Barbara Klepfer, MSN, RN-BC Anne Mamiya, MT(ASCP) Lisa Votti, MSN, RN-BC Austin, TX November 21, 2014 © Seton Healthcare Family1

Meaningful Use: What Does it Mean?Barbara Klepfer, MSN, RN-BC

Anne Mamiya, MT(ASCP) Lisa Votti, MSN, RN-BC

Austin, TXNovember 21, 2014

© Seton Healthcare Family 1

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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Objectives

© Seton Healthcare Family

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)

Overview

http://www.hhs.gov/recovery/

American Recovery and Reinvestment Act (ARRA) of 2009




Preserve/create jobs; promote economic recovery

Assist those most impacted by recessionProvide 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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Purpose of ARRA


DIVISION A—APPROPRIATIONS PROVISIONS 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 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

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Table of Contents for ARRA


http://www.gpo.gov/fdsys/pkg/BILLS-111hr1enr/pdf/BILLS-111hr1enr.pdf

A part of the ARRA legislationHealth 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

HITECH Act

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http://www.cms.gov/Regulations-and-Guidance/Legislation/EHRIncentivePrograms/Basics.html



EHR Final Rule Incentives for MUProvides guidelines for EHR adoption Provides guidelines on qualifying for incentives

Standards & Certification CriteriaIdentifies certification process of EHRs

Privacy & SecurityIncrease privacy during health information

exchangeGuidelines for encryption & destruction of health

information

HITECH – 3 Areas of Focus

7© Seton Healthcare Family

Utilization of EHRs for meaningful use to achieve 5 health care goals:Improve quality, safety, and efficiency of

care while reducing disparitiesEngage patients and families in their carePromote public and population health &

improve outcomesImprove care coordinationPromote the privacy and security of EHRs

Why is This Important?


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.

Definition of Meaningful Use


http://www.cms.gov/Regulations-and-Guidance/Legislation/EHRIncentivePrograms/Meaningful_Use.html

http://www.nejm.org/doi/full/10.1056/NEJMp0912825



Stage 1

• 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 2

• 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.

Stage 3

• From lessons learned (Final Rule is not out)• Simplify and reduce reporting• Promote innovative approach, reward good behavior• Consolidate

Stages of Meaningful Use


http://www.healthit.gov/providers-professionals/national-learning-consortiumhttp://www.healthit.gov/providers-professionals/step-5-achieve-meaningful-use-stage-1

http://www.healthit.gov/providers-professionals/step-5-achieve-meaningful-use-stage-1





ARRA Meaningful Use TimelineEH: Eligible Hospital – Follow Federal Fiscal Year (October – September)

EP: Eligible Professional –Follow Calendar Year (January – December)

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Incentive PaymentsPayment 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 2015Incentive payments decrease for hospitals that start

receiving payments in 2014 and laterHospitals 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:

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 15


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Stage 1 MU


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 Objectives5 Menu Objectives from a list of 10 (at least

one must be a public health measure)16 out of 29 Clinical Quality Measures

Stage 1 Meaningful Use 2014


http://www.gpo.gov/fdsys/pkg/FR-2014-09-04/pdf/2014-21021.pdf




MU ObjectiveStage 1 2014

Core/Menu Threshold

CPOE Core 30% Meds

Drug-Drug/Drug-Allergy Checks Core ImplementProblem List Core 80%Medication List Core 80%Medication Allergy List Core 80%Demographics Core 50%Vital Signs Core 50%Smoking Status Core 50%

Clinical Decision Support Core Implement 1 rule

View, Download, and Transmit Core 50%-Provide Ability

Protect Electronic Health Information Core Security Risk Assessment

Stage 1 2014 – Eligible Hospitals and CAHs

http://www.healthit.gov/sites/default/files/2014editionehrcertificationcriteria_mustage1.pdf

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MU ObjectiveStage 1 2014

Core/Menu ThresholdImmunization Registry (public health) Menu 1 testReportable Labs (public health) Menu 1 testSyndromic Surveillance (public health) Menu 1 testDrug formulary checks Menu ImplementAdvance Directives Menu 50%Incorporate Lab Results Menu 40%Generate Patient List by Condition Menu 1 reportPatient-Specific Education Menu 10%Medication Reconciliation Menu 50%

Summary of Care at Transition Menu 50%

Clinical Quality Measures CQM 16 of 29 across 3 domains


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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)

Stage 1 Reporting

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http://www.cms.gov/Regulations-and-Guidance/Legislation/EHRIncentivePrograms/Downloads/Hospital_Attestation_Stage1Worksheet_2014Edition.pdf

https://www.cms.gov/Regulations-and-Guidance/Legislation/EHRIncentivePrograms/downloads/MU_Stage1_ReqOverview.pdf© Seton Healthcare Family

Objectives and Clinical Quality MeasuresReporting may be yes/no or

numerator/denominator attestationReporting through attestationReference worksheet for Stage 1

Stage 1 Reporting

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https://www.cms.gov/Regulations-and-Guidance/Legislation/EHRIncentivePrograms/downloads/MU_Stage1_ReqOverview.pdf


Meaningful Use Clinical Quality Measures Beginning FY14CMS

eMeasure ID NQF # Version # Measure TitleNational Quality Strategy Domain

55 0495 3Emergency Department (ED)-1 Emergency Department Throughput – Median time from ED arrival to ED departure for admitted ED patients

Patient and Family Engagement

111 0497 3ED-2 Emergency Department Throughput – admitted patients – Admit decision time to ED departure time for admitted patients

Patients and Family Engagement

104 0435 3 Stroke-2 Ischemic stroke – Discharged on antithrombotic therapy.

Clinical Process/ Effectiveness

71 0436 4 Stroke-3 Ischemic stroke – Anticoagulation Therapy for Atrial Fibrillation/Flutter


91 0437 4 Stroke-4 Ischemic stroke – Thrombolytic Therapy Clinical Process/ Effectiveness

72 0438 3 Stroke-5 Ischemic stroke – Antithrombotic therapy by end of


105 0439 3 Stroke-6 Ischemic stroke – Discharged on Statin Medication


107 N/A 3 Stroke-8 Ischemic or hemorrhagic stroke – Stroke education


102 0441 3 Stroke-10 Ischemic or hemorrhagic stroke – Assessed for Rehabilitation Care Coordination

108 0371 3 Venous Thromboembolism (VTE)-1 VTE prophylaxis Patient Safety190 0372 3 VTE-2 Intensive Care Unit (ICU) VTE prophylaxis Patient Safety

73 0373 3 VTE-3 VTE Patients with Anticoagulation Overlap Therapy


109 N/A 3VTE-4 VTE Patients Receiving Unfractionated Heparin (UFH) with Dosages/Platelet Count Monitoring by Protocol (or Nomogram)


110 N/A 3 VTE-5 VTE discharge instructions Patient and Family Engagement

114 N/A 3 VTE-6 Incidence of potentially preventable VTE Patient Safety22

Meaningful Use Clinical Quality Measures Beginning FY14CMS

eMeasure ID NQF # Version # Measure TitleNational Quality Strategy Domain

100 0142 3 AMI-2-Aspirin Prescribed at Discharge for AMI Clinical Process/ Effectiveness

113 0469 3 PC-01 Elective Delivery Prior to 39 Completed Weeks Gestation


60 0164 3 AMI-7a Fibrinolytic Therapy Received Within 30 minutes of Hospital Arrival


53 0163 3 AMI-8a Primary PCI Received Within 90 Minutes of Hospital Arrival


30 0639 4 AMI-10 Statin Prescribed at Discharge Clinical Process/ Effectiveness

188 147 4PN-6 Initial Antibiotic Selection for Community- Acquired Pneumonia (CAP) in Immunocompetent Patients

Efficient Use of Healthcare Resources

171 527 4 SCIP-INF-1 Prophylactic Antibiotic Received within 1 Hour Prior to Surgical Incision Patient safety

172 528 4 SCIP-INF-2 Prophylactic Antibiotic Selection for Surgical Patients

Efficient Use of Healthcare Resources

178 453 4SCIP-INF-9 Urinary catheter removed on Postoperative Day 1 (POD1) or Postoperative Day 2 (POD2) with day of surgery being day zero

Patient Safety

32 496 4 ED-3 Median time from ED arrival to ED departure for discharged ED patients Care Coordination

26 N/A 2 Home Management Plan of Care (HMPC) Document Given to Patient/Caregiver (CAC-3)


9 480 3 Exclusive Breast Milk Feeding (PC-05) Clinical Process/ Effectiveness

185 716 3 Healthy Term Newborn Patient Safety

31 1354 3 Hearing screening before hospital dischargeClinical Process/ Effectiveness

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Stage 2 MU


Meet 16 Core Objectives

Meet 3 out of 6 Menu Objectives

Report 16 of 29 Clinical Quality Measures



Stage 1 and 2 Comparison for Eligible Hospitals and CAHs

MU Objective

Stage 1 2014 Stage 2 2014

Core/Menu Threshold Core/Menu Threshold

CPOE Core 30% Meds Core60% Meds30% Lab30% Rad

Drug-Drug/Drug-Allergy Checks Core Implement Incorporated into the CDS objective

Problem List Core 80% Incorporated into the Summary of Care at Transition as required elements

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 80%

Clinical Decision Support Core Implement 1 rule Core1) 5 interventions 2) Drug-Drug/Drug-Allergy Checks

View, Download, and Transmit Core 50%-Provide Ability Core

1) 50%-Provide Ability2) 5%-View, Download or Transmit

Protect Electronic Health Information Core Security Risk Assessment Core Security Risk

Assessment 26

Stage 1 and 2 Comparison for Eligible Hospitals and CAHs

MU ObjectiveStage 1 2014 Stage 2 2014

Core/Menu Threshold Core/Menu ThresholdImmunization Registry (public health) Menu 1 test Core Ongoing submissionReportable Labs (public health) Menu 1 test Core Ongoing submissionSyndromic Surveillance (public health) Menu 1 test Core Ongoing submissionDrug formulary checks Menu Implement Incorporated into ePrescriptionsAdvance Directives Menu 50% Menu 50%Incorporate Lab Results Menu 40% Core 55%Generate Patient List by Condition Menu 1 report Core 1 reportPatient-Specific Education Menu 10% Core 10%Medication Reconciliation Menu 50% Core 50%

Summary of Care at Transition Menu 50% Core

1) 50%-any method2) 10%-electronic3) 1 exchange with different EHR technology

Med Administration Using Assistive Technology with eMAR Core 10%

Electronic Progress Notes Menu 30%Imaging results Menu 10%Family Health History Menu 20%Electronic Prescriptions Menu 10%

Electronic Lab Results to Ambulatory Providers Menu 20%

Clinical Quality Measures CQM 16 of 29 across 3 domains CQM 16 of 29 across 3

domains 27

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 availabilityProviders 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

CMS 2014 CEHRT Flexibility

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ARRA Meaningful Use TimelineEH: Eligible Hospital – Follow Federal Fiscal Year (October – September)

EP: Eligible Professional –Follow Calendar Year (January – December)

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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.

https://www.congress.gov/bill/113th-congress/house-bill/5481

2015 Reporting Period

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Begins in 2017

NPRM for Stage 3 expected in first quarter of 2015

Draft areas of focusClinical Decision Support (CDS)Patient engagementCare coordinationPopulation management


Stage 3

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Innovations to Achieve Meaningful Use


Transmit prescriptions to local pharmacies

Report data to state or national health department(s) &/or CMS Smoking status of pts 13 yrs or olderClinical Quality Measures Immunization registriesLab resultsSyndromic surveillance data (monitor for

outbreaks/epidemics)Texting results or orders

Health Information Exchange


Exchange clinical information w/ next provider of care or referral to a consultantPatient demographicsAllergies Height/WeightLab & other test resultsProcedure listProblem & Diagnosis listMedication listAdvance DirectivesReferralsSummary of care

Pt Care Summary at Transition of Care


Electronic copy of record to patients within 3 business days

Electronic copy of discharge instructionsPatient 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

Patient Access to EHR


Electronic orders – legible, dated, signedElectronic medication reconciliationDuplicate order checkingStandardization of order sets aligned

withEvidence-based medicineFormulariesClinical preferences Quality improvement efforts

Computerized Provider Order Entry (CPOE)


Closed Loop Medication Administration

Bar Code Scanning (Positive Pt ID)

Patient education via television or computer

Clinical Device InterfacesPhysiologic MonitorsPulse OximetersSmart IV PumpsSmart BedsVentilatorsPatient Call LightsEmergency Call Lights

Utilization of social media for reminders, check-ins, etc.

Technology Adoption


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

Clinical Decision Support (CDS) – Interventions


http://www.cms.gov/Regulations-and-Guidance/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-and-Guidance/Legislation/EHRIncentivePrograms/RegistrationandAttestation.html

http://www.cms.gov/apps/stage-1-meaningful-use-attestation-calculator/

Attestation Process





http://www.cms.gov/apps/stage-1-meaningful-use-attestation-calculator/

Questions


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-and-Guidance/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-and-Guidance/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-and-Guidance/Legislation/EHRIncentivePrograms/Downloads/How_Payment_Adj_Affect_ProvidersTipsheet.pdf

Centers for Medicare and Medicaid Services (2013). EHR Incentive Program for Medicare Hospitals: Calculating Payments Retrieved from http://www.cms.gov/Regulations-and-Guidance/Legislation/EHRIncentivePrograms/Downloads/MLN_TipSheet_MedicareHospitals.pdf

Centers for Medicare and Medicaid Services (2014). Registration User Guide for Eligible Hospitals. Retrieved November 2014 from https://www.cms.gov/Regulations-and-Guidance/Legislation/EHRIncentivePrograms/downloads/EHRHospital_RegistrationUserGuide.pdf

References











https://www.cms.gov/Regulations-and-Guidance/Legislation/EHRIncentivePrograms/downloads/EHRHospital_RegistrationUserGuide.pdf

https://www.cms.gov/Regulations-and-Guidance/Legislation/EHRIncentivePrograms/downloads/EHRHospital_RegistrationUserGuide.pdf

Center for Medicare and Medicaid Services (2014). Stage 2. Retrieved from http://www.cms.gov/Regulations-and-Guidance/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-and-Guidance/Legislation/EHRIncentivePrograms/Downloads/ClinicalDecisionSupport_Tipsheet-.pdf

Center for Medicare and Medicaid Registration & Attestation. (2014). Retrieved from http://www.cms.gov/Regulations-and-Guidance/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/113th-congress/house-bill/5481

References

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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_mustage1.pdf

HealthIT.gov (2014). How to implement EHRs. Retrieved from http://www.healthit.gov/providers-professionals/ehr-implementation-steps/step-5-achieve-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_.v3.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

U.S. Department of Health & Human Services (2010, September). HHS Home > Recovery > Overview. Retrieved September 9. 2010, from HHS.gov/Recovery: http://www.hhs.gov/recovery/overview/index.html

References





http://www.healthit.gov/providers-professionals/ehr-implementation-steps/step-5-achieve-meaningful-use

http://www.healthit.gov/providers-professionals/ehr-implementation-steps/step-5-achieve-meaningful-use

http://www.healthit.gov/FACAS/sites/faca/files/muwg_stage3_draft_rec_07_aug_13_.v3.pdf

http://fdsys.gpo.gov/fdsys/pkg/BILLS-111hr1ENR/pdf/BILLS-111hr1ENR.pdf

http://www.hhs.gov/recovery/overview/index.html

Documents

Barbara Klepfer, MSN, RN-BC Anne Mamiya, MT(ASCP) Lisa Votti, MSN, RN-BC Austin, TX November 21, 2014 © Seton Healthcare Family1