The Centers for Medicare and Medicaid Services has added five new Frequently Asked Questions related to health information exchange and public health reporting requirements under the electronic health records meaningful use program, and updated an existing FAQ:

New Question: Can a state capture electronic Clinical Quality Measures, or eCQMs, for the Medicaid EHR Incentive Program through a Health Information Exchange (HIE)?

Answer: Yes, a state can capture clinical quality data for eCQMs using an HIE, and states should consider the health data landscape of their state when designing a system to collect eCQMs for the Medicaid EHR Incentive Program. Utilizing an HIE can allow the state to collect more sophisticated patient-level data, to encourage provider adoption, and to facilitate alignment between various programs, such as those authorized under the HITECH Act, Accountable Care Organizations, and Medical Homes.

In order to use an HIE for quality data collection, a state would need to develop infrastructure to capture electronic clinical quality measures through the Quality Reporting Data Architecture (QRDA) format. In addition, eligible professionals and hospitals would either have to generate the QRDA files using the provider’s Certified EHR Technology and/or the HIE itself would have to be certified as an EHR module for eCQMs.

The Office of the National Coordinator for Health Information Technology and CMS published a state-focused electronic clinical quality reporting toolkit to provide support for states developing the policy and IT infrastructure for electronic clinical quality measurement. Further, states can request Federal Financial Participation at the 90/10 HITECH rate to assist in building the infrastructure to submit eCQMs electronically for the Medicaid EHR Incentive program. For more information, please see the State Medicaid Directors Letter #11-004:
http://downloads.cms.gov/cmsgov/archived-downloads/SMDL/downloads/SMD11004.pdf.

New Question: Can a public health agency use a HIE to interface with providers who are submitting public health data to meet the public health objectives of meaningful use (such as submitting information to an immunization registry, reporting lab results to a public health agency or reporting syndromic surveillance information)?

Answer: There are a variety of methods for the exchange of public health information, and CMS does not limit or define the receiving capabilities of public health entities. Among other requirements as specified in the regulations, a provider must submit data for the public health objectives of meaningful use as follows:

• The information required by a public health meaningful use objective must originate from the provider’s Certified Electronic Health Records Technology (CEHRT); and

• The information sent from the provider’s Certified EHR Technology must be formatted according to the standards and implementation specifications associated with the public health meaningful use objective.

If a provider intends to use an intermediary as an extension of their CEHRT to satisfy a meaningful use requirement and not simply to transport the data, the intermediary would need to be certified as an EHR Module for that purpose.  When obtaining a CMS certification number from the Certified HIT Products List (CHPL), a provider would need to include the intermediary’s certification number during their attestation.

New Question: If a provider utilizes a health information organization that participates with the eHealth Exchange but is not connected to public health entities in the provider’s state, does the provider still need to connect to those entities for purposes of participating in the Medicare and Medicaid EHR Incentive Program?

Answer: Yes, to meet the requirements for meaningful use, the provider must connect to the appropriate public health entities in his or her state, even if the provider has connected to an eHealth Exchange participant for other reasons. This can be accomplished by expanding the eHealth Exchange participant connections to include public health agencies, or through direct connections from the provider to the public health agency, or through a different third-party interface.

The information required by a public health meaningful use objective must originate from the provider's Certified Electronic Health Records Technology (CEHRT), and the information sent from that technology must be formatted according to the standards and implementation specifications associated with the public health meaningful use objective. If a provider wishes to use an health information exchange (HIE) or other intermediary to connect to a public health agency and perform a function to meet the meaningful use requirement, the provider must use an HIE or intermediary that is certified as an EHR Module for that purpose. CMS recognizes the variety of methods in which the exchange of public health information could take place, and therefore does not seek to limit or define the receiving capabilities of public health entities (see FAQ 3461).

New Question: How does a provider attest to a meaningful use objective (e.g., the “transitions of care,” “view/download patient data,” and public health objectives) where the provider electronically transmits data using technical capabilities provided by a HIE?

Answer: Several meaningful use objectives require eligible professionals, eligible hospitals, and Critical Access Hospitals (CAH) to conduct electronic transmissions. In general, eligible professionals, eligible hospitals, and CAHs may use an HIE to meet a particular meaningful use objective if the HIE has been certified to support that objective. If an eligible professional, eligible hospital, or CAH uses an HIE to satisfy a particular meaningful use objective, the provider will need to include the HIE’s certification number, as a certified Electronic Health Records (EHR) Module, in their attestation.

A provider can determine whether the HIE they intend to use has been certified to support meaningful use objectives by using the Certified Health Information Technology (HIT) Products List (CHPL), available at http://www.healthit.gov/CHPL. This is a list of all EHR technology issued a “Complete EHR” or “EHR Module” certification for the purposes of the EHR Incentive Program.

New Question: If an EP or hospital attesting to meaningful use in the EHR Incentive Program submits a successful test to the immunization registry in year 1 of Stage 1 and engages with the immunization registry in year 2, but does not achieve ongoing submission of data to the immunization registry during their reporting period in year 1 or year 2, should they attest to the measure or the exclusion?

Answer: The Stage 1 MU measure requires the EP or hospital to perform at least one test of certified EHR technology’s capacity to submit electronic data to immunization registries, and follow-up submission if that test is successful. An EP or hospital that can demonstrate engagement with the immunization registry during year 2 would attest to meeting the measure even if that engagement was not in the form of another test. This engagement could be communication with the immunization registry showing that another test is not beneficial, work towards follow-up submission or an update showing that additional action by the provider towards follow-up submission is not beneficial for year 2. It is not acceptable to use the test from year 1 to meet the measure for year 2. The provider needs to show evidence of action taken during year 2 that demonstrates both that another test is not beneficial in moving towards follow-up submission and that follow-up submission is not possible in year 2. This principle applies to all of the public health objectives.

Updated Question: If multiple eligible professionals or eligible hospitals contribute information to a shared portal or to a patient's online personal health record (PHR), how is it counted for meaningful use when the patient accesses the information on the portal or PHR?

Answer: This answer is relevant to the following meaningful use measure:

For Eligible Professionals:  “More than 5 percent of all unique patients seen by the eligible professional during the EHR reporting period (or their authorized representatives) view, download or transmit to a third party their health information.”

For Eligible Hospitals and Critical Access Hospitals: “More than 5 percent of all unique patients (or their authorized representatives) who are discharged from the inpatient or emergency department (Place of Service 21 or 23) of an eligible hospital or CAH view, download or transmit to a third party their information during the EHR reporting period.”

If an eligible professional sees a patient during the EHR reporting period, the eligible professional may count the patient in the numerator for this measure if the patient (or an authorized representative) views online, downloads, or transmits to a third party any of the health information from the shared portal or online PHR.  The same would apply for an eligible hospital or CAH if a patient is discharged during the EHR reporting period. The respective eligible professional, eligible hospital or CAH must have contributed at least some of the information identified in the Stage 2 final rule to the shared portal or online PHR for the patient.  However, the respective provider need not have contributed the particular information that was viewed, downloaded, or transmitted by the patient.

Although availability varies by state and geographic location, some Health Information Exchanges (HIEs) provide shared portal or PHR services. If a provider uses an HIE for these services to make information available to patients, in order to meet meaningful use requirements the provider must use an HIE that is certified as an EHR Module for that purpose.  The HIE must be able to verify whether a particular provider actually contributed some of the information identified in the Stage 2 final rule to the shared portal or PHR for a particular patient. If a provider elects to use the HIE for these shared portal or PHR services, the provider must include the HIE’s certification number as part of their attestation.

All meaningful use FAQs are available here.

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