ehr onc final certification - Department of Health Care Services

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such requirements are generally context specific and determined when a HIPAA covered entity uses or discloses protected health information or when a HIPAA covered entity requests protected health information from another HIPAA covered entity. We do not preclude, however, Complete EHR and EHR Module developers from including additional features to assist HIPAA covered entities comply with these and other HIPAA Privacy Rule requirements. Comment. A commenter recommended that the summary care record should include the durable medical equipment and supplies used by the patient. Response. Presently, the correlated meaningful use objective and measure do not specify that a patient summary record must contain information regarding durable medical equipment. Accordingly, we do not believe that it would be appropriate to require this as a condition of certification. c. Specific Certification for Complete EHRs or EHR Modules Designed for an Inpatient Setting - §170.306 §170.306(a) - Computerized provider order entry Meaningful Use Stage 1 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 Meaningful Use Stage 1 Measure More than 30% of unique patients with at least one medication in their medication list seen by the EP or admitted to the eligible hospital’s or CAH’s inpatient or emergency department (POS 21 or 23) have at least one medication order entered using CPOE Page 160 of 228 Certification Criterion Interim Final Rule Text: Enable a user to electronically record, store, retrieve, and manage, at a minimum, the following order types: (1) Medications; (2) Laboratory; (3) Radiology/imaging; (4) Blood bank; (5) Physical therapy; (6) Occupational therapy; (7) Respiratory therapy; (8) Rehabilitation therapy; (9) Dialysis; (10) Provider consults; and (11) Discharge and transfer. Final Rule Text: §170.306(a) Computerized provider order entry. Enable a user to
electronically record, store, retrieve, and modify, at a minimum, the following order types: (1) Medications; (2) Laboratory; and (3) Radiology/imaging. A commenter recommended that we clarify what is meant by order entry because the commenter believes that within the confines of many hospitals, just about any “order” can be performed. A few commenters requested that “diet orders” be added to the list of CPOE order types in order to prevent inconsistent patient care. Another commenter recommended that speech-language pathology and audiology also be added. Two commenters noted that the certification criterion specifies a long list of order types. The commenters recommended that we not attempt to create an exhaustive list. One of the commenters also noted that no information is given as to what constitutes adequate functionality for any of the orders after the first three order types and that some, such as “dialysis” may not be appropriate order functionality for a general EHR system for hospitals. Both commenters recommended that we remove all orders from four through 10 and replace them with a single provision “other order types.” Response. Consistent with the revisions we made to the CPOE certification criterion associated with Complete EHRs and EHR Modules designed for an ambulatory setting, we agree with those commenters who recommended that we specify a minimum core set of orders as a condition of certification. Accordingly, we identify medication, laboratory, and radiology/imaging as the minimum types of orders a Complete EHR or EHR Module designed for inpatient settings must include in order to be certified. While this certification criterion is now the same as the certification criterion for Complete EHRs and EHR Modules designed for an ambulatory setting, we have not combined and Page 161 of 228
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DEPARTMENT OF HEALTH AND HUMAN SERV
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HHS Department of Health and Human
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5. Definition of Qualified EHR 6. D
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technology. Section 3004(b)(1) of t
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esolve identified technical challen
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Some commenters appear to have misi
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efficiencies and desired quality im
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codes must be used “inside” an
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not necessarily have applied to our
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3. Definition of Implementation Spe
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program established by the National
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criteria adopted by the Secretary a
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Comment. In the context of the defi
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y the certification criteria for a
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commenters asked whether we meant t
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adopted by the Secretary. The secon
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Response. We would like to make cle
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Response. In the Interim Final Rule
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could be a health care professional
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standard for certain purposes. In s
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e voluntary and would not be requir
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already existing regulatory require
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setting). We also include, where ap
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clarification on why the number of
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more clearly specify this capabilit
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Response. While we do not require t
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that check, the functionality show
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Response. The comments are correct
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enable the user to electronically r
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longitudinal care, or whether the E
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EHR and EHR Module developers to pr
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suggestions for different age range
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Record smoking status for patients
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23) during the EHR reporting period
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laboratory test results are receive
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commenters reasoned that because a
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laboratory test results to be elect
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or outreach Generate patient lists.
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months). We believe that these revi
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that the PQRI 2009 Registry XML spe
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To better align this certification
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the capability specified by the cer
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vendors were unwilling or unable to
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the concerns expressed by some comm
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Page 89 of 228 electronically compa
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(1) The standard (and applicable im
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for the purposes of demonstrating c
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Guide for Immunization Messaging Re
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Response. We clarify for commenters
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serve as a limiting factor, however
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Page 101 of 228 Unchanged Comment.
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Comment. One commenter suggested th
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Response. We appreciate the thought
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Complete EHRs or EHR Modules design
Page 109 and 110: Response. We disagree. As stated ab
Page 111 and 112: Response. As discussed above, we ha
Page 113 and 114: SHA-1 and other secure hash algorit
Page 115 and 116: misinterpreted our example and stat
Page 117 and 118: Other commenters also expressed con
Page 119 and 120: eferenced in FIPS 140-2 Annex A, wh
Page 121 and 122: of the most secure encryption algor
Page 123 and 124: the disclosure was made (recipient)
Page 125 and 126: Use CPOE for medication orders dire
Page 127 and 128: equire EHRs to build custom interfa
Page 129 and 130: esult, we do not believe that this
Page 131 and 132: was needed before RxNorm could be a
Page 133 and 134: • MDDB - Medi-Span Master Drug Da
Page 135 and 136: Response. We do not believe that it
Page 137 and 138: Send reminders to patients per pati
Page 139 and 140: specified data elements and CMS’s
Page 141 and 142: what would qualify as a "response."
Page 143 and 144: Comment. A commenter recommended th
Page 145 and 146: in accordance with one of the adopt
Page 147 and 148: Comments. Many commenters suggested
Page 149 and 150: flexibility in this certification c
Page 151 and 152: productive, confusing, time-consumi
Page 153 and 154: include in this initial set. Accord
Page 155 and 156: to the HITSP C32 implementation spe
Page 157 and 158: Response. Again, we do not believe
Page 159: e achieved without these and recomm
Page 163 and 164: EHRs and EHR Modules designed for a
Page 165 and 166: §170.205(a)(2)(iii); and (v) The s
Page 167 and 168: Response. We disagree, as doing so
Page 169 and 170: Dental Terminology as a condition o
Page 171 and 172: However, we do not preclude Complet
Page 173 and 174: ability of CCD and CCR to support t
Page 175 and 176: ability to receive these reports. M
Page 177 and 178: commenters acknowledged and express
Page 179 and 180: a meaningful use objective they wou
Page 181 and 182: CMS and ONC had worked together to
Page 183 and 184: The eligible professional or eligib
Page 185 and 186: EHR technology with the needs of us
Page 187 and 188: The RFA requires agencies to analyz
Page 189 and 190: values seemed low and that the gap
Page 191 and 192: commenter provided), our assumption
Page 193 and 194: absolute low we estimated for a per
Page 195 and 196: number of previously CCHIT-certifie
Page 197 and 198: for Certification Low High Page 197
Page 199 and 200: Finally, the third type of cost we
Page 201 and 202: 2012 15% $10.10 $30.80 $20.45 3-Yea
Page 203 and 204: The RFA requires agencies to analyz
Page 205 and 206: The Office of Management and Budget
Page 207 and 208: The standards and implementation sp
Page 209 and 210: The Secretary adopts the following
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any edition other than that specifi
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(e) Regenstrief Institute, Inc., LO
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4. Revise subpart C to read as foll
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smoker; current some day smoker; fo
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(2) Generate audit log. Enable a us
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(3) Medication allergy list; (4) De
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§170.205(a)(1) or §170.205(a)(2).
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(d) Electronic copy of health infor
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specifications) specified in §170.
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