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Meaningful Use

HIT: Meaningful Use


The American Recovery and Reinvestment Act (ARRA) of 2009 emphasizes the need for the U.S. to move toward the use of electronic health records (EHRs). To encourage a more widespread adoption of interoperable health information technology, the legislation calls for the Office of the National Coordinator (ONC) for Health IT, in consultation with NIST, to recognize a program for the voluntary certification of health information technology as being in compliance with applicable certification criteria to meet defined meaningful use requirements. In collaboration with ONC, NIST has developed the necessary functional and conformance testing requirements, test cases, and test tools in support of the health IT certification program for Meaningful Use at all stages.

Industry Need Addressed

Under the health IT certification program, authorized testing laboratories will use the NIST test method to evaluate EHR software and systems so doctor's offices, hospitals and other healthcare providers have confidence in the systems they purchase. As defined in ARRA, the Federal government will provide Medicare and Medicaid incentive payments to healthcare providers who meaningfully use EHR systems which meet ONC certification standards and criteria.

NIST/ITL Approach

In collaboration with ONC, NIST researchers have assisted in developing a program for the voluntary certification of health IT systems as being in compliance with applicable certification criteria to meet meaningful use.NIST has published several ONC approved test methods (test procedures, test data, test tools) for testing EHR systems to meet all stages of certification criteria and standards. During the development of the test method, NIST collaborated with ONC to ensure that the relevant standards and certification criteria were consistent and effectively represented within the test procedures. The approved NIST developed test method evaluates components of EHR systems such as electronic prescribing, submission of laboratory results, how they plot and display growth charts, and how they control access so that only authorized users can retrieve information.

NIST makes available the following tools for Meaningful Use Stage 1 testing:

  • 2014 Test Method ( – The approved test procedures to be used in the health IT certification program.
  • 2014 Edition Tools ( – These test tools are intended to assess the certification criteria stated in the associated test procedures.
  • 2014 R2 Edition tool ( - NIST has developed a tool to test requirements and standards related to message transport specifications expressed within the 2014 R2 Edition of the ONC Standards & Certification Criteria2. The tool, commonly referred to within this document and accompanying resources as the Edge Testing Tool (ETT), tests for adherence to the Edge Protocol standards during valid communication sessions between the ETT and a System Under Test (SUT).


Certification provides assurance to purchasers and other users that an EHR system, or other relevant technology, offers the necessary technological capability, functionality, and security to help meet the meaningful use criteria established for a given phase.

Created July 8, 2015, Updated August 25, 2016