Meaningful Use of Electronic Health Records

An electronic medical record on a tablet

New technology can identify reportable cancer cases in health care providers’ electronic health records and report them to cancer registries automatically.

Cancer reporting from ambulatory providers to state cancer registries is a public health objective for Stages 2 and 3 Meaningful Use (MU).

Promoting Interoperability Program (Formerly 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 meaningful use (MU) of electronic health records (EHR), 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.

Through their EHR Incentive Programs, now called Promoting Interoperability Programs, CMS establishes the criteria that eligible professionals (EPs) and 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 MU criteria described by CMS. CMS released the criteria for EPs and hospitals for Stages 2 and 3 in Final Rules published in the Federal Register on September 4, 2012 and October 16, 2016, respectively. ONC released the corresponding standards for health information technology systems (including EHRs) in Final Rules published in the Federal Register on the same dates.

More information on MU and public health can be found on CDC’s Public Health Data Interoperability web site.

Cancer and Promoting Interoperability Program (Meaningful Use)

As of 2019, all EPs must use EHRs that are certified to the ONC 2015 Edition cancer reporting standards in order to use cancer reporting as one of their public health measures for incentive payments.

The CMS Stage 3 Final Rule—

  • Outlines the EP objective, measure, and exclusions for public health reporting, which includes cancer.
  • Provides specific information about cancer registry reporting as a public health registry reporting measure.
  • Summarizes public health and clinical data registry reporting objective and measures in Table 9.
  • Summarizes objectives, measures, and certification criteria for EPs in Table 13.

The CMS Stage 2 Final Rule—

The ONC 2015 Edition Final Rule—

The ONC 2014 Edition Final Rule—

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 first Implementation Guide for Healthcare Provider Reporting to Central Cancer Registries. Based on lessons learned through implementation of this standard and input from CCRs, EHR vendors, and other stakeholders, CDC updated the implementation guide to the HL7 CDA® Release 2 Implementation Guide: Reporting to Public Health Cancer Registries from Ambulatory Healthcare Providers, Release 1, DSTU Release 1.1 – US Realm. 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

Page last reviewed: December 14, 2021