The Centers for Medicare and Medicaid Services has issued two new frequently asked questions about the electronic health records meaningful use program and updated two other questions. One question is particularly intriguing:

(FAQ9112) Can an eligible professional (EP) or hospital charge patients a fee to have access to the Certified Electronic Health Records (EHR) Technology solution that is used to meet the meaningful use objective of providing patients the ability to view online, download and transmit their health information?

ANSWER: We do not believe it would be appropriate for the EP or hospital to charge the patient a fee to access the Certified EHR Technology solution regardless of whether the solution is in the form of a provider-specific portal, an online personal health record, community portal or some other solution. This is consistent with the position taken in the Stage 1 final rule (75 FR 44358) and reiterated in the Stage 2 final rule (77 FR 53999) with regard to the meaningful use objective to provide patients with clinical summaries of office visits.  Access to the Certified EHR Technology solution would be provided to satisfy the requirements of the “view online, download and transmit” objective, rather than in response to a request from a patient.  We note that the charging of fees for health information provided in response to a patient’s request is governed by the HIPAA Privacy Rule.

(FAQ9114) When meeting the meaningful use measure for “secure messaging” in the Electronic Health Records (EHR) Incentive Programs, which requires that more than 5 percent of unique patients send a secure message using the electronic messaging function of Certified EHR Technology (CEHRT), is it required that the patient only use an interface that is certified or can any secure message received into the eligible professional’s CEHRT count for this measure?

ANSWER: As part of this objective, the eligible professional (EP) must make available to patients a secure messaging option certified to the 2014 edition certification criteria. However, this option is not the only way that a patient can send a secure message to an EP. Any secure message that is received using the electronic messaging function of the EP’s CEHRT counts toward the measure regardless of whether the interface the patient used to create the message was specific to the EP’s CEHRT.

(Updated FAQ7811) If an eligible provider (EP) practices at an outpatient location, a location other than an inpatient (place of service 21) or emergency department (place of service 23), and that location is only equipped with Certified Electronic Health Records (EHR) Technology certified to the criteria applicable to an inpatient setting, must the EP include that location in their meaningful use calculations?

ANSWER: No, this location is not equipped with Certified EHR Technology with all the capabilities necessary for an EP to satisfy the meaningful use objectives and measures. Accordingly, this location (like all outpatient locations) would be in the denominator of the calculation to determine whether the EP’s outpatient encounters meet the 50 percent threshold, but not in the numerator as the location is not equipped with Certified EHR Technology. Also the location would not be included in the calculations of the EP’s meaningful use measures in either the denominator or the numerator.

However, an EP can consider the location equipped with Certified EHR Technology if they have access to Certified EHR Technology certified to the criteria applicable to an ambulatory setting, which fills the gaps between inpatient and ambulatory. FAQ#3077 explains access to Certified EHR Technology, and ONC FAQ #6-12-025-2 outlines the gaps between inpatient and ambulatory Certified EHR Technology.

If the EP chooses to equip the location with Certified EHR Technology with the applicable criteria, the EP must then include that location in all calculations including both the 50 percent threshold calculation and the meaningful use measures calculations.

(Updated FAQ3819) For Stage 1 and 2 meaningful use objectives of the Medicare and Medicaid Electronic Health Record (EHR) Incentive Programs that require submission of data to public health agencies, if multiple eligible professionals (EPs) are using the same certified EHR technology across several physical locations, can a single test or onboarding effort serve to meet the measures of these objectives?

ANSWER: The Stage 2 Final Rule (CMS-0044-F) changed the way shared Certified EHR Technologies are handled for testing both for Stage 1 and Stage 2 public health agencies and for the Stage 2 measure option for summary of care records at transitions of care and referrals. Previously, if multiple EPs are using the same certified EHR technology in different physical locations/settings (e.g., different practice locations), there must be a single test performed for each physical location/setting.

Under changes made in the Stage 2 Final Rule providers that use the same EHR technology and share a network for which their organization either has operational control of or license to use can conduct one test that covers all providers in the organization.  For example, if a large group of EPs with multiple physical locations use the same EHR technology and those locations are connected using a network that the group has either operational control of or license to use, then a single test would cover all EPs in that group.  Similarly, if a provider uses an EHR technology that is hosted (cloud-based) on the developer's network, then a single test for Stage 1 public health measures or a single effort to register and onboard for the Stage 2 public health measures would allow all EPs, eligible hospitals, and CAHs using the EHR technology that is hosted (cloud-based) on the developer's network to meet the measure.

All meaningful use FAQs are available here.

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