Stage 1 Menu Set Objective for Eligible Providers (EPs), Eligible Hospitals or Critical Access Hospitals (CAHs) to Submit Syndromic Surveillance Data

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Meaningful Use Requirements - Objectives and Measures

Eligible providers may choose at least one of two public health objectives and measures from a menu set to meet the meaningful use requirements in Stage 1. These objectives include submitting electronic immunization information to immunization registries or immunization information systems, and/or submitting electronic syndromic surveillance data to public health agencies.  Eligible hospitals must also choose at least one public health objective from the menu set which includes the two objectives previously listed and/or submitting electronic laboratory results to public health agencies. See eHealth in Public Health for more information about meaningful use.

In order to fulfill the public health objective of capability to submit electronic syndromic surveillance data to a public health agency, hospitals must comply with two federal regulations:

I. CMS Final Rules EHR Incentive Program Section 495.6(e)(10), Paragraph Citation 75 FR 44568 and 495.6(g)(10), Paragraph Citation 75 FR Page 44570 (Also see CMS Final Rules for the EHR Incentive Program).

Objective: Capability to submit electronic syndromic surveillance data to public health agencies and actual submission according to applicable law and practice.

Measure: Performed at least one test of certified EHR technology's capacity to provide electronic syndromic surveillance data to public health agencies and follow-up submission if the test is successful (unless none of the public health agencies to which an EP [eligible hospital or CAH] submits such information has the capacity to receive the information electronically).

Exclusion for Eligible Providers: Exclusion in accordance with paragraph (a)(2) of this section. An EP who does not collect any reportable syndromic information on their patients during the EHR reporting period or does not submit such information to any public health agency that has the capacity to receive the information electronically.

Exclusion for Eligible Hospitals and CAHs: Exclusion in accordance with paragraph (a)(2) of this section. No public health agency to which the eligible hospital or CAH submits information has the capacity to receive the information electronically.

II. ONC Final Rules Health Information Technology Standards, Implementation Specifications, and Certification Criteria for Electronic Health Record Technology (75 FR 44590)

The Electronic Health Record (EHR) System or module submitting the syndromic surveillance data must be certified using the following criteria and standards:

                Summary of Syndromic Surveillance Standards, Implementation Specifications and Certification Criteria

Frequently Asked Questions Regarding Syndromic Surveillance:

What if I do not collect syndromic surveillance data?

As an eligible provider, you may be eligible for an exclusion from this objective and measure.  Please see CMS Final Rules below:

“If an EP does not collect any reportable syndromic information on their patients during the EHR reporting period, then they are excluded from this measure according to the discussion of whether certain EP, eligible hospital or CAH can meet all Stage 1 meaningful use objectives given established scopes of practices.” (75 FR Page 44368)

Also see:

“Exclusion in accordance with paragraph (a)(2) of this section. An EP who does not collect any reportable syndromic information on their patients during the EHR reporting period or does not submit such information to any public health agency that has the capacity to receive the information electronically.” (Section 495.6(e)(10)(iii), 75 FR Page 44568)

What types of syndromic surveillance data do I retrieve, record and submit?

CMS and ONC Final Rules do not elaborate on the type of “syndrome-based public health surveillance information” to be retrieved, modified, recorded or submitted.  However, CMS Final Rules state: “This test must include the transfer of either actual or ‘dummy’ data to the chosen public health agency.” (75 FR Page 44368)

Please also see "Additional Resources for Syndromic Surveillance" below for recommendations on syndromic surveillance reporting from the International Society for Syndromic Surveillance (ISDS) and CDC.

When can I submit the syndromic surveillance data to the public health agency?

CMS Final Rules state: “The testing could occur prior to the beginning of the EHR reporting period, but must occur prior to the end of the EHR reporting period. If the test is successful, then the EP, eligible hospital, or CAH should institute regular reporting to that entity according to applicable law and practice.” (75 FR Page 44368)

The CMS website lists Meaningful Use reporting timelines and other important dates.

For Medi-Cal, see the Department of Health Care Services (DHCS) website.

Where do I submit the syndromic surveillance data?

CMS Final Rules state: “EPs, eligible hospitals, and CAHs should attempt to identify one public health agency with whom to conduct a test of the submission of electronic data.” (75 FR Page 44368)   The California Department of Public Health (CDPH) recommends that eligible providers, eligible hospitals, and CAHs submit their syndromic surveillance data to their local health departments (LHDs).  Please see this list (PDF) and this map of LHDs that can or cannot currently accept syndromic surveillance data.

Can I submit the data to another public health agency that is able to accept my data?

No - CMS Final Rules state for the syndromic surveillance measure: “Perform at least one test of certified EHR technology's capacity to provide electronic syndromic surveillance data to public health agencies and follow-up submission if the test is successful (unless none of the public health agencies to which an EP [eligible hospital or CAH] submits such information has the capacity to receive the information electronically).  Therefore, we recommend that EPs, eligible hospitals, and CAHs submit their syndromic surveillance data only to their LHDs as successful testing will require each entity to continue submitting data.  The designated LHD will be the best agency to utilize the syndromic surveillance data. 

What should I do if the public health agency is not able to receive my data?

ONC Final Rules state: “We recognize that some public health agencies do not yet have the capability of electronically receiving information. We do not believe that this should serve as a limiting factor, however, or preclude Certified EHR Technology from having the capability to transmit information in a standard format.” (75 FR Page 44616)

In addition, CMS Final Rules state:  “We agree that many areas of the country currently lack the infrastructure to support the electronic exchange of information. As meaningful use seeks to ensure certified EHR technology has the capability to submit electronic data to public health agencies, we only require a single test if a receiving entity is available and follow up submission only if that test is successful.” (75 FR Page 44360)

Your eligible hospital and CAH may be eligible for an exclusion from this objective and measure.  Please see CMS Final Rules below:

Exclusion for Eligible Hospitals and CAHs: Exclusion in accordance with paragraph (a)(2) of this section. No public health agency to which the eligible hospital or CAH submits information has the capacity to receive the information electronically. (Section 495.6(g)(10)(iii), 75 FR Page 44568)

What if my submission failed?

CMS Final Rules state: “A failed attempt would meet the measure. We highly encourage EPs, eligible hospitals, and CAHs to work with their vendor and the receiving entity with whom they tested to identify the source of the failure and develop remedies, but for Stage 1 of meaningful use a failed attempt would meet the requirements.” (75 FR Page 44368)

When do I attest to Meaningful Use?

Start and end dates to attest for the EHR Incentive Program are different for Medicare versus Medi-Cal programs and hospitals versus providers.  Please see important dates listed by CMS below:

• April 18, 2011 – Attestation for the Medicare EHR Incentive Program begins. 
• November 30, 2011 – Last day for eligible hospitals and critical access hospitals to register and attest to receive an Incentive Payment for Federal fiscal year (FY) 2011.
• February 29, 2012 – Last day for eligible professionals to register and attest to receive an Incentive Payment for calendar year (CY) 2011.

The CMS website lists Meaningful Use reporting timelines and other important dates.

For Medi-Cal, see the DHCS website.

How do I attest for meeting Meaningful Use?

CMS and Med-iCal will accept a yes/no attestation to verify that eligible providers, eligible hospitals or CAHs have fulfilled the objective and measure of submitting electronic syndromic surveillance data in the first year reporting period.  For auditing purposes, CMS also states that “all providers attesting to receive an EHR incentive payment for either Medicare or Medicaid EHR Incentive Programs should retain ALL relevant supporting documentation (in either paper or electronic format used in the completion of the Attestation Module responses).  Documentation to support the attestation should be retained for six years post-attestation. Documentation to support payment calculations (such as cost report data) should continue to follow the current documentation retention processes.”

For eligible providers, eligible hospitals or CAHs in jurisdictions where the LHD can accept messages, please contact the LHD for proper documentation.

For eligible providers, eligible hospitals or CAHs in jurisdictions where the LHD cannot accept messages, CDPH recommends printing the California Public Health Capacity to Receive Electronic Syndromic Surveillance Data (PDF) document. This list will be continually updated as LHDs acquire the capability to accept messages. The list may serve as supporting documentation that the LHD in your jurisdiction could not accept messages at the time your syndromic surveillance message was sent.

Medicare Hospitals and CAHs

• Visit the CMS website for more information on attestation.
• CMS has prepared a Meaningful Use Attestation Calculator to assist you prior to submitting your attestation to see if you would be able to meet all of the necessary measures to successfully demonstrate meaningful use and qualify for an EHR incentive payment.
• Also, review the CMS Attestation User Guide (PDF, 6.4 MB)for hospitals and CAHs to provide step-by-step instructions for login and completing attestation. For the public health objectives, see pages 19 to 23 of the user guide.
  

Medi-Cal Hospitals and Critical Access Hospitals

• Visit the DHCS website for more information on attestation.
• DHCS has also prepared an Attestation Workbook (Excel)to assist you in preparing for attestation. 

Where do I send my attestation to?

Medicare providers and hospitals must demonstrate Meaningful Use through the CMS web-based Registration and Attestation System.

Medi-Cal providers and hospitals, please submit your attestation to the Department of Health Care Services.

Additional Resources for Syndromic Surveillance:

• The Centers for Disease Control and Prevention (CDC) has released the PHIN HL7 v. 2.5.1 Messaging Guide for Syndromic Surveillance.
• The International Society for Syndromic Surveillance (ISDS) in conjunction with CDC has provided recommendations for syndromic surveillance reporting from hospital emergency rooms and urgent care clinics to public health.

Additional Resources and FAQs Regarding Meaningful Use:

• Office of the National Coordinator for Health Information Technology (ONC): ONC is at the forefront of the administration’s health IT efforts and is a resource to the entire health system to support the adoption of health information technology and the promotion of nationwide health information exchange to improve health care.

ONC Regulations Frequently Asked Questions

• Centers for Medicare and Medicaid Services (CMS): The CMS has oversees the Medicare and Medicaid EHR Incentive Programs which provide a financial incentive for the "meaningful use" of certified EHR technology to achieve health and efficiency goals.

CMS Frequently Asked Questions

• The Centers for Disease Control and Prevention (CDC): The CDC is engaged in EHR policy decisions to improve care for individuals and provide leadership to leverage Meaningful Use for public health. Currently, we are collaborating with and providing input to ONC and CMS for consideration of public health priorities within Meaningful Use now and in the future. CDC incorporates partner feedback in our input through our engagement with national public health organizations (e.g., ASTHO, NACCHO, APHL, etc.). In an effort to educate stakeholders, CDC is also working to provide consolidated information to its programs and partners as well as through forums to the general public.

CDC Meaningful Use Website

CDC Meaningful Use Frequently Asked Questions

• Association of State and Territorial Health Officials (ASTHO): ASTHO is a national nonprofit organization representing the public health agencies of the United States, the U.S. Territories, and the District of Columbia, as well as the 120,000 public health professionals these agencies employ. ASTHO members, the chief health officials of these jurisdictions, are dedicated to formulating and influencing sound public health policy and to assuring excellence in state-based public health practice.

ASTHO Frequently Asked Questions About Meaningful Use

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