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Stage 1 Core Measure 4

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Measure at a Glance

Type: calculated percentage

Denominator: permissible prescriptions

Duration: calculated over the entire EHR reporting period

Objective: Generate and transmit permissible prescriptions electronically (eRx).
Measure: More than 40 percent of all permissible prescriptions written by the EP are transmitted electronically using certified EHR technology.
Exclusion:Any EP who writes fewer than 100 prescriptions during the EHR reporting period.
Additional Exclusion: (available beginning in 2013) Any EP who does not have a pharmacy within their organization and there are no pharmacies that accept electronic prescriptions within 10 miles of the EP's practice location at the start of his/her EHR reporting period.

CMS Technical Specification

TennCare Notes

For EPs pursuing Stage 1 meaningful use in 2013 and any year after 2013, for either the 90 day or full calendar year reporting period, an additional exclusion is available. EPs who qualify for either exclusion may exclude this measure.

The attestation portal will require the EP to enter the numerator and denominator of the measure as defined in the technical specification. Additionally, for EPs who attest without an exclusion, the portal will require the name of the eRx service and the name of a pharmacy to which the EP transmitted.

Please note this measure requires more than 40% of all permissible prescriptions. The attestation numerators and denominators are calculated to the hundredths place in the attestation portal, so while a proportion of 40.01% will be evaluated as a successful attestation, 40.00% will not.

Relevant CMS FAQs

  • 10067: explaining "permissible prescriptions"
  • 10284: meeting the measure when there is an internal pharmacy (Keywords: internal pharmacy)
  • 10137: using intermediary networks that convert prescriptions to a computer-based fax (Keywords: intermediary networks)
  • 10475: describing limitations for patients seen at a non-EHR site and entered into the EHR later (Keyword phrase: "it is unlikely that CPOE could occur")

Additional Resources
Review the Schedule II-V restrictions by which "permissible prescriptions" are defined. (As in the technical specification: "Any prescription not subject to these restrictions would be permissible.")

Federal Regulations Governing This Measure

CMS' Final Rule

§ 495.6(d)(4) see objective, measure and exclusion above

Standards and Certification Final Rule

§ 170.304(b) Electronic prescribing. Enable a user to electronically generate and transmit prescriptions and prescription-related information in accordance with:

  1. The standard specified in Sec. 170.205(b)(1) or Sec. 170.205(b)(2); and
  2. The standard specified in Sec. 170.207(d).

§ 170.205(b) Electronic prescribing.

  1. Standard. The National Council for the Prescription Drug Programs (NCPDP) Prescriber/Pharmacist Interface SCRIPT standard, Implementation Guide, Version 8, Release 1 (Version 8.1) October 2005 (incorporated by reference in Sec. 170.299)
  2. Standard. NCPDP SCRIPT Standard, Implementation Guide, Version 10.6 (incorporated by reference in Sec. 170.299).

§ 170.207(d) Medications. Standard. Any source vocabulary that is included in RxNorm, a standardized nomenclature for clinical drugs produced by the United States National Library of Medicine.