Meaningful Use of Electronic Health Records

The Centers for Medicare & Medicaid Services proposes cancer reporting to state cancer registries as a new public health objective for Stage 2 of the criteria for meaningful use of electronic health records.

Meaningful Use Overview

The American Recovery and Reinvestment Act, enacted in February 2009, includes many measures to modernize our nation's infrastructure, one of which is the Health Information Technology for Economic and Clinical Health (HITECH) Act. The HITECH Act supports the concept of electronic health records-meaningful use (EHR-MU), an effort led by the Centers for Medicare & Medicaid Services (CMS) and the Office of the National Coordinator for Health IT (ONC). HITECH proposes the meaningful use of interoperable electronic health records throughout the United States' health care delivery system as a critical national goal.

CMS establishes the criteria that eligible professionals (EP) and hospitals as well as critical access hospitals must meet to qualify for Medicare and/or Medicaid electronic health record (EHR) incentive payments as they adopt, implement, upgrade, or demonstrate meaningful use of certified EHR technology. ONC establishes the standards, implementation specifications, and certification criteria for EHR technology that will support implementation of the Stage 2 criteria described by CMS. The criteria and standards are published in the Federal Register as notices of proposed rulemaking (NPRM) by the respective agencies and are open for public comment. Both the CMS NPRM and the ONC NPRM for Stage 2 of Meaningful Use were published in the Federal Register on March 7, 2012.

More information on meaningful use and public health can be found on CDC's Meaningful Use Web site.

Cancer and Meaningful Use

The CMS NPRM

• Outlines the proposed EP objective, measure, and exclusions for reporting to a state cancer registry.
• Table 4 summarizes the Stage 2 objectives and measures.
• Table 6 provides clinical quality measures, including several for cancer.

The ONC NPRM

• Addresses the cancer registry reporting standards.
• Provides a reference and link to the Implementation Guide for Healthcare Provider Reporting to Central Cancer Registries, Draft, February 2012 [PDF-626KB] on CDC's Meaningful Use Web site. ONC proposes to adopt this guide to certify that EHR systems meet the criteria described in the NPRM.

Cancer Reporting

Population-based cancer surveillance is critical for cancer control activities aimed at reducing cancer morbidity and mortality, the second leading cause of death in the United States and the leading cause of death in Canada. Population-based public health central cancer registries (CCRs) across the U.S. and most of Canada are mandated to collect complete and timely cancer diagnostic, treatment, and outcome data from hospitals, physician offices, treatment centers, clinics, laboratories, and other sources. Recent shifts from hospital settings toward ambulatory health care settings for cancer treatment are increasing the importance of non-hospital health care providers' data for cancer surveillance. As health care providers adopt modern EHR systems, the opportunity to automate cancer registry reporting from health care provider settings also is increasing and becoming more feasible. Certified EHR technology can improve the process by identifying reportable cancer cases and treatments to the provider and facilitating electronic reporting either automatically or upon provider verification.

Through a collaborative effort with the North American Association of Central Cancer Registries, state CCRs, Integrating the Healthcare Enterprise, and other organizations, CDC developed the Implementation Guide for Healthcare Provider Reporting to Central Cancer Registries. This document contains the necessary specifications for the implementation of standardized data transmissions from a health care provider EHR to the CCR. A single method will allow efficient and accurate transmission of cancer information while reducing the burden on EHR system-specific or registry-specific implementations.

The Implementation Guide provides the business rules and specifications for EHR systems to—

• Identify reportable cancer cases.
• Identify the specific data elements to be retrieved and included in the cancer event report.
• Create a valid Health Level 7 Clinical Document Architecture, Release 2 (HL7 CDA R2) cancer event report.
• Transmit the cancer event report to a CCR over a secure electronic transmission mechanism.

Any questions about cancer reporting and the implementation guide can be directed to cancerinfo@cdc.gov.