Jeff Grant, President HCMA, Inc. www.hcma-consulting.com jeff@hcma-consulting.com

Jeff Grant, President HCMA, Inc. www.hcma-consulting.com jeff@hcma-consulting.com

Financial i Disclosure Provide consulting services to Compulink Business Systems, Inc.and to their users.

Who am I? Over 20 years Practice Management, Operations, Revenue Cycle Management & HIT Consulting with nearly 1,000 practices Speaker at AAO, ASCRS, Hawaiian Eye, SECO, AOA, Vision Expo, & State Associations Contributing Editor Optometric Management Magazine Articles in Primary CareOptometry News (PCON), Administrative Eyecare, Ophthalmology Management, Ophthalmology Times, Premier Surgeon, Ophthalmology Business, & Advanced Ocular Care Assisted ddozens of practices with EHR selection/implementation l t

Why implement tehr? A national survey of doctors* who are ready for meaningful use offers important evidence: 79% of providers report that with an EHR, their practice functions more efficiently 82% report that sending prescriptions electronically (e prescribing) saves time 68% of providers see their EHR as an asset with recruiting physicians 75% receive lab results faster 70% report enhances in data confidentiality *Jamoom, E., Patel, V., King, J., & Furukawa, M. (2012, August). National perceptions of EHR adoption: Barriers, impacts, and federal policies. National conference on health statistics.

Payments So Far According to CMS, as of January 31, 2013st: More than $2.1 Billion Medicare EHR incentive payments to over 122,000EP s Optometrists = 4,576 Ophthalmologists = 3,354 Medicaid Plans launched in 48 States

Where are we right iht now? Stage 1 Stage 2

Medicare Mdi vs. Medicaid Mdi id Payment Amount Eligibility

Medicare Mdi Incentive

MU Reporting Periods 90 Days in your first payment year, regardless of when you start Full calendar year in subsequent years For those that attested first in 2011, must meet Stage 2 in 2014 and Stage 3 in 2016 All others will be required to demonstrate 2 years @ Stage 1, 2 years @ Stage 2, & 2 years @ Stage 3 90 days for everyone in 2014 (extra flexibility to ensure Stage 2 compliance)

MU Reporting Periods Every EP who attests to being a Meaningful User, gets to use Stage 1 requirements for at least two years: If your first payment year is 2013, you get to use Stage 1 rules in 2013 and 2014; if your first payment year is 2014, you get to use Stage 1 rules in 2014 and 2015; etc. EP s who first attested in 2011, get to use Stage 1 rules for three years (2011, 2012 & 2013).

Stage 1 or Stage 2?

Stage 1 or Stage 2? Providers who were early demonstrators of meaningful use in 2011 will meet three consecutive years of meaningful use under the Stage 1 criteria i bf before advancing to the Stage 2 criteria i in 2014. All other providers would meet two years of meaningful use under the Stage 1 criteria before advancing to the Stage 2 criteria in their third year. For 2014 only: All providers regardless of their stage of meaningful use are only required to demonstrate meaningful use for a three month EHR reporting period. For Medicare providers, this 3 month reporting period is fixed to the quarter of either the fiscal (for eligible hospitals and CAHs) or calendar (for EPs) year in order to align with existing CMS quality measurement programs, such as the Physician Quality Reporting System (PQRS) and Hospital Inpatient Quality Reporting (IQR). For Medicaid providers only eligible to receive Medicaid EHR incentives, the 3 month reporting period is not fixed, where providers do not have the same alignment needs. CMS is permitting this one time three month reporting period in 2014 only so that all providers who must upgrade to 2014 Certified EHR Technology will have adequate time to implement their new Certified EHR systems.

Stage 1 Thru the end of 2013 when Stage 2 rules commence. 15 Core Set Measures All must be met. Stage 2 17/ All must be met. 10 Menu Set Measures 5 must be met. (At least one of the Menu Set Measures must be Public Health Related) Stage 2 3 of 6 must be met (1 Old & 5 New) Clinical Quality Measures 3 Core, 3 Alternate Core, 3 Alternate Set Stage 2 9 of 64

Clinical Quality Measure (CQM) Reporting 3 Core Measures All 3 must be reported. 3 Alternate Core Measures If the denominator for one or more of the Core Measures is zero, you will be required to report results for up to three Alternate Core Measures. 38 Additional i Measures Must report on 3 Measures from this list. In sum, EPs must report on 6 total measures: 3 required core measures (substituting alternate core measures where necessary) and 3 additional measures. It s okay to have 0% for any/all CQM s s. Stage 2: 9 out of 64 Measures from at least 3 of the 6 Quality Strategy Domains Electronic reporting begins for 2nd year and after attestor

CQM Reporting Core Set St

CQM Reporting Alternate Core Set

Stage 1 Changes for 2013

CPOE Beginning in 2013, CMS is adding an optional alternate measure to the objective for computerized provider order entry (CPOE). The current measure for CPOE is based on the number of unique patients with a medication in their medication list that was entered using CPOE. The new, alternate measure is based on the total number of medication orders created during the EHR reporting gperiod. An EP, eligible hospital, or CAH may select either measure for this objective in Stage 1 in order to achieve meaningful use. (Note that this alternative measure will be requiredfor all providers in Stage 2.) 2)

CPOE

Electronic Prescribing Beginning in 2013, CMS is adding an additional exclusion to the objective for electronic prescribing for providers who are not within a 10 mile radius of a pharmacy that accepts electronic prescriptions.

Electronic Prescribing

Record & Chart Changes in Vital Signs CMS is changing the measure of the objective for recording and charting changes in vital signs for EPs, eligible hospitals, and CAHs. Thecurrent measure specifies that vital signs must be recorded for more than 50 percent of all unique patients ages 2 and over. The new measure amends that age limit to recording blood pressure for patients ages 3 and over and height and weight for patients of all ages.

Record & Chart Changes in Vital Signs

Record & Chart Changes in Vital Signs The exclusions for this objective for EPs are also changing. Current Exclusions: All three vital signs (height, weight, blood pressure) are not relevant to their scope of practice, or If the EP sees no patients 2 years or older. New Stage 1 changes: An EP can claim an exclusion if the EP sees no patients 3 years or older (the EP would not have to record blood pressure), If all three vital signs are not relevant to their scope of practice (the EP would not record any vital signs), If height and weight are not relevant to their scope of practice (the EP would still record blood pressure), or If blood pressure is not relevant to their scope of practice (the EP would still record height and weight).

Record & Chart Changes in Vital Signs

Record & Chart Changes in Vital Signs This new measure and these new exclusions are optional in 2013 but will be required in 2014 and beyond.

Electronic Exchange of Key Clinical Info Beginning in 2013, the objective for electronic exchange of key clinical i l information will no longer be required dfor Stage 1 for EPs, eligible hospitals, and CAHs. Providers faced numerouschallenges in understanding the requirements for this objective, so we are moving instead to a more robust requirement for electronic health information exchange as a part of the Stage 2 objective for providing a summary of care record following a transition of care or referral.

Report Clinical Quality Measures Beginning in 2013, there will no longer be a separate objective for reporting ambulatory or hospital clinical i l quality measures as a part of meaningful use. It is important to note, however, that EPs, eligible hospitals, and CAHs will still be required to report on clinical quality measures in order to achieve meaningful use. CMS is simply removing the standalone objective that requires providers to attest that they plan to report on clinical i l quality measures because it is redundant. d

Public Health Reporting Objectives Beginning in 2013, all of the Stage 1 public health objectives (submitting data to an immunization registry, submitting data to a syndromic surveillance database, or submitting reportable lab results to a public health agency) will require that providers perform at least one test of their CEHRT s capability to send data to public health agencies, except where prohibited. The intent of this modification is to encourage all EPs, eligible hospitals, and CAHs to submit public health data, even when not required by State/local law. Therefore, if providers are authorized to submit the data, they should do so even if it is not required by either law or practice. If the test of submission is successful, provider should institute regular reporting with the entity with whom the successful test was conducted.

New for Stage 2 1. Enter at least one electronic progress note created, edited and signed by an EP for more than 30% of unique patients. 2. More than 10% of all scans and tests whose result is an image ordered by the EP for patients seen during the EHR reporting period are incorporated into or accessible through Certified EHR Technology. 3. More than 20% of all unique patients seen by the EP during the EHR reporting period have a structured data entry for one or more first degree relatives or an indication that family health history has been reviewed. 4. Successful ongoing submission of cancer case information from Certified EHR Technology to a cancer registry for the entire EHR reporting period. 5. Successful ongoing submission of specific case information from Certified EHR Technology to a specialized registry for the entire EHR reporting period.

Questions about your incentive? DON'T: Callyour MAC/Carrier/FI INSTEAD: Call the EHR Information Center 7:30 a.m. 6:30 p.m. (CST) Mon Fri 1 888 734 6433 Obtain registration status Acquire attestation status Review payment information Check progress towards meeting the annual allowed charge threshold amount

EHR Incentive Payment taudits Compliance reviews to validate provider eligibility through their meaningful use attestations including verification of meaningful use and would also review components of the payment formulas. Identify and recoup overpayments oepay etsmade under the incentive e payment programs that result from incorrect or fraudulent attestations, quality measures, cost data, patient data, or any other submission required to establish eligibility or to qualify for a payment. Medicare FFS EPs will need to maintain evidence of qualification to receive incentive payments py for 10 years after the date they register for the incentive program.

EHR Incentive Payment taudits If you are selected for an audit you will receive a letter from Figliozzi and Company with the CMS logo on the letterhead. Meaningful use audit questions can be directed to Peter Figliozzi at (516) 745 6400 x302 or by email at pfigliozzi@figliozzi.com. Figliozzi and Company s website is http://www.figliozzi.com/. It is IMPERATIVE to you maintain evidence that supports the information you use(d) when you attest(ed). This might be information contained in your certified EHR, reports that you used, etc.

EHR Incentive Payment taudits Audit Focus: The denominator for certain measures should be identical Be able to prove self attestation t ti measures (documentation ti from EHR vendor or screen shots) Copy of report generated from CEHRT and used to attest Certified EHR used at location where at least 50% of encounters occur.

Preventing Payment Adjustments Prevent 1% payment adjustment that begins 2015 by being a MU in 2013. Adjustment goes up 1% per year until 2019 (5%).

PQRS with EHR Incentive? PQRS Incentive is still available even if you get the EHR Incentive. Affordable Care Act (ACA) (Section 10331, March 2010) Provides Physician Quality Reporting incentives through 2014 and added PFS reductions starting in 2015. Authorized incentive payment amounts for each program year: 2013 & 2014 0.5% Authorized payment adjustment to fee schedule hdl amount beginning in 2015 for those who do not satisfactorily report in 2013 2015 98.5% 2016 and subsequent years 98.0%

E Rx Payment tadjustment t 2013PaymentAdjustment (1.5%) Based on reporting 10 erx events between 1/1/12 & 6/30/12 Automatic Exclusion for 2013 erx payment py adjustment: EP s who achieved meaningful use during 1/1/11 6/30/12 and has attested to this by 1/1/13 or have registered by 1/31/13. 2014 Payment penalty (2.0%) Based on reporting 25 erx events between 1/1/12 & 12/31/12 No word on Automatic Exclusion for 2014.

2013 is THE critical year Avoid $15,000 per EP reduction Avoid 2015 EHR payment adjustment Avoid 2015 PQRS payment adjustment t

Thank You! Jeff Grant, President HCMA, Inc. www.hcma Consulting.com Consulting jeff@hcma Consulting.com

Core Set St& Menu Set St Details of each measure on thefollowing slides are provided for your information.

Meaningful luse Core Set St 1. CPOE Objective: Use CPOE for medication orders directly entered by any licensed healthcare professional who can enter orders into the medical record per state, local and professional guidelines. Measure: More than 30 percent of all unique patients with at least one medication in their medication list seen by the EP during the EHR reporting period have at least medication order entered using CPOE. Exclusion: Any EP who writes fewer than 100 prescriptions during the EHR reporting period. Attestation: Numerator / Denominator or Exclusion Stage 2: More items fall under CPOE and higher %.

Meaningful luse Core Set St 2. Drug Drug, Drug, Drug Allergy Interaction Checks Objective: Implement drug drug and drug allergy checks. Measure: Implement drug drug and drug allergy checks for the entire EHR reporting period. Exclusion: None Attestation: Yes / No Stage 2: Moved to Clinical Decision Support.

Meaningful luse Core Set St 3. Maintain a Problem List Objective: Maintain up to date problem list of current and active diagnoses. Measure: More than 80 percent of all unique patients seen by the EP have at least one entry or an indication that no problems are known for the patient recorded as structured data. Exclusion: None Attestation: Numerator / Denominator Stage 2: No longer separate; incorporated into Stage 2 Summary of Care document at Transitions of Care and Referrals.

Meaningful luse Core Set St 4. E Prescribing Objective: Generate and transmit permissible prescriptions electronically (erx). Measure: More than 40 percent of all permissible prescriptions written by the EP are transmitted electronically using CEHRT. Exclusion: Any EP who writes fewer than100 prescriptions during the EHR reporting period. Attestation: Numerator / Denominator or Exclusion Stage 2: Goes to 50% and includes requirement for drug formulary.

Meaningful luse Core Set St 5. Active Medication List Objective: Maintain active medication list. Measure: More than 80 percent of all unique patients seen by the EP have at least one entry (or an indication that the patient is not currently prescribed any medication) recorded as structured data. Exclusion: None Attestation: Numerator / Denominator Stage 2: No longer separate; incorporated into Stage 2 Summary of Care document at Transitions of Care and Referrals.

Meaningful luse Core Set St 6. Active Medication Allergy List Objective: Maintain active medication allergy list. Measure: More than 80 percent of all unique patients seen by the EP have at least one entry (or an indication that the patient has no known medication allergies) recorded as structured data. Exclusion: None Attestation: Numerator / Denominator Stage 2: No longer separate; incorporated into Stage 2 Summary of Care document at Transitions of Care and Referrals.

Meaningful luse Core Set St 7. Record Demographics Objective: Record the following demographics: preferred language, gender, race and ethnicity, and date of birth Measure: More than 50 percent of all unique patients seen by the EP have demographics recorded as structured data. Exclusion: None Attestation: Numerator / Denominator Stage 2: Goes to 80%

Meaningful luse Core Set St 8. Record Vital Signs: Objective: Record and chart changes in the following vital signs: height, weight and blood pressure and calculate and display body mass index (BMI) for ages 2 and over; plot and display growth charts for children 2 20 years, including BMI. Measure: For more than 50 percent of all unique patients t age 2 and over seen by the EP, height, weight and blood pressure are recorded as structured data. The CEHRT will calculate BMI and the Growth Chart if applicable to patient based on age. Exclusion: Any EP who either see no patients 2 years or older, or who believes that all three vital signs of height, weight, and blood pressure of their patients have no relevance to their scope of practice. Attestation: Numerator / Denominator or Exclusion Stage 2: More than 80% of all unique patients seen by the EP have blood pressure (for patients age 3 and over only) and height and weight (for all ages) recorded as structured data. You can report BP only and exclude HT/WT.

Meaningful luse Core Set St 9. Smoking Status Objective: Record smoking status for patients 13 years old or older Measure: More than 50 percent of all unique patients 13 years old or older seen by the EP have smoking status recorded as structured data. Exclusion: Any EP who sees no patients 13 years or older. Attestation: Numerator / Denominator or Exclusion Stage 2: Goes to 80%. NOTES: The frequency of updating this information is left to the provider and guidance is provided already from several sources in the medical community. The information could be collected by any member of the medical staff.

Meaningful luse Core Set St 10. Report Clinical Quality Measures Stage 2: No longer a separate measure, but you must continue to submit. Submission will be electronic in 2014.

Meaningful luse Core Set St 11. Clinical Decision Support Objective: Implement one clinical decision support rule relevant to specialty or high clinical priority. Measure: Implement one clinical decision support rule. Exclusion: None Attestation: Yes / No Stage 2: Implement 5 clinical decision support interventions related to 4 or more clinical quality measures. Drug Contraindications and Formulary checks included.

Meaningful luse Core Set St 12. Electronic Copy of Health Information Objective: Provide patients with an electronic copy of their health information (including diagnostics test results, problem list, medication lists, medication allergies) upon request. Measure: More than 50 percent of all patients of the EP who request an electronic copy of their health information are provided it within 3 business days. Exclusion: Any EP that has no requests from patients or their agents for an electronic copy of patient health information during the EHR reporting period. Attestation: Numerator / Denominator or Exclusion Stage 2: i) More than 50% of all unique patients seen by the EP during the EHR reporting period are provided timely (available to the patient within 4 business days after the information is available to the EP) online access to their health information. ii) More than 5% of all unique patients seen by the EP during the EHR reporting period (or their authorized representatives) view, download, or transmit to a third party their health information.

Meaningful luse Core Set St 13. Clinical Summaries Objective: Provide clinical summaries for patients for each office visit. Measure: Clinical summaries provided to patients for more than 50 percent of all office visits within 3 business days. Exclusion: Any EP who has no office visits during the EHR reporting period. Attestation: Numerator / Denominator or Exclusion Stage 2: Within one (1)business day.

Meaningful luse Core Set St 14. Electronically Exchange Clinical Information Stage 2: This measure is eliminated from Stage 1 in 2013 and is no longer a measure for Stage 2.

Meaningful luse Core Set St 15.Privacy & Security (HIPAA) Objective: Protect electronic health information created or maintained by the CEHRT through the implementation of appropriate technical capabilities. Measure: Conduct or review a security risk analysis of the CEHRT technology, and implement security updates and correct identified security deficiencies as part of its risk management process. Exclusion: None Attestation: Yes / No NOTE: Compliance with HIPAA privacy and security rules is required for all covered entities, i regardless of whether h or not they participate i in the EHR incentive programs. Furthermore, compliance with the HIPAA Privacy and Security Rules constitutes a wide range of activities, procedures and infrastructure.

Meaningful luse Core Set St 15. Pi Privacy & Security (HIPAA) OCR levies $100,000 fine against Phoenix Cardiac Practice for HIPAA Privacy/Security Violations (4 17 12) According to OCR, the practice did not: implement adequate policies and procedures, document employee training, identify a security officer, conduct a risk analysis, or obtain business associate contracts with Internet based email and calendar services.

Meaningful luse Core Set St 15. Privacy & Security (HIPAA) Cardiology Practice in Phoenix fined $100,000 by OCR. OCR's investigation revealed that Phoenix Cardiac Surgery failed: to implement adequate policies and procedures to appropriately safeguard patient information; to document that it trained any employees on its policies and procedures on the Privacy and Security Rules; to identify a security official and conduct a risk analysis; and to obtain business associate agreements with Internet based email and calendar services where the provision of the service included storage of and access to its ephi.

Meaningful luse Menu Set St 1. Drug Formulary Checks Objective: Implement Drug Formulary Checks. Measure: The EP has enabled this functionality and has access to at least one internal or external formulary for the entire EHR reporting gperiod. Exclusion: Any EP who writes fewer than 100 prescriptions during the EHR reporting period should be excluded from this objective and associated measure. Attestation: Yes / No or Exclusion Stage 2: This measure is incorporated into the e Prescribing measure for Stage 2.

Meaningful luse Menu Set St 2. Lab Results Objective: Incorporate clinical lab test results into EHR as structured data. Measure: More than 40 percent of all clinical lab tests results ordered by the EP during the EHR reporting period whose results are aein et either e in a positive/negative or numerical format are incorporated in certified EHR technology as structured data. Exclusion: An EP who orders no lab tests whose results are either in a positive/negative or numeric format during the EHR reporting period. Attestation: Numerator / Denominator or Exclusion Stage 2: Becomes Core Goes to 55%

Meaningful luse Menu Set St 3. Patient Lists Objective: Generate lists of patients by specific conditions to use for quality improvement, reduction of disparities, research, or outreach. Measure: Generate at least one report listing patients of the EP or eligible hospital with a specific condition. Exclusion: None Attestation: Yes / No Stage 2: Becomes Core

Meaningful luse Menu Set St 4. Patient Reminders Objective: Send reminders to patients per patient preference for preventive/follow up care. Measure: More than 20 percent of all patients 65 years or older or 5 years old or younger were sent an appropriate reminder during the EHR reporting period. Exclusion: An EP who has no patients t 65 years old or older or 5 years old or younger with records maintained using certified EHR technology. Attestation: Numerator / Denominator or Exclusion Stage 2: Becomes Core Use EHRt to identify (clinically (lii ll relevant) and provide reminders for preventive/follow up care for more than 10% of patients t with two or more office visits in the last 2 years.

Meaningful luse Menu Set St 5. Timely Electronic Access to Health Information Objective: Provide patients with timely electronic access to their health information (including lab results, problem list, medication lists, medication allergies) within four business days of the information being available to the EP. Measure: At least 10 percent of all unique patients seen by the EP are provided timely (available to the patient within four business days of being updated in the certified EHR technology) electronic access to their health information subject to the EP s discretion to withhold certain information. Exclusion: Any EP that neither orders nor creates any of the information listed at 45 CFR 170.304(g) during the EHR reporting period. Attestation: Numerator / Denominator or Exclusion Stage 2: Eliminated from Stage 1 in 2014 and is no longer a measure for Stage 2. NOTE: There may be situations where a provider may decide that electronic access of a portal or Personal Health Record is not the best forum to communicate results. Within the confines of laws governing patient access to their medical records, we would defer to EP s, eligible hospital or CAH s judgment as to whether to hold information back in anticipation of an actual encounter between the provider and the patient.

Meaningful luse Menu Set St 6. Education Resources Objective: Use certified EHR technology to identify patient specific education resources and provide those resources to the patient if appropriate. ate Measure: More than 10 percent of all unique patients seen by the EP are provided patient specific education resources. Exclusion: None Attestation: Numerator / Denominator Stage 2: Become Core

Meaningful luse Menu Set St 7. Medication Reconciliation Objective: The EP who receives a patient from another setting of care or provider of care or believes an encounter is relevant should perform medication reconciliation. Measure: The EP performs medication reconciliation for more than 50 percent of transitions of care in which the patient is transitioned into the care of the EP. Exclusion: An EP who was not the recipient i of any transitions of care during the EHR reporting period. Attestation: Numerator / Denominator or Exclusion Stage 2: Becomes Core NOTE: CMS defines "transition of care as the movement of a patient from one setting of care (hospital, ambulatory primary care practice, ambulatory, specialty care practice, long term care, home health, rehabilitation facility) to another.

Meaningful luse Menu Set St 8. Transition of Care Summary Objective: The EP transitions their patient to another setting of care or provider of care or refers their patient to another provider of care should provide summary care record for each transition of care or referral. Measure: The EP who transitions or refers their patient to another setting of care or provider of care provides a summary of care record for more than 50 percent of transitions of care and referrals. Exclusion: An EP who neither transfers a patient to another setting nor refers a patient to another provider during the EHR reporting period. Attestation: t ti Numerator / Denominator or Exclusion Stage 2:: Become Core

Meaningful luse Menu Set St 8. Transition of Care Summary Stage 2:: Become Core 1. The EP who transitions or refers their patient to another setting of care or provider of care provides a summary of care record for more than 50% of transitions of care and referrals. 2. The EP who transitions or refers their patient to another setting of care or provider of care provides a summary of care record either a) electronically transmitted to a recipient using CEHRT or b) where the recipient receives the summary of care record via exchange facilitated by an organization that is a NwHIN Exchange participant or is validated through an ONC established governance mechanism to facilitate exchange for 10% of transitions and referrals. 3. The EP who transitions or refers their patient to another setting of care or provider of care must either a) conduct one or more successful electronic exchanges of a summary of care record with a recipient using technology that was designed by a different EHR developer than the sender's, or b) conduct one or more successful tests with the CMS designated dtest EHR during the EHR reporting period.

Meaningful luse Menu Set St 9. *Submission of electronic immunization data (*public health related) Objective: Capability to submit electronic data to immunization registries or Immunization Information Systems and actual submission in accordance with to applicable law and practice. Measure: Performed at least one test of CEHRT's capacity to submit electronic data to immunization i i registries i and follow up submission i if the test is successful l( (unless none of the immunization registries to which the EP, submits such information have the capacity to receive the information electronically). Exclusion: An EP who administers no immunizations during the EHR reporting period or where no immunization registry has the capacity to receive the information electronically. Attestation: Yes / No or Exclusion Stage 2: Becomes Core Capability to submit electronic data to immunization registries or Immunization Information Systems and actual submission except where prohibited and in accordance with applicable law and practice. NOTES: 1) We clarify that this objective and its associated measure apply only to EPs that administer one or more immunizations during the EHR reporting period. 2) A failed attempt meets the measure. 3) This measure is related to Public Health.

Meaningful luse Menu Set St 10. *Submission of electronic syndromic surveillance data (public health related) Objective: Capability to submit electronic syndromic surveillance data to public health agencies and actual submission in accordance with applicable law and practice. Measure: Performed at least one test of CEHRT's capacity to provide electronic syndromic surveillance data to public health agenciesandand 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 have the capacity to receive the information electronically). Exclusion: 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. Attestation: Yes / No or Exclusion Stage2: No Change NOTES: 1) The use of test information about a fictional patient that would be identical in form to what would be sent about an actual patient would satisfy this objective. 2) A failed attempt would meet the measure. 3) This measure is related to Public Health.