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Meaningful Use of Electronic Health Records

Cancer reporting from ambulatory providers to state cancer registries is a new public health objective for Stage 2 Meaningful Use.

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 (EPs) 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 for Stage 2 Meaningful Use Final Rules released by the ONC and CMS were published in the Federal Register on September 4, 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 Stage 2 Meaningful Use Final Rule

  • Outlines the EP objective, measure, and exclusions for reporting to a state cancer registry.
  • Table B5 summarizes the Stage 2 objectives and measures.
  • Table 8 provides clinical quality measures, including several for cancer.

The ONC Stage 2 Meaningful Use Final Rule addresses the cancer registry reporting standards. ONC adopted the Implementation Guide for Ambulatory Healthcare Provider Reporting to Central Cancer Registries, August 2012 [PDF-1.9MB] to certify that EHR systems meet the criteria described in the Stage 2 Meaningful Use Final Rule.

ONC has released a new Notice of Proposed Rulemaking (NPRM) for Voluntary 2015 Edition EHR Certification Criteria. This notice of proposed rulemaking introduces the beginning of the ONC's more frequent approach to health information technology certification regulations. The 2015 Edition EHR certification criteria proposed in this rule would be voluntary. In conjunction with this new proposed rule, CDC has issued an updated implementation guide, Implementation Guide for Ambulatory Healthcare Provider Reporting to Central Cancer Registries, HL7 Clinical Document Architecture (CDA), Release 1.1, March 2014 [PDF-2.0MB], that addresses technical corrections and clarifications for interoperability with EHRs and cancer registries.

Additional documentation and clarifications can be found in Cancer Reporting Clarification Document for Electronic Health Record (EHR) Technology Certification [PDF-832KB].

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

Guidance for State Cancer Registries, EHR/EMR Vendors, and Providers

Guidance Document Name and Description Status
Identifying Critical External Partnerships Physician Reporting Planning Document [PDF-279KB]
Guidance on estimating the total number of physicians, also specifically MU eligible professionals and/or physician groups.
Identifying State EHR Vendors Physician Reporting Planning Document [PDF-162KB]
Guidance on how states can identify EHR vendors, Health Information Exchanges (HIEs), Regional Extension Centers (RECs)/Regional Assistance Centers (RACs), including, but not limited to, surveys, trade Web sites/magazines, and associations.
Promotion of Physician Reporting
Guidance on how states can generate interest from providers, including, but not limited to, brochures and webinar slides.
In progress
Counting Physicians by Specialty [PDF-391KB]
Guidance on tracking the total number of physicians reporting for MU and non-MU-related cancer reporting.
Performance Measures for Physician Reporting
Guidance on performance measures for physician reporting (such as cost/benefit, backlog, new cases, and communication with state Medicaid program).
In progress
Ongoing Submission
Guidance on defining "successful ongoing submission" for MU.
In progress
On-Boarding New Providers
Guidance for state registry process for on-boarding new providers, including standards for communicating results back to senders (such as test plans, measure success, and plans for adding new providers). On-boarding includes initial contact between the provider and the state registry, testing of data exchange, transport testing, content validation, and initiation of routine reporting.
To do
Transport Options [PDF-309KB]
Describes the different transport options and suggests recommendations that states should consider.
Guidance for Implementing Public Health Agency/State Cancer Registry MU [PDF-432KB]
Checklist that identifies high-level items that states need to address for MU; defines what is included in a state action plan.
Provider Site Responsibilities and Contact Information [PDF-305KB]
Template of contact information that each state should collect from each provider.
MU Fact Sheet
Template for state fact sheets on MU.
In progress
Declaration of Readiness
Guidance for public health agencies/state cancer registries that intend to receive data from EPs enrolled in the MU program.
To do
Central Cancer Registry Process Physician Event Reporting Use Case
Describes the workflow and steps needed for receiving and processing the HL7 Clinical Document Architecture (CDA) physician cancer reports.
In progress
Electronic Mapping, Reporting and Coding (eMaRC) Plus User Guide
In progress
Vendor Guidance
Guidance document to EHR vendors that will direct them to the person who can answer questions about different issues. It will include items that may vary based on state implementations, such as information about who the vendor should work with (registry and/or RECs) and batch versus single submissions.
To do
Cancer Standards and On-Boarding Activities
Guidance document for HIEs/RECs that will provide important information about the cancer standard and on-boarding activities required for state cancer registries.
To do
MU Quality Assurance Testing Guide [PDF-632KB]
Guidance document for states to outline the quality assurance testing process for providers' education.
Provider Checklist for Achieving MU for Cancer Reporting [PDF-321KB]
Provider checklist for achieving MU for cancer reporting within your state, reviewing eligibility, testing, validating, confirmation, and going live.
Registration of Intent
Guidance for eligible professionals on registration of intent for providers who intend to meet MU stage 2.
To do
Guidance on official communication sent from public health and/or state cancer registries to EPs that affirm a provider has submitted public health data for MU successfully.
To do
On-Boarding Fact Sheet
Fact sheet for on-boarding, referring to the testing and validation process.
To do
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