Barbara Klepfer, MSN, RN-BC
Anne Mamiya, MT(ASCP)
Lisa Votti, MSN, RN-BC
Austin, TX
November 21, 2014
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Objectives
 Review requirements of the 3 stages of
the American Recovery and Reinvestment
Act (ARRA).
 Identify at least 4 innovations related to
ARRA which must occur to achieve
meaningful use (MU).
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Overview
American Recovery and Reinvestment Act (ARRA) of 2009
 United States Department of Health and
Human Services (HHS) implements and
manages ARRA programs
 Healthcare Information Technology (HIT)
infrastructure being built
 Centers for Medicare & Medicaid Services
(CMS) provides reimbursement incentives to
those successful in achieving Meaningful
Use (MU)
http://www.hhs.gov/recovery/
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Purpose of ARRA
 Preserve/create jobs; promote economic
recovery
 Assist those most impacted by recession
 Provide investments needed to increase
technological advances in science and
health
 Invest in long-term economic profits
 Stabilize state and local government
budgets
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Table of Contents for ARRA
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DIVISION A—APPROPRIATIONS PROVISIONS
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TITLE I—AGRICULTURE, RURAL DEVELOPMENT, FOOD AND DRUG ADMINISTRATION,AND RELATED
AGENCIES
TITLE II—COMMERCE, JUSTICE, SCIENCE, AND RELATED AGENCIES
TITLE III—DEPARTMENT OF DEFENSE
TITLE IV—ENERGY AND WATER DEVELOPMENT
TITLE V—FINANCIAL SERVICES AND GENERAL GOVERNMENT
TITLE VI—DEPARTMENT OF HOMELAND SECURITY
TITLE VII—INTERIOR, ENVIRONMENT, AND RELATED AGENCIES
TITLE VIII—DEPARTMENTS OF LABOR, HEALTH AND HUMAN SERVICES,AND EDUCATION, AND RELATED
AGENCIES
TITLE IX—LEGISLATIVE BRANCH
TITLE X—MILITARY CONSTRUCTION AND VETERANS AFFAIRS AND RELATED AGENCIES
TITLE XI—STATE, FOREIGN OPERATIONS, AND RELATED PROGRAMS
TITLE XII—TRANSPORTATION, HOUSING AND URBAN DEVELOPMENT, AND RELATED AGENCIES
TITLE XIII—HEALTH INFORMATION TECHNOLOGY
TITLE XIV—STATE FISCAL STABILIZATION FUND
TITLE XV—ACCOUNTABILITY AND TRANSPARENCY
TITLE XVI—GENERAL PROVISIONS—THIS ACT
DIVISION B—TAX, UNEMPLOYMENT, HEALTH, STATE FISCAL RELIEF, AND OTHER PROVISIONS
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TITLE I—TAX PROVISIONS
TITLE II—ASSISTANCE FOR UNEMPLOYED WORKERS AND STRUGGLING FAMILIES
TITLE III—PREMIUM ASSISTANCE FOR COBRA BENEFITS
TITLE IV—MEDICARE AND MEDICAID HEALTH INFORMATION TECHNOLOGY; MISCELLANEOUS MEDICARE
PROVISIONS
TITLE V—STATE FISCAL RELIEF
TITLE VI—BROADBAND TECHNOLOGY OPPORTUNITIES PROGRAM
TITLE VII—LIMITS ON EXECUTIVE COMPENSATION
http://www.gpo.gov/fdsys/pkg/BILLS-111hr1enr/pdf/BILLS-111hr1enr.pdf
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HITECH Act
 A part of the ARRA legislation
 Health Information Technology for Economic and
Clinical Health (HITECH)
 HITECH allocates $19 billion to hospitals and
physicians who demonstrate “meaningful use” of
electronic medical records
 HHS regulates and guides development of
interoperable, private and secure nationwide
health information technology infrastructures
http://www.cms.gov/Regulations-and-Guidance/Legislation/EHRIncentivePrograms/Basics.html
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HITECH – 3 Areas of Focus
 EHR Final Rule Incentives for MU
 Provides guidelines for EHR adoption
 Provides guidelines on qualifying for incentives
 Standards & Certification Criteria
 Identifies certification process of EHRs
 Privacy & Security
 Increase privacy during health information
exchange
 Guidelines for encryption & destruction of health
information
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Why is This Important?
 Utilization of EHRs for meaningful use to
achieve 5 health care goals:
 Improve quality, safety, and efficiency of care
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while reducing disparities
Engage patients and families in their care
Promote public and population health &
improve outcomes
Improve care coordination
Promote the privacy and security of EHRs
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Definition of Meaningful Use
Meaningful Use is defined by the use of certified
EHR technology in a meaningful manner (for
example electronic prescribing); ensuring that the
certified EHR technology is connected in a manner
that provides for the electronic exchange of health
information to improve the quality of care; and that
in using certified EHR technology the provider must
submit to the Secretary of Health & Human
Services (HHS) information on quality of care and
other measures.
http://www.cms.gov/Regulations-and-Guidance/Legislation/EHRIncentivePrograms/Meaningful_Use.html
http://www.nejm.org/doi/full/10.1056/NEJMp0912825
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Stages of Meaningful Use
Stage
1
Stage
2
Stage
3
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• 5 Domains:
• D1: Improve Quality, Safety, Efficiency
• D2: Engage Patients and Families
• D3: Improve Care Coordination
• D4: Improve Public and Population Health
• D5: Ensure Privacy and Security for Personal Health Information
• Stage 1 + Stage 2
• Objective is to increase health information exchange between
providers and promote patient engagement by giving patients secure
online access to their health information.
• From lessons learned (Final Rule is not out)
• Simplify and reduce reporting
• Promote innovative approach, reward good behavior
• Consolidate
http://www.healthit.gov/providers-professionals/national-learning-consortium
http://www.healthit.gov/providers-professionals/step-5-achieve-meaningful-use-stage-1
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ARRA Meaningful Use Timeline
EH: Eligible Hospital – Follow Federal
Fiscal Year (October – September)
EP: Eligible Professional –Follow
Calendar Year (January – December)
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Incentive Payments
 Payment years under the EHR Incentive Programs
follow the federal fiscal year (Oct – Sept)
 Hospitals can begin receiving payments in any year
from FFY 2011 to FFY 2015
 Incentive payments decrease for hospitals that start
receiving payments in 2014 and later
 Hospitals that are not meaningful users of certified
EHR technology will be subject to payment
adjustments beginning in FFY 2015
 Product of 3 factors with complex formulas:
1. An Initial Amount
2. The Medicare Share
3. A Transition Factor applicable to the payment year
http://www.cms.gov/Regulations-and-Guidance/Legislation/EHRIncentivePrograms/Downloads/MLN_TipSheet_MedicareHospitals.pdf
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Adjustments (aka Penalties)
 Adjustments will be applied:
 At the start of the 2015 fiscal year (FY) for eligible
hospitals and CAHs (October 1, 2014)
 At the start of the calendar year (CY) for EPs
(January 1, 2015)
 EPs, eligible hospitals, and CAHs must continue
to demonstrate meaningful use every year to
avoid payment adjustments in subsequent
years.
https://www.cms.gov/Regulations-and-Guidance/Legislation/EHRIncentivePrograms/Downloads/How_Payment_Adj_Affect_ProvidersTipsheet.pdf
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How are Adjustments Applied?
 For Eligible Hospitals
 Applied to the % increase to the Inpatient Prospective Payment System
(IPPS) payment rate
 Hospitals receive a reduced update to the IPPS standardized amount
 Payment adjustments are cumulative for every consecutive year the
hospital is not a meaningful user
 For CAHs
 Applied to the Medicare reimbursement for inpatient services during the
cost reporting period in which they failed to demonstrate meaningful use
 For a cost reporting period that begins in FY 2015, a CAH reimbursement
would be reduced from 101 percent of its reasonable costs to 100.66
percent
 To Avoid Adjustments
 Eligible Hospitals must:
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Demonstrate meaningful use prior to the 2015 calendar/fiscal payment
adjustment year (and every year after)
2013 participation will avoid the 2015 adjustment for those that participate in
2013
2014 participation will avoid the 2015 adjustment for those that begin
participation in 2014
 CAHs must:
 Demonstrate meaningful use during the same FY the payment adjustments take
place to avoid the adjustments (starting in 2015, and beyond)
https://www.cms.gov/Regulations-and-Guidance/Legislation/EHRIncentivePrograms/Downloads/How_Payment_Adj_Affect_ProvidersTipsheet.pdf
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Stage 1 Meaningful Use 2014
 Final rule for requirements for 2014 Stage
1 were released with Stage 2 Final rules
 Eligible hospitals (EH) and Critical Access
Hospitals (CAH)must meet:
 11 Required Core Objectives
 5 Menu Objectives from a list of 10 (at least
one must be a public health measure)
 16 out of 29 Clinical Quality Measures
http://www.cms.gov/Regulations-and-Guidance/Legislation/EHRIncentivePrograms/Meaningful_Use.html
http://www.gpo.gov/fdsys/pkg/FR-2014-09-04/pdf/2014-21021.pdf
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Stage 1 2014 – Eligible Hospitals and CAHs
MU Objective
Stage 1 2014
Core/Menu
Threshold
CPOE
Core
30% Meds
Drug-Drug/Drug-Allergy Checks
Problem List
Medication List
Medication Allergy List
Demographics
Vital Signs
Smoking Status
Core
Core
Core
Core
Core
Core
Core
Implement
80%
80%
80%
50%
50%
50%
Clinical Decision Support
Core
Implement 1 rule
View, Download, and Transmit
Core
50%-Provide
Ability
Protect Electronic Health Information
Core
Security Risk
Assessment
http://www.healthit.gov/sites/default/files/2014editionehrcertificationcriteria_mustage1.pdf
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Stage 1 2014 – Eligible Hospitals and CAHs
Stage 1 2014
MU Objective
Immunization Registry (public health)
Reportable Labs (public health)
Syndromic Surveillance (public health)
Drug formulary checks
Advance Directives
Incorporate Lab Results
Generate Patient List by Condition
Patient-Specific Education
Medication Reconciliation
Core/Menu
Menu
Menu
Menu
Menu
Menu
Menu
Menu
Menu
Menu
Threshold
1 test
1 test
1 test
Implement
50%
40%
1 report
10%
50%
Summary of Care at Transition
Menu
50%
Clinical Quality Measures
CQM
16 of 29 across 3
domains
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Stage 1 Reporting
 Reporting period is 90 consecutive days
for first year.
 If you have previously attested to Stage 1
then you must report for an entire federal
fiscal year.
 Exception for FFY 2014. (allows for a 90
day or 1 quarter reporting period)
http://www.cms.gov/Regulations-andGuidance/Legislation/EHRIncentivePrograms/Downloads/Hospital_Attestation_Stage1Worksheet_2014Edition.pdf
https://www.cms.gov/Regulations-and-Guidance/Legislation/EHRIncentivePrograms/downloads/MU_Stage1_ReqOverview.pdf
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Stage 1 Reporting
 Objectives and Clinical Quality Measures
 Reporting may be yes/no or
numerator/denominator attestation
 Reporting through attestation
 Reference worksheet for Stage 1
https://www.cms.gov/Regulations-and-Guidance/Legislation/EHRIncentivePrograms/downloads/MU_Stage1_ReqOverview.pdf
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Meaningful Use Clinical Quality Measures Beginning FY14
CMS
eMeasure ID
NQF #
55
0495
111
0497
104
0435
71
0436
91
0437
4
72
0438
3
105
0439
3
107
N/A
3
102
0441
3
108
190
0371
0372
3
3
73
0373
3
109
N/A
3
110
N/A
3
VTE-5 VTE discharge instructions
114
N/A
3
VTE-6 Incidence of potentially preventable VTE
Version # Measure Title
Emergency Department (ED)-1 Emergency
3
Department Throughput – Median time from ED
arrival to ED departure for admitted ED patients
ED-2 Emergency Department Throughput –
3
admitted patients – Admit decision time to ED
departure time for admitted patients
Stroke-2 Ischemic stroke – Discharged on anti3
thrombotic therapy.
Stroke-3 Ischemic stroke – Anticoagulation Therapy
4
for Atrial Fibrillation/Flutter
Stroke-4 Ischemic stroke – Thrombolytic Therapy
Stroke-5 Ischemic stroke – Antithrombotic therapy
by end of
Stroke-6 Ischemic stroke – Discharged on Statin
Medication
Stroke-8 Ischemic or hemorrhagic stroke – Stroke
education
Stroke-10 Ischemic or hemorrhagic stroke –
Assessed for Rehabilitation
Venous Thromboembolism (VTE)-1 VTE prophylaxis
VTE-2 Intensive Care Unit (ICU) VTE prophylaxis
VTE-3 VTE Patients with Anticoagulation Overlap
Therapy
VTE-4 VTE Patients Receiving Unfractionated
Heparin (UFH) with Dosages/Platelet Count
Monitoring by Protocol (or Nomogram)
National Quality
Strategy Domain
Patient and Family
Engagement
Patients and Family
Engagement
Clinical Process/
Effectiveness
Clinical Process/
Effectiveness
Clinical Process/
Effectiveness
Clinical Process/
Effectiveness
Clinical Process/
Effectiveness
Patient and Family
Engagement
Care Coordination
Patient Safety
Patient Safety
Clinical Process/
Effectiveness
Clinical Process/
Effectiveness
Patient and Family
Engagement
Patient Safety
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Meaningful Use Clinical Quality Measures Beginning FY14
CMS
eMeasure ID
NQF #
100
0142
113
0469
60
0164
53
0163
30
0639
188
147
171
527
4
172
528
4
178
453
4
32
496
4
26
N/A
2
9
480
3
185
716
3
31
1354
National Quality
Version # Measure Title
Strategy Domain
Clinical Process/
3
AMI-2-Aspirin Prescribed at Discharge for AMI
Effectiveness
PC-01 Elective Delivery Prior to 39 Completed
Clinical Process/
3
Weeks Gestation
Effectiveness
AMI-7a Fibrinolytic Therapy Received Within 30
Clinical Process/
3
minutes of Hospital Arrival
Effectiveness
AMI-8a Primary PCI Received Within 90 Minutes of Clinical Process/
3
Hospital Arrival
Effectiveness
Clinical Process/
4
AMI-10 Statin Prescribed at Discharge
Effectiveness
PN-6 Initial Antibiotic Selection for CommunityEfficient Use of
4
Acquired Pneumonia (CAP) in Immunocompetent
Healthcare Resources
Patients
3
SCIP-INF-1 Prophylactic Antibiotic Received within 1
Patient safety
Hour Prior to Surgical Incision
SCIP-INF-2 Prophylactic Antibiotic Selection for
Efficient Use of
Surgical Patients
Healthcare Resources
SCIP-INF-9 Urinary catheter removed on
Postoperative Day 1 (POD1) or Postoperative Day 2 Patient Safety
(POD2) with day of surgery being day zero
ED-3 Median time from ED arrival to ED departure
Care Coordination
for discharged ED patients
Home Management Plan of Care (HMPC) Document Patient and Family
Given to Patient/Caregiver (CAC-3)
Engagement
Clinical Process/
Exclusive Breast Milk Feeding (PC-05)
Effectiveness
Healthy Term Newborn
Patient Safety
Clinical Process/
Hearing screening before hospital discharge
Effectiveness
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Stage 2 2014 – Eligible Hospitals and CAHs
 Meet 16 Core Objectives
 Meet 3 out of 6 Menu Objectives
 Report 16 of 29 Clinical Quality Measures
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Stage 1 and 2 Comparison for Eligible Hospitals and CAHs
Stage 1 2014
MU Objective
Stage 2 2014
Core/Menu
Threshold
Core/Menu
Threshold
CPOE
Core
30% Meds
Core
60% Meds
30% Lab
30% Rad
Drug-Drug/Drug-Allergy Checks
Core
Implement
Problem List
Core
80%
Medication List
Core
80%
Medication Allergy List
Core
80%
Demographics
Core
50%
Core
80%
Vital Signs
Core
50%
Core
80%
Smoking Status
Core
50%
Core
Clinical Decision Support
Core
Implement 1 rule
Core
80%
1) 5 interventions
2) DrugDrug/Drug-Allergy
Checks
Incorporated into the CDS
objective
Incorporated into the Summary of
Care at Transition as required
elements
View, Download, and Transmit
Core
50%-Provide Ability
Core
1) 50%-Provide
Ability
2) 5%-View,
Download or
Transmit
Protect Electronic Health Information
Core
Security Risk
Assessment
Core
Security Risk
Assessment
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Stage 1 and 2 Comparison for Eligible Hospitals and CAHs
MU Objective
Immunization Registry (public health)
Reportable Labs (public health)
Syndromic Surveillance (public health)
Drug formulary checks
Advance Directives
Incorporate Lab Results
Generate Patient List by Condition
Patient-Specific Education
Medication Reconciliation
Summary of Care at Transition
Stage 1 2014
Core/Menu
Threshold
Menu
1 test
Menu
1 test
Menu
1 test
Menu
Implement
Menu
50%
Menu
40%
Menu
1 report
Menu
10%
Menu
50%
Menu
50%
Stage 2 2014
Core/Menu
Threshold
Core
Ongoing submission
Core
Ongoing submission
Core
Ongoing submission
Incorporated into ePrescriptions
Menu
50%
Core
55%
Core
1 report
Core
10%
Core
50%
Core
1) 50%-any method
2) 10%-electronic
3) 1 exchange with
different EHR
technology
Med Administration Using Assistive Technology
with eMAR
Electronic Progress Notes
Imaging results
Family Health History
Electronic Prescriptions
Core
10%
Menu
Menu
Menu
Menu
30%
10%
20%
10%
Electronic Lab Results to Ambulatory Providers
Menu
20%
CQM
16 of 29 across 3
domains
Clinical Quality Measures
CQM
16 of 29 across 3
domains
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CMS 2014 CEHRT Flexibility
In August 2014, CMS released a final rule that grants flexibility to
providers who are unable to fully implement 2014 Edition CEHRT
for an EHR reporting period in 2014 due to delays in 2014 Edition
CEHRT availability
Providers scheduled to demonstrate Stage 2 of meaningful use
for an EHR reporting period in 2014 that have not fully
implemented 2014 Edition CEHRT can:
 Demonstrate 2013 Stage 1 objectives and 2013 CQMs with 2011
Edition CEHRT or a combination of 2011 and 2014 Edition CEHRT
 Demonstrate 2014 Stage 1 objectives and 2014 CQMs with 2014
Edition CEHRT or a combination of 2011 and 2014 Edition CEHRT
 Demonstrate Stage 2 objectives and 2014 CQMs with 2014 Edition
CEHRT or a combination of 2011 and 2014 Edition CEHRT
http://www.cms.gov/Regulations-and-Guidance/Legislation/EHRIncentivePrograms/Stage_2.html
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ARRA Meaningful Use Timeline
EH: Eligible Hospital – Follow Federal
Fiscal Year (October – September)
EP: Eligible Professional –Follow
Calendar Year (January – December)
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2015 Reporting Period
 H.R.5481 - To continue the use of a 3month quarter EHR reporting period for
health care providers to demonstrate
meaningful use for 2015 under the
Medicare and Medicaid EHR incentive
payment programs, and for other
purposes.
https://www.congress.gov/bill/113th-congress/house-bill/5481
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Stage 3
 Begins in 2017
 NPRM for Stage 3 expected in first quarter
of 2015
 Draft areas of focus
 Clinical Decision Support (CDS)
 Patient engagement
 Care coordination
 Population management
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Health Information Exchange
 Transmit prescriptions to local
pharmacies
 Report data to state or national health
department(s) &/or CMS
 Smoking status of pts 13 yrs or older
 Clinical Quality Measures
 Immunization registries
 Lab results
 Syndromic surveillance data (monitor for
outbreaks/epidemics)
 Texting results or orders
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Pt Care Summary at Transition of Care
 Exchange clinical information w/ next
provider of care or referral to a consultant
 Patient demographics
 Allergies
 Height/Weight
 Lab & other test results
 Procedure list
 Problem & Diagnosis list
 Medication list
 Advance Directives
 Referrals
 Summary of care
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Patient Access to EHR
 Electronic copy of record to patients
within 3 business days
 Electronic copy of discharge instructions
 Patient portals for patients to enter home
medications, health history information,
update Advance Directives information,
etc.
 Identify education resources for patient
and provide information to patient to
access electronically
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Computerized Provider Order Entry (CPOE)
 Electronic orders – legible, dated, signed
 Electronic medication reconciliation
 Duplicate order checking
 Standardization of order sets aligned with
 Evidence-based medicine
 Formularies
 Clinical preferences
 Quality improvement efforts
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Technology Adoption
 Closed Loop Medication Administration
 Bar Code Scanning (Positive Pt ID)
 Patient education via television or computer
 Clinical Device Interfaces
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Physiologic Monitors
Pulse Oximeters
Smart IV Pumps
Smart Beds
Ventilators
Patient Call Lights
Emergency Call Lights
 Utilization of social media for reminders, check-ins, etc.
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Clinical Decision Support (CDS) –
Interventions
 Drug-Drug, Drug-Allergy, Drug-Food, Drug-Formulary
checks
 Duplicate ordering alerts
 Clinical quality measures rules
 Real-time monitoring of patients meeting quality measure
criteria
 Plan of Care rules
 Evidence-based support
 An Order Set
http://www.cms.gov/Regulations-andGuidance/Legislation/EHRIncentivePrograms/Downloads/ClinicalDecisionSupport_Tipsheet-.pdf
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Attestation Process
 To attest for the Medicare EHR Incentive Program in your first year of
participation, you will need to have met meaningful use for a
consecutive 90-day reporting period.
 Submit intent to attest on CMS website:
 Successfully register for the Medicare EHR Incentive Program;
 Meet meaningful use criteria using certified EHR technology; and
 Successfully attest, using CMS' Web-based system, that you have met
meaningful use criteria using certified EHR technology.
 Meet reporting requirements for attestation
http://www.cms.gov/Regulations-andGuidance/Legislation/EHRIncentivePrograms/RegistrationandAttestation.html
http://www.cms.gov/apps/stage-1-meaningful-use-attestation-calculator/
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References

Blumenthal, D. (February 4, 2010). “Launching HITECH”. New England Journal of Medicine.
362(5): 382-385. Retrieved September 22, 2010 from:
http://www.nejm.org/doi/full/10.1056/NEJMp0912825

Centers for Medicare and Medicaid Services (2014) . Medicare and Medicaid EHR Incentive
Program Basics. Retrieved from http://www.cms.gov/Regulations-andGuidance/Legislation/EHRIncentivePrograms/Basics.html

Centers for Medicare and Medicaid Services (2014) . 2014 Definition Stage 1 of Meaningful
Use. Retrieved from http://www.cms.gov/Regulations-andGuidance/Legislation/EHRIncentivePrograms/Meaningful_Use.html

Centers for Medicare and Medicaid Services (2014) . Medicare EHR Incentive Program
Payment Adjustments: What Providers Need to Know Retrieved from
https://www.cms.gov/Regulations-andGuidance/Legislation/EHRIncentivePrograms/Downloads/How_Payment_Adj_Affect_Provid
ersTipsheet.pdf

Centers for Medicare and Medicaid Services (2013). EHR Incentive Program for Medicare
Hospitals: Calculating Payments Retrieved from http://www.cms.gov/Regulations-andGuidance/Legislation/EHRIncentivePrograms/Downloads/MLN_TipSheet_MedicareHospital
s.pdf

Centers for Medicare and Medicaid Services (2014). Registration User Guide for Eligible
Hospitals. Retrieved November 2014 from https://www.cms.gov/Regulations-andGuidance/Legislation/EHRIncentivePrograms/downloads/EHRHospital_RegistrationUserGui
de.pdf
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References
 Center for Medicare and Medicaid Services (2014). Stage 2. Retrieved from
http://www.cms.gov/Regulations-andGuidance/Legislation/EHRIncentivePrograms/Stage_2.html
 Center for Medicare and Medicaid Services (2014). Clinical Decision Support:
More Than Just ‘Alerts’ Tipsheet. Retrieved from
http://www.cms.gov/Regulations-andGuidance/Legislation/EHRIncentivePrograms/Downloads/ClinicalDecisionSupp
ort_Tipsheet-.pdf
 Center for Medicare and Medicaid Registration & Attestation. (2014). Retrieved
from http://www.cms.gov/Regulations-andGuidance/Legislation/EHRIncentivePrograms/RegistrationandAttestation.html
 Congress.gov (2014). H.R.5481 - To continue the use of a 3-month quarter EHR
reporting period for health care providers to demonstrate meaningful use for
2015 under the Medicare and Medicaid EHR incentive payment programs, and
for other purposes. Retrieved from https://www.congress.gov/bill/113thcongress/house-bill/5481
43
References

HealthIT.gov (2014). National Health Consortium. Retrieved from
http://www.healthit.gov/providers-professionals/national-learning-consortium

HealthIT.gov (2014). Retrieved from
http://www.healthit.gov/sites/default/files/2014editionehrcertificationcriteria_mustag
e1.pdf

HealthIT.gov (2014). How to implement EHRs. Retrieved from
http://www.healthit.gov/providers-professionals/ehr-implementation-steps/step-5achieve-meaningful-use

HealthIT.gov. Federal Advisory Committees. Draft recommendations for stage 3.
retrieved November 18, 2014 from
http://www.healthit.gov/FACAS/sites/faca/files/muwg_stage3_draft_rec_07_aug_13_.v
3.pdf
HITECH Answers (2014). Meaningful Use. Retrieved from
http://www.hitechanswers.net/ehr-adoption-2/meaningful-use/
One Hundred Eleventh Congress of the United States of America (January 6, 2009).
American Recovery and Reinvestment Act of 2009. Retrieved September 2010 from:
http://fdsys.gpo.gov/fdsys/pkg/BILLS-111hr1ENR/pdf/BILLS-111hr1ENR.pdf
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U.S. Department of Health & Human Services (2010, September). HHS Home >
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