Meeting Meaningful Use Attestation: EHR System (Part 1)

One of the key requirements for receiving the EHR incentive payment is to meet the 15 core set measures (CSM) and five of the 10 menus set measures (MSM) set forth by the Center for Medicare and Medicaid Services (CMS).  Many of the measures will be met simply by using a certified EHR system.  However, some measures are more challenging and will require process changes within the practice for compliance.


CSM 1.  Use computerized physician order entry for medication orders for 30% of unique patients.

Strategy: Simply entering the medication details into the EHR will satisfy this measure for most practices.

Exclusion:  If you write fewer than 100 prescriptions during the reporting period.

Staff involved:  Clinical

Unique Patient – If a patient is seen by an eligible professional more than once during the EHR reporting period, then for purposes of measurement, they only count once in the denominator for the measure.


CSM 4.  Generate and transmit more than 40% of all permissible prescriptions electronically.

Strategy: All certified EHR systems contain e-prescribing functions.  Most of these systems would automatically “count” your e-prescribing actions when you submit the prescription electronically.

Exclusion:  If you write fewer than 100 prescriptions during the reporting period.

Staff involved: Clinical


CSM 7.   Record demographics for more than 50% of all unique patients.  You must record preferred language, gender, race, ethnicity and date of birth.

Strategy:  You record patient demographics now, but maybe not all the required values.  This is likely something your front desk staff will need to enter, typically after the patient arrives for the visit or with data imported from a patient registration portal.

Exclusion:  None

Staff involved:  Front desk/check-in/patient registration


CSM 8.  Record and chart changes in the following vital signs: height, weight and blood pressure, display BMI and plot/display growth charts for 50% of all unique patients two years old and older.

Strategy:  This measure has caused the most concern and questions.  The measure requires you to “record” changes in vital signs, but it doesn’t say “weigh and measure” your patients.  Therefore, this data could be self-reported by patients.  You can exercise the exclusion available if you believe that measuring these vital signs falls outside the scope of the practice.  The final decision on the exclusion of this measure is up to you.

Exclusion:  Any eligible professional who either sees no patients age two years or older, or who believes that all three vital signs of height, weight and blood pressure of their patients have no relevance to their scope of practice.

Staff involved:  Clinical


CSM 10.  Report clinical quality measures (CQM).

Strategy:  Become familiar with the Core, Alternate Core, and Specialty-specific options.  Chances are that you will report zero for all the Core and Alternate Core measures, but you will definitely need to report on three eyecare-specific measures (one relating to primary open angle glaucoma and two relating to diabetic retinopathy).  Your certified EHR software will generate the information you’ll need to enter when you attest.

Exclusion:  None

Staff involved:  Clinical

Note:  In 2012 you will be required to submit an electronic file containing your CQM information.


CSM 11.  Implement one clinical decision support (CDS) rule relevant to your specialty or high clinical priority.

Strategy:  The EHR vendors are handling this in different ways and will present the “rule” in different ways.  You must implement one rule that is relevant to eyecare.  For example, the CDS rule, for a given diagnosis, might present alternative drugs, a list of tests that might need to be ordered based on frequency, etc.  Once the CDS rule(s) has (have) been presented, the event would be logged in the EHR.

Exclusion:  None

Staff involved:  clinical