Medicare and Medicaid Electronic Health Records Incentives Program

Through the American Recovery and Reinvestment Act of 2009 (Recovery Act), the Centers for Medicare and Medicaid Services (CMS) is authorized to make incentive payments to Eligible Professionals (EPs) and Eligible Hospitals (EHs) demonstrating meaningful use of certified Medicare and Medicaid Electronic Health Records (EHR) technology.

The three main components of Meaningful Use include:

  1. The use of a certified EHR in a meaningful manner.
  2. The use of certified EHR technology for electronic exchange of health information to improve the quality and coordination of health and 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 are using certified EHR technology in specific ways that can be measured significantly in quality and in quantity. The Missouri Department of Health and Senior Services (DHSS) is the state Public Health Authority (PHA) and accepts messages from EPs and EHs for the public health measures of Meaningful Use.


Declaration of Readiness

DHSS is ready to accept messages for the following measures:

  • Immunization Registry Reporting: Uni-directional only (messages to DHSS)

    • Uni-directional reporting satisfies Stage 2 requirements.
  • Syndromic Surveillance

  • Electronic Laboratory Reporting (ELR)

  • Cancer Registry Reporting (Public Health Registry/Specialized Registry)

DHSS is not ready to accept messages for the following measures:

  • Stage 3 Bi-directional Immunization Registry Reporting: See below for more information.

  • Electronic Initial Case Reporting (eICR)


Beginning the Data Submission Process

Step 1: Registration | Step 2: Read Resources | Step 3: Onboarding

In order to register your intent for Meaningful Use data submission, complete the registration process below. After completing the registration of intent, DHSS will invite you to begin the onboarding process.

Registration of Intent - Get Started button

Registry Resources
  • ShowMeVax registry available since June 2011
  • Available for EPs and EHs that administer immunizations
Electronic Laboratory Reporting (ELR)
  • Available for EHs
Syndromic Surveillance
  • Available for EHs and EPs that practice at urgent care clinics
Cancer Registry (Public Health/Specialized Registry)
  • Under development
  • Available for EPs that directly treat cancer cases

How do I meet the active engagement requirement?

In order to receive incentive payments, EPs and EHs must achieve active engagement with DHSS for each public health registry for which they are eligible to report. You can meet the requirement by meeting one of the following criteria:

  • The provider has completed the registration of intent and is awaiting invitation to begin testing and validation from DHSS.
  • The provider has completed the registration of intent and is engaged in the testing and validation process, but has not yet reached production.
  • The provider has completed the registration of intent and has reached production within their reporting period or within a prior reporting period.


If an EP or EH does not qualify to report for a measure, they are eligible for an exclusion for that measure. Exclusion documents are available for the following measures:

  • Immunizations:
    • For EPs or EHs that do not administer immunizations
    • For EPs or EHs that plan to attest for Stage 3, see below for more information.
  • Syndromic Surveillance: For EHs that do not have an emergency room or EPs that do not practice at an urgent care clinic
  • Cancer Registry Reporting: For EPs that do not directly treat cancer cases

EPs or EHs may be eligible for multiple exclusions based on the nature of their practice. To obtain exclusion documents, contact the Meaningful Use Coordinator at (573) 751-6127 or

Stage 3 Immunziation Registry Reporting

DHSS has not yet declared readiness for HL7 2.5.1 bi-directional immunization reporting, therefore any EP or EH that plans to attest for Meaningful Use Stage 3 is eligible for an exclusion for the measure. DHSS will update the declaration of readiness section above 6 months before the readiness date.

What role does DHSS play?

To accomplish the goals of Meaningful Use, DHSS works with each provider to confirm their submission of electronic data and that their data submissions meet the state or national standards. Any changes to the provider’s electronic messages require DHSS to review to assure the changes have not impacted the quality of the data.


For questions related to the public health measures, contact the DHSS Meaningful Use Coordinator at (573) 751-6127 or