TMG Meaningful Use

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Outpatient Meaningful Use for WorldVistA

Hello. My name is Kevin Toppenberg, MD. I am a primary care physician in Greeneville, TN. I have been active in the VistA community for at least 7 years, and have used VistA in my office during this time. I have decided to pursue meaningful use certification with VistA. This page will document my progress towards this, and record notes that I make to myself along the way. I hope this is helpful to others.

In CMS terminology, I am an "Eligible Provider" (EP), not a hospital. Also, I am going after Medicare (not Medicaid) certification. So my discussion below will be targeted accordingly.

NOTE: Other are welcome to make enhancements to this page

Q: Where can I find the certification status of WorldVistA?

  • Go to CMS Certified Health IT Products
  • Search for "WorldVistA" -- NOTE: the search engine on this page is flaky. I found that when I clicked the search button, it would return a list of ALL technology. But when I then simply clicked search AGAIN (with WorldVistA still in the search term box), then it would find it.

Q: There seems to be so many steps to be ready to attest meaningful use. It's overwhelming. Any overview sites?

Q: What's the bottom line? What do I have to do to be ready to attest meaningful use?

  1. Meet 20 of 25 "Meaningful Use Objectives" source
    • Must meet 15 "core" measures
    • Must also meet 5 of 10 possible "menu" set measures
  2. Meet 6 of 41 "Clinical Quality Measures (CQM's)" source
    • Must meet 3 required core quality measures
    • must also meet 3 of 38 possible additional quality measures
  3. Attest to meeting requirements using Y/N answers and by supplying data from the Quality Measures package.

TODO SMH: Reference and write about the Quality Measures package.

Q: Can you tell me more about the 15 "core" meaningful use measures? (all are required)

(Detailed instructions on meeting these will be provided in more detail below.)

Measure Link to CMS Source VISTA fulfillment Attestation Type
CPOE -- Provider directly enters in orders Source Fulfillment Rate > 30%
Implement drug-drug and drug-allergy interaction checks Source Fulfillment Yes/No
Maintain an up-to-date problem list of current and active diagnoses Source Fullfillment Rate > 80%
Generate and transmit permissible prescriptions electronically (eRx) Source not available Rate > 40%
Maintain active medication list Source Fulfillment Rate > 80%
Maintain active medication allergy list Source Fulfillment Rate > 80%
Record required demographics Source Fulfillment Rate > 50%
Record required vital signs Source Fulfillment Rate > 50%
Record smoking status for patients aged 13 yrs and up Source Fulfillment Rate > 50%
Report clinical quality measures to CMS Source Fulfillment Yes/No (Measures are reportable rates however)
Implement 1 clinical decision support rule Source Fulfillment Yes/No
Provide patients with an electronic copy of their health information Source Fulfillment Rate > 50%
Provide clinical summaries for patients for each office visit within 3 days Source Fulfillment Rate > 50%
Perform at least 1 test of exchanging key clinical information with another entity electronically Source Fulfillment Yes/No
Protect electronic health information Source

1 2 3 4 5 6

Yes/No

Q: What about the 5 "menu" set of meaningful use objectives? (5 of 10 possible are required)

Measure Link to CMS Source VISTA fulfillment Attestation Type
Implement drug formulary checks Source Fulfillment Yes/No
Incorporate lab results into EHR as structured data Source Fulfillment Rate > 40%
Generate list of patients by specific conditions for quality improvement Source Fulfillment Yes/No
Send patient reminders per patient preference Source NOT DONE NOT DONE
Provide patients with timely electronic access to their health information Source NOT DONE NOT DONE
Provide patient-specific education resources Source Fulfillment Rate > 10%
Perform medication reconcilliation Source Fulfillment Rate > 50%
Send summary care record to other providers Source Fulfillment Rate > 50%
Submit data to immunization registries Source Fulfillment Yes/No
Submit syndromic surveillance data Source NOT DONE NOT DONE

Q: What about the required Clinical Quality Measures (CQM)?

You must report the 3 core measures. If any of the 3 core measures are reported with zero values for the denominator, you are required to pick an alternate core measure to report in addition, even if these yield zero. For example if: NQF 0028 & NQF 0421 are 0; report 2 measures from the alternate core measures.

In addition to the core/alternate core measures, you need to report an additional 3 measures from the additional list of 38 CQMs.

Click here for a list of all measures afrom the CMS website along with the instructions just above.

NB: If you see the numerator and denomiator logic filled out, it means that the measure is fully supported in the Quality Measurement Package. If they are not there, then they are unsupported; you may still report on them, but you will have to do extra work on your end to make them work.

Core Measures

Measure Description Sources Denominator in VISTA Numerator in VISTA
NQF0013 Hypertension: Blood Pressure Measurement details2 Patients with Hypertenstion Blood Pressure recorded as a Vital
NQF0028 Tobacco: Use Asessment details Patients Health factors in NFQ0028AB Tobacco Managment Dialog
Tobacco Cessation Intervention details Patients who smoke Health factors in NFQ0028AB Tobacco Managment Dialog
NQF0421 Adult Weight Screening and Follow-up details Patients with high BMI Health factors in MU NQF0421 BMI DI

Alternate Core Measures

If you reported 0 for all 3 core measures, you must report on all 3 alternate core measures even if you will report zeroes for all 6 measures.

Measure Description Sources Denominator in VISTA Numerator in VISTA
NQF 0024 BMI for age 2-18 details Obese Patients in the Date Range (using Vitals package) ICD9/CPT codes V65.3, 97802, G0270, S9449, S9452, S9470
NQF 0041 Influenza vaccination details Patients Immunization (IM FLU, 3 yrs) in MU NQF0041 INFLUENZA MANAGEMENT DI
NQF 0038 Childhood immunization status details Patients <= 2 yo Dialog MU NQF0038 IMMUNE MANAGEMENT DI

Additional Core Measures

An additional 3 from a list of 38 CQM's must be reported.

Measure Description Sources Denominator in VISTA Numerator in VISTA
NQF0059 Diabetes: Hemoglobin A1c Poor Control details Diabetics via Meds or Diagnosis Lab HEMOGLOBIN A1C or Health Factor PQRI HBA1C>9 MK
NQF0061 Diabetes: Low Density Lipoprotein (LDL) Management and Control details Diabetics via Meds or Diagnosis Lab LDL CHOLESTEROL or Health Factor PQRI LDL < 100
NQF0064 Diabetes: Blood Pressure Management details Diabetics via Meds or Diagnosis Blood Pressure entered via Vitals Package.
The rest of these are not fully supported in the Quality Measures package.
NQF0081 Heart Failure (HF): Angiotensin-Converting Enzyme (ACE) Inhibitor or Angiotensin Receptor Blocker (ARB) Therapy for Left Ventricular Systolic Dysfunction (LVSD) details
NQF0070 Coronary Artery Disease (CAD): Beta-Blocker Therapy for CAD Patients with Prior Myocardial Infarction (MI) details
NQF0004 Initiation and Engagement of Alcohol and Other Drug Dependence Treatment: a)Initiation, b) Engagement


    1. Pneumonia Vaccination Status for Older Adults details
    2. Breast Cancer Screening details
    3. Colorectal Cancer Screening details
    4. Coronary Artery Disease (CAD): Oral Antiplatelet Therapy Prescribed for Patients with CAD details
    5. Heart Failure (HF): Beta-Blocker Therapy for Left Ventricular Systolic Dysfunction (LVSD) details
    6. Anti-depressant medication management: (a) Effective Acute Phase Treatment, (b)Effective Continuation Phase Treatment details
    7. Primary Open Angle Glaucoma (POAG): Optic Nerve Evaluation details
    8. Diabetic Retinopathy: Documentation of Presence or Absence of Macular Edema and Level of Severity of Retinopathy details
    9. Diabetic Retinopathy: Communication with the Physician Managing Ongoing Diabetes Care details
    10. Asthma Pharmacologic Therapy details
    11. Asthma Assessment details
    12. Appropriate Testing for Children with Pharyngitis details
    13. Oncology Breast Cancer: Hormonal Therapy for Stage IC-IIIC Estrogen Receptor/Progesterone Receptor (ER/PR) Positive Breast Cancer details
    14. Oncology Colon Cancer: Chemotherapy for Stage III Colon Cancer Patients details
    15. Prostate Cancer: Avoidance of Overuse of Bone Scan for Staging Low Risk Prostate Cancer Patients details
    16. Smoking and Tobacco Use Cessation, Medical Assistance: a) Advising Smokers and Tobacco Users to Quit, b) Discussing Smoking and Tobacco Use Cessation Medications, c) Discussing Smoking and Tobacco # Use Cessation Strategies details
    17. Diabetes: Eye Exam details
    18. Diabetes: Urine Screening details
    19. Diabetes: Foot Exam details
    20. Coronary Artery Disease (CAD): Drug Therapy for Lowering LDL-Cholesterol details
    21. Heart Failure (HF): Warfarin Therapy Patients with Atrial Fibrillation -- NQF 0084
    22. Ischemic Vascular Disease (IVD): Blood Pressure Management details
    23. Ischemic Vascular Disease (IVD): Use of Aspirin or Another Antithrombotic details
    24. Initiation and Engagement of Alcohol and Other Drug Dependence Treatment: a) Initiation, b) Engagement details
    25. Prenatal Care: Screening for Human Immunodeficiency Virus (HIV) -- NQF 0012
    26. Prenatal Care: Anti-D Immune Globulin -- NQF 0014
    27. Controlling High Blood Pressure details
    28. Cervical Cancer Screening details
    29. Chlamydia Screening for Women details
    30. Use of Appropriate Medications for Asthma details
    31. Low Back Pain: Use of Imaging Studies details
    32. Ischemic Vascular Disease (IVD): Complete Lipid Panel and LDL Control details
    33. Diabetes: Hemoglobin A1c Control (<8.0%) details