"The Oxbow EMR makes practicing medicine fun again."

"The Oxbow EMR has improved my ability to charge for the appropriate level of service."

"I love the Oxbow EMR!"

"I couldn't run my practice, at least not profitably, without the Oxbow EMR."

Ease & Speed

  • Outrageously easy.

  • Blazingly fast.

  • Faster than paper or dictation.

  • New user support: handwriting and dictation


  • Automated charting.

  • Real-time Decision Support.

  • Proactive Medicine.

  • Fully automated Quality reporting.


  • Flat monthly fee.

  • No upfront fee.

  • No hidden fees.

  • No add-on module fees.

  • No update or maintenance fees.

  • Hardware and installation included.

  • Hardware under warranty for life.

Nuts and Bolts of Meaningful Use

August 2011
Matthew Hahn, MD

Dr. Matthew Hahn, who contributed to the design of the Oxbow EMR, runs his own private practice in Hancock, MD, Hahn & Nelson Family Medicine, where he sees patients 5 days each week. Dr. Hahn is a member of the Maryland Academy of Family Physicians, Chairman of the Western Maryland Academy of Family Physicians, multi-year winner of the Maryland Doctor of the Year title, and has worked extensively in the fields of Quality Improvement and Maximizing Benefits of EMR/EHR Usage. Dr. Hahn participates in both Meaningful Use and Patient Centered Medical Home using the Oxbow EMR. At the end of every day, after seeing his last patient, Dr. Hahn goes home happy with no additional data entry keeping him at the office.

Our practice has recently undertaken the daunting Meaningful Use (MU) attestation process, and we are bloodied but as yet unbroken. We have learned a great deal along the way, which I would like to share with you, in the hopes that our pain will increase your gain, if you decide to try the same thing.

But first, be warned...

Meaningful use, like all things produced by CMS, is overly cumbersome and complex, to a degree that it largely defeats its own purposes. Its complexity has already spawned a mini industry in Maryland, in the form of the management service organizations (MSO).

Meaningful use is extraordinarily harsh out of necessity. Ten years without cohesive federal HIT policy has resulted in a chaotic EMR market where there is little consistent, structured medical data, and worse, extremely limited ability to communicate between systems. Meaningful use is a desperate attempt to undo the damage.

As I wrote in my previous column, I advise against an EMR purchase decision that depends solely upon the meaningful use incentives. You should purchase an EMR that is usable and affordable. You should use MU guidelines to help define what attributes a functional EMR should have. Actually receiving the MU incentive payment should be viewed as icing on the cake. You've been warned...

Let's get down to the nuts and bolts of MU. First of all, there is no rush! As you may know, the meaningful use program spans five years, and pays $44,000 over that period, with the payments being front-loaded ($18,000 for the first year). You can start in 2011 or 2012, and still be eligible for the entire $44,000. If you start in 2013, you would still be eligible for $39,000. If you do intend to begin in 2011, there are a number of important dates: October 3, 2011 is the last day to begin your reporting period. For complete details regarding the program payment schedule, go to the following link: https://www.cms.gov/EHRIncentivePrograms/35_Basics.asp.

As you also may know, the Meaningful Use EHR Incentive Program consists of 15 required Core Measures, and 10 Menu Set Measures. To qualify for the MU incentive payment, you must satisfy all 15 Core Measures, and 5 of the 10 Menu Set measures, one of which must be the submission of data to an immunization registry or the submission of electronic syndromic surveillance data. For details regarding everything you need to know regarding the basic measures, and how to register and attest, CMS now has a useful website, with an overview page available here. From this overview page, there are a multitude of links to the information you will need. Be prepared, there are so many links, your head will spin. Many times, now, I have found a valuable link, gone to another page to check some other information, and then not been able to find the first link again! Because the site can be difficult to navigate, I will provide my favorite links:

Meaningful Use Table of Contents Core and Menu Set Measures: This document describes each of the measures, and within each individual measure, there is another link to a more complete definition. This is the single best place to start learning about the meaningful use program.

Attestation Worksheet: this is a very nice worksheet where you can score your progress.

Attestation User Guide for Eligible Professionals: this 63-page guide is required reading.

The above information is more than enough to get you started with the basics. There are four (at least) measures that need some clarification. Disclaimer: these measures have been somewhat loosely defined, and even the experts that I have consulted are just getting their bearings, so I apologize for any inaccuracies (or if CMS or state agencies redefine the measure).

Core Measure #14, the capability to exchange key clinical information electronically: the requirement is only asking for a TEST. The test can fail, but you can still attest that you have met the measure so long as you've tried. You must attempt to exchange data with another entity who has "distinct EHR technology" different from your own. There is little specific guidance regarding who you can exchange the data with. The Maryland Health Information Exchange (HIE) will likely become a key exchange location and data repository. At the time of this writing, details regarding the HIE are still being ironed out. You will likely need to contact your EHR vendor for assistance with satisfying the data exchange.

Core Measure #15, protect electronic health information: to satisfy this measure, you must attest that you have conducted or reviewed a security risk analysis "in accordance with the requirements under 45 CFR 164.308(a)(1)." In other words, you will need to conduct a HIPAA security analysis of your practice. I have found few simple tools to guide one through this process. My current favorite can be found at: http://www.hhs.gov/ocr/privacy/hipaa/administrative/securityrule/smallprovider.pdf.

Menu Set Public Health Measures (there are two, and you must perform at least one of them), the "capability to submit electronic data to immunization registries" and the "capability to submit electronic syndromic surveillance data to public health agencies": once again, an unsuccessful test is satisfactory. Beginning June 14, 2011, the Maryland Department of Health and Mental Hygiene is able to accept the public health measures. The Department has created an online survey that allows you to submit information necessary to begin the testing process. To fill out the survey, go to http://dhmh.state.md.us/mma/ehr/html/meaningfuluse.html. In addition to providing you with a survey tool to begin the testing process, this web page contains information about the specifications for data submission.

OK, that is the fruit of my labor so far regarding MU. It only took me three years, developing an EMR, implementing an EMR in my own office, helping other practices with implementation issues, countless hours of research, and multiple interviews with experts to get to this point. I hope it helps you. I feel your pain.

Matthew Hahn, MD