The Down and Dirty of Meaningful Use

The Down and Dirty of “Meaningful Use”

So, by now we all know about the HITECH Act of 2009. We know that the Department of Health and Human Services is encouraging medical practices to adopt a digital system for documenting patient’s medical history. There is also free money available for doctors that do start using an electronic system. There are slight variations in requirements for doctors and hospitals; this article will only deal with private doctors. The key to getting the incentive payments is showing “Meaningful Use”. So lets see exactly what that those requirements are.

Meaningful use (Stage 1):


The first step in achieving meaningful use is to have a certified electronic health record (EHR) sytem and to be able to show that it is being used to meet the designated requirements. These requirements have been divided into (15) Core requirements and (10) Menu Items. Providers must meet all 15 of the Core Requirements (some exclusions apply – discussed later in this article). From the 10 Menu Items, providers must choose 5 (again, some exclusions apply – discussed later in this article). Here are the requirements:


Core Requirements:

     1. Use computerized order entry for medication orders.

     2. Implement drug-drug, drug-allergy checks.

     3. Generate and transmit permissible prescriptions electronically.

     4. Record demographics.

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

     6. Maintain active medication list.

     7. Maintain active medication allergy list.

     8. Record and chart changes in vital signs.

     9. Record smoking status for patients 13 years old or older.

    10.Implement one clinical decision support rule.

    11.Report ambulatory quality measures to CMS or the States.

    12.Provide patients with an electronic copy of their health information upon


    13.Provide clinical summaries to patients for each office visit.

    14.Capability to exchange key clinical information electronically among providers

         and patient authorized entities.

    15.Protect electronic health information (privacy & security)


Menu Requirements:

     1. Implement drug-formulary checks.

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

     3. Generate lists of patients by specific conditions to use for quality improvement,

         reduction of disparities, research, and outreach.

     4. Send reminders to patients per patient preference for preventive/ follow-up care

     5. Provide patients with timely electronic access to their health information

         (including lab results, problem list, medication lists, allergies)

     6. Use certified EHR to identify patient-specific education resources and provide to

         patient if appropriate.

     7. Perform medication reconciliation as relevant

     8. Provide summary care record for transitions in care or referrals.

     9. Capability to submit electronic data to immunization registries and actual


    10.Capability to provide electronic syndromic surveillance data to public health   



These are the requirements for Meaningful Use. Practitioners can apply for the Federal

incentives by a means called “attestation” after 90 days of use. Many EHR systems will

keep track of your progress for you and guide you towards meeting the outlined

criteria. The requirements listed above are for Stage 1, There are more stages, but they

will be discussed in future articles.


Now, as promised, a brief discussion on the exclusions. Some of the core and menu

items are not applicable to certain practices. If this is the case, you will need to file for

an exclusion. A good example will be core item #9. If your practice is a pediatric office,

you do not see patients over 13 years of age. An exclusion for that item will be granted

to your practice. On the Menu Items there are 10 to choose from. You must first try to

find 5 that are applicable to your practice. If only 3 or 4 can be applied, then you must

choose another 1 or 2 (to reach a total of 5 items) and apply for an exception for those



This act, like any and all legislation passed, can be difficult to understand. Hopefully this

article was helpful in simplifying the requirements. Also, I hope it helps medical

professionals understand some of the reasons behind the legislation. In the long run,

the more doctors that are using an electronic system, the better the collaboration and

the better the care. Another main part of the legislation is to allow the patient access to

their own records (people sometimes forget that they are not the property of the Dr’s

office). A meaningful use certified system will meet all these requirements and more.


Though there are many good EHR systems, we at Client Fit have chosen to specialize in

Practice Fusion. It is fully “Meaningful Use” certified, and best of all, it’s free. look us up