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Stage 1 Core Measure 1

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Measure at a Glance

Type: calculated percentage

Denominator: unique patients with a medication list, which may be limited to patients maintained by CEHRT

Alternate Denominator: medication orders created by the EP or during the EHR reporting period.

Duration: calculated over the entire EHR reporting period

Objective: Use computerized provider order entry (CPOE) for medication orders directly entered by any licensed healthcare professional who can enter orders into the medical record per state, local, and professional guidelines.
Measure: More than 30 percent of all unique patients with at least one medication in their medication list seen by the EP have at least one medication order entered using CPOE.
Alternate Measure: More than 30 percent of medication orders created by the EP during the EHR reporting period are recorded using computerized provider order entry,
Exclusion: Any EP who writes fewer than 100 prescriptions during the EHR reporting period.

CMS Technical Specification

TennCare Notes
The attestation portal will require the EP to enter the numerator and denominator of the measure as defined in the technical specification. As published in the September 4, 2012 CMS rule, the alternate measure is available in any year. As the portal does not yet reflect this option, please upload a document to the core measures attestation screen if attesting using the alternate measure. Also, the alternate measure is not reflected in the CMS technical specification, so the alternate numerator and denominator have been defined as

Alternate Numerator: Number of orders in the denominator recorded using CPOE
Alternate Denominator: Number of medication orders created by the EP or during the EHR reporting period.

Please note this measure requires more than 30% of all unique patients (or all medication orders, if the alternate measure is chosen). The numerators and denominators are calculated to the hundredths place in the attestation portal, so while a proportion of 30.01% will be evaluated as a successful attestation, 30.00% will not.

Relevant CMS FAQs

  • 10071: clarifying who can enter information
  • 10134: instructing who should enter information when
  • 10475: describing limitations for patients seen at a non-EHR site and entered into the EHR later
  • 10639: meeting the measure when medications are infrequently ordered
  • 10462: determining the inclusion of patients billed under POS 22

Additional Resources
The following articles examining CPOE may inform plans to appropriately and successfully integrate CPOE into practices:

Classen D, Bates D, Denham C. Meaningful use of computerized prescriber order entry. Journal of Patient Safety. 2010; 6: 15-23.
Metzger J, Welebob E, Bates D, Lipsitz S, Classen D. Mixed results in the safety performance of computerized physician order entry. Health Affairs. 2010; 29: 655-663.
Niazkhani Z, Pirnejad H, Berg M, Aarts, J. The impact of computerized provider order entry systems on inpatient clinical workflow: a literature review. Journal of the American Medical Informatics Association 2009; 16:5 39-49.

Although more applicable to hospital settings, the HIMSS CPOE Wiki provides a wealth of information about CPOE in planning and practice, including unintended consequences as well as successful stories.

Although many blogs and online communities feature commentary on CPOE, each refers directly to the CMS FAQs in addressing concerns.

Federal Regulations Governing This Measure

CMS' Final Rule

§ 495.6(d)(1) see objective, measure and exclusion above

Standards and Certification Final Rule

§ 170.304(a) Computerized provider order entry. Enable a user to electronically record, store, retrieve, and modify, at a minimum, the following order types:

  1. Medications;
  2. Laboratory; and
  3. Radiology/imaging.