Minnesota Electronic Disease Surveillance System (MEDSS)
PO Box 64975
St. Paul, MN 55164-0975
http://www.health.state.mn.us/divs/istm/medss/index.html
Meaningful Use Incentives and ELR
Incentive payments are now available to eligible health
care providers for “meaningful use” of electronic health
record (EHR) technology where one small but important
component is Electronic Laboratory Reporting (ELR).
ELR is the electronic transmission of laboratory reports
which relate to reportable conditions from laboratories to
public health departments. ELR has many benefits,
including improved timeliness, reduction of manual data
entry errors, and reports that are more complete. This
fact sheet provides a brief overview of ELR
requirements of meaningful use in Minnesota.
Background
The establishment of interoperable electronic health
records has been a state and national priority since 2004.
In 2008, Minnesota established a mandate for all
providers to implement an interoperable electronic
health record by 2015. The passage of the American
Recovery and Reinvestment Act of 2009 (ARRA)
provided funding to help achieve this goal.
Specifically, the Health Information Technology for
Economic and Clinic Health (HITECH) Act under
ARRA authorized the Centers for Medicare and
Medicaid Services (CMS) to administer incentive
payments to eligible health care providers and hospitals
for adopting, implementing, and demonstrating
meaningful use of electronic health record technology.
Timing and eligibility for incentives
The CMS incentive program began in 2011 and will be
implemented in three stages. Eligibility criteria and
requirements vary depending on whether a provider
applies in the Medicare or Medicaid category:
Eligible Medicare professionals and hospitals must
demonstrate meaningful use of certified electronic
health record technology each year of the program to
receive incentive payments.
Eligible Medicaid professionals and hospitals may
qualify for incentive payments if they adopt,
implement, upgrade, or demonstrate meaningful use
in their first year of participation, with
demonstration of meaningful use required in
subsequent years of the program.
Providers who meet these criteria began receiving
payment as early as spring 2011.
What qualifies as demonstrating meaningful
use of EHRs?
Specific meaningful use objectives were outlined in a
final rule released by CMS in July 2010. In stage 1 of
the incentive program (through 2013) eligible health
professionals must meet a series of 15 core objectives
(14 for eligible hospitals) and at least 5 of 10 menu set
objectives. Examples of core objectives include using
the certified EHR technology to: record patient
demographics, maintain patient diagnoses, maintain
patient medication and allergy lists, and generate and
transmit electronic prescriptions.
Although providers have flexibility in choosing menu set
options, 1 of the 5 options must be specific to public
health. The three public health menu objectives include
submitting electronic data to public health agencies on
immunizations, syndromic surveillance and reportable
lab results.
What qualifies as ELR requirements for Stage 1
meaningful use?
The Stage 1 meaningful use objective for ELR is the
capability to submit electronic data on reportable (as
required by state or local law) lab results to public health
agencies and actual submission in accordance with
applicable law and practice.
To meet requirements, a provider must perform at least
one test of the certified EHR technology’s capacity to
provide electronic submission of reportable lab results to
the public health agency (in this case the Minnesota
Department of Health) and to continue to submit data if
the test is successful.
To meet the meaningful use objective on ELR,
Minnesota health care providers should electronically
submit data from a certified electronic health record
system using national standards (HL7 2.5.1) to
MDH.
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Meaningful Use Incentives and ELR– Page 2
National standards and MDH/ELR-specific
requirements
As part of meaningful use, national standards have been
defined for the message structure and content. In
addition, MDH has developed a set of MDH ELR
implementation specifications, with detailed information
and guidelines on how to create an ELR message for
MDH, as well as information on the process to use
during the implementation. The specifications can be
downloaded from
http://www.health.state.mn.us/medss/elr.html. Both
national standards and MDH specifications need to be
followed.
Successful data submissions for ELR include those
with all of the following characteristics:
 Submitted from a certified EHR technology
 Follows the HL7 2.5.1 IG for lab reporting to
public health
 Includes LOINC codes for tests
 Use coded results, preferably SNOMED codes
 Passes content validation as defined in the
MDH Implementation Specifications for ELR
 Sent to MDH using a secure transport
mechanism
Electronic Laboratory reporting to MDH should:
Follow the message format specified in the HL7
version 2.5.1 Implementation Guide: Electronic
Laboratory Reporting to Public Health, Release 1
(http://www.hl7.org/implement/standards/v2messa
ges.cfm) (HL7 membership needed to download
the guide, it can also be purchased from HL7 for
non-members).
Use LOINC codes to send information about
performed tests.
Follow the specifications and guidelines in the
“MDH Implementation Guide for ELR.”
Include tests and results for the conditions
specified in the “MDH Implementation Guide for
ELR” and in accordance to the MN disease
reporting rule.
Use coded values for results, preferably SNOMED
codes.
Follow the implementation process outlined in the
“MDH Implementation Guide for ELR.”
Send data to MDH using a secure transport
mechanism.
Submissions using direct data entry, message content
where MDH translates local codes to LOINC codes, or
electronic transfer in flat file format, do not qualify
under the meaningful use objective.
Additional resources
MN e-Health Initiative: www.health.state.mn.us/ehealth/index.html
REACH (Regional Extension and Assistance Center for
HIT): http://www.khareach.org
Centers for Disease Control and Prevention:
http://www.cdc.gov/ehrmeaningfuluse/
Centers for Medicare and Medicaid EHR Incentive
Program www.cms.gov/EHRIncentivePrograms
ONC Standards, Final rule:
(http://healthit.hhs.gov/portal/server.pt/community/healt
hit_hhs_gov__meaningful_use_-_providers/2998)
For more information, contact MEDSS (Minnesota Electronic
Disease Surveillance System):
[email protected]
http://www.health.state.mn.us/medss/elr.html
Next steps for providers
1. Adopt and implement EHR technology certified for
the meaningful use incentive program or determine
if your current EHR technology is certified. Check
the list of meaningful use-certified products at
http://onc-chpl.force.com/ehrcert.
2. Review the MDH implementation specifications at
http://www.health.state.mn.us/medss/elr.html.
3. Fill out the registration form found on the website
listed above and send it to
[email protected].
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