According to the Annual HIMSS Leadership Survey, “Meaningful Use” is the number one priority of hospital information technology departments for 2011. More than 20 billion dollars in federal incentives are available in the next four years, and billions in penalties will follow. While Meaningful Use is about medical records and electronic health record (EHR) use, a small portion of the program focuses on release of information from the EHR. The remainder of the requirements concentrate on clinical events, and functions specific to EHR systems. As with any new program, the rules are the tip of the iceberg, while implementing them uncovers numerous additional questions, issues, and points of interpretation. This white paper will provide a basic primer on Meaningful Use and then delve more deeply into the specific rules and fine print surrounding Meaningful Use and release of information.

Executive Summary

Meaningful Use refers to a series of requirements and reporting using certified EHR technology. The requirements will increase in complexity, and the thresholds will gradually be raised over the course of three stages. Hospitals and eligible professionals (mostly doctors) can receive significant incentive payments from The Centers for Medicare & Medicaid Services (CMS) for the first four years of the programs (2011-2014) by meeting the Meaningful Use requirements. After 2015 CMS reimbursements will be reduced by 1% annually, up to 5% total, for all hospitals and eligible providers who do not meet the requirements.

Facilities may use combinations of certified EHR modules or complete EHR systems to meet the requirements. Non-certified software can be used for tallying and reporting the values for Meaningful Use, as long as the certified EHR technology is capturing the information as well. Certification of technology includes eight security requirements, which help ensure the entire process is secure as required under HIPAA and HITECH.

One of the Meaningful Use requirements deals specifically with release of medical information: providing an electronic copy of medical records to patients who request it in that format, and doing so within three business days. The details of this requirement and the finer points of implementing the reporting are the subject of the final sections of this white paper. For a complete understanding of the EHR incentive programs, and to plan a Meaningful Use project, please review the regulations as published in the Federal Register. Links to the regulations appear in the Appendix of this document.

Meaningful Use Primer

This primer is a rapid introduction to the basic concepts related to Meaningful Use and the EHR incentive programs. For more detail, refer to the CMS EHR incentive website, and to the regulations. The Appendix contains links to the source documents, as well as quotes from the sources where they apply to release of information, specifically.

Incentives and Penalties

Meaningful Use is a program from the American Recovery and Reinvestment Act of 2009 (ARRA). ARRA provides for EHR incentive programs which are administered by the Centers for Medicare & Medicaid Services (CMS), a division of the Department of Health and Human Services. Under these programs, providers and hospitals can demonstrate and report Meaningful Use of certified EHR technology in order to receive bonuses starting in 2011. Providers and hospitals failing to demonstrate and report Meaningful Use after 2014 will be subject to penalties reducing their Medicare reimbursements.

The incentives can be up to $44,000 per eligible Medicare provider or up to $63,750 per Medicaid provider, and millions of dollars for a hospital, depending on the size of their Medicare and Medicaid reimbursements. Penalties will start with a 1% reduction of Medicare reimbursements in 2015, and increase 1% each year after that up to 5% in 2019, remaining at 5% until the provider or hospital complies. Medicaid reimbursements will not be reduced as a penalty under this program-only Medicare reimbursements will be affected.

Hospitals and providers may begin participating at any time in the programs. The year they start is referred to as their “first year.” Bonuses and the difficulty of the programs change over time, to encourage early participation. The first year a hospital

or provider reports on Meaningful Use, the reporting period is any consecutive 90 days of the reporting year. This provides leeway to meet the requirements in the first year. In all subsequent years, the participant must report on the entire year of data. Hospitals must report using the federal fiscal year, October 1 through September 30. Providers must report using the calendar year.

Two groups of recipients, and two programs

There are two different groups of recipients – hospitals and providers who are independent of hospitals. The regulations have significant detail defining an eligible provider and an eligible hospital, and how they are counted and separated for reporting under Meaningful Use. In general, hospitals report one set of Meaningful Use numbers as a single entity, while providers must apply for the incentive as individuals, even if this means accumulating data across multiple entities where the provider might be making Meaningful Use of certified EHR technology. HealthPort recommends careful review of the regulations to determine if you qualify, and how you need to gather your Meaningful Use statistics. There are also specific rules for critical access hospitals, which have separate sections in the regulations. Medicare Advantage organizations may also be able to qualify for incentive payments.

There are also two different yet similar incentive programs – one for Medicare and one for Medicaid. Hospitals can participate in both, but eligible providers must select either to participate under Medicare or under Medicaid. (Note: providers can switch between the programs once during the life of the programs). There are thresholds to be able to qualify under the Medicaid program; one which includes a certain percentage of low-income patients receiving care from the provider or hospital. For the Medicare program, the participant must demonstrate Meaningful Use in the participant’s first year. For the Medicaid program, a hospital or provider can receive the bonuses in the first year without measuring Meaningful Use, provided they can attest to real progress toward implementation of certified EHR technology. Progress can be measured in ways such as installing the technology, upgrading to a certified release, etc. One additional difference between the programs is that the Medicare program is administered directly by CMS, while the Medicaid program will be administered by each state separately. This means that reporting, and even some rules, may vary slightly state-by-state for the Medicaid program.

Certification versus Meaningful Use

There are actually two different rules related to the EHR incentive programs. The certification rule was written by the Office of the National Coordinator for Health Information Technology (ONC), about EHR systems and modules and is of most interest to EHR and other technology vendors. The other rule was written by CMS about the incentive programs and defines who is eligible and the Meaningful Use of certified EHR technology.

Vendors and producers of EHR software and systems must comply with the certification rule in order for their products to be used by providers and hospitals in the pursuit of Meaningful Use incentives. Certification requires that the EHR products be able to perform certain actions, contain certain features, produce output in certain national standard formats, and have security capabilities to ensure the confidentiality of protected health information as defined under HIPAA and HITECH. Not all of those tools and formats need to be used in every case for Meaningful Use. It is important to separate these two rules and concepts (certification versus Meaningful Use), because they have different purposes. The certification rule is meant to ensure that certain tools are available to all providers and hospitals. Meaningful Use does not always require the facility to use those tools in every case; there is significant choice left for the hospitals and providers. Using certified software does not guarantee that a provider or hospital will meet Meaningful Use. Meaningful Use requires certain activities by providers and hospitals and the correct measuring of those activities. This difference between the two rules will be further illustrated in the next section.

National Standards and Meaningful Use

The certification rule contains a number of national standards designed to enable interoperability between EHR technologies. Theydetermine the language and grammar which all EHR systems must use to communicate with each other, and with agencies such as the CDC, public health departments, etc. Some of these standards pertain to code sets to ensure all systems are referring to the same healthcare ideas in the same way. Examples include codes for diagnoses and codes for procedures. Standards like these are in place for drugs, lab results, and other medical values.

The most important standards for interoperability, however, are the Continuity of Care Record (CCR) and the Continuity of Care Document (CCD). Both of these include standard arrangements of medical data into groups of labeled data fields. These formats allow one EHR system to read and store data sent by another EHR system. Both CCR or CCD will pass EHR certification testing; however, most experts predict the CCD will eventually replace CCR, because it is more robust, and combines with the popular HL7 formats already in use throughout the healthcare industry. CCD also does a more thorough job handling unformatted medical documents which are passed between EHRs.

The certification rule requires that certified EHR technology must be able to produce CCD or CCR output for certain parts of the medical record, including medication lists, problem lists, medical allergy lists, lab results, and others. However, while the EHR must produce these technical formats for certification, the hospital or provider does not need to use those formats for every communication of EHR data. For instance, copies of medical records to patients, even when delivered electronically, can be “human-readable” only, not CCD or CCR. Another case of the difference between certification and Meaningful Use requirements involves encryption. EHRs must contain flexible and strong encryption tools, to protect patient data. However, in the Meaningful Use rule, CMS stated that providers and hospitals must decide when and where to use this encryption technology, and did not require the use of it for Meaningful Use.

The Requirements for Meaningful Use – “Core” and “Menu”

The requirements for Meaningful Use will increase over time. CMS and ONC will release subsequent rules which will detail the changes. These different plateaus of requirements are called “stages” in the regulations. The list below is Stage 1. Stages 2 and 3 are currently being defined, will have public comment periods, and are scheduled to be made into rules in September or October of 2011 and 2013, respectively.

Meaningful Use Stage 1 is broken down into two lists of requirements, one for hospitals and a slightly different list for eligible providers. Both of those lists are further broken down into two parts – the core requirements and the menu requirements. To demonstrate Meaningful Use a participant must meet ALL of the core requirements, and five out of ten of the menu requirements. Below is an abbreviated list of the requirements, showing core and menu for hospitals and for eligible providers.

When reporting Meaningful Use, the rule allows exemption from some requirements. If a particular provider or hospital does not meet the measure because they don’t provide certain services, they may qualify for an exemption for that requirement. For example, chiropractors can qualify for Meaningful Use as eligible providers (if they see sufficient Medicaid or Medicare patients); however, because they do not prescribe medications, they would be exempt from the e-prescribing requirements. Each requirement describes the measure, the threshold, and exemptions, if any – see the regulations for this detail.

CMS has indicated for Stage 2 that ALL of the requirements below will become core requirements, and some thresholds will be raised.

Reporting Meaningful Use

To qualify for the incentives and avoid the penalties in later years, a provider or hospital must use certified EHR technology. The regulations clearly state in several places that a hospital or provider can use a complete EHR system which is certified for ALL of the Meaningful Use requirements, or the facility can use a series of separate EHR modules which are certified for one or more Meaningful Use requirement. The facility can even choose to use a combination of a complete EHR and EHR modules. Whatever combination the facility chooses must cover ALL of the requirements, and a facility must have installed EHR technology for ALL of the requirements including the menu items NOT chosen for Meaningful Use. In other words, the installed technology must cover all 24 or 25 requirements, even if the facility isn’t going to use all of that technology in the first year to demonstrate Meaningful Use. See Appendix, item number 7, for more information about this last point.

Most requirements have a threshold the hospital or provider must meet. In these cases, not only must the facility use the EHR technology to fulfill the requirement, but they must measure their use, and the measure must be over a certain number or “ratio” to qualify. For example, the EHR must have the basic demographic data recorded for at least 80% of the patients in the system. This ratio is made up of a denominator (all the patients in the system) and a numerator (all of those patients who have the six required demographic fields completed). Many of the requirements have a defined measure similar to this– in the format of ratios with carefully defined denominators and numerators. The concept of measures and thresholds will be further illustrated later in this paper, when discussing the release of information requirement.

While the measures are taken for a hospital as a whole, the measures are taken for each provider separately. This makes the reporting for providers more complex, with some events counting for more than one provider, and others only counting for a single provider. Check the regulations carefully for details for each measure and how to count across the provider/patient population.

Reporting to CMS will be done by attestation and manual entry into a website at some point during 2011. More of the reporting will be electronic in future years, with the EHR technology connecting to CMS for submission of measures. The rules for any electronic submission will be refined in future regulations.

The most complex requirement of the core lists for both providers and hospitals is the Clinical Quality Measures reporting. This requirement opens up into another list of required and elective items which must be tracked and reported to CMS. There are no thresholds for these clinical measures yet; CMS simply wants the data. The number of required clinical measures is expected to increase over time, and CMS may eventually incorporate thresholds.

Meaningful Use and Release of Information

While the lists of requirements for Meaningful Use contain several items which involve transferring medical records, most are related to clinical events (such as discharge, or electronically passing data from EHR to EHR for continued care) or they involve interfaces with public health agencies. One, however, deals with a traditional release of medical records, also know as release of information. The requirement is to provide an electronic copy of the medical record when a patient requests it that format, and to do so within three business days. The rest of this paper describes this requirement in greater detail.

Both eligible providers and hospitals must complete this requirement for Meaningful Use; it is a core requirement on both lists. The threshold for this requirement is set (for Stage 1) at 50%. This means that, of the record requests that qualify under Meaningful Use, 50% or more of those requests must be delivered within three business days.

More specifically, the denominator and numerator used to calculate the 50% are described as follows:

Denominator

• Request must be made by a patient or a patient’s personal representative (other requesters are excluded from this Meaningful Use requirement)
• Patient requester must request delivery of an electronic copy of her/his medical records
• The records must be stored in a certified EHR technology (older records, or records stored in other systems, are excluded from Meaningful Use calculations)
• For hospitals, the medical records must be for either inpatient or emergency room service; outpatient records do not count in this measure for Stage 1.

It is important to note that a hospital can count emergency department admissions for the denominators for measures associated with Stage 1 of Meaningful Use objectives in one of two ways but the hospital must select one of the methods and use it for ALL of the Meaningful Use measures:

• Observation Services Method-The denominator should include the following visits to the emergency department:
  • The patient is admitted to the inpatient setting (place of service) through the emergency department.
  • The patient initially presented to the emergency department and is treated in the emergency department’s observation unit or otherwise receives observation services.
• All Emergency Department Visits Method – Includes all emergency department visits in the denominator for all measures requiring inclusion of emergency department admissions. All actions taken in the inpatient or emergency department of the hospital would count for purposes of determining Meaningful Use.

Numerator

• The number of the requests in the denominator which were delivered within three business days.

When the numerator and denominator are calculated, and the ratio is converted to a percentage, the result must be 50% or more for the hospital or provider to qualify for the incentive.

In the first year, the provider or hospital need only report on any consecutive 90-day period; so the denominator and numerator are calculated from requests made within that 90 days. In subsequent years the calculation is made on the entire year’s tally of requests.

The definition of business days excludes weekends and federal holidays; they do not count against the three-day limit. The timer starts when the request is received by the facility, and ends when the record copy is sent to the patient. The regulations are clear that the patient does not need to receive the records for the timer to stop; rather, the timer stops when the facility sends them. The specific example in the regulations describes putting a CD copy of the records in the mail; the timer stops when the CD is mailed and not when the patient receives the CD. The same would be true about an e-mail message informing a patient that the records are now available for downloading from a secure portal; the timer stops when the e-mail is sent and not when the patient actually accesses the records on-line or opens the e-mail.

For hospitals, all requests are pooled for a single calculation for the entire hospital. For eligible providers, the calculation must be made for each provider separately. If the medical records request is not specific to a single provider, but instead is a request made to the practice, then the request counts for ALL providers who actually saw the patient during the Meaningful Use reporting period. For more information about this, see the Appendix, item number 6.

The format of the records is up to the facility; however, the facility is expected to make an effort to accommodate a patient’s request in regards to the preferred format. CD, USB device, and secure portal are all specifically mentioned as valid electronic formats. The record copy must be human-readable. The records must fulfill the requirements of HIPAA and HITECH regarding the patient’s rights of access and limitations providers can place on access. Finally, the HIPAA and HITECH regulations, as well as the Office for Civil Rights which enforces the privacy and security rule under HIPAA and HITECH, have left facilities free to decide when to encrypt medical records. In other words, the decision about whether to encrypt the medical records is left up to the facility.

For an EHR module to be certified for this requirement, the software must demonstrate the ability to create the electronic copy in either CCR or CCD format and also to provide a human-readable version of the records. For Meaningful Use, however, the hospital or provider need only provide the patient with a human-readable version (not the CCR or CCD copy). See the Appendix, item number 5, for CMS correspondence about this distinction.

CMS has also stated that a facility can deliver records with software which is not certified. Only the EHR which contains the records must be certified; software used to deliver the records after the EHR creates an outgoing copy, does not need to be certified. CMS and regulations also state that the tallying of the denominator and numerator as well as the calculating of the ratio for reporting to CMS may also be performed outside the certified EHR technology with tools or methods which are not certified. See the Appendix, item numbers 4 and 5, for more information on these points.

Questions You Should be Asking Regarding Meaningful Use Requirements, Your Facility, and Your Release of Information Process:

• 1. When will your facility count a request as “received” and start the “three business day” timer?
• 2. Will your facility encourage or offer patients the option “up front” to request electronic copies of their medical records, or will you wait for patients to ask for electronic copies?
• 3. How will your facility handle a request for electronic copies which covers medical records in both the certified EHR and also in other forms, such as paper charts? Will you be able to deliver both portions of the records electronically within three business days? Will you need to split the request, fulfilling the request for the Meaningful Use portion of the record (i.e. the items stored in the certified EHR) earlier, and sending the paper record copies later, so they don’t hold up the Meaningful Use portion of the request?
• 4. Can your release of information process handle requests within three business days? Would that extend to hybrid chart requests (where the records are in both the certified EHR and in other, more time-consuming formats, like paper)?
• 5. Can your release of information process properly track and report the tallies you must demonstrate at the end of the reporting period? Will the process provide a detailed audit trail to show for each request the date/time received/fulfilled?
• 6. What format(s) will your facility offer to patients? CD? Electronic delivery over a secure portal? The latter is the fastest method, and the most secure.

Frequently Asked Questions

How do we measure three business days?

Clock starts with the date/time of the receipt of the request. Facilities should have a policy defining the receipt date. Clock stops with the date/time the records are sent. The example in the regulations is for burning a CD, and the clock stops when the CD is put in the mail, not when the patient receives it. The electronic delivery equivalent would be when the system sends an e-mail to the patient, “Your records are ready,” rather than when the patient logs in.

Is HealthPort going to certify for Meaningful Use?

Yes – as an EHR Module for this requirement (and for the security requirements which all EHR modules and systems must pass). Note that certification is not necessary per CMS or the regulations for delivering electronic record copies, nor for tallying and calculating the numbers for reporting on this requirement. HealthPort tools can thus be used even prior to certification, but HealthPort believes facilities will have greater peace of mind if their release of information partner is also certified.

Can we use HealthPort’s certified module if our EHR is certified as a complete EHR? Don’t we need to use the EHR for all Meaningful Use activities in that case?

Throughout the regulations, it is clearly stated that a facility may use a group of certified modules, in any combination they choose, as long as all of the modules are certified and they have a complete set of certified modules installed. Also, CMS has made clear that delivery of the records and the tallying of the denominator and numerator can all be done with non-certified software as long as the certified EHR creates the outbound record copy and captures the Meaningful Use data.

How is the price of copies of medical records for patient requests determined?

HIPAA states that patients can be charged only a “reasonable, cost-based” fee by number of pages reproduced. No administrative or search/retrieval fee can be charged to patients. However, if the search fee is removed, a state’s statutory or regulatory fee is deemed by HIPAA to be reasonable; therefore, patients can be charged an amount up to the total of (i) number of pages multiplied by the state’s per-page rates, plus (ii) postage if the records are mailed. If there is no state fee in a state’s laws, the fee must be calculated based on the “reasonable, cost-based” standard. HIPAA does not control any requests for records other than those by patients.

Does HealthPort guarantee that it will meet the 50% electronic delivery ratio needed for the Meaningful Use requirement?

While HealthPort cannot guarantee that any particular facility or provider will meet the 50% electronic delivery ratio needed for the Meaningful Use requirement, we would like to highlight several facts about our process that could assist with this requirement:

• 1. Our average turn-around times on all requests are well below three business days.
• 2. When electronic delivery is used, and e-mail addresses are collected from patients, the turnaround time is even faster.
• 3. HealthPort will specifically monitor Meaningful Use requests for timely delivery.

Will HealthPort also handle the electronic discharge instructions requirement?

The electronic discharge instructions requirement is meant to take place as the patient is being discharged, and is thus part of a clinical process. The regulations mention that, ideally, this event would accompany a review of the instructions at time of discharge. We believe this is best handled directly from the certified EHR, on demand, at time of discharge.

What should our facility be doing now to prepare for the release of information and other Meaningful Use requirements?

A good place to begin is the list of “Questions You Should Be Asking” in the section prior to this FAQ section. Begin discussions with your EHR vendor(s) about certification and certified versions of the software. This requirement (patient electronic copies of medical records) depends on the medical records being stored in certified EHR technology. Also, the EHR incentive programs website by CMS has information and tools to determine if you are eligible, to help you decide which program best suits your facility, and to further explain the details of the programs. See Appendix, item number 1, for a link to this website. Your facility can register for the programs. Registration is now open for the Medicare programs, and states may have opened registration for Medicaid. See the EHR incentive programs website for more information on registering. Check with your compliance department or any Meaningful Use committee that may have been formed to determine who is going to register your facility.

Appendix – Source Material and Quotes from Regulations and CMS Correspondence

1. CMS has a website specifically about the EHR incentive programs:

http://www.cms.gov/EHRIncentivePrograms/

Both rules that apply to certification and Meaningful Use were published in the Federal Register on July 28, 2010.

2. The Certification Rule can be downloaded from:

http://edocket.access.gpo.gov/2010/pdf/2010-17210.pdf

This rule applies primarily to vendors of EHR software. Hospitals and eligible providers must install and use certified EHR technology meaningfully to qualify for the incentive; the list of items required appears in the Meaningful Use Rule.

3. The Meaningful Use Rule can be downloaded from:

http://edocket.access.gpo.gov/2010/pdf/2010-17207.pdf

The section of comments dealing specifically with patients’ electronic copy of medical records starts on page 44353, at the bottom of the first column, and ends on page 44355. Other sections of the rule apply to this requirement as well.

4. Frequently asked questions about Meaningful Use reporting and using non-certified software to calculate and report appears on the CMS web site at:

http://questions.cms.hhs.gov/app/answers/detail/a_id/10465/p/21%2C26%2C1139/sessionL3NpZC81OThVTnJuaw%3D%3D

The text of that FAQ reads:

“If data is captured using certified electronic health record (EHR) technology, can an eligible professional or eligible hospital use a different system to generate reports used to demonstrate Meaningful Use for the Medicare and Medicaid EHR Incentive Programs?”

“As long as data is captured using certified EHR technology, eligible professionals and eligible hospitals may use a separate, uncertified system to generate reports on the measures of the core and menu set Meaningful Use objectives. These separate, uncertified systems can also be used to calculate numerators and denominators using data from the certified EHR system. Eligible professionals and eligible hospitals will then enter this information in CMS’s web-based Medicare and Medicaid EHR Incentive Program Registration and Attestation System. Eligible professionals and eligible hospitals will fill in numerators and denominators for Meaningful Use objectives, indicate if they qualify for exclusions to specific objectives, report on clinical quality measures, and legally attest that they have successfully demonstrated Meaningful Use. Please note that eligible professionals and eligible hospitals cannot use a non-certified system to generate reports for the clinical quality measures. Numerator and denominator information for clinical quality measures must be reported directly from certified EHR technology. For additional clarification about this, please refer to the following FAQ from the Office of the National Coordinator of Health Information Technology: http://healthit.hhs.gov/ portal/server.pt/community/onc_regulations_faqs/3163/faq_13/20775. For more information about the Medicare and Medicaid EHR Incentive Program, please visit http://www.cms.gov/EHRIncentivePrograms.”

5. HealthPort asked CMS, through its counsel in Washington, D.C., the following questions regarding Meaningful Use and certification:

“Question 1: Once a certified EHR (which is capable of producing the medical record in both CCD or CCR and human readable formats) has produced a copy of the medical record for the patient in a way that meets the Meaningful Use requirement, can a separate, non-certified piece of software (such as a secure portal) be used to deliver the copy of the medical record to the patient consistent with the requirements for Meaningful Use under CMS’s regulations?

CMS’s answer: “Yes. As long as the certified EHR is capable of producing the electronic health record using the standards certified by ONC, a separate non-certified system can serve as the method of delivery for the patient’s EHR information.”

Question 2: We understand that the certified EHR has to be capable of producing the electronic copy of the specified health information for a patient in both CCD or CCR and human readable formats. Does that mean that the health information has to be delivered to the patient in both formats, or can the eligible provider or eligible hospital/critical access hospital determine, consistent with Meaningful Use, and based on their judgment (independently or in conjunction with the patient) to deliver the specified health information only in one format, e.g., a human readable format such as a PDF file?”

CMS’s answer: “Correct. Again, the certified EHR must be capable of producing the electronic health record using the standards certified by ONC (in this case, CCD, CCR, and human readable formats), but the provider does not have to provide an electronic copy of the patient’s health information in all formats. Form and format should be human-readable and comply with the HIPAA Privacy Rule, as specified at 45 CFR 164.524(c). The media could be any electronic form such as patient portal, PHR, CD, USB fob, etc. Please note that EPs are expected to make reasonable accommodations for patient preference as outlined in 45 CFR 164.522(b). If the patient agrees, a portal to download EHR information or a PDF could satisfy the measure of this objective.”

6. A frequently asked question on the CMS website discusses the calculation of the numerator and denominator for the electronic medical records copy requirement for eligible professionals.

http://questions.cms.hhs.gov/app/answers/detail/a_id/10269/session/L3NpZC96QzVXalduaw%3D%3D

The text for that FAQ and answer is:

Question: “To meet the Meaningful Use objective ‘provide patients with an electronic copy of their health information’ for the Medicare and Medicaid Electronic Health Record (EHR) Incentive Programs, how should the numerator and denominator be calculated for patients who see multiple eligible professionals (EPs) in the same practice (e.g., in a multi-specialty group practice)?”

Answer: “If the request for an electronic copy of their health information is made by a patient to a specific EP, then the patient should be counted in the numerator and denominator for that specific EP. If the patient makes a request for an electronic copy of their health information that is not to a specific EP (e.g., by request to the practice’s administrative staff), then the patient should be counted in the numerators and denominators for all EPs with whom the patient has had an office visit during the EHR reporting period.

For more information about the Medicare and Medicaid EHR Incentive Program, please visit http://www.cms.gov/EHRIncentivePrograms.”

7. The FAQ and answer on the CMS website which states that a facility must have certified EHR technology for ALL of the Meaningful Use requirements, even though the facility need only report on 19 or 20 of them, appears at the following web site:

http://questions.cms.hhs.gov/app/answers/detail/a_id/10162/session/L3NpZC96QzVXalduaw%3D%3D

The text of this FAQ follows (the sentence about installing ALL of the capabilities is the last one in the answer):

“How should eligible professionals (EPs) select menu objectives for the Medicare and Medicaid Electronic Health Records (EHR) Incentive Programs?”

“EPs are required to report on a total of five Meaningful Use objectives from the menu set. When selecting five objectives from the menu set, EPs must choose one option from the public health menu set. If an EP is able to meet the measure of one of the public health menu objectives but can be excluded from the other, the EP should select and report on the public health menu objective they are able to meet. If an EP can be excluded from both public health menu objectives, the EP should claim an exclusion from only one public health objective and report on four additional menu objectives from outside the public health menu set. We encourage EPs to select menu objectives that are relevant to their scope of practice, and claim an exclusion for a menu objective only in cases where there are no remaining menu objectives for which they qualify or if there are no remaining menu objectives that are relevant to their scope of practice. For example, we hope that EPs will report on five measures, if there are five measures that are relevant to their scope of practice and for which they can report data, even if they qualify for exclusions in the other objectives. Please note that EPs must have complete certified EHR technology (or a complete set of certified EHR modules) capable of supporting all of the core and menu set objectives, including any objectives for which the EP can claim an exclusion and menu set objectives the EP does not select.

For more information about the Medicare and Medicaid EHR Incentive Program, please visit http://www.cms.gov/EHRIncentivePrograms.