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Healthcare IT for Health Information Exchanges

Healthcare IT (Information Technology) for Health Information Exchanges

Sustainable Success: State CIOs and Health Information Exchange – While NASCIO has continued to track the role of the State CIO in

National Association of State Chief Information Officers (NASCIO)

Health Information Exchange (HIE), the recently released issue brief highlights the importance of a sustainable public HIE. State-run HIEs are mainly utilizing two types of usage fees and, in some instances, using a combination of the two. The first model, the transaction fee model, is used when charging for each set of data that is sent or received. The second model, a subscription fee model, allows providers and users to set a predetermined level of data access. The subscription fee can be set at a weekly, monthly or annual rate and may include varying levels of services.


As AHIMA points out, the HIE implementation challenge will be to create a standardized interoperable model that is patient centric, trusted, longitudinal, scalable, sustainable, and reliable. The goal of HIE is to facilitate the secure access, use, and control of health information in support of patient-centered care delivered in a safe, high quality, cost effective, and timely manner.

HIMSS clarifies that the terms “RHIO” and “Health Information Exchange” or “HIE” are often used interchangeably. RHIO (regional health information organization) is a group of organizations with a business stake in improving the quality, safety and efficiency of healthcare delivery.  RHIOs are the building blocks of the proposed National Health Information Network (NHIN) initiative proposed by David Brailer, MD, and his team at the Office of the National Coordinator for Health Information Technology (ONCHIT).

Based on initial recommendations from the Nationwide Health Information Network Work Group, the Direct Project was launched in March 2010 to specify a simple, secure, scalable, standards-based way for participants to send authenticated, encrypted health information directly to known, trusted recipients over the Internet. The Direct Project expands existing Nationwide Health Information Network standards and service descriptions to address the key Stage 1 requirements for Meaningful Use, and to provide an easy “on-ramp” to nationwide exchange for a wide set of providers and organizations. For more information about the Direct Project, please visit http://www.directproject.org.

The Direct Project specifies a simple, secure, scalable, standards-based way for participants to send authenticated, encrypted health information directly to known, trusted recipients over the Internet.

The Office of the National Coordinator for Health Information Technology (ONC) has awarded $16 million in new Challenge Grants to encourage breakthrough innovations for health information exchange that can be leveraged widely to support nationwide health information exchange and interoperability.

The ONC-funded State HIE Cooperative Agreement Program promotes secure exchange of health information to enable patient-centered care and providers’ achievement of meaningful use requirements.
State/SDE Recipient
State HIE Cooperative Agreement Award2011 HIE Challenge Grant Supplement AmountChallenge
Colorado Regional Health Information Organization$9,175,777.00$1,718,783.002
Georgia Department of Community Health$13,003,003.00$1,686,989.003
Indiana Health Information Technology, Inc.$10,300,000.00$1,718,439.004
Indiana Health Information Technology, Inc.*$10,300,000.00$1,267,970.003
Massachusetts Technology Park Corporation$10,599,719.00$1,717,610.002
Massachusetts Technology Park Corporation*$10,599,719.00$1,675,019.005
Maryland Department of Health & Mental Hygiene$9,313,924.00$1,683,171.002
HealthShare Montana$5,767,926.00$1,400,802.005
North Carolina Department of State Treasurer$12,950,860.00$1,708,693.001
Oklahoma Health Care Authority$8,883,741.00$1,719,086.002
* Indiana Health Information Technology, Inc. and Massachusetts Technology Park Corporation were each awarded two Challenge Grant awards.


State Level Meaningful Use Incentive Payment Program

Medicaid EHR Incentive Program for States

The Medicaid EHR Incentive Program is a voluntary program established by Congress, but administered individually by each State and territory. While we currently estimate that every State will have an Incentive Program in the future, the preparation for the program varies from State to State. Below is the estimated date each State intends to begin accepting registrations for their Medicaid EHR Incentive Program.These dates are provided to CMS by the States, and this list is updated monthly. Even States that are listed as “Unknown” are progressing toward program launch; however, they have not provided CMS with an estimated launch date.


StateExpected Launch DateProgram URL
AKJanuary 2011http://hss.state.ak.us/hit/
ALApril 2011http://www.onehealthrecord.alabama.gov/
ARSpring 2011 https://www.medicaid.state.ar.us/provider/arra.aspx
ASUnknownNo State URL Known
AZJuly 2011 http://www.azahcccs.gov/HIT/about/Incentives.aspx
CASpring 2011http://medi-cal.ehr.ca.gov/
COUnknown http://www.colorado.gov/cs/Satellite/HCPF/HCPF/1251581838726
CTUnknown https://www.ctdssmap.com/CTPortal/Provider/EHR%20Incentive%20Program/tabId/53/Default.aspx
DCUnknownNo State URL Known
DESpring 2011 http://dhss.delaware.gov/dhss/dmma/ehr_summary.html
FLAugust 2011 http://fhin.net/FHIN/MedicaidElectronicHealthRecordIncentiveProgram.shtml
GAUnknown http://dch.georgia.gov/00/article/0,2086,31446711_154959664_156789923,00.html
HIUnknown http://www.med-quest.us/providers/ElectronicHealthRecordIncentiveProgram.html
IAJanuary 2011 http://www.ime.state.ia.us/Providers/EHRIncentives.html
IDFall 2011http://www.MedicaidEHR.dhw.idaho.gov
ILlate Spring 2011http://hfs.illinois.gov/ehr/
INMid-2011 http://provider.indianamedicaid.com/general-provider-services/ehr-incentive-program.aspx
KSJune 2011http://www.khpa.ks.gov/hite/default.htm
KYJanuary 2011http://chfs.ky.gov/dms/EHR.htm
LAJanuary 2011 http://www.lamedicaid.com/provweb1/EHR/EHRIndex.htm
MAUnknownNo State URL Known
MDUnknown http://www.dhmh.state.md.us/mma/ehr/index.html
MEAugust 2011http://www.maine.gov/dhhs/oms/HIT/index.html
MIJanuary 2011http://michiganhealthit.org/
MNFall 2011 http://www.dhs.state.mn.us/ehrincentives
MOApril 2011http://www.dss.mo.gov/mhd/ehr/
MPUnknownNo State URL Known
MSJanuary 2011http://ms.arraincentive.com/
MTSpring 2011 http://medicaidprovider.hhs.mt.gov/providerpages/ehrincentives.shtml
NCJanuary 2011http://www.ncdhhs.gov/dma/provider/ehr.htm
NDMay 2011http://www.healthit.nd.gov/medicaid
NEFall 2011http://www.dhhs.ne.gov/med/EHR.htm
NHWinter 2011/2012http://www.NHMedicaidHIT.org
NJUnknownNo State URL Known
NVSummer 2011https://dhcfp.nv.gov/EHRIncentives.htm
NYSeptember 2011 http://www.health.ny.gov/regulations/arra/department_of_health_programs.htm#health_it
OHJune 2010http://jfs.ohio.gov/OHP/HIT%20Program.stm
OKJanuary 2011http://www.okhca.org/EHR-incentive
ORSummer 2011http://www.oregon.gov/DHS/mhit/incentive.shtml
PAJune 2011 http://www.dpw.state.pa.us/provider/healthcaremedicalassistance/medicalassistancehealthinformationtechnologyinitiative/index.htm
PRUnknownNo State URL Known
RIJune 2011 http://www.dhs.ri.gov/Portals/0/Uploads/Documents/Public/MA_Providers/ehr_incentive_prg.pdf
SCJanuary 2011http://hit.scdhhs.gov/hit/
SDFall 2011 http://www.dss.sd.gov/medicalservices/incentiveprogram/
TNJanuary 2011http://www.tn.gov/tenncare/hitech.html
TXJanuary 2011 http://www.tmhp.com/Pages/HealthIT/HIT_Home.aspx
UTSeptember 2011 http://health.utah.gov/medicaid/provhtml/HIT.htm
VAFall 2011 http://dmasva.dmas.virginia.gov/Content_pgs/pr-arra.aspx
VIUnknownNo State URL Known
WAJune 2011 http://hrsa.dshs.wa.gov/MedicaidHealthCareReform/IT.shtml
WISummer 2011http://www.dhs.wisconsin.gov/ehrincentive/
WVUnknownNo State URL Known
WYSummer 2011http://www.wyomingincentive.com/

Last updated February 18, 2011

Information provided by States

Information subject to change without notice

Strong Interest in Medicare and Medicaid EHR Incentive Programs


Four states issue first Medicaid incentive payments

More than 21,000 providers initiated registration for the Medicare and Medicaid EHR Incentive Programs in January and four states reported initial Medicaid incentive payments totaling $20,425,550, the Centers for Medicare & Medicaid Services announced today. In addition, the Office of the National Coordinator for Health Information Technology (ONC) announced that as of Feb. 11, 2011, more than 45,000 providers requested information or registration help from 62 Regional Extension Centers (RECs). RECs provide hands-on support for providers who want to adopt and become meaningful users of electronic health information technology. This early interest in the Medicare and Medicaid EHR programs reveals strong support for these programs that will advance health care through improvements in patient safety, quality of care, and patient involvement in treatment options.

Eligible professionals and hospitals must register in order to participate in the Medicare and Medicaid EHR incentive programs. Registration opened on Jan. 3, 2011, at http://www.cms.gov/EHRIncentivePrograms/20_RegistrationandAttestation.asp.

Survey results released by ONC on January 13 indicate that “four-fifths of the nation’s hospitals, and 41 percent of office-based physicians, intend to sign up for the incentive payments.” For more information on the survey, please visit: http://www.hhs.gov/news/press/2011pres/01/20110113a.html

“This strong early interest in the Medicare and Medicaid EHR incentive programs among providers and state Medicaid programs is most welcome and very encouraging,” said Donald Berwick, M.D., administrator of CMS. “We encourage early adoption, and we’re seeing the registration numbers continue on an upward trajectory. The valuable feedback we’ve in these early weeks of the program helps us to fine-tune our list of frequently asked questions and other resources to increase providers’ understanding of the incentive programs and help them in getting signed up.”

Eleven states have launched Medicaid EHR incentive programs, and incentives have been issued by four states. Highlights include the following:

  • On January 5, Oklahoma and Kentucky issued incentives totaling $2,842,500. Kentucky made an initial payment of $2.86 million to a teaching hospital, University of Kentucky Healthcare . This payment comprised one-third of the hospital’s overall expected amount for participating in the incentive program. On the same day, Kentucky disbursed an incentive of $1.3 million to Central Baptist Hospital . Also on January 5, Oklahoma issued incentive payments to two physicians at the Gastorf Family Clinic of Durant, Okla., totaling $42,500 ($21,250 each), for having adopted certified EHRs.
  • On January 12, Louisiana announced a payment of $63,750 to Winn Community Health Center , the first federally qualified health center (FQHC) in the nation to receive an incentive payment. The incentive payment consisted of $21,250 for each of three eligible professionals at the clinic.
  • During the week of January 17, Iowa issued its first Medicaid EHR incentive payments in the amount of $21,250 each for two eligible professionals.

Additional Medicaid incentive payments are in process. States that have launched their Medicaid EHR Incentive Programs are Alaska , Iowa , Kentucky , Louisiana , Michigan , Mississippi , North Carolina , Oklahoma , South Carolina , Tennessee , and Texas . Medicare providers will be able to attest to meaningful use in mid- to late April, and issuance of Medicare payments is scheduled to begin in May.

The Medicare and Medicaid EHR Incentive Programs were established by the Health Information Technology for Economic and Clinical Health Act (HITECH), part of the American Recovery and Reinvestment Act of 2009. Under HITECH, Medicare and Medicaid incentive payments will be available to eligible professionals, eligible hospitals, and critical access hospitals (CAHs) when they adopt certified EHR technology and successfully demonstrate “meaningful use” of the technology in ways that improve quality, safety, and effectiveness of patient-centered care.

“The HITECH Act marked a new level of national commitment to health information technology. The implementation of HITECH is in high gear,” said David Blumenthal, national coordinator for health information technology. “HHS has built a strong foundation of support, and health care providers are responding. We are seeing a rapidly accelerating pace toward the adoption and meaningful use of EHRs. The result will be better quality and more effective care, which benefits both patients and providers.”

For 2011, Medicare eligible professionals and hospitals will demonstrate meaningful use through CMS’ web-based Medicare and Medicaid EHR Incentive Program Registration and Attestation System. In the Registration and Attestation System, providers will fill in numerators and denominators for the meaningful use objectives and clinical quality measures, indicate if they qualify for exclusions to specific objectives, and legally attest that they have successfully demonstrated meaningful use. Once providers have completed a successful online submission through the Attestation System, they will be eligible for a Medicare EHR incentive payment. The Attestation System for the Medicare EHR Incentive Program will open in mid- to late April. CMS plans to release additional information about the attestation process soon.


For the Medicaid EHR Incentive Program, providers will follow a similar process using their state’s attestation system. Check here to see states’ scheduled launch dates for their Medicaid EHR Incentive Programs: http://www.cms.gov/apps/files/medicaid-HIT-sites/.

For more information on the Medicare and Medicaid EHR Incentive Programs, visit http://www.cms.gov/ehrincentiveprograms/.

For more information on ONC’s health information technology activities, visit www.healthit.gov.

Approved HIE State Plans

Currently Approved HIE State Strategic and Operational Plans

Approved State Plans:

The list below represents the currently approved state specific strategic and operational plans for creating HIE capacity.

StateStrategic /Operational Plans
State Summaries
Entity Responsible for GrantPlan Approval Date
CaliforniaStrategic and Operational Plans
To view the documents separately click here (easier download)
California Health and Human Services Agency6/16/2010
DelawareState SummaryDelaware Health Information Network5/17/2010
IdahoComing SoonIdaho Health Data Exchange12/7/2010
IllinoisComing SoonIllinois Department of Healthcare and Family Services12/10/2010
MaineState SummaryState of Maine/Governor’s Office of Health Policy & Finance8/16/2010
MarylandStrategic and Operational PlansThe Maryland Department of Health and Mental Hygiene5/14/2010
MichiganStrategic and Operational Plans
Amendment 1
Michigan Department of Health11/29/2010
NebraskaStrategic and Operational PlansNebraska Department of Administrative Services11/5/2010
New HampshireComing SoonNew Hampshire Department of Health and Human Services12/10/2010
New MexicoStrategic and Operational PlansLCF Research, New Mexico1/25/2010
North CarolinaStrategic and Operational Plans
State Summary
North Carolina Department of State Treasurer11/3/2010
OregonComing SoonState of Oregon12/10/2010
South CarolinaStrategic and Operational PlansSouth Carolina Department of Health & Human Services8/30/2010
TennesseeStrategic and Operational Plans
Gap Analysis
State Summary
State of Tennessee9/17/2010
TexasStrategic and Operational PlansTexas Health and Human Services Commission11/3/2010
UtahStrategic and Operational PlansUtah Department of Health5/12/2010
VermontStrategic and Operational Plans
State Summary
Vermont Department of Human Services10/26/2010
WashingtonComing SoonWashington Health Care Authority12/10/2010
WisconsinComing SoonWisconsin Department of Health and Family Services12/10/2010

HHS awards $320 million to expand primary care workforce

HHS Secretary Kathleen Sebelius has announced $320 million in grants under the Affordable Care Act (ACA) to strengthen the health care workforce.  Of those grants, $253 million will go to improve and expand the primary care workforce under the Prevention and Public Health Fund of the Affordable Care Act.  Another $67 million in Health Profession Opportunity Grants will provide low-income individuals with education, training and supportive services that will help them prepare to enter and advance in careers in the healthcare sector.

“Chronic diseases, most of which are preventable, are one of the main reasons health care costs have soared over the past several decades,” said Secretary Sebelius.  “Investing in our primary care workforce will strengthen the role that wellness and prevention play in our health care system.  With these grants, Americans from all backgrounds will have new opportunities to enter the health care workforce.” 

Prevention and Public Health Fund Workforce Grants

The $253 million in Prevention and Public Health Fund grants are awarded under six health professions programs administered by HHS’ Health Resources and Services Administration (HRSA).  The programs are designed to build the primary care workforce and provide community-based prevention.  States will receive funding to support comprehensive workforce planning and implementation strategies that best address local current and projected workforce shortages. 

“These grants are the most comprehensive yet in addressing our nation’s shortage of key health professionals,” said Mary K. Wakefield, Ph.D., R.N., administrator of HRSA.  “They will provide much-needed support for increasing primary care capacity by expanding training programs for primary care providers, increasing access to patient care clinics, strengthening state-level workforce planning and providing training for personal home health care aides.  All are vital to our future healthcare workforce.”

Primary Care Residency Expansion (PCRE) – $167.3 million

The PCRE program funds 82 accredited primary care residency training programs to increase the number of residents trained in general pediatrics, general internal medicine, and family medicine.  Grantees will use the 5-year grant to provide stipend support for new enrollees in 3-year primary care residency training programs.  By 2015, the program will support the training of 889 new primary care residents over the number currently being trained and more than 500 of these residents will have completed their training. 

Expansion of Physician Assistant Training (EPAT) – $30.1 million

Access to primary care also improves with an expanded primary care physician assistant workforce. The EPAT program will fund 28 primary care physician assistant training programs for 5 years.  The program funds student stipends of $22,000 per student per year, for 2 years.  It is projected that more than 700 physician assistants will receive funding with more than 600 fully trained by 2015.

Advanced Nursing Education Expansion (ANEE) – $31 million

The ANEE program will provide $31 million in funds to 26 schools of nursing to increase full-time enrollment in primary care nurse practitioner (NP) and nurse midwife (NMW) programs.  It is projected that over 1,300 primary care nursing stipends will be supported through this 5-year program.  By providing a stipend of $22,000 per student per year for up to 2 years, this funding aims to reduce the financial burden of attending school full-time and to accelerate graduation rates to increase the number of advanced practice nurses. Grantees project that 600 NPs and NMWs in total will be fully trained by 2015.

Nurse Managed Health Clinics (NMHC) – $14.8 million

This program will fund 10 grantees for 3 years to operate NMHCs to provide primary care.  A NMHC is a nurse-practice arrangement, managed by advanced practice nurses, that provides primary care or wellness services to underserved or vulnerable populations and that is associated with a school, college, university or department of nursing, federally qualified health center, or independent nonprofit health or social services agency. Clinics serve as valuable clinical training sites for students in primary care, and also enhance nursing practice by increasing the number of clinical teaching sites for interdisciplinary primary and community health students. Funding will provide access to primary care for approximately 94,000 patients and training for more than 900 advanced practice nurses. 

State Health Workforce Development – $5.6 million

Twenty-six (26) states will receive funding to begin comprehensive health care workforce planning or implementation.  Planning grants (limited to one year and $150,000 plus 15 percent matching funds) assess a state’s current health workforce and include activities such as gathering and analyzing data, examining current resources, policies and practices, and identifying ways to remove barriers at state and local levels.  Implementation grants (limited to 2 years with 25 percent matching funds) allow states to convene stakeholders at the state and regional levels to develop and implement development plans that address workforce needs.  These activities are expected to result in a 10 to 25 percent increase in the primary care health workforce over a 10-year period.

Personal and Home Care Aide State Training (PHCAST) – $4.2 million

Direct care workers provide an estimated 70 to 80 percent of the paid hands-on long-term care and personal assistance to Americans who are elderly, or living with disabilities or other chronic conditions. The PHCAST program is a demonstration project that supports states in developing and evaluating a competency-based uniform curriculum to train qualified personal and home care aides.  Personal and home care aides (PHCAs) are projected to be the fourth fastest growing direct care occupation in the United States between 2008 and 2018.  The six state grantees participating in the 3-year project anticipate that they will train over 5,100 PHCAs by 2013.

Prevention and Public Health Fund workforce grant award tables by state are available at http://www.hhs.gov/news/press/2010pres/09b/state_charts.html.

Health Profession Opportunity Grants

The Health Profession Opportunity Grants, administered by the Administration for Children and Families’ Office of Family Assistance, will provide 32 grants to entities in 23 states. These grants will provide low-income individuals with successful training programs for a variety of healthcare professions, including: home care aides, certified nursing assistants, medical assistants, pharmacy technicians, emergency medical technicians, licensed vocational nurses, registered nurses, dental assistants, and health information technicians. Grantees will also provide additional supportive services such as transportation, dependent care, and temporary housing.   A broad range of entities will receive grants, including five Native American and tribal organizations as well as non-profit organization, state and local governments, and community colleges.

“The absence of qualified workers in the healthcare field threatens the quality and availability of medical care, and the economic stability and growth potential of local communities,” said David A. Hansell, acting assistant secretary for the Administration for Children and Families. “The training initiatives will provide low-income families the opportunity for economic independence and a better life for themselves and their children while helping to strengthen our health care workforce.” 

“TANF recipients and other low-income individuals want to succeed in the workplace but sometimes lack the skills to do so,” said Earl Johnson, director for the Office of Family Assistance. “The Health Profession Opportunity Grants will offer quality training and an opportunity to enter a dynamic job sector with real opportunities for career advancement.”

Health Profession Opportunity Grants award tables by state are available at http://www.hhs.gov/news/press/2010pres/09d/state_charts.html.

For more information on how the Affordable Care Act is investing in the health care workforce, go to www.HealthCare.gov.  For more information on HRSA’s health professions programs, go to bhpr.hrsa.gov. For more information on the Office of Family Assistance visit http://www.acf.hhs.gov/programs/ofa/.


ONC Publishes FAQs on Meaningful Use, EHR Certification Criteria

The Office of the National Coordinator for Health IT recently posted a set of answers to 20 frequently asked questions about its incentive program for the “meaningful use” of electronic health records, Government Health IT reports

Download all 20 Questions and Answers [PDF – 79 KB]

  1. Question [9-10-001-1]: What certification criteria will ONC-ATCBs use to certify EHR technology for purposes of the “deeming” provision of the Physician Self-Referral Prohibition and Anti-Kickback Electronic Health Record (EHR) Exception and Safe Harbor Final Rules?
  2. Question [9-10-002-1]: If my EHR technology is capable of submitting batch files to an immunization registry using the adopted standards (HL7 2.3.1 or 2.5.1 and CVX), is that sufficient for demonstrating compliance with the certification criterion specified at 45 CFR 170.302(k)?
  3. Question [9-10-003-1]: In the “Initial Set of Standards, Implementation Specifications, and Certification Criteria for Electronic Health Record Technology” Final Rule published on July 28, 2010, the Secretary adopted the following implementation specifications at 45 CFR 170.205(d)(2) for HL7 2.5.1 – Public Health Information Network HL7 Version 2.5 Message Structure Specification for National Condition Reporting Final Version 1.0 and Errata and Clarifications National Notification Message Structural Specification. We believe that these implementation specifications may have been adopted in error because they only provide direction to public health agencies on how to report to the Centers for Disease Control and Prevention (CDC). Therefore, their adoption does not appear to either provide the appropriate or requisite implementation guidance for the adopted standard, HL7 2.5.1, or more importantly, to enable the user to “electronically record, modify, retrieve, and submit syndrome-based public health surveillance information…,” as required by the adopted certification criterion, 45 CFR 170.302(l). Please clarify whether these implementation specifications are appropriate for the intended capability specified by the public health surveillance certification criterion at 45 CFR 170.302(l)?
  4. Question [9-10-004-1]: I currently use EHR version 1.3 which I purchased from EHR technology developer XYZ. EHR technology developer XYZ has informed me that it is not going to seek certification for EHR version 1.3. Can I seek certification for EHR version 1.3 or can I partner with a group of other health care providers that also use version 1.3 to split the cost of certification? Additionally, if EHR version 1.3 becomes certified can anyone else using EHR version 1.3 rely on the certification issued to EHR version 1.3?
  5. Question [9-10-005-1]: I am an EHR technology developer. I have sought and achieved certification for the Complete EHR that I sell. The Complete EHR, however, is also designed to be sold in separate components so that I can offer my customers different prices based on the capabilities they seek to implement. Is it possible for me to sell components of my certified Complete EHR separately as certified EHR Modules, or do I need to seek testing and certification for each of the separate components that I plan to sell as certified EHR Modules?
  6. Question [9-10-006-1]: I submitted a Complete EHR for certification, but it has not passed a test for one or more of the certification criteria. Can I request that the ONC-ATCB certify the EHR technology that I submitted as an EHR Module instead (i.e., certify only those capabilities that have been tested successfully)?
  7. Question [9-10-007-1]: My hospital purchased a certified EHR Module that provides approximately 75% of the capabilities we need to meet the definition of Certified EHR Technology. The other 25% are provided by our own self-developed system(s). Can we have our self-developed system tested and certified as an EHR Module and then subsequently use the combination of our self-developed certified EHR Module with the certified EHR Module we purchased to meet the definition of Certified EHR Technology? As a follow up, do we need to have the combination of the purchased certified EHR Module and our self-developed certified EHR Module tested and certified together as a Complete EHR (above and beyond the certifications they have already been issued)?
  8. Question [9-10-008-1]: If an EHR Module addresses multiple certification criteria (thus providing multiple capabilities), does it need to be tested and certified to the applicable privacy and security certification criteria as a whole or for each capability?
  9. Question [9-10-009-1]: I’m an EHR technology developer and I’ve had my Complete EHR certified. I work with business partners/distributors and permit them to sell my (unmodified) certified Complete EHR under their own brand/name/label. Is this business practice permitted? Is there anything that I should do or be aware of?
  10. Question [9-10-010-1]: My EHR technology is designed to receive demographic data from a registration system or a practice management system. The data from these other IT systems is then used by my EHR technology to demonstrate compliance with one or more certification criteria. Do these other IT systems that act as data sources to my EHR technology need to be certified?
  11. Question [9-10-011-1]: I’ve identified that I am using two different EHR technologies to meet a single certification criterion (my document management system receives and displays summary records (45 CFR 306(f)(1)) and my EHR technology from EHR technology developer XYZ transmits summary records (45 CFR 306(f)(2)). Do both EHR technologies need to be certified?
  12. Question [9-10-012-1]: How many clinical quality measures must EHR technology be capable of calculating in order to get certified?
  13. Question [9-10-013-1]: I plan on sending/transferring meaningful use quality reporting data from my EHR technology to my “data warehouse” and have the data warehouse submit/report out the data to CMS. Does my data warehouse need to be certified?
  14. Question [9-10-014-1]: I’ve selected a certified Complete EHR [or certified EHR Module] from EHR technology developer XYZ. That being said, I prefer the certified CPOE EHR Module designed by EHR technology developer ABC over the CPOE capability included in EHR technology developer XYZ’s Complete EHR. Can I use the certified CPOE EHR Module from EHR technology developer ABC instead of the CPOE capability included in EHR technology developer XYZ’s certified Complete EHR? Alternatively, can I use both of the certified CPOE capabilities included in EHR technology developer XYZ and ABC’s EHR technologies at the same time? In other words, can I use duplicative or overlapping certified capabilities of different certified EHR technologies without jeopardizing my ability to meaningfully use Certified EHR Technology?
  15. Question [9-10-015-1]: I am an EHR technology developer preparing my EHR technology for certification. I am relying on a 3rd party software program to demonstrate my compliance with a specific certification criterion. Does this 3rd party software program need to be independently certified?
  16. Question [9-10-016-1]: I’m in the process of implementing EHR technology developer XYZ’s certified Complete EHR [or certified EHR Module] “E-HealthSystem2010.”Scenario 1: I have determined that E-HealthSystem2010 needs to be reconfigured in order to connect with one of my patient registration systems. Can I reconfigure E-HealthSystem2010 without compromising the certified status of my implementation of E-HeatlhSystem2010?

    Scenario 2: EHR technology developer XYZ communicated to my organization that they relied upon a 3rd party software program “PatientInfoTracker 2.0” for the purposes of demonstrating compliance with the “generate patient lists” certification criterion specified at 45 CFR 170.302(i) in achieving E-HeatlhSystem2010’s certification. I have already implemented, use, and would like to continue using “SuperListGenerator 7.0.” I have determined that I can reconfigure SuperListGenerator 7.0 to work with E-HeatlhSystem2010. Can I use SuperListGenerator 7.0 in lieu of PatientInfoTracker 2.0 without compromising the certified status of my implementation of E-HeatlhSystem2010?

  17. Question [9-10-017-1]: Under the Medicare and Medicaid EHR Incentive Programs Final Rule, eligible health care providers are permitted to defer certain meaningful use objectives and measures and still receive an EHR incentive payment. However, it is our understanding that in order for us to have our EHR technology certified, we must implement all of the applicable capabilities specified in the adopted certification criteria regardless of whether we intend to use all of those capabilities to qualify for our EHR incentive payment. Is our understanding correct?
  18. Question [9-10-018-1]: I use or would like to use an “interface” to submit data to a public health agency/registry. Does this interface need to be certified?
  19. Question [9-10-019-1]: The “electronic copy of health information” certification criteria (45 CFR 170.304(f) and 45 CFR 170.306(d)) each require that Certified EHR Technology “enable a user to create an electronic copy of a patient’s clinical information… in: (1) Human readable format; and (2) On electronic media or through some other electronic means….” Is there more than one way to demonstrate compliance with these certification criteria?
  20. Question [9-10-020-1]: The certification criterion at 45 CFR 170.302(n) specifies that “[f]or each meaningful use objective with a percentage-based measure, electronically record the numerator and denominator and generate a report including the numerator, denominator, and resulting percentage associated with each applicable meaningful use measure.” Is it possible for the action of “record” in the certification criterion to be implemented in different ways and still remain in compliance with the certification criterion? For example, could “record” comprise the ability of a centralized analytics EHR Module to accept or retrieve raw data from another EHR Module or EHR Modules, and upon receipt of this raw data, the centralized analytics EHR Module would calculate the numerator, denominator, and the resulting percentage as specified by 45 CFR 170.302(n)?

Additional FAQs

HHS Early Retiree Reinsurance Program

Affordable Care Act Early Retiree Reinsurance Program

Rising health care costs have made it difficult for employers and unions to provide quality, affordable health coverage for workers and retirees while also remaining competitive in the global marketplace.

Last week, HHS announced that nearly 2,000 businesses, State governments and non profit organizations have been approved for the Early Retiree Reinsurance Program, which is designed specifically to help employers continue to provide health insurance coverage for early retirees.

Join our live Web Chat this upcoming Thursday September 9, at 1:10 P.M EDT at www.HealthCare.gov/live to find out more about the Program.

HHS Secretary Sebelius, Richard Popper, Deputy Director for Insurance Programs at the Office of Consumer Information and Insurance Oversight and Mary Beth Kuderik, Chief Financial Officer of the United Auto Workers Retiree Medical Benefits Trust, which is participating in the Early Retiree Reinsurance Program, will discuss and answer YOUR questions.

Send in your questions to Healthcare@hhs.gov and we’ll answer as many as possible during the Web Chat. We will also take questions live from twitter using handle @HHSGOV.

You can find previous Web Chats on www.HealthCare.gov and browse the site to find all the latest information available from HHS on the new law.

Thanks for participating!

Jenny Backus
Acting Assistant Secretary of Public Affairs
& Moderator of the HHS Weekly Web Chat

Federal Funding for State Medicaid HIT Activities

CMS Letter Outlines State Requirements for Medicaid Directors

On Tuesday, CMS issued a letter to Stated Medicaid Directors. This is an update to the State Medicaid HIT Plan (SMHP) Overview from 2009. In July, the ONC issued a PIN (Program Information Notice) to State HIEs entitled “Requirements and Recommendations for the State Health Information Exchange Cooperative Agreement Program.” It outlined responsibilities under the program, recommended roles for the HIT Coordinators, and elements of the state strategic and operational plans.

The Recovery Act provides 100 percent Federal financial participation (FFP) to States for incentive payments to eligible Medicaid providers to adopt, implement, upgrade, and meaningfully use certified EHR technology, and 90 percent FFP for State administrative expenses related to the program.

Section 4201 of the ARRA provides 90% FFP HIT Administrative match for three activities to be done under the direction of the SMA:
1. Administer the incentive payments to eligible professionals and hospitals;
2. Conduct adequate oversight of the program, including tracking meaningful use by providers; and
3. Pursue initiatives to encourage the adoption of certified EHR technology to promote health care quality and the exchange of health care information.

Enclosure A outlines CMS’ expectations and provides examples of potentially allowable activities and reasonable costs related to State administration of the program.

Enclosure B provides additional information about CMS’ initial expectations for States’ auditing and oversight of their Medicaid EHR Incentive Program.

Enclosure C outlines the CMS guiding principles for the availability of the 90 percent FFP administrative matching funds for basic administration and oversight of the Medicaid EHR Incentive Program, as well as efforts to promote its success among eligible Medicaid providers.

Enclosure D outlines the CMS process for reviewing the SMHP and associated funding request documents (HITECH and MMIS).

Initial guidance on section 4201 of the American Recovery and Reinvestment Act of 2009 (Recovery Act), Pub. L. 111-5 which establishes a program for payment to providers who adopt and become meaningful users of electronic health records was issued in September 2009.  The initial SMHP provided State Medicaid Agencies (SMAs) and CMS with a common understanding of the activities the SMA will be engaged in over the next 5 years relative to implementing Section 4201 Medicaid provisions of the American Recovery and Reinvestment Act (ARRA).

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