Meaningful Use

Welcome to the Missouri Department of Health and Senior Services (DHSS) Meaningful Use (MU) web page. Our goal is to provide general information about Meaningful Use; share helpful resources that include frequently asked questions (FAQs) with responses, and provide instructions on submitting electronic data from certified EHRs to the department. Check back frequently to view updates and new information as it becomes available.

What is "Meaningful Use"?

The American Recovery and Reinvestment Act of 2009 established a program for payment to providers who adopt and become meaningful users of electronic health records (EHRs). The Act specifies three main components of Meaningful Use:

  1. The use of a certified EHR in a meaningful manner, such as e-prescribing.
  2. The use of certified EHR technology for electronic exchange of health information to improve quality of health care.
  3. The use of certified EHR technology to submit clinical quality and other measures.

Simply put, "meaningful use" means providers need to show they're using certified EHR technology in ways that can be measured significantly in quality and in quantity.

Who is eligible for incentive payments?

The Medicare and Medicaid EHR Incentive Programs will provide incentive payments to eligible professionals (EPs), eligible hospitals (EHs) and critical access hospitals (CAHs) as they adopt, implement, upgrade or demonstrate meaningful use of certified EHR technology. See definitions for EPs, EHs, and CAHs.

The Centers for Medicare and Medicaid Services (CMS) believes the “meaningful use” of certified EHR technology will assist providers to achieve health and efficiency goals. By putting into action and meaningfully using an EHR system, providers will reap benefits beyond financial incentives–such as reduction in errors, availability of records and data, reminders and alerts, clinical decision support, and e-prescribing/refill automation.”

Why are the use of Electronic Health Records (EHRs) Important?

According to CMS, EHRs do not achieve their potential benefits merely by transferring information from paper form into digital form. EHRs can only deliver their benefits when the information and the EHR are standardized and “structured” in uniform ways, just as ATMs depend on uniformly structured data. Therefore, the “meaningful use” approach required identification of standards for EHR systems.

Similarly, EHRs cannot achieve their full potential if providers do not use the functions that deliver the most benefit – for example, exchanging information, and entering orders through the computer so that the “decision support” functions and other automated processes are activated. Therefore, the “meaningful use” approach requires that providers meet specified objectives in the use of EHRs, in order to qualify for the incentive payments.

What are the Criteria for Meaningful Use?

The criteria for meaningful use eligible providers must comply with to receive incentive payments will be staged in three steps over the course of the next five years.

The Stage 1 meaningful use criterion includes 15 “core” objectives for eligible professionals and 14 for hospitals. Eligible professionals and hospitals in the final rule both have 10 objectives in a “menu set” from which they select and comply with five. Included in the “menu sets” are objectives related to public health. Objectives Number 9 and 10 for EPs and Numbers 8, 9, and 10 for EHs.

What role does DHSS play?

The 10 objectives in the ”menu set” for each group includes objectives for the submission of electronic data from the certified EHRs to public health agencies.  To accomplish this DHSS must work with each provider to confirm DHSS is able to receive their submission of electronic data and that their data submissions meet the national standards. Once this is confirmed, ongoing data submissions can be implemented.  Any changes to the provider’s electronic file requires DHSS to review the file to assure the changes have not impacted the quality of the data.  You may contact the department at (573) 751-6080 or submit questions about electronic data submissions to MoPHIE@health.mo.gov.

What three types of data are identified in the public health related menu set objectives?

The following three types of data are identified.  Included in the information provided about each are links to the data guides for transmitting electronic data. 

Immunizations

Meaningful use includes the opportunity for EPs, EHs and CAHs to submit immunization information to state registries as one option to meet objectives for the use of EHRs, in order to qualify for the incentive payments.  This includes Missouri’s ShowMeVax, a computerized registry of immunization records.  Using ShowMeVax, participating providers can access confidential records for a single client using a secure connection.  ShowMeVax provides information about vaccinations documented or administered by other participating providers.  The system also allows the provider to update the client’s immunizations record when vaccines are administered. 

Compliance with MU is expected to increase the number of facilities that provide updated electronic vaccine information to ShowMeVax.  This will help build a more complete registry, providing a more effective resource for vaccine providers; as well as providing data for DHSS to help manage vaccine preventable illnesses.

For more information about ShowMeVax, contact:

Bureau of Immunization Assessment and Assurance
Missouri Department of Health and Senior Services
PO Box 570
Jefferson City, MO 65102-0570
Phone: 877-813-0933
Fax: 573-526-0238
Email: ShowMeVaxSupport@health.mo.gov
Access Messaging Guides for submitting electronic Immunization data.

Syndromic Surveillance

Submission of syndromic surveillance from hospitals, urgent care and ambulatory care clinics is an important tool used by public health for early event detection and monitoring of health trends of the community. It uses pre-diagnostic information such as “chief complaints” from people seeking acute care to identify patterns of illness. In Missouri, syndromic surveillance is used to monitor seasonal trends such as influenza-like illness along with a broad spectrum of other syndromes to help identify possible outbreaks and other issues of public health concern in the community.

DHSS currently receives data from 90 facilities under the Hospital Electronic Syndromic Surveillance (HESS) Reporting Rule (19 CSR 10-33.040) specifically for syndromic surveillance. Seventy of these facilities are reporting to DHSS in HL7 format. HESS data are processed using the Electronic Surveillance System for the Early Notification of Community-based Epidemics (ESSENCE), which is web-based software specifically designed for syndromic surveillance. ESSENCE groups chief complaints from electronic ED data into ‘syndrome’ categories.  This information is used to determine if the number of visits is greater than expected for that facility based on historical data and statistical analyses to conduct early event detection.  Syndrome groups used are: botulism-like, fever, gastrointestinal, hemorrhagic illness, neurological, rash, respiratory, and shock/coma.

Hospitals, ambulatory care and urgent care clinics that do not currently report HESS data who wish to participate should review the current HL7 specifications for versions HL7 2.3.1 and 2.5.1 to determine if they are interested in pursuing syndromic surveillance as a public health-related objective for MU for Stage 1 and Stage 2. DHSS is not currently accepting eligible professional submissions for syndromic surveillance from specialists including ophthalmologists, chiropractors, podiatrists and oncology clinics. 

For more information on ESSENCE and how the data are used by hospitals and public health authorities on a daily basis, visit ESSENCE's web site or contact::

Missouri ESSENCE Program
Phone:  573-751-6407
Fax:  573-526-0235
Email:  ESSENCE@health.mo.gov  

Reportable Lab Results

Laboratory results for infectious as well as environmental diseases/conditions are reportable in DHSS and/or local public health agencies.  DHSS currently receives these data in many formats (mail, fax, phone, HL7 message, etc.)  As technology and public health move forward, and with the advent of meaningful use, DHSS reporters have the opportunity to meet meaningful use requirements by beginning the process of submitting their laboratory results electronically through HL7 messaging. 

Questions about reportable lab results may be directed to:

Bureau of Communicable Disease Control and Prevention (CDCP)
Phone: 573-751-6268
Email:  MoPHIE@health.mo.gov

DHSS is utilizing the PHIN Implementation Guide for Transmission of Laboratory-Based Reporting of Public Health Information, Version 2.3.1 of the Health Level Seven (HL7) Standard Protocol as the guidance for development of implementation and message validation for laboratory results. For purposes of meaningful use our guidance comes from the “HL7 Version 2.5.1 Implementation Guide: Electronic Laboratory Reporting to Public Health”.  The following CDC link provides information on availability of the guidance, http://www.cdc.gov/osels/phitpo/mu/elr.html. To download the guidance document requires an HL7 Organization membership or it may be purchased through the HL7 store.

The Missouri State Public Health Laboratory (SPHL) is developing the capability of receiving electronic test orders and sending electronic result reports to submitters that have a certified EHR and the technical infrastructure for HL7 messaging.  Implementation of this capability will 1) reduce the result reporting time for the submitter due to the results being sent electronically and imported into the submitters EHR 2) decrease the possibility of error due the elimination of duplicate entry in multiple systems, for both the submitter and the SPHL 3) allow the SPHL to electronically transfer results for the reportable diseases to the DHSS.

For more information on electronic lab submission, contact:

Missouri State Public Health Laboratory
Phone: 573-751-3334
Email:  MoPHIE@health.mo.gov