Stage 2 Meaningful use has added two new measures for EPs related to public health registries. The first relates to submission of cancer diagnoses to public health maintained central cancer registries which is mandatory in most states. The second relates to submission of data to other, unspecified specialized public health registries maintained by public health agencies or national specialty societies (specialized registries operated by patient safety organizations and quality improvement organizations also qualify).
The Medicare and Medicaid Programs Electronic Health Record Incentive Program Stage 2 Final Rule (August, 2012), contains the following objective and measure relative to cancer registries in its Stage 2 (beginning in 2014) criteria for Meaningful Use:
EP Objective: Capability to identify and report cancer cases to a state cancer registry, except where prohibited, and in accordance with applicable law and practice.
EP Measure: Successful ongoing submission of cancer case information from CEHRT to a cancer registry for the entire EHR reporting period.
For other public health registries the final rule contains the following objective and measure:
EP Objective: Capability to identify and report specific cases to a specialized registry (other than a cancer registry), except where prohibited, and in accordance with applicable law and practice.
EP Measure: Successful ongoing submission of specific case information from CEHRT to a specialized registry for the entire EHR reporting period.
These items are included in a "menu set" of objectives from which providers can choose for achieving meaningful use.
An EP can be excluded from these measures if it does not treat patients relevant to the disease captured in the registry, if the public health agency cannot accept data in the specified standard and no other entity has been designated to do so on its behalf (like an HIE), if the public health agency does not indicate its capability to collect data, or if the public health agency is not capable of enrolling the EP in a timely way.
Though the Proposed Rule recognizes that the infrastructure to support HIEs is still developing, there is an expectation that as the program proceeds expectations for submission of syndromic surveillance information to public health agencies via HIE will increase.
The Final Rule for Health Information Technology: Standards, Implementation Specifications, and Certification Criteria for Electronic Health Record Technology, 2014 Edition; Revisions to the Permanent Certification Program for Health Information Technology (August, 2012) identifies the following standards for cancer data exchange:
§ 170.205 Content exchange standards and implementation specifications for exchanging electronic health information
(i):Cancer information. Standard. HL7 Clinical Document Architecture (CDA), Release 2.0, Normative Edition (incorporated by reference in § 170.299). Implementation specifications. Implementation Guide for Ambulatory Healthcare Provider Reporting to Central Cancer Page 440 of 474 Registries, HL7 Clinical Document Architecture (CDA), (incorporated by reference in § 170.299).
Testing procedures are not yet available.