Meaningful Use Criteria for Electronic Health Records

The American Recovery and Reinvestment Act of 2009 offers payments to hospitals and doctors participating in
Medicare and Medicaid programs that adopt and successfully demonstrate meaningful use of certified electronic health record (EHR) technology.


On July 28, 2010, the Federal Register published the final ruling from the Centers for Medicare & Medicaid Services (CMMS) regarding the Electronic Health Record Incentive Program which begins in 2011.

The final ruling may be found in the document titled “Medicare and Medicaid Programs; Electronic Health Record Incentive Program”.

I reviewed the 275 page document (you can download it here) and it isn’t easy to follow. My goal was to find out where Adobe Acrobat and other Adobe offerings could be used, at least at a high level.


My first impressions is that from a technical level it is not a well-authored document and difficult to use. Notable problems with the document:

  • No navigational bookmarks or links
  • No Table of Contents
  • Tables are actually graphic elements and not searchable
  • Not accessible to the visually impaired
  • Protected from changes since it is a certified document


There are, however, a number of tables which make it easier to understand the main requirements. In particular, “Table 2: Stage 1 Meaningful Use Objectives and Associated Measures Sorted by Core and
Menu Set” offers a basic overview which is a good starting point.

I used a bit of Acrobat magic to extract Table 2 from the document and added a few checks to areas where I thought Adobe technology could fit in.


You can download the 944K document from the widget below or directly from this link.

You can click the Continue Reading link below to read more about my thoughts.


What does this mean for Hospital and Healthcare Practitioners?

If you want to get the maximum Medicaid reimbursement, you must show “meaningful use” of electronic healthcare records.


Due to the complexity of implementing the technology, the CMMS has offered a phased approach to adoption. There are a ‘‘core set’’ of objectives and ‘‘menu set’’ of objectives. The “core” set must be implemented in order to be compliant. The “menu” set can have percentage achievement.

One vaguely worded Core requirement is to “Engage patients and families in their health care”.

In this section (page three of the document I provided), I see an immediate application for PDF:

Provide patients with an electronic copy of their health information (including diagnostic test results, problem list, medication lists, medication allergies), upon request

Instead of walking out of your doctor’s office with a bunch of paper, you could instead receive your medical records on a thumbdrive, emailed to you, or made available via the web.


PDF is a perfect format to share medical records for individual practitioners:

  1. Anyone with the nearly ubiquitous and free Adobe Reader can open a PDF document
  2. Paper documents can be scanned and saved as PDFs
  3. Electronic documents of any kind can be “printed” or saved to PDF
  4. PDFs may be encrypted with a password so that they can be safely distributed electronically
  5. PDFs can serve as a secure container for other types of documents such as audio or video


Large hospitals will likely try to fulfill these requirements in a more automated process, on the server or in the cloud.

Adobe offers a number of server-based tools in our LiveCycle family of products which can:

  • Create and PDFs from a number of sources, including XML health records
  • Combine documents, add page numbering and watermarks, and other document operations
  • Add security or digital rights management
  • Provide workflow and auditing


So, if you are wondering how all of this might work, you’ll be happy to know that a very hardworking group of professionals have already done much of the work for you.

AIIM is a non-profit industry group focused
on helping users to understand the challenges associated with managing
documents, content, records, and business processes. One AIIM working group has developed PDF Healthcare, a Best Practices guide for using PDF in the Healthcare industry.


AIIM offers a number of very useful PDF Healthcare Resources on their site including:

  • FAQs
  • PDF Healthcare Implementation Guide
  • Sample Files, including XML-based PDF health data interchange forms
  • Presentations and Testimonials

. . . and many others.

I’ve written about the PDF Healthcare options available on AIIM site previously in my article on PDF Healthcare Sample Materials.


I encourage you to check it out today!

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