for patients 13 years old or older
    • Exclusion:An EP who did not see patients 13 years or older would be excluded from this requirement
  10. Objective: Report ambulatory clinical quality measures to CMS
    • Exclusion: None
  11. Objective: Implement one clinical decision support rule relevant to specialty or high clinical priority along
    with the ability to track compliance with that rule  

    • Exclusion: None
  12. Objective: Provide patients with an electronic copy of their health information (including diagnostics test
    results, problem list, medication lists, medication allergies) upon request 

    • Exclusion: An EP who has no requests from patients or their agents for an electronic copy of patient health information during the EHR reporting period would be excluded from this requirement
  13. Objective: Provide clinical summaries for patients for each office visit
    • Exclusion: An EP who has no requests from patients or their agents for an electronic copy of patient health information during the EHR reporting period would be excluded from this requirement
  14. Objective: Capability to exchange key clinical information (for example, problem list, medication list, medication allergies, and diagnostic test results), among providers of care and patient authorized entities
    electronically 

    • Exclusion: None
  15. Objective: Protect electronic health information created or maintained by the certified EHR technology through the implementation of appropriate technical capabilities
    • Exclusion: None

Menu Objectives

This is where you can really save yourself some effort.

There are 10 menu items, and you need to choose 5 for attestation.

Why would you not try to get as many exclusions here as possible??

Here are the Stage 1 Menu Set Objective Exclusions:

  1. Objective:Capability to submit electronic data to immunization registries or immunization information systems and actual submission in accordance with applicable law and practice.  This Objective has 2 exclusions:
    • Exclusion 1:  An EP who does not perform immunizations during the EHR reporting period would be excluded from this requirement
    • Exclusion 2:  If there is no immunization registry that has the capacity to receive the information electronically, an EP would be excluded from this requirement
  2. Objective: Capability to submit electronic syndromic surveillance data to public health agencies and actual submission in accordance with applicable law and practice.  This also has 2 exclusions:
    • Exclusion 1:  If an EP does not collect any reportable syndromic information on their patients during the EHR reporting period, then the EP is excluded from this requirement
    • Exclusion 2:  If there is no public health agency that has the capability to receive the information electronically, then the EP is excluded from this requirement
  3. Objective: Implement drug formulary checks.
    • Exclusion: Any EP who writes fewer than 100 prescriptions during the EHR reporting period would be excluded from this requirement
  4. Objective: Incorporate clinical lab test results into EHR as structured data
    • Exclusion: Any EP who orders no lab tests whose results are either in a positive/negative or numeric format during the EHR reporting period would be excluded from this requirement
  5. Objective: Generate lists of patients by specific conditions to use for quality improvement, reduction of disparities, research, or outreach.
    • Exclusion: None
  6. Objective: Send reminders to patients per patient preference for preventive/follow-up care.
    • Exclusion: Any EP who has no patients 65 years or older or 5 years old or younger with records maintained using certified EHR technology is excluded from this requirement
  7. Objective: Provide patients with timely electronic access to their health information (including lab results, problem list, medication lists, and allergies) within four business days of the information being available to the EP.
    • Exclusion: Any EP that neither orders nor creates lab tests or information that would be contained in the problem list, medication list, medication allergy list (or other information as listed at 45 CFR 170.304(g)) during the EHR reporting period would be excluded from this requirement
  8. Objective: Use certified EHR technology to identify patient-specific education resources and provide thoseresources to the patient if appropriate.
    • Exclusion: None
  9. Objective: The EP who receives a patient from another setting of care or provider of care or believes anencounter is relevant should perform medication reconciliation.
    • Exclusion: An EP who was not the recipient of any transitions of care during the EHR reporting period would be excluded from this requirement
  10. Objective: The EP who transitions their patient to another setting of care or provider of care or refers their patient to another provider of care should provide summary care record for each transition of care or referral.
    • Exclusion: An EP who does not transfer a patient to another setting or refer a patient to another provider during the EHR reporting period would be excluded from this requirement

If it feels a bit confusing and overwhelming, then join the club…the clarification club.

We’ve created a simple to follow Meaningful Use Kit to help you and/or your practice manager get through this process as quickly and easily as possible.

Click here to take a look at our Meaningful Use Kit.

 

 

The source document for these questions can be found on the CMS website.