Core Measure 1
Core Measure 1
Objective
Provide patients with an electronic copy of their health information (including
diagnostic test results, problem list, medication lists, medication allergies),
upon request.
Measure
More than 50% of all patients who request an electronic copy of their health information
are provided it within 3 business days.
Exclusion
Based on ALL patient records: 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.
Core Measure 2
Core Measure 2
Objective
Implement drug-drug and drug-allergy interaction checks.
Measure
Have you enabled the functionality for drug-drug and drug-allergy interaction checks
for the entire EHR reporting period?
Core Measure 3
Core Measure 3
Objective
Maintain an up-to-date problem list of current and active diagnoses
Measure
More than 80% of all unique patients seen by the EP have at least one entry or an
indication that no problems are known for the patient recorded as structured data.
Numerator
Number of patients in the denominator who have at least one entry or an indication
that no problems are known for the patient recorded as structured data in their
problem list.
Core Measure 4
Core Measure 4
Objective
Generate and transmit permissible prescriptions electronically (eRx).
Measure
More than 40% of all permissible prescriptions written by the EP are transmitted
electronically using certified EHR technology.
Exclusion
Based on ALL patient records: Any EP who writes fewer than 100 prescriptions during
the EHR reporting period would be excluded from this requirement.
Core Measure 5
Core Measure 5
Objective
Maintain active medication list.
Measure
More than 80% of all unique patients seen by the EP have at least one entry (or
an indication that the patient is not currently prescribed any medication) recorded
as structured data.
Core Measure 6
Core Measure 6
Objective
Maintain active medication allergy list.
Measure
More than 80% of all unique patients seen by the EP have at least one entry (or
an indication that the patient has no known medication allergies) recorded as structured
data.
Core Measure 7
Core Measure 7
Objective
Record all of the following demographics: • Preferred language • Gender • Race •
Ethnicity • Date of birth
Measure
More than 50% of all unique patients seen by the EP have demographics recorded as
structured data.
Numerator
Number of patients in the denominator who have all the elements of demographics
(or a specific exclusion if the patient declined to provide one or more elements
or if recording an element is contrary to state law) recorded as structured data.
Core Measure 8
Core Measure 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 years, including BMI.
Measure
More than 50% of all unique patients age 2 and over seen by the EP, height, weight
and blood pressure are recorded as structured data.
Exclusion 1
Based on ALL patient records: An EP who does not see patients 2 years or older would
be excluded from this requirement.
Exclusion 2
Based on ALL patient records: 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.
Core Measure 9
Core Measure 9
Objective
Record smoking status for patients 13 years old or older.
Measure
More than 50% of all unique patients 13 years or older seen by the EP have smoking
status recorded as structured data.
Exclusion
Based on ALL patient records: An EP who did not see patients 13 years or older would
be excluded from this requirement.
Core Measure 10
Core Measure 10
Objective
Report ambulatory clinical quality measures to CMS.
Measure
Although clinical quality measures are not included in this tool, EPs will be required
to submit numerator, denominator, and exclusion information for clinical quality
measures during the online attestation process. If you plan to submit clinical quality
measure information during attestation, answer yes to the following question: Will
you submit Clinical Quality Measures?
Core Measure 11
Core Measure 11
Objective
Implement one clinical decision support rule relevant to specialty or high clinical
priority along with the ability to track compliance to that rule.
Measure
Have you implemented one clinical decision support rule relevant to specialty or
high clinical priority along with the ability to track compliance to that rule?
Core Measure 12
Core Measure 12
Objective
Provide patients with an electronic copy of their health information (including
diagnostic test results, problem list, medication lists, medication allergies),
upon request.
Measure
More than 50% of all patients who request an electronic copy of their health information
are provided it within 3 business days.
Exclusion
Based on ALL patient records: 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.
Core Measure 13
Core Measure 13
Objective
Provide clinical summaries for patients for each office visit.
Measure
Clinical summaries provided to patients for more than 50% of all office visits within
3 business days.
Exclusion
Based on ALL patient records: Any EP who has no office visits during the EHR reporting
period would be excluded from this requirement.
Core Measure 14
Core Measure 14
Objective
Capability to exchange key clinical information (for example, problem list, medication
list, allergies, diagnostic test results), among providers of care and patient authorized
entities electronically
Measure
Have you performed at least one test of certified EHR technology’s capacity to electronically
exchange key clinical information?
Core Measure 15
Core Measure 15
Objective
Protect electronic health information created or maintained by the certified EHR
technology through the implementation of appropriate technical capabilities.
Measure
Have you conducted or reviewed a security risk analysis per 45 CFR 164.308 (a)(1)
and implemented security updates as necessary and corrected identified security
deficiencies as part of your risk management process?
Menu Measure 1
Menu Measure 1
You must choose at least one of Menu Measure 1 or Menu Measure 2.
Objective
Capability to submit electronic data to immunization registries or immunization
information systems and actual submission in accordance with applicable law and
practice.
Measure
Performed at least one test of certified EHR technology’s capacity to submit electronic
data to immunization registries and follow up submission if the test is successful
(unless none of the immunization registries to which the EP submits such information
have the capacity to receive the information electronically).
Exclusion 1
Based on ALL patient records: An EP who does not perform immunizations during the
EHR reporting period would be excluded from this requirement.
Exclusion 2
Based on ALL patient records: If there is no immunization registry that has the
capacity to receive the information electronically, an EP would be excluded from
this requirement.
Menu Measure 2
Menu Measure 2
You must choose at least one of Menu Measure 1 or Menu Measure 2.
Objective
Capability to submit electronic syndromic surveillance data to public health agencies
and actual submission in accordance with applicable law and practice
Measure
Performed at least one test of certified EHR technology’s capacity to provide electronic
syndromic surveillance data to public health agencies and follow-up submission if
the test is successful (unless none of the public health agencies to which an EP
submits such information have the capacity receive the information electronically).
Exclusion 1
Based on ALL patient records: 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
Based on ALL patient records: If there is no public health agency that has the capability
to receive the information electronically, then the EP is excluded from this requirement.
Menu Measure 3
Menu Measure 3
If you met both Menu Measures 1 and 2, you need to meet three of Menu Measures 3-10.
If you only met one of Menu Measure 1 and 2, you need to meet four of Menu Measures
3-10.
Objective
Implement drug formulary checks.
Measure
The EP has enabled this functionality and has access to at least one internal or
external drug
Exclusion
Based on ALL patient records: Any EP who writes fewer than 100 prescriptions during
the EHR reporting period would be excluded from this requirement
Menu Measure 4
Menu Measure 4
Objective
Implement drug formulary checks .
Measure
The EP has enabled this functionality and has access to at least one internal or
external drug formulary for the entire EHR reporting period.
Exclusion
Based on ALL patient records: Any EP who writes fewer than 100 prescriptions during
the EHR reporting period would be excluded from this requirement.
Menu Measure 5
Menu Measure 5
Objective
Generate lists of patients by specific conditions to use for quality improvement,
reduction of disparities, research or outreach.
Measure
Generate at least one report listing patients of the EP with a specific condition.
Menu Measure 6
Menu Measure 6
Objective
Send reminders to patients per patient preference for preventive/follow up care.
Measure
More than 20% of all unique patients 65 years or older or 5 years or younger were
sent an appropriate reminder during the EHR reporting period.
Exclusion
Based on ALL patient records: 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.
Menu Measure 7
Menu Measure 7
Objective
Provide patients with timely electronic access to their health information (including
lab results, problem list, medication lists and allergies) within 4 business days
of the information being available to the EP.
Measure
At least 10% of all unique patients seen by the EP are provided timely (available
to the patient within four business days of being updated in the certified EHR technology)
electronic access to their health information subject to the EP’s discretion to
withhold certain information.
Exclusion
Based on ALL patient records: Any EP who neither orders nor creates lab tests or
information that would be contained in the problem list, medication list, or medication
allergy list during the EHR reporting period would be excluded from this requirement.
Menu Measure 8
Menu Measure 8
Objective
Use certified EHR technology to identify patient-specific education resources and
provide those resources to the patient if appropriate.
Measure
More than 10% of all unique patients seen by the EP during the EHR reporting period
are provided patient-specific education resources.
Menu Measure 9
Menu Measure 9
Objective
The EP who receives a patient from another setting of care or provider of care or
believes an encounter is relevant should perform medication reconciliation.
Measure
The EP performs medication reconciliation for more than 50% of transitions of care
in which the patient is transitioned into the care of the EP.
Exclusion
Based on ALL patient records: An EP who was not on the receiving end of any transition
of care during the EHR reporting period would be excluded from this requirement.
Menu Measure 10
Menu Measure 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 of care
record for each transition of care or referral.
Measure
The EP who transitions or refers their patient to another setting of care or provider
of care provides a summary of care record for more than 50% of transitions of care
and referrals.
Exclusion
Based on ALL patient records: 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.