EHR/EMR Updates 2014 Regulatory Changes

Many Physician Office Laboratories (POL’s) have begun the transition from the paper, old record-keeping system to the new, streamlined electronic health or medical records systems. This migration has been encouraged in many cases due to the U.S. Government’s financial support programs that offer incentives for healthcare facilities to make the change. One challenge has been the evolution of technology often moves faster than the speed of legislation, implementation and general understanding of the process. The regulatory process regarding EHR/EMR has always been turtle-like in its conception and implementation. At each stage of updating and in some cases upgrading a practice’s EHR/EMR it is always prudent to determine not only where the next step will lead, but also what is required for compliance.


If a physician’s practice accepts patients under Medicare, Medicaid, or is part of an ACO there has probably been much discussion about Meaningful Use (MU), Measureable Outcomes and EHR/EMR. Accountable Care Organizations (ACOs) are groups of doctors, hospitals, and other health care providers, who come together voluntarily to give coordinated high quality care to their Medicare patients.[1] With this coordination comes the necessity for documentation. Documentation not only drives the method of care delivery but also the financial aspect of patient care. The 2014 Centers for Medicare & Medicaid Services (CMS) Clinical Quality Measures have been published and we will review some important criteria in this article. When fully functional and exchangeable, the benefits of EHRs offer far more than a paper record can. [2]

 Electronic Health Records/Electronic Medical Records:

  • Improve quality and convenience of patient care
  • Increase patient participation in their care
  • Improve accuracy of diagnoses and health outcomes
  • Improve care coordination
  • Increase practice efficiencies and cost savings



Beginning in 2014, the reporting of clinical quality measures (CQMs) has changed for all providers. EHR technology that has been certified to the 2014 standards and capabilities will contain new CQM criteria, and eligible professionals (EPs), eligible hospitals, and critical access hospitals (CAHs) will report using the new 2014 criteria regardless of whether they are participating in Stage 1 or Stage 2 of the Medicare and Medicaid Electronic Health Record (EHR) Incentive Programs. Although CQM reporting has been removed as a core objective for both EPs and eligible hospitals and CAHs, all providers are required to report on CQMs in order to demonstrate meaningful use.[3]

The following are CMS communications regarding CQMs for 2014.


2014 and Beyond

For 2014, CMS is not requiring the submission of a core set of CQMs.  Instead we identify two recommended core sets of CQMs, one for adults and one for children.  We encourage eligible professionals to report from the recommended core set to the extent those CQMs are applicable to your scope of practice and patient population.[4],[5]


EPs must report on 9 of the 64 approved CQMs

Recommended core CQMs – encouraged but not required

  • 9 CQMs for the adult population

Adult Recommended Core Measures

  • Controlling High Blood Pressure
  • Use of High-Risk Medications in the Elderly
  • Preventive Care and Screening:  Tobacco Use:  Screening and Cessation Intervention
  • Use of Imaging Studies for Low Back Pain
  • Preventive Care and Screening:  Screening for Clinical Depression and Follow-Up Plan
  • Documentation of Current Medications in the Medical Record
  • Preventive Care and Screening:  Body Mass Index (BMI) Screening and Follow-Up
  • Closing the referral loop: receipt of specialist report
  • Functional status assessment for complex chronic conditions


  • 9 CQMs for the pediatric population

Pediatric Recommended Core Measures

  • Appropriate Testing for Children with Pharyngitis
  • Weight Assessment and Counseling for Nutrition and Physical Activity for Children and Adolescents
  • Chlamydia Screening for Women
  • Use of Appropriate Medications for Asthma
  • Childhood Immunization Status
  • Appropriate Treatment for Children with Upper Respiratory Infection (URI)
  • ADHD:  Follow-Up Care for Children Prescribed Attention-Deficit/Hyperactivity Disorder (ADHD) Medication
  • Preventive Care and Screening:  Screening for Clinical Depression and Follow-Up Plan 
  • Children who have dental decay or cavities




Eligible Hospitals and CAHs must report on 16 of the 29 approved CQMs

Selected CQMs must cover at least 3 of the National Quality Strategy domains (See “Measure Selection Process” below.)


Beginning in 2014, all Medicare-eligible providers beyond their first year of demonstrating meaningful use must electronically report their CQM data to CMS. (Medicaid EPs and hospitals that are eligible only for the Medicaid EHR Incentive Program will electronically report their CQM data to their state.) See “Reporting Options for EPs” and “Reporting Options for Eligible Hospitals and CAHs” below for more information.


Measure Selection Process

CMS selected the recommended core set of CQMs for EPs based on analysis of several factors:

  • Conditions that contribute to the morbidity and mortality of the most Medicare and
  • Medicaid beneficiaries
  • Conditions that represent national public health priorities
  • Conditions that are common to health disparities
  • Conditions that disproportionately drive healthcare costs and could improve with better

quality measurement

  • Measures that would enable CMS, States, and the provider community to measure quality of care in new dimensions, with a stronger focus on parsimonious measurement
  • Measures that include patient and/or caregiver engagement


In addition, CMS selected all CQMs to align with the Department of Health and Human Services’ National Quality Strategy priorities for health care quality improvement. These domains include:

  • Patient and Family Engagement
  • Patient Safety
  • Care Coordination
  • Population and Public Health
  • Efficient Use of Healthcare Resources
  • Clinical Processes/Effectiveness


When selecting a CQMs to report, EPs, eligible hospitals, and CAHs must select CQMs that cover at least three of these six domains. A complete list of 2014 CQMs and their associated National Quality Strategy domains will be posted on the CMS EHR Incentive Programs website ( in the future. CMS will also post the recommended core set of CQMs for EPs.


CMS has created a wealth of tools to assist in staying compliant with the EHR/EMR updates. From the CMS Measures Management System to EHR Incentives Program there is a website that can assist practices determine what is best. The 2014 EHR/EMR Updates are meant to continuously improve the process of electronic data collection to improve patient care. Thousands of Physician practices across the country are doing their part in staying compliant to uplift the public health system.


Maria S. Hardy is the Technical Writer for COLA’s Education subsidiary, COLA Resources, Inc. (CRI), a leader in online continuing education for physicians, laboratory personnel and allied health professionals.  CRI offers continuing education through online courses, informational products in both electronic and hard copy form, webinars and workshops on cutting-edge technology and regulatory issues such as IQCP, and CRI Symposia for Clinical Laboratories and Workshops, providing live educational sessions and interactive seminars with leading industry organizations. For more information, visit their website at, or call 1-800-981-9883.



[1] Accountable Care Organizations (ACO)

[2] Health Care Quality & Convenience

[3] 2014 Clinical Quality Measures Tipsheet

[4] Recommended Core Measures

[5]2014 Clinical Quality Measures (CQMs) Pediatric Recommended Core Measures