General Meaningful Use FAQs

While CMS and ONC are the federal agencies responsible for administering Meaningful Use, several other stakeholder organizations provide information.

The following are links to web pages on Meaningful Use:

• Office of the National Coordinator for Health Information Technology (ONC)
• Centers for Medicare and Medicaid Services (CMS)
• Association of State and Territorial Health Officials (ASTHO)
• National Association of City and County Health Officials (NACCHO)
• Healthcare Information and Management Systems Society (HIMSS)
• International Society for Disease Surveillance (ISDS)
• Indian Health Service (IHS)

Additional external links are available at: https://www.cdc.gov/EHRmeaningfuluse/links.html

The Centers for Disease Control and Prevention (CDC) is engaged in EHR policy decisions to improve care for individuals and provide leadership to leverage Meaningful Use for public health. Currently, we are collaborating with and providing input to ONC and CMS for consideration of public health priorities in Meaningful Use now and in the future. CDC incorporates partner feedback in our input through our engagement with national public health organizations (e.g., ASTHO, NACCHO, APHL, etc.). In an effort to educate stakeholders, CDC is also working to provide consolidated information to its programs and partners, as well as through various forums, including:

• CDC Meaningful Use Website: https://www.cdc.gov/EHRmeaningfuluse/
• Partner calls and webinars:
  • Joint Public Health Forum and CDC Nationwide (https://www.cdc.gov/EHRmeaningfuluse/partnercall.html)
  • Community of Practice (CoP) for Leveraging Federal Financial Participation (FFP) including 90/10 for Medicaid Health Information Technology (HIT) Activities(https://www.cdc.gov/EHRmeaningfuluse/cop.html)
• Meaningful Use (MU) Public Health (PH) Reporting Requirements Task Force (https://www.cdc.gov/ehrmeaningfuluse/meaningful-use-mu-public-health-ph-reporting-requirements-task-force.html)
• Meaningful Use Public Health Technical Assistance Team - To request assistance from this team, email meaningfuluse@cdc.gov with “Request for Technical Assistance” in the Subject line.

For further information please contact: meaningfuluse@cdc.gov

The CDC supports several initiatives that help public health agencies leverage EHR MU, including:

• Meaningful Use Public Health Technical Assistance Team
• Stage 2 Meaningful Use Public Health Reporting Requirements Task Force
• Knowledge & Best Practices sharing and collaboration platforms-
  • Joint Public Health Forum and CDC Nationwide
    (https://www.cdc.gov/EHRmeaningfuluse/partnercall.html)
  • Public Health (PH) - Electronic Health Records (EHR) Vendors Collaboration Initiative (http://www.phconnect.org/group/public-health-ehr-vendors-collaboration-initiative)
  • CoP for Leveraging Federal Financial Participation (FFP) for Medicaid HIT Activities (http://www.phconnect.org/group/cop-leveraging-ffp-for-medicaid-hit-activities)
• Standards and Interoperability Public Health Tiger Team (PHTT)

Resources available to jurisdictional health departments can be found at the following links:

• https://www.cdc.gov/EHRmeaningfuluse/resources.html
• https://www.cdc.gov/EHRmeaningfuluse/ELRTF.html

The CDC collaborates with its federal partners (CMS and ONC) on HIT policy development and in defining Stages 1-3 criteria for Meaningful Use. Additionally, CDC works with other national partners such as Joint Public Health Informatics Taskforce (JPHIT), Association of State and Territorial Health Officials (ASTHO), and International Society for Disease Surveillance (ISDS) to develop policies, guidelines, and methods, and to promote a shared vision for how public health interacts with the healthcare community. CDC works with Health Level 7 (HL7), Integrating the Healthcare Enterprise (IHE) and other standard development organizations on development and implementation of interoperable messaging and vocabulary standards and implementation guides.

The Office of the National Coordinator for Health Information Technology (ONC) Health Information Technology Certification Program provides a defined process to ensure that EHR technologies meet the adopted standards and certification criteria to help providers and hospitals achieve MU objectives and measures established by CMS. To receive an incentive payment, providers must use an EHR that is certified specifically for the Medicare and Medicaid EHR Incentive Programs.

In the ONC HIT Certification Program, certification and testing activities are performed by separate entities. Certification is conducted by ONC-Authorized Certification Bodies (ONC-ACBs) and testing is performed by Accredited Testing Laboratories (ATLs). Developers and Vendors first test their product with an ATL, and if their product meets the requirements, they work with an ONC-ACB to certify the product. Once the product is certified, it is submitted to ONC, who posts approved products to the Certified Health IT Product List (CHPL). 

• ONC HIT Certification Program Information
• Certified Health IT Product List (CHPL)

The ONC’s Final Rule for the standards and certification criteria for certified EHR technology is silent on transport methods and routing of messages to public health. Therefore, the EHR certification does not address transport for public health objectives.

• The CMS Stage 1 Final Rule encourages providers and registries to work together to develop efficient, electronic submission of data to the public health agency (PHA) for MU.
• The CMS Stage 2 Final Rule allows PHA to dictate the transport mechanism in their jurisdiction and requires an eligible provider to utilize the transport method or methods supported by the PHA in order to achieve meaningful use.

1. Meaningful Use activities will improve the collaboration between clinical and public health care at local and state levels through:

• Implementation of electronic reporting to PH (immunization, laboratory, syndromic surveillance, cancer, and specialized registries)
• Improvement of a patient-centric preventive care (preventive care-oriented quality care measures)

2. MU rules bring attention to the readiness of State Public Health agencies for a “bi-directional communication” with clinical care providers
3. MU supports the use and continued development of standardized data elements and messaging implementation guides (data exchange) for the MU Public Health measures.

Stage 1 of meaningful use has three public health objectives in the menu set (optional set) for eligible professionals (EPs), eligible hospitals (EHs) and critical access hospitals (CAHs).  EPs, EHs, and CAHs are required to select one public health objective from the menu set. The three public health objectives are:

1. Capability to submit electronic data to immunization registries or Immunization Information Systems and actual submission in accordance with applicable law and practice.
2. Capability to submit electronic data on reportable (as required by state or local law) lab results to public health agencies and actual submission in accordance with applicable law and practice. (Note: This objective is for EHs/CAHs only)
3. Capability to submit electronic syndromic surveillance data to public health agencies and actual submission in accordance with applicable law and practice.

Stage 2 of meaningful use has five public health objectives. Some of the Stage 1 objectives have been moved to the core set and new objectives added to the menu set. The five public health objectives are:

1. Capability to submit electronic data to immunization registries or immunization information systems except where prohibited, and in accordance with applicable law and practice. (Note: Core objective for EPs, EHs, and CAHs)
2. Capability to submit electronic reportable laboratory results to public health agencies, except where prohibited, and in accordance with applicable law and practice. (Note: Core objective for EHs/CAHs only)
3. Capability to submit electronic syndromic surveillance data to public health agencies, except where prohibited, and in accordance with applicable law and practice. (Note: Core objective for EHs/CAHs, and menu objective for EPs)
4. Capability to identify and report cancer cases to a state cancer registry except where prohibited, and in accordance with applicable law and practice. (Note: Menu objective for EPs only)
5. Capability to identify and report specific cases to a specialized registry (other than a cancer registry), except where prohibited, and in accordance with applicable law and practice. (Note: Menu objective for EPs only)

An EHR vendor would first have an Accredited Testing Laboratory (ATL) test their EHR product using the ONC-Approved Test Method that aligns with the 2014 Edition EHR Certification Criteria. Once a product is successfully tested, the vendor then works with an ONC-Authorized Certification Body (ONC-ACB) to certify the product as Certified EHR Technology (CEHRT). Certified products are submitted to ONC and posted to the Certified Health IT Product List (CHPL) at: http://oncchpl.force.com/ehrcert?q=chpl

For more information on the ONC HIT Certification Program see: http://www.healthit.gov/policy-researchers-implementers/developers-vendors

CMS has an eHealth Interactive Timeline Tool for viewing the milestones for various eHealth programs, including the EHR Incentive Programs available at: http://cms.gov/apps/interactive-timeline/

The Office of the National Coordinator for Health Information Technology (ONC) maintains the Certified Health IT Product List (CHPL) which provides the authoritative, comprehensive listing of Complete Electronic Health Records (EHRs) and EHR Modules that have been tested and certified under the ONC HIT Certification Program at the Certified Health IT Product List (CHPL) site: http://oncchpl.force.com/ehrcert?q=chpl.  The CHPL site allows searching by the certification criteria EHR products met.

The Public Health Meaningful Use Coordinator is encouraged to be an executive level staff person to lead and coordinate a state’s public health agency's response to the meaningful use requirements, and to participate with other coordinators across the country in jointly advancing public health readiness for this challenge. This role includes:

1. Making timely decisions, such as which relevant state public health information systems will need to be readied for the EHR Incentive Programs and the meaningful use requirements.
2. Defining the process for local public health systems to test the submission of meaningful use data directly from providers and accept the data where successful.
3. Working with your state Medicaid agency to ensure that public health perspectives are considered in how Medicaid will implement the EHR Incentive Program in your state, including public health IT system infrastructure assessments and enhancements. Medicaid Agencies might have fiscal resources available to contribute toward this effort.
4. Serving as a public health liaison to your state’s Health IT Coordinator and to the State Medicaid Director, if they are not in your same agency.
5. Serving as a public health liaison to your state’s Health Information Exchange governance and planning activities.
6. Serving as a central point of contact for information and assistance by the Centers for Disease Control and Prevention (CDC) and the Joint Public Health Informatics Taskforce (JPHIT).

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The CDC currently offers several types of technical assistance to state and local health departments related to Meaningful Use, including:

• Meaningful Use Public Health Technical Assistance Team - To request assistance from this team, email meaningfuluse@cdc.gov with “Request for Technical Assistance” in the Subject line.
• The CDC National Program of Cancer Registries provides support and tools for cancer registries. (For more information refer to: https://www.cdc.gov/cancer/npcr/meaningful_use.htm)
• The CDC Immunization Information Systems Support Branch (IISSB) provides technical support to Immunization Registries. (For more information refer to: https://www.cdc.gov/vaccines/programs/iis/meaningful-use/index.html)
• CDC provides Electronic Laboratory Reporting Technical Assistance (ELR TA) to further advance the implementation of ELR to public health departments. ELR TA is requested by the public health department filling out a one page form and sending it to edx@cdc.gov. (Note: ELR TA is only available to ELC Cooperative Agreement grantees).

For answer, please see CMSFAQ# 12653