Goals of the Medicare and Medicaid Electronic Health Records Programs

The American Recovery and Reinvestment Act of 2009 (ARRA) authorized incentive payments to eligible hospitals and physicians that are "meaningful users" of electronic health records (EHRs). As a result of the incentives and other funding opportunities, policymakers hope that the majority of hospitals and physicians will have adopted electronic health records by 2015. The Department of Health and Human Services (HHS) has the lead in implementing the provisions of this law through two offices: The Office of the National Coordinator for Health Information Technology (ONC) and the Centers for Medicare & Medicaid Services (CMS).

The meaningful use program has three primary goals: (1) standardizing the electronic capture of information such as patient demographics or clinical orders and results; (2) improving quality at the point of care; and (3) using clinical decision support and patient self-management tools as vehicles to improve the quality, safety and efficiency of treatments.

In the first year of the Medicaid program, hospitals and physicians that meet the eligibility criteria (generally 10 percent of patient volume for hospitals, less for children's hospitals) can receive funds to support adoption, implementation, and upgrading of certified EHR technology. Other than that one year of funding under Medicaid, the EHR incentive funds are available only to hospitals that can demonstrate they are "meaningful users" of EHRs. After 2015, hospitals that have not become meaningful users of EHRs will face payment penalties from Medicare.

The meaningful use program is being implemented in phases. During Stage 1, to qualify as a meaningful user for Medicare and Medicaid, a hospital must:

(1) Possess EHR technology certified against all 24 objectives of meaningful use,
(2) Meet each of 14 "core" objectives of meaningful use
(3) Meet at least 1 public health objectives, and at least 4 additional "menu set" objectives; and
(4) Report on each of 15 clinical quality measures generated directly from the certified EHR.

Some of the objectives of meaningful use also require that you gather information according to specific standards, such as the race and ethnicity codes adopted by the federal Office of Management and Budget.

This website provides a map to locate AHA and federal government resources to assist you. The AHA's Regulatory Advisories on the final CMS rule on meaningful use at http://www.aha.org/aha/advisory/2010/100813-regulatory-adv.pdf and related certification requirements at http://www.aha.org/aha/advisory/2010/100720-regulatory-adv.pdf lay out how these programs have been designed, including eligibility, payment formulas, and requirements to meet meaningful use.

CMS has provided specific definitions and guidance regarding the calculation of each objective in two sets: one set of guidance for hospitals and one set of guidance for health professionals. Links to the hospital guidance are provided below in the chart AHA has created to simplify your finding information about each objective. Links to both sets of guidance are provided in the Related Resources section of this website.

Both ONC and CMS maintain websites with important information about implementing EHRs at your hospital. Hospital management and IT staff will want to become familiar with these sites:

CMS has already begun registering providers to participate in the EHR incentive programs. A process is being developed by which hospitals and health professionals can attest that they have met the required set of objectives and their selected optional objectives for phase 1 of EHR meaningful use. This web-based attestation will then be the qualifying mechanism for the Medicare incentive payments. The AHA's Regulatory Advisory on Registration and Attestation provides important information to get started with the registration and attestation processes. Both registration and attestation will be done through a CMS website: http://www.cms.gov/EHRIncentivePrograms/20_RegistrationandAttestation.asp#TopOfPage.

The AHA has provided a guide to the registration and attestation process for hospitals that highlights key information you will not want to miss.

As part of the registration and attestation process, you will need to consult the list of products that have been certified through the new federal products. This list is called the Certified HIT Product's List and is maintained by ONC.

Both ONC and CMS have published dozens of Frequently Asked Questions (FAQs) available on their websites. Important updates are sometimes provided as answers to questions, so you should check these sites routinely. Here are links to these questions and answers:

The National Institute of Standards and Technology (NIST) provided the detailed test scripts that were used to certify EHRs. Hospitals that choose to pursue site certification for all or part of the systems will need to view these test scripts. They also serve as a good resource for identifying specific standards that are supported by certified EHRs and used for meaningful use.

Approved Test Procedures, Version 1.0, for evaluating conformance of complete EHRs and/or EHR Modules to the initial set of standards, implementation specifications, and certification criteria defined in the Health Information Technology: Initial Set of Standards, Implementation Specifications, and Certification Criteria published on July 13, 2010 and approved on August 2, 2010 for the Office of the National Coordinator for Health Information Technology (ONC) Temporary Certification Program can be found at: http://healthcare.nist.gov/use_testing/finalized_requirements.html

ONC has funded the development of Regional Extension Centers and Health Information Exchanges to provide technical support to hospitals and physicians who are working to develop electronic health records. More information on the State Health Information Exchange Cooperative Agreement Program is available on this site under Related Resources, as is a list of products that have been certified as meeting the requirements for EHR meaningful use.

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