Introduction

The American Reinvestment & Recovery Act (ARRA) was enacted on February 17, 2009. ARRA includes many measures to modernize our nation's infrastructure, one of which is the "Health Information Technology for Economic and Clinical Health (HITECH) Act". The HITECH Act supports the concept of electronic health records - meaningful use [EHR-MU], an effort led by Centers for Medicare & Medicaid Services (CMS ) and the Office of the National Coordinator for Health IT (ONC). HITECH proposes the meaningful use of interoperable electronic health records throughout the United States health care delivery system as a critical national goal. Meaningful Use is defined by the use of certified EHR technology in a meaningful manner (for example electronic prescribing); ensuring that the certified EHR technology is connected in a manner that provides for the electronic exchange of health information to improve the quality of care; and that in using certified EHR technology the provider must submit to the Secretary of Health & Human Services (HHS) information on quality of care and other measures.

The concept of meaningful use rested on the '5 pillars' of health outcomes policy priorities, namely:

1. Improving quality, safety, efficiency, and reducing health disparities
2. Engage patients and families in their health
3. Improve care coordination
4. Improve population and public health
5. Ensure adequate privacy and security protection for personal health information

CMS grants an incentive payment to Eligible Professionals (EPs) or Eligible Hospitals (EHs), who can demonstrate that they have engaged in efforts to adopt, implement or upgrade certified EHR technology. In order to encourage widespread EHR adoption, promote innovation and to avoid imposing excessive burden on healthcare providers, meaningful use was showcased as a phased approach, which is divided into three stages which span 2011 (data capture and sharing), 2013 (advanced clinical processes) and 2015 (improved outcomes). The incentive payments range from $44,000 over 5 years for the Medicare providers and $63,750 over 6 years for Medicaid providers (starting in 2011). Participation in the CMS EHR incentive program is totally voluntary, however if EPs or EHs fail to join in by 2015, there will be negative adjustments to their Medicare/Medicaid fees starting at 1% reduction and escalating to 3% reduction by 2017 and beyond.

Meaningful Use Stage 1

On July 13, 2010, CMS/ONC displayed the final rules as related to meaningful use in the context of objectives and measures and standards, implementation and vocabulary respectively. The final rules were published in the Federal Register on July 28, 2010, and became effective on September 26, 2010. The CMS final rule requirements have been divided into 15 core set objectives, and 10 menu set objectives (where there is an option to pick 5 of 10. However, it is mandatory to include at least one population/public health measure). In the future, ONC and CMS intend to propose expansion on the stage 1 criterion where it is likely that the currently proposed menu set of measures will be transitioned into the core set for stage 2.

HITECH is a powerful opportunity for public health. With a phased approach, by 2015 public health will have more and stronger partners working to improve population health. There is increased opportunity to reduce disparities, control chronic diseases, and build a health promoting healthcare system that is accountable for the health of our communities and our country.

For 2011, the public health community is working to assess and ensure readiness in Immunization Information Systems (IIS), Electronic Laboratory Reporting (ELR) and Syndromic Surveillance (SS). Public health will need to both test capability of systems to report and actually receive data where required and accepted. Public health will seek to expand current case reporting between hospitals/providers and public health and increase capacity for data management and analysis. There will be a need to coordinate across programs, state health information technology (HIT) coordinators, state Health Information Exchange (HIE) plans, and CMS.

Below you will find links to the Final Rule for MU Stage 1:

• CMS Stage 1 MU Final Rule
• ONC Stage 1 MU Final Rule

Meaningful Use Stage 2

On August 23, 2012 the Centers for Medicare & Medicaid Services and Office of the National Coordinator for Health IT released 1) final requirements for Stage 2 Meaningful Use (MU) that hospitals and health care providers must meet in order to qualify for incentives during the second stage of the program, and 2) the criteria that electronic health records must meet to achieve certification. In Stage 2 MU, the Eligible Professionals (EPs) must meet or qualify for an exclusion to 17 core objectives and 3 of 6 menu set objectives. Similarly, the Eligible Hospitals (EHs) and Critical Access Hospitals (CAHs) must meet or qualify for an exclusion to 16 core objectives and 3 of 6 menu objectives. This final rule delays the onset of Stage 2 MU criteria until 2014; the start date for EHs will be October 1st, 2013 and for EPs it will be January 1st, 2014. Specific to the Stage 2 MU Public Health objectives, the capability to submit electronic data for Immunizations is in the core set for EPs, and the capability to submit electronic data for Immunizations, Reportable Laboratory Results and Syndromic Surveillance are all in the core set for EHs. In addition, two new public health objectives for EPs have been added to the menu set, they include the capability to identify and report 1) cancer cases to a cancer registry and 2) specific cases to a specialized registry (other than a cancer registry).

Below you will find links to the Final Rule for MU Stage 2:

• CMS Stage 2 MU Final Rule
• ONC Stage 2 MU Final Rule

Modified Meaningful Use Stage 2 (2015-2017) and Stage 3 Meaningful Use

On October 16, 2015, the Centers for Medicare & Medicaid Services (CMS) released the final rule on Medicare and Medicaid Programs, Electronic Health Record Incentive Program—Stage 3 and Modifications to Meaningful Use in 2015 through 2017. This final rule specifies the requirements that eligible professionals (EPs), eligible hospitals, and critical access hospitals (CAHs) must meet in order to qualify for Medicare and Medicaid electronic health record (EHR) incentive payments and avoid downward payment adjustments under the Medicare EHR Incentive Program.

For Modified Stage 2 in 2015 through 2017, the EP's would be required to attest to any combination of two measures out of three (Stage 1 EPs in 2015 must meet at least 1 measure in 2015, Stage 2 EPs must meet at least 2 measures in 2015, and all EPs must meet at least 2 measures in 2016 and 2017) and EH's/CAH's would be required to attest to any combination of three measures out of four (Stage 1 eligible hospitals and CAHs must meet at least 2 measures in 2015, Stage 2 eligible hospitals and CAHs must meet at least 3 measures in 2015, all eligible hospitals and CAHs must meet at least 3 measures in 2016 and 2017). For Stage 3 MU(Optional in 2017 and Mandatory in 2018) EPs would be required to attest to any combination of two measures out of five and EHs and CAHs would be required to attest to any combination of four measures out of six. In addition, the Office of the National Coordinator for Health Information Technology (ONC), Department of Health and Human Services (HHS), also released the final rule on 2015 Edition Health Information Technology (Health IT) Certification Criteria, 2015 Edition Base Electronic Health Record (EHR) Definition, and ONC Health IT Certification Program Modifications This final rule finalizes a new edition of certification criteria (the 2015 Edition health IT certification criteria or ''2015 Edition'') and a new 2015 Edition Base Electronic Health Record (EHR) definition, while also modifying the ONC Health IT Certification Program to make it open and accessible to more types of health IT and health IT that supports various care and practice settings.

Below you will find links to these Final Rules:

• CMS Modified Stage 2 and Stage 3 Final Rule
• ONC Modified Stage 2 and Stage 3 Final Rule