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How do I calculate and report these objectives and measures?

Medicaid providers that adopt, implement, or upgrade during their first year of participating in the program are not required to attest to these measures that year.  They must, however, demonstrate Meaningful Use in subsequent years of the program.  For their first year of demonstrating Meaningful Use, providers will report these measures through attestation.  For the following years, providers will electronically submit these data.  Providers participating in the Medicaid EHR incentive program will report to their state, while those participating in the Medicare EHR incentive program will report to CMS.  

For each of the required functional objectives and clinical quality measures, you are required to report the beginning and end dates of the reporting period, and if applicable, report the numerator and denominator for each measure.  Some measures are answered by a yes/no response (e.g., the drug-drug and drug-allergy interaction checks were enabled for the entire EHR reporting period).  Other measures are percentage based (e.g., 40 percent of prescriptions ordered were generated and transmitted electronically using certified EHR technology).  Percentage-based measures require that you calculate an aggregate numerator and denominator.  Most of the measure calculations include only those patients that have an EHR record.  Some of the measures, however, (e.g., “Record Demographics” and “Maintain an Up-to-Date Problem List”) account for the total patient population, which includes all patients seen or admitted during the EHR reporting period, regardless of whether their records are kept using certified EHRs technology.  

If a functional objective or measure is not applicable to your clinical practice (i.e., there are no eligible patients or actions for the denominator), the provider would be excluded from having to meet that measure.  For example, chiropractors do not e-Prescribe, and so would be excluded from having to meet that measure.  For the clinical quality measures, if any of the three core measures is inapplicable, you should report on one or more of the alternate core measures.  If all six of the core and alternate core measures are inapplicable, you may choose any three of the “additional” measures and only report on those three measures.  The three core measures, for example, are not likely to apply to pediatricians and only two of the three alternate core measures will apply to pediatricians.  

Related Resources:

EHR Incentive Program Meaningful Use – CMS information on reporting Meaningful Use objectives and measures.
Quality Measures- electronic specifications – CMS reporting specifications and requirements.  
EHR Incentive Program Frequently Asked Questions – CMS responses to frequently asked questions regarding EHR Incentive Program requirements.
Quality Reporting and Quality Improvement – PowerPoint presentation by Michelle Pichardo of the Institute for Family Health discusses the integration of EHR systems into practice and how changes in workflow promote quality reporting and improvement.