unique patients seen by the EP have at problem list for longitudinal care in accordance with:
date problem list of current and 162.1002(a)(1) for the indicated conditions.
least one entry or an indication that no (1) The standard specified in §170.207(a)(1); or
active diagnoses.
problems are known for the patient (2) At a minimum, the version of the standard specified in §170.207(a)(2) - IHTSDO SNOMED CT® July 2009
recorded as structured data. §170.207(a)(2). version
CORE
§495.6(d)(5)(ii) - More than 80% of all §170.302(d) - Maintain active medication list. Enable a user to
§495.6(d)(5)(i) - Maintain active unique patients seen by the EP have at electronically record, modify, and retrieve a patient's active
medication list. least one entry (or an indication that the medication list as well as medication history for longitudinal
patient is not currently prescribed any care.
medication) recorded as structured data.
[75 FR 44338-39] [75 FR 44604]
§495.6(d)(6)(ii) - More than 80% of all §170.302(e) - Maintain active medication allergy list. Enable a
§495.6(d)(6)(i) - Maintain active unique patients seen by the EP have at user to electronically record, modify, and retrieve a patient's
medication allergy list. least one entry (or an indication that the active medication allergy list as well as medication allergy
patient has no known medication history for longitudinal care.
allergies) recorded as structured data.
[75 FR 44339-40] [75 FR 44605]
**Unofficial Recitations of Portions of 42 CFR Part 495 and 45 CFR Part 170**
Note: MU measures may be subject to paragraph (c) of 495.6 and exclusions to measures may be subject to paragraph (a) (eligible professionals) of section 495.6. -1-
MEANINGFUL USE
42 CFR 495.6(d)-(e) CERTIFICATION CRITERIA STANDARD(S)
45 CFR 170.302 & 170.304 45 CFR 170.205, 170.207, & 170.210
Stage 1 Objective Stage 1 Measure
EPs Ambulatory Setting
§495.6(d)(7)(i) - Record all of the
§170.304(c) - Record demographics. Enable a user to
following demographics:
electronically record, modify, and retrieve patient Race and Ethnicity.
(A) Preferred language. §495.6(d)(7)(ii) - More than 50% of all
demographic data including preferred language, gender, race, §170.207(f) - The OMB Standards for Maintaining,
(B) Gender. unique patients seen by the EP have
ethnicity, and date of birth. Enable race and ethnicity to be Collecting, and Presenting Federal Data on Race
(C) Race. demographics recorded as structured
recorded in accordance with the standard specified at and Ethnicity, Statistical Policy Directive No. 15,
(D) Ethnicity. data.
§170.207(f). October 30, 1997.
(E) Date of birth.
[75 FR 44340-42] [75 FR 44627]
status for patients 13 years old or seen by the EP have smoking status
recorded as structured data. current some day smoker; former smoker; never smoker;
older.
smoker, current status unknown; and unknown if ever
§495.6(d)(9)(iii) - Exclusion: Any EP who sees no smoked.
CORE
**Unofficial Recitations of Portions of 42 CFR Part 495 and 45 CFR Part 170**
Note: MU measures may be subject to paragraph (c) of 495.6 and exclusions to measures may be subject to paragraph (a) (eligible professionals) of section 495.6. -2-
MEANINGFUL USE
42 CFR 495.6(d)-(e) CERTIFICATION CRITERIA STANDARD(S)
45 CFR 170.302 & 170.304 45 CFR 170.205, 170.207, & 170.210
Stage 1 Objective Stage 1 Measure
EPs Ambulatory Setting
Patient summary record.
§170.205(a)(1) - HL7 CDA Release 2, CCD.
§170.304(f) - Electronic copy of health information. Enable a Implementation specifications: HITSP Summary
user to create an electronic copy of a patient’s clinical Documents Using HL7 CCD Component
information, including, at a minimum, diagnostic test results, HITSP/C32.
problem list, medication list, and medication allergy list in: §170.205(a)(2) - ASTM E2369 Standard
(1) Human readable format; and Specification for Continuity of Care Record and
(2) On electronic media or through some other electronic Adjunct to ASTM E2369.
§495.6(d)(12)(i) - Provide patients §495.6(d)(12)(ii) - More than 50% of all means in accordance with:
patients who request an electronic copy Problems.
with an electronic copy of their (i) The standard (and applicable implementation §170.207(a)(1) - The code set specified at 45 CFR
health information (including of their health information are provided it specifications) specified in §170.205(a)(1) or
within 3 business days. 162.1002(a)(1) for the indicated conditions.
diagnostics test results, problem §170.205(a)(2); and §170.207(a)(2) - IHTSDO SNOMED CT® July 2009
list, medication lists, medication §495.6(d)(12)(iii) - Exclusion: Any EP that has no (ii) For the following data elements the applicable standard version.
allergies), upon request. requests from patients or their agents for an must be used:
electronic copy of patient health information (A) Problems. The standard specified in §170.207(a)(1) Laboratory test results.
during the EHR reporting period. §170.207(c) - LOINC® version 2.27, when such
or, at a minimum, the version of the standard specified
in §170.207(a)(2); codes were received within an electronic
(B) Laboratory test results. At a minimum, the version of transaction from a laboratory.
the standard specified in §170.207(c); and Medication.
(C) Medications. The standard specified in §170.207(d). §170.207(d) - Any source vocabulary that is
included in RxNorm, a standardized
SET
§170.304(h) - Clinical summaries. Enable a user to provide §170.205(a)(1) - HL7 CDA Release 2, CCD.
clinical summaries to patients for each office visit that Implementation specifications: HITSP Summary
include, at a minimum, diagnostic test results, problem list, Documents Using HL7 CCD Component
medication list, and medication allergy list. If the clinical HITSP/C32.
summary is provided electronically it must be: §170.205(a)(2) - ASTM E2369 Standard
(1) Provided in human readable format; and Specification for Continuity of Care Record and
(2) Provided on electronic media or through some other Adjunct to ASTM E2369.
electronic means in accordance with: Problems.
§495.6(d)(13)(i) - Provide clinical §495.6(d)(13)(ii) - Clinical summaries (i) The standard (and applicable implementation §170.207(a)(1) - The code set specified at 45 CFR
summaries for patients for each provided to patients for more than 50% specifications) specified in §170.205(a)(1) or 162.1002(a)(1) for the indicated conditions.
office visit. of all office visits within 3 business days. §170.205(a)(2); and §170.207(a)(2) - IHTSDO SNOMED CT® July 2009
§495.6(d)(13)(iii) - Exclusion: Any EP who has no (ii) For the following data elements the applicable standard version.
office visits during the EHR reporting period. must be used:
(A) Problems. The standard specified in §170.207(a)(1) Laboratory test results.
or, at a minimum, the version of the standard §170.207(c) - LOINC® version 2.27, when such
specified in §170.207(a)(2); codes were received within an electronic
(B) Laboratory test results. At a minimum, the version of transaction from a laboratory.
the standard specified in §170.207(c); and Medication.
(C) Medications. The standard specified in §170.207(d). §170.207(d) - Any source vocabulary that is
included in RxNorm, a standardized
nomenclature for clinical drugs produced by the
United States National Library of Medicine.
[75 FR 44358-59] [75 FR 44631-32]
**Unofficial Recitations of Portions of 42 CFR Part 495 and 45 CFR Part 170**
Note: MU measures may be subject to paragraph (c) of 495.6 and exclusions to measures may be subject to paragraph (a) (eligible professionals) of section 495.6. -3-
MEANINGFUL USE
42 CFR 495.6(d)-(e) CERTIFICATION CRITERIA STANDARD(S)
45 CFR 170.302 & 170.304 45 CFR 170.205, 170.207, & 170.210
Stage 1 Objective Stage 1 Measure
EPs Ambulatory Setting
§170.304(i) - Exchange clinical information and patient
summary record.
(1) Electronically receive and display. Electronically receive Patient summary record.
and display a patient’s summary record, from other §170.205(a)(1) - HL7 CDA Release 2, CCD.
providers and organizations including, at a minimum, Implementation specifications: HITSP Summary
diagnostic tests results, problem list, medication list, and Documents Using HL7 CCD Component
medication allergy list in accordance with the standard HITSP/C32.
(and applicable implementation specifications) specified §170.205(a)(2) - ASTM E2369 Standard
in §170.205(a)(1) or §170.205(a)(2). Upon receipt of a Specification for Continuity of Care Record and
patient summary record formatted according to the Adjunct to ASTM E2369.
§495.6(d)(14)(i) - Capability to
alternative standard, display it in human readable format.
exchange key clinical information Problems.
(2) Electronically transmit. Enable a user to electronically
(for example, problem list, §170.207(a)(1) - The code set specified at 45 CFR
§495.6(d)(14)(ii) - Performed at least one transmit a patient summary record to other providers and
medication list, medication 162.1002(a)(1) for the indicated conditions.
test of certified EHR technology's capacity organizations including, at a minimum, diagnostic test
allergies, and diagnostic test §170.207(a)(2) - IHTSDO SNOMED CT® July 2009
to electronically exchange key clinical results, problem list, medication list, and medication
results), among providers of care version.
information. allergy list in accordance with:
and patient authorized entities
(i) The standard (and applicable implementation Laboratory test results.
electronically.
specifications) specified in §170.205(a)(1) or §170.207(c) - LOINC® version 2.27, when such
§170.205(a)(2); and codes were received within an electronic
(ii) For the following data elements the applicable standard transaction from a laboratory.
must be used:
(A) Problems. The standard specified in §170.207(a)(1) Medication.
SET
or, at a minimum, the version of the standard §170.207(d) - Any source vocabulary that is
specified in §170.207(a)(2); included in RxNorm, a standardized
(B) Laboratory test results. At a minimum, the version of nomenclature for clinical drugs produced by the
United States National Library of Medicine.
CORE
[75 FR 44617]
§495.6(d)(15)(i) - Protect electronic §495.6(d)(15)(ii) - Conduct or review a
health information created or security risk analysis in accordance with §170.302(p) - Emergency access. Permit authorized users
maintained by the certified EHR the requirements under 45 CFR (who are authorized for emergency situations) to access
technology through the 164.308(a)(1) and implement security electronic health information during an emergency.
implementation of appropriate updates as necessary and correct
technical capabilities. identified security deficiencies as part of [75 FR 44617]
its risk management process.
**Unofficial Recitations of Portions of 42 CFR Part 495 and 45 CFR Part 170**
Note: MU measures may be subject to paragraph (c) of 495.6 and exclusions to measures may be subject to paragraph (a) (eligible professionals) of section 495.6. -4-
MEANINGFUL USE
42 CFR 495.6(d)-(e) CERTIFICATION CRITERIA STANDARD(S)
45 CFR 170.302 & 170.304 45 CFR 170.205, 170.207, & 170.210
Stage 1 Objective Stage 1 Measure
EPs Ambulatory Setting
§170.302(r) - Audit log. Record actions related to electronic health
(1) Record actions. Record actions related to electronic health information.
information in accordance with the standard specified in §170.210(b) - The date, time, patient
§170.210(b). identification, and user identification must be
(2) Generate audit log. Enable a user to generate an audit log recorded when electronic health information is
for a specific time period and to sort entries in the audit created, modified, accessed, or deleted; and an
log according to any of the elements specified in the indication of which actions(s) occurred and by
standard at §170.210(b). whom must also be recorded.
[75 FR 44618-20]
Verification that electronic health information has
§170.302(s) - Integrity.
not been altered in transit.
(1) Create a message digest in accordance with the standard
§170.210(c) - A hashing algorithm with a security
specified in §170.210(c).
(2) Verify in accordance with the standard specified in strength equal to or greater than SHA-1 (Secure
§170.210(c) upon receipt of electronically exchanged Hash Algorithm (SHA-1) as specified by the
[Repeat]
§495.6(d)(15)(ii) - Conduct or review a health information that such information has not been National Institute of Standards and Technology
security risk analysis in accordance with altered. (NIST) in FIPS PUB 180-3 (October, 2008) must
§495.6(d)(15)(i) - Protect electronic
the requirements under 45 CFR (3) Detection. Detect the alteration of audit logs. be used to verify that electronic health
health information created or
maintained by the certified EHR 164.308(a)(1) and implement security information has not been altered.
technology through the updates as necessary and correct [75 FR 44620-21]
implementation of appropriate identified security deficiencies as part of
technical capabilities. its risk management process.
§170.302(t) - Authentication. Verify that a person or entity
SET
[75 FR 44621]
Encryption and decryption of electronic health
§170.302(u) - General encryption. Encrypt and decrypt information.
electronic health information in accordance with the §170.210(a)(1) - Any encryption algorithm
standard specified in §170.210(a)(1), unless the Secretary identified by the National Institute of Standards
determines that the use of such algorithm would pose a and Technology (NIST) as an approved security
significant security risk for Certified EHR Technology. function in Annex A of the Federal Information
Processing Standards (FIPS) Publication 140-2
(incorporated by reference in §170.299).
[75 FR 44621-23]
**Unofficial Recitations of Portions of 42 CFR Part 495 and 45 CFR Part 170**
Note: MU measures may be subject to paragraph (c) of 495.6 and exclusions to measures may be subject to paragraph (a) (eligible professionals) of section 495.6. -5-
MEANINGFUL USE
42 CFR 495.6(d)-(e) CERTIFICATION CRITERIA STANDARD(S)
45 CFR 170.302 & 170.304 45 CFR 170.205, 170.207, & 170.210
Stage 1 Objective Stage 1 Measure
EPs Ambulatory Setting
§495.6(e)(1)(ii) - The EP has enabled this
functionality and has access to at least
one internal or external formulary for the §170.302(b) - Drug-formulary checks. Enable a user to
§495.6(e)(1)(i) - Implement drug-
entire EHR reporting period electronically check if drugs are in a formulary or preferred
formulary checks.
drug list.
§495.6(e)(1)(iii) - Exclusion: Any EP who writes
fewer than 100 prescriptions during the EHR
[75 FR 44334-36] reporting period. [75 FR 44600-03]
§495.6(e)(2)(ii) - More than 40% of all §170.302(h) - Incorporate laboratory test results.
clinical lab tests results ordered by the (1) Receive results. Electronically receive clinical laboratory
EP during the EHR reporting period test results in a structured format and display such results
whose results are either in a in human readable format.
§495.6(e)(2)(i) - Incorporate clinical positive/negative or numerical format are (2) Display test report information. Electronically display all
lab-test results into EHR as incorporated in certified EHR technology the information for a test report specified at 42 CFR
structured data. as structured data. 493.1291(c)(1) through (7).
(3) Incorporate results. Electronically attribute, associate, or
§495.6(e)(2)(iii) - Exclusion: Any EP who orders no
lab tests whose results are either in a positive/
link a laboratory test result to a laboratory order or patient
negative or numeric format during the EHR record.
reporting period.
[75 FR 44346-47] [75 FR 44607-09]
§170.302(i) - Generate patient lists. Enable a user to
electronically select, sort, retrieve, and generate lists of
§495.6(e)(3)(i) - Generate lists of
patients according to, at a minimum, the data elements
SET
**Unofficial Recitations of Portions of 42 CFR Part 495 and 45 CFR Part 170**
Note: MU measures may be subject to paragraph (c) of 495.6 and exclusions to measures may be subject to paragraph (a) (eligible professionals) of section 495.6. -6-
MEANINGFUL USE
42 CFR 495.6(d)-(e) CERTIFICATION CRITERIA STANDARD(S)
45 CFR 170.302 & 170.304 45 CFR 170.205, 170.207, & 170.210
Stage 1 Objective Stage 1 Measure
EPs Ambulatory Setting
§170.302(m) - Patient-specific education resources. Enable a
§495.6(e)(6)(i) - Use certified EHR
user to electronically identify and provide patient-specific
technology to identify patient- §495.6(e)(6)(ii) - More than 10% of all
education resources according to, at a minimum, the data
specific education resources and unique patients seen by the EP are
elements included in the patient's: problem list; medication
provide those resources to the provided patient-specific education
list; and laboratory test results; as well as provide such
patient if appropriate. resources.
resources to the patient.
(1) Electronically receive and display. Electronically receive Patient summary record.
and display a patient’s summary record, from other §170.205(a)(1) - HL7 CDA Release 2, CCD.
providers and organizations including, at a minimum, Implementation specifications. HITSP Summary
MENU
diagnostic tests results, problem list, medication list, Documents Using HL7 CCD Component
medication allergy list in accordance with the standard HITSP/C32.
(and applicable implementation specifications) specified §170.205(a)(2) - ASTM E2369 Standard
in §170.205(a)(1) or §170.205(a)(2). Upon receipt of a Specification for Continuity of Care Record and
patient summary record formatted according to the Adjunct to ASTM E2369.
§495.6(e)(8)(i) - The EP who §495.6(e)(8)(ii) - The EP who transitions or alternative standard, display it in human readable format.
transitions their patient to another refers their patient to another setting of (2) Electronically transmit. Enable a user to electronically Problems.
care or provider of care provides a §170.207(a)(1) - The code set specified at 45 CFR
setting of care or provider of care transmit a patient summary record to other providers and
summary of care record for more than 162.1002(a)(1) for the indicated conditions.
or refers their patient to another organizations including, at a minimum, diagnostic test
provider of care should provide 50% of transitions of care and referrals. results, problem list, medication list, medication allergy §170.207(a)(2) - IHTSDO SNOMED CT® July 2009
summary care record for each §495.6(e)(8)(iii) - Exclusion: An EP who neither list in accordance with: version.
transition of care or referral. transfers a patient to another setting nor refers a (i) The standard (and applicable implementation
patient to another provider during the EHR
Laboratory test results.
reporting period.
specifications) specified in §170.205(a)(1) or §170.207(c) - LOINC® version 2.27, when such
§170.205(a)(2); and codes were received within an electronic
(ii) For the following data elements the applicable standard transaction from a laboratory.
must be used:
(A) Problems. The standard specified in §170.207(a)(1) Medication.
or, at a minimum, the version of the standard §170.207(d) - Any source vocabulary that is
specified in §170.207(a)(2); included in RxNorm, a standardized
(B) Laboratory test results. At a minimum, the version of nomenclature for clinical drugs produced by the
the standard specified in §170.207(c); and United States National Library of Medicine.
(C) Medications. The standard specified in §170.207(d).
**Unofficial Recitations of Portions of 42 CFR Part 495 and 45 CFR Part 170**
Note: MU measures may be subject to paragraph (c) of 495.6 and exclusions to measures may be subject to paragraph (a) (eligible professionals) of section 495.6. -7-
MEANINGFUL USE
42 CFR 495.6(d)-(e) CERTIFICATION CRITERIA STANDARD(S)
45 CFR 170.302 & 170.304 45 CFR 170.205, 170.207, & 170.210
Stage 1 Objective Stage 1 Measure
EPs Ambulatory Setting
**Unofficial Recitations of Portions of 42 CFR Part 495 and 45 CFR Part 170**
Note: MU measures may be subject to paragraph (c) of 495.6 and exclusions to measures may be subject to paragraph (a) (eligible professionals) of section 495.6. -8-